Predominance of Trichophyton tonsurans causing tinea capitis: A 12-year retrospective study in the north of Iran

Document Type : Original Articles

Authors

1 Invasive Fungi Research Centre (IFRC), Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran

2 Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

3 Health Science Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran

4 Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

5 Department of Dermatology, School of Medicine, Sari Bu Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran

6 Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda

Abstract

Background and purpose: Among different clinical entities of dermatophytosis, tinea capitis (TC) is considered a major public health challenge in the world, especially in regions with poor health and low income. Therefore, this study aimed to provide a retrospective analysis of the patients suspected of TC who were referred to the medical mycology laboratory of Mazandaran, a northern province of Iran.
Materials and Methods: A retrospective analysis was performed on the patients suspected of TC who were referred to the medical mycology laboratory from July 2009 to April 2022. Hair roots and skin scrapings were collected from the participants. The laboratory diagnosis was confirmed by direct microscopic examination and culture. Finally, 921 out of 11095 (8.3%) patients were suspected of TC.
Results: Based on the findings, TC was confirmed in 209 out of 921 patients (22.7%). In terms of gender, 209 TC patients (75.1%) were male. Moreover, the male to female ratio of TC patients was 1:3.0. Trichophyton tonsurans (146/174, 83.91%) was the most etiological agent,followed by T. mentagrophytes (13/174, 7.47%), T. violaceum (9/174, 5.17%), Microsporum canis (3/174, 1.71%), T. verrucosum (2/174, 1.15%) and T. rubrum (1/174, 0.57%). Besides, endothrix (77.0%) was the most prevalent type of hair invasion.
Conclusion: The results revealed the predominance of T. tonsurans, as a causative agent of TC. Despite the prevalence of TC, the absence of appropriate consideration highlights that it is a neglected complication among children.

Keywords

Main Subjects

References

  1. Patel GA, Schwartz RA. Tinea capitis: still an unsolved problem? Mycoses. 2011; 54(3):183-8.
  2. Upadhyay V, Kumar A, Singh AK, Pandey J. Epidemiological characterization of dermatophytes at a tertiary care hospital in Eastern Uttar Pradesh, India. Curr Med Mycol. 2019; 5(1):1-6.
  3. Achterman RR, White TC. A foot in the door for dermatophyte research. PLoS Pathog. 2012; 8(3):e1002564..
  4. Benedict K, Whitham HK, Jackson BR, editors. Economic Burden of Fungal Diseases in the United States. Open Forum Infect Dis. 2022; 9(4):ofac097.
  5. Suh DC, Friedlander SF, Raut M, Chang J, Vo L, Shin HC, et al. Tinea capitis in the United States: Diagnosis, treatment, and costs. J Am Acad Dermatol. 2006; 55(6):1111-2.
  6. Alemayehu A, Minwuyelet G, Andualem G. Prevalence and etiologic agents of dermatophytosis among primary school children in Harari Regional State, Ethiopia. J Mycol. 2016; 2016.

7. Khosravi AR, Shokri H, Mansouri P. Immediate hypersensitivity and serum IgE antibody responses in patients with dermatophytosis. Asian Pac J Allergy Immunol. 2012; 30(1):40-7.

  1. Khosravi AR, Shokri H, Vahedi G. Factors in etiology and predisposition of adult tinea capitis and review of published literature. Mycopathologia. 2016; 181(5-6):371-8.
  2. Nguyen CV, Collier S, Merten AH, Maguiness SM, Hook KP. Tinea capitis: A single-institution retrospective review from 2010 to 2015. Pediatr Dermatol. 2020; 37(2):305-10.
  3. Michaels BD, Del Rosso JQ. Tinea capitis in infants: recognition, evaluation, and management suggestions. J Clin Aesthet Dermatol. 2012; 5(2):49-59.
  4. Lee HJ, Kim JY, Park KD, Jang YH, Lee SJ, Bang YJ, et al. Analysis of adult patients with tinea capitis in southeastern Korea. Ann Dermatol. 2020; 32(2):109-14.
  5. Abastabar M, Rezaei-Matehkolaei A, Shidfar MR, Kordbacheh P, Mohammadi R, Shokoohi T, et al. A Molecular Epidemiological Survey of Clinically Important Dermatophytes in Iran Based on Specific RFLP Profiles of Beta-tubulin Gene. Iran J Public Health. 2013; 42(9):1049-57.
  6. Rezaei-Matehkolaei A, Makimura K, de Hoog S, Shidfar MR, Zaini F, Eshraghian M, et al. Molecular epidemiology of dermatophytosis in Tehran, Iran, a clinical and microbial survey. Med Mycol. 2013; 51(2):203-7.
  7. de Hoog GS, Dukik K, Monod M, Packeu A, Stubbe D, Hendrickx M, et al. Toward a Novel Multilocus Phylogenetic Taxonomy for the Dermatophytes. Mycopathologia. 2017; 182(1-2):5-31.
  8. Tafti HS, Falahati M, Kordbacheh P, Mahmoudi M, Safara M, Rashidian S, et al. A survey of the etiological agents of scalp and nail dermatophytosis in Yazd, Iran in 2014-2015. Curr Med Mycol. 2015; 1(4):1.
  9. Fuller L, Barton R, Mohd Mustapa M, Proudfoot L, Punjabi S, Higgins E, et al. British A ssociation of D ermatologists' guidelines for the management of tinea capitis 2014. Br J Dermatol. 2014; 171(3):454-63.
  10. Aghamirian MR, Ghiasian SA. Dermatophytoses in outpatients attending the Dermatology Center of Avicenna Hospital in Qazvin, Iran. Mycoses. 2008; 51(2):155-60.
  11. Dogo J, Afegbua SL, Dung EC. Prevalence of Tinea capitis among school children in Nok community of Kaduna State, Nigeria. J Pathog. 2016; 2016.
  12. Coulibaly O, Kone AK, Niaré-Doumbo S, Goïta S, Gaudart J, Djimdé AA, et al. Dermatophytosis among schoolchildren in three eco-climatic zones of Mali. PLoS Negl Trop Dis. 2016; 10(4):e0004675.
  13. Bassyouni RH, El-Sherbiny NA, Abd El Raheem TA, Mohammed BH. Changing in the epidemiology of tinea capitis among school children in Egypt. Ann Dermatol. 2017; 29(1):13-9.
  14. Ansari S, Hedayati MT, Zomorodian K, Pakshir K, Badali H, Rafiei A, et al. Molecular Characterization and in vitro antifungal susceptibility of 316 clinical isolates of dermatophytes in Iran. Mycopathologia. 2016; 181(1-2):89-95.
  15. Rezaei-Matehkolaei A, Rafiei A, Makimura K, Graser Y, Gharghani M, Sadeghi-Nejad B. Epidemiological aspects of dermatophytosis in Khuzestan, southwestern Iran, an Update. Mycopathologia. 2016; 181(7-8):547-53.
  16. de Hoog GS, Guarro J. Atlas of clinical fungi: Centraalbureau voor schimmelcultures; 1995.
  17. Khaled JM, Golah HA, Khalel AS, Alharbi NS, Mothana RA. Dermatophyte and non dermatophyte fungi in Riyadh City, Saudi Arabia. Saudi J Biol Sci. 2015; 22(5):604-9.
  18. Seebacher C, Bouchara JP, Mignon B. Updates on the epidemiology of dermatophyte infections. Mycopathologia. 2008; 166(5-6):335-52.
  19. Grover C, Arora P, Manchanda V. Tinea capitis in the pediatric population: a study from North India. Indian J Dermatol Venereol Leprol. 2010; 76(5):527-32.
  20. Abastabar M, Babaei M, Mohammadi R, Valadan R, Javidnia J, Zaedi A, et al. Iranian national survey on tinea capitis: antifungal susceptibility profile, epidemiological characteristics, and report of two strains with a novel mutation in SQLE gene with homology modeling. Mycopathologia. 2022.
  21. Bassiri Jahromi S, Khaksar AA. Aetiological agents of tinea capitis in Tehran (Iran). Mycoses. 2006; 49(1):65-7.
  22. Afshar P, Vahedi L, Ghasemi M, Mardanshahi A. Epidemiology of tinea capitis in northeast Iran: a retrospective analysis from 1998 to 2012. Int J Dermatol. 2016; 55(6):640-4.
  23. Getso MI, Hashemi SJ, Ghazvini RD, Yusuf SM, Khodavaisy S, Gerami-Shoar M, et al. Determination of dermatophytes isolated from tinea capitis using conventional and ITS-based sequencing methods in Kano, Nigeria. J Mycol Med. 2021; 31(3):101157.
  24. Rodriguez-Cerdeira C, Martinez-Herrera E, Szepietowski JC, Pinto-Almazan R, Frias-De-Leon MG, Espinosa-Hernandez VM, et al. A systematic review of worldwide data on tinea capitis: analysis of the last 20 years. J Eur Acad Dermatol Venereol. 2021; 35(4):844-83.
  25. Mikaeili A, Kavoussi H, Hashemian AH, Shabandoost Gheshtemi M, Kavoussi R. Clinico-mycological profile of tinea capitis and its comparative response to griseofulvin versus terbinafine. Curr Med Mycol. 2019; 5(1):15-20.
  26. Zampella JG, Kwatra SG, Blanck J, Cohen B. Tinea in tots: cases and literature review of oral antifungal treatment of tinea capitis in children under 2 years of age. J Pediatr. 2017; 183:12-8.
  27. Adesiji YO, Omolade BF, Aderibigbe IA, Ogungbe OV, Adefioye OA, Adedokun SA, et al. Prevalence of tinea capitis among children in Osogbo, Nigeria, and the associated risk factors. Diseases. 2019; 7(1):13.
  28. Moto JN, Maingi JM, Nyamache AK. Prevalence of Tinea capitis in school going children from Mathare, informal settlement in Nairobi, Kenya. BMC Res Notes. 2015; 8(1):1-4.
  29. Pai VV, Hanumanthayya K, Tophakhane RS, Nandihal NW, Kikkeri NS. Clinical study of tinea capitis in Northern Karnataka: A three-year experience at a single institute. Indian Dermatol Online J. 2013; 4(1):22-6.
  30. Kermani F, Moosazadeh M, Hedayati MT, Abastabar M, Haghani I, Aghili SR, et al. Molecular epidemiology of Tinea gladiatorum in contact sports in northern Iran. Mycoses. 2020; 63(5):509-16.
  31. Zhi H, Shen H, Zhong Y, Sang B, Lv W, Li Q, et al. Tinea capitis in children: A single-institution retrospective review from 2011 to 2019. Mycoses. 2021; 64(5):550-4.
  32. Aritonang JP, Alverina L, Hidajat D. Gray Patch Tinea Capitis in Two Siblings. 2nd Global Health and Innovation in conjunction with 6th ORL Head and Neck Oncology Conference (ORLHN 2021); 2022.
  33. Park SK, Park SW, Yun SK, Kim HU, Park J. Tinea capitis in adults: A 18-year retrospective, single-centre study in Korea. Mycoses. 2019; 62(7):609-16.
  34. Halaji Z, Sadri M, Dadvar F. Analysis of 58 cases of tinea capitis in Tehran Razi hospital. Acta Med Iran. 2001; 39(2):109-12.
  35. Ilkit M. Favus of the scalp: an overview and update. Mycopathologia. 2010; 170(3):143-54.
  36. Oudaina W, Biougnach H, Riane S, El Yaagoubil I, Tangi R, Ajdae L, et al. Epidemiology of tinea capitis in outpatients at the children's hospital in Rabat (Morocco). J Mycol Med. 2011; 21(1):1-5.
  37. Costa-Orlandi CB, Magalhaes GM, Oliveira MB, Taylor EL, Marques CR, de Resende-Stoianoff MA. Prevalence of dermatomycosis in a Brazilian tertiary care hospital. Mycopathologia. 2012; 174(5-6):489-97.
  38. Chokoeva AA, Zisova L, Chorleva K, Tchernev G. Aspergillus niger - a possible new etiopathogenic agent in Tinea capitis? Presentation of two cases. Braz J Infect Dis. 2016; 20(3):303-7.
  39. Ebrahimi M, Zarrinfar H, Naseri A, Najafzadeh MJ, Fata A, Parian M, et al. Epidemiology of dermatophytosis in northeastern Iran; A subtropical region. Curr Med Mycol. 2019; 5(2):16-21.
  40. Kallel A, Hdider A, Fakhfakh N, Belhadj S, Belhadj-Salah N, Bada N, et al. Tinea capitis: Main mycosis child. Epidemio-logical study on 10years. J Mycol Med. 2017; 27(3):345-50.
  41. Zuluaga A, Cáceres DH, Arango K, Bedout Cd, Cano LE. Epidemiology of tinea capitis: A 19 years' experience in a Colombian, specialized clinical laboratory. Infectio. 2016; 20(4):225-30.
  42. Maraki S, Mavromanolaki VE. Epidemiology of derma-tophytoses in Crete, Greece a 5-year Survey. Med Mycol J. 2016; 57(4):69-75.
  43. Chokoeva AA, Zisova L, Sotiriou E, Miteva-Katrandzhieva T. Tinea capitis: a retrospective epidemiological comparative study. Wien Med Wochenschr. 2017; 167(3-4):51-7.
  44. Leung AKC, Hon KL, Leong KF, Barankin B, Lam JM. Tinea capitis: an updated review. Recent Pat Inflamm Allergy Drug Discov. 2020;14(1):58-68.
  45. Bendjaballah-Laliam A, Djazer H. Epidemiology of Tinea capitis in the suburbs of Tipasa, Algeria. J Mycol Med. 2014; 24(2):141-3.
  46. Thakur R. Tinea capitis in Botswana. Clin Cosmet Investig Dermatol. 2013; 6:37-41.
  47. Zhan P, Geng C, Li Z, Jin Y, Jiang Q, Tao L, et al. Evolution of tinea capitis in the Nanchang area, Southern China: a 50-year survey (1965-2014). Mycoses. 2015; 58(5):261-6.
  48. Vyas A, Pathan N, Sharma R, Vyas L. A clinicomycological study of cutaneous mycoses in sawai man singh hospital of jaipur, north India. Ann Med Health Sci Res. 2013; 3(4):593-7.
  49. Deng S, Bulmer GS, Summerbell RC, De Hoog GS, Hui Y, Graser Y. Changes in frequency of agents of tinea capitis in school children from Western China suggest slow migration rates in dermatophytes. Med Mycol. 2008; 46(5):421-7.
  50. Zaraa I, Hawilo A, Trojjet S, Euch DE, Mokni M, Osman AB. Tinea capitis in infants in their first 2 years of life: a 12-year study and a review of the literature. Dermatol Online J. 2012; 18(7).
  51. Kassem R, Shemesh Y, Nitzan O, Azrad M, Peretz A. Tinea capitis in an immigrant pediatric community; a clinical signs-based treatment approach. BMC Pediatr. 2021; 21(1):363.
  52. Bonifaz A, Araiza J, Sánchez AT, Zamora AB, Sáenz AG, Juárez AM. Tinea gladiatorum due to Trichophyton tonsurans in a school wrestling team in Mexico: A case series. Curr Med Mycol. 2020; 6(4):62.
  53. Kermani F, Moosazadeh M, Hosseini SA, Bandalizadeh Z, Barzegari S, Shokohi T. Tinea gladiatorum and dermatophyte contamination among wrestlers and in wrestling halls: a systematic review and meta-analysis. Curr Microbiol. 2020; 77(4):602-11.
  54. Naseri A, Fata A, Najafzadeh MJ, Shokri H. Surveillance of dermatophytosis in northeast of Iran (Mashhad) and review of published studies. Mycopathologia. 2013; 176(3-4):247-53.
  55. Chadeganipour M, Mohammadi R, Shadzi S. A 10-Year study of dermatophytoses in Isfahan, Iran. J Clin Lab Anal. 2016; 30(2):103-7.
  56. Segal E, Elad D. Human and Zoonotic Dermatophytoses: epidemiological aspects. Front Microbiol. 2021; 12:713532.
  57. Greywal T, Friedlander SF. Dermatophytes and other superficial fungi. Principles and Practice of Pediatric Infectious Diseases Elsevier; 2018.

 

 

 

Current Medical Mycology
Volume 9, Issue 1
March 2023
Pages 21-27

Files

Share

How to cite

Statistics