Dermatophyte infection transmitted by an African pygmy hedgehog

Abstract

Dermatophyte infection transmitted by an African pygmy hedgehog Dear Editor, A 44-year-old woman presented in the outpatient clinic with severe itching, redness, and rash on the skin of the third finger of the right hand, of 2 weeks duration. The dermatological examination revealed an erythematous infiltrative plaque, sharply separated from the surrounding skin, which covered the medial and distal phalanges of the third finger of the right hand. Vesicles filled with clear or yellowish contents as well as erosions were observed within the plaque (Fig. 1a,b). Based on the medical history and clinical findings, a working diagnosis of secondarily infected dyshidrotic eczema was made. Topical treatment was started with a cream containing fusidic acid and betamethasone valerate. One week later, a significant deterioration of the dermatological status was observed with the appearance of bullae, abundant exudation, and diffuse erythemo-edema in the affected area. Treatment with topical gentamicin, systemic antibiotic treatment with amoxicillin/clavulanic acid, and systemic antiviral treatment with valaciclovir was started. The microbiology swabs and PCR for herpes virus type 1 and type 2 came back negative. At the follow-up appointment, a more detailed history revealed that the patient held two African pygmy hedgehogs of the genus Atelerix albiventris as pets (Fig. 2). One of the hedgehogs had suffered with acariosis for several months before our patient developed her rash, which was treated with subcutaneous ivermectin until it resolved. For several weeks, however, our patient had noticed an annular area with loss of the hedgehog’s spikes. The affected region was also red and scaly. We discontinued the topical and systemic treatment and performed a Wood lamp examination which showed greenish fluorescence. A microscopic preparation stained with black chlorazole showed septate hyphae with fusiform macroconidia. On the 9th day, culture on Sabouraud dextrose agar showed powdery texture with cinnamon color on the back, characteristic of Microsporum gypseum. The patient was treated with topical fenticonazole nitrate cream and with systemic terbinafine 250 mg daily for 14 days. The follow-up examination showed significant improvement, and treatment was continued with miconazole nitrate/hydrocortisone cream twice daily for 21 days more (Fig. 1c,d). Mycological examination of the African pygmy hedgehog in a veterinary clinic also showed Microsporum gypseum, isolated from the affected areas. The hedgehog was treated with enilconazole and a repeated course of ivermectin, which led to complete resolution of the skin condition and recovery of the spikes in the affected area. The African pygmy hedgehog (Atelerix albiventris) is an insectivorous animal that lives in the steppe and savannah regions of Africa. Due to the increasingly popular hobby of keeping hedgehogs as pets, there is an increased risk of transmitting infectious or parasitic agents from these pets to their owners. The spread of hedgehogs through online stores without detailed information about their origin or health can contribute to the spread of zoonoses through direct contact with hedgehogs, their excrements, or food.