Jactatio capitis nocturna with persistence in adulthood. Case report.
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B):655-7.Jactatio capitis nocturna with persistence in adulthood. Case report.1, , , .1Centro de Estudos do Sono (CES) do Hospital das Clínicas (HC) da Faculdade de Medicina, Universidade de S?o Paulo (FMUSP), Brasil. rosalves@usp.brAbstractRhythmic movement disorder, also known as jactatio capitis nocturna, is an infancy and childhood sleep-related disorder characterized by repetitive movements occurring immediately prior to sleep onset and sustained into light sleep. We report a 19-year-old man with a history of headbanging and repetitive bodyrocking since infancy, occurring on a daily basis at sleep onset. He was born a premature baby but psychomotor milestones were unremarkable. Physical and neurological diagnostic workups were unremarkable. A hospital-based sleep study showed: total sleep time: 178 sleep efficiency index 35.8; sleep latency 65 REM latency 189 min. There were no respiratory events and head movements occurred at 4/min during wakefulness, stages 1 and 2 NREM sleep. No tonic or phasic electromyographic abnormalities were recorded during REM sleep. A clinical diagnosis of rhythmic movement disorder was performed on the basis of the clinical and sleep studies data. Clonazepam (0.5 mg/day) and midazolam (15 mg/day) yielded no clinical improvement. Imipramine (10 mg/day) produced good clinical outcome. In summary, we report a RMD case with atypical clinical and therapeutical features.PMID: 9850765
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External link. Please review our .The rise and fall of fluorescent tinea capitis.
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):127-33.The rise and fall of fluorescent tinea capitis..AbstractThe epidemiology of tinea capitis has had a remarkable change in the past 20 years. It is important for physicians to realize that most tinea capitis in the United States is caused by Trichophyton tonsurans and that these lesions cannot be diagnosed by the Wood's lamp. Trichophyton tonsurans tinea capitis is frequently misdiagnosed because the lesions mimic such common scalp conditions as dandruff and seborrhea. Further, this organism can cause chronic tinea capitis in women that may become a infectious reservoir for other family members. A negative potassium hydroxide preparation will not rule out infection with T tonsurans and cultures are necessary. Scalp lesions in children should be considered tinea capitis until culturally proved otherwise.PMID: 6680181
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):138-48.Tinea capitis in Iraq: laboratory results.1, .1Department of Community Medicine, Tikrit University College of Medicine, Tikrit, Iraq.AbstractA school survey of 4461 primary-school children was carried out in which 204 cases of tinea capitis were clinically diagnosed. All cases were cultured and examined microscopically in order to compare the validity of the two methods. Microscopy detected 92 positive cases (45.1%), whereas culture detected 105 cases (51.4%). We also isolated and identified the species causing tinea capitis in our sample. These included Trichophyton verrucosum (38 cases), T. rubrum (22 cases), T. mentagrophytes var. mentagrophytes (12 cases) and T. tonsurans (11 cases). Our results are compared with other studies.PMID:
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Tinea capitis (also known as "Herpes tonsurans", "Ringworm of the hair," "Ringworm of the scalp," "Scalp ringworm", and "Tinea tonsurans") is a cutaneous
() of the . The disease is primarily caused by
genera that invade the hair shaft. The clinical presentation is typically single or multiple patches of hair loss, sometimes with a 'black dot' pattern (often with broken-off hairs), that may be accompanied by inflammation, scaling, pustules, and itching. Uncommon in adults, tinea capitis is predominantly seen in pre- children, more often boys than girls.
At least eight species of dermatophytes are associated with tinea capitis. Cases of Trichophyton infection predominate from Central America to the United States and in parts of Western Europe. Infections from Microsporum species are mainly in South America, Southern and Central Europe, Africa and the Middle East. The disease is infectious and can be transmitted by humans, animals, or objects that harbor the fungus. The fungus can also exist in a carrier state on the scalp, without clinical symptomatology. Treatment of tinea capit
is the most commonly used drug, but other newer antimycotic drugs, such as , , and
have started to gain acceptance.
It may appear as thickened, scaly, and sometimes boggy swellings, or as expanding raised red rings (). Common symptoms are severe
of the scalp, , and
patches where the fungus has rooted itself in the skin. It often presents identically to dandruff or seborrheic dermatitis. The highest incidence in the United States of America is in American boys of school age.
There are three type of tinea capitis, , , these are based on the causative microorganism, and the nature of the symptoms. In microsporosis, the lesion is a small red
around a hair shaft that eventually the hairs break off 1–3 mm above the scalp. This disease used to be caused primarily by , but in Europe, M. canis is more frequently the causative fungus. The source of this fungus is typically s it may be spread through person to person contact, or by sharing contaminated brushes and combs. In the United States, Trichophytosis is usually caused by , while T. violaceum is more common in Eastern Europe, Africa, and India. This fungus causes dry, non-inflammatory patches that tend to be angular in shape. When the hairs break off at the opening of the , black dots remain. Favus is caused by T. schoenleinii, and is endemic in South Africa and the Middle East. It is characterized by a number of yellowish, circular, cup-shaped crusts () grouped in patches like a piece of honeycomb, each about the size of a split pea, with a hair projecting in the center. These increase in size and become crusted over, so that the characteristic lesion can only be seen around the edge of the scab.
Tiniea capitis may be difficult to distinguish from other skin diseases that cause scaling, the basis for the diagnosis is positive microscopic examination and microbial culture of epilated hairs.
examination will reveal bright green to yellow-green fluorescence of hairs infected by M. canis, M. audouinii, M. rivalieri, and M. ferrugineum and a dull green or blue-white color of hairs infected by T. schoenleinii. Individuals with M. canis infection
will show characteristic small comma hairs. Histopathology of scalp biopsy shows fungi sparsely distributed in the stratum corneum and hyphae extending down the hair follicle, placed on the surface of the hair shaft. These findings are occasionally associated with inflammatory tissue reaction in the local tissue.
The treatment of choice by dermatologists is a safe and inexpensive oral medication, , a secondary metabolite of the fungus Penicillium griseofulvin. This compound is fungistatic (inhibiting the growth or reproduction of fungi) and works by affecting the
system of fungi, interfering with the
and cytoplasmic . The recommended pediatric dosage is 10 mg/kg/day for 6–8 weeks, although this may be increased to 20 mg/kg/d for those infected by T. tonsurans, or those who fail to respond to the initial 6 weeks of treatment. Unlike other fungal skin infections that may be treated with
therapies like creams applied directly to the afflicted area, griseofulvin must be taken or this allows the drug to penetrate the hair shaft where the fungus lives. The effective therapy rate of this treatment is generally high, in the range of 88–100%. Other oral antifungal treatments for tinea capitis also frequently reported in the literature include , , these drugs have the advantage of shorter treatment durations than griseofulvin. However, concern has been raised about the possibility of rare side effects like
or interacti furthermore, the newer drug treatments tend to be more expensive than griseofulvin.
On September 28, 2007, the
stated that
( hydrochloride, by ) is a new
approved for use by
aged 4 years and older. The
can be sprinkled on a child's food to treat the infection. Lamisil carries hepatotoxic risk, and can cause a metallic taste in the mouth.
From the site of inoculation, the fungus grows down into the , where it invades keratin. Dermatophytes are unique in that they produce keratinase, which enables them to use keratin as a nutrient source. Infected hairs become brittle, and after three weeks, the clinical presentation of broken hairs is evident.
There are three types of infection:
Ectothrix: Characterized by the growth of fungal spores () on the exterior of the hair shaft.  Infected hairs usually fluoresce greenish-yellow under a . Associated with , , , and .
Endothrix: Similar to ectothrix, but characterized by arthroconidia restricted to the hair shaft, and restricted to anthropophilic bacteria.  The cuticle of the hair remains intact and clinically this type does not have florescence.  Associated with
and , which are anthropophilic.
Favus: Causes crusting on the surface of the skin, combined with hair loss.  Associated with .
Tinea capitis caused by species of
is a contagious disease that is
in many countries. Affecting primarily pre- children between 6 and 10 years, it is more common i rarely does the disease persist past age sixteen. Because spread is thought to occur through direct contact with afflicted individuals, large outbreaks have been known to occur in schools and other places where children a however, indirect spread through contamination with infected objects () may also be a factor in the spread of infection. In the USA, tinea capitis is thought to occur in 3-8% of the
up to one-third of households with contact with an infected person may harbor the disease without showing any symptoms.
The fungal species responsible for causing tinea capitis vary according to the geographical region, and may also change over time. For example,
was the predominant
agent in North America and Europe until the 1950s, but now
is more common in the USA, and becoming more common in Europe and the United Kingdom. This shift is thought to be due to the widespread use of griseofulvin, which is more effective against M. audounii than T. tonsurans; also, changes in immigration patterns and increases in international travel have likely spread T. tonsurans to new areas. Another fungal species that has increased in prevalence is , especially in urban populations of the United Kingdom and Europe.
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Tinea capitis is a fungal infection of the scalp. It is also called
of the scalp.Related skin infections may be found:In a man's beardIn the groin (jock itch)Between the toes (athlete's foot)
Fungi are germs that can live on the dead tissue of the hair, nails, and outer skin layers. Tinea capitis is caused by mold-like fungi called dermatophytes.The fungi grow well in warm, moist areas. A tinea infection is more likely if you: Have minor skin or scalp injuriesDo not bathe or wash your hair oftenHave wet skin for a long time (such as from sweating)Tinea capitis or ringworm can spread easily. It most often affects children and goes away at puberty. However, it can occur at any age.You can catch tinea capitis if you come into direct contact with an area of ringworm on someone else's body. You can also get it if you touch items such as combs, hats, or clothing that have been used by someone with ringworm. The infection can also be spread by pets, particularly cats.
Tinea capitis may involve only parts of the scalp, or all of it. Areas that are infected appear bald with small black dots, due to hair that has broken off.You may have round, scaly areas of skin that are red or swollen (inflamed). You may also have pus-filled sores called kerions.You may have a low-grade fever of around 100 - 101 ?°F or swollen lymph nodes in the neck.There is almost always
of the scalp.Tinea capitis may cause hair loss and lasting scars.
Your health care provider will look at your scalp for signs of
tinea capitis. A special lamp called a
test can help diagnose a fungal scalp infection.The health care provider may swab the area and send it for a culture. It may take up to 3 weeks to get these results.Rarely, a
of the scalp will be done.
The health care provider will prescribe medicine you take by mouth to treat ringworm in the scalp.Griseofulvin, terbinafine, and itraconazole are the types of medicine used to treat this condition.You will need to take the medicine for 4 - 8 weeks.Steps you can do at home include:Keep the area clean. Wash with a medicated shampoo, such as one that contains ketoconazole or selenium sulfide. Shampooing may slow or stop the spread of infection, but does not get rid of ringworm on its own.
Other family members and pets should be examined and treated, if necessary.Other children in the home may want to use the shampoo 2 - 3 times a week for around 6 weeks.Adults only need to wash with the shampoo if they have signs of tinea capitis or ringworm.Once the shampoo has been started:Wash towels in warm, soapy water and dry each time they are used by someone who is infectedSoak combs and brushes for 1 hour a day in a mixture of one-half bleach and one-half water. Do this for 3 days.No one in the home should share combs, hairbrushes, hats, towels, pillowcases, or helmets with other people.
It may be hard to get rid of tinea capitis. Also, the problem may come back after it is treated. In many cases it gets better
on its own after puberty.
Call your health care provider if you have symptoms of tinea capitis. Home care is not enough to get rid of tinea capitis.
Fungal infection - Infection - fungal - T Ringworm - scalp
Elewski BE, Hughey LC, Sobera JO, et al. Fungal Diseases. In: Bolognia JL, Jorizzo JL, Schaffer JV, et al, eds.DermatologyHay RJ. Dermatophytosis and other superficial mycoses. In: Mandell GL, Bennett JE, Dolin R, eds.Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases
Updated by: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.