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Dermatophytes and Other Fungi Associated with Skin Mycoses in Tripoli, Libya

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Dermatophytes and Other Fungi Associated with Skin Mycoses in Tripoli, Libya View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by MURAL - Maynooth University Research Archive Library MYCOSES 45, 101–104 (2002) ACCEPTED:MARCH 16, 2001 Dermatophytes and other fungi associated with skin mycoses in Tripoli, Libya Dermatophyten und andere Pilze assoziiert mit Dermatomykosen in Tripoli, Libyen M. S. Ellabib1, Z. Khalifa2 and K. Kavanagh3 Key words. Dermatophytes, Candida, Malassezia, dermatophytosis, candidosis, pityriasis, epidemiology, Libya. Schlu¨ sselwo¨rter. Dermatophyten, Candida, Malassezia, Dermatophytosen, Candidosen, Pityriasis, Epidemiologie, Libyen. Summary. This study sought to determine the Microsporum canis 8.1% (94 cases), Epidermophyton prevalence of skin infections and their causa- floccosum 6.6% (76 cases) and Trichophyton tive agents in the Libyan population. Samples mentagrophytes 3.1% (36 cases). were collected from 2224 patients attending the Dermatology Clinics of the Tripoli Medical Cen- Zusammenfassung. DieseStudieuntersucht tre (TMC) between August 1997 and December die Verbreitung von Hautinfektionen und deren 1999 and were submitted to a mycology labo- Erreger in der Bevo¨lkerung von Libyen. Proben ratory for analysis. Diagnosis was confirmed by von 2224 Patienten, die die Dermatologische Kli- microscopic examination in 1180 cases (53.1%) nik des Tripoli Medical Center (TCM) zwischen and the causative agent was isolated and cul- August 1997 and Dezember 1999 besucht hatten, tured in 1160 cases (52.2%). Dermatophytes, wurden analysiert. Mikroskopische Untersuchun- Malassezia furfur and Candida albicans were the most gen besta¨tigten die Diagnose in 1180 Fa¨llen common etiological agents isolated. Tinea cor- (53.1%). Erreger wurden in 1160 Fa¨llen (52.2%) poris accounted for 45.9% of cases (85% of cases isoliert. Dermatophyten, Malassezia furfur and occurred in children below 15 years of age). The Candida albicans waren die am ha¨ufigsten isolierten frequency of the other clinical types in descend- a¨tiologischen Agentien. Tinea corporis trat auf ing order was pityriasis versicolor 27.8% (322 in 45.9% der Fa¨lle (85% bei Kindern unter cases), candidiosis 13.4% (156 cases), tinea pedis 15 Jahren). Andere klinische Typen waren in 8.1% (94 cases), tinea manuum 2.6% (30 cases) absteigender Ha¨ufigkeit: Pityriasis versicolor and tinea barbae 2.2% (26 cases). Trichophyton 27.8% (322 Fa¨lle), Candidose 13.4% (156 Fa¨lle), violaceum was the most common etiological agent, Tinea pedis 8.1% (94 Fa¨lle), Tinea manuum responsible for 44% (300 cases) of dermatophyte 2.6% (30 Fa¨lle) und Tinea barbae 2.2% (26 Fa¨lle). infections. Malassezia furfur was ranked the second Trichophyton violaceum war das am ha¨ufigsten auf- most frequent causative agent being found in tretende a¨tiologische Agens bei Dermatophytosen 27.8% of cases, followed by Trichophyton rubrum (44%, 300 Fa¨lle). Den zweiten Rang nahm 13.8% (160 cases) and Candida albicans 10% Malassezia furfur ein,(27.8%derFa¨lle), gefolgt von (116 cases). Other species isolated included Trichophyton rubrum (13.8%, 160 Fa¨lle) und Candida albicans (10%, 116 Fa¨lle). Andere Erreger waren: 1Department of Medical Microbiology, Medical College, Microsporum canis 8.1% (94 Fa¨lle), Epidermophyton Al-Fateh University, Tripoli, 2Mycology Section, Central floccosum 6.6% (76 Fa¨lle) und Trichophyton Laboratory, Tripoli Medical Centre, Libya, and 3Department mentagrophytes 3.1% (36 Fa¨lle). of Biology, National University of Ireland Maynooth, Co. Kildare, Ireland. Correspondence: Dr Kevin Kavanagh, Medical Mycology Introduction Unit, Department of Biology, NUI Maynooth, Co. Kildare, Ireland. Tel: (+353) 708 3859 Fax: (+353) 708 3845 E-mail: Superficial mycoses of the skin are amongst [email protected]. the most prevalent human infectious diseases 102 M. S. ELLABIB ET AL. observed in clinical practice [1]. The etiological divided into two portions—one for microscopic agents comprise the dermatophytes and yeasts examination and one for culture. Samples responsible for infections including candidosis were analysed microscopically and by growth and pityriasis versicolor [2]. Tinea capitis and morphology at the Mycology Laboratory of tinea corporis are most frequently recorded in the TMC. children while tinea unguium, tinea pedis and tinea versicolor are more prevalent in adults [3]. Microscopic Examination Many epidemiological studies have investigated the prevalence of fungi responsible for superficial Microscopic examination of the samples was per- mycoses in different regions of the world [4–6]. formed following treatment with an aqueous However, with the exception of a few early stud- solution of 20% potassium hydroxide (KOH). A ies [7, 8] the actual prevalence and incidence of portion of the sample was placed on a slide and fungal diseases and their most common etiologi- 50 mlofKOHwasadded.After5min,thewet cal agents among Libyan nationals are unknown. preparation was examined for the presence of There are no epidemiological data in the litera- fungal elements and their diagnostic morphology. ture to ascertain the true incidence of fungal infections and their etiological agents in this Fungal Culture population group. An epidemiological study has been performed over a number of years in the All samples were cultured on Sabouraud Tripoli Medical Centre (TMC) where superficial glucose chloramphenicol actidione agar (SCCA), fungal infections are among the most common Sabouraud glucose gentamicin chloramphenicol skin diseases seen in patients attending the der- agar (SGCA) and dermatophyte test agar (DTA) matology clinic. The aim of the work presented (BioMerieux, Marcy-l’Etoile, France) which was here was to determine the incidence of the most made to the manufacturer’s instructions. Olive prevalent fungi associated with skin infections oil(2%)wasaddedtoSGCAwhenpityriasis with reference to dermatophytes and yeasts in the versicolor was suspected. The plates were inocu- district of Tripoli over a period of 28 months. lated with finely divided pieces from the samples and incubated at 25 or 30 uCforupto4weeks. Theplateswereexaminedtwice-weeklyforevi- Materials and methods dence of growth. Fungal isolates were then sub- cultured onto Sabouraud and potato glucose Patient selection agar in Petri dishes. The isolates were examined From August 1997 to December 1999, samples macroscopically and microscopically following were taken from skin lesions including skin folds, staining with lactophenol cotton blue. The der- glabrous skin, the hand, feet or face of 2224 matophytes species were identified by gross and patients attending the Dermatology Clinic at the microscopic morphology and by in vitro tests, if Tripoli Medical Centre. Patient selection was per- required, based on the criteria enumerated by formed following medical examination and the Rebell and Taplin [9] and Frey et al. [10]. site of sample collection depended upon the na- Candida species were first identified using API ture of the skin lesion. All patients included in 20C AUX Commercial System (BioMerieux, this study resided in the city of Tripoli or in the Marcy-l’Etoile, France). All Candida albicans iso- lates were tested for germ tube production in immediate adjoining rural areas. The patient u group consisted of 740 males and 420 females human serum at 37 Caswellasforchlamy- (childrenrangedinagefrom1to15yearswith dosporesformationoncornmealagarplus an average age of 12 years and adults ranged Tween 80. from 16 to 60 years with an average age of 30 years). Male children accounted for 322 cases, Results female children for 136, adult males for 418 and adult females for 284 cases of culture positive Samples were obtained from a total of 2224 identification. patients who presented with suspected superficial mycoses during the course of this study. Diagno- sis was confirmed by microscopic examination in Sample collection 1180 cases (53.1%), and the causative agents Allsamplesconsistedofscalesandscrapings were isolated in 1160 cases (52.2%). From the taken from the rim of lesions using a sterile scal- total number of isolates that were identified by pel blade following cleaning of the affected sites culture growth, species of dermatophytes were with 70% (v/v) isopropyl alcohol. Samples were the most prevalent and accounted for 682 cases mycoses 45, 101–104 (2002) DERMATOMYCOSES IN LIBYA 103 (58.8% of all culture positive fungal infections), cases were in children below the 15 years of age. M. furfur and C. albicans werethenextmostcom- Tinea pedis was observed more frequently in mon fungi being isolated in 322 (27.8%) and adults and twice as commonly in female patients 116 (10%) cases, respectively. The frequency of than males. With the exception of tinea pedis skin mycoses among patients attending the der- and tinea manuum in which T. rubrum was the matology clinic is presented in Table 1. Of all predominant isolate, T. violaceum waseitherthe dermatophytes, Trichophyton violaceum was by far most common etiological agent, as in tinea the most commonly isolated etiological agent and corporis, or ranked second in the other forms accounted for 44% (300 cases) of dermatophyte of ringworm infection. The frequency of derma- isolates, while T. rubrum was ranked second as tophytic infections according to body site is showninTable2. presented in Table 3. Infection of glabrous skin, According to the anatomic site involvement of such as the chest, neck and back, was most dermatophyte infection, tinea corporis was the commonly associated with the lipophilic yeast M. predominantclinicalformofallringworminfec-
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