Mushrooms microsporum. Microsporia: etiology and treatment. How and how to disinfect microsporia

Microsporia is a highly contagious dermatophytosis caused by fungi of the genus Microsporum.

Etiology and epidemiology of microsporia

The most commonly isolated causative agents of microsporia are fungi Microsporum canis, which are zoophilic fungi that are ubiquitous in the world, causing dermatophytes in cats (especially kittens), dogs, rabbits, guinea pigs, hamsters, in more rare cases - in monkeys, tigers, lions , wild and domestic pigs, horses, sheep, silver foxes, rabbits, rats, mice, hamsters, guinea pigs and other small rodents, as well as poultry. Infection occurs mainly through contact with sick animals or through objects infected with their hair. Infection of a person from a person is extremely rare, on average in 2% of cases.

Microsporum audouinii is a common anthropophilic pathogen that can cause predominantly damage to the scalp in humans, less often smooth skin. Children get sick more often. The pathogen is transmitted only from a sick person to a healthy person directly through contact or indirectly through contaminated care and household items.

Microsporia is characterized by seasonality. The peaks of detection of microsporia are observed in May-June and in September-November. Various endogenous factors can contribute to the onset of the disease: the chemistry of sweat, the state of the endocrine and immune systems. In addition, children have insufficient density and compactness of epidermal and hair cell keratin, which also contributes to the introduction and development of fungi of the genus Microsporum.

Microsporia is a disease with the highest contagiousness of the entire group of dermatophytosis. Mostly children are ill, often newborns. Adults get sick less often, while the disease is often recorded in young women. The rarity of microsporia in adults is associated with the presence of fungistatic organic acids (in particular, undicylenic acid) in the skin and its appendages.

In recent years, there has been an increase in the number of patients with chronic mycosis against the background of severe systemic lesions - lupus erythematosus, chronic glomerulonephritis, immunodeficiency states, and intoxications.

Microsporia classification

• microsporia caused by anthropophilic fungi Microsporum audouinii, M. ferrugineum;
• microsporia caused by zoophilic fungi canis, M. distortum;
• microsporia caused by geophilic fungi gypseum, M. nanum.

According to the depth of the lesion, they distinguish:

• superficial microsporia of the scalp;
• superficial microsporia of smooth skin (with damage to vellus hair, without damage to vellus hair);
• deep suppurative microsporia.

Symptoms of microsporia

Microsporum canis affects hair, smooth skin, very rarely nails; foci of the disease can be located both on open and closed parts of the body. The incubation period of the disease is 5-7 days.
On smooth skin, lesions have the appearance of edematous, raised erythematous spots with clear boundaries, rounded or oval outlines, covered with grayish scales. Gradually, the spots increase in diameter, and along their periphery a raised roller is formed, covered with vesicles and serous crusts. In 80-85% of patients, vellus hair is involved in the infectious process. Eyebrows, eyelids and eyelashes may be affected. With microsporia of smooth skin, there are no subjective sensations, sometimes patients may be disturbed by moderate itching.

With microsporia of the scalp, lesions are located more often in the occipital, parietal and temporal regions. In the initial period of the disease, a focus of peeling occurs at the site of the introduction of the pathogenic fungus. In the future, the formation of one or two large foci of round or oval outlines with clear boundaries ranging in size from 3 to 5 cm in diameter and several small foci - screenings, ranging in size from 0.3-1.5 cm is characteristic. The hair in the foci is broken off and protrudes above the level skin by 4-5 mm.

Along with the typical clinical symptoms of zooanthroponotic microsporia, atypical variants of it have often been observed in recent years. These include infiltrative, suppurative (deep), exudative, rosacea-like, psoriasiform and seboroid (flowing like asbestos lichen), trichophytoid, exudative forms, as well as a "transformed" variant of microsporia (with a modification of the clinical picture as a result of the use of topical corticosteroids) .

With the infiltrative form of microsporia, the lesion on the scalp rises somewhat above the surrounding skin, is hyperemic, the hair is often broken off at the level of 3-4 mm. Weakly expressed sheath of fungus spores at the root of broken hair.

With an infiltrative-suppurative form of microsporia, the lesion usually rises significantly above the skin surface due to pronounced infiltration and the formation of pustules. When pressing on the affected area, pus is released through the follicular openings. Discharged hair is glued together with purulent and purulent-hemorrhagic crusts. Scabs and melted hair are easily removed, exposing the gaping mouths of the hair follicles, from which, like a honeycomb, a light yellow pus is released. The infiltrative-suppurative form is more common than other atypical forms, sometimes proceeding in the form of Celsus kerion - inflammation of the hair follicles, suppuration and the formation of deep painful nodes.

Due to the absorption of decay products of fungi and the associated secondary infection, intoxication of the patient's body is observed, which is manifested by malaise, headaches, fever, enlargement and soreness of regional lymph nodes.

The formation of infiltrative and suppurative forms of microsporia is facilitated by irrational (usually local) therapy, serious concomitant diseases, as well as late seeking medical help.

The exudative form of microsporia is characterized by severe hyperemia and swelling, with small vesicles located against this background. Due to the constant impregnation of the scales with serous exudate and gluing them together, dense crusts are formed, the removal of which exposes the moist eroded surface of the focus.

microsporia exudative form

With the trichophytoid form of microsporia, the lesion process can cover the entire surface of the scalp. The centers are numerous small, with a weak pityriasis peeling. The borders of the foci are indistinct, there are no acute inflammatory phenomena. This form of mycosis can acquire a chronic sluggish course, lasting from 4-6 months to 2 years. The hair is sparse or there are areas of focal alopecia.

trichophytoid form

With the seborrheic form of microsporia of the scalp, hair is mainly thinned. The foci of rarefaction are abundantly covered with yellowish scales, upon removal of which a small amount of broken hair can be found. Inflammatory phenomena in the foci are minimal, the boundaries of the lesion are fuzzy.

seborrheic form

Diagnosis of microsporia

The diagnosis of microsporia is based on the data of the clinical picture and the results of laboratory and instrumental studies:

• microscopic examination for fungi (at least 5 times);
• inspection under a fluorescent filter (Wood's lamp) (at least 5 times);
• cultural studies to identify the type of pathogen in order to properly conduct anti-epidemic measures;

When prescribing systemic antimycotic drugs, it is necessary to:

• general clinical blood test (1 time in 10 days);
• general clinical analysis of urine (1 time in 10 days);
• biochemical study of blood serum (before treatment and after 3-4 weeks) (ALT, AST, total bilirubin).

Differential diagnosis of microsporia

Microsporia is differentiated with trichophytosis, pink lichen Zhiber, seborrhea, psoriasis.

The superficial form of trichophytosis of the scalp is characterized by small scaly foci of round or irregular shape with very mild inflammation and some thinning of the hair. The presence in the lesions of short, gray hairs broken off 1-3 mm above the level of the skin is characteristic. Sometimes the hair breaks off above the level of the skin and looks like so-called "black dots". In differential diagnosis with microsporia, attention is paid to highly broken hair, having muff-like caps covering fragments of hair, asbestos-like peeling. Of decisive importance in the diagnosis is the fluorescence of the emerald color in the rays of the Wood's lamp of the affected hair, the detection of elements of the pathogenic fungus and the isolation of the pathogen in the cultural study.

Zhibera pink lichen is characterized by more pronounced inflammation, a pink tint of foci, the absence of sharp boundaries, peeling in the form of “crumpled tissue paper”, the absence of a characteristic emerald glow and the detection of elements of a pathogenic fungus during microscopic examination.

For psoriasis, the clarity of the boundaries, the dryness of the lesions, the silvery nature of the scales, and the absence of muff-like layers of scales on the affected hair are more characteristic.

Treatment of microsporia

Treatment Goals

• clinical cure;
• negative microscopic examination results for fungi.

General notes on therapy

With microsporia of smooth skin (less than 3 lesions) without damage to vellus hair, external antimycotic agents are used.

Indications for the appointment of systemic antimycotic drugs are:

• multifocal microsporia of smooth skin (3 or more lesions);
• microsporia with damage to vellus hair.

Treatment of these forms is based on a combination of systemic and local antimycotic drugs.

Hair in the lesions is shaved once every 5-7 days or epilated.

Indications for hospitalization

• lack of effect from outpatient treatment;
• infiltrative suppurative form of microsporia;
• multiple foci with lesions of vellus hair;
• severe comorbidity;
• according to epidemiological indications: patients from organized groups in the absence of the possibility of isolating them from healthy individuals (for example, in the presence of microsporia in people living in boarding schools, orphanages, hostels, children from large and asocial families).

Microsporia treatment regimens:

• Griseofulvin orally with a teaspoon of vegetable oil 12.5 mg per kg of body weight per day

Additionally, therapy with locally acting drugs is carried out:

• ciclopirox, cream
• ketoconazole cream, ointment
• isoconazole cream
• bifonazole cream
• 3% salicylic acid and 10% sulfur ointment
• sulfur (5%) - tar (10%) ointment

In the treatment of the infiltrative-suppurative form, antiseptics and anti-inflammatory drugs are initially used (in the form of lotions and ointments):

• Ichthyol, ointment 10%
• potassium permanganate, solution 1:6000
• ethacridine, solution 1: 1000
• furatsilin, solution 1:5000

Then the treatment is continued with the above antifungal drugs.

Alternative treatment regimens

• terbinafine 250 mg
• itraconazole 200 mg

Special situations

microsporia - Pregnancy and lactation.

The use of systemic antimycotic drugs during pregnancy and lactation is contraindicated.

Treatment of all forms of microsporia during pregnancy is carried out only with locally acting drugs.

Treatment of children with microsporia:

Griseofulvin orally with a teaspoon of vegetable oil 21-22 mg per kg of body weight per day

Treatment is considered complete with three negative results of the study, conducted at intervals of 5-7 days.

Additionally, therapy with locally acting drugs is carried out:

• ciclopirox, cream
• ketoconazole cream, ointment
• isoconazole cream
• bifonazole cream
• 3% salicylic acid and 10% sulfuric ointment, alcohol tincture of iodine
• sulfur (5%) - tar (10%) ointment

Alternative treatment regimens

• terbinafine: children weighing >40 kg - 250 mg once a day orally after meals, children weighing 20 to 40 kg - 125 mg once a day orally after meals, children with body weight<20 кг — 62,5 мг 1 раз в сутки
• itraconazole: children over the age of 12 years - 5 mg per 1 kg of body weight

Requirements for treatment outcomes

• resolution of clinical manifestations;
• lack of hair glow under a fluorescent filter (Wood's lamp);
• three negative control results of microscopic examination for fungi (microsporia of the scalp - 1 time in 5-7 days; microsporia of smooth skin with damage to vellus hair - 1 time in 5-7 days, microsporia of smooth skin - 1 time in 3-5 days).

In view of the possibility of relapses, after the end of treatment, the patient should be under dispensary observation: with microsporia of the scalp and microsporia of smooth skin with damage to vellus hair - 3 months, with microsporia of smooth skin without damage to vellus hair - 1 month.

Control microscopic studies during dispensary observation should be carried out: with microsporia of the scalp and microsporia of smooth skin with involvement of vellus hair in the process - 1 time per month, with microsporia of smooth skin - 1 time in 10 days.

The conclusion about recovery and admission to an organized team is given by a dermatovenereologist.

Prevention of microsporia

Preventive measures for microsporia include sanitary and hygienic, incl. compliance with personal hygiene measures, and disinfection measures (preventive and focal disinfection).

Focal (current and final) disinfection is carried out in places where the patient is identified and treated: at home, in children's and medical organizations.

Preventive sanitary-hygienic and disinfection measures are carried out in hairdressing salons, baths, saunas, sanitary checkpoints, swimming pools, sports complexes, hotels, hostels, laundries, etc.

Anti-epidemic measures in the detection of microsporia:

• For a patient with microsporia, identified for the first time, a notice is submitted within 3 days to the department of registration and registration of infectious diseases of the FBUZ "Center for Hygiene and Epidemiology" and its branches, to territorial skin and venereal dispensaries.
• Each new disease should be considered as newly diagnosed.
• When registering a disease in medical organizations, organized groups and other institutions, information about the sick person is entered in the register of infectious diseases.
• The journal is maintained in all medical organizations, medical offices of schools, preschool institutions and other organized groups. Serves for personal registration of patients with infectious diseases and registration of information exchange between medical organizations and organizations of state sanitary and epidemiological supervision.
• The patient is isolated.

• If a disease is detected in children's institutions, a patient with microsporia is immediately isolated and current disinfection is carried out before being transferred to a hospital or home.
• Until the recovery of a patient with microsporia, a child is not allowed to enter a preschool educational institution, school; an adult patient is not allowed to work in children's and communal institutions. The patient is forbidden to visit the bath, pool.
• In order to maximize isolation, the patient is allocated a separate room or part of it, items for individual use (linen, towel, washcloth, comb, etc.).
• In the first 3 days after the identification of the patient in preschool educational institutions, schools, higher and secondary specialized educational institutions and other organized groups, the medical personnel of these institutions conduct an examination of contact persons. Examination of contact persons in the family is carried out by a dermatovenereologist.

• Inspection is carried out before the final disinfection.
• Further medical supervision with a mandatory examination of the skin and scalp using a fluorescent lamp is carried out 1-2 times a week for 21 days with a mark in the documentation (observation sheet is being maintained).
• The current disinfection in the foci is organized by the medical organization that established the disease. Current disinfection before hospitalization, recovery is carried out either by the patient himself or by the person caring for him.
• Responsibility for the implementation of current disinfection in organized groups and medical organizations rests with its medical staff. Current disinfection is considered timely organized if the population begins to carry it out no later than 3 hours from the moment the patient is identified.
• The final disinfection is carried out in the foci of microsporia after the patient leaves the foci for hospitalization or after the recovery of the patient who was treated at home, regardless of the duration of hospitalization or recovery.

• In some cases, the final disinfection is carried out twice (for example, in the case of isolation and treatment of a sick child in the isolation ward of a boarding school: after isolation - in the premises where the patient was and after recovery - in the isolation ward). If a child attending a preschool institution or school falls ill, the final disinfection is carried out in the preschool institution (or school) and at home. In a secondary school, the final disinfection is carried out according to epidemiological indications. The final disinfection in the outbreaks is carried out by the disinfection station. Bedding, outerwear, shoes, hats, carpets, soft toys, books, etc. are subject to chamber disinfection.
• An application for final disinfection in home outbreaks and isolated cases in organized groups is submitted by a medical worker of a medical organization of a dermatovenereological profile.
• When registering 3 or more cases of microsporia in organized groups, as well as for epidemiological indications, a medical worker of a medical organization of a dermatovenereological profile and an epidemiologist of institutions of state sanitary and epidemiological supervision are organized. At the direction of the epidemiologist, final disinfection is prescribed, the volume of disinfection is determined.

• The medical worker who established the disease is working to identify the source of infection (the presence of contact with sick animals). Animals (cats, dogs) are sent to a veterinary clinic for examination and treatment, followed by the presentation of a certificate at the place of treatment and observation of the patient with microsporia. In case of suspicion of a homeless animal, information is transferred to the relevant animal trapping services.

IF YOU HAVE ANY QUESTIONS REGARDING THIS DISEASE, PLEASE CONTACT DERMATOVENEROLOGIST ADAEV KH.M:

Email: [email protected]

INSTAGRAM @DERMATOLOG_95

Etiology

Epidemiology

Clinic

The rise in the incidence of microsporia begins at the end of summer, peaking in October–November, and decreasing to a minimum occurs in March–April. The incubation period for zoonotic microsporia is 5-7 days.

The nature of the manifestations of microsporia is due to the location of the lesions and the depth of penetration of the pathogen. There are microsporia of smooth skin and microsporia of the scalp.

Microsporia of smooth skin At the site of the introduction of the fungus, an edematous, elevated red spot with clear boundaries appears. Gradually, the spot increases in diameter.

A continuous raised roller is formed along the edge, represented by small nodules, bubbles and crusts. In the central part of the spot, inflammation resolves, as a result of which it acquires a pale pink color, with pityriasis peeling on the surface.

Thus, the focus has the form of a ring. The number of foci in microsporia of smooth skin is usually small (1-3).

Their diameter ranges from 0.5 to 3 cm. Most often, the lesions are located on the skin of the face, neck, forearms and shoulders.

There are no subjective sensations or moderate itching is disturbing. In newborns and young children, as well as in young women, severe inflammation and minimal peeling are often noted.

In persons prone to allergic reactions (in particular, in patients with atopic dermatitis), the fungus is often masked by manifestations of the underlying process and is not always diagnosed in a timely manner. The use of local hormonal preparations only enhances the spread of fungal infection.

A rare variety of microsporia should include damage to the skin of the palms, soles and nail plates. Damage to the nails is characterized by an isolated lesion of the nail, usually its outer edge.

Initially, a dull spot is formed, which eventually acquires a white color. The nail in the area of ​​whitening becomes softer and more brittle, and may subsequently collapse.

Microsporia of the scalp The defeat of the scalp with microsporia occurs mainly in children aged 5–12 years. It is generally accepted that the rarity of this form in adults is due to the presence of organic acids in their hair that slow down the growth of the fungus.

This fact indirectly confirms the independent recovery of children during puberty, when there is a change in the composition of sebum. Interestingly, microsporia of the scalp is practically not found in children with red hair.

Foci of microsporia of the scalp are located mainly on the crown, in the parietal and temporal regions. Usually there are 1-2 large foci ranging in size from 2 to 5 cm, with round or oval outlines and clear boundaries.

On the edge of large foci, there may be screenings - small foci with a diameter of 0.5–1.5 cm. At the beginning of the disease, a peeling area forms at the site of infection.

In the early days, the fungus is located only at the mouth of the hair follicle. On closer inspection, you can see a whitish ring-shaped scale surrounding the hair like a cuff.

On the 6-7th day, microsporia spreads to the hair itself, which becomes brittle, breaks off 4-6 mm above the level of the surrounding skin and looks as if trimmed (hence the name “ringworm”). The remaining stumps look dull, covered with a grayish-white cap, which is a spore of the fungus.

If the stumps are “stroked”, they deviate in one direction and, unlike healthy hair, do not restore their original position. The skin in the lesion, as a rule, is slightly reddened, edematous, its surface is covered with grayish-white small scales.

With a suppurative form of microsporia against the background of significant inflammation, soft nodes of a bluish-red color are formed, the surface of which is covered with pustules. When pressed through the holes, pus is released.

The formation of the suppurative form of microsporia is facilitated by irrational (usually local) therapy, the presence of serious concomitant diseases, and a late visit to the doctor.

Prevention

Diagnostics

Treatment

Modern ointments are applied twice a day: clotrimazole, ciclopirox, isoconazole, bifonazole, etc. The drug terbinafine (lamizil), produced in the form of a 1% cream and spray, has proven itself well.

With severe inflammation, it is advisable to prescribe combined preparations containing additional hormones. Such agents include ointments mycosolone and travocort.

When attaching a bacterial infection, Triderm cream is useful. With deep forms of microsporia, preparations containing dimexide are indicated.

In particular, in such situations, a 10% solution of quinosol is widely used (quinosol and salicylic acid 10.0 each, dimexide 72.0, distilled water 8.0). The solution should be applied 2 times a day until the fungi disappear.

With the defeat of vellus, and even more so long hair, it is necessary to conduct systemic antifungal therapy for microsporia. In the treatment of microsporia of the scalp, griseofulvin, an antibiotic produced by a mold, is still the drug of choice.

Griseofulvin, produced in the form of tablets of 125 mg. The drug is taken daily in 3-4 doses with a meal with a teaspoon of vegetable oil, which is necessary to increase the solubility of griseofulvin and increase the duration of its action.

For children under the age of 3 years, it is preferable to prescribe griseofulvin in the form of a suspension, 8.3 ml of which corresponds to 1 tablet (125 mg) of the drug. Continuous therapy is carried out until the first negative result of the analysis for fungi, after which griseofulvin is taken for 2 weeks at the same dose every other day, and then for another 2 weeks 2 times a week.

The general course of treatment is 1.5–2 months. In the process of treatment, it is necessary to shave off the hair weekly and wash the hair 2 times a week.

It is recommended to simultaneously rub any antifungal ointment into the focus area. In parallel with taking an antifungal drug, manual hair removal can be carried out with a preliminary application of a 5% griseofulvin patch to the lesion.

Of the side effects of griseofulvin, headache, allergic rashes, discomfort in the pancreas should be noted. Due to the toxic effect on the liver, griseofulvin is contraindicated in children who have had hepatitis or who suffer from liver disease.

The drug is also not prescribed for diseases of the kidneys, peptic ulcer of the stomach and duodenum, neuritis, blood diseases, photodermatosis. In recent years, terbinafine (Lamisil) has been an alternative to griseofulvin.

In the treatment of microsporia of the scalp, terbinafine is used in the form of tablets, available in doses of 125 and 250 mg. In the treatment of microsporia of the scalp in children, the dose of terbinafine is set depending on body weight.

Terbinafine is taken once a day. Tolerability of the drug is good.

Patients may be disturbed by a feeling of fullness in the stomach, minor pain in the abdomen. Compliance with a diet aimed at stopping flatulence relieves patients of discomfort.

Attention! The described treatment does not guarantee a positive result. For more reliable information, ALWAYS consult a specialist.

microsporia is a common infectious disease caused by a microscopic fungus of the genus Microsporum. The high frequency of this disease is explained by the fact that the microorganism that causes it is extremely contagious and is found in fairly high concentrations in the soil, on some types of plants and animals.

Microsporia refers to dermatophytosis, that is, to skin diseases, which can affect both smooth skin and skin covered with hair. The defeat of the scalp, which is accompanied by hair loss and some change in the skin, is commonly known as ringworm. However, this term cannot be applied to all types of microsporia. Mostly children are ill, which is associated with a less developed and more susceptible immune system, with insufficient hygiene skills, as well as with more frequent contact with animals ( street cats and dogs). However, it should be noted that childhood lesions often resolve spontaneously by puberty.

Depending on the type of fungus and the type of skin lesion, the following types of microsporia are distinguished:

• superficial;
• infiltrative suppurative.

Infiltrative suppurative microsporia is a severe form of the disease caused by zoophilic fungi, that is, fungi that affect mainly animals, and the natural source of which are dogs and cats. The damage caused by these microsporums affects the deeper layers of the skin, which is accompanied by a productive inflammatory reaction with the formation of purulent infiltrates. In severe cases, a large purulent focus is formed, a general malaise develops, and body temperature rises.

According to statistics, children under the age of 10 are most susceptible to infection. Some types of microsporia ( especially saprophytic, that is, living in the soil and the environment) are found almost five times more often among boys than among girls, which is explained by their greater mobility and some features of social and everyday behavior. At the same time, after puberty, the situation becomes the opposite. This is due, firstly, to hormonal changes, and secondly, to the fact of closer and closer contact of women with children, who are the main group of patients. Infection with zoonotic species of the fungus occurs equally often among both boys and girls.

The severity of the disease depends on the type of infectious agent and, accordingly, its ability to penetrate tissues and cause local changes, as well as on the site of infection and the reaction of the body. In the vast majority of cases, ringworm and other types of microsporia do not pose any threat to the life of the infected. However, the aesthetic defect created by the disease, as well as the itching present in some cases ( which can be both subtle and extremely intense) create significant discomfort for the patient. We should not forget that children with a defect in the hairline caused by ringworm often cannot socially adapt normally, as they are ridiculed by their peers. Such a situation can negatively affect their psycho-emotional development and cause significant psychological disorders in the future. Thus, it is essential to start adequate therapy as early as possible.

Interesting Facts

• microsporia pathogen is able to survive for long periods of time in environmental conditions ( some mushroom species can survive up to 10 years outside of a natural host);
• adults are characterized by damage to the smooth skin of the body, while in children the scalp is more often affected;
• microsporia does not affect nails;
• damage to the deep skin layers, accompanied by the formation and release of pus, is called kerion ( translated from Greek - honeycombs), which is associated with the peculiar appearance of inflamed and swollen skin, from the enlarged pores of which ooze pus.

Skin structure

The skin acts as a protective barrier that prevents damage to internal organs and tissues. In addition, it protects the body from the effects of many adverse environmental factors.

The skin performs the following functions:

• UV protection. Melanin found in the skin dark pigment) is able to absorb ultraviolet radiation, due to which the skin protects the underlying soft tissues and organs from the harmful effects of sunlight.
• Temperature difference protection. The skin and subcutaneous adipose tissue isolate the body, stabilizing its temperature. The ability of blood vessels to expand when temperature rises and constrict when it decreases allows the body to regulate temperature, as well as protect internal organs from overheating or hypothermia. Sweat glands located in the thickness of the skin contribute to cooling the skin and, accordingly, the whole body due to the active evaporation of sweat during hot periods.
• Protection from toxins. The stratum corneum of the skin is impenetrable to some organic and inorganic poisons and acids. However, thanks to a well-developed and extensive network of blood vessels, the skin is able to actively absorb and absorb certain substances. For this reason, it is not recommended to expose the skin to potentially hazardous substances for a long time, as they can provoke not only a local, but also a systemic reaction. In case of contact with the skin of pesticides, it is necessary to immediately wash them off with plenty of water, and then seek qualified medical help from a doctor.
• Bacteria protection. Intact skin is impervious to most bacteria and pathogens. However, reduced local immunity, local irritation, microtrauma, cracks, wounds and other defects contribute to the penetration and development of infection.
• Sensitive perception. In the thickness of the skin there are sensitive nerve fibers, receptors, free nerve endings that are able to convert mechanical information into electrical impulses that are processed by the central nervous system and form a sensation. The skin has tactile, vibration, pain and temperature sensitivity. The formed sensations allow not only to perceive information from the outside and interact with the outside world, but also protect the body from a long stay in adverse or dangerous conditions.
• immune function. Immune cells in the skin produce immunoglobulins ( antibodies) that perform nonspecific ( directed against most pathogenic microorganisms) protective function.
• Retention of fluids and a number of substances in the body. The skin covers not only protect the body from the effects of adverse environmental factors, but also prevent excessive loss of fluids and a number of useful substances. This happens due to the fact that the skin isolates the internal environment of the body and does not allow plasma ( liquid component of blood) to go outside. Thanks to this, the constancy of the internal environment is maintained. With massive burns or injuries, when the skin loses its anatomical and functional integrity, the body loses a large amount of plasma and electrolytes, which has an extremely negative effect on the patient's condition.

• epidermis;
• dermis;
• subcutaneous adipose tissue.

Epidermis

The epidermis consists mainly of keratinocytes - special cells that synthesize a number of proteins during their development ( initially soft, but then hardening), which form the stratum corneum of the skin.

Several layers are distinguished in the epidermis, each of which inherently reflects a certain stage in the development of keratinocytes.

The epidermis consists of the following layers:

• basal;
• spiny;
• grainy;
• brilliant;
• horny.

Spiny layer It is represented by several rows of keratinocytes, which are interconnected by peculiar spikes - outgrowths formed by intercellular bridges. These spikes arise due to some reduction of the cell and condensation of its contents. The spinous layer, like the basal layer, is able to divide and fill in skin defects, but this happens only when the basal layer is damaged.

Granular layer formed by 2 - 3 rows of flat cells, in which there are interspersed with waterproof proteins - precursors of keratin.

glitter layer present only in areas with rough thick skin ( palms, soles). It is a thin layer of pinkish color, which is formed by flat keratinocytes devoid of a nucleus.

stratum corneum is the most superficial layer of the epidermis and is represented by several rows of flat keratinocytes, in which all intracellular organs are replaced by keratin, a solid waterproof protein.

The epidermis is in a state of constant renewal, as under the influence of various factors ( both external and internal) the cells of the stratum corneum are constantly exfoliating. In order to prevent the formation of skin defects, exfoliated cells are replaced by new ones. This happens through the constant division and development of keratinocytes, which, as they grow, move from deeper layers to the surface.

Dermis

The dermis is made up of the following layers:

• papillary;
• reticulate.

papillary layer The dermis is represented by loose connective tissue, which forms peculiar papillae. Due to this structure, this layer has significant elasticity and stretchability, which is extremely important for maintaining the skin structure.

mesh layer It is represented by a denser connective tissue, which is able to withstand significant mechanical stress.

in the dermis ( predominantly in the papillary layer) skin appendages are located ( skin follicles and various glands), which perform a number of important physiological functions.

Skin appendages are represented by the following structures:

• sebaceous glands;
• sweat glands;
• hair follicles;
• nails.

sweat glands are glands of external secretion with a simple structure, the main function of which is the production of a watery secret - sweat. There are two types of sweat glands in the human body - eccrine and apocrine. The first, eccrine, are located on the entire surface of the body and are glands that synthesize simple sweat, which is 99% water, due to which it is involved in the regulation of body temperature. The second, apocrine, are located in the armpits, in the perineum and anus, in some parts of the face. They synthesize a viscous secret that has a pronounced odor. These sweat glands are not involved in the regulation of body temperature, but their secretory activity increases in stressful situations. Apocrine glands develop during puberty.

hair follicles are complex structures formed by the dermis and epidermis. They are located on the entire surface of the body, with the exception of the palmar surface of the hands, soles of the feet, glans penis, clitoris, lips. The hair follicle, which is the basis of the follicle, is located deep in the skin, and on the face it can lie in the subcutaneous fatty tissue. The hair growing from the bulb is a structure formed by three shells. The outside of the hair is covered with horny scales ( cuticle), under which there is a cortical substance, represented by dead cells. In the center of the hair is the medulla, formed by keratin cells and air cavities. Such a concentric structure provides the necessary mechanical stability of the hair and realizes their protective potential.

Milk glands are special modified sweat glands that, under the influence of a number of stimuli, are able to synthesize milk. The mammary glands are present in both women and men, however, against the background of hormonal differences during puberty, they fully develop only in women. The mammary glands are located in the chest area in such a way that their excretory ducts exit through the nipple.

Nails are also derivatives of the skin. They are formed from keratin, which is synthesized by skin cells. Due to the presence of minerals, water and fat, the nails are elastic and fairly hard. The main function of the nail is to protect the fingertips and stiffen them.

The dermis contains blood and lymphatic vessels, as well as nerve fibers that provide communication between the central nervous system and the peripheral parts of the body. Nutrients and oxygen entering the skin through the blood vessels penetrate the epidermis by diffusion and provide its nutrition.

It should be noted that in addition to nutritional ( trophic) and respiratory function, blood vessels are involved in thermoregulation. This happens by changing the volume of blood flowing to the skin. Since the skin has a large area and is in direct contact with the environment, an increase in blood supply during vasodilation leads to cooling of the blood, and a decrease in constriction leads to heat conservation, which, in turn, affects the entire body temperature. This mechanism of thermoregulation is of great importance both in the warm and in the cold season. It should be noted that the use of alcoholic beverages contributes to the expansion of blood vessels located in the skin, which creates the illusion of warmth ( due to the greater flow of blood and heat to the skin, temperature receptors are activated), but which increases heat loss and increases the risk of severe frostbite.

Subcutaneous adipose tissue

Subcutaneous adipose tissue performs the following functions:

• Mechanical protection of internal tissues. The fatty layer located under the skin helps to soften the blows, which provides some protection to the internal organs.
• Skin mobility. The subcutaneous fat layer provides the mobility of the skin, that is, it allows the skin to slide relative to the underlying soft tissues and bone structures. Perhaps this is both due to the loose structure of fat, and because of the rather loose connection between the dermis and the fat layer.
• Thermal insulation. Fat is a substance that conducts heat poorly. Thus, the fat layer allows for some time to maintain a constant body temperature, regardless of environmental conditions. However, it should be noted that for long-term heat retention ( or cooling) other, more effective and controlled mechanisms of thermoregulation are needed.
• Supply of nutrients. Fat is an energy-rich chemical structure. In conditions of insufficient intake of nutrients, the body begins to break down its own adipose tissue, thereby replenishing the energy deficit.

Properties of fungi of the genus Microsporum

Under natural conditions, representatives of this family of fungi are able to grow only on structures rich in keratin ( protein produced by epidermal cells). For this reason, microsporums can only infect the skin directly ( rather, the epidermis) and hair follicles. As noted above, microsporia does not affect the nails.

For pathogenic fungi ( however, as for most other mushrooms) a characteristic structural feature is the presence of mycelium - a thin branched thread that grows from the base of the fungus and with which it spreads. Mycelium is one giant multinucleated cell, which was formed as a result of the fusion of many cells of the fungus. Mycelium is able to form fungi, and under certain conditions, to form spores. Spores are cells with a dense shell, which, when released into a favorable environment, can develop into a full-fledged fungus, in other words, spores are one of the ways fungi reproduce.

The main causative agents of microsporia are the following fungi:

• Microsporum canis;
• Microsporum ferruginum.

Microsporum ferrugineum (rusty microsporium) is a fungus that can infect humans, and under certain conditions, some animals. It is extremely contagious and can infect a person when even a small amount of the fungus enters. Colonies of this fungus grown on artificial nutrient media have a brown or reddish color that resembles rust on iron ( hence the corresponding species name). The mycelium is wide and flat.

It should be noted that the microsporum family is not limited to these two representatives, but they are of the greatest clinical and practical importance. The remaining members of this family have a similar structure and similar properties.

Causes of microsporia

An important factor that contributes to the spread of infection is the high resistance of fungi in the external environment. Most representatives of the microsporum family are able to retain their infectious and pathogenic properties for many months and even years.

It should be noted that for zoophilic forms of microsporia, the initial source of which was any animals, a limited number of transmissions is characteristic. This is explained by the gradual weakening of the fungal strain on a substrate that is not natural for it ( in this case, human skin).

Adults are much less likely to suffer from microsporia. This is explained by a more stable immune system, developed non-specific factors of protection against bacterial and fungal infections, hormonal factors, as well as hygienic considerations. In addition, it should be noted that due to age-related changes in the hairline, microsporia almost never affects the scalp in adults, but is limited only to the smooth skin of the body.

It should be understood that just getting the fungus on the surface of the skin does not guarantee the development of ringworm ( or other clinical form of the disease). Symptomatic disease requires some interaction between the infecting microorganism and the infecting macroorganism ( human). In other words, the development of a fungal infection depends on the infectious dose and on the pathogenicity of the fungus, on the one hand, and on the immunity and defenses of a person, on the other.

The pathogenicity of the fungus depends on the following factors:

• type of fungus
• amount of fungus.

Number of fungus or, in other words, infectious dose, is a factor that determines the rate of development and severity of the disease. The more fungal cells that got on the skin at the time of infection, the higher the risk of developing a clinically pronounced disease.

The body's defenses are represented by a number of non-specific substances that are produced by the cells of the body and are capable of destroying fungal cells ( have fungicidal activity). The second line of defense is formed by immune cells that are located in the epidermis and are able to actively absorb foreign cellular elements. All these factors are directly dependent on the general condition of the body, on the status of the immune system, as well as on the health of the skin.

The following factors reduce local protective potential and increase the risk of developing microsporia:

• Atopy ( genetic predisposition). Atopy is a genetically determined condition in which, under the influence of a number of stimuli, an excessive amount of class E immunoglobulins is synthesized, which activates the cascade of allergic reactions. As a result, an inadequate local reaction develops, which weakens local immunity.
• Local or systemic use of glucocorticosteroids. The use of drugs that reduce immunity, one way or another, reduces the protective potential of the skin and increases the risk of infection. Most often, this occurs under the influence of glucocorticosteroid hormones, which are used in the form of various ointments or creams to treat other skin pathologies. To prevent infection, these drugs should be used only as prescribed by a doctor and strictly follow the recommendations and instructions.
• Ichthyosis. Ichthyosis is a hereditary skin disease in which, due to a violation of a number of regulatory mechanisms, excessive keratinization of the skin occurs. As a result, peculiar scales form on the skin ( similar to fish scales), the skin loses its elasticity and is injured at the slightest movement.
• Diseases of the connective tissue and blood vessels . Changes that occur in the connective tissue framework of the skin and in the wall of blood vessels against the background of a number of autoimmune diseases impair local blood circulation and reduce the number of immune cells and protective factors on the skin surface.
• The state of immunodeficiency. The state of immunodeficiency can occur against the background of taking drugs that reduce immunity ( with cancerous tumors, after organ transplantation, against the background of severe systemic disorders), or after serious diseases of the immune system. In addition, immune function is impaired when infected with the human immunodeficiency virus ( HIV), as well as some genetic abnormalities.

• Excessive sweating. Sweat changes the environment, increases acidity, changes the electrolytic balance on the surface of the skin. In addition, moisture softens keratin, making the stratum corneum of the epidermis more susceptible to infectious agents.
• professional risks. Frequent and prolonged contact with sick or stray animals significantly increases the risk of infection with zoophilic forms of microsporia.
• High humidity environment. High humidity of the environment not only creates favorable conditions for the growth of the fungus, but also, as noted above, softens the epidermis, reducing its protective potential.

After the penetration of a pathogenic fungus into the body, the incubation period begins, which can last from 2 weeks to 2 months. At this time, the development and reproduction of the fungus occurs, the cellular components of the infectious agent begin to form. This period is not characterized by any external clinical manifestations. Symptoms of the disease occur after sufficient accumulation of the fungus and the development of a productive inflammatory reaction, which, in fact, forms the clinical picture.

Thus, despite a sufficiently developed immunity, under certain circumstances, fungi can easily infect a person and cause a disease of varying severity.

Symptoms of microsporia

Depending on the clinical manifestations, it is customary to distinguish the following types of microsporia:

• microsporia of the scalp ringworm);
• microsporia of smooth skin;
• microsporia of the face ( damage to the facial vegetation in men);
• kerion.

Common signs for all types of microsporia is the appearance of a red spot ( usually annular), within which the hairline becomes brittle and baldness develops. This usually results in enlarged regional lymph nodes ( with damage to the head - lymph nodes of the neck). In most cases, itching is either absent or extremely unexpressed and does not cause significant discomfort to the patient.

Skin lesions of the scalp ringworm)

The disease gradually spreads, forming multiple foci. Due to the growth of these foci from the center to the periphery, characteristic ring lesions are formed, which can merge with each other.

Inflammation is usually mild, but in some cases a severe inflammatory reaction may occur with the formation of a purulent infiltrate ( kerion).

ringworm symptoms

Symptom	Description of the symptom and the mechanism of its occurrence	characteristic image
Red annular lesions	The fungus that has penetrated the skin provokes a local inflammatory response, which is accompanied by the expansion of blood vessels, which gives a red tint to the focus. Due to the expansion of the focus from the center to the periphery, a peculiar annular shape is created.
Small pustules covered with crusts and broken hairs	Pus is a mixture of dead immune and fungal cells. In most cases, the disease proceeds without the formation of abscesses, however, in severe cases, small sores and pustules may form.
Baldness within the focus	Fungi of the genus Microsporum are not able to penetrate the cortical substance of the hair, so they infect it from the outside. At the same time, the fungus destroys keratin and a number of other protein substances of the hair, thereby weakening it. As a result, the hair breaks a few millimeters above the surface.
Black dots within the focus	Black dots are the remaining hair roots.
Gray scales and excessive keratinization of the skin within the focus	Fungal infection disrupts the mechanism of regulation of normal renewal and keratinization of the skin, thereby increasing the thickness of the stratum corneum of the epidermis.

Smooth skin lesions

The defeat of the facial vegetation in men

Kerion

Diagnosis of microsporia

Laboratory diagnostics

When collecting material for laboratory diagnostics, the following rules must be observed:

• before taking a sample, it is necessary to remove all remnants of ointment and other medicines from the skin and hair with a napkin soaked in alcohol;
• hair from the focus is collected by cutting them with scissors or by pressing a damp cloth to which the broken hairs stick;
• fragments of skin and hair can be scraped off the affected area with a blunt scalpel or glass slide;
• fragments of hair and skin can be sent to the laboratory in special dark and light envelopes, which, thanks to the created contrast, allow you to see the amount of material collected.

Laboratory diagnosis of microsporia is carried out in the following ways:

• direct microscopy. Direct microscopy involves the study of biological material obtained from a patient under a light microscope in order to identify signs characteristic of a fungal infection. To increase the efficiency of this method, hair samples are pre-soaked in a 10-20% potassium alkali solution, which softens the hair and allows better visualization of its internal structure. With microsporia, spores and mycelium are detected, which partially destroy the cortical layer of the hair ( cuticle), but which do not penetrate the medulla. It should be noted that a similar picture is observed not only with microsporia, but also with a number of other fungal infections.
• Cultivation of the fungus on special media. In order to accurately identify the fungus and determine its species, as well as, if necessary, to determine its sensitivity to antifungal drugs, a cultural method is used, which involves sowing pathological material on special media with subsequent cultivation. A significant disadvantage of this method is its duration, since it takes one to two weeks to grow the fungus.

Wood's lamp

Wood's lamp is a source of ultraviolet radiation, equipped with a special glass that transmits light rays of a certain wavelength ( for maximum efficiency). Hair affected by microsporia glows under a Wood's lamp with a characteristic bright green or yellow-green color.

Histological examination

Treatment of microsporia

The course of treatment of microsporia itself can last quite a long time. This is due to the high resistance of the pathogen to various drugs. In this regard, the treatment approach is complex, using various methods. This allows you to quickly eliminate the causative agent of the disease and prevent possible relapses ( repeated exacerbations of the disease). A cosmetic defect after a disease may persist for some time and sometimes requires additional consultation with a cosmetologist.

There are the following methods of treatment of microsporia:

• general methods of treatment;
• drugs for systemic treatment;
• preparations for local treatment;
• folk methods of treatment.

General Treatments

It is also necessary to monitor the normal intake of vitamins in the patient's body ( varied diet, intake of vitamin and mineral complexes). This will strengthen the immune system and speed up recovery.

The patient should use personal hygiene products - washcloths, towels ( changing them every few days), comb. Other family members and other persons from the patient's environment are recommended to undergo a preventive examination by a dermatologist.

Preparations for systemic treatment

The main antifungal drugs for systemic treatment are:

• Griseofulvin. For adults, the dose is 12.5 mg per 1 kg of body weight per day ( mg/kg/day). The maximum total daily dose is 1 g. Children are recommended 22 mg / kg / day. The drug is taken until the appearance of negative results of microbiological analysis. After that, at the discretion of the attending physician, the course may be extended with a decrease in dose and more rare receptions ( 2 - 3 times a week). It is advisable to use the drug with fatty foods ( e.g. with milk, butter), as this contributes to its more complete assimilation.
• Terbinafine. The standard dose is calculated depending on the body weight of the patient. Small children under 20 kg are recommended to take 62.5 mg / day, older children and adolescents weighing 20-40 kg are prescribed 125 mg / day. Adults over 40 kg receive 250 mg daily. The term of admission is on average 8 - 12 weeks.

Preparations for local treatment

Topical preparations for microsporia

Folk methods of treatment

The main folk remedies for the fight against ringworm are:

• garlic juice. A clove of garlic is cut lengthwise and rubbed with its juice on the affected area of ​​\u200b\u200bthe skin. This procedure is performed once a day ( preferably in the morning). After that, during the day, lichen can be lubricated with birch charcoal or plantain.
• garlic vinegar. This tool is widely used in the treatment of many dermatological diseases. To prepare it, a few cloves of garlic are cut and poured with 0.5 liters of apple cider vinegar. The resulting mixture must be infused for 1 to 2 weeks, shaking occasionally. After cooking with vinegar, rub the affected area of ​​\u200b\u200bthe skin. To enhance the therapeutic effect, you can add a few drops of camphor oil to the infusion before use.
• Sophora japonica. To prepare this remedy, you need 50 g of the fruits or flowers of this plant. In the absence of contraindications, it is recommended to make an alcohol infusion. For 50 g of grass, you need 0.5 liters of vodka ( strength not less than 35 degrees). Infusion lasts 3 - 4 weeks in a dark place. After preparation, the infusion is filtered and taken orally 3 teaspoons per day. A certain therapeutic effect in case of microsporia can also be given by the usual brewing of tea with the addition of Japanese Sophora.
• Ointment based on broth of sea fish. To prepare the ointment, you will need about 400 ml of rich broth, 100 g of butter and gruel from several heads of grated garlic. This mixture is gently applied to the affected area of ​​the skin 2-3 times a day, wrapping for 30-60 minutes with a clean bandage.

All folk remedies against ringworm are used until signs of recovery appear. Since this process can take several months, it is recommended that you seek the advice of a dermatologist. With its help, it will be possible to successfully combine traditional medicine with highly effective pharmaceutical preparations, which will lead to a speedy recovery.

The main criterion for stopping the course of treatment is not the disappearance of symptoms, but a special microbiological analysis. If the scalp is affected, 3 scrapings are made with a five-day break. In addition, the hair is illuminated with a fluorescent lamp ( Wood's lamp), which detects fungi. With the localization of lichen on the skin, 3 scrapings are made with a three-day break. If all tests are negative, the patient is considered fully recovered and the course of treatment is stopped. This decision must be made by the attending physician.

Prevention of microsporia

Prevention of microsporia is based on the following activities:

• Examination of persons in contact with patients. Due to the long incubation period, as well as the frequent cases of asymptomatic carriage of the fungus, all persons who have come into contact with patients are subject to a thorough examination.
• Use of special antifungal shampoos. To prevent latent transmission and reduce the risk of infection, close and prolonged contact with sick people is recommended to use an active treatment regimen using a range of antifungal shampoos. For this, special mixtures based on selenium sulfide or povidone-iodine can be used ( considered to be the most effective). These shampoos should be used twice a week for 15 minutes, for four weeks.

Occurs when a person is infected with fungi of the genus Microsporum. Parasitic microorganisms affect mainly the skin, hair of the head, mustache, beard, eyebrows, pubis and genitals, vellus hair. Rarely, fingernails and toenails are infected.

Disease-causing fungi are ubiquitous. Favorable conditions for their life are created in regions with a warm, humid climate.

In nature, there are zoophilic, anthropophilic, geophilic fungi Microsporum, almost all species are dangerous to humans.

Geophilic fungi live in the soil, infection occurs when working with the earth, in summer cottages. Anthropophilic fungi are found on human skin.

Zoophilic fungi are spread by animals. The danger of microsporia infection for humans is stray animals.

Epidemiology, ways of infection with microsporia

Mostly children suffer from a fungal infection, there is an increase in the number of cases of microsporia in newborns.

Adults practically do not get sick with microsporia of the scalp, and when infected, they heal themselves due to the presence of organic acids in the hair that have antifungal activity.

Mostly young women get sick in adulthood, as well as people suffering from chronic diseases that cause a decrease in immunity.

The percentage of adults suffering from microsporia has recently been increasing and this is due to the growth of neuroendocrine diseases, HIV-infected people.

With inadequate treatment, the disease acquires a chronic course with sluggish, erased symptoms. This leads to the spread of infection.

Infection of both children and adults with microsporia occurs most often from a sick animal, usually a kitten, less often from a sick dog.

Symptoms

Up to 97% of microsporia infections are caused by the zoophilic fungus Microsporum canis.

The incubation period of this fungus - the time from the penetration of fungal hyphae into the skin until the onset of symptoms of microsporia, lasts 7 days. The smooth skin of the trunk, extremities and the scalp are most often affected.

Microsporia of smooth skin

The maximum number of infections in children is observed in early summer and autumn, which is associated with the time of birth of kittens, which are more susceptible to infection than adult animals, and the time they return to school.

The first symptoms of microsporia of smooth skin in children appear on the skin in the form of a red spot (as shown in the photo) at the site of infection. Adults can also become infected with a fungal infection, and the number of such cases is growing.

The localization of the manifestation of symptoms of microsporia of smooth skin corresponds to contact with a sick animal, usually the skin of the face, hands, neck (see photo).

Unusual places of foci of microsporia are also noted, so foci of infection are observed on the skin of the palms, feet, lower legs, penis, pubis, labia, and on the nail plate.

The number of patients with microsporia with lesions of the genitals has increased over the last period of time. You can get infected not only through direct sexual contact, but also through a washcloth, soap, towel.

A feature of microsporia of the smooth skin of the genitals is the abundance of blood vessels in this area, which contributes to the spread of the process in depth, making treatment difficult.

A symptom of microsporia in humans is the appearance of redness (see photo). The spot is edematous, rises slightly above the surface of the skin, has a clear outline.

Gradually, along its border, a roller is formed, consisting of crusts, bubbles, nodules, the spot takes the form of a ring. The central part of the spot acquires a pale pink color, the skin on its surface is flaky.

The size of the ring reaches 3 cm, the number of foci of infection does not exceed 3. The focus of infection does not bother the patient, some discomfort causes itching in the affected area.

In individuals suffering from atopic dermatitis, the fungus is not always able to be recognized in a timely manner, since it has similar manifestations with atopy, and the use of corticosteroid ointments only increases the spread of fungal infection.

Such patients have papular-squamous microsporia of smooth skin, rashes on the chest, back, face, accompanied by severe itching, significant peeling of the skin.

The skin of the lower leg can also be affected by microsporia, with deep lesions up to 3 cm in diameter occurring, the disease occurs more often in young women. Microsporia of the feet (shown in the photo) is manifested by characteristic rashes on the soles.

The fungus Microsporum canis is capable of causing damage and destruction of the nail. The first symptom of infection is the appearance of a dull spot on the nail plate close to the roller.

Gradually, the stain acquires a white color, softens, collapses. Microsporic onychomycosis is difficult to diagnose in a timely manner, since it practically does not bother the patient, the disease becomes a chronic source of infection.

Sick microsporia of the scalp caused by the zoophilic fungus Microsporum canis, more often children 5-12 years old.

The exception is red-haired children. For them, protection against infection is the special chemical composition of organic acids in the secretion of the sebaceous glands of the scalp.

The same acids are found in the hair of adults, which explains the cases of spontaneous recovery of children with microsporia when they reach adulthood.

The foci of infection with microsporia in children are located on the crown, crown, in the temporal region (see photo). Initially, fungal hyphae penetrate the hair follicle and create a kind of cuff around the hair.

After the incubation period, the changes become apparent: the hair in the lesion is broken off by the fungus, leaving stumps 4-6 mm high. Usually there are no more than two lesions, sizes in diameter - up to 5 cm.

Stumps of broken hair look like trimmed, for which the disease got its common name "ringworm".

Stumps of hair are dull, covered with a gray coating. If the hair on the infected area is stroked, they deviate and do not restore their original position.

In the lesion, swelling, redness, and peeling of the skin are noted. Near the main focus of infection, small screenings of the fungus, small foci up to 1.5 cm in size are often noted.

The clinical picture of microsporia of the scalp when infected with an anthropophilic fungus is somewhat different (shown in the photo). The lesions are small, multiple, with indistinct boundaries.

Sites of infection are localized on the marginal zone of hair growth of the head, often one focus is located in the scalp, and the other is on the smooth skin of the face.

Rare types of microsporia of the scalp

Atypical cases of microsporia include seborrheic, deep, trichophytoid, exudative forms of the disease.

With seborrheic microsporia, the hair thins, covered with yellowish dandruff scales, under which broken hair is found.

Trichophytoid form of microsporia is more common in older people, characterized by low broken hair (1-2 mm above the skin) and the presence of long hair in the lesion.

With exudative microsporia, vesicles with exudate form in the focus of infection. The serous fluid impregnates the flaky scales, glues them together, forming crusts.

With a deep suppurative form of microsporia, the focus of infection acquires a red-cyanotic color, becomes inflamed, and pus is released when pressed on it.

With this form of microsporia, a person (as in the photo) may experience symptoms of intoxication of the body, which requires complex treatment.

Diagnostics

Before treating microsporia, such diagnostic measures are carried out as a luminescent study of the lesion under a Wood's lamp, microscopic, cultural examination.

The most accurate way to determine the type of pathogenic fungus that caused microsporia, and to choose the right treatment, is the cultural method.

Samples of diseased hair, scales from the lesion are applied to a special Saburo nutrient medium. In the case of microsporia, the growth of a colony of the fungus is noted already on the 3rd day. The colony is a white disk covered with a delicate fluff, for which the fungus received the name fluffy microsporum.

Treatment of microsporia

The causative agents of microsporia are highly resistant to antimycotics and require the use of large doses of drugs in the treatment.

For the treatment of microsporia, mainly griseofulvin, lamisil are used.

Griseofulvin is taken orally with vegetable oil to enhance the secretion of bile and dissolve the drug. Wash down the medicine with sour juice - apple, lemon, which enhances the absorption of griseofulvin.

Griseofulvin is hepatotoxic, Karsil, Liv-52 are taken to protect the liver. The course of treatment with griseofulvin lasts up to 2 months according to a special scheme, the maximum daily dose is 1 g.

Lamisil is considered an effective drug in the treatment of microsporia in humans. Lamisil tablets are rapidly absorbed in the digestive tract, act directly on the cells of the fungus, accelerate recovery even with severe suppurative forms of microsporia.

In addition to taking antimycotics, patients with microsporia are treated with external agents. Every week, the hair in the lesions is removed by shaving or epilation.

The focus of infection daily after waking up is treated with an alcohol tincture of iodine. In the evening, bifosin or sulfuric ointment containing additives of salicylic acid and tar is rubbed into the diseased area of ​​\u200b\u200bthe skin.

From pus and crusts, the affected area is cleaned with the help of compresses with solutions of licorice root, mummy, ichthyol. They make lotions with gibitan. In the treatment of microsporia in children, 1% mycospore creams, travogen, lamisil cream are effective.

Prevention

To prevent microsporia in humans, strict measures are taken to prevent the spread of infection. For each patient with a confirmed diagnosis, a notice in the form 281 is filled out.

The patient's family is examined, all persons who have come into contact with the patient are also examined by medical workers to detect infection with microsporia.

The prevention of microsporia includes examination and treatment, if necessary, of a pet infected with a fungus. Responsible attitude towards stray animals that children or parents themselves bring into the house will help prevent infection.

Even in the absence of visible foci of microsporia on the muzzle, ears, paws, it is necessary to examine the animal at the veterinarian under a Wood's lamp, to sow wool from different parts of the skin.

Precaution will help protect children from contact with a sick animal and prevent the spread of infection.

Forecast

The prognosis of microsporia with timely treatment and adequate systematic treatment under the supervision of a physician is favorable.

We also suggest that you familiarize yourself with other types of dermatomycosis in the following articles.

zooanthroponic mycosis skin causative agent

Microsporia is a zooanthroponotic anthropurgic mycosis of the skin, hair, and sometimes nails, caused by various species of fungi of the genus Microsporum, with a contact mechanism for the transmission of the pathogen.

The disease was first described in Paris by the Hungarian scientist Gruby (1843). The causative agents of microsporia are dermatomycetes of the genus Microsporum.

Microsporums are usually divided into three groups - anthropophilic, zoophilic and geophilic. Rukavishnikova, V.M. Mycoses of the feet / V.M. Rukvishnikova - M.: EliksKom, 2003. - P.76

Anthropophilic: M.audoinii, M.langeroni - common in North Africa and Western Europe; M.ferrugineum dominates Eastern Europe, Southwest Asia and West Africa; M.rivaliery is endemic in the Congo.

zoophilic-. M.canis (felineum, lanosum, equinum) - the most common causative agent of human and animal microsporia, is ubiquitous; stray cats, dogs, less often other mammals are natural reservoirs; M.galinae - chickens; M. persicolor - mice and other small rodents; M.distortum - monkeys, cats, dogs; M.papit - monkeys.

Geophilic: M.gypseum, M.racemosum, M.qookey, M.magellanicum. This group of microsporums does not play a significant role in the formation of the epidemic process, but, nevertheless, is described in the literature as the causative agents of "gardener's mycosis".

M.gypseum is ubiquitous in soil, especially garden soil. Described as the causative agent of lesions of smooth skin, scalp and nail plates, the latter is very rare.

In the epidemic processes of the European part of Russia, the proportion of the zoophilic fungus M.canis is 99%, the anthropophilic fungus M.ferrugineum - about 1%, the geophilic fungus M. gypseum - about 0.5%. At the same time, Mcanis is relatively evenly distributed throughout the Eurasian continent, M. audoinii accounts for a significant proportion in Central and Southern Europe, and M. ferrugineum is equally widespread in Siberia and the Far East.

Microsporia caused by M.canis is the dominant mycosis of smooth skin and scalp in childhood in Europe, USA and South American countries, Japan, Israel, Qatar, Kuwait, United Arab Emirates. This is a kind of cosmopolitan mushroom, according to the apt expression of one of the leading domestic mycologists, Ph.D. V.M. Rukavishnikova, practically the only causative agent of microsporia in the world, with the exception of African countries. Microsporia prevails in Europe, especially in the Mediterranean, USA and South America, Japan, Israel, Kuwait, Qatar, United Arab Emirates. Khmelnitsky, O.K. Pathomorphology of human mycoses / O.K. Khmelnitsky, N.M. Khmelnitskaya. - SPb.: SPb MALO, 2005, - S. 98.

Epidemiology of microsporia

Infection with anthropophilic fungi occurs through direct contact with a sick person, or indirectly, through household items (hats, combs, clothes, bedding, etc.). At present, anthroponotic microsporia is much less common than zoonotic, mainly in the Asian part of Russia and Siberia.

In Russia, the incidence of microsporia averages about 71.6 per 105 population. In Moscow and the Moscow region, it accounts for 96.2% of all dermatomycosis with hair lesions.

The main sources of human infection with zoophilic fungi are cats (80.5%), mostly strays, and especially kittens and dogs. Up to 80% of all infections occur through direct contact. Animals that rarely suffer from microsporia, but are a possible source of human infection, include monkeys, tigers, lions, wild and domestic pigs (especially piglets), horses, sheep, silver-black foxes, rabbits, rats, mice, hamsters, guinea pigs and other small rodents, as well as poultry.

Microsporia mainly (up to 65%) affects children, including children of the first year of life; while the incidence of the last year from year tends to slow but steady growth. Infection with a zoophilic fungus from person to person is possible, but it does not exceed 2-4%. Cases of infection of children after playing with sand (on the beach, in the sandbox) are also described. fungi of the genus Microsporum are extremely stable in the external environment.

Thus, most children (and adults) become infected through direct contact with a sick animal. Transmission of the microsporia pathogen from person to person is possible.

The main contingent - children aged 6-14 years. Adults make up 15-25% of patients, but this ratio did not always exist - in the 1970-80s, the proportion of adults among patients with microsporia was only 3-5%.

The peak incidence of microsporia in central Russia falls on August-October, when the epizootic reaches its peak among stray animals, cats and dogs, and children come into contact with them on vacation or already in the city.

Anthroponous microsporia, caused by a rusty microsporum, is transmitted mainly only from a sick person to a healthy person directly upon contact with him; indirect infection through care and household items is currently rare. This form of microsporia is more contagious than zoonotic. Currently, this mycosis is found relatively rarely in our country.

In recent years, patients with a chronic course of mycosis against the background of severe systemic lesions - lupus erythematosus, chronic glomerulonephritis, immunodeficiency states, and intoxications began to be registered. Rukavishnikova, V.M. Mycoses of the feet / V.M. Rukvishnikova - M.: EliksKom, 2003. - P.79

Pathogenesis

Microsporums have a tropism for structures containing keratin, affect animal hair, human skin and hair. Very rarely, unlike trichophytons, microsporums affect nails.

In the pathogenesis of microsporia, immune and non-immune resistance factors play a certain role. The factors of non-immune resistance include the composition and acidity of sebum, genetically determined features of the structure of the stratum corneum of the skin and hair. The immune factors of resistance include the cytokines of Langerhans cells, the phagocytic activity of macrophages, the antigen-presenting role of immunocompetent cells, etc. Phagocytosis is the main factor of immune resistance in any mycoses; it may not be completed in the presence of certain types of endocrine pathology in a patient (diabetes mellitus).

With mycoses of the skin, even infectious immunity is not resistant, and is expressed practically only in the presence of allergic sensitization in some patients to these fungi.

On smooth skin, M. canis tends to give a large number of small foci, and M. ferrugineum - 1-3 large ones. The rule of greater affinity of anthropophilic fungi for the acid-lipid and antigenic composition of human skin works here. On hairless skin, the acid-lipid composition is different, as a result of which the ratio of germination and sporulation processes also changes radically. It is known that zoophilic fungi in general cause more pronounced inflammatory phenomena than anthropophilic ones, but it does not at all follow that zoophilic fungi are less adapted to life in the human body than anthropophilic ones. The incubation period for zoonotic microsporia is 3-8 days, for anthroponotic - 4-6 weeks. Rukavishnikova, V.M. Mycoses of the feet / V.M. Rukvishnikova - M.: EliksKom, 2003. - P.81.