Fungal follicular infections tend to occur on the scalp (tinea capitis) and face (tinea barbae). Infection in areas other than the scalp or beard often follows the use of topical steroids on sites with superficial fungal infections. Tinea capitis occurs mainly in children and is the most contagious of the superficial fungal infections. Trichophyton tonsurans causes more than 90% of cases in the United States. Other organisms include Microporum canis and Microporum audouinii.Fungal folliculitis can be difficult to distinguish from bacterial. Tinea is not often suspected until a patient has failed treatment with antibiotics. Hints toward tinea infection include a more insidious onset, alopecia, scaling, and fewer pustules than seen in bacterial folliculitis. Involved hairs in fungal infections can be removed with only gentle manipulation. Hairs that have broken close to the skin surface may appear as black dots. M. audouinii fluoresces under black light but T. tonsurans does not. Fungal culture of scales and several hairs can be performed for speciation.Systemic antifungals are needed to penetrate the follicle. Although resistance is emerging, griseofulvin remains the drug of choice. However, concerns regarding resistance and drug toxicity prompt many clinicians to use terbenifine, itraconazole or fluconazole instead. Close contacts should be prophylactically treated with ketoconazole or selenium sulfide shampoo.*112/348/5*

Patients who are being treated for latent tuberculosis should be monitored periodically for the following:• Signs and symptoms of active tuberculosis• Adherence to the prescribed regimens• Complications from the medical regimens, especially hepatitisPatients should be educated on the signs and symptoms of hepatitis and should be instructed to stop medications and seek medical attention immediately for such an event. Patients on isoniazid should be monitored at least monthly. Routine monitoring of liver enzymes for patients on isoniazid is indicated when baseline liver readings are elevated or when risk factors for liver disease are present. Patients on pyrazinamide and rifampin should be seen every 2 weeks, and testing of liver enzymes and bilirubin should be obtained. If signs or symptoms of hepatoxicity develop, the liver enzymes should be tested and the medical regimen should be discontinued. Approximately 10% to 20% of patients taking isoniazid will develop some mild asymptomatic elevation of liver-associated enzymes. These are usually self-limited and do not necessitate discontinuation of therapy. If elevations in liver-associated enzymes exceed five times the upper limit of normal or the patient notes abdominal symptoms, then the drug should be discontinued, and the patient followed closely for signs of hepatotoxicity.*58/348/5*