Skip to main content

Advertisement

Log in

Tineas Due to Trichophyton erinacei: An Emerging Disease?

  • Review
  • Published:
Current Fungal Infection Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

In order to raise awareness and inform physicians of tineas secondary to Trichophyton erinacei, a review of the epidemiology, clinical picture, diagnosis, therapeutic strategies, and cases reported in the literature was carried out.

Recent Findings

We found 74 cases reported in the literature, where the UK held the first place, followed by a boom of cases in Asia. The main form of presentation was tinea manuum, associated with the handling of hedgehogs without adequate protective material. Luliconazole, a relatively new drug, could be an effective therapeutic option.

Summary

Tineas secondary to T. erinacei are definitely an emerging clinical entity which does not seem to be diminishing in the near future. Over the past few years, the popularity and number of domesticated hedgehogs have increased significantly worldwide, and hand in hand with these changes has come an increase of cases reported in humans. In order to make a diagnostic confirmation, it is imperative to perform a molecular study, since otherwise, it is impossible to differentiate T. erinacei from other members of the Trichophyton mentagrophytes Complex. The treatment of choice is systemic, usually with terbinafine, likewise, informing hedgehog owners about the possibility of transmission and preventive measures is fundamental.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data Availability

All data generated or analyzed during this study are included in this published article.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Bonifaz A. Micología médica básica. CDMX, Mexico: México: McGraw-Hill; 2020. p. 123–79.

    Google Scholar 

  2. Cardona-Hernández MA, López-Ortiz KV, Rodríguez-Silva J, Tiña inflamatoria por Trichophyton erinacei. ¿Una enfermedad emergente? Dermatol Rev Mex. 2021;65(suplemento 1):S151–6. https://doi.org/10.24245/dermatolrevmex.v65id.5437.

    Article  Google Scholar 

  3. Gnat S, Łagowski D, Dyląg M, Nowakiewicz A. European hedgehogs (Erinaceus europaeus L.) as a reservoir of dermatophytes in Poland. Microb Ecol. 2022;84(2):363–75. https://doi.org/10.1007/s00248-021-01866-w. A study in which the prevalence of dermatophytes in wild E. europaeus in Poland was determined, as well as their sensitivity to different drugs and MICs.

    Article  ADS  PubMed  Google Scholar 

  4. Frías-De-León MG, Martínez-Herrera E, Atoche-Diéguez CE, González-Cespón JL, Uribe B, Arenas R, et al. Molecular identification of isolates of the Trichophyton mentagrophytes complex. Int J Med Sci. 2020;17(1):45–52. https://doi.org/10.7150/ijms.35173. A study of the T. mentagrophytes Complex with emphasis on molecular studies for a proper identification of these agents.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Le Barzic C, Cmokova A, Denaes C, Arné P, Hubka V, Guillot J, et al. Detection and control of dermatophytosis in wild European hedgehogs (Erinaceus europaeus) admitted to a French wildlife rehabilitation centre. J Fungi (Basel). 2021;(7, 2):74. https://doi.org/10.3390/jof7020074. A study in which the frequency of dermatophytes in E. europaeus was determined in a wildlife rehabilitation center in France. The morphological characterization of the dermatophytes was also evaluated.

  6. Coronado-Aguilar A, Perez-Olivos ML, Mayorga-Garibaldi JL, Mayorga-Rodríguez J, Erika C-M, Francisca H-H. Inflammatory tinea manuum due to Trichophyton erinacei from an African hedgehog. Adv Microbiol. 2018;08(12):1021–8. https://doi.org/10.4236/aim.2018.812069.

    Article  Google Scholar 

  7. Marples MJ, Smith JM. The hedgehog as a source of human ringworm. Nature. 1960;188:867–8. https://doi.org/10.1038/188867b0. The first case reported in the literature was associated to contact with a domesticated hedgehog.

    Article  ADS  CAS  PubMed  Google Scholar 

  8. Riley PY, Chomel BB. Hedgehog zoonoses. Emerg Infect Dis. 2005;11(1):1–5. https://doi.org/10.3201/eid1101.040752. A solid review on zoonotic diseases associated with hedgehogs.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lammoglia-Ordiales L, Martínez-Herrera E, Toussaint-Caire S, Arenas R, Moreno-Coutiño G. Tiña incógnita y granuloma de Majocchi adquirido de un erizo. Un caso mexicano [Mexican case of tinea incognito and granuloma de Majocchi acquired from a hedgehog]. Rev Chilena Infectol. 2018;35(2):204–6. https://doi.org/10.4067/s0716-10182018000200204.

    Article  PubMed  Google Scholar 

  10. Rivaya B, Fernández-Rivas G, Cabañes FJ, Bielsa I, Castellá G, Wang JH, et al. Trichophyton erinacei: an emergent pathogen of pediatric dermatophytosis. Rev Iberoam Micol. 2020;37(3-4):94–6. https://doi.org/10.1016/j.riam.2020.06.001. Report of 2 cases of tinea in pediatric patients associated with contact with hedgehogs.

    Article  PubMed  Google Scholar 

  11. TXT’s Soobin shares heartbreaking news about his pet hedgehog Odi. In: Koreaboo. 2023. https://www.koreaboo.com/news/txts-soobin-heartbreaking-news-hedgehog-odi-dying/. Accessed: 15 Aug 2023.

  12. Serendipit Consulting. 5 facts about hedgehogs. In: AZPetVet. 2022. https://www.azpetvet.com/5-facts-about-hedgehogs/. Accessed: 15 Aug 2023.

  13. Bexton S, Nelson H. Comparison of two systemic antifungal agents, itraconazole and terbinafine, for the treatment of dermatophytosis in European hedgehogs (Erinaceus europaeus). Vet Dermatol. 2016;27(6):500–e133. https://doi.org/10.1111/vde.12378. A comparative study evaluating the efficacy of terbinafine versus itraconazole in the treatment of dermatophytosis in E. europaeus.

    Article  PubMed  Google Scholar 

  14. Doss GA. Dermatologic diseases of four-toed hedgehogs. Vet Clin North Am Exot Anim Pract. 2023;26(2):443–53. https://doi.org/10.1016/j.cvex.2022.12.007.

    Article  PubMed  Google Scholar 

  15. Abarca ML, Castellá G, Martorell J, Cabañes FJ. Trichophyton erinacei in pet hedgehogs in Spain: ocurrence and revision of its taxonomic status. Med Mycol. 2017;55(2):164–72. https://doi.org/10.1093/mmy/myw057. This study evaluated the taxonomic status of T. erinacei and reported its frequency, morphological characteristics, and urease activity in pet hedgehogs.

    Article  CAS  PubMed  Google Scholar 

  16. Durán-Valle MT, Sanz-Rodríguez N, Almagro-Moltó M, Gómez-Garcés JL. Lesión cutánea facial en una niña de 11 años [Facial skin lesion in an eleven year old child]. Enferm Infecc Microbiol Clin. 2013;31(4):266–7. https://doi.org/10.1016/j.eimc.2012.08.004.

    Article  PubMed  Google Scholar 

  17. Bonifaz A, Tirado-Sánchez A, Mercadillo P, Moreno-López LM, Fierro-Arias L, Araiza J, et al. Clinical and mycological study of 42 cases of dermatophytic granuloma (Majocchi granuloma). J Dtsch Dermatol Ges. 2021;19(5):758–61. https://doi.org/10.1111/ddg.14453.

    Article  PubMed  Google Scholar 

  18. Borges-Costa J, Martins ML. Trichophyton erinacei skin infection after recreational exposure to an elephant in Southeast Asia. Pathog Glob Health. 2014;108(1):58–9. https://doi.org/10.1179/2047773213Y.0000000117.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jury CS, Lucke TW, Bilsland D. Trichophyton erinacei: an unusual cause of kerion. Br J Dermatol. 1999;141(3):606–7. https://doi.org/10.1046/j.1365-2133.1999.03092.x.

    Article  CAS  PubMed  Google Scholar 

  20. Yee G, Al Aboud AM. Tinea corporis. In: In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.

    Google Scholar 

  21. Leung AK, Lam JM, Leong KF, Hon KL. Tinea corporis: an updated review. Drugs Context. 2020;9 https://doi.org/10.7573/dic.2020-5-6.

  22. Rebollo N, López-Barcenas AP, Arenas R. Tiña de la cabeza. Actas Dermosifiliogr. 2008;99(2):91–100. https://doi.org/10.1016/s0001-7310(08)74630-1.

    Article  CAS  PubMed  Google Scholar 

  23. English MP, Hewitt M, Evans CD, Warin RP. Hedgehog ringworm. Br Med J. 1962;1(5272):149–51. https://doi.org/10.1136/bmj.1.5272.149. Largest published series in the literature of tineas by T. erinacei in humans.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Phaitoonwattanakij S, Leeyaphan C, Bunyaratavej S, Chinhiran K. Trichophyton erinacei Onychomycosis: the first to evidence a proximal subungual onychomycosis pattern. Case Rep Dermatol. 2019;11(2):198–203. https://doi.org/10.1159/000501424. First report of proximal subungual onychomycosis and disseminated T. erinacei tinea in an immunosuppressed patient.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Grover C, Khurana A. Onychomycosis: newer insights in pathogenesis and diagnosis. Indian J Dermatol Venereol Leprol. 2012;78(3):263–70. https://doi.org/10.4103/0378-6323.95440.

    Article  PubMed  Google Scholar 

  26. Rhee DY, Kim MS, Chang SE, Lee MW, Choi JH, Moon KC, et al. A case of tinea manuum caused by Trichophyton mentagrophytes var. erinacei: the first isolation in Korea. Mycoses. 2009;52(3):287–90. https://doi.org/10.1111/j.1439-0507.2008.01556.x.

    Article  CAS  PubMed  Google Scholar 

  27. Nenoff P, Krüger C, Ginter-Hanselmayer G, Tietz HJ. Mycology - an update. Part 1: Dermatomycoses: causative agents, epidemiology and pathogenesis. J Dtsch Dermatol Ges. 2014;12(3):188–209. https://doi.org/10.1111/ddg.12245.

    Article  PubMed  Google Scholar 

  28. Kovitwanichkanont T, Chong AH. Superficial fungal infections. Aust J Gen Pract. 2019;48(10):706–11. https://doi.org/10.31128/AJGP-05-19-4930.

    Article  PubMed  Google Scholar 

  29. Shy R. Tinea corporis and tinea capitis. Pediatr Rev. 2007;28(5):164–74. https://doi.org/10.1542/pir.28-5-164.

    Article  PubMed  Google Scholar 

  30. Weishaupt J, Kolb-Mäurer A, Lempert S, Nenoff P, Uhrlaß S, Hamm H, et al. A different kind of hedgehog pathway: tinea manus due to Trichophyton erinacei transmitted by an African pygmy hedgehog (Atelerix albiventris). Mycoses. 2014;57(2):125–7. https://doi.org/10.1111/myc.12113.

    Article  PubMed  Google Scholar 

  31. Lee DW, Yang JH, Choi SJ, Won CH, Chang SE, Lee MW, et al. An unusual clinical presentation of tinea faciei caused by Trichophyton mentagrophytes var. erinacei. Pediatr Dermatol. 2011;28(2):210–2. https://doi.org/10.1111/j.1525-1470.2011.01391.x.

    Article  PubMed  Google Scholar 

  32. Frantz T, Rampton R, Wohltmann W. Bullous eruption caused by an exotic hedgehog purchased as a household pet. Cutis. 2020;105(6):314–6.

    Article  PubMed  Google Scholar 

  33. De Brito M, Halliday C, Dutta B, Fanning E, Kossard S, Curtin L, et al. A prickly souvenir from a hedgehog café: tinea manuum secondary to Trichophyton erinacei via international spread. Clin Exp Dermatol. 2020;45(4):459–61. https://doi.org/10.1111/ced.14111.

    Article  PubMed  Google Scholar 

  34. Harada K, Hiruma J, Maeda T, Tsuboi R. Case of tinea manuum transmitted by a hedgehog in an animal cafe. J Dermatol. 2019;46(10):e344–5. https://doi.org/10.1111/1346-8138.14894.

    Article  PubMed  Google Scholar 

  35. Jang MS, Park JB, Jang JY, Yang MH, Kim JH, Lee KH, et al. Kerion celsi caused by Trichophyton erinacei from a hedgehog treated with terbinafine. J Dermatol. 2017;44(9):1070–1. https://doi.org/10.1111/1346-8138.13647.

    Article  CAS  PubMed  Google Scholar 

  36. Romano C, Gianni C, Papini M. Tinea capitis in infants less than 1 year of age. Pediatr Dermatol. 2001;18(6):465–8. https://doi.org/10.1046/j.1525-1470.2001.1861997.x.

    Article  CAS  PubMed  Google Scholar 

  37. Isa-Isa R, Arenas R, Isa M. Inflammatory tinea capitis: kerion, dermatophytic granuloma, and mycetoma. Clin Dermatol. 2010;28(2):133–6. https://doi.org/10.1016/j.clindermatol.2009.12.013.

    Article  PubMed  Google Scholar 

  38. Simpson JR. Tinea barbae caused by Trichophyton erinacei. Br J Dermatol. 1974;90(6):697–8. https://doi.org/10.1111/j.1365-2133.1974.tb06701.x.

    Article  CAS  PubMed  Google Scholar 

  39. Sidwell RU, Chan I, Francis N, Bunker CB. Trichophyton erinacei kerion barbae from a hedgehog with direct osculatory transfer to another person. Clin Exp Dermatol. 2014;39(1):38–40. https://doi.org/10.1111/ced.12197.

    Article  CAS  PubMed  Google Scholar 

  40. Moriarty B, Hay R, Morris-Jones R. The diagnosis and management of tinea. BMJ. 2012;345:e4380. https://doi.org/10.1136/bmj.e4380.

    Article  PubMed  Google Scholar 

  41. Walsh AL, Merchan N, Harper CM. Hedgehog-transmitted Trichophyton erinaceid causing painful bullous tinea manuum. J Hand Surg Am. 2021;46(5):430.e1–3. https://doi.org/10.1016/j.jhsa.2020.06.015.

    Article  PubMed  Google Scholar 

  42. Ruszkowski JJ, Hetman M, Turlewicz-Podbielska H, Pomorska-Mól M. Hedgehogs as a potential source of zoonotic pathogens-a review and an update of knowledge. Animals (Basel). 2021;11(6):1754. https://doi.org/10.3390/ani11061754.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Lim SS, Shin K, Mun JH. Dermoscopy for cutaneous fungal infections: a brief review. Health Sci Rep. 2022;5(1):e464. https://doi.org/10.1002/hsr2.464.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Lightfoot TL. Therapeutics of African pygmy hedgehogs and prairie dogs. Vet Clin North Am Exot Anim Pract. 2000;3(1):155–72. https://doi.org/10.1016/s1094-9194(17)30099-3.

    Article  CAS  PubMed  Google Scholar 

  45. Gebauer S, Uhrlass S, Koch D, Krüger C, Rahmig N, Hipler UC, et al. Painful circumscribed bullous dermatosis of the left hand after contact with African four-toed hedgehogs. J Dtsch Dermatol Ges. 2018;16(6):787–90. https://doi.org/10.1111/ddg.13536.

    Article  PubMed  Google Scholar 

  46. Concha M, Nicklas C, Balcells E, Guzmán AM, Poggi H, León E, et al. The first case of tinea faciei caused by Trichophyton mentagrophytes var. erinacei isolated in Chile. Int J Dermatol. 2012;51(3):283–5. https://doi.org/10.1111/j.1365-4632.2011.04995.x.

    Article  PubMed  Google Scholar 

  47. Hui L, Choo KJL, Tan JBX, Yeo YW. Inflammatory tinea manuum due to Trichophyton erinacei from a hedgehog: a case report and review of the literature. J Bacteriol Mycol. 2017;4(4):1057.

    Google Scholar 

  48. Choi E, Huang J, Chew KL, Jaffar H, Tan C. Pustular tinea manuum from Trichophyton erinacei infection. JAAD Case Rep. 2018;4(6):518–20. https://doi.org/10.1016/j.jdcr.2018.01.019.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Kim J, Tsuchihashi H, Hiruma M, Kano R, Ikeda S. Tinea corporis due to Trichophyton erinacei probably transmitted from a hedgehog. Med Mycol J. 2018;59(4):E77–9. https://doi.org/10.3314/mmj.18-00006.

    Article  PubMed  Google Scholar 

  50. Philpot CM, Bowen RG. Hazards from hedgehogs: two case reports with a survey of the epidemiology of hedgehog ringworm. Clin Exp Dermatol. 1992;17(3):156–8. https://doi.org/10.1111/j.1365-2230.1992.tb00193.x.

    Article  CAS  PubMed  Google Scholar 

  51. Mochizuki T, Takeda K, Nakagawa M, Kawasaki M, Tanabe H, Ishizaki H. The first isolation in Japan of Trichophyton mentagrophytes var. erinacei causing tinea manuum. Int J Dermatol. 2005;44(9):765–8. https://doi.org/10.1111/j.1365-4632.2004.02180.x.

    Article  PubMed  Google Scholar 

Download references

Author Contributions

P.L.R: structure, writing, research and review of the work. F.L.R., M.L.MdO. and C. J.M.:  research and information process and iconographic support. A.B. Design, writing and general revision.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alexandro Bonifaz.

Ethics declarations

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lumbán-Ramírez, P., Lumbán-Ramírez, F., de Oca-Loyola, M.L.M. et al. Tineas Due to Trichophyton erinacei: An Emerging Disease?. Curr Fungal Infect Rep (2024). https://doi.org/10.1007/s12281-024-00488-2

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12281-024-00488-2

Keywords

Navigation