Ring worm infections that will not die, coming soon to a classroom near you

There is yet another reason to wash your hands and clean up surfaces touched by children-- a brand new species of ring worm fungus that will not die. Even with oral anti-fungal drugs and topicals at the same time, many children with this new species of ring worm fungus are still contagious and it just keeps coming back. Worse it is linked to increases in asthma and allergies among susceptible children (and adults?).

I hate to bring more bad news but school nurses and teachers should be aware of this new and incredibly resistant fungus.

Thirty years ago, cat ring worm which was the common species was easy to cure with a few applications of a topical anti-fungal. No more. And this new fungus is even more resistant than cat ring worm. Scary.

Sadly it is not the only fungus which has virtually incurable strains spreading across the nation. Many new strains of athlete's foot fungus are completely resistant to most topical anti-fungals. Be careful and be caution in common areas where lots of folks walk barefoot. Be sure to wear sandals in public showers and at public pools or where ever there are moist surfaces that other folks walk barefoot on.

Oral anti-fungals were considered the big guns for resistant strains. Orals were the last line of defense. Now apparently the human fungi pathogens are defeating all of our fungicides, just as the bacterial pathogens like MRSA are defeating our antibiotics. We are unlikely to get new anti-fungals any time soon. Fungus cells unlike bacteria cells are close relatives to our own body cells. With so few differences between them and us, it is devilishly difficult to find an effective target that will kill fungus cells without killing our own cells.

Scary stuff. Just as with resistant bacteria, resistant fungi will be naturally selected for the most virulence once it is unchecked by medication. The more virulence, the more spores (or infections cells) are produced and the more chance the pathogen has to spread and to infect others. It is a winning strategy for a pathogen. Evolution sadly is working against us.

All we can do is be extremely careful when working with children and aggressively treat fungal infections. In the old days we soaked infected body parts in vinegar solutions. Fungus hates vinegar.

Remember to clean common surface areas. These are places that many people touch with their hands or with their feet. Use 10% bleach solution and clean often.

These fungus spores are not only cling to hats and combs, they will cling to any surface an infected child touches after scratching the infected area on his or her body. They will linger on common surfaces for quite some time, perhaps weeks. Think of the spores like tiny invisible bubbles covered with Velcro that sticks to surfaces until the next potential host touches that surface, then the Velcro releases and the spore infects the next host.

Study finds treatment-resistant ringworm prevalent among children in metro elementary schools

Kansas City, Mo – April 19, 2010 – Approximately 7 percent of elementary school children across the bi-state, Kansas City metropolitan area are infected with the fungus Trichophyton tonsurans (T. tonsurans), the leading cause of ringworm in the U.S., according to a new study published today in Pediatrics. This is the largest study to date aimed at defining infection prevalence of the scalp fungus in children living in a metropolitan area and has implications for children nationwide.

"The organism T. tonsurans has become the leading cause of scalp infection in the U.S., and we believe it is on the rise in inner city areas," said Susan Abdel-Rahman, Pharm.D., lead study author and professor of pediatrics and pharmacy at Children's Mercy Hospitals and Clinics. "This study supports what I and many of my peers are seeing – children with scaly, itchy scalps and hair loss are prevalent in metropolitan areas. If not treated, ringworm can lead to permanent hair loss, which can damage a child's self image. There is also some evidence that it may worsen seemingly unrelated problems such as asthma and allergic rhinitis."

Although its name suggests otherwise, ringworm is caused by a fungus, not a worm. In the past, Microsporum species were the main cause of ringworm, often passed to humans from cats and dogs. However, in recent years, T. tonsurans emerged, which spreads directly between humans, and is more challenging to screen for and treat.

The study of 10,514 children in grades K through 5 across 44 schools found that 6.6 percent of the children evaluated were infected with T. tonsurans. Infection rates varied markedly based on age and race, with African American children at greatest risk. More than 18 percent of the youngest African American children evaluated (kindergarten and first grade) were infected, with that number dropping to 7 percent by the time they reached fifth grade. In contrast, infection rates in Hispanic (1.6 percent) and Caucasian children (1.1 percent) were significantly lower. The reason for the dramatically higher prevalence in African Americans is not clear.

Current treatment regimens for T. tonsurans require a course of oral antifungal medicine typically for six to eight weeks until the symptoms resolve. However, in many of these children the fungus will not be completely eliminated. Consequently, children can still spread the infection to their classmates after being treated. "T. tonsurans has learned how to stay on the host and avoid eradication. This can be very frustrating for children who keep getting re-infected and for their parents who are doing everything they can to prevent this," added Abdel-Rahman. "We have only recently started to appreciate just how many children carry this pathogen so we don't yet know the best way to tackle this problem. However, I do advise parents to limit the sharing of items that come into contact with the scalp such as hats, combs, brushes and pillows. Watch closely for signs of infection such as flaking that looks like dandruff, white patchy scaling, itching, hair thinning or loss, and small pus-filled bumps, especially when your child has come in contact with another infected child. Make an appointment to see your doctor if you suspect that your child is infected and make sure to take the prescribed medicine as directed along with the application of a medicated shampoo two to three times a week."
###
About Children's Mercy Hospitals and Clinics
Children's Mercy Hospitals and Clinics, located in Kansas City, Mo., is one of the nation's top pediatric medical centers. The 314-bed hospital provides care for children from birth through the age of 18, and has been recognized by the American Nurses Credentialing Center with Magnet designation for excellence in nursing services, and ranked by U.S. News & World Report as one of "America's Best Children's Hospitals." Its faculty of 600 pediatricians and researchers across more than 40 subspecialties are actively involved in clinical care, pediatric research, and educating the next generation of pediatric subspecialists. For more information about Children's Mercy and its research, visit childrensmercy.org. For breaking news and videos, follow us on Twitter, YouTube and Facebook.