Introduction

Tinea capitis is the most common dermatophyte infection of the scalp affecting mainly children and rarely adults [1]. Although dermatophytes have worldwide distribution, some species found in specific areas. Trichophyton violaceum and T. verrucosum have been reported as the most common agents of tinea capitis in Iran [3–6]. Microsporum vanberuseghemii is a geophilic species and more common in Russia, India, Africa and the United States [7]. It produces occasional infections in dogs, squirrels, cats and humans [7–12]. To the best of our knowledge, dermatophytosis with M. vanbreuseghemii has not been documented in Iran and this is the first case of M. vanbreuseghemii infection in human reported in Mashhad, Iran.

Case Report

A 7-year-old boy with a history of an infected scalp for the past 2–3 weeks was referred to the Medical Mycology Laboratory of Imam Reza Hospital, Mashhad University of Medical Sciences. The patient had lesions in the occiput region. Physical examination revealed inflammatory lesions (kerion) with pustule, crust, pus and loss of hairs on the back of his head and cervical lymphadenopathy (Fig. 1a).

Fig. 1
figure 1

Tinea capitis. a Kerion lesions with cervical lymphadenopathy (arrow) and b erythematous plaque with hair loss

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Based on the information of patient’s father, his brother also had lesions on the scalp, so he was advised to bring the others boy to the laboratory, and he also examined for tinea capitis. The latter had scaly, erythematous plaque with hair loss on the scalp (Fig. 1b). Hair samples and scales were collected. Direct microscopic examination of the hairs revealed an ectothrix invasion. Samples were cultured on Sabouraud glucose agar [Merck, Germany] with chloramphenicol and mycobiotic agar [Difco, Eeast Molesey, UK] and incubated at 27°C. Cream-white and rapidly growing colonies with a powdery to cottony surface developed after 2 weeks. The colonies reverse were yellowish. The colonies were flat at first and later became gently folded in centre (Fig. 2). Microscopic characteristics of these fungi were the abundant formation of many large, cylindro-fusiform, 7–10-celled, thick-walled macroconidia (Fig. 3). The size of macroconidia was approximately 58–61 × 10 μm. The microconidia were smooth, ovale form and 4–8 μm in length. Hair perforation and urease tests were positive. The two isolates identified as M. vanbreuseghemii. The macroscopic and microscopic features of colonies that grew on culture media were similar in both cases. The patients were successfully treated with oral griseofulvin (12.5 mg/kg/day) for 5 weeks.

Fig. 2
figure 2

Colony of M. vanbreuseghemii on mycobiotic agar after 2 weeks

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Fig. 3
figure 3

Cylindro-fusiform macroconidia of M. vanbreuseghemii

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Discussion

Tinea capitis is a fungal infection of the scalp. It affects primarily prepubertal children. The epidemiology of tinea capitis varies within different geographical areas throughout the world [1, 2]. Several authors have reported tinea capitis as one of the most common dermatophytosis in Iran [4–6, 13, 14]. The aetiological agents of tinea capitis vary according to the geographical region. On the basis of the study of Ginter-Hanselmayer et al. [1], M. canis is still the most common reported causative agent of tinea capitis in Europe. Lari et al. [4] and Bassiri-jahromi et al. [3] reported Trichophyton violaceum as the most common aetiological agent of tinea capitis in Tehran [Iran], whereas chadeganipour et al. [5, 6] and Omidynia et al. [14] reported T. verrucosum and T. shoenleinii as the most causative agents of tinea capitis in Isfahan and Hamedan, respectively.

Microsporum vanbreuseghemii is a geophilic species rarely involved in ringworm of man, dog, squirrel and cat [7]. M. vanbreuseghemii was first isolated in 1959 from a squirrel and in 1960 from a dog [10]. The clinical features of the tinea capitis caused by M. vanbreuseghemii are similar to those of infections caused by other geophilic dermatophytes. Tinea capitis due to geophilic and zoophilic dermatophytes is often inflammatory [15, 16]. In the present study, the lesions were also purulent and inflammatory; this is in agreement with the finding of other authors.

Tinea capitis is very contagious, especially within families and school children. This infection may be passed among humans by direct contact with infected people or with contaminated subjects. Several authors have reported recovering M. vanbreuseghemii from soil [17, 18] and contact to soil or infected animal can cause disease in human. We have not been able to determine certainty source of infections. The patient’s history showed that they had not contact with animals; therefore, soil has been probably the source of infection, and we speculate that the first patient has been infected by contact with soil and the infection has been then spread by human-to-human contact. Although few cases of tinea capitis due to M. gypseum have been reported [3, 4, 13], there have been no records of M. vanbreuseghemii in Iran. In conclusion, M. vanbreuseghemii is reported for the first time as the cause of dermatophytosis in Iran (Mashhad).