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Asymptomatic dermatophyte carriers in the households of children with tinea capitis
A J Pomeranz1, S S Sabnis, G J McGrath
1Medical College of Wisconsin, Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, USA.
Insights
Asymptomatic carriage of scalp fungus (tinea capitis) was found in 16% of household contacts, with persistence up to two months. Treating these carriers may prevent spread and active infection.
Area of Science:
- Dermatology
- Infectious Diseases
- Public Health
Background:
- Tinea capitis is a common fungal infection of the scalp, particularly in children.
- Asymptomatic carriage of dermatophytes can contribute to the spread of tinea capitis within households.
- Understanding carrier states is crucial for effective control strategies.
Purpose of the Study:
- To determine the prevalence and duration of asymptomatic tinea capitis carriage in household contacts.
- To identify factors associated with fungal carriage.
- To assess the risk of carriers developing clinical disease.
Main Methods:
- A cross-sectional, cohort prevalence study was conducted.
- Household contacts of children diagnosed with tinea capitis were evaluated.
- Cultures were used to identify dermatophyte carriers (asymptomatic) and index cases, with carriers monitored for up to six months.
Main Results:
- The initial prevalence of asymptomatic carriage was 16% among household contacts, with 32% of families having at least one carrier.
- The carrier state persisted in 41% of individuals at two months.
- Only 7% of carriers developed active tinea capitis, and no significant associations were found with age, sex, comb sharing, or cosleeping due to sample size limitations.
Conclusions:
- A significant proportion of household contacts are asymptomatic carriers of tinea capitis, acting as potential reservoirs for infection.
- Consideration should be given to treating asymptomatic carriers, possibly with sporicidal shampoos, to reduce transmission.
- High rates of cosleeping and comb sharing suggest these behaviors may facilitate disease spread within families.
Objectives:
To determine the prevalence of the carrier state in household contacts in children with tinea capitis, the duration of the carrier state, factors associated with carriage, and the proportion of carriers who develop clinical disease.
Design:
Cross-sectional, cohort, prevalence study.
Setting:
General pediatric clinic serving an indigent, inner-city, African American population.
Patients:
Household contacts in children with tinea capitis. Index cases and carriers (no clinical evidence of infection) were identified by culture. Carriers were monitored until the results of their culture became negative, they developed clinical disease, or a 6-month period had elapsed.
Results:
Fifty-six index cases and 114 contacts (50 adults and 64 children) were evaluated. Ninety-eight percent of the dermatophytes identified in index cases and 100% in carriers were Trichophyton tonsurans. At the initial visit, 18 (16%) of 114 (95% confidence interval [95% CI], 10-24) of contacts were carriers and 14 (32%) of 44 of the families studied had at least 1 carrier. At the 2-, 4-, and 6-month visits, the carrier state persisted in 7 (41%) of 17 (95% CI, 19-67), 3 (20%) of 15 (95% CI, 4-48), and 2 (13%) of 15 (95% CI, 2-40), respectively. Three of the carriers were lost to follow-up. Of the carriers, 1 (7%) of 15 (95% CI, 0.2-32) developed tinea capitis. Univariate and multivariate analysis showed no association of carrier state to age, sex, comb sharing, or cosleeping. However, cosleeping and comb sharing were common among the contacts, occurring 75% and 78% of the time, respectively, making statistical correlation difficult with our sample size.
Conclusions:
Initial prevalence of asymptomatic carriage of dermatophytes among household contacts of a child with tinea capitis was 16%, with 41% of carriers persisting up to 2 months. Thirty-two percent of families had at least 1 member who was a carrier. Seven percent of the carriers developed an active infection. Treatment of carriers with sporicidal shampoo should be considered since they may act as a reservoir for infection or develop active disease. The high prevalence of cosleeping and comb sharing may be important factors in the spread of the disease.
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