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The predictive value of symptoms in diagnosing childhood tinea capitis
1Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, USA.
Insights
In children with suspected tinea capitis, adenopathy is a strong indicator of fungal infection. The absence of adenopathy and alopecia suggests a fungal infection is unlikely, improving diagnostic precision.
Area of Science:
- Pediatric Dermatology
- Mycology
- Infectious Diseases
Background:
- Tinea capitis is a common fungal infection of the scalp in children.
- Accurate diagnosis is crucial for effective treatment and preventing spread.
- Clinical signs and symptoms can vary, making diagnosis challenging.
Purpose of the Study:
- To identify the most predictive clinical signs and symptoms for positive fungal cultures in pediatric tinea capitis.
- To enhance diagnostic accuracy for fungal scalp infections in children.
Main Methods:
- A convenience survey was conducted in an urban hospital-based pediatric practice.
- 100 children with suspected tinea capitis (presenting with pruritus, scaling, alopecia, or adenopathy) were enrolled.
- Scalp fungal cultures were obtained, and clinical findings were correlated with culture results.
Main Results:
- 68% of children had positive fungal cultures.
- A significant relationship was found between the number of clinical signs/symptoms and positive fungal cultures (P<.001).
- Adenopathy (LR 7.5) and alopecia (LR 3.3) were strong predictors of positive fungal cultures. Children with both adenopathy and alopecia or scaling had high rates of positive cultures.
Conclusions:
- Adenopathy is a key indicator for fungal infections in suspected pediatric tinea capitis cases.
- The absence of both adenopathy and alopecia significantly reduces the likelihood of fungal infection.
- Clinical assessment of signs and symptoms aids in precise diagnosis and treatment of tinea capitis.
Objective:
To determine which sign, symptom, or combination thereof best predicts cultures positive for fungi in children with possible tinea capitis.
Design:
Convenience survey.
Setting:
Urban hospital-based general pediatric practice.
Patients:
Results were obtained on 100 consecutive children presenting with at least 1 sign or symptom (scalp pruritus, scaling, diffuse or circumscribed alopecia, or occipital adenopathy).
Intervention:
All enrolled children had samples for scalp cultures taken. Demographic information and clinical findings were verified by the author.
Main Outcome Measure:
Whether detected clinical findings can predict the outcome of fungal cultures.
Results:
Cultures positive for fungi were found in 68 children. There was a significant relationship (Fisher exact test; P<.001) between the number of signs and symptoms and a culture positive for fungi. Positive likelihood ratios were 7.5, 3.3, 1.4, and 1.1 for the presence of adenopathy, alopecia, pruritus, and scaling, respectively, for children with cultures positive for fungi. All children (n = 55) who presented with both adenopathy and alopecia and 60 of 62 children who presented with both adenopathy and scaling had cultures positive for fungi. No cultures positive for fungi were found in children without adenopathy and scaling; only 1 of 68 children without adenopathy and alopecia had a culture positive for fungi.
Conclusions:
In children who are suspected of having tinea capitis, there is a high likelihood of cultures positive for fungi in those with adenopathy. A fungal infection is rarely the cause when neither adenopathy nor alopecia is present. Attention to signs and symptoms in children with suspected tinea capitis can result in better diagnostic and treatment precision.