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Tinea caused by Lophophyton gallinae

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Overview

Tinea caused by Lophophyton gallinae is a fungal dermatophytosis primarily affecting birds, particularly poultry and pet birds, but can occasionally be encountered in zoonotic contexts involving humans. This condition manifests as superficial skin infections, often leading to alopecia, scaling, and pruritus. Clinicians should be vigilant, especially in settings with close contact between humans and infected birds, as zoonotic transmission is possible though rare. Early recognition and intervention are crucial to prevent complications and manage symptoms effectively in both avian and human patients 1.

Pathophysiology

The pathophysiology of Lophophyton gallinae infection involves the invasion of keratinized tissues by the fungus, which thrives in warm, moist environments typical of avian skin and feathers. At the cellular level, the fungus disrupts the epidermal barrier integrity, leading to inflammation and subsequent clinical manifestations such as scaling and hair loss. The fungal hyphae penetrate the stratum corneum, utilizing keratin as a nutrient source, which can trigger an immune response characterized by inflammatory cell infiltration. This interaction disrupts normal keratinocyte proliferation and differentiation, contributing to the characteristic lesions observed clinically 1.

Epidemiology

Lophophyton gallinae infections are predominantly reported in avian populations, particularly in commercial poultry farms and pet bird collections. While human cases are infrequent, they can occur in individuals with prolonged exposure to infected birds, such as veterinarians, bird handlers, and pet owners. No specific age or sex predilection has been noted in human cases, but the risk is heightened in environments where close contact with birds is frequent. Epidemiological trends suggest an increase in reported cases coinciding with heightened awareness and improved diagnostic capabilities, though precise incidence rates remain underreported 1.

Clinical Presentation

In avian hosts, Lophophyton gallinae typically presents with circular, scaly patches on the skin and feather loss, often localized around the head, face, and vent regions. In humans, clinical presentations can mimic other dermatophytoses, featuring pruritic, scaly patches that may involve the scalp, face, and extremities. Red-flag features include rapid progression of lesions, systemic symptoms (indicative of disseminated infection), and failure to respond to initial antifungal therapy, which should prompt immediate reevaluation and further diagnostic testing 1.

Diagnosis

Diagnosis of Lophophyton gallinae infection involves a combination of clinical evaluation and laboratory confirmation. Key diagnostic steps include:

  • Clinical Assessment: History of exposure to infected birds and characteristic skin lesions.
  • Microscopic Examination: Direct microscopy of skin scrapings or hair samples using potassium hydroxide (KOH) preparation to identify fungal elements.
  • Culture: Fungal culture on Sabouraud dextrose agar with appropriate incubation conditions (30°C) to isolate and identify Lophophyton gallinae.
  • PCR Testing: Molecular methods such as PCR can provide rapid and specific identification, particularly useful in confirming species-specific diagnosis.
  • Specific Criteria and Tests:

  • KOH Preparation: Presence of septate hyphae with occasional arthroconidia.
  • Culture: Colonies typically grow within 10-14 days, showing characteristic morphology.
  • PCR: Positive amplification of Lophophyton-specific DNA sequences.
  • Differential Diagnosis:

  • Other Dermatophytoses: Distinguish by species-specific morphology on culture or PCR.
  • Contact Dermatitis: History of exposure and lack of fungal elements on KOH.
  • Psoriasis: Scaly plaques without fungal elements and characteristic histopathological features.
  • Management

    First-Line Treatment

  • Topical Antifungals: Terbinafine 1% cream or solution applied twice daily for 4-6 weeks.
  • Systemic Therapy: For extensive or refractory cases, oral terbinafine 250 mg daily for 4-6 weeks.
  • Specifics:

  • Terbinafine:
  • - Dose: Topical 1% cream/solution bid; oral 250 mg daily. - Duration: 4-6 weeks. - Monitoring: Clinical response, liver function tests (especially with oral therapy).

    Second-Line Treatment

  • Alternative Oral Agents: Fluconazole 50-100 mg daily for 4-6 weeks if terbinafine is contraindicated or ineffective.
  • Combination Therapy: In severe cases, consider combining topical and systemic antifungals under specialist guidance.
  • Specifics:

  • Fluconazole:
  • - Dose: 50-100 mg daily. - Duration: 4-6 weeks. - Monitoring: Renal function, complete blood count.

    Refractory Cases

  • Consultation: Dermatologist or infectious disease specialist.
  • Advanced Therapies: Itraconazole or other triazole antifungals, tailored based on resistance patterns and clinical response.
  • Specifics:

  • Itraconazole:
  • - Dose: 200 mg daily. - Duration: As per specialist recommendation. - Monitoring: Liver function tests, drug interactions.

    Complications

  • Chronic Infections: Persistent lesions leading to scarring and significant discomfort.
  • Secondary Infections: Bacterial superinfections requiring antibiotics.
  • Zoonotic Spread: Potential for transmission to humans, especially in high-risk occupational settings.
  • Management Triggers:

  • Persistent Lesions: Reassessment and possible change in antifungal therapy.
  • Systemic Symptoms: Consider broader differential diagnosis and referral.
  • Prognosis & Follow-Up

    The prognosis for both avian and human cases is generally good with appropriate antifungal therapy. Prognostic indicators include early diagnosis, adherence to treatment regimens, and absence of underlying immunosuppression. Follow-up intervals typically involve clinical reassessment at 2-4 weeks post-treatment initiation, with resolution of symptoms usually observed within 4-6 weeks. Long-term monitoring is recommended in cases of recurrent infections or persistent exposure risks 1.

    Special Populations

  • Pregnancy: Limited data; topical treatments are preferred over systemic agents due to potential teratogenic risks.
  • Pediatrics: Similar management principles apply, with emphasis on gentle topical formulations and close monitoring for adverse effects.
  • Elderly: Increased vigilance for drug interactions and renal/hepatic impairment when prescribing systemic antifungals.
  • Key Recommendations

  • Diagnose via KOH preparation and fungal culture to confirm Lophophyton gallinae infection (Evidence: Strong 1).
  • Initiate treatment with topical terbinafine for localized infections (Evidence: Moderate 1).
  • Consider oral terbinafine for extensive or refractory cases (Evidence: Moderate 1).
  • Monitor liver function tests during systemic antifungal therapy (Evidence: Moderate 1).
  • Refer refractory cases to a dermatologist or infectious disease specialist (Evidence: Expert opinion).
  • Advise strict hygiene practices in environments with high bird contact to prevent zoonotic transmission (Evidence: Expert opinion).
  • Evaluate for secondary bacterial infections in cases with worsening symptoms (Evidence: Moderate 1).
  • Ensure follow-up assessments at 2-4 weeks post-treatment to monitor response (Evidence: Moderate 1).
  • Avoid systemic antifungals in pregnant women unless absolutely necessary, preferring topical treatments (Evidence: Expert opinion).
  • Tailor treatment in elderly patients considering potential drug interactions and organ function (Evidence: Expert opinion).
  • References

    1 Soto-Díaz AU, Villarreal ML, Medrano NS, Victorio-De Los Santos M, Sciutto E, Cerón JAE et al.. Metabolomic Profiling of Seasonal Katsumadin Production in Ternstroemia lineata. Molecules (Basel, Switzerland) 2026. link 2 Paľová M, Ručová D, Goga M, Kolarčik V. Spatial and Temporal Patterns of Endopolyploidy in Mosses. Genes 2020. link 3 Hohe A, Reski R. From axenic spore germination to molecular farming. One century of bryophyte in vitro culture. Plant cell reports 2005. link 4 Bonaly J, Mestre JC. Flow fluorometric study of DNA content in nonproliferative Euglena gracilis cells and during proliferation. Cytometry 1981. link 5 Nardi JB, Kafatos FC. Polarity and gradients in lepidopteran wing epidermis. II. The differential adhesiveness model: gradient of a non-diffusible cell surface parameter. Journal of embryology and experimental morphology 1976. link

    Original source

    1. [1]
      Metabolomic Profiling of Seasonal Katsumadin Production in Ternstroemia lineata.Soto-Díaz AU, Villarreal ML, Medrano NS, Victorio-De Los Santos M, Sciutto E, Cerón JAE et al. Molecules (Basel, Switzerland) (2026)
    2. [2]
      Spatial and Temporal Patterns of Endopolyploidy in Mosses.Paľová M, Ručová D, Goga M, Kolarčik V Genes (2020)
    3. [3]
    4. [4]
    5. [5]

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