Ring-like Lesions On The Scalp Of a Newborn- Spot Diagnosis?

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Image Source: The New England Journal of Medicine

Can a newborn get a fungal infection within a week of birth?

A Somalian mother brought her 3-week-old newborn boy to the pediatrician with three large scalp lesions for the past 2 weeks. The lesion had first appeared during the first week of birth.

On examination of the scalp, the lesions were annular with falt, hyperkeratotic center surrounded by raised papular and pustular borders (Panel A).

On further questioning, the mother revealed that she had similar lesions on her upper trunk.

Scraping and swab were taken from the neonate’s scalp lesions. Culture on Sabouraud’s dextrose agar grew yellow-colored colonies with radiating hyphae (Panel B). Polymerase-chain-reaction (PCR) assays of extracted DNA identified trichophyton species, and DNA sequencing revealed Trichophyton soudanense.

 The baby was diagnosed with a fungal infection of the scalp, tinea capitis, commonly known as ringworm infection. Trichophyton soudanense is endemic in Africa and emerging in Europe, although it is rare in newborns.

Owing to the rarity of tinea capitis in neonates, there are no well-defined standard guidelines for treating affected neonates. The baby was started on intravenous fluconazole and topical clotrimazole and octenidine therapy.

At the 1-week-follow-up, they were seen to be resolving, but residual hyperpigmentation was noticed (Panel C). Oral fluconazole was given for an additional 2 weeks.

Tinea capitis is used to describe fungal infection of the scalp (capitis). Trichophyton is a genus of fungi that is responsible for causing tinea. Different species are found prevalent in different parts of the world. Trichophyton soudanense is prevalent in the sub-Saharan Africa region.

Tine capitis may present in a variety of ways, including dry dandruff-like scales, or a smooth area with hair loss, or black dots representing broken hair, or even like an abscess like mass called kerion.

In some cases, lymph nodes at the back of the head and neck are also seen swollen secondary to tinea capitis.

The diagnosis can be suspected on clinical evaluation, but for confirming the diagnosis, microscopic examination and the cultures of the scraping may be necessary. In some cases, even a biopsy may be required.

In cases where even one child is infected, it is advisable to screen all family members for signs of tinea capitis. The carriers may not exhibit clinical features of infection but to limit the spread, treatment of carriers is also necessary. All close contacts, including playmates and school mates, should also be examined for such lesions. Antifungal shampoo may be sufficient for treating contacts. Oral treatment will be required if the cultures come out to be positive.

References

Christian Fremerey, M. a. (2018, May 24). Tinea Capitis in a Newborn. Retrieved from The New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMicm1711862

Cox DR, Blank F. Tinea Capitis Due to Trichophyton soudanense. Arch Dermatol. 1977;113(11):1600. DOI:10.1001/archderm.1977.01640110120024

Nenoff P, Krüger C, Schulze I, et al. Tinea capitis and onychomycosis due to Trichophyton soudanense: Successful treatment with fluconazole-literature review. Hautarzt. 2018;69(9):737-750. DOI:10.1007/s00105-018-4155-0

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Dr. Arsia Parekh
Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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