Is a Ringworm Infection Really Caused by a Worm? Case Study Number Three Emerita Arias Ofili Okolonwamu Romelene Juban

Sings and Symptoms African American female child Large patches of apparent hair loss and broken hair shafts Inflammation of the surface of the scalp Annular spreading lesions on the chin, neck, trunk, abdomen, and underside of forearm Edges of the lesions were raised and red and the center dry and scaly Intensive itching

Physical Observation

Further Information to Make a Diagnosis If the patient has close contact with any animals at home (cats, dogs, horses, etc.) If there is anyone at home with any kind of skin disorder If the patient has any direct or indirect contact with natural soil Skin scraping for KOH (potassium hydroxide) examination and culture sent to lab Scrapings inoculated on MSA, EMB, and fungal media Ultraviolet examination of scalp region Fluorescence noticed on the remaining shafts

Differential Diagnosis: Tinea/Ringworm Infection

Possible Causes for These Lesions Direct contact with a person who has a fungal infection Direct contact with fungi contaminated items (bedding clothes, towels, brushes, etc.) Direct contact with soil containing fungi Contact with pets that have a fugal infection

Possible Etiologic Agents DERMATOPHYTES: Microsporum audouinii (scalp and body) Microsporum gypseum (feet, hands, body, scalp, rarely nails) Micropsorum canis (body in adults, scalp in children,rarely nails) Trichophyton mentagrophytes (feet, body, nails, scalp, hands, groin, does not infect hair) Epidermophyton floccosum (groin, body, epidemic athlete’s foot, occasionally nails, does not infect hair)

Most Likely Etiologic Agent Causing this Infection Microsporum sp. Microsporum audouinii Once caused epidemic tinea capitis in preadolescents Affects scalp and body Fluoresce under Wood’s light

Suggested Treatment and Care Topical Treatment Antifungal creams and powders that contain: clotrimazole, miconazole, econazole, or ciclopirox. Apply twice a day for 2-3 weeks If not improvement of condition after topical treatment, oral medication will be prescribed: terbinafine 125mg po q24h time 4weeks (or 6-12 mg/kg per day)

Spread of Condition and Prevention from Spreading Condition can by spread by direct contact with a fungal agent when inflammatory skin reactions are present from other conditions; fungus thrive producing skin infections. Can prevent recurrence and spreading by Completing treatment and rechecking patient in 4 weeks Keeping skin clean and dry Keeping good general personal hygiene Keeping good hygiene of family pets

References: Picture from:http://www.bigcscottsboro.com/ringworm.html 1. www.cdc.gov/healthypets/diseases/ringworm.htm 2. www.nlm.nih.gov/medlinesplus/ency/article/001439htm 3. http://www2.provlab.ab.ca/bugs/webbug/mycology/etiol.htm 4. Leboffe J. Michael. “A Photographic Atlas for the 3rd Edition Microbiology Laboratory.” Englewood, Colorado: Morton Publishing Company, Copyright 2005. 5. Sanford, P. Jay M.D. “The Sanford Guide to Antimicrobial Therapy 2006 36th Edition.” Sperryville, VA: Antimicrobial Therapy, Inc., 1969.