White Piedra (Knotted Trichosporia)

What is the White Piedra (Knotted Trichosporia)?

The white piedra (knotted trichosporia) is an anthroponotic mycotic lesion of the hair cuticle.

The disease is more often registered in countries with a warm or tropical climate. In persons with immunodeficiencies, fungemia with the development of endophthalmitis, brain abscesses, endocarditis, etc. are possible.

Causes of the White Piedra (Knotty Trichosporia)

The causative agent of the white piedra (trichosporosis) – basidiomycete – Trichosporon beigelii – is localized in the scales and hair of the beard, in which nodules consisting of hyphae and oval art-spores appear. On Saburo agar, the fungus grows in the form of soft cream colonies.

Microscopic examination of the areas of the affected hair reveals a coupling around the hair consisting of ascospores, the hair shaft remains outside the lesion.

Pathogenesis during the White Piedra (Knotty Trichosporia)

The source of the peidra is a sick person. Piedra occurs in individuals of both sexes, but more often in young women. When a white piedra affects the hair on the head, beard, mustache, as well as in the genital area. Infection occurs when using someone else’s combs, hats. Lubrication of hair with sour milk and linseed oil, humid warm climate and excessive sweating, a violation of the integrity of the cuticle of the hair contribute to the disease. In our country, this is a rare disease. The white piedra is found in the countries of Europe, the USA, Japan and the southern regions of our country.

Symptoms of the White Piedra (Knotted Trichospory)

The disease is chronic. On the surface of the hair, small, very dense white nodules appear that are oval or irregular in shape, covering the hair in the form of a clutch. Nodules are a collection of fungal spores. Nodules are easily identified by palpation. Sometimes when the hair is tightened, the nodules stick together, forming bunches that look like sheaves of cereal (“Colombian koltun”). When bending such hair, a peculiar crunch is heard, caused by the destruction of a dense colony of the fungus. It affects only the hair shaft, but breaking it does not occur.

With neutropenia (most often in patients with leukemia), this fungus can cause a generalized infection. Fungemia is accompanied by the appearance of a common papular or hemorrhagic rash. In the future, the elements of the rash are transformed into large tense blisters with hemorrhagic content.

Blood culture usually gives a positive result.

Diagnosis of the White Piedra (Knotted Trichospory)

The diagnosis is easily established on the basis of the peculiarities of the clinical symptoms. In difficult cases, the diagnosis can be confirmed by microscopic and cultural studies. Microscopy of the nodules on the hair reveals a wide (4-6 microns) mycelium, which breaks down into oval, round and rectangular arthrospores, arranged in mosaic or clusters.

On the environment Saburo formed grayish-yellow, dark cream, black colonies.

Piedra is differentiated from the so-called false pedestal, caused by bacteria forming porous cream-colored colonies with a scalloped border on the periphery and pediculosis on the Saburo medium.

Treatment of the White Piedra (Knotted Trichosporia)

The most effective method of treating a white piedra is shaving the hair, after which recovery is quickly achieved. If the patient refuses to shave the hair, then a daily shampooing with a hot solution of mercuric chloride (mercury dichloride) at a dilution of 1: 1000 and brushing the nodules with a frequent comb, followed by washing the head with hot water and soap are shown. Amphotericin B is also used for treatment, sometimes in combination with 5-fluorocytosine. Inside recommend taking vitamin A.

Prevention of White Piedra (Knotted Trichosporia)

For the prevention of white piedra should follow the rules of personal hygiene.

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