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CASE REPORT

TINEA CORPORIS CAUSED BY MICROSPORUM AUDOUINII  

Mungky Sukarnadi, Safruddin Amin, Wiwiek Dewiyanti  

Department of Dermatovenereology Medical Faculty of Hasanuddin University / WahidinSudirohusodo Hospital Makassar

ABSTRACT

Tinea corporis is a superficial dermatophyte fungal infection of the

trunk, leg and arm region. These infections are by the caused by species ofTrichophyton, Epidermophyton and Microsporum.

One case of tinea corporis et causa Microsporum audouinii in a 61 years old

woman was reported. Diagnosis was established based on history, physical

examination, direct microscopic examination with potassium hydroxide (KOH

10%) and culture. The patient was treated with oral ketoconazole and topical

treatment contains a combination of Salicyl acid 3%, 6% benzoic acid and

vaseline 30gr (AAV1). Eight days after therapy, the patient showed clinical and

mycological improvement.

Key words:  Microsporum audouini, ketoconazole, tinea corporis 

 Address for correspondence : Mungky Sukarnadi, dr., Department of Dermatovenereology Medical Faculty of Hasanuddin University / WahidinSudirohusodo Hospital Makassar, 11 Komp. TNI AL Dewakang Jl. Koptu Harun Makassar, South Sulawesi, Indonesia 90245,smungky@yahoo.com 

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Mungky Sukarnadi   tinea corporis caused by microsporum audouin i i

INTRODUCTION

Dermatophytosis is a superficial infection

caused by dermatophyte fungi on keratin-containing tissues such as nails, hair and

stratum corneum of the skin. Tinea

corporis is a superficial fungal infection

caused by dermatophytes on regional

bodies, legs, and arms. ( 1-3 ) 

Dermatophyte fungi are classified

based on habitat or source of infection, ie

geophilic, zoophilic, and anthropophilic.

Three fungi most commonly found in

cases of tinea corporis is Trichophytonrubrum, Trichophyton mentagrophytes and

Epidermophyton floccosum.  Trichophyton

rubrum, Microsporum canis and

Trichophyton mentographytes  a common

cause in the United States. Some species

have a predilection for certain body parts,

such as Microsporum audouinii   typical

cause of tinea capitis and Trichopyton

rubrum  which generally causes tinea

pedis, but they also can cause tineacorporis. ( 1 , 4-6 ) 

The incidence of dermatophyte

infection according to a survey World

Health Organization  (WHO) that

approximately 20% of people worldwide

are infected, especially tinea corporis

(70%), followed by tinea cruris, tinea pedis

and onychomycosis. ( 7 )  Incident

dermatomycosis in Indonesia shows the

highest incidence of dermatophytosisfollowed by pityriasis versicolor and

candidiasis skin. ( 8 ) 

Clinical picture of tinea corporis

varied, can be demarcated erythematous

plaques with more rising edge and the

center of the lesion tends to heal (central

healing). Adjacent lesions can coalesce to

form polycyclic pattern. Lesions of tinea

corporis can also serpiginous and annular

(ringworm-like). ( 1 ) 

Diagnosis of tinea corporis can be

established based on history, physical

examination and investigation by direct

microscopic examination and culture. ( 1 , 9 ,

10 )  Patient with tinea corporis usually

responds well to topical antifungal

treatment within 2-4 weeks. Various

preparations allilamin, imidazole, and

available in several forms. Patient with

extensive lesions or fail with topical

treatments, anti-fungal preparations can

be administered orally, such as

griseofulvin, ketoconazole, itraconazole

and terbinafin. ( 1 , 11 , 12 ) 

Microsporum  audounii   is a

dermatophyte fungus anthropophilic group

most likely to cause tinea capitis, although

rarely reported to cause tinea corporis. ( 4 ,

5 , 13 ) In this paper, we reported a case of

tinea corporis in a woman 61 years old

caused by Microsporum audouinii  

CASE REPORT 

 A woman aged 61 years old, occupation a

housewife came to dermatovenereology

clinic Wahidin Sudirohusodo hospital with

chief complaint red spots on the upper left

arm since 1 year ago. Patient also

complained of itchy, and while sweating

itchy getting worse . Initially lesion showed

reddish patches scaly and became

larger. Previous history of similar

complaints (+). History of its own

lubrication purchased at pharmacies (notknown the title), but not improved. Family

history of similar disease undeniable.

Denied a history of diabetes mellitus.

Denied a history of allergy.

Physical examination on the region of the

left brachial showed erythema plaques

with elevated edges and fine scales .

(Figure 1.AB)

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IJDV Vol.2 No.2 2013

Figure 1. Erythematous plaques with elevated

edges and fine scales on the the left brachial region  

Direct microscopic examination ofskin scrapings of the lesion with KOH 10%

solution showed insulated length and

branching hyphae. (Figure 2)

Figure 2. Long, septate and branching hyphae on

KOH 10% examination 

Culture examination conducted by

the specimen scrapings of skin lesions on

media Saboroud's Dextrose Agar   (SDA).

Macroscopic picture looks a brownish red

colonies with elevated surfaces and edges

are white gray, bottom looks brownish

yellow colonies. (Figure 3.AB)

Figure 3A. SDA culture day 21 showed a brownish red

colonies with elevated surfaces and edges are white gray.3B. Bottom side showed brownish yellow colonies. 

On microscopic examination using

staining Lactophenol Cotton Blue (LCB) of

culture looks macroaleurospora andbizarre branching. (Figure 4.AB)

Figure 4A. Macroaleurospora 4B.  Branching

 Bizarre 

Final diagnosis is established tineacorporis caused by Microsporum

audouinii. Management of this case oral

ketoconazole 200 mg per day, and topical

therapy contains 3% salicylic acid ,

benzoic acid 6% and vaseline 30gr (AAV1)

applied two times a day.

On day 8 therapy, clinical

improvement appeared in the form of

macular hypopigmentation with complaint

of itching diminished. (Figure 5). Direct

microscopic examination with 10% KOH

showed negative result and continued

therapy.

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Mungky Sukarnadi   tinea corporis caused by microsporum audouin i i

Figure 5. On the day 8 therapy showed macular

hypopigmentation. 

DISCUSSION 

In this case report, patient

diagnosed tinea corporis caused by

Microsporum audouinii   based on history,

physical examination and investigations

using direct microscopic examination

followed by culture examination to

determine the cause of the species.

Tinea corporis is a disease that

causes itching and complaints intensifiedwhen the patient sweats. Clinical picture of

tinea corporis vary, and may be macular

erythematous plaque with an active edge

and accompanied squama, with the center

of the cure (central healing).  ( 1 )  In this

case, patient complaints of itching

erythematous plaques with elevated edges

and fine scales on the left brachial region.

Microscopic examination of skin scrapings

specimens using 10% KOH solution is asimple diagnostic method to see length

hyphae, branched hyphae, and arthospora

Scales collected by scrape edge of an

active lesion, then dropped 10-20% KOH

solution. ( 1 , 4 , 5 , 14 ) In this case KOH 10%

examination showed length and branching

hyphae. Fungal culture is used to confirm

the diagnosis and identify pathogenic

species. Culture media is a selective

medium for the isolation of dermatophytes,and then stored at a temperature of 26 0 C

( 1 , 2 )  In our case, on day 21

macroscopically showed maroon colonies

with elevated surface and gray white edge,

the bottom side showed brownish yellow

colonies. Microscopic picture looks

macroaleurospora and bizarre branching. 

Culture results according to Microsporum

audouinii. ( 15 ) 

Microsporum audouinii   an anthro-

pophilic dermatophyte fungi spesises

which is one of the most frequent causes

of dermatophytes (61.5%) in tinea capitis,

especially in children who are in Latin

 America and South Africa, but this species

can also infect the skin and nails. ( 13 ) 

Reported a young woman from Germany

with tinea corporis due to Microsporum 

audouinii  accompanied by tinea capitis.( 16) 

Systemic antifungal therapy is

indicated if the lesions are extensive or

fails to topical treatment, recurrent or

chronic, or if the skin condition gets worse.( 11 , 12 )

  Ketoconazole is an antifungalsystemic broad spectrum imidazole group

and is fungistatic. Mechanism of action of

ketoconazole that inhibit the biosynthesis

of ergosterol, the main sterol which serves

to maintain the integrity of the fungal cell

membrane, by inhibiting the enzyme

cytochrome P-450 lanosterol 14α

demetilase an enzyme essential for fungal

cell membrane ergosterol synthesis. (  4 ,  7 ,

12 ) In a study to compare strength between

itraconazole and fluconazole and the

ketoconazole and fluconazole obtained

similar results with a cure rate of

approximately 90% for all three drugs. ( 17 ) 

In this case , patient was treated

ketoconazole 200 mg per day. On day 8

therapy, lesions looks macular

hypopigmentation, itching diminished and

negative KOH examination. Other oral

anti-fungal medication that can be given to

tinea corporis is fluconazole, itraconazole,

griseofulvin, and terbinafin. On a compa-

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rative study of adults showed fluconazole

150 mg per week for 4 to 6 weeks,

itraconazole 100 mg per day for 15 daysand terbinafin 250 mg per day for 2 weeks

is as effective by administering griseofulvin

200 mg per day for 2 to 6 weeks. ( 1 ) 

Research conducted comparing Clayton

and Connor clotrimazole cream and

Whitfield's ointment was not found

significant differences and showed

negative mycological results after 4 weeks

of treatment. Whitfield's ointment is

fungistatic and keratolytic.

( 18 , 19 )

  In thiscase, topical treatment with

 AAV1/Whitfield 's ointment was applied

two times a day.

Non-medicamentous management by

reducing the predisposing factors, suggest

to wear loose clothing and absorb sweat,

dry off after shower and sweating. ( 2 ) 

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