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Questions Answered: 215

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148
67

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Microbiology

Pathogens

Question 115 of 215

A 16 year old girl is brought to ED with an itchy scaly rash on her arm shown below. Which of the following is the most likely infective agent:

By Grook Da Oger (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY-SA 3.0 , via Wikimedia Commons

(Image by Grook Da Oger (Own work) [CC BY-SA 3.0 , via Wikimedia Commons)

Answer:

The patient most likely has tinea corporis (ringworm), caused by dermatophytes. Three genera of filamentous fungi are implicated in dermatophytosis: Epidermophyton spp., Microsporum spp. and Trichophyton spp..

Dermatophytes

Microbiology / Pathogens / Yeasts and Fungi

Last Updated: 21st April 2019

Three genera of filamentous fungi are implicated in dermatophytosis: Epidermophyton spp., Microsporum spp. and Trichophyton spp..

Transmission

Dermatophyte infection is spread via close personal contact.

Clinical Features

It may occur on the head and scalp (tinea capitis), body (tinea corporis) and feet (tinea pedis).

Ringworm typically presents as itchy, red, scaly, patch-like lesions that spread outwards, leaving a pale centre.

Chronic nail infection produces discolouration and nail thickening.

Scalp infection is often associated with hair loss and scarring.

Diagnosis

Diagnosis is often clinical and does not require laboratory confirmation. The scalp may demonstrate a characteristic fluorescence when examined under Wood's light dependent on the infecting fungal species.

If laboratory confirmation is required (e.g. if diagnosis is unclear, if infection has not responded to treatment or if oral antifungals are being considered) skin scrapings, nail clippings and hair samples should be collected as appropriate. Diagnosis may be made by direct microscope examination of wet mounts or by culture.

Treatment

Treatment is usually topical with imidazole antifungals (e.g. miconazole, clotrimazole or ketoconazole) but if severe or refractory may require oral terbinafine for several weeks.

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l
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