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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 5  |  Issue : 1  |  Page : 81-84

Microbiological Observation of Superficial Fungal Infections in A Tertiary Care Hospital; A Hospital Based Study in South West Bihar


1 Associate Professor, Dept. of Microbiology, NMCH, Jamuhar, Sasaram, India
2 Tutor, Dept. of Microbiology, NMCH, Jamuhar, Sasaram, India
3 Professor, Dept. of Microbiology, NMCH, Jamuhar, Sasaram, India
4 Assistant Professor, Dept. of Microbiology, NMCH, Jamuhar, Sasaram, India

Date of Web Publication20-Nov-2020

Correspondence Address:
Mukesh Kumar
Associate Professor, Dept. of Microbiology, NMCH, Jamuhar, Sasaram
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


Introduction: Superficial mycoses are among the most frequent forms of human infections, affecting more than 20-25% of the world's population. They are predominantly caused by a group of closely related keratinophilic mycelial fungi, dermatophytes and less frequently by nondermatophytic fungi like Malassezia. These infections are especially common in tropical countries like India due to environmental factors like heat and humidity.
Aims and objectives: The aim of this study was to analyze the trends of fungal species causing superficial fungal infections among patients presenting to dermat clinic in tertiary care center..
Materials and methods: This was a cross-sectional study carried out over a period of three months from August 2018 to October 2018 in Narayan Medical College & Hospital Jamuhar Sasaram. Samples were obtained from patients who attended the dermatology department of NMCH Jamuahr Sasaram. These samples were collected with standard mycological protocol and then sample were subjected to10% KOH mount for direct microscopy and culture in Sabouraud dextrose agar (SDA) with cycloheximide chloramphenicol and speciation with Lactophenol Cotton Blue(LCB) mount.
Result: A total of 310 sample were processed of which skin scraping was 305 (98.38%) followed by nail clipping 3 (0.96%) and plucked hair 2 (0.64%). Out of 310 sample examined 260 sample showed septate fungal hyphae with direct microscopy; Of which 78(30%) showed growth on SDA. Among 78 isolates, 74(94.88%) were dermatophytes, of which Trichophyton mentagrophytes were maximum 26(32.05%) followed by T. verrucosum 21 (26.92%), T. tonsurans 16 (20.51%), T. rubrum 7(8.9%) and non speciated Trichophyton species were 6(7.6%).
Conclusion: Our study showed that T. mentagrophytes was the commonest dermatophyte causing superficial fungal infection.

Keywords: Dermatophytes, Malassezia, Trichophyton


How to cite this article:
Kumar M, Ansary S, Kumar P, Pratap R, kumar A. Microbiological Observation of Superficial Fungal Infections in A Tertiary Care Hospital; A Hospital Based Study in South West Bihar. J Indira Gandhi Inst Med Sci 2019;5:81-4

How to cite this URL:
Kumar M, Ansary S, Kumar P, Pratap R, kumar A. Microbiological Observation of Superficial Fungal Infections in A Tertiary Care Hospital; A Hospital Based Study in South West Bihar. J Indira Gandhi Inst Med Sci [serial online] 2019 [cited 2021 Jan 18];5:81-4. Available from: http://www.jigims.co.in/text.asp?2019/5/1/81/301085




  Introduction: Top


Superficial fungal infections are the most common fungal infections. According to World Health Organization (WHO), the prevalence rate of superficial fungal infection worldwide has been found to be 20-25%. Its prevalence varies in different countries. It is more prevalent in tropical and subtropical countries like India where the heat and humidity is high for most part of the year. The Superficial fungal infections involves malasaeziosis, dermatophytosis, piedra and tinea nigra and they mainly cause infection of cornified layer of skin and its appendages.[1]

The lipophilic yeast Malassezia species is the most common cause of dandruff, seborrhoeic dermatitis, folliculitis, papillomatosis, and tinea (Pityriasis) versicolor. However, the exact species implicated still remains unclear. The prevalence of fungal infection also depends on the social, geographical and economical status of the patients.[2]

Although the infection is not invasive and easy to cure, its recurrence is a major public health problem.[3] Humans are the normal hosts for this group and transmission may occur by direct contact or indirectly from source of infection.[4] These infections are especially common in tropical countries like India due to environmental factors like heat and humidity, the risk factors include socio-economic conditions like overcrowding, poverty and neglect of personal hygiene.[5]

Dermatophytes are the predominant causes of cutaneous fungal infections. “Ring worm” is common terms used for infections caused by dermatophytes.[6] This study was undertaken to describe the superficial fungal infection at a teaching hospital in the southwest Bihar.


  Materials and Methods: Top


This study was conducted in department of Microbiology Narayan Medical College Jamuhar Sasaram. This was a prospective study carried out over a period of 3 months August to October 2018. Samples were obtained from patients who attended the dermatology OPD of NMCH Jamuhar Sasaram South West Bihar in India with clinical features suggestive of superficial fungal infections like ringworm, hypo and hyper pigmented skin lesions, were included in this study after obtaining verbal informed consent and boils, furuncle carbuncle were excluded for the study. The study has been started after taking Institutional ethical clearance. A total of 310 skin scrapings, nail clipping and hair pluck were collected and then subjected to 10% KOH mount for skin scraping and 20% KOH mount for nails and hair and observed under low and high power microscope to look for fungal elements (yeast cells, hyphae and arthroconidia). After microscopy samples were inoculated on Sabouraud dextrose agar (SDA) with cycloheximide Chloramphenicol and incubated in BOD incubator for 2-3weeks. Growth pattern on SDA was observed daily for 1st week and then weekly for next 2weeks. The morphology of fungal isolates were demonstrated with Lacto phenol cotton blue( LCB) mount.


  Results: Top


A total of 310 patients who were clinically diagnosed with superficial fungal infection were included in the study in a period of 3months in the department of microbiology NMCH Jamuhar, of which 260(83.87%) were positive with KOH mount and 78(25.16%) were positive with culture.

Among 310 clinically diagnosed superficial fungal infection were distributed between the ranges of 6 months to 70 years of age group. The most common age group affected with superficial fungal infections was 21-30 years (30%) followed by 31-40 years (26%) and the age group affected least was 0-10 years (2.259%) as shown in [Table 1]. Males were more commonly affected 166 (53%) than females 144 (47%) and majority of the samples were skin scraping 305 (98.38%) followed by nail clipping 3 (0.96%) and plucked hair 2 (0.64%).
Table 1: Age Distribution among patients with superficial fungal infection

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Out of 310 patients the most commonly affected group comprised of housewives 113 (36.45%) followed by laborers 77 (24.835%), students 68(21.93%) and farmers 52 (16.77%) [Table 2]. Majority were from low socio economic group.
Table 2: Occupation and superficial fungal infection

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Clinically, tinea corporis 150(48%) was the commonest superficial fungal infection, followed by tinea cruris 108(35%), tinea pedis 17(5.48%), tinea facaei 12(4%),tinea mannum 10(3.22%), tinea unguim5(1.6%), tinea capitis 3(1%) and tinea barbae1(.32%) [Table 3].
Table 3: Etiological agents of superficial fungal infection

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On the basis of culture characteristics, out of 78 culture positive samples, 74 (95%) grew dermatophytes and 4 (5%) grew Pityriasis versicolor. Among 74 dermatophytes Trichophyton mentagrophytes 26(32.05%) were maximum isolates followed by T. verrucosum 21 (26.92%), T. tonsurans 16 (20.51%), T.rubrum 7(8.9), non speciated Trichophyton species 6(7.6%) and 1 mixed isolates T. verrucosum and T.rubrum as shown in [Table 3].


  Discussion: Top


Superficial fungal infections continue to be a worldwide problem, constituting a large number of cases to dermatology outpatient clinics. Prevalence of different types of fungal infections varies according to race and geographical location, environmental conditions, and socioeconomic factors.[7]

The commonest age group involved was 21 to 30 years (30 %) followed by 31 to 40 years (26.1%) which is similar to study done by Poyyamozhi et al.[8]

The proportion of superficial fungal infections in males were 53% and females 47% which is similar to a study done by Penmetcha et al.who showed that 52.8% were male and 47.2% were female. This could be because of type male working in field sweating and not maintaining proper hygiene.[9] In contrary, a study conducted by Eklebirhan et al. showed that females were more affected by dermatophytes than males.[10]

Pityriasis versicolor was the next common type of superficial fungal infection in our study and with 1.29% patients having this, which is lower than the study conducted by Ibadan et al. and Abakaliki et al. who reported prevalence of 4.6% and 4.7%, respectively.[11],[12]

Out of a total of 310 clinically diagnosed cases of superficial fungal infections 83.87% showed positivity with KOH mount and 25.16% from culture. This could be because most of the patients came with history of applying medication on lesion either 12 or 48 hrs before seeking attention to doctor. These variations between KOH mount and culture where KOH positivity rate was higher than culture positivity have also been noted by Kamothi and Vikash et.al.[13],[14]

In the current study we observed that most commonly affected site for superficial fungal infection was groin region 29.35%, followed by trunk 22.58% and least affected area was scalp (0.96 %). [Table 3] which is similar to study conducted by Narasimhalu et.al.[4]

Among all the clinical types, Tinea corporis was the predominant (48%) infections. Similar findings were also reported from the study conducted by kumar et al and Balakumar et al. Tinea cruris was the second most important clinical manifestation with 35% cases followed by T.pedis. The least number of cases were those of Tinea barbae (0.32%) as shown in [Table 3][16],[17]

Trichophyton species was found to be the major causative agent of dermatophytosis in our study. Of the total number of 74 dermatophytes isolated, three dominant Trichophyton were T.mentagrophytes(32.05%), T. verrucosum(26.92%) and T.tonsurans (20.51%) followed by T. rubrum(8.9%). In our study no Microsporum and Epidermophyton were isolated. Apart from this we got one mixed infection of T. mentagrophytes and T. Verrucosum in the same sample and we have reported 6 isolates of Trichophyton spp which were not speciated as shown in [Table 3][18],[19].

In the present study, the most common species identified was T. mentagrophytes (32.05%). Similar findings were also observed by Sahai et al. and Bhatia et al. where as study conducted by Venkatesan et al. and kannan et al. found T. rubrum to be the most common culture isolate.[8],[20]

Tinea corporis and tinea cruris were the most common clinical presentations and T. mentagrophytes and T. verrucosum was the most common organism causing dermatophyte infection. Trichophyton mentagrophytes was the leading organism causing dermatophytic infection surpassing Trichophyton rubrum which is similar to study conducted by J. S. Poyyamozhi et al.[22]

The analysis of the occupational profile of the subjects in this study showed that housewives, were more commonly affected followed by labourers , farmers and students, This might be attributable to the unhealthy working environments and also poor housing conditions making them constantly exposed to hot humid climatic conditions and also can be attributable to the personal hygiene.[8] One more important finding we noticed in our study that, not a single yeast like cells were isolated.

On following up the cases, recurrence was the most common complain of the patients after cessation of the treatment. This could be due to improper treatment, which can lead to development of resistant fungal strains. So it is necessary to treat the infection with the specifically based on the MIC of Anti Fungal Susceptibility Testing (AFST).


  Conclusion: Top


To conclude our study T.corporis is the most common clinical manifestation. T. mentagrophytes is the commonest isolate followed by T.verrucosum and commonly affected site was inguinal region. We recommend proper counseling of the patients about the adherence to treatment protocol and proper hygiene, by clinicians to avoid recurrence and chronicity of infections. We also recommend further community based study to know the prevalence of superficial fungal infections in this region.







 
  References Top

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A Lakshmanan, P Ganeshkumar, S Raam Mohan, M Hemamalini, R Madhavan. Epidemiological and clinical pattern of dermatomycoses in rural India. Indian Journal of Medical Microbiology.2015;33:134- 136.  Back to cited text no. 1
    
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Nidhi Negi, Vibha Tripathi, Reshmi Chanda Choudhury, Jitendra Singh Bist, Neeti Kumari and Iva Chandola. Clinicomycological Profile of Superficial Fungal Infections Caused by Dermatophytes in a Tertiary Care Centre of North India. Int.J. Curr. Microbiol. App. Sci (2017) 6(8): 3220-3227.  Back to cited text no. 6
    
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Sevim akcaglar, Beyza ener , Semra cikman toker, Bulent ediz , Sukran tunali, Okan tore. A comparative study of dermatophyte infections in bursa,turkey; isham2011, medical mycology, 49, 602-607.  Back to cited text no. 7
    
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J. S. Poyyamozhi1, Anandhi Lakshmanan2. Profile of dermatophyte infections among rural population: a facility based prospective observational study. Int J Community Med Public Health. 2018 Apr;5(4):1354-1359.  Back to cited text no. 8
    
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