Dermatology Department, Sheba Medical Center, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
BMC Pediatr. 2021 Aug 26;21(1):363. doi: 10.1186/s12887-021-02813-x.
Tinea capitis is a common cutaneous infection of the scalp and hair follicles, typically diagnosed by direct examination and culture. Treatment with oral antifungals is usually withheld until mycology results are available. In Israel, African refugee children demonstrate higher susceptibility to Tinea capitis and generally fail to undergo follow-up evaluations.
This study aimed to identify the clinical characteristics and treatment responses of refugee children in Israel with Tinea capitis, in order to formulate a treatment plan for primary care physicians. To this end, demographic, clinical and laboratory data were extracted from the electronic medical records of 76 refugee children presenting with Tinea capitis during 2016-2017. All measured variables and derived parameters are presented using descriptive statistics. The correlation between background clinical and demographic data and Tinea capitis diagnosis was assessed using the chi-squared and Wilcoxon tests. Correlations between demographic/clinical/laboratory characteristics and other types of fungi or other important findings were assessed using a T-test.
Scaling was the most common clinical finding. Cultures were positive in 64 (84%) and direct examination in 65 (85%) cases, with a positive correlation between the methods in 75% of cases. The most common fungal strain was T. violaceum. Fluconazole treatment failed in 27% of cases. Griseofulvin 50 mg/kg/day was administered to 74 (97%) children, and induced clinical responses. No side effects were reported.
The key aim of this study was to emphasize the importance of diagnosis and treatment of these immigrant children by their primary pediatric doctor since it takes, an average of 4.3 months until they visit a dermatologist. During this critical time period, the scalp can become severely and permanently damaged, and the infection can become systemic or cause an outbreak within the entire community. In conclusion, we recommend to relate to scaly scalp in high-risk populations as Tinea capitis, and to treat with griseofulvin at a dosage of up to 50 mg/kg/day, starting from the first presentation to the pediatrician.
头癣是一种常见的头皮和毛囊真菌感染，通常通过直接检查和培养来诊断。在获得真菌学结果之前，通常会避免使用口服抗真菌药物。在以色列，非洲难民儿童对头癣的易感性更高，而且通常不会进行随访评估。
本研究旨在确定在以色列的难民儿童中头癣的临床特征和治疗反应，以便为初级保健医生制定治疗计划。为此，从 2016 年至 2017 年期间因头癣就诊的 76 名难民儿童的电子病历中提取了人口统计学、临床和实验室数据。所有测量变量和衍生参数均采用描述性统计进行呈现。使用卡方检验和 Wilcoxon 检验评估背景临床和人口统计学数据与头癣诊断之间的相关性。使用 T 检验评估人口统计学/临床/实验室特征与其他类型真菌或其他重要发现之间的相关性。
鳞屑是最常见的临床发现。培养物阳性率为 64 例（84%），直接检查阳性率为 65 例（85%），两种方法的阳性相关性为 75%。最常见的真菌株是 T. violaceum。氟康唑治疗失败率为 27%。74 例（97%）儿童给予 50mg/kg/天的灰黄霉素治疗，诱导临床反应。未报告任何副作用。
本研究的主要目的是强调初级儿科医生诊断和治疗这些移民儿童的重要性，因为他们平均需要 4.3 个月的时间才能看皮肤科医生。在这个关键时期，头皮可能会严重且永久性受损，感染可能会变得全身性或在整个社区内爆发。总之，我们建议将高危人群的鳞屑性头皮视为头癣，并使用高达 50mg/kg/天的灰黄霉素进行治疗，从儿科医生的首次就诊开始。
