Dermatophytosis in northern Africa

Infections caused by dermatophytes are a global problem and a major public health burden in the world today. In Africa, especially in the northern geographical zone, dermatophytic infections are being reported at an alarming rate. This is mostly because of some local but unique cultural practices, socioeconomic and environmental conditions, lack of reliable diagnostic personnel and facilities and ineffective treatment. Interestingly, the pathogen spectrum and the clinical manifestation are most times different from what is seen in other continents. Several epidemiological studies have been performed on the incidence and aetiology of dermatophytoses in northern Africa. However, there is currently no review article with up‐to‐date information on the relevant findings reported so far in this region. This information is necessary for clinicians who treat dermatophytic infections all over the world since agents of dermatophytes are no longer restricted because of the rapid mobility of humans from one part of the world to another. Moreover, the epidemiology of dermatophytoses is known to change over time, thus requiring the update of information from time to time. A review of relevant studies published on dermatophytoses in northern Africa is presented. This covers all of old Sudan, Algeria, Egypt, Libya, Tunisia and Morocco.     

Microsporum nanum - a report from Malawi (Africa)

Summary. Microsporum nanum Fuentes 1956 has been identified in scrapings from a skin lesion in a patient in Karonga District, Malawi, Africa. We believe that this is the first such identification from the African continent. The patient had a single skin lesion in his popliteal fossa and was known to rear pigs.
Zusammenfassung. Microsporum nanum Fuentes 1956 wurde von den Hautschuppen eines Patienten im Karonga Distrikt, Malawi, Afrika angezüchtet. Diese Identifizierung scheint die erste auf dem afrikanischen Kontinent zu sein. Der Patient hatte eine typische Hautläsion in der Kniekehle und hielt Schweine.     

The occurrence of dermatophytes in Slovakia

Summary. We have compared the epidemiology of dermatophytoses in Slovakia during the periods 1956–85 and 1986–92. Infections caused by Trichophyton rubrum gradually increased while infections due to Trichophyton verrucosum and Microsporum canis decreased.
Zusammenfassung. In der Arbeit wird die Epidemiologie der Dermatophytosen in der Slowakei in den Jahren 1986–1992 dargestellt und die Daten werden mit den Beobachtungen der vorher-gehenden Periode 1956–1985 verglichen. Die Inzidenz der durch Trichnphyton rubrum hervorgerufenen Mykosen nimmt stetig zu. Die durch Trichophyton verrucosum bedingten Mykosen sowie die Microsporum canis -Infektionen nehmen ab.     

The aetiological agents of tinea capitis in Zaragoza (Spain)

Between 1977 and 1997, 190 cases of tinea capitis were observed. The age groups most commonly infected were 1-10 years old. The following dermatophytes were isolated: Microsporum canis (119), Trichophyton mentagrophytes (57), Trichophyton tonsurans (seven), Trichophyton verrucosum (three), Trichophyton violaceum (one), Trichophyton schoenleinii (one), Trichophyton soudanense (one) and Microsporum audouinii (one).     

Isolation of dermatophytes and non-dermatophytic fungi from soil in Nigeria

A total of 60 soil samples were collected from Ifite Awka, Nnamdi Azikiwe University and Amawbia, all located in Awka Urban, Anambra State, Nigeria. An additional sample was collected from a household rug-carpet vacuum cleaner from a house located in Enugu city, Enugu State (a neighbouring state). The 61 samples were investigated for the occurrence of dermatophytic and non-dermatophytic fungi, using the hair-bait technique and agar dilution procedure. The medical importance of the isolates in the samples is discussed.     

Tinea capitis in The Netherlands (Rotterdam area)

This retrospective study reviews the occurrence and treatment of various forms of tinea capitis at the out-patient clinic for Dermatology and Pediatric Dermatology of the University Hospital Sophia/Dijkzigt over the period 1977-1988. Tinea capitis was diagnosed in 64 children. Trichophyton violaceum was the pathogen most frequently isolated, with Microsporum canis ranking second. The potassium hydroxide preparation was positive in 58% of the cases. Four cases showed a positive potassium hydroxide preparation with a negative culture. Immigrant children from Morocco were the largest group (61%). A zoophilic dermatophyte was isolated in 15 cases (27%). A pet animal was the source of infection in 4 cases. The ratio between boys and girls was equal in the patient population studied. In 43% of the children suffering from tinea capitis the clinical features were mild flaking without hair loss (so called seborrheic dermatitis-like infection).     

Production of elastase, urease and sulphatase by Epidermophyton floccosum (Harz) Langeron et Milochevitch (1930)

The production of elastase, urease and sulphatase by the primary isolations as well as by subsequent transfer cultures of Epidermophyton floccosum was studied. The granular culture did not produce enzymes studied. Production of all of the enzymes was recorded by the time when pleomorphic areas appeared in the culture. In subsequent transfer cultures made separately from the pleomorphic and granular growth areas, the pleomorphic cultures were active anzyme producers while a minimal or no production could be recorded in the granular cultures. These findings show that the transformation of the granular growth to the pleomorphic one is connected to activation of production of elastase, urease and sulphatase by E. floccosum.

Zusammenfassung

Es wurde die Erzeugung von Elastase, Urease und Sulfatase von Epidermophyton floccosum bei Erstisolierungen sowie deren Subkulturen untersucht. Die granulär wachsende Pilzform entwickelte keine der untersuchten Enzyme. Hingegen wurde die Produktion aller dieser Enzyme zu der Zeit verzeichnet, als pleomorphe Wachstumszonen zwischen den granulären Wuchsformen erschienen. Von den pleomorphen und den granulären Wuchszonen wurden getrennt Subkulturen hergestellt. Die pleomorphen Wuchstypen waren aktive Enzymbildner, während von den granulären Typen nur minimal oder keine Enzyme produziert werden konnten. Diese Ergebnisse zeigten, daß mit der Umwandlung des granulären Wuchstyps zum pleomorphen die Förderung der Enzymbildung — Elastase, Urease und Sulfatase — bei Epidermophyton floccosum in Gang gesetzt wird.     

Tinea circinata manus due to Microsporum gypseum in a HIV-positive boy in Uganda, east Africa

A 15-year-old HIV-positive Ugandan boy suffered from several dry and hyperkeratotic lesions of his left hand and forearm with circinated, erythematous and scaly morphology. Microsporum gypseum could be isolated as causative agent of this ringworm. Species differentiation was confirmed and specified by sequence analysis of the internal transcribed spacer of the ribosomal DNA. Successful topical treatment of the tinea manus was started with clotrimazole-containing ointment.     

Epidemiology of dermatophytoses observed in Rome, Italy, between 1985 and 1993

Summary. Between 1985 and 1993, 13 880 patients were studied for possible forms of dermatophytoses. The most frequently isolated dermatophyte was in 2821 positive cases Microsporum canis (50%), followed by Trichophyton rubrum (27%), Trichophyton mentagrophytes (10.6%), Epidermophyton floccosum (9.3%), Microsporum gypseum (2.3%), Trichophyton violaceum (0.6%), Trichophyton tonsurans (0.2%) and Trichophyton verrucosum (<0.1%). The genera and species isolated were also considered in relation to the site of the lesion. Our epidemiological data were compared with those obtained by other authors in other cities and with those obtained in Rome in previous studies conducted between 1972–77 and 1978–83. Results obtained by various investigators in Europe are also discussed.
Zusammenfassung. Zwischen 1985 und 1993 wurden 13 880 Patienten auf mögliche dermatophytosen untersucht. Aus insgesamt 2821 positiven Fällen ergab sich die folgende Häufigkeitsreihe isolierter Dermatophyten: Microsporum canis (50%), Trichophyton rubrum (27%), Trichophyton mentagrophytes (10.6%), Epidermophyton floccosum (9.3%), Microsporum gypseum (2.3%), Trichophyton violaceum (0.6%), Trichophyton tonsurans (0.2%) und Trichophyton verrucosum (<0.1%). Gattung und Art werden in Bezug auf die Infektlokalisation ebenfalls diskutiert. Unsere epidemiologischen Daten werden verglichen mit Daten anderer Autoren in anderen Städten und mit älteren Studien aus Rom, die von 1972–1977 und von 1978–1983 durchgeführt wurden. Ergebnisse analoger Studien aus anderen Gebieten Europas werden ebenfalls diskutiert.     

Prevalence of tinea capitis as well as of asymptomatic carriers in school children in Nablus area (Palestine)

A study of tinea capitis was carried out during October 1998, involving 8531 school children aged 6-14 years (4718 males and 3813 females), attending 12 primary schools located in urban, rural, and refugee camp communities in the Nablus district in the Palestinian Authority. A total of approximately 1389 of the school children aged 6-12 years (724 males and 665 females) were also surveyed on three occasions at 2-3 month intervals, over a 9-month period (October 1998-May 1999) using the hair brush technique, for prevalence of asymptomatic tinea capitis carriage. Twenty-three(0.27%) mycologically proven cases of tinea capitis were detected.     

Epidemiology of the Dermatophytoses in the Florence Area: 1982–84.1. Microsporum canis Infections*

Summary: Microsporum canis was the most frequently isolated dermatophyte between 1982 and 1984, with an incidence of 45.19%. This dermatophyte caused almost all cases of tinea capitis (94.99%) and the majority of cases of tinea corporis (75.73%). Some epidemiological data are reported, as well as certain cases with an atypical morphology. Zusammenfassung: Vom Jahre 1982 bis 1984 war Microsporum canis der am häufigsten isolierte Dermatophyt, mit einer Häufigkeit von 45,19%. Dieser Dermatophyt verursachte die meisten Fálle von Tinea capitis (94,99%), wie auch von Tinea corporis (75,73%). Es wird fiber einige epidemiologische Angaben und atypische Bilder berichtet.     

Distribution of dermatophytes and other related fungi in Jaipur city,with particular reference to soil pH

Screening of 217 soil samples of different habitats, such as PG study centre, garden, farmhouse, nursery, roadside, hostel, animal habitat, bird habitat, marriage garden, temple, vegetable market and house dust, was carried out for the presence of dermatophytes and related fungi in relation to soil pH. A total of 461 isolates belonging to 26 genera and 34 species were recorded. Soil pH values vary from 3 to 10.5. Trichophyton verrucosum, Microsporum audouinii and M. canis were isolated for the first time in Jaipur from pH range 7.0 to 9.0. Chrysosporium tropicum (46.08%) was the most predominant fungus isolated from pH range 6.5 to 9.5. Trichophyton mentagrophytes (24.88%) was the second most common fungal species isolated from pH 6.5 to 9.5. Most of the keratinophilic fungi were isolated from pH 6.5 to 8.5. Only one isolate of Fusarium moniliforme was reported from a highly acidic site at pH 3. Roadside and garden soils were found to be the most suitable sites for almost all keratinophilic fungi.     

The Role of Cats and Dogs in the Epidemiological Cycle of Microsporum canis*/Die Rolle von Katzen und Hunden im epidemiologischen Zyklus des Microsporum canis

Summary: In order to study the presence of dermatophytes in healthy domestic animals, 104 cats and 126 dogs were studied in São Paulo (Brazil), by using the technique of Mariat & Tapia. Microsporum canis was verified in 88.46% of cats and in 7.93% of dogs. In a lower percentage, M. gypseum, Trichophyton mentagrophytes and T. ajelloi were also isolated. In view of these data, more attention should be given to the cats due to their importance in the transmission and persistence of M. canis. Zusammenfassung: Zur Untersuchung auf Anwesenheit auf Dermatophyten in gesunden Haustieren wurden 104 Katzen und 126 Hunde in São Paulo (Brasilien) mit der Technik von Mariat & Tapia untersucht Microsporum canis konnte bei 88,46% der Katzen und bei 7,93% der Hunde isoliert werden. Mit einem niedrigeren Prozentsatz wurden auch M. gypseum, Trichophyton mentagrophytes und T. ajelloi gefunden. Die Ergebnisse zeigen die Bedeutung gesunder Katzen für die übertragung und den Weiterbestand von Microsporum canis-Infektionen.     

Design considerations for identifying breast cancer risk factors in a population‐based study in Africa

Although breast cancer is becoming more prevalent in Africa, few epidemiologic studies have been undertaken and appropriate methodologic approaches remain uncertain. We therefore conducted a population‐based case–control study in Accra and Kumasi, Ghana, enrolling 2,202 women with lesions suspicious for breast cancer and 2,161 population controls. Biopsy tissue for cases prior to neoadjuvant therapy (if given), blood, saliva and fecal samples were sought for study subjects. Response rates, risk factor prevalences and odds ratios for established breast cancer risk factors were calculated. A total of 54.5% of the recruited cases were diagnosed with malignancies, 36.0% with benign conditions and 9.5% with indeterminate diagnoses. Response rates to interviews were 99.2% in cases and 91.9% in controls, with the vast majority of interviewed subjects providing saliva (97.9% in cases vs. 98.8% in controls) and blood (91.8% vs. 82.5%) samples; lower proportions (58.1% vs. 46.1%) provided fecal samples. While risk factor prevalences were unique as compared to women in other countries (e.g., less education, higher parity), cancer risk factors resembled patterns identified elsewhere (elevated risks associated with higher levels of education, familial histories of breast cancer, low parity and larger body sizes). Subjects with benign conditions were younger and exhibited higher socioeconomic profiles (e.g., higher education and lower parity) than those with malignancies, suggesting selective referral influences. While further defining breast cancer risk factors in Africa, this study showed that successful population‐based interdisciplinary studies of cancer in Africa are possible but require close attention to diagnostic referral biases and standardized and documented approaches for high‐quality data collection, including biospecimens.