Prevalence of Dermatophytic Fungal Infections in Children: A Recent Study in Anambra State, Nigeria

Epidemiology of Dermatophytes Isolated from Clinical Samples in a Hospital in Eastern Saudi Arabia: A 20-Year Survey

BACKGROUND

Dermatophytes are group of fungi that cause superficial infections via enzymes that degrade keratin in human skin. Several factors, including climate, gender, age, lifestyle, human migration, cultural habits, and socioeconomic status influence the prevalence of dermatophyte infections. We analyzed the prevalence of dermatophyte isolates in a hospital in Eastern Saudi Arabia from 2000 to 2019.

METHODS

The data on fungal cultures were obtained from the Laboratory Information System of the Mycology Laboratories at Johns Hopkins Aramco Healthcare, and were used for the analysis. Fungal isolates were examined microscopically for the presence of specialized hyphal structures and conidia. The Vitek^® MS microbial identification system (biomerieux) was used if the culture type was not identified microscopically.

RESULTS

Among the 10,021 samples analyzed, 3040 (30.33%) were positive for fungi and only 398 (3.97%) were dermatophytes. Microsporum species was the most common dermatophyte accounting for 50.5% (n = 201) followed by trichophyton with 36.9% (n = 147). The most common positive samples were scrapping (251, 63%) and hair (68, 17%). Culture positivity relative to the age groups revealed a cluster of positive dermatophyte species in children < 10 years of age with 215 (54%) of all cases and among 10-19 years of age with 60 (15) of the cases (p < 0.001). Microsporum species were the prevalent dermatophytes in patients  < 10 years of age, while Epidermophyton species were the most frequent dermatophyte species in age groups 10-19, 20-29, and 30-39 years. However, Trichophyton species were the most frequent dermatophyte species in individuals 70-79 years. The percentage of Microsporum and Trichophyton species decreased significantly over time (p < 0.001). In addition, there was a significant seasonal variation in relation to Trichophyton species. A comparison between the most frequent species showed that there was no difference in relation to gender, but there was a difference in relation to the specimen type and age group.

CONCLUSION

Dermatophytosis was common among children and adolescent with the most common samples were scrapping and hair. There was a significant reduction in Microsporum and Trichophyton species over time.

Tinea Capitis by Microsporum audouinii: Case Reports and Review of Published Global Literature 2000-2016

Tinea capitis caused by Microsporum audouinii is reported herein from two Brazilian schoolchildren, which are brothers. Arthroconidia were evidenced on direct examination of scalp hair, and a fungus of the genus Microsporum was isolated from cultures of each patient. The isolated fungi were classified as M. audouinii by visualization of species-specific structures, including: pectinate hyphae, chlamydospores, and fusiform macroconidia, sterile growth with characteristic brown pigment in rice grains, and through DNA sequencing of the internal transcriber spacer region. Patients were refractory to ketoconazole, but the two cases had a satisfactory response to oral terbinafine. All M. audouinii infections described in this century were reviewed, and to our knowledge, this is the first literature description of this species from South America. Misidentification of M. audouinii with Microsporum canis can occur in this area, leading to erroneous data about the occurrence of this species.

Prevalence of Tinea Capitis among School Children in Nok Community of Kaduna State, Nigeria

In recent years, the prevalence of tinea capitis, an infection of the scalp by dermatophytes, has increased in children worldwide. This cross-sectional study was carried out to determine the prevalence and risk factor of tinea capitis among school children in Nok community of Kaduna State, Nigeria. A total of 100 children were screened and 45% were diagnosed to have tinea capitis after fungal culture and microscopy. The prevalence of tinea capitis among girls was higher (51.4%) than that among boys (41.5%) but not significantly different (p = 0.402). The prevalence with respect to age was lower for the age group 5-10 years (42.6%) than that of 11-15 years (50%) but was not significantly different (p = 0.524). Trichophyton rubrum (28.8%) and Microsporum canis (22.7%) were the most prevalent dermatophytes isolated and the least were Trichophyton verrucosum (4.5%) and Trichophyton tonsurans (4.5%). There were 73.3% single infection while 26.7% had 2-4 dermatophytes of the genera Microsporum and Trichophyton. The predisposing factors with statistically significant association with tinea capitis were number of children in the family (p = 0.02) and sharing of the same bed (p = 0.002). This indicates the high tendencies of spread of tinea capitis through human-to-human mode of transmission and possible animal contact. Community health education on the cause, mode of transmission, prevention, and prompt treatment of tinea capitis is recommended.

Isolation, Identification, and In Vitro Antifungal Susceptibility Testing of Dermatophytes from Clinical Samples at Sohag University Hospital in Egypt

Aim

The objective of this study was to isolate, identify, and explore the in-vitro antifungal susceptibility pattern of dermatophytes isolated from clinically suspected cases of dermatophytosis (tinea infections) attending the Dermatology Outpatient Clinic.

Methods

This study was conducted at Sohag University Hospital from December 2014 to December 2015. Clinical samples (e.g., skin scrapings and hair stumps) were collected under aseptic precautions. The identification of dermatophytes was performed through microscopic examination using 10% potassium hydroxide (KOH) with 40% dimethyl sulphoxide (DMSO) mounts and culture on Sabouraud dextrose agar (SDA) and on Dermasel agar base media, both supplemented with chloramphenicol and cycloheximide. All dermatophytes isolates were subjected to antifungal susceptibility testing using the agar-based disk diffusion (ABDD) method against Clotrimazole, Miconazole, Fluconazole, and Griseofulvin. Data were analyzed via SPSS 16, using Chi square and a screening test (cross-tabulation method).

Results

A total of 110 patients of dermatophytosis were studied. The patients were clinically diagnosed and mycologically confirmed as having tinea capitis (49), tinea corporis (30), tinea pedis (16), tinea cruris (9), or tinea barbae (6). The dermatophytes isolates belonged to 4 species: Microsporum canis 58 (52.7%), Microsporum gypseum 23 (20.9%), Trichophyton mentagrophytes 18 (16.4%), and Microsporum audouinii 11 (10%). The most effective antifungal drugs tested were Clotrimazole, followed by Miconazole (95.5% and 84.5% of isolates were susceptible, respectively).

Conclusion

Every patient with a tinea infection should be properly studied for a mycological examination and should be treated accordingly. Dermasel agar is more useful as an identification medium in the isolation of dermatophytes. The ABDD method appears to be a simple, cost-effective, and promising method for the evaluation of antifungal susceptibility of dermatophytes.

Dermatophytosis among Schoolchildren in Three Eco-climatic Zones of Mali

BACKGROUND

Dermatophytosis, and particularly the subtype tinea capitis, is common among African children; however, the risk factors associated with this condition are poorly understood. To describe the epidemiology of dermatophytosis in distinct eco-climatic zones, three cross-sectional surveys were conducted in public primary schools located in the Sahelian, Sudanian and Sudano-Guinean eco-climatic zones in Mali.

PRINCIPAL FINDINGS

Among 590 children (average age 9.7 years) the overall clinical prevalence of tinea capitis was 39.3%. Tinea capitis prevalence was 59.5% in the Sudano-Guinean zone, 41.6% in the Sudanian zone and 17% in the Sahelian eco-climatic zone. Microsporum audouinii was isolated primarily from large and/or microsporic lesions. Trichophyton soudanense was primarily isolated from trichophytic lesions. Based on the multivariate analysis, tinea capitis was independently associated with male gender (OR = 2.51, 95%CI [1.74-3.61], P<10(-4)) and residing in the Sudano-Guinean eco-climatic zone (OR = 7.45, 95%CI [4.63-11.99], P<10(-4)). Two anthropophilic dermatophytes species, Trichophyton soudanense and Microsporum audouinii, were the most frequent species associated with tinea capitis among primary schoolchildren in Mali.

CONCLUSIONS

Tinea capitis risk increased with increasing climate humidity in this relatively homogenous schoolchild population in Mali, which suggests a significant role of climatic factors in the epidemiology of dermatophytosis.

Dermatophyte and non dermatophyte fungi in Riyadh City, Saudi Arabia

Background

Dermatophytes are a scientific label for a group of three genera (Microsporum, Epidermophyton and Trichophyton) of fungus that causes skin disease in animals and humans. Conventional methods for identification of these fungi are rapid and simple but are not accurate comparing to molecular methods.

Objective

This study aimed to isolate human pathogenic dermatophytes which cause dermatophytosis in Riyadh City, Saudi Arabia and to identify these fungi by using conventional and molecular methods.

Methods

The study was conducted in Medical Complex, Riyadh and King Saud University. Samples of infected skin, hairs and nails were collected from 112 patients. Diagnosis of skin infections, direct microscopic test, isolation and identification of dermatophytes by conventional and molecular methods were carried out.

Results

The results indicated that the tinea capitis infection had the highest prevalence among the patients (22.3%) while Tinea barbae had the lowest. In this study the identified dermatophyte isolates belong to nine species as Trichophyton violaceum, Trichophyton verrucosum, Trichophyton rubrum, Trichophyton mentagrophytes, Trichophyton schoenleinii, Trichophyton concentricum, Microsporum canis, Microsporum audouinii and Epidermophyton floccosum which cause skin infections were isolated during this study. Non dermatophyte isolates included 5 isolates from Aspergillus spp. 4 isolates from Acremonium potronii and 15 isolates from Candida spp. M. canis were the most common species (25% of isolated dermatophytes). Out of the 52 dermatophyte isolates identified by conventional methods, there were 45 isolates identified by the molecular method.

Conclusions

The results concluded that approximately M. canis caused a quarter of dermatophyte cases, tinea capitis infection was prevalent and the molecular method was more accurate than conventional methods.

The Prevalence and Pattern of Superficial Fungal Infections among School Children in Ile-Ife, South-Western Nigeria

Fungal infections of the skin and nails are common global problems with attendant morbidity among affected individuals. Children are mostly affected due to predisposing factors such as overcrowding and low socioeconomic factors. The aim of this study was to determine the prevalence and the clinical patterns of superficial fungal infections among primary school children in Ile-Ife. A multistage sampling was conducted to select eight hundred pupils from ten primary schools in Ile-Ife. Data on epidemiological characteristics and clinical history was collected using a semistructured questionnaire and skin scrapings were done. The prevalence of superficial fungal infections among the 800 respondents was 35.0%. Male pupils constituted 51.0% of respondents while the females were 49.0%. The mean age for all the respondents was 9.42 ± 2.00. Tinea capitis was the commonest infection with a prevalence of 26.9% and tinea unguium, tinea corporis, and tinea faciei had a prevalence of 0.8%, 0.6%, and 0.5%, respectively. Tinea manuum had the least prevalence of 0.1%. Pityriasis versicolor had a prevalence of 4.4%. Microsporum audouinii was the leading organism isolated. The study shows that the prevalence of superficial fungal infection (SFI) among primary school children in Ile-Ife is high with tinea capitis as the commonest SFI.

Epidemiology of tinea capitis among school-age children in Meiganga, Cameroon

Tinea capitis (TC) commonly called scalp ringworm is a worldwide concern and a public health problem in Africa. This study aimed at determining the epidemiologic profile of TC among school-aged children in the savanna zone of Cameroon. All children present at school during this study period, August 2011-July 2012, were examined for signs suggestive of TC. Children not registered at school were excluded from the study. Pathologic specimens were taken from suspected head lesions and cultured. Amongst the 4601 children, average age 10.7±0.16 years, 377 presented with suggestive TC lesions giving a prevalence of 8.1%. The proportion of boys with TC was (63.7%) higher than in girls (36.3%) (P≤0.05). TC manifestations varied; small plaques of alopecia 59.26% were the most frequent. Communal living was the most incriminated risk factor. Three hundred and thirty six isolates were obtained in culture. The prevalence was significantly higher (P<0.05) in age range between 8 and 12 years, followed by that between 13 and 15. The most prevalent isolate was T. soudannense 56.8%, followed by T. rubrum 29.2%. Only 6.0% of the isolates belonged to the genus Microsporum.

Dermatophytoses in domesticated animals

Dermatophytes are among the most frequent causes of ringworm infections in domesticated animals. They are known to serve as reservoirs of the zoophilic dermatophytes and these infections have important zoonotic implication. In Nigeria and probably West Africa, there are not many studies on the incidence of dermatophytosis in domesticated animals. In the current study, 538 domesticated animals with clinically suggestive lesions were investigated for dermatophytes. Identification of dermatophyte species was performed by macro- and micro morphological examination of colonies and by biochemical methods. In the cases of isolates that had atypical morphology and/or biochemical test results, the rDNA internal transcribed spacer region 2 (ITS 2) sequencing was performed. Out of this number, 214 (39.8%) were found to be colonized by a variety of ten species of dermatophytes. M. canis was the most frequently isolated species (37.4%), followed by T. mentagrophytes (22.9%) and T. verrucosum (15.9%). M. persicolor and T. gallinae were jointly the least species isolated with a frequency of 0.55% respectively. The recovery of dermatophyte isolates previously shown to be common etiological agents of dermatophytosis especially from children in the same region suggests that animal to human transmission may be common. Possible implications and recommendations are discussed.

Oral Candida isolates among HIV-infected subjects in Nigeria

BACKGROUND

Nigeria is a West African country of more than 150 million persons with the second highest case of HIV/AIDS infected patients in the world. The species spectrum of oral yeast colonization and the susceptibility to a wide range of antifungal agents is poorly understood in Nigeria especially in the south east, south south, and the northern axis. This study evaluates the species spectrum of oral colonization by Candida species in HIV-infected patients in Nigeria and the in vitro susceptibility pattern of the Candida isolates to a broad range of antifungal agents.

METHODS

Two hundred oropharyngeal swabs from HIV-infected patients and 100 age-matched healthy controls were screened for yeast isolates using standard procedures and confirmed by the analytical profile index 20C along with other biochemical tests. In vitro susceptibility testing of the yeast isolates to antifungals were performed using the broth microdilution method protocol recommended by the Clinical Laboratory Scientific Institute.

RESULTS

Of 200 patients screened, 120 (60%) were colonized by yeasts. C albicans was the dominating species in both groups with 54 (45%) isolated from HIV subjects. The non-albicans Candida species accounted for 55% with C tropicalis 22 (18.3%) showing the highest frequency. We observed that 11.7% of all yeasts isolates were resistant to fluconazole, 8.3% to flucytosine, 7.5% to itraconazole, and 1.7% to voriconazole. All isolates were susceptible to amphotericin B and most of them demonstrated very low voriconazole minimal inhibitory concentrations. Apart from C albicans, C tropicalis and C parapsilosis isolates were also recovered from apparently healthy control subjects.

CONCLUSION

Although C albicans continues to be the dominant Candida species in oral Candida carriage of HIV-infected patients in Nigeria, the nonalbicans Candida species are increasing. Furthermore, the finding of resistant isolates in our study emphasizes the need for antifungal susceptibility testing whenever antifungal treatment is desired especially in HIV-infected subjects.

Dermatophyte infections in Cairo, Egypt

In this study, we examined dermatophyte infections in patients referred to the Department of Dermatology, EL-Houd El-Marsoud Hospital, Cairo, during March 2004 to June 2005. Of 506 patients enrolled in this investigation, 403 (79.6%) were clinically diagnosed as having dermatophytoses (age range 6-70 years; males 240; females 163). Species identification determined by observation of their macroscopic and microscopic characteristics was complemented with sequencing of the internal transcribed spacer ITS1-5.8S-ITS2 rDNA region. The most common dermatophyte infection diagnosed was tinea capitis (76.4%), followed by tinea corporis (22.3%) and tinea unguium (1.2%). The most frequently isolated dermatophyte species was Trichophyton violaceum, which accounted for most (71.1%) of all the recovered dermatophytes, followed by Microsporum canis (21.09%), Trichophyton rubrum (6.2%), and Microsporum boullardii (0.49%); both Epidermophyton floccosum and Trichophyton tonsurans were each only rarely isolated (0.24%).

Childhood dermatomycoses study in Sfax Hospital, Tunisia

Mycoses are frequent affections in childhood. Fungal type varies according to the age and the affected organ. The aim of this study was to determine the aetiological agents of childhood dermatomycoses and to draw attention to the diversity of their clinical manifestations. Retrospective study dealing with children's cases with age <16-year old and having dermatomycosis diagnosed between 1991 and 2005 at the Parasitology and Mycology Laboratory of Sfax University Hospital. A total of 4559 children suspected to have superficial mycoses were examined. Dermatomycosis diagnosis was confirmed in 49.3% of cases. Dermatophytes were the most prevalent fungal agents and accounted for 1865 cases (80.6%) dominated by Trichophyton violaceum (54.1%) and Microsporum canis (24.5%). Tinea capitis (69.4%) was the most common type of infection, followed by tinea corporis (20%). Superficial yeast infections (442 cases) were dominated by Malassezia infections (71%). Candida infections were mainly due to Candida albicans (58%). The clinical features of paediatric dermatomycoses vary with the age of the children: tinea capitis and tinea corporis were more frequent before 13 years of age. After this age, tinea versicolor and onychomycoses became more common.

Tinea capitis among primary school children in Anambra state of Nigeria

Tinea capitis continues to be a common problem of infancy and childhood, particularly among those living in unhygienic crowded conditions. The prevalence and aetiology of tinea capitis have not been well defined in Anambra state of Nigeria - hence the need to undertake this study. A total of 47,723 primary school children residing in different regions of the State was screened for tinea capitis between 2002 and 2005. Of this number, 4498 (9.4%) had tinea capitis. The highest prevalence of the disease occurred in the Southern region of the state (12.6%). Schools in urban areas recorded lower prevalence of the disease. Male : female prevalence ratio of 1.6 : 1 was recorded. Tinea capitis occurred significantly more in children below 10 years of age than in those above this age (chi(2 )= 3.178; P < 0.10). Of 502 isolates recovered in culture, Microsporum audouinii was the most prevalent (42%), followed by M. ferrugineum (17%) and Trichophyton mentagrophytes (16%). Four of the samples revealed spore head of Aspergillus spp. in direct sample microscopy. A total of 29 (6%) isolates was atypical forms. The majority (91%) of children with the lesion came from families of three or more children, living in crowded apartments. Results showed that tinea capitis remains an important public health problem in Anambra state of Nigeria.

In vitro susceptibility testing of dermatophytes isolated from pediatric cases in Nigeria against five antifungals

The antifungal activities of itraconazole, ketoconazole, fluconazole, terbinafine and griseofulvin were tested by broth microdilution methods against 71 isolates of dermatophytes isolated from Nigerian children. Most drugs were very active against all the dermatophytes and the MIC 90 ranged from 0.03 to 8.0 µg/mL. This appears to be the first documented data on the antifungal susceptibility testing of isolates of dermatophytes from Nigerian children.

Prevalence of dermatophytosis in junior secondary schoolchildren in Ogun State, Nigeria

A total of 2772 randomly selected junior secondary school pupils (aged 8-14) from 60 schools were examined for dermatophytic infections by direct microscopy and culture-based laboratory diagnostic methods. Of these, 641 (23.21%) had dermatophytosis. Out of these, 376 (13.56%) were male while 265 (9.56%) were female. Aetiological agents identified with infection were Microsporum canis (30.19%), Microsporum audouinii (32.92%), Trichophyton interdigitale (14.37%), Trichophyton soudanense (9.73%) and Trichophyton tonsurans (12.05%). Most of the dermatophytes encountered were anthropophilic species. Microsporum canis was the only zoophilic dermatophyte. Differences were not observed in infection pattern for all the different geo-political zones that make up the state. The head and the skin of the students were more frequently infected than the nails and toes. Infection frequency increased steadily up to age 11 after which it drastically decreased.