Kerion Celsi: the changing face of Microsporum species infection?

M. Skerlev

Author address: 

Department of Dermatology and Venereology, Zagreb University Hospital Center and Medical School of Zagreb University, Zagreb, Croatia

Abstract: 

Kerion Celsi is a highly inflammatory, suppurative fungal infection of the scalp caused by zoophilic dermatophytes in themajority of (but not in all) cases. Trichophyton (T.) mentagrophytes, rubrum, and violaceum have been traditionally recognized as typical pathogens in such cases, however, the clinical features and the etiologic agents of fungal scalp infections these days might sometimes be quite different from the routine we have been used to. Thus, some atypical and unusual variations of tinea capitis due to Microsporum (M.) species are presented regarding the clinical pattern. There has been an epidemic outbreak of M. canis infection in Croatia in the last 25 years, from one positive culture in 1978 up to 407 positive isolates in 2004. The scalp was involved in about 30% of all these infections. In themajority of cases, the clinical pattern was the superficial tinea capitis with the small spored ectotrix type. However, during the last 5 years, 48 cases of typical kerion Celsi due to Microsporum species (belonging to the both M. canis and M. gypseum species) were observed (not mixed infection with T. mentagrophytes). The clinical features consisted of painful inflammatory mass on the scalp with loose hairs, pustular discharge, sinus formation, mycetoma like grains and thick crusting. In 39 cases, M. canis, and in nine cases, M. gypseum were isolated by culture. Some examples of the kerion Celsi due to M. canis in adults are presented, as well. Staphylococcus aureus was isolated from the scalp surface overlying the kerion and from the pus within the kerion in about 70% of patients. Gram-negative bacteria were found in the same locations in about 10% of patients, respectively. These data indicate that bacteria are frequently cultured from kerions. Kerion Celsi (especially due to M. canis) represents a certain therapeutic problem because of the impressive clinical features and children’s age in themajority of cases. In the first stage of the treatment, the antibacterial agents should be topically applied in the thick layer. Otherwise, using only topical antimycotic therapy in kerion Celsi, the course of disease may be prolonged and the therapeutic result may be poor. The antimycotics for oral use should be applied, as well. However, it should be pointed out that kerion due to M. canis represents a greater therapeutic problem as compared to T. mentagrophytes. Moreover, the new or previously very sporadic etiologic agents causing kerion have been recently observed in Croatia, such as T. tonsurans, mostly in wrestlers, so far. The ’open questions’ regarding kerion, such as the role of bacteria, and the appropriate treatment including the use of steroids to modify the intensity of the inflammatory response resulting with scarring have not been completely answered, so far. The most recent advances require corresponding evolution of diagnostic and treatment strategies of kerion in order to provide the suitable laboratory testing and antifungal therapy and to prevent the unnecessary surgical procedures.
2005

abstract No: 

O2.8

Full conference title: 

2nd Trends in Medical Mycology
    • TIMM 2nd (2010)