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

2. 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

3. Physical Observation

4. 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

5. Differential Diagnosis: Tinea/Ringworm Infection

6. 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

7. 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)

8. 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

9. 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)

10. 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

11. References: Picture from:http://www.bigcscottsboro.com/ringworm.html 3.
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 th Edition.” Sperryville, VA: Antimicrobial Therapy, Inc., 1969.