title: Epidemiological changes in tinea capitis over the sixty years of economic growth in China.
abstract: BACKGROUND
  Tinea capitis is a fungal infection of the scalp occurring commonly in children. Historical data indicate that clinical manifestations and the spectrum of etiologic agents vary greatly with geography, as well as socioeconomic affected populations.
  
  
  OBJECTIVE
  To study the possible connection between socioeconomic status, the disease patterns and the variability of etiological agents.
  
  
  METHODS
  We reviewed tinea capitis in China through literature since 1956. The disease pattern was correlated with economic and public health management protocols. Historical data on fungal identification were mostly obtained by morphology. The accuracy of these historical results was further confirmed by use of both morphological and ITS identification on a control set of 90 isolates collected recently from local hospital.
  
  
  RESULTS
  Full agreement of the two identification methods implies that data from the literature were sufficiently reliable to allow comparison across reported cases. In sum, 88 papers involving 25 administrative provinces and municipalities with 38,962 clinical strains met the inclusion criteria of this review. Zoophilic species Microsporum canis is the most prevalent agent within large, modernized cities in China today accounting for over 80% of infections. In contrast, anthropophilic dermatophytes, particularly Trichophyton violaceum, are geographically endemic only in some southeastern and northwestern regions.
  
  
  CONCLUSIONS
  Economic development and urbanization of cities favor a shift of etiological agents from anthroponoses to zoonoses in contemporary China. Pets are becoming the most likely sources of infection in modern lifestyles, replacing the earlier human-to-human transmission mode. However, the latter transmission mode is still prevalent in less developed areas lacking adequate social and public health facilities.
authors.affiliation: Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing 210042, China Dermatology Hospital of Jiangxi Province, Jiangxi Provincial institute of Dermatology, Nanchang 330001, China CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Ping
authors.initials: P
authors.lastname: Zhan
authors.affiliation: Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing 210042, China Georgetown University Medical Center, Department of Microbiology / Immunology, Washington, DC 20057, United States.
authors.forename: Dongmei
authors.initials: D
authors.lastname: Li
authors.affiliation: Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing 210042, China Dermatology Department, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009 China.
authors.forename: Chong
authors.initials: C
authors.lastname: Wang
authors.affiliation: Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.
authors.forename: Jiufeng
authors.initials: J
authors.lastname: Sun
authors.affiliation: Dermatology Hospital of Jiangxi Province, Jiangxi Provincial institute of Dermatology, Nanchang 330001, China.
authors.forename: Chengfang
authors.initials: C
authors.lastname: Geng
authors.affiliation: Dermatology Hospital of Jiangxi Province, Jiangxi Provincial institute of Dermatology, Nanchang 330001, China.
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Xiong
authors.affiliation: Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands Department of Medical Microbiology and Infectious Diseases, Erasmus MC, The Netherlands.
authors.forename: Seyedmojtaba
authors.initials: S
authors.lastname: Seyedmousavi
authors.affiliation: Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing 210042, China liumyco@hotmail.com.
authors.forename: Weida
authors.initials: W
authors.lastname: Liu
authors.affiliation: CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands de.hoog@cbs.knaw.nl.
authors.forename: G Sybren
authors.initials: GS
authors.lastname: de Hoog
mesh_terms: D002681:China / Q000453:epidemiology; D004271:DNA, Fungal / Q000235:genetics; D021903:DNA, Ribosomal Spacer / Q000235:genetics; D057217:Economic Development; D005658:Fungi / Q000145:classification* / Q000166:cytology / Q000235:genetics / Q000302:isolation & purification*; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008828:Microbiological Techniques; D012959:Socioeconomic Factors; D014006:Tinea Capitis / Q000453:epidemiology* / Q000266:history / Q000382:microbiology*; D014507:Urbanization
chemical_list: D004271:DNA, Fungal; D021903:DNA, Ribosomal Spacer
keywords: dermatophytes; emerging economy and disease; epidemiology; tinea capitis; transmission