Epidemiological study Tr. equinum in wrestlers in Hungwy 
Triclwphyton eifUinum irifectwns among 
young wrestkrs in Hungary 
N. Eros, Zs. Karolyi and E. Molnar 
------------ --------------SUM MARY 
Epidemic-like tinea corporis and capitis cases were seen among a group of wrestlers aged from 8 to 17 
years in Miskolc (Hungary) between July of 1997 and August of 1998. The fungal cultures revealed 
Trichophyton equinum as causative agent. Anthropophilic spreading of this zoophilic dermatophyte could 
be stemmed by using topical and systemic antimycotics and with special preventive measures. 
Introduction 
Trichophyton equinum is a zoophilic dermatophyte 
first described by Matruchot and Dassonville in 1898 
and later by Gedoelst in 1902. It causes equine derma-
tophytosis that can rarely be transmitted to humans. 
Sporadic human infections occasionally occur in 
patients by contact with infected horses (1,2). Epide-
mical human infection was first described by Simon and 
Tarok in Budapest (Hungary) among young wrestlers 
in 1997 (3). 
Material and methods 
We revealed 28 cases of tinea corporis and 3 cases 
of tinea capitis among 8 to 17-year-old wrestlers in 
Miskolc (Hungary) betweenJuly of 1997 and August of 
1998. The distribution of the affected sites is shown on 
table 1. The e1ythematous, scaly, annular or gyrated pla-
ques were 1 to 5 cm in diameter and alopecia was found 
on the scalp (Figures 1-2). 
Direct microscopic examination of skin scrapings 
and hair samples revealed hyphae, many arthrospores 
within the hair and ectothrix spores around them. 
Samples were placed on Sabouraud's dextrose agar and 
on Mycosel fungal isolation media and the cultures were 
incubated at 26°c for 2 weeks. Initially white colonies 
developed with deep yellow reverse, later brownish due 
to the diffusion ofthe pigment (Figure?). Lactophenol 
cotton blue microscopic preparations demonstrated 
septate, branching hyphae and numerous laterally 
placed microconidia. There were also chlamydospores 
in lateral and intercalar localizations (Figure 4). We 
found few stunted, cigar-shaped macroconidia consis-
ting of 3 to 5 cells with thin, plain wall. The in vitro hair 
acta dermatovenerologica A.P.A. Vol 8, 99, No 2 ----------------------- --------- 63 
Tr. equinum in wrestlers in Hungary 
64 
Epidemiological study 
Figure 1 . Annular, erythe-
matous lesions on the back. 
Figure 2. Typical mycotic 
lesion on the scalp. 
Figure 3. Microconidia and 
chlamydospores in the 
lactophenol cotton blue 
microscopic preparation. 
Figure 4. Trichophyton 
equinum colonies on 
Mycosel agar. 
acta dermatovenerologica A.P.A. Vol 8, 99, No 2 
Epidemio l og ical stud y 
Table 1 . Distribution of the affected sites. 
scalp 3 
tace 3 
neck 1 
trunk 11 
upper extremities 10 
lower extremities 3 
perforation tests were negative. 
According to these morphological features the 
pathogen was identified as Trichophyton equinum and 
can be differentiated from other similar dermatophytes 
such as Trichophyton mentagrophytes, T rubrum, T 
erinacei and T interdigitale. Because it did not require 
nicotinic acid for its growth, a rare variant was diagnosed 
namely Trichophyton equinum var. autotrophicum. 
Only 6 cultures were found to be positive out of 31 
cases, the negative results were probably due to the 
previous antimycotic treatment. 
Only topical antimycotic treatment was introduced 
in cases of tinea corporis using clotrimazole, ciclopirox 
olamine, econazole, ketoconazole, natamycin and ter-
Tr. equinum in wrestlers in Hungary 
binafine. In cases of tinea capitis topical ciclopirox 
olamine and oral terbinafine treatment was successful 
after three months. 
In order to prevent the infection we recommended 
regular use of ketoconazole containing shampoo for 
showering and washing hair both in the infected and 
non-infected persons. Disinfection ofthe wrestling mats 
and other sports implements was necessary to stop the 
source of infection. 
Discussion 
Infection of wrestlers by herpes simplex virus and 
dermatophytes is a specific problem, so they have their 
own terminology: "herpes gladiatorum" and "tinea 
corporis gladiatorum". Few reports were published 
about mycotic epidemics among w restlers since 1966, 
mainly originating from tbe USA. Tbe patbogen agent 
was Trichophyton tonsurans in almost eve1y case (Table 
2). In Hungary Trichophyton equinum infections were 
first reported by Simon and Torok in 1997; it started 
among young wrestlers in Budapest (3). We suppose 
that the infection spread from tbere to our city during 
wrestling matcbes and common trainings. 
Table 2. Major mycotic epidemics among wrestlers. 
1966. Sweden wrestlers Trichophyton Frisk, Heilborn, Melon (4) 
1992. NewYork, USA student wrestlers Trichophytontonsurans Stiller, Klein, Dorman (5) 
1992. Maryland, USA 9 to 15 year 5/8 tinea corporis, Trichophytontonsurans Cohen, Schmidt (6) 
old wrestlers capitis 
1992. New Jersey, USA university wrestlers Trichophyton tonsurans Rosenthal, Sangueza, Klein (7) 
1992-93. Alaska,USA 14 to 19 year 10/21 tinea corporis Trichophytontonsurans Beller, Gessner (8) 
old wrestlers 
1993. Boston,USA 18to21 year 4 tinea corporis ? Werninghaus (9) 
old wrestlers 
1993. Sweden wrestlers 19 Trichophytontonsurans Hradil, Hersle, Nordin, 
Faergemann (10) 
1994-96. Buda pest, 5 to 16 year 24/44 tinea corporis, Trichophyton equinum Simon, T6r6k (3) 
Hungary old wrestlers capitis var. autotrophicum 
1997-98. Miskolc, 8 to 17 year 6/31 tinea corporis, Trichophyton equinum Eros, Karolyi, Molnar 
Hungary old wrestlers capitis var. autotrophicum 
acta dermatovenerologica A.P.A. Vol 8, 99, No 2 6J 
T,: equinum in wrestlers in Hungary E pidemi o l ogica l study 
Although Trichophyton equinum is a zoophilic 
dermatophyte, the spread of this infection seems to be 
rather anthropophilic than zoophilic, because none of 
the wrestlers had contact with infected horses and the 
infection was cumulated in a closed community. We 
did not find any infected personal belongings or sports 
implements , therefore their etiological role as a source 
of infection could be excluded. The infection spread 
from one wrestler to the other due to the close skin 
contact, sweating and possible excoriations. 
wrestlers. Trichophyton equinum does not seem to be 
a highly pathogenic dermatophyte. The glabrous skin 
mycoses produced only mild symptoms and responded 
well to topical antimycotic treatment. In one of the three 
scalp mycoses a severe inflammatory reaction was 
observed which required a three months-long oral 
terbinafine and topical antimycotic treatment for cure. 
The epidemic could only be stemmed by screening 
all members of the wrestling team and treating all of 
the infected patients at the same tirne. The use of 
antimycotic shampoo for all members, disinfection of 
the sports implements and clothes were our successful 
preventive measures to stop the epidemic. 
These mycotic infections were only observed in the 
age group of 8 to 17 years. The infection was not 
transmitted to the adults training with the young 
:RE.FE .H.E CES 
AUTHORS' 
ADDRESSES 
66 
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case. J Am Acad Dermatol 1994; 30: 785-7. 
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1997; 73: 197-202. 
4. Frisk A, Heilborn H, Melon B. Epidemic occurence of trichophytosis among wrestlers. Acta Derm 
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5. Stiller MJ, Klein WP, Dorman RI, Rosenthal S. Tinea corporis gladiatorum: an epidemic ofTrichophyton 
tonsurans in student wrestlers. J Am Acad Dermatol 1992; 27: 632-3. 
6. Cohen BA, Schmidt C. Tinea gladiatorum (letter). N EnglJ Med 1992; 327: 820. 
7. Rosenthal S et al. Brote epidemico de tinea corporis producido por Trichophyton tonsurans en 
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8. Beller M, Gessner BD. An outbreak of tinea corporis gladiatorum ona high school wrestling team. J 
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9. Werninghaus K. Tinea corporis in wrestlers (letter). J Am Acad Dermatol 1993; 28: 1022-3. 
10. Hradil E et al. An epidemic of tinea corporis caused by Trichophyton tonsurans among wrestlers in 
Sweden. Acta Derm Venereol 1995; 75: 305-6. 
Nora Eros, MD, Department oj Dermatology, Semmelweis Hospital, Csaba 
kapu 6, H-3501 Miskolc, Hungary 
Zsuzscinna J{ciroly MD, same address 
Erzsebet Molnar, same address 
acta dermatovenerologica A.P.A. Vol 8, 99, No 2