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ORIGINAL ARTICLE
Year : 2006  |  Volume : 51  |  Issue : 4  |  Page : 262-264
Dermatophytosis in Karaj, Iran


1 Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
2 Department of Parasitology and Mycology, Institute of Health and Research, Tehran University of Medical Sciences, Tehran, Iran

Correspondence Address:
Keyvan Pakshir
Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, P.O. BOX: 71345-1168
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.30290

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   Abstract 

Background: Dermatophytosis is an infection of skin, hair and nails of the human and animals which is caused by a large group of the fungi named dermatophytes. Purpose: The aim of our study was to determine the prevalence and causative agents of dermatophytosis in Karaj city. Materials and Methods: During five years, a total of 3475 patients clinically suspected to dermatomycoses referred to Ebnesina Diagnostic Medical Laboratory in Karaj city entered our study and samples were taken from the infected area of the skin and appendages. Results: 887 cases of dermatophytosis (806 culture proved) were diagnosed among the suspected cases. The species of dermatophytes were identified as Epidermophyton floccosum 311 (38.6%), Trichophyton mentagrophytes 197 (24.5%), Trichophyton verrucosum 125 (15.5%), Trichophyton rubrum 48 (5.9%), Trichophyton violaceum 34 (4.2%), Microsporum canis 29 (3.6%), Microsporum gypseum 26 (3.2%), Trichophyton tonsurans 20 (2.5%), Trichophyton schoenleinii 3 (0.4%) and unknown dermatophytes 13 (1.6%). Epidermophyton floccosum and tinea cruris were the most common etiological agents and clinical types of dermatophytosis, respectively. Conclusion: Dermatophyte species could transmit to human by direct or indirect contact with infected human and animals and their subjects. Promotion of public health care and self-hygiene may play an important role to control this disease.


Keywords: Dermatophytosis, Epidermophyton, Karaj, dermatophyte


How to cite this article:
Pakshir K, Hashemi J. Dermatophytosis in Karaj, Iran. Indian J Dermatol 2006;51:262-4

How to cite this URL:
Pakshir K, Hashemi J. Dermatophytosis in Karaj, Iran. Indian J Dermatol [serial online] 2006 [cited 2018 Jan 17];51:262-4. Available from: http://www.e-ijd.org/text.asp?2006/51/4/262/30290



   Introduction Top


Dermatophytosis is an infection of the skin, hair or nails caused by dermatophytes, a group of related filamentous fungi also known as ringworm fungi.[1] They can be divided into three groups of anthropophilic, zoophilic and geophilic depending on their natural habits and host preferences. Fungi in all three categories may cause human infections.[1] These organisms, which attack the keratinized tissue of living host, are classified into three genera of Epidermophyton , Trichophyton and Microsporum.[2] The prevalence of dermatophytoses varies in different geographical locations. Many epidemiological studies have investigated the prevalence of fungi responsible for superficial mycoses in different regions of the world and many parts of Iran.[3],[4],[5],[6] The immigration of labour, troop movements, emigrations and other traveling played important roles in spreading of these fungi.[1] The Karaj city is located on the west side of Tehran, the capital city of Iran. The population is about four million and most of residents are descendents of immigrants and the economy of the city is mostly based on agricultural products such as fruits and vegetables. This study was undertaken to determine the prevalence and etiological agents of dermatophytosis and site of the infection among the patients of Karaj city.


   Materials and Methods Top


Specimens (skin, hair and nail) were collected from 3475 patients suspected of dermatophytosis by scraping of the infected area, using a sterile scalpel blade and tweezers at the Avicenna Diagnostic Medical Laboratory. A portion of each sample was examined microscopically by KOH 10-20% and lactophenol solutions. The other portion was cultivated on sabouraud dextrose agar and mycosel agar. The cultures were incubated at 25°C for one to three weeks. Identification of the etiological agents performed based on the gross morphology of the fungal colony (texture, color, surface and reverse pigment, topography), rate of colony growth and microscopic characterization of their conidia (type of macroconidia, shape and size of microconidia) and accessory structures, using slide culture method.


   Results Top


A total of 887 cases of dermatophytosis from 3475 patients clinically suspected of dermatomycoses were diagnosed by direct examination and 806 cases were confirmed by culture.

The patients consisted of 506 females and 381 males, ranged in age from six months to 74 years with an average age of 32 years. The frequency of tinea type was presented in [Table - 1]. Tinea cruris was the most frequent clinical feature (215 cases) followed by tinea corporis (202 cases), tinea pedis (184 cases), tinea capitis (101 cases), tinea unguium (87 cases), tinea mannum (65 cases), tinea barbae (30 cases) and tinea faciei (5 cases).

Nine species from three genera of dermatophytes were identified as shown in [Table - 2]. Epidermophyton floccosum (311, 38.6%) was the most frequently causative agent of dermatophytosis. The other dermatophytes were identified as Trichophyton mentagrophytes 197 (24.5%), Trichophyton verrucosum 125 (15.5%), Trichophyton rubrum 48 (5.9%), Trichophyton violaceum 34 (4.2%), Microsporum canis 29 (3.6%), Microsporum gypseum 26 (3.2%), Trichophyton tonsurans 20 (2.5%),  Trichophyton schoenleinii More Details 3 (0.4%) and unknown dermatophytes 13 (1.6%).

E. floccosum from foot and groin, T. mentagrophytes from hand, body and nail, T. verrucosum from bear and M. canis from head were the most fungi isolated from different sites of tinea infection as shown in [Table - 3].


   Discussion Top


The dermatophytes are among the commonest infectious agents of man and no persons or geographic areas are free of them.[7] Our data revealed that the anthropophilic fungi were the major cause of dermatophytosis in Karaj city. Humans are the normal hosts for this group and transmission may occur by direct contact or indirectly by fomites,[8] however, host factors such as immunologic status and local factors such as trauma, excessive moisture or occlusive clothing may constitute risk factors when combined with exposure to the etiologic fungi. Among the most common scenarios of dermatophytosis are tinea capitis, tinea cruris, tinea pedis and tinea unguium (onychomycosis).[2]

According to the anatomic sites of dermatophytosis infection, tinea corporis in Libya, an area in south of Tehran and Yemen Republic,[3],[6],[9] tinea pedis in Croatia,[10] tinea capitis in United States and Isfahan[2],[4] were the predominant clinical forms of dermatophytosis. In our study, the most common clinical feature of ringworm, was tinea cruris. It seems that exercises, crowded places, low degree of personal hygiene, sitting at a desk and long time driving might be the major causes and risk factors for this problem.

The most frequently isolated dermatophytes in Libya, New Zealand, Yemen and Croatia were T. mentagrophytes , T. violaceum , M. canis and T. rubrum , respectively.[3],[5],[9],[10] The major dermatophytes involved in human disease in the United States and Europe were T. rubrum and T . mentagrophytes , followed by T. tonsurans , E. floccosum and M. canis .[2] In an epidemiological study in south of Tehran, capital of Iran[6] and according to our study E. floccosum , an anthropophilic species, was the most etiological agents of dermatophytosis, although in Isfahan, central province of Iran, T. verrucosum was the dominant agent.[4] The most important source of transmission of anthropophilic dermatophyte species was by men to men and it seems that E. floccosum gradually became the dominant agent of dermatophytosis in these areas.

Tinea favusa is a family-centered infection and its transmission requires long- term association and exposure. Rippon reported that, less than half of the tinea capitis examined in Iran, showed scutula but the other studies in Iran revealed that this rate decreased.[4],[11] In our study, less than 2.97% of tinea capitis led to scutula features. Uses of new methods in diagnosis of mycotic diseases, progress in primary health care services and effective antifungal therapy of tinea capitis along with health education were the major causes for decreasing this rate. Tinea cruris was most commonly caused by T. rubrum worldwide, followed by E. floccosum and T. mentagrophytes,[7] but in our study, E. floccosum was the dominant agent of tinea cruris. Tinea pedis was most commonly caused by E. floccosum in North America,[2] T. rubrum in Libya, Yemen and Poland[3],[9],[12] and T. mentagrophytes in Isfahan and Croatia.[4],[10] Compared to the reports from North America,[2] E. floccosum was the dominant agent of tinea pedis in Karaj city and as the reports from Isfahan, Croatia and Tehran,[4],[10],[13] T. mentagrophytes was the most prevalent species of tinea unguium in our study. We could not identify 13 species of dermatophytes because there was no distinct macroscopic and microscopic colony characterization. Moreover, 9.13% of positive samples had no growth on media. Inappropriate use of antimycotic treatments and self-medication before sampling could be the main cause in this problem. This is the first report of dermatophytosis in Karaj city. Since immigrant people with different traditions and cultures comprise most of this population and due to the proximity of the city to Tehran, people migrate from all parts of Iran to this area, so it could affect the fungal fauna and the distribution of the new species. Promotion of public health care and self-hygiene may play an important role to control these diseases.


   Acknowledgment Top


The authors would like to thank of Dr. Rahim Shafigh, Head of Avicenna Diagnostic Medical Laboratory and Dr. Davood Mehrabani, the Center for Development of Clinical Studies of Nemazi Hospital for editorial assistance.

 
   References Top

1.Kwon-Chung KG, Bennett JE. Medical Mycology. Lea and Febiger: Philadelphia; 1992. p. 105-62.  Back to cited text no. 1      
2.Rinaldi MG. Dermatophytosis: Epidemiological and microbiological update. J Am Acad Dermatol 2000;43:S120-4.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Ellabib MS, Khalifa Z, Kavanagh K. Dermatophytes and other fungi associated with skin mycoses in Tripoli, Libya. Mycoses 2002;45:101-4.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Chadeganipour M, Shadzi S, Dehghan P, Movahed M. Prevalence and etiology of dermatophytoses in Isfahan, Iran. Mycoses 1997;40:321-4.  Back to cited text no. 4  [PUBMED]    
5.Singh D, Patel DC, Rogers K, Wood N, Riley D, Morris AJ. Epidemiology of dermatophyte infection in Auckland, New Zealand. Australas J Dermatol 2003;44:263-6.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]  
6.Falahati M, Akhlaghi L, Lari AR, Alaghebandan R. Epidemiology of dermatophytosis in an area south of Tehran, Iran. Mycopathologia 2003;156:279-87.   Back to cited text no. 6      
7.Rippon JW. Medical Mycology, The pathogenic fungi and the pathogenic Actinomycetes. 3rd ed. WB Saunders: Philadelphia; 1988. p. 197-224.  Back to cited text no. 7      
8.Weitzman I, Summerbell RC. The dermatophytes. Clin Microbiol Rev 1995;8:240-59.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]  
9.Mahmoud AL. A study of dermatophytoses in Sanaa, Yemen Republic. Mycoses 2002;45:105-8.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]  
10.Brajac I, Prpic-Massari L, Stojnic-Sosa L, Gruber F. Dermatomycoses in Rijeka area, Croatia, before, during and after the war 1990-1999. Mycoses 2002;46:213-7.  Back to cited text no. 10      
11.Lari AR, Akhlaghi L, Falahati M, Alaghehbandan R. Characteristics of dermatophytoses among children in an area south of Tehran, Iran. Mycoses 2005;48:32-7.  Back to cited text no. 11  [PUBMED]  [FULLTEXT]  
12.Kaszuba A, Seneczko F, Lipowczan G, Bienias L, Kostusiak M, Lupas S. Fungal flora in human skin and skin appendages infections in the region of Lodz, Poland. Mycoses 1998;41:249-53.  Back to cited text no. 12      
13.Khosravi AR, Mansouri P. Onychomycosis in Tehran, Iran: Prevailing fungi and treatment with itraconazole. Mycopathologia 2001;150:9-13.  Back to cited text no. 13  [PUBMED]  [FULLTEXT]  



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3]

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