Characteristics of dermatophytoses among children in an area south of Tehran, Iran

Trends in the epidemiology of dermatophytosis in the Middle East and North Africa region

Dermatophytosis corresponds to a broad series of infections, mostly superficial, caused by a group of keratinophilic and keratinolytic filamentous fungi called dermatophytes. These mycoses are currently considered to be a major public health concern worldwide, particularly in developing countries such as those in the Middle East and North Africa (MENA) region. Here we compiled and discussed existing epidemiologic data on these infections in the MENA region. Most of the available studies were based on conventional diagnostic strategies and were published before the last taxonomic revision of dermatophytes. This has led to misidentifications, which might have resulted in the underestimation of the real burden of these infections in the MENA countries. Our analysis of the available literature highlights an urgent need for further studies based on reliable diagnostic tools and standard susceptibility testing methods for dermatophytosis, which represents a major challenge for these countries. This is crucial for guiding appropriate interventions and activating antifungal stewardship programs in the future.

Superficial mycoses, a matter of concern: Global and Indian scenario-an updated analysis

Superficial mycoses of skin, nails and hair are among the common fungal infections. They are caused by dermatophytes, non-dermatophyte moulds, yeasts and yeast-like fungi. Such fungal infections are widespread all over the world and are predominant in tropical as well as subtropical regions. Environmental factors, such as warm, humid and pitiable hygienic conditions, are conducive for their growth and proliferation. Although it does not cause mortality, it is known to be associated with excessive morbidity which may be psychological or physical. This affects the quality of life of the infected individuals which leads to a negative impact on their occupational, emotional and social status. Such infections are increasing on a global scale and, therefore, are of serious concern worldwide. This review article covers the global and Indian scenario of superficial mycoses taking into account the historical background, aetiological agents, prevalence, cultural and environmental factors, risk factors, pathogenesis and hygienic practices for the prevention of superficial mycoses.

Epidemiology of dermatophytoses in paediatric population in Southwestern Poland, 2011-2016

INTRODUCTION

Dermatophytoses are the most common superficial fungal infections in paediatric population. Its pathogen pattern has changed over years.

AIM

To analyse the spectrum of dermatophytoses in children living in Southwestern Poland, in the years 2011-2016.

MATERIAL AND METHODS

A total of 1705 patients were diagnosed with fungal skin infection in the Mycological Laboratory, Dermatology Department of the Wroclaw Medical University. Of them, 163 were under 18 years of age.

RESULTS

In 105 cases, dermatophytoses were detected. The collected specimens were examined using direct microscopy examination, staining, culture on specific media and PCR technique. The most common dermatophytes were Trichophyton rubrum and Trichophyton tonsurans (31.4% each), followed in the descending order by Trichophyton mentagrophytes (21.9%), Microsporum canis (13.3%) and Epidermophyton floccosum (1.9%). The most commonly affected body sites were glabrous skin of the trunk and extremities (41.7%), followed by face (22.2%), scalp (15.7%) and toe nails (14.8%).

CONCLUSIONS

This study revealed the most common types of dermatophytoses and their pathogens in children in Southwestern Poland. In comparison to earlier data obtained from this region, new epidemiological trends have been revealed. We observed the shift towards anthropophilic dermatophyte infections and an increasing number of onychomycosis in children. Because of climatic variations, migration, and changing lifestyle practices, further studies on dermatophytoses are necessary to improve our knowledge on the epidemiology of fungal infections.

Epidemiological Characteristics and Risk Factors of Tinea Pedis Disease Among Adults Attending Tikrit Teaching Hospital/ Iraq

BACKGROUND

Tinea pedis is one of the most common skin infections of interdigital toe webspace as well as feet skin and may affect the nail or the hand. It is caused by dermophytes fungi especially Trichophyton species. Direct contact with a contaminated environment or animal is the main mode of transmission. Tinea pedis is more frequent among adults than children and more among those with the previous infection with the disease, diabetes mellites, abnormally increased sweating, and the disease is common among individuals who wear unventilated (occlusive) footwear. Tinea pedis is 2-4 times more common in men than females.

AIM OF THE STUDY

To study the epidemiological characteristics and risk factors of tinea pedis disease.

METHODS

Descriptive study was conducted on patients attending the dermatology outpatient clinic in Tikrit Teaching Hospital, Tikrit, Iraq. The study was done during the period from 1st November 2018-10th June 2019. The sample included 680 persons. The cases were diagnosed clinically and by a direct microscope. The demographic information of patients was obtained according to certain questionnaire design. The study was done to reveal the epidemiology of tenia pedis disease among affected patients.

RESULTS

The frequency of tinea pedis cases among the study sample was 7% (48/ 680). It has been observed that there was no significant association as a result of the difference in gender, body weight, positive family history, history, presence of fungal skin disease, and presence of nail trauma. On the contrary, a significant association was observed as a result of the presence of the young age group, diabetes mellitus, and history of wearing occlusive shoes.

CONCLUSION

The frequency of tinea pedis disease among the study sample was 7%. There was a significant association between age group and the presence of diabetes mellitus disease and wearing occlusive shoes.

Tinea manuum: A report of 18 cases observed in the metropolitan area of Milan and review of the literature

OBJECTIVE

Tinea manuum is considered in Italy as an uncommon infection, although no recent epidemiological data are available.

METHODS

In the period 2000-2018, we observed in the metropolitan area of Milan 18 patients with mycologically tinea manuum.

RESULTS

The infection was monolateral in all patients and characterised by erythema and scaling; in two patients, each vesicles and pustules were present. Two patients had also onychomycosis of one fingernail. No cases of simultaneous tinea pedis were observed. As far as the job of these patients is concerned, seven of them were masseurs, three barbers, two cattlemen, two masons, one car mechanic, one florist, one maid and one veterinarian. Trichophyton rubrum was isolated in 6 patients, Microsporum canis in 4, Trichophyton gypseum in 3, Trichophyton verrucosum in 3 and Trichophyton violaceum in 2 patients.

CONCLUSION

Masseurs were the most affected. Trichophyton rubrum and Microsporum canis were the most frequent isolated dermatophytes.

Characterizing the clinical isolates of dermatophytes in Hamadan city, Central west of Iran, using PCR-RLFP method

OBJECTIVE

Dermatophytosis is one of the most common mycotic infections, which considered as a public health problem in the major of countries. This study evaluated the molecular epidemiology of dermatophytosis in patients referred to Farshchian hospital in Hamadan city with PCR-RFLP method.

MATERIALS AND METHODS

Four hundred and five specimens from clinically suspected patients of dermatophytosis were collected and analyzed by direct microscopic and culture. The isolates were identified by PCR-RFLP method using the MvaI restriction enzyme.

RESULTS

Of the 405 specimens, 88 specimens were positive in direct examination and culture. Among the patients, 64.8% were males and35.2% females. Tinea pedis (31.8%) was the most common type of dermatophytosis followed by tinea corporis (22.7%), tinea cruris (20.5%), tinea capitis (10.2%), tinea manuum (5.7%), tinea faciei (4.6%) and tinea unguium (4.6%). Trichophyton interdigitale (36.4%) was the most common isolate followed by Trichophyton rubrum (27.3%), Epidermophyton floccosum (17%), Trichophyton tonsurans (11.4%), Microsporum canis (4.5%), Microsporum gypseum (2.3%) and Trichophyton benhamiae (1.1%).

CONCLUSION

Our finding showed that the anthropophilic dermatophyte species causing dermatophytosis are increasing, and molecular methods are reliable assays for accurse identification of dermatophyte species in epidemiological studies.

A 10-Year Study of Dermatophytoses in Isfahan, Iran

Dermatophyte infections are very common worldwide and their epidemiological characteristics vary according to the geographical region and have altered in the last decades. The aim of the present investigation was to determine the diversity of causative agents of dermatophytoses and describe the epidemiological condition of infection in Isfahan, Iran, between 2003 and 2012. Specimens were collected from hair, nail, and skin and were examined by conventional methods such as direct microscopy, culture on sabouraud dextrose agar with chloramphenicol and cycloheximide (Mycosel agar) and sabouraud glucose agar, Trichophyton agars, growth on rice grains, urease test, and hair perforation test. Of 13,469 clinically suspected cases, 11.5% were affected with dermatophytoses. Tinea capitis was the most frequent form of infection (52.7%), followed by tinea corporis (24%), tinea pedis (8.9%). Trichophyton verrucosum was the most prevalent causative agent (40.6%), followed by T. mentagrophytes var. interdigitale (17.6%), Epidermophyton floccosum (13%), T. violaceum (12%), T. rubrum (4.1%). Age range of patients was between 1 and 80 years. Housewives were the most patients in our study. The study emphasizes importance of epidemiological surveys of dermatophyte species for the better management of infection.

Epidemiological trends in zoophilic and geophilic fungi in Iran

BACKGROUND

Dermatophytes can be divided into geophilic (soil), zoophilic (animals) and anthropophilic (human) strains, depending on the source of the keratin. The predominant organisms vary within a given geographical region during different periods, which is influenced by a number of factors, such as population movements, socioeconomic circumstances and level of surveillance. Thus, the incidence is very variable.

AIM

To determine the epidemiology of superficial fungal infections due to zoophilic and geophilic fungi in patients referred to the Pasteur Institute of Iran.

METHODS

The clinical presentation of zoophilic and geophilic dermatophyte-related infections was reviewed retrospectively from the medical records of all subjects referred to our laboratory for assessment of cutaneous fungal infection. Mycological examination consisted of culturing of pathological material followed by direct microscopy. Diagnosis was based on the macroscopic and microscopic characteristics of the colonies.

RESULTS

Of the 3976 clinically suspected cases of dermatophytosis, 239 (39.6%) were zoophilic dermatophytosis, confirmed by direct examination and culture. They occurred in 93 (39%) female patients and 146 (61%) male patients (median age 27.4 years, range 1.5-75). The commonest zoophilic fungi isolated were Trichophyton mentagrophytes var. mentagrophytes (28%), followed by Trichophyton verrucosum (9.3%) and Microsporum canis (2.2%). The geophilic fungus Microsporum gypseum was isolated from 0.33% of patients.

CONCLUSION

This study identifies the epidemiological trends and the predominant organisms causing zoophilic dermatophytosis in humans in Tehran. Consideration of the current epidemiological trends in the incidence of cutaneous zoophilic fungal pathogens is essential for investigation, diagnosis and treatment.

Tinea faciei due to microsporum canis in children: a survey of 46 cases in the District of Cagliari (Italy)

Dermatophytoses are frequent in children, but involvement of the facial skin has peculiar aspects that should be considered a separate entity: tinea faciei. Microsporum canis infection in tinea faciei has not been widely documented. To review cases of tinea faciei due to M. canis in children diagnosed at the Dermatology Clinic, University of Cagliari. Between 1990 and 2009, all children with dermatophyte infections of the facial skin were recruited for the study after parental consent. Diagnosis was made through direct microscopic and cultural examination. Age, sex, clinical form, illness duration, identified dermatophyte, source of infection, and treatment were recorded. Forty-six cases of tinea faciei due to M. canis in children aged 11 months to 15 years (29 male/17 female) were diagnosed. In 42 (91.3%) children, the illness was the result of contact with pets, and 4 (8.7%) cases resulted from contact with children affected by tinea capitis due to M. canis. Clinical manifestations were typical ringworm in 34 (74%) patients, whereas in 12 (26%) cases, atypical forms mimicking atopic dermatitis, impetigo, lupus erythematosus, and periorificial dermatitis were observed. In 18 (39%) cases, involvement of the vellus hair follicle was documented as ectothrix invasion. Topical or systemic antifungal therapy was effective in all patients. Tinea faciei shows a complex spectrum of differential diagnosis and age-related variations with respect to other superficial dermatophytosis. M. canis is the main organism responsible in children residing in Cagliari, capitol city of Sardinia, Italy. Close collaboration with veterinary and educational programs within infant communities are required for adequate prevention.

Tinea capitis due to Microsporum vanbreuseghemii: report of two cases

Two cases of dermatophytosis caused by Microsporum vanbreuseghemii are reported. A 7-year-old boy and his brother were examined for tinea capitis. Hair samples and skin scrapings were collected from each patient to microscopy and culture. Direct microscopic examination of the hairs using lactophenol revealed an ectothrix invasion. Cultures inoculated with portions of clinical material yielded M. vanbreuseghemii after 2 weeks. The identification of the fungi were based on colony morphology on mycobiotic agar, microscopic characteristic on slide cultures, biochemical reactions and hair perforation tests.

Onychomycosis in Iran: epidemiology, causative agents and clinical features

BACKGROUND

Onychomycosis represents the most frequently encountered nail disease, which is difficult to eradicate with drug treatment.

AIM

This study was undertaken to document the clinico-mycological pattern of onychomycosis in Iran. Results of mycological tests of nail scrapings collected over a 4-year period were analyzed.

METHODS

Both direct microscopy and cultures of the nail material were performed to identify the causative agents.

RESULTS

The microscopic and/or cultural detection of fungi was positive in 40.2% of samples. The most common clinical type noted was distolateral subungual onychomycosis in 48.4% of cases. Etiological fungal agents were 50% dermatophytes, 46.8% yeasts, and 3.2% saprophytic moulds. The most frequently detected dermatophyte species were Trichophyton rubrum (48.4%) and T. mentagrophytes (41.9%). Among yeasts, Candida albicans (58.6) was most common, followed by C. parapsilosis (17.2%), C. glabrata (10.3%), C. krusei and C. tropicalis (each 6.9%). Aspergillus niger and A. flavus were the most frequent saprophytic moulds. Females were affected more frequently than males, and in both sexes those most infected were between 40-49 years of age. Fingernails were affected more frequently than toenails.

CONCLUSIONS

The clinico-epidemiological data collected can serve as reference for future research and may be useful in the development of preventive and educational strategies.

The spectrum of fungal infections with a special reference to dermatophytoses in the capital area of Kuwait during 2000-2005: a retrospective analysis

BACKGROUND

Fungal infections constitute a major health problem all over the world. Signs and symptoms induced by various dermatophytic infections are difficult to distinguish clinically from each other. So, characterization by in vitro culture is required for appropriate diagnosis and treatment as well as to study the epidemiological characteristics in a region.

OBJECTIVES

The present retrospective work was aimed to study the spectrum of fungal infections of the skin, nails and hairs in the Capital area of Kuwait over a span of 5 years and to compare the results with those reported earlier from this region and other parts of the world. PATIENTS/MATERIALS: The study was conducted on 2,730 patients referred from dermatology outpatients to mycology laboratory suspected to have fungal infection over a 5-year period. Identification of dermatophyte isolates obtained was done by conventional microscopic examination in all patients, whereas culture techniques were performed for 1,593 of them.

RESULTS

Among 2,730 patients, 1,437 were men and 1,293 were women with a men to women ratio of 1.1:1. The age ranged from 3 months to 70 years (mean age 28.5 years). The clinical diagnosis of these patients was as follows: onychomycosis; tinea corporis; tinea capitis; tinea pedis; tinea cruris; tinea manum and tinea versicolor. Potassium hydroxide (KOH) examination showed positive results in 39% of all cases, whereas positive cultures were obtained in 29% of cultured specimens. Among dermatophytes, six species were isolated: Trichophyton mentagrophytes (39%), Microsporum canis (16%), Trichophyton rubrum (10%), Epidermophyton floccosum (6.2%), Trichophyton violaceum (2.4%) and Trichophyton verrucosum (0.4%). Trichophyton mentagrophytes was isolated from all body sites. Candida and Aspergillus niger were isolated on cycloheximide-free cultures in cases with onychomycosis.

CONCLUSIONS

Cutaneous fungal infections including dermatophytes remain prevalent in this part of the world. The most common isolate was T. mentagrophytes followed by Candida species. The least isolate was T. verrucosum. Species identification in relation to factors such as time, place and population is warranted in order to implement treatment regimens and to propose potential control measures.

Tinea corporis due to Trichophyton simii - a first case from Iran

A 25-year-old man was examined for tinea corporis. Microscopic examination of direct 10% KOH mount of skin scraping revealed the presence of hyaline, septate, branching hyphae. Cultures inoculated with portions of skin scrapings yielded, after two weeks Trichophyton simii. The identification of the fungus was based on colony morphology on mycobiotic agar and microscopic characteristics on slide cultures. Microscopic features of T. simii were cylindrical, 3-7 celled, thin-walled macroconidia. In older culture, macroconidia converted into chlamydospores, which is an important characteristic of T. simii.

Causative agents of superficial mycoses in Istanbul, Turkey: retrospective study

The aim of the present study was to determine the percentage of agents, which can give rise to superficial fungal infections in Istanbul, Turkey. Between 2000 and 2007, the clinical samples collected from 8,200 patients attending the outpatient Dermatology Clinic at Mihrimahsultan Medical Center were examined by direct microscopy and culture. Pathogen fungi were detected in 5,722 of the patients. Of the isolates were 4,218 (74%) dermatophytes, 1,196 (21%) Candida sp., 170 (3%) Malassezia furfur, and 138 (2%) Trichosporon sp. Among the dermatophytes, Trichophyton sp. was the most common isolate followed by Epidermophyton floccosum (243) and Microsporum sp. Among the Candida species, C. albicans (549) was also frequently found. Onychomycosis was the most prevalent type of infection, followed by tinea pedis, tinea cruris, tinea corporis, and tinea capitis. In conclusion, our study showed that the most common isolated agents from superficial infections were T. rubrum being Candida sp. the second most prevalent.

Epidemiology of dermatophytoses in Sfax, Tunisia

The distribution of dermatophytes varies in different countries and geographical areas depending on several factors. To determine the frequency of aetiological agents and the clinical variants of dermatophytoses, we carried out a study between 1998 and 2007. Out of 25 432 subjects suspected to have superficial mycoses, 9960 (39.2%) were affected with dermatophytoses; 14957 positive samples were obtained. The mean age was 35.7 years (range: 21 days to 97 years). Sex ratio was 0.9. Our patients were from urban regions in 81.9% of cases. The most common type of infection was onychomycosis (30.3%), followed by tinea pedis (24.8%), intertrigo (21.7%), tinea corporis (11.4%) and tinea capitis (9.6%). Fifteen patients had generalised dermatophytosis. Hadida and Schousboe disease was diagnosed in one case with lethal evolution. The most isolated dermatophyte was Trichophyton rubrum (74.5%), followed by T. violaceum (7.9%), T. mentagrophytes (7.5%), Microsporum canis (3.8%), Epidermophyton floccosum (0.7%) and T. verrucosum (0.54%). Other species were occasionally isolated: T. schoenleinii, T. tonsurans, M. audouinii and M. ferrugineum. The prevalence of dermatophytoses remains high in our country (996 cases/year). Trichophyton rubrum is the predominant causal agent. However, zoophilic agents become more prevalent. Epidemiological surveys are an essential tool for developing strategies for infection control.

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.

Dermatophytoses in outpatients attending the Dermatology Center of Avicenna Hospital in Qazvin, Iran

Dermatophytosis is still being considered as one of the major public health problems in many parts of the world. To identify the prevalence and etiological agents of dermatophytoses, a study was carried out between 2004 and 2006. Out of 1023 subjects suspected to have cutaneous mycoses, 348 (34%) patients were affected with dermatophytoses. The causative agents were identified macroscopically and microscopically after the clinical samples were subjected to potassium hydroxide examination and culture isolation. Epidermophyton floccosum was the most frequently isolated species representing 32.8% of isolates, followed by T. rubrum (18.1%), T. verrucosum (17.2%), T. mentagrophytes var. interdigitale (15.8%), T. mentagrophytes var. mentagrophytes (6.6%) and T. violaceum, T. schoenleinii and Microsporum canis (0.9%). The most common type of infection was tinea cruris (31.9%) affecting in particular male patients. Some other most prevalent tinea types were tinea corporis (20.7%), tinea pedis (19%), and tinea unguium (11.2%). To the best of our knowledge, this is the first report on dermatophytoses in Qazvin and the first study that shows tinea cruris as a major type of superficial fungal infection in Iran. The frequency of tinea was higher in males and tinea cruris showed a remarkably increasing tendency and was an important public health issue in Qazvin.

Characteristics of superficial fungal infections in the Riyadh region of Saudi Arabia

BACKGROUND

The prevalence and characteristics of superficial fungal infections (SFIs) vary with climatic conditions, lifestyle, and population migration patterns. This study was undertaken to determine the characteristics of SFIs amongst patients visiting the dermatology clinic of Riyadh Military Hospital, Riyadh, Saudi Arabia, during the period 2003-2005.

METHODS

One hundred and nineteen patients with confirmed SFI (37 males and 82 females), aged between 5 months and 67 years, were included in this study. The diagnosis of SFI was based on clinical presentation confirmed by laboratory analysis. The type of mycotic pathogen and the site of infection were recorded as a function of age and sex.

RESULTS

Onychomycosis (40.3%) was the most frequent infection, followed by tinea capitis (21.9%), tinea pedis (16%), tinea cruris (15.1%), and tinea corporis (6.7%). Tinea capitis was most prevalent (15.1%) in children (male to female ratio, 1 : 1.57), whereas tinea pedis was most common (11.8%) in adults (male to female ratio, 1 : 2.5). Trichophyton mentagrophytes and Microsporum canis were the most common dermatophytes responsible for tinea infections, and T. mentagrophytes, Candida spp., and Aspergillus spp. were mainly responsible for onychomycosis.

CONCLUSION

The prevalence of SFI was twofold greater in females than males. Children were most commonly affected by tinea capitis, whereas adults generally suffered from tinea pedis. The frequency of onychomycosis was nearly three times higher in adults. This study clearly shows that SFIs are of concern in both genders and in all age groups.

First Case of Microsporum ferrugineum from Iran

This is a first case of Microsporum ferrugineum from Iranian patient. A 42 year old man was examined for tinea faciei infection. Direct KOH preparations from skin scraping revealed hyaline septate branching mycelium. Cultures of skin scrapings yielded M. ferrugineum after three weeks. Isolate was identified based on colony morphology on Sabouraud's dextrose agar medium (S), microscopic morphology of slide culture, and biochemical reactions.