Rigworm of the Scalp in Adults Caused by Trichophytonof the Scalp in Adults Caused by Trichophyton

Abstract

In the litterature of the subject, the incidence of the ringworm of the scalp in adults is held to be infrequent. The relevant descriptions until now have mainly been concerned with sporadic cases and summarized reports on the instances recorded.

Our investigations were carried out in the north-eastem part of Bosnia, an area where the disease is endemic and widespread. A systematic examination was made of the entire population of the region. As a result, of a total of 117,350 people subjected to a thorough examination 3,026 individuals were found to be affected with the ringworm of the scalp. The diagnosis was based on the chinical picture which was regularly checked up by means of microscope findings in a 20%. Potassium hyroxide preparation, and frequently by cultures on Sabouraud’s medium of maltose agar.

Thanks to the above systematic examinations we have succeeded in establishing the fact that among a population where the children are found to be affected with the ringvvorm of the scalp caused by Trichophyton, analogous affections constantly occur in the adults as well.

Influence of age is shown on the basis of data collected in one of the systematically examined districts. In the 16—20 year group 34.8% of the people proved affected with the disease, compared with 17°/oo in the group 20 and over. In some of the restricted areas (Koraj) the rate of incidence of the disease in the 16 and over group was found to be 36% of the total number of those affected by it.

Analogous condition subject to certain fluctuations of morbidity-dependent on đuration of the epidemic, intensity of the exposure and size of the parasite reservoir — was also found in the other systematically examined regions.

Evidently, our data go to show that the incidence of the ringworm of the scalp in adults caused by Trichophyton represents a most significant clinical and epidemiologic fact which can hardly be termed, in the classical sense, a rare and exceptional phenomenon.

Besides the permaneiit occurence of thle ringworm of the scalp in adults in the endemic areas, the existence of a constant sex ratio in people infected with the disease after puberty came to be recognised as well. Up to the age of puberty no such distinction could be established in the systematically examined population, whereas after the age of puberty the sex ratio was found to be constant.

In the 16—20 year group 71 p.c. of those affected with the disease were women; the rate, however, rose up to 99 p.c. in the higher age groups. This law governing the spread of the disease, wich appears to be of very great singigficance for the pathogenesis of the ringworm of the scalp caused by Trichoplyton, was found to prevail uniformly in the whole area.

As regards the spread of the disease in so far as individual members of families are concerned, the results showed that there was one infected member each in 58 p.c. of families affected by the disease, and two, three, four, and five or more infected members in 24,5%, 10,3%, 4,7%, and 1,6% of families respectively.

Further analyses concerning the relationship between the affected family members disclosed the fact that in 69.3 p.c. of the families only the childern were infected; in 16,4 p.c. ot he families both children and mother had the disease; in 13.8 p.c. of the families only the mother, and in 0.5% only the father was infected.

The relatively high percentage of families where the mother was infecten only, suggests that the infection found in adults originates, as a rule, from the one occuring in childhood. Moreaver, this fact indicates that in a family where both mother and children are afflicted, it is the mother that should be regarded as the primary source of infection rather than the children.

Clinical and subjetive symptoms of the ringworm of the scalp caused by Trichophyton are as a rule much less pronounced in adults than in children up to the age of puberty. Hence the infection often passes unnoticed, the anamnesis data frequently being negative. Neither the appearance of infected hairs nor their microscopic pictures were such as to enable us to differentiate between those of a child with strongly marked changes and those of an adult showing only slight signs of the disease. Nor could we observe any difference in morphological appearance of a culture of the same kind of Trichophyton in Sabouraud’s medium of maltose agar to enable us to conclude whether the culture had been isolated from a child or an adult. The same holds good in respect of the microscopic morphology of the culture. Guinea-pigs cutaneous inoculated with infected material equally failed to give any indication of whether the culture (Trichophyton violaceum. Trich.ophyton gypseum) originated from the scalp of a child or of an adult.

These investigations go to show that it is not the changes in virulence of pathogenetic fungi nor any specific kind of trichophyton rigworm particularly pathogenetic in adults that we are concerned with here; it is rather the insufficiently developed local resistance of the scalp to the infection.

As regards the fungi isolated from the scalps of adults in our material, by far the most frequent was found to be the Trichophyton violaceum (91.7%), the rest consisting largely of the Trichophyton gypseum. The same species were found and isolated in people infected before puberty, which might lead to the conclusion that the kind of ringworm met with in adults corresponds to the one found in children from the given area. The age limit for the occurrence of the disease in adults could not be determined, the oldest woman found infected being in the eighties.

A complete explanation of the occurrence of the disease in adults has not been found as yet; it is probable however that it may be due to lack of resistance to infection brought about owing to disfunction of adrogenous hormones, which is capable of showing itself in a direct way or othervvise. Our investigations to this effect are still going on, and the results are to be published later.