Abstract
Asymptomatic carrier is defined as an individual who has dermatophyte-positive scalp culture without signs or symptoms of tinea capitis. The prevalence of asymptomatic carriage differs from region to region with a rate of 0.1–49%. Anthropophilic dermatophytes, Trichophyton tonsurans and Trichophyton violaceum, have been generally associated with high rates of asymptomatic carriage. Hence, the presence of dermatophytes on healthy scalp hairs of children may be a potential source of infection for schoolmates, playmates and/or households. Although it was also reported in adults, most carriage has been observed in children especially among those between 4 and 8 years of age, while male to female ratios vary between studies. It is still unclear, whether carriers should be treated with topical antifungal shampoos or oral antifungals or both, as some studies indicate that some untreated cases become culture-negative after 2–12 months. This review provides details on related dermatophyte fungi, laboratory diagnosis, epidemiology, ways of spreading as well as treatment and follow-up results of asymptomatic carriage. An integration into the school health programs is proposed, which will render the possible dealing of the subject in a comprehensive and reasonable manner.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Abbreviations
- AC:
-
Asymptomatic carriage
- STC:
-
Symptomatic tinea capitis
References
Gupta AK, Summerbell RC. Tinea capitis. Med Mycol 2000;38:255–87.
Padhye AA, Summerbell RC. The dermatophytes. In: Hay R, Merz W, editors. Topley and Wilson’s microbiology and microbial infections, medical mycology. 10th ed., vol. 5. London: Arnold Publishers; 2005. p. 220–43.
Bocobo FC, Eadie GA, Miedler JA. Epidemiologic study of tinea capitis caused by T. tonsurans and M. audouinii. Public Health Rep 1965;80:891–8.
Elewski BE. Tinea capitis: a current prespective. J Am Acad Dermatol 2000;42:1–20.
Aly R, Hay RJ, Del Palacio A, Galimberti R. Epidemiology of tinea capitis. Med Mycol 2000;38:183–8.
Aksungur L. Dermatophytic flora of tinea capitis of Eastern Anatolia. Turk J Pediatr 1968;10:23–31.
Erbakan N. Dermatophytosis as seen in our clinic for the past nine years. In: Aksungur L, editor. 6. Ulusal Dermatoloji Kongresi (21–24 Eylul 1976, Mersin). Cukurova Universitesi Yayınlari No: 1. Adana: Kemal Matbaasi; 1976. p. 123–6.
Kucukterzi H, Ekmen H. Cerahatli dermatofit infeksiyonlarında etiyolojik arastirmalar. Turk Hijy Tecr Biyol Derg 1963;23:84–9.
Ergenekon G, Ural A. Etiology of tinea capitis in eastern Anatolia. In: Aksungur L, editor. 6. Ulusal Dermatoloji Kongresi (21–24 Eylul 1976, Mersin). Cukurova Universitesi Yayınlari No: 1. Adana: Kemal Matbaasi; 1976. p. 113–22.
Abdel-Rahman SM, Simon S, Wright KJ, Ndjountche L, Gaedigk A. Tracking Trichophyton tonsurans through a large urban child care center: defining infection prevalence and transmission patterns by molecular strain typing. Pediatrics 2006;118:2365–73.
Greer DL. Treatment of symptom-free carriers in management of tinea capitis. Lancet 1996;348:350–1.
Mackenzie DWR, Burrows D, Walby AL. Trichophyton sulphureum in a residental school. Br Med J 1960;2:1055–8.
Midgley G, Clayton YM. Distribution of dermatophytes and Candida spores in the environment. Br J Dermatol 1972;86:69–77.
Pomeranz AJ, Sabnis SS, McGrath GJ, Esterly NB. Asymptomatic dermatophyte carriers in the households of children with tinea capitis. Arch Pediatr Adolesc Med 1999;153:483–6.
Ive FA. The carrier state of dermatophytes in Nigeria. Br J Dermatol 1966;78:219–21.
Sharma V, Hall JC, Knapp JF, Sarai S, Galloway D, Babel DE. Scalp colonization by Trichophyton tonsurans in an urban pediatric clinic? Asymptomatic carrier state. Arch Dermatol 1988;124:1511–3.
Williams JV, Honig PJ, McGinley KJ, Leyden JJ. Semi-quantitative study of tinea capitis and the asymptomatic carrier state in inner-city school children. Pediatrics 1995;96:265–7.
Mariat F, Adan-Campos C, Gentilini M, Gaxotte P. Presence de dermatophytes chez l’homme en l’absence de lesions cliniques. Bull Soc Fr Dermatol Syphiligr 1967;74:724–9.
White JML, Higgins EM, Fuller LC. Screening for asymptomatic carriage of Trichophyton tonsurans in household contacts of patients with tinea capitis: results of 209 patients from South London. J Eur Acad Dermatol Venereol 2007;21:1061–4.
Babel DE, Baughman SA. Evaluation of the adult carrier state in juvenile tinea capitis caused by Trichophyton tonsurans. J Am Acad Dermatol 1989;21:1209–12.
Vargo K, Cohen BA. Prevalence of undetected tinea capitis in household members of children with disease. Pediatrics 1993;92:155–7.
Cuétara MS, del Palacio A, Pereiro M, Amor E, Alvarez C, Noriega AR. Prevalence of undetected tinea capitis in a school survey in Spain. Mycoses 1997;40:131–7.
Cuétara MS, del Palacio A, Pereiro M, Noriega AR. Prevalence of undetected tinea capitis in a prospective school survey in Madrid: emergence of new causative fungi. Br J Dermatol 1998;138:658–60.
Ghannoum M, Isham N, Hajjeh R, et al. Tinea capitis in Cleveland: survey of elementary school students. J Am Acad Dermatol 2003;48:189–93.
Neil G, Hanslo D, Buccimazza S, Kibel M. Control of the carrier state of scalp dermatophytes. Pediatr Infect Dis J 1990;9:57–8.
Figueroa JI, Hawranek T, Abraha A, Hay RJ. Tinea capitis in south-western Ethiopia: a study of high risk factors for infection and carriage. Int J Dermatol 1997;36:661–6.
Omar AA. Ringworm of the scalp in primary-school children in Alexandria: infection and carriage. East Mediterr Health J 2000;6:961–7.
Hay RJ, Clayton YM, De Silva N, Midgley G, Rossor E. Tinea capitis in south-east London: a new pattern of infection with public health implications. Br J Dermatol 1996;135:955–8.
Babel DE, Rogers AL, Beneke ES. Dermatophytosis of the scalp: incidence, immune response, and epidemiology. Mycopathologia 1990;109:69–73.
Ali-Shtayeh MS, Salameh AA, Abu-Ghdeib SI, Jamous RM, Khraim H. Prevalence of tinea capitis as well as asymptomatic carriers in school children in Nablus area (Palestine). Mycoses 2002;45:188–94.
Sberna F, Farella V, Geti V, et al. Epidemiology of the dermatophytoses in the Florence area of Italy: 1985–1990. Trichophyton mentagrophytes, Epidermophyton floccosum and Microsporum gypseum infections. Mycopathologia 1993;122:153–62.
Jacyk WK, Baran E, Lawande RV, Walow B. Tinea capitis in Northern Nigeria. Mykosen 1982;25:221–6.
Frieden IJ. Tinea capitis: asymptomatic carriage of infection. Pediatr Infect Dis J 1999;18:186–90.
Polonelli L, Garcovich A, Morace G. Dermatophyte carriers among school children. Mykosen 1982;25:254–7.
Ilkit M, Demirhindi H, Yetgin M, Ates A, Turac-Bicer A, Yula E. Asymptomatic dermatophyte scalp carriage in school children in Adana, Turkey. Mycoses 2007;50:130–4.
Akbaba M, Ilkit M, Sutoluk Z, Ates A, Zorba H. Comparison of hairbrush, toothbrush and cotton swab methods for diagnosing asymptomatic dermatophyte scalp carriage. J Eur Acad Dermatol Venereol (in press).
Möhrenschlager M, Bruckbauer H, Seidl HD, Ring J, Hofmann H. Prevalence of asymptomatic carriers and cases of tinea capitis in five to six-year-old preschool children from Augsburg, Germany: results from the MIRIAM study. Pediatr Infect Dis J 2005;24:749–50.
Al-Sogair S, Hay RJ. Fungal infection in children: tinea capitis. Clin Dermatol 2000;18:679–85.
Friedlander SF, Pickering B, Cunningham BB, Gibbs NF, Eichenfeld LF. Use of the cotton swab method in diagnosing tinea capitis. Pediatrics 1999;104:276–9.
Sugita T, Shiraki Y, Hiruma M. Real-time PCR TaqMan assay for detecting Trichophyton tonsurans, a causative agent of tinea capitis, from hairbrushes. Med Mycol 2006;44:579–81.
Shiraki Y, Hiruma M, Hirose N, Sugita T, Ikeda S. A nationwide survey of Trichophyton tonsurans infection among combat sport club members in Japan using a questionnaire form and the hairbrush method. J Am Acad Dermatol 2006;54:622–6.
Hubbard TW, de Triquet JM. Brush-culture method for diagnosing tinea capitis. Pediatrics 1992;90:416–8.
Head ES, Henry JC, MacDonald EM. The cotton swab technique for the culture of dermatophyte infections—its efficacy and merit. J Am Acad Dermatol 1984;11:797–801.
Bonifaz A, Isa-Isa R, Araiza J, Cruz C, Hernández MA, Ponce RM. Cytobrush-culture method to diagnose tinea capitis. Mycopathologia 2007;163:309–13.
Clayton YM, Midgley G. A new approach to the investigation scalp ringworm in London school children. J Clin Pathol 1968;21:791–4.
Honig PJ. Tinea capitis: recommendations for school attendance. Pediatr Infect Dis J 1999;18:211–4.
Asawanonda P, Taylor CR. Wood’s light in dermatology. Int J Dermatol 1999;38:801–7.
Hay RJ, Robles W, Moore MK. Tinea capitis in Europe: new perspective on an old problem. J Eur Acad Dermatol Venereol 2001;15:229–33.
Bergson CL, Fernandes NC. Tinea capitis: study of asymptomatic carriers and sick adolescents, adults and elderly who live with children with the disease. Rev Inst Med Trop S Paulo 2001;43:87–91.
Reid BJ, Shimkin MB, Blank F. Study of tinea capitis in Philadelphia using case and control groups. Public Health Rep 1968;83:497–501.
Honig PJ, Smith LR. Tinea capitis masquerading as atopic or seborrheic dermatitis. J Pediatr 1979;94:604–5.
Katoh T, Sano T, Kagawa S. Isolations of dermatophyte from clinically normal scalps in M. canis infections using the hairbrush method. Mycopathologia 1990;112:23–5.
Chakrabarti A, Sharma SC, Handa S, Chander J, Kumar D, Sahgal R. Association of hypersensitivity and carriage of dermatophytes in clinically normal sites in patients with tinea cruris. Mycopathologia 1995;131:71–4.
Lobato MN, Vugia DJ, Frieden IL. Tinea capitis in California children: a population-based study of a growing epidemic. Pediatrics 1997;99:551–4.
Raubitschek F. Infectivity and family incidence of black-dot tinea capitis. Arch Dermatol 1959;79:477–9.
Hebert AA, Head ES, MacDonald EM. Tinea capitis caused by Trichophyton tonsurans. Pediatr Dermatol 1985;2:219–23.
Seebacher C, Abeck D, Brasch J, et al. Tinea capitis: ringworm of the scalp. Mycoses 2007;50:218–26.
Barlow D, Saxe N. Tinea capitis in adults. Int J Dermatol 1988;27:388–90.
Allen HB, Honig PJ, Leyden JJ, McGinley KJ. Selenium sulphide: adjunctive therapy for tinea capitis. Pediatrics 1982;69:81–3.
Sancak B, Ilkit M, Ates A, Arıkan S. Klinik örneklerden izole edilen dermatofit suslarının ketokonazol, itrakonazol ve terbinafine in vitro duyarlılığı. In: Tumbay E, Inci R, Hilmioglu-Polat S, Metin DY, editors. 5. Ulusal Mantar Hastalıkları ve Klinik Mikoloji Kongresi (20–23 Haziran 2007, Canakkale)- Tutanaklar. Infek Derg 2007;21 Suppl 2:248–50.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ilkit, M., Demirhindi, H. Asymptomatic dermatophyte scalp carriage: laboratory diagnosis, epidemiology and management. Mycopathologia 165, 61–71 (2008). https://doi.org/10.1007/s11046-007-9081-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11046-007-9081-0