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Dermatophyte Infections: A Fungus Among Us?

Teaser: 

Miriam Armanious, BSc, MD candidate,1 Joseph M. Lam, MD, FRCPC,2

1Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario.
2Clinical Associate Professor, Department of Pediatrics, Associate Member, Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, BC.

CLINICAL TOOLS

Abstract: Superficial fungal infections are a common occurrence in adults and children alike. Dermatophytes are the primary cause of these infections, which generally present as erythematous, scaling, annular lesions. Also referred to as "tinea", these infections are classified based on where they are found on the body, as different locations can have slightly different presentations and treatment requirements. This article provides an overview of these various presentations of dermatophyte infections and their risk factors, as well as recommended therapies.
Key Words: dermatophytes, fungal infections, therapies.
Dermatophyte infections, also known as tinea, are very common fungal infections in humans. They occur on the superficial skin, hair, and nails, and can present in many different locations on the body.
Tinea captis is most common in children and can cause hair loss or abscess formation.
When tinea infections are treated with topical corticosteroids, they become harder to detect and are referred to as tinea incognito.
Tinea infections are common, but should be confirmed with KOH microscopy and/or culture from a skin scraping, nail clipping, or hair sample.
Tinea capitis can be mistaken for eczema or seborrheic dermatitis
Check patients who have tinea infection for tinea pedis, since this is a common source of infection for sites on the rest of the body
Treatment for dermatophyte infections can include oral antifungal agents such as terbinafine or grise-ofulvin in a weightdependent dose, or topical antifungal agents. Systemic agents are generally re-served for presentations that penetrate hair follicles and nails, or those that are refractory to topical treatment.
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Related Terms: Dermatology, dermatophytes, fungal infection, therapies
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A Case of Calcified Nodule in the Base of the Tongue

Teaser: 

Dr. Pradeep Shenoy, MD, FRCS, FACS, DLO,1 Dr. Lyew Warren, MD, FRCPC,2

1ENT & Neck Surgeon, Campbellton Regional Hospital, Campbellton, New Brunswick, Canada.
2Consultant Pathologist, Campbellton Regional Hospital, New Brunswick, Canada.

CLINICAL TOOLS

Abstract: Calcified nodules are uncommon in the base of tongue. Solitary amyloid metaplasia can occur at the base of the tongue and can produce calcification and are difficult to diagnose by histopathological examination.1 Ossoeus choristoma of the tongue is a rare benign condition producing calcified nodule in the base of the tongue.2 Unusual ectopic osseous tongue masses are reported in dermoid cysts or teratomas.3 Osteoma of the base is also reported in the literature.4 Venous malformations with phleboliths are also described in the literature5 causing calcified nodules at the base of tongue.
Key Words: calcified nodules, amyloid metaplasia, osseous choriostoma, dermoid cyst, teratoma and phlebolith.
There are various conditions like ectopic thyroid, lipoma, lymphoma, lymphoid hyperplasia and metastatic lymphatic spread can present with base of tonge swelling. Only a few conditions discussed in the article can have calcified nodule at the base of the tongue.
Base of tongue pathology can be easily missed unless prompt examination, investigations and management is done.
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Related Terms: Otolaryngology, calcified nodules, amyloid metaplasia, osseous choriostoma, dermoid cyst, terratoma and phlebolith
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JCCC 2019 Issue 3

Table of Contents

Ankylosing Spondylitis and Spinal Fractures

Teaser: 

Andrew Kanawati, BSc, MBBS MSc (Hons) UNSW Mast Anat (UNE) FRACS (Orth),1Nicolas Dea, MD, MSc, FRCSC,2Parham Rasoulinejad, BHSc, MD, FRCSC, MSc, 3Christopher S. Bailey, MD, FRCSC, MSc,4

1 Clinical Fellow, London Health Sciences Centre Spine Program, London, ON.
2Spine Surgeon, Clinical Associate Professor of Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, BC.
3 Assistant Professor, Department of Surgery, Division of Orthopaedic Surgery, Schulick School of Medicine and Dentistry, The University of Western Ontario, London, ON.4 Orthopaedic Surgeon, Division of Orthopaedic Surgery, London Health Sciences Center, and Associate Professor, Dept. of Surgery, University of Western Ontario, London, ON.

CLINICAL TOOLS

Abstract: Ankylosing spondylitis is a seronegative spondyloarthropathy associated with HLA-B27. The main site of pathology is the enthesis (site of tendon insertion). The axial skeleton is affected primarily, with the sacroiliac joints initially involved, with the enthesopathy resulting in fibrosis, calcification and fusion of the sacroiliac joints and spine. There is a high incidence of spine fractures in patients with AS, and there is a high rate of missed fractures, therefore advanced imaging in the form of CT and/or MRI is necessary. Due to their highly unstable nature, surgical management of spine fractures in AS is preferable to non-operative care.
Key Words: Ankylosing spondylitis, spondyloarthropathy, sacroiliitis, spine fracture.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
The spine and sacroiliac joints are the primary site of pathology in AS.
The natural history of the disease causes eventual fusion and kyphosis.
Spinal fractures occur at a higher incidence in AS compared to general population.
There is a high rate of missed fractures, and secondary neurologic complications.
Advanced imaging (CT and/or MRI) is mandatory to rule out fracture, because of high false-negative results of plain radiography.
The patient’s kyphosis must be taken into account when applying full spine precautions for suspected fracture.
Patients must not be forced into extension as this may shift an initially non-displaced fractures.
Loss of flexibility and ankylosis of the spinal column results in long lever arms and behavior akin to a long bone, therefore fractures of the spine are highly unstable and usually require surgical stabilization.
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Related Terms: Back Health, Ankylosing spondylitis, spondyloarthropathy, sacroiliitis, spine fracture
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Yellow and yellow-brown papules and plaques: Differentiating look-alikes in children’s dermatology

Teaser: 

Lauren Schock, BSc, MD Program,1 Joseph M. Lam, MD, FRCPC,2

1Cumming School of Medicine, University of Calgary, Calgary, AB.
2Clinical Associate Professor, Department of Pediatrics, Associate Member, Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, BC.

CLINICAL TOOLS

Abstract: Yellow-hued papules and plaques in children can be difficult to differentiate as many causes are rare and may not be frequently outside of specialty pediatric dermatology settings. We will review some of the common and concerning yellow-brown papules and plaques found in infants and children and discuss appearance and distribution, pathophysiology, associated findings, and management.
Key Words: dermatology, pediatric, yellow lesions.
Nevus sebaceous typically grow in proportion with patients in early childhood. Excision should be deferred until adolescence to avoid the use of general anesthetic and an informed decision can be made by the child.
Benign cephalic histiocytosis and juvenile xanthogranuloma are both forms of non-Langerhans cell histiocytosis and are benign and self limited.
Consider a diagnosis of tuberous sclerosis in any child presenting with connective tissue nevi, especially if white macules, angiofibroma, or periungual fibroma are also found.
Screen children with necrobiosis lipodica for retinopathy and neuropathy.
Use your hands – rub a suspected lesion of mastocytosis; if urticaria is elicited (a red, itchy, swollen papule or plaque), you have found Darier's sign. Mastocytosis is likely. Be prepared to treat the child with antihistamines if needed.
Juvenile xanthogranulomas are more common under two years of age, and typically appear on the head and neck. Cutaneous xanthomas often occur overlying tendons, or as grouped papules over the extensor surfaces and buttocks.
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Related Terms: Dermatology, dermatology, pediatric, yellow lesions
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The Role of Screening and Brace Management for Adolescent Idiopathic Scoliosis

Teaser: 

Kedar Padhye, MBBS, DNB (Ortho), 1Reza Ojaghi, MD, 2Fábio Ferri-de-Barros, MD, MSc, FSBOT, FSBOP (Hon.), FRCSC, FCS(ECSA),3

1 Clinical Fellow (Pediatric Spine Surgery)Division of Paediatric Surgery, Section of Orthopaedic Surgery, Alberta Children's Hospital, University of Calgary, Calgary, Alberta.
2Orthopaedic Surgery Resident, Department of Orthopedics, University of Ottawa, Ottawa, Ontario.
3 Department of Orthopedics, Alberta Children's Hospital, Calgary, Alberta.

CLINICAL TOOLS

Abstract: Adolescent Idiopathic Scoliosis (AIS) is defined as curvature of spine in the coronal plane with a Cobb angle of more than 10°. AIS affects 1-3% of children younger than 16 years of age. Less than 20% of those children will progress to severe deformity requiring interventions. Screening with clinical examination and selective radiographic assessment seems to be a cost-effective approach to filter specialist referrals but current literature is controversial. Evidence supports brace management of AIS for skeletally immature patients with primary scoliosis measuring 25°–40. The risk reduction for progression to the surgical range (deformity greater than 50 degrees) is 56%. Timely diagnosis and evidence-based brace management of AIS seem likely to reduce the surgical burden. The implementation of screening guidelines at the primary care level is a critical step.
Key Words: scoliosis; idiopathic; Brace treatment; conservative treatment; screening.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
Bracing is an effective but time sensitive intervention for managing AIS in skeletally immature patients with primary scoliosis measuring 25 to 40 degrees.
Clinical screening is required to identify AIS patients who eligible for bracing.
Improving access to bracing for eligible patients requires a collaborative approach involving primary care physicians and specialists.
1. A systematic collaborative approach involving primary care physicians for screening patients and referring to tertiary care ensures timely assessment and management for eligible patients.
2. Evidence supports brace management of AIS for skeletally immature patients with primary scoliosisl measuring 25°–40°, with the goal of preventing deformity progression to the surgical threshold.
3. A full time (18-23h/day) rigid brace treatment may mitigate the surgical burden of AIS by approximately 30%.
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Related Terms: Back Health, Scoliosis, idiopathic, Brace treatment, conservative treatment, screening
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