Volume 73 - Number 1 : Case Report
Microsporum gypseum infection in Aids patient: a case report
Infecção por Microsporum gypseum em paciente com aids:
relato de caso
Authorship
Nurimar C. Fernandes Fabrício Lamy
Tiyomi Akiti
Maria da Glória C. Barreiros
Abstract
Report of a case of tinea corporis caused by Microsporum gypseum in a 36-year-old female Aids patient. The literature does not refer this dermatophyte as a common etiologic agent in this group of patients.The lesions were generalized,psoriasiform and refractory to treatment with
ketoconazole and itraconazole.
Keywords: Dermatomycoses; Microsporum; acquired immunodeficiency syndrome; tinea
Resumo
Relato de caso de tinea corporis por Microsporum gypseum em paciente com Aids de 36 anos. Segundo a literatura, este dermatófito não é um agente comum neste grupo de pacientes. As lesões eram psoriasiformes, generalizadas e não responderam ao tratamento com cetoconazol e itraconazol.
Palavras-chave: Dermatomicose; Microsporum; síndrome de imunodeficiência adquirida; tinha INTRODUCTION
In the human immunodeficency virus (HIV) infected patient, dermatophytosis usually manifests as tinea pedis or unguium and the prevalent dermatophyte is Trichophyton rubrum.1,2 Tinea pedis infection in HIV positive persons is similar in appearance to the disease in non HIV-infected persons. The incidence of dermatophytosis of the glabrous skin in HIV-positive patients is about 40%.3 Tinea cruris is frequent in any stage of HIV infection.4 The most common isolated
dermatophytes are Trichophyton rubrum, Trichophyton mentographytes and Epidermophyton
floccosum. 5,6
infection due to Microsporum gypseum which failed to respond to the usual therapy. A 36 year-old white female, born in Rio de Janeiro and registered at Hospital Universitário
Clementino Fraga Filho. HIV-positive since 1992, developed red scaling patches on the face and thorax, in november 1995. Direct microscopy of skin scales revealed dermatophyte hyphae; culture was negative. The clinical picture did not respond to ketoconazole (200mg daily for two months) and itraconazole (100mg daily for one month). The lesions spread slowly and in July 1996 they became generalized; they were erythematous, scaling, circinate, large, irregular and psoriasiform (Figure 1, 2). The skin scrapings did not reveal dermatophytes.
Figure 1 - Large, irregular, scaling eruption on face and scalp
Microsporum gypseum was isolated on culture with the following specific features (Figure 3, 4): colonies with a flat, spreading powdery surface, cinnamon-buff to brown, scalloped and ragged edges. Microscopic morphology revealed septated hyphae and a great number of thin-walled and roughened macroconidia with 4 to 6 septa.
Figure 3 - Colony with a flat, spreading, powdery surface
Figure 4 - Microscopic morphology: septate byphae and macroconidia (400x)
By this time a severe pneumonia was not controlled and the patient died.
The prevalence of Microsporum gypseum in Rio de Janeiro makes clear that our patient is unusual not only for the psoriasiform eruption but also for the isolated dermatophyte ( Table 1).
DISCUSSION
Table 1 - Prevalence os Microsporum gypseum in Rio de Janeiro
Geophilic organisms are adapted for soil habitation. The fungi sporadically infect humans and when they do the resulting disease is usually inflammatory. Microsporum gypseum is the most common geophilic fungus isolated in human infections. Although soil isolates of Microsporum
gypseum are of low virulence, strains cultured from humans are more virulent and account for
epidemic spread of the infection under appropriate conditions.7 Human infection due to geophilic species often originates from infected animals; the infection by direct contact is not common.8 Microsporum gypseum causes tinea capitis and tinea corporis. Lesions are usually inflammatory, impetiginous and sometimes bullous with rapid development and resolution.8
Invasion of hair is of the ectothrix type and spores are sparsely arranged in chains. Microsporum
gypseum produces suppuration, kerion and favus-like crusts on the scalp.8 The infection is common in South America.
Penneys 9 described a HIV positive case with large plaques with silvery scales on the trunk: resembling psoriasis; Microsporum species were isolated. Bakos 10 described a favus like eruption on glabrous skin in a patient with Aids. Microsporum gypseum was isolated and the infection did not respond to oral ketoconazole.
Seventy-one cases of human dermatophytoses caused by Microsporum gypseum were diagnosed in the hinterland of Rio Grande do Sul (Brazil) during 1960- 1990.11
An outbreak by Microsporum gypseum was described in Brazil 12 although the human infections are usually sporadic.
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