Background: Dermatophytosis are a group of superficial fungal infection of keratinized tissues, such as the epidermis, hair, and nails.1 Dermatophytosis causes 16–75% of all the mycological infections worldwide and severe diseases in immunocompromised patients. Frequency, distribution, and their etiologic agents of dermatophytosis vary based on the age, topography, socioeconomic status, climate, and domestication of animals.2 It is more prevalent in tropical countries such as India, due to climate & living condition. 3. Method: It was a cross-sectional study of 110 patients attending the Dermatology outpatient of the Tertiary care center for 18months from March 2021 to September 2022. Clinically suspected cases of dermatophytosis with informed consent were included in the study. A pre structured proforma was used to collect data on history, clinical examination, KOH Mount, SDA Culture & Calcoflour stain. Patients on antifungals for >4 weeks & whose KOH or Culture showed organisms other than dermatophytes were excluded. Result: Among 110 patients of the study population, mean age group affected was 34.2 years. Males are more affected than females (54.55%) who were daily wage workers from lower socioeconomic strata. [Table 1]. Most common site of infection was Groin (54.54%) followed by buttocks (44.54%). The risk factors associated are poor hygiene & fomites among subjects [Table 2]. Most common clinical variant of dermatophytosis was Tinea corporis with cruris (42.73%). (Figure 1) Commonest organism isolated from the culture was Trichophyton mentagrophytes (24.55%) [Figure 3], followed by Trichophyton rubrum (22.73%) [Figure 4]; Trichophyton tonsurans (2.73%) and Trichophyton violaceum (1.81%) [Figure 5] with average time taken for the culture to grow was around 14 to 21 days. KOH & Calcofluor positivity was seen in 84 (98.82%) whereas KOH & culture positive was seen in 43 (75.43%). We found calcofluor with KOH could pick up faint fungal elements which was missed in culture. Conclusion: The study highlights Tinea corporis and Tinea cruris as the predominant clinical variant, with Trichophyton mentagrophytes emerges as the most frequently isolated organism, emphasizing its significance rampant & resistant dermatophytosis in this topography. Furthermore, the findings suggest Calcofluor staining as a superior method for microscopy in diagnosing dermatophytosis compared to KOH, potentially due to its enhanced sensitivity in detecting fungal elements. These observations provide valuable insights into the epidemiology and diagnostic methods of dermatophytosis but also emphasize the importance of accurate and efficient diagnostic techniques in clinical practice. This contributes to understanding of dermatophytosis & associated risk factors aiding in improved management of these infections.
Dermatophytosis are a group of superficial fungal infection of keratinized tissues, such as the epidermis, hair, and nails.1 Dermatophytosis causes 16–75% of all the mycological infections worldwide and severe diseases in immunocompromised patients. Frequency, distribution, and their etiologic agents of dermatophytosis vary based on the age, topography, socioeconomic status, climate, and domestication of animals.2 It is more prevalent in tropical countries such as India, due to climate & living condition. 3
Dermatophytosis are included in the category of difficult to treat dermatoses such as psoriasis, vitiligo, pemphigus, and erythroderma. It was previously considered as most trivial condition to which has now become most stubborn disease to treat .4,5 Quality of life of patients is affected significantly due to its frequent relapses. The complex interplay of host, environment, and agent factors are attributed for the challenging scenario in treatment of the disease which varies as per the topography. The following study aimed to identify the most common causative organism; clinical patterns associated risk factors in this geographic area. Also to evaluate the sensitive method of investigation to find the fungal elements.
It was a cross-sectional study of 110 patients attending the Dermatology outpatient of the Tertiary care center for 18months from March 2021 to September 2022. Clinically suspected cases of dermatophytosis with informed consent were included in the study. A pre structured proforma was used to collect data on history, clinical examination, KOH Mount, SDA Culture & Calcoflour stain. Patients on antifungals for >4 weeks & whose KOH or Culture showed organisms other than dermatophytes were excluded.
Skin scrapings, Hair strands and Nail clippings were collected and transported to Microbiology lab wrapped in a dark colored paper. KOH Mount: sample was seen under microscope for fungal elements by using 10% KOH for Skin, 20% for Hair and 40% for Nails. Calcofluor white (AMD labs Bangalore India): sample was stained with Calcofluor white and 10% KOH for one minute and looked for fungal elements in fluorescent microscope.
Culture (Micro Express): The material is inoculated on two SDA (Sabouraud’s dextrose agar) slope with Chloramphenicol and Cycloheximide. One tube incubated i n Biological Oxygen Demand (BOD) incubator at 220C , one tube at Room temperature (370C) and observed for growth for 4-6 weeks.
Among 110 patients of the study population, mean age group affected was 34.2 years. Males are more affected than females (54.55%) who were daily wage workers from lower socioeconomic strata. [Table 1]. Most common site of infection was Groin (54.54%) followed by buttocks (44.54%). The risk factors associated are poor hygiene & fomites among subjects [Table 2]. Most common clinical variant of dermatophytosis was Tinea corporis with cruris (42.73%). (Figure 1) Commonest organism isolated from the culture was Trichophyton mentagrophytes (24.55%) [Figure 3], followed by Trichophyton rubrum (22.73%) [Figure 4]; Trichophyton tonsurans (2.73%) and Trichophyton violaceum (1.81%) [Figure 5] with average time taken for the culture to grow was around 14 to 21 days. KOH & Calcofluor positivity was seen in 84 (98.82%) whereas KOH & culture positive was seen in 43 (75.43%). We found calcofluor with KOH could pick up faint fungal elements which was missed in culture. (Table 3 & 4) (Figure 2)
Table 1: Demographic details of the subjects taken in this study |
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Demographic factor |
Most involved |
Percentage |
Age |
31-40 years |
29.09% |
Socioeconomic status |
Lower socioeconomic status |
50% |
Occupation |
Daily Wages |
32.73% |
Duration |
Months |
62.73% |
Symptoms |
Itching Hyperpigmentation Scaling Pain Discharge Thickening of skin Hair loss Burning sensation |
97.272% 90.90% 89.09% 10.09% 9.09% 9.09% 7.27% 6.36% |
Table 2: Risk Factors seen in the participants |
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Risk factors |
Frequency (N=110) |
Percentage |
Past history |
Positive: 39 |
35.45% |
Family history |
Positive: 41 |
37.27% |
Fomites |
Towel: 22 Razor: 22 Soap: 17 Comb: 8 Foot wear: 3 |
30.55% 30.55% 23.6% 11.11% 4.16% |
Personal Hygiene (Frequency of bathing) |
Alternate days: 71 Daily: 25 Once in 3 days: 14 |
64.54% 22.73% 12.72% |
Comorbidities |
Diabetes: 5 Hypertension: 2 Thyroid: 1 Diabetes with hypertension: 1 |
4.35% 1.82% 0.91% 0.91% |
Pets |
Present: 7 |
6.36% |
More than 2 sites involved |
75 |
68.18% |
Table 3: KOH, Culture and Calcofluor results of study participants |
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KOH |
Calcofluor |
Culture |
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Positive |
Negative |
Positive |
Negative |
|
Positive |
84 (98.82%) |
1 (1.17%) |
43 (75.43%) |
31 (58.49%) |
Negative |
12 (48%) |
13 (52%) |
14 (24.56%) |
22 (41.51%) |
Table 4: Clinical variants & Fungal species isolated by Culture |
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Culture Report |
T. mentagrophyte |
T.rubrum |
T.tonsurans |
T.violaceum |
T. Corporis |
7 (25.9%) |
12 (48%) |
|
1 (50 %) |
T. Cruris |
1 (3.7%) |
1 (4%) |
|
|
Onychomycosis |
1 (3.7%) |
1 (4%) |
|
|
T. Corporis, T. Cruris |
13 (48.14%) |
10(40%) |
3 (100%) |
|
T. Corporis, T. Cruris,
T. faciei |
2 (7.4%) |
|
|
|
T. Corporis, T. Cruris,
T. pedis |
1 (3.7%) |
|
|
|
T. Corporis, T. faciei,
T. Barbae |
|
1 (4%) |
|
1 (50%) |
T. Corporis, T. pedis |
1 (3.7%) |
|
|
|
T. Corporis, T. capitis |
1 (3.7%) |
|
|
|
Figure 1: Clinical variants of Dermatophytosis
Figure 2: Calcofluor White & KOH in 10X