RINGWORM OF SCALP - PDF Document

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  1. Acute Communicable Disease Control Manual (B-73) REVISION— NOVEMBER 2014 RINGWORM OF SCALP (Outbreaks only) (Tinea capitis) 1. Agent: Various species of Trichophyton and Microsporum; e.g., Trichophyton tonsurans, Microsporum audouinii, M. canis. Trichophyton tonsurans is responsible for 90% of the cases in the USA. 2. Identification: a. Symptoms: May begin as small papules that spread peripherally, leaving scaly patches of baldness; or as numerous discrete pustules; or as discrete areas of hair loss studded by stubs of broken hairs. Occasionally boggy, raised and suppurative lesions (kerions) develop. Favus (infection by T. schoenleinii) is characterized by mousy odor and yellowish, cup-like crusts. b. Differential Diagnosis: Other derma- toses. c. Diagnosis: Microscopic examination of hairs and skin scales in 10% potassium hydroxide, Wood's (ultraviolet) light, or culture. Lesions caused by M. canis and M. audouinii fluoresce yellow-green under Wood’s light. Trichophyton species do not fluoresce. Culture is necessary for organism identification. 3. Incubation: Unknown, thought to be 1-3 weeks. Usually 10-14 days. 4. Reservoir: Humans (principally) for T. tonsurans, M. audouinii, and T. schoenleinii; animals, primarily dogs, cats, and cattle, harbor other species. 5. Source: Fomites contaminated with infected hair and skin scales. 6. Transmission: Direct skin-to-skin or indirect contact from fomites. 7. Communicability: As long as active lesions or viable spores on contaminated fomites are present. 8. Specific Treatment: Terbinafine by mouth for 6 weeks. Selenium sulfide shampoos (1% or 2.5%) decrease fungal shedding and may help reduce transmission. In resistant cases with kerion formation, the combination of oral prednisone and griseofulvin may be helpful. 9. Immunity: Reinfections are rare. REPORTING PROCEDURES 1. Reportable (outbreaks only). Code of Regulations, Section 2500.) 2. Report Form: DISEASE REPORT FORM (CDPH 8554) 3. Epidemiologic Data: a. Site of infection. b. Exposure to known infected humans or animals, such as a dog, cat, or farm animal. c. Shared hair-care items or fomite, e.g., hair clippers, combs, brushes, hats, pillowcases, etc. CONTROL OF CASE & CONTACTS Investigate outbreaks only. Initiate evaluation within 24 hours. CASE: Isolation: None. CONTACTS: No restrictions. Encourage examination of household, other close contacts, and pets for evidence of infection. Treat if infected. PREVENTION-EDUCATION 1. Stress personal cleanliness; encourage individual combs, personal items. Include proper sterilization of barbering equipment. (California OUTBREAK/UNUSUAL brushes and other PART IV: Acute Communicable Diseases RINGWORM OF SCALP— page 1

  2. Acute Communicable Disease Control Manual (B-73) REVISION— NOVEMBER 2014 2. Advise transmission can occur between animals and humans. 3. Advise child-care providers that children’s cots and mats should be arranged such that the children are placed head to toe. DIAGNOSTIC PROCEDURES Container: Mycology. Laboratory Form: Test Requisition and Report Form H-3021 Examination Requested: Dermatophyte. Material: Hair and/or scalp scrapings. Amount: Several hairs from involved area. Storage: Room temperature. Remarks: Place material into provided 50 ml plastic tube. households with pets that PART IV: Acute Communicable Diseases RINGWORM OF SCALP— page 2