https://onlinelibrary.wiley.com/doi/10.1111/jdv.19874

 

Acute inflammatory tinea manuum caused by Nannizzia gypsea transmitted by an Africa pigmy hedgehog 

 

Authors and affiliations:

Malena Gergovska¹, Mariela Hitova¹, Karen Manuelyan³, Jana Kazandjieva^1,2

¹Dermatology Clinic EuroDerma – Sofia, Bulgaria

²Department of Dermatology and Venereology, Medical University – Sofia, Bulgaria

³Department of Dermatology and Venereology, Medical Faculty, Trakia University and UMHAT “Prof. Dr. St. Kirkovich”, Stara Zagora, Bulgaria

 

Running head: Dermatophyte infection caused by Nannizzia gypsea

Acknowledgements: none

Conflict of interests: none

Funding and relationship to industry: none

This paper contains 586 words, 2 figures, 0 tables, and 5 references

 

Corresponding author: Malena Gergovska, MD, PhD

Dermatology Clinic EuroDerma - Sofia

Sofia, Bulgaria
4 P. Slavejkov Boul.
1431 Sofia, Bulgaria

Email: malena_t@abv.bg

 

Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Ethics: The patients in this manuscript have given written informed consent to the publication of their case details.

 

Fungal skin infections are among the most frequently encountered conditions in routine dermatological practice. The clinical presentation is typically distinctive and the diagnosis relatively straightforward. Instances with atypical clinical manifestations can pose diagnostic challenges.

 

We present a rare case of a 35-year-old female patient with tinea manuum caused by an Nannizzia gypsea (formerly  Microsporum gypseum).[1] The patient had complained of persistent itching and a rash of three months' duration. She presented with marked erythema and grouped pustules on her entire left-hand fourth finger, excluding the fingertip. (Fig. 1) The affected skin had a relatively sharply demarcated edge on the dorsum of the finger and less clear proximally.

 

Herpes simplex infection (herpetic whitlow) and bacterial infection were considered as differential diagnoses, but the clinical picture exhibited a remarkable similarity to a case, previously seen and published by our team [2], of a dermatophyte infection with Nannizzia gypsea, transmitted by an African pygmy hedgehog. Inquiry disclosed that our new patient had also owned an African pygmy hedgehog (genus Atelerix albiventris) as a pet. When the patient's symptoms had initially manifested, she had replaced the hedgehog with a ferret.

 

Primary microscopic preparation stained with black chlorazole demonstrated septate hyphae with fusiform macroconidia. Scales from the peripheral zone of the lesion were sampled on a day of examination on Sabouraud-chloramphenicol agar petri and after 10 days of incubation at 27 °C macroscopic examination of the primary culture showed  flat, powdery, cinnamon-colored colonies (Fig. 2). Microscopic examination of the culture colonies coloured by black chlorazole showed a number of large, thin-walled, verrucose with 4-6 septations macroconidia  , suggestive of N. gypsea. 

 

PCR for herpes simplex was negative and the microbiological swabs showed no significant bacterial growth.

 

The patient started treatment with systemic Terbinafine 250 mg  daily for 14 days plus topical miconazole nitrate/hydrocortisone. The treatment led to marked improvement. We could not trace the new owner of the hedgehog.

 

The four-toed African pygmy hedgehog, also known as Atelerix albiventris, is an insectivorous hedgehog species native to central and eastern Africa. Both the African pygmy hedgehog [3],[4] and the European wild hedgehog can transmit pathogenic fungi to humans, leading to dermatophytosis. Nannizzia gypsea is a worldwide geophilic fungus rarely responsible for human infections with an affinity for upper dermal layers. [1] Common  clinical manifestations of glabrous skin infections caused by N. gypsea are the classic ringworm but recognition of rarer manifestations is important.

 

Our diagnosis was based on our experience with another patient [2], who owned a pygmy hedgehog, with a very similar clinical presentation. Two things seem to be very characteristic in these dermatophytic infections. First, only one finger is affected because the pet owners use it to pet the hedgehog, which is small and difficult to caress with the whole hand. Second, the clinical picture is characterized by atypical pustular and vesiculo-bullous changes, resembling bacterial infection, herpetic whitlow, or dyshidrosis.

 

With the increasing popularity of keeping hedgehogs as pets, there is a significant risk of transmitting parasitic or infectious agents from these pets to their owners. In recent years, hedgehogs have been predominantly sold through online shops, often lacking detailed information about their health status and origin. This contributes significantly to the spread of various zoonotic diseases through direct contact with hedgehogs, their waste, or their food and excrements.[5] Timely diagnosis of dermatophyte infections in pets is crucial to prevent them from spreading to their owners. A detailed history can point the clinician to the correct diagnosis.

 

 

Figures:

Fig. 1. Erythematous rash with multiple pustules, covering all the phalanges of the fourth finger of the left hand.

Fig. 2: Culture on Sabouraud agar petri after 10 days shows flat, powdery, buff colored colonies, confirmative of Nannizzia gypsea.

  

References:

1. de Hoog G.S., Dukik K., Monod M., Packeu A., Stubbe D., Hendrickx M. Toward a novel multilocus phylogenetic taxonomy for the dermatophytes. Mycopathologia. 2017; 182:5–31]
2. Gergovska M, Manuelyan K, Hitova M, Kazandjieva J. Dermatophyte infection transmitted by an African pygmy hedgehog. Int J Dermatol. 2021 ;60(8):1036-1037. 
3. Krawczyk, A., van Leeuwen, A., Jacobs-Reitsma, W. Presence of zoonotic agents in engorged ticks and hedgehog faeces from Erinaceus europaeus in (sub) urban areas. Parasites Vectors. 2015; 8: 210
4. Ruszkowski J, Hetman M, Turlewicz-Podbielska H, Pomorska-Mól M. Hedgehogs as a Potential Source of Zoonotic Pathogens—A Review and an Update of Knowledge. Animals 2021, 11(6), 1754 
5. Weitzman I, R C Summerbell. The dermatophytes. Clin Microbiol Rev. 1995; 8(2):240-259