title: [Tinea capitis profunda due to Trichophyton verrucosum with cMRSA superinfection in an infant].
abstract: A 28-month-old boy developed a cutaneous and subcutaneous lesion of the scalp together with alopecia. Treatment with sulfadiazine silver ointment and oral administration of cefaclor failed. The boy lived on a farm where cows and calves were present. He presented with a 5 cm erythematous, erosive, edematous, and sharply defined lesion with yellow crusts and circumscribed alopecia on the temporoparietal scalp. Peripheral hairs were easily epilated. Swabs from the wound revealed cMRSA (community acquired methicillin-resistant Staphylococcus aureus, Panton Valentine Leukocidin [PVL] toxin negative). There was no improvement after treatment with cefuroxime intravenously over 3 days. Therapy was changed to vancomycin and fosfomycin. Because of the purulent abscess, surgical incision was performed. PCR (polymerase chain reaction)-Elisa assay detected Trichophyton (T.) interdigitale-DNA from wound secretion and skin biopsy. Because of the clinical and molecular diagnosis of tinea capitis, oral antifungal therapy with fluconazole 5 mg kg(-1) body weight was started, along with cotrimoxazole and fosfomycin for the cMRSA. After 4 weeks incubation, the causative agent T. verrucosum was grown on culture and its identity confirmed by sequencing of the "internal transcribed spacer" (ITS) region of the ribosomal DNA. After 4 weeks of fluconazole, the lesion was nearly healed.
authors.affiliation: Klinik für Kinderheilkunde u. Jugendmedizin, Niels-Stensen-Kliniken, Marienhospital Osnabrück.
authors.forename: R-H
authors.initials: RH
authors.lastname: Blömer
authors.forename: N
authors.initials: N
authors.lastname: Keilani
authors.forename: A
authors.initials: A
authors.lastname: Faber
authors.forename: B
authors.initials: B
authors.lastname: Rodeck
authors.forename: C
authors.initials: C
authors.lastname: Krüger
authors.forename: S
authors.initials: S
authors.lastname: Uhrlaß
authors.forename: Y
authors.initials: Y
authors.lastname: Gräser
authors.forename: P
authors.initials: P
authors.lastname: Nenoff
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D002675:Child, Preschool; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D012536:Scalp Dermatoses / Q000175:diagnosis* / Q000188:drug therapy*; D013207:Staphylococcal Skin Infections / Q000175:diagnosis* / Q000188:drug therapy*; D014006:Tinea Capitis / Q000175:diagnosis* / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole