Journal of Babylon University/Pure and Applied Sciences/ No.(4)/ Vol.(23): 2015



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Journal of Babylon University/Pure and Applied Sciences/ No.(4)/ Vol.(23): 2015

Survey of Dermatophytosis in Patient of Al- Sweara Hospital
NoorIsmeal Nasser

Technical Instite/kufa, Departement of Medical Laboratory
NoorIsmeal@yahoo.com
Astract

This study was conducted to determined the occurrence and causative agents of dermatophytosis in patients attending the Dermatology section of Al- Sweara hospital during the period from August 2012 to July 2013 . A total of 200 samples were collected including infected skin, hair and nail, 146 samples were found to be positive. The result revealed that The main causative agent that cause different type of dermatophytic infection was T. rubrum 32.8% followed by T. mentagrophytes 30.1%. the higher percent of infection appear to be in the age group 1-15years 31.5% followed by 16-30 years 30.1% also found that the most predominant clinical condition observed in this age groups was T. capitis 14.3% and T. corporis 10.2% while T. pedis 6.1% appear to be the main causative agents in the age group 31-45 years in addition to that very few cases of dermatophytic infection found in older patient 61 years and above. Male members were affected more than the female, where are the infection percent in male was 61.6% while in female 38.3% but the result statistically non significant. The statistical analysis of the collecting data achieved by using Chi – square test and the percentage.



Key Words: fungi , Dermatophytosis, Epidemiology, T. capitis, onycomycosis. dermatomycosis

الخلاصة

أجريت الدراسة لتحديد مدى انتشار القوباء الحلقية والأنواع الفطري المسببة لها لدى المرضى المراجعين لقسم الأمراض الجلدية في مستشفى الصويرة العام. ابتداء من شهر أب 2012 ولغاية شهر تموز2013. حيث تم جمع 200 عينة شملت أجزاء من الجلد , الشعر, والأظافر المصابة , وان 146 من هذه العينات أعطت نتيجة ايجابية 73%. وأظهرت الدراسة إن فطر Trichophyton rubrum هو العامل المسبب الأكثر شيوعا لحالات مختلفة من القوباء الحلقية وبنسبة عزل بلغت 32.8% يليه فطر T. mentagrophytes بنسبة عزل 30.1% بالإضافة لأنواع أخرى من الفطريات.

بينت الدراسة إن أعلى نسبة إصابة كانت ضمن الفئة العمرية من 1-15سنة وبنسبة 31.5% تليها الفئة العمرية 16-30 وبنسبة 30.1%. ووجد إن Tinea capitis فطريات الرأس و Tinea corporis فطريات الجلد هي الحالات المرضية الأكثر شيوعا لدى المرضى بعمر 15 سنة فما دون وبنسبة 14.3% و 10.2% على التوالي. بينما tinea pedis فطريات القدم هي الأكثر شيوعا لدى الفئة العمرية 31-45 وبنسبة 6.1%, وكانت نسبة الإصابة بالقوباء الحلقية لدى المرضى بعمر 61 فما فوق هي 5.4%, و أن نسبة الإصابة لدى الذكور أعلى 61.6% من الإناث 38.3% , إحصائيا لم يكن لجنس المريض إي تأثير معنوي على نسبة الإصابة بالقوباء الحلقية .

الكلمات الدالة:- الفطريات, القوباء الحلقية , علم الوبائيات, فطريات الرأس, التهاب الأظافر الفطري, الفطريات الجلدية

Introduction

Dermatophytosis is a superficial fungal infection on the skin, hair and nails. It is one of the most common diseases around the world caused by truedermatophytes, Trichophyton,Microsporum and Epidermophyton), yeast like candida species and moulds Aspergillus, Alternaria, Fusarium etc.(Hasanetal., 2011).Dermatophytes typically do not affect the mucus membranes but rather affect the keratinized tissues and spread by direct contact from infected human beings (anthropophilic organisms), animals (zoophilic organisms), and soil (geophilic organisms) and by indirect way from fumets. Although the clinical signs of dermatophytosis may vary depending on the affected region of the body, pruritis is the most common symptom in humans(Nwezeetal, 2010).

Dermatophytes infection usually refer to as “Tinea and are classified into different types depending on the site infected on the human body; Tinea capitis usually infect of the scalp and hair , typically there are Mild scaling lesions to widespread alopecia. Kerion: highly inflammatory, suppurating lesion caused by zoophilic dermatophytes. Black dot appearance seen with ectothrix hair invasion. Favus is a distinctive infection with grey, crusting lesions. Asymptomatic carrier state recognized, may promote spread of infection (Sanuth& Efuntoye, 2010). Tinea corporis Usually affects exposed body sites skin of the trunk, legs and arms. Exact nature depends on infecting organism; infections due to zoophilic species are often more inflammatory and may be pustular. Typically, there are itching, dry, circular, scaling lesions. Fungus more active at margin therefore more erythematous (Weitzman&Summerbell, 1995). Tinea cruris Usually Infect the skin of the groin and pubic region typically there are One or more rapidly spreading erythematous lesions with central clearing on the inside of the thighs, intense pruritis. Lesions with raised erythematous border and brown scaling. Infection may extend locally and spread to other body sites and others (Sanuth&Efuntoye, 2010). The characteristic and epidemiology of these dermatophytes significantly affected by cultural back ground, geographic location and population migration pattern. Avery significant variations in the pattern of dermatophytosis in different countries is clearly evident from studies performed by (Ayadietal, 1993; Staats & Korstanje et al.,1995; Weitzman & Summer, 1995; Ellabib &Khalifa, 2001;Anosikeet al.,2005). The heterogenicity in the distribution pattern of dermatophytes in different parts of the word has been attributed to factors of climate, life style and prevalence of immunodeficiency disease in community (Ungpakron,2005).

Material and Methods

A total of 200 clinical samples were collected from patients attending the Dermatology Clinic at Al-sweara hospital with suspected clinical symptoms of fungal infection during the period from August 2012 to July 2013. Before collecting the sample the infected area was prepared with 70% alcohol and ensured for total dryness. Then the samples were collected by scrapping, if it is skin, clipping if it is nail or hair by making use of the sterile scalpel or forceps. Collected samples were kept in a sterile container and transferred to the laboratory for further analysis.(Eran. Richardson ,1989).

Microscopic examination of the samples was performed following treatment with an aqueous solution of 20% potassium hydroxide (KOH). A portion of the sample was placed on a slide and 50 μL of KOH was added. After 5 min., the wet preparation was examined for the presence of fungal elements and their diagnostic morphology. All samples were cultured on Sabouraud chloramphenicol cycloheximide agar (SCCA, SDA with cycloheximide 0.5 mg/mLand chloramphenicol 0.05 mg/mL), Sabouraud gentamicin chloramphenicol agar (SGCA), and dermatophyte test agar (DTA). Olive oil (2%) was added to SGCA when pityriasis versicolor was suspected (Eran Richardson, 1989; Ellis, 1994). The plates were inoculated with finely divided pieces from the samples and incubated at 25°C or 30°C for up to 4 weeks. The plates were examined twice weekly for evidence of growth. Fungal isolates were then subcultured onto Sabouraud and potato dextrose agar in petri dishes. The isolates were examined macroscopically by noticed the mycelia texture, rate of growth, and changes in the coloration of the medium due to alkaline production by the dermatophytes and microscopically using lactophenol cotton blue, Characteristics features of conidia such as the shape, sizes as well as the septate pattern of the conidia and hyphae and some special features including chlamydospores and antler shaped hyphal formation were taken to consideration in identification. (Al-doory,1980). Chi – square test and the percentage were used for statistical analysis of the data (Snedecor & Cochran, 1974).
Results and Discussion:-

Diagnosis was confirmed by microscopic examination in 146 cases 73% . From the total isolates identified by culture growth, dermatophytes species were the most common, accounting for 59.5% of all fungal infections. Trichophyton rubrum was the most common isolates in this study 32.8% which was also reported as the main causative agent of Tinea in the study of (Venkatesan et al.,2007), followed by Trichophyton mentagrophytes30.1%, Candida ssp.15%, Microsporum canis14.3%, Epidermophy tonfloccosum 4.1, Fusariumssp.2% and Rhizopus species 1.3% as shown in Table 1.

The epidemiology of superficial fungal infections has changed significantly in the last century and reflects changes in the environmental conditions, socioeconomic conditions, lifestyle, and migration. Few studies have investigated the etiology of superficial fungal infections in the developing world, and consequently, there is less knowledge of any changes to their epidemiology (Foster et al., 2004; Ginter-Hanselmayer et al.,2007).

It is clearly shown from the result of this study that patients with age group 1-15 years has the highest percentage of infection 31.5% followed by 16-30 years 30.1%,Tinea capitis and Tinea corporis appear to be the most predominant clinical conditions observed in this age groups while Tinea pedis was found to be more in patients of age group 31-45 years and 46-60 years. Age group of 61years and above showed very few cases of dermatophytic infections, the results obtained were statistically significant (p<0.05) for the age groups as shown in Table 2, This finding is in agreement with the result of (Ameh& Okolo,2004).the highest percentage of infection by Tinea capitis in this age groups may be due to it is more common in children than in adults and occurs most frequently in hot climate(Havlickova,et al.,2008) in addition to that it is highly contagious and the infection may be accord through contacts with stray cats and dogs also its treatment is very problematic in children before the puberty because the physiological and pharmacokinetics features of antifungals in the hair at this age are hardly taken into account into the corresponding clinical studies(Seebacheret al.,2006). Both zoophilic and anthropophilic dermatophyte species are possible pathogens with considerable geographic differences (Schwinn et al.,1995).

According to the anatomic site involvement of dermatophyte infection, tinea corporis was the predominant clinical form of all ringworm infections seen, in which 25.3% of cases were of children below 15 years of age followed by T. corporis (21.9), while Tinea pedis was found more frequently in adults, as shown in Table 2,This finding is agree with the result of another study encompassing 2,203 patients with dermatomycoses in Isfahan, Iran, also Tinea capitis was the most prevalent clinical form (54.1%), followed by tinea corporis, tinea pedis (8.9%) and tinea cruris (6.8%), also in agreement with finding from Saudia Arabia (Abanmi, et al., 2008 ). This result may be due to low level of fungi static fatty acids at early stage and large family size may cause some neglect (in terms of hygiene standard), the sharing of towels, clothing and hair accessories may lead to spread of dermatophytes (Ansarin,H. et al., 2001). The humidity and temperature are well known factors affecting fungal penetration through the stratum corneum of the skin (Morishita et al. ,2003).

the result revealed that Male members were affected more than the female, the positive cases for males was 61.6% while for females was 38.3% but the results obtained were statistically non significant (p<0.05) for gender as shown in Table 3 , this finding is agree with some studies recorded higher prevalence of dermatophyte, in males 67.1% than females 32.9% (Falahati. et al.,2003 &Falahati. et al.,2005) In contrast (AlSheikh,2009) who found that dermatophytic infection in females 49.6% were almost double compared to males 26% . This variation in all these result may be indicate that the gender of patients doesn't the only factor that contribute to the occurrence of dermatophytosis, also there is other factor may be effect on the percent of dermatophytic infection in the examend population like predominantly the nature of job, personnel hygiene and the frequent interaction of man with different peoples of the society, all that could have been the reason for increase incidence of dermatophytes in male(Falahatiet al.,2003). While the lower incidence in females may be also due to the non-reporting of the female patients to the hospitals due to the prevailing social stigma in the rural population around this city (Saunteet al.,2008).





Fungi species

Total no of samples

Clinical manifestations

Rhizopus species

Fusarium Ssp.

Candida Ssp.

Trichophytonrubrum

Trichophytonmentagrophytes

Microsporumcanis

Epidermophytonfloccosum







%

No

%

No

%

no

%

no

%

no

%

no

%

no

%

no




0

0

0

0

3.4

5

8.3

12

2.7

4

0.6

1

1.3

2

16.4

24

Tinea cruris

0

0

0

0

1.3

2

14.6

16

4.7

7

2

3

2.7

4

19.1

32

Tineacorporis

1.3

2

0

0

2

3

4.1

6

11.6

15

7.5

11

0

0

25.3

37

Tineacapitis

0

0

0.6

1

4.1

6

6.8

10

7.5

11

0

0

0

0

17.1

28

Tineapedis

0

0

1.3

2

4.1

6

2.7

4

4.7

7

4.1

6

0

0

21.9

25

Onychomycosis

1.3

2

2

3

15

22

32.8

48

30.1

44

14.3

21

4.1

6

100

146

total
Table1 :- distribution of fungi species causing skin mycosis at deferent body sites.


Table 2: distribution of skin mycosis according to age groups and infection sites.

Different age group

Total no of samples

Clinical manifestations

61-above

46-60

31-45

16-30

0-15







%

no

%

no

%

no

%

no

%

no

%

no




2

3

2.7

4

4.1

6

6.1

9

1.3

2

16.4

24

Tinea cruris

0

0

0

0

4.7

7

6.8

10

10.2

15

21.9

32

Tinea corporis

0

0

0

0

4.1

6

6.8

10

14.3

21

25.3

37

Tinea capitis

2

3

3.4

5

6.1

9

4.7

7

2.7

4

19.1

28

Tinea pedis

1.3

2

3.4

5

4.1

6

5.4

8

2.7

4

17.1

25

Onychomycosis

5.4

8

9.5

14

23.2

34

30.1

44

31.5

46

100

146

total

X2= 40.3, P˂0.05 signifecant

X2&P value


Table 3:-Distribution of skin mycosisa cording to gender and infection sites.

gender

Total no of samples

Clinical manifestations

femal

male

%

no

%

no

%

no




6.8

10

9.5

14

16.4

24

Tineacruris

6.1

9

15.7

23

21.9

32

Tineacorporis

9.5

14

15.7

23

25.3

37

Tineacapitis

8.9

13

10.2

15

19.1

28

Tineapedis

6.8

10

10.2

15

17.1

25

Onychomycosis

38.3

56

61.6

90

100

146

total

X2= 3, P˂0.05 no signifecant

X2&P value


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