Microsporum Canis (Chermette Et Al, 2008)

Involvement of dermatophytes in animal and human pathology

V. Cozma, V. Mircean, C. Magdaş, T. Băguţ

University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca Faculty© of Veterinary by author Medicine Department of Parasitology and Parasitic Diseases

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Dermatophytoses are cosmopolitan contagious mycoses confined to cutaneous layers, caused by keratinophilic and keratinolitic fungi known as dermatophytes.

• Ringworm

• Tinea plus latin suffix • Tinea corporis • Tinea manuum • Tinea capitis © by author • Tinea pedis (athletes foot) • Tinea cruris (jock itch) • Tinea unguium (onychomycosis) ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Importance

 Worldwide spread diseases

 Medical: usually mild except in heavily infected young animals  Economic: long duration of the disease/ cost of control measures, consequent impairments on hide and skin industry

 Aesthetic:

 PublicESCMID health: contagious Online & zoonotic Lecture diseases Library

Involvement of dermatophytes in animal and human pathology______

Etiology

 Kingdom Fungi  phylum Ascomycota  class Euascomycetes  order Onygenales  family Arthrodermataceae  genus Arthroderma  phylum Deuteromycota  class Hyphomycetes © by order author Moniliales  family Moniliaceae  genus Trichophyton Microsporum ESCMID Online Lecture Epidermophyton Library

Involvement of dermatophytes in animal and human pathology______

Etiology

Dermatophyte species Main source Others Zoonosis Anamorphs Teleomorphs M. canis A. otae Cat, dog, horse All mammals +

M. equinum - Horse Cat, dog + M. persicolor A. persicolor Microtid rodents Dog, cat + M. gypseum A. incurvata Soil All mammals + Microspoum M. nanum A. obtusa Soil Pig + T. mentagrophytes A. benhamiae Rodents All mammals + T. verrucosum - © by authorCattle All mammals + T. equinum - Horse Cat, dog +/- T. erinacei - Hedgehog Dog +

Trichophyton T. simii A. simii Primates Fowl, dog, cat + T. ESCMIDgallinae Online- LectureBirds Library- + Involvement of dermatophytes in animal and human pathology______

Morphology

 Filamentous micetes

 Dimorphic micettes – in vivo – hyphaes, arthrospores

- in vitro - microconidia, macroconidia, hyphaes with ornamentations, clamidospores © by author

ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Epidemiology

1. Descriptive epidemiology

Wordwide spread diseases: one of the most frequent skin diseases of pets and livestock.

 Zoophilic species: M. canis, T. verrucosum, T. mentagrophytes, T. equinum, M. persicolor  Anthropophilic species: E. floccosum, M. audouinii, T. tonsurans, T. violaceum, T. rubrum  Geophilic species: multiply in soil as saprobes and can become parasites © by author • M. gypseum, M. nanum • M. cookei, M. praecox, T. ajelloi, T. terrestre - not usually considered as pathogens are isolated in culture from coats or skin lesions ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Epidemiology

1. Descriptive epidemiology

 Evolution- sporadically - enzootic: catteries, herds, stables - epizootic: calves

 Sezonality: calves © by author

ESCMID Online Lecture Library Epidemiology

2. Analytic epidemiology

 Sources of infection - infected animals, asymptomatic carriers - contaminated crusts, scales and hairs - high resistance of arthrospores (1-4 years)  Contamination – directly - indirectly

ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Epidemiology

2. Analytic epidemiology

 Host specificity

• variable composition and structure of the keratins • specific requirements and enzymatic equipment of dermatophyte species • occurrence of particular genes responsible for pathogenicity • the various defence mechanisms© by developed author by the hosts

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Involvement of dermatophytes in animal and human pathology______

Epidemiology

2. Analytic epidemiology  Receptivity – species, age, diet, health • bovines, cats, dogs, horses • contamination may be easier in longhaired animals. • birds, sheep and goat → not often infected by dermatophytes • young animals are more frequently infected by dermatophytes than adults • stronger immunity in older animals due to the multiple contacts with the fungus • hyperadrenocorticism, © immunosuppressive by author chemotherapy (corticotherapy), feline immunodeficiency virus (FIV) , the feline leukaemia virus (FeLV), nutritional disorders, tumoral disease, stress

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Involvement of dermatophytes in animal and human pathology______

Epidemiology

2. Analytic epidemiology

 Contributing factors

 communities: catteries, kennels, stables, cowshed or intensive breeding units  overpopulation  season  hunting, contact with cats,© by rodents author  high resistance of the dermatophyte conidia  geophilic dermatophytes → animals with outdoor contacts ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Epidemiology

 Prevalence – Italy – cats – 24.7% – 97% M. canis – 2.6% M. gypseum – 0.2% T. mentagrophytes – dogs – 18.7% – 83% M. canis – 13% M. gypseum – 5.5% T. mentagrophytes (Mancianti et al., 2002) – France – cats – 29% – dogs – 22% (Pinard© et by al, 1987)author - Switzerland – cats –29.3% - dogs – 7.1% - guinea pigs - 38.1% (Drouot et al, 2008) – CroatiaESCMID – cats – 40.7% Online – 98.7% M. Lecture canis (Pinter Libraryet al.,1999)

Involvement of dermatophytes in animal and human pathology______

Epidemiology

 Prevalence

– Romania – cats – 46% – 98.3% M. canis – dogs – 4.7% – 80% M. canis – 13.3 % T. mentagrophytes – 6.6% M. gypseum (Mircean, 2006)

USA – cats – 14.9% (61/408) – 91. 8% M. canis (Lewis et al., 1991) © by author Brazil - 9.8% in dogs - M. canis, M. gypseum (Copetti et al, 2006) ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Epidemiology

 Prevalence

T. verrucosum – Italy – 87.7% (Papini et al., 2008) – 48.7% (Galuppi et al., 2002) – 4.5- 19% (Moretti et al., 1998) – Spain – 25% (Cabanes et al., 1997) - Romania – 10-50% (Suteu and Dulceanu, 2001) – Japan – 17.1 – 58.6% (Takatori et al., 1993)

ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Pathogenesis

 The kinetics of infectious process

- keratinophilic and keratinolytic properties

- limited to keratinised layers of the epidermis and cutaneous adnexae

- depends on fungus/host reactions towards the dermatophyte © by author

ESCMID Online Lecture Library adherence of arthrospores to corneocytes: 3 - 12 h

germination: 6-24 hours (humidity, warm, maceration, excoriation)

invasion and penetration of the stratum corneum

penetration of keratinised external+internal root sheath

ESCMID Online Lecture Library infection of adiacent hair folicles Involvement of dermatophytes in animal and human pathology______

Pathogenesis

 Factors that mediate adherence of dermatophytes

- carbohydrate-specific adhesins expressed on the surface of microconidia in T. rubrum (Esquenazi et al., 2004)

- fibrillar projections connect fungal arthrospores to keratinocytes in T. mentagrophytes (Kaufman et al., 2007)

- dermatophytic-secreted proteases are necessary for efficient adhrence (Vermout et al., 2008)© by author

- subtilisin, fungalysins , and dipeptidyl-peptidases

ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Pathogenesis

 Inflammatory response

• there is an inverse relationship between the degree of inflammation and duration of disease

• a dermatophyte provokes a more intense inflamatory reaction on a host to which it is not adapted than it does on its natural host

• T. mentagrophytes and T. rubrum – substances that diminish cell- mediated imune response and© inhibit by stratumauthor corneum turnover (Dahl, 1993)

ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Pathogenesis

 Adaptative immunity

Humoral immunity • humoral immunity to dermatophytes is not protective • however antibodies (IgM, IgG, IgA, IgE) are detected in infected animals and humans

Cell-mediated immune response • the most important immunological© bydefence author mechanism • the more characteristic cell-mediated immune response to dermatophytes is DTH • the resolution of dermatophytosis is mediated by DTH (Almeida, 2008) ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Clinical features

 General presentation of animal ringworm  regular and circular alopecia → general alopecia  erythematous margins  thin desquamation  pruritus generally absent  lesions single or multiple  localised on any part of the animal (anterior part the head)  centrifugal spread of lesions  specific or particular aspects of lesions are sometimes observed according to the host species and the dermatophytes involved

 Pustular foliculitis © by author  Kerions due to T. mentagrophytes or M. canis  Pseudomycetoma  Onychomycosis

 SubclinicalESCMID infections Online Lecture Library

Involvement of dermatophytes in animal and human pathology______

Clinical features

Dermatophytosis in Feline

• M. canis > 90% of the cases • M. gypseum, M. persicolor, T. mentagrophytes, T. equinum

• asymptomatic carriage © by author

• firstly localised on the bridge of the nose, the external side of the pinnae andESCMID auricular margins, Online the distal Lecture part of the legs,Library and the tail

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ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Clinical features

Dermatophytosis in Canine

•M. canis, T. mentagrophytes, M. gypseum •10- to 40-mm isolated or multiple wellcircumscribed patchy hairless and non-pruriginous lesions • hunting dogs/burrowing → facial lesions, bridge of the nose, the periocular areas, margins of the© earsby →author M. gypseum, M. persicolor, T. mentagrophytes , T. erinacei

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ESCMID Online Lecture Library Kerion due to Microsporum canis (Chermette et al, 2008)

Kerions  T. mentagrophytes , M. canis  usually single or in small number, and often localised on the face circular and prominent on the skin severe inflammation and suppurative folliculitis

Kerion in hunting dog (original) ESCMID Online Lecture Library Clinical features

Dermatophytosis in Equine T. equinum, M. equinum, M. canis, T. mentagrophytes , M. gypseum  hairs slightly erected at the beginning of the infection, subsequent small alopecic lesions  dry aspect of lesions: thin powdery scales,hairs broken at their base  primary localisations of lesions mainly under the saddle and the girth areas

ESCMID Online Lecture Library (Chermette et al, 2008)

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ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Clinical features

Dermatophytosis in other pets

T. mentagrophytes, M. canis, M. persicolor , M. gypseum, • head, ears, flanks and tail • well-defined patches of alopecia, with a marked scaling and erythema in some cases, or as kerions.

ESCMID Online Lecture Library (Chermette et al, 2008)

ESCMID Online Lecture Library Drouot et al, 2008 Drouot et al, 2008

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ESCMID Online Lecture Library Diagnosis

 History, clinical appearance, diagnostic procedures

 History of animal life • way and date of acquisition • contact with other animals • possible appearance of skin lesions on the owners

ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Diagnosis

 Specimen collection - sufficient amount - useful to collect certain samples from a number of different sites - from the edge of the infected area - before any local or systemic antifungal treatment

Skin -scrape lesions with active inflammatory border otherwise they will be scraped entirely © by author -very inflammatory and/or oozing scrapping will be followed by swabbing - vinyl tape (Robert and Pihet, 2008) ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Diagnosis

 Specimen collection

Nails - nail clipping - scraping with a small curette or a scalpel blade - scratching (Quereshi et al, 2004)

ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Diagnosis

 Direct examination

- hairs, scales, crusts, nail fragments, exudates

- clearing reagents : - KOH (10%) - lactophenol cotton blue - clorolactophenol - polivinilic alcohol - calcoflour white © by author - microscopic examination: hyphaes and clusters/chains of fungal arthroconidia

ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Diagnosis

ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Diagnosis

 Wood lamp examination - useful for M. canis infection - M. canis infected hairs → yellow-green flourescence - not all M. canis strains produce flourescence - topical treatments may destroy fluorescence - infected crusts are not fluorescent, only the hairs - diagnosis confirmed by direct examination/mycological culture

ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Diagnosis

 Culture

- gold standard for the identification of dermatophytes - phenotypic identification of dermatophyte species - hairs, scales, crusts, claws and tissue biopsies

Media - Sabouraud dextrose agar supplemented with cyclohexamide and antibiotics (chloramphenicol, penicillin-gentamicin) - Dermatophyte Test Medium© (DTM) by author

ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Diagnosis

 Culture

ESCMID Online Lecture Library Microsporum canis on Sabouraud media Involvement of dermatophytes in animal and human pathology______

 Culture - DTM

Microsporum canis on DTM ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Diagnosis

ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Diagnosis

 Histology - rarely necessary - diagnosing unusual forms

- periodic acid Schiff (PAS) - methenamine silver - hematoxylin-eosin - immunohistocemistry- micetoma produced by M. canis (Abramo et al., 2001)

- folliculitis and furunculosis © by author - hyperplastic perivascular or interstitial dermatitis - intra-epidermal pustular dermatitis - epidermal or follicular acantholysis (Chermette et al., 2008) ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

ESCMID Online Lecture Library Treatment

• combination of systemic and topical treatment. • systemic antifungal drugs → speed the resolution of the infection • topical antifungals → reduce the risk of transmission and environmental contamination

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Topical therapy

Enilconazole Miconazole 2% Miconazole spray 1:50 solution 2-3x weekly 3-day intervals, 4-6 weeks (Allow to remain on hair ©for 5by to 10 author minutes)

Creams, gels (miconazole, ketoconazole) – used on solitary lesion ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Treatment

Systemic therapy Griseofulvin Antifungal and keratinophilic dogs & cats: 50 mg/kg/day (2x), 4-6 weeks large animals: 7.5–10 mg/kg Theratogenic → should not be given to pregnant females Side-effects: vomiting, diarrhoea© by author

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Treatment

Ketoconazole Antifungal, keratinophilic diazole, 5-10 mg/kg/day (2x) Teratogenic Side-effects: vomiting

Itraconazole Better tolerated than ketoconazole, 5-10 mg/kg/day (1-2x) Teratogenic Side-effects less than with ketoconazole, use with care in pets with liver disease. © by author Terbinafine: well tolerated by cats and dogs 30–40 mg/kg/day (Moriello, 2004) ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Imunoprophylaxy

ESCMID Online Lecture Library Involvement of dermatophytes in animal and human pathology______

Control and prevention of the disease in the animal reservoir is the most important measure to reduce occurrence in human

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