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Mycologic Study of Tinea Capitis in Qatar Mohamed 0 , El-Benhawi, M,Sc,, Somaia Fathy, M,Sc,, M,D,, A, H, Moubasher, Ph,D,, and Nawal S, Alem, D,D,

Abstract: The causative dermatophytic species of tinea capitis were identified in 91 patients in Qatar. Microsporum canis was the most common isolated organism (86.81%) followed by Microsporum ferrugineum and Trichophyton violaceum. A gray patch type of tinea oapitis was the predominant presentation (87.91%), and the disease was more prevalent among Qatari boys.

Tinea capitis is a common skin disorder of childhood that can be caused by various dermatophytic species, the predominant organism of which varies with time and geographic location,' The studies of the predominant species and its relation with various factors affecting its distribution are of considerable importance in designing prophylactic programs in different communities. Thus far, no data exist for the causative dermatophyte of tinea capitis in Qatar, The aim of this work was to identify the causative pathogens and their probable sources of infection so that a proper preventive health program could be implemented. Patients and Methods • A group of 91 patients who presented clinically with tinea capitis were selected at random during a period of 6 months from among the patients attending the dermatology outpatient clinics at Hamad Medical Corporation, The history, clinical presentation, and possible source of infection were recorded for each. The clinical presentation was classified according to the criteria of Blaylock et al,^ into gray patch, blaek dot, seborrhoeic, kerion, and favus.

The following procedures were carried out for each patient: I) Wood's light examination; 2) cleaning of the lesions with 70% alcohol and sample collection of infected hairs and skin scraping using a sterile forceps and scalpel; 3) direct slide microscopic examination after using 10% potassium hydroxide preparation; 4) direct inoculation of the specimens oti Dematophyte Test Media (DTM) after which readings were taken after 1-2 weeks; and 5) culture of part of the specimen for each patient, which was sent in sterile tubes to the Microbiology Department, Faculty of Science in Qatar University, on a modified Sabouraud's dextrose agar with cyclohexamide and chloramphenicol. The cultures were grown for 3-4 weeks at 28°C before being discarded as negative. Growing colonies were studied for both morphologic and microscopic characteristics. Results Results are summarized in Tables 1 and 2, There were 57 boys and 34 girls in the study group. The age range was from 3 months to 12 years. The majority of patients (55; 60,43%) were in the age group 0-5 (Table 1), The duration of the lesions varied from 1 to 12 weeks, with a mean of 5,57 weeks. Qataris formed the majority (49; 53.84%) of patients; 42 patients (46,15%) were expatriates. Eighty patients had the gray patch type of tinea capitis, 10 had kerion, and 1 had the black dot type. Wood's light showed green fluorescence in 56 patients and potassium hydroxide preparation was posiTable 1. Age and Sex Distribution

From the Department of Dermatology, Hamad Medical Corporation, and Botany Department, Faculty of Science, and Scientific and Applied Research Center, Qatar University, Doha, Qatar, Address correspondence to: Somaia Fathy, M,Sc,, M,D,, Dermatology Department, Hamad Medical Corporation, P.O, Box 3050, Doha, Qatar,

204

Age Group (yrs)

Boys

Girls

Total

5-10 10-15

30 26 1

25 9 0

55 35 1

Total

57

34

91

0-5

March 1991, Vol. 30, No. 3

Tinea Capitis in Qatar • El-Benhawi et al.

No. 3

205

Table 2. The Type of Dermatophyte Cultured and the Clinical Presentation Clinical Types Gray Patch

Kerion

Black Dot

Seborrhoeic

Total

M. canis M. ferrugineum T. violaceum T. mentagrophyte

IA 4 2 0

4 3 2 1

1 0 0 0

0 0 0 0

79 7 4 1

Total

80

10

1

0

91

Derniatophyte

tive in 86 children. The morphologic and microscopic identification of colony growth on DTM was reconfirmed with the mycologic identification of the fungal colonies grown on Sabouraud's dextrose agar and showed that Microsporum canis was the most common dermatophyte grown 79 (86,81%) followed by Microsporum ferrugineum 1 (7.69%) and Trichophyton violaceum 4 (4.39%). Table 2 summarizes the relation between the types of dermatophyte cultured and the clinical presentation. The majority of patients (77) acquired their infection from playing with pet animals at their homes, especially cats. Three cases were transmitted human to human, and the possible source for the rest was unidentified.

most common pathogen. In our study, M. ferrugineum was the second most common, T. violaceum was less common, and not one case of T. rubrwn was identified. There has not been any previous studies about tinea capitis in Qatar, so the probabilities of changing the pattern and type of dermatophyte are unknown. This study is useful in determining the causative dermatophyte and pattern of infection, hence a prospective campaign in Qatar must consider that the entire population of children must be examined, that a preventive health campaign should educate the people about the infective diseases that can be transmitted by domestic animals, and that domestic animals should be checked regularly and properly treated by a veterinarian.

Discussion From the present study M. canis, a known zoophilic dermatophyte, was found to be the most common dermatophyte causing tinea capitis in Qatar. Gray patch tinea capitis was the predominant clinical presentation (80 patients) and most of them grew M. canis (74 patients). The disease was more prevalent among Qataris. Qatar is a small community whose population does not exceed 1 million. Many Qataris have a small farm near their houses. Pet animals, especially cats, are very popular among Qatari children and were the source of infection in 84,61% ofthe studied group. Boys were more susceptible to the infection. This is in accordance with other studies,-''* implying that short hairs facilitate contact with fungal spores. In comparison to other communities, reports from Egypt^ and the Middle East^ have shown T. violaceum to be the most common pathogen. In Libya"* T. rubrwn was the most common pathogen, while M. canis constituted the third most common dermatophyte. This is contrary to our study that showed M. canis to be the

Acknowledgment Mr, A, El-Shanwany, M,Sc,, provided technical assistance in mycologic studies ofthe recovered organisms.

References 1, Roberts SOB, Mackenzie DWR, Mycology; tinea capitis. In: Rook A, Wilkinson DS, Ebling FJG, et al,, eds. Textbook of Dermatology, 4th ed, Oxford: Blackweli Scientific, 1986:911915, 2, Blaylock WK, Shadomy HJ, Shadomy S, Fungal diseases with cutaneous involvement. In: Fitzpatrick TB, Andt KA, Clark WH, et al,, eds. Dermatology in General Medicine, Ist ed. New York: McGraw-Hill. 1971:1786-2004, 3, Abu El-Souod SM, Katoo A, Bushra E, Study on pathogenic dermatomycosis in Egypt, 2. Tinea capitis, J MRI, 1985;6:169187, 4, Kanwar AJ, Belhaj MS, Tinea capitis in Benghazi, Libya, Int J Dermatol, 1987:26:371-373, 5, Amer M, Taha M, Tosson Z, et al. The frequency of causative dermatophytes in Egypt, Int J Dermatol, 1981:20:431-434, 6, Raubitschek F, Infectivity and family incidence of black dot tinea capitis. AM A Arch Dermatol Syphilol, 1959:74:477-479,

Mycologic study of tinea capitis in Qatar.

The causative dermatophytic species of tinea capitis were identified in 91 patients in Qatar. Microsporum canis was the most common isolated organism ...
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