Clinico-Mycological Study Of Dermatophytosis At A Tertiary Care Hospital.

Abstract

Background Dermatophytosis is a superficial fungal infection of keratinized tissue. Dermatophytes are a specialized group of fungi causing dermatophytosis that affects skin, hair, and nail. The evolution of the dermatophytes is constantly influenced by the geographic and socioeconomic conditions. The disease has a high carriage rate thus affecting a majority of people and also leading to chronicity and frequent relapses among patients. The disease is associated with significant morbidity and poor quality of life Objective To determine the epidemiological trends of dermatophytosis among patients attending skin OPD at a tertiary care centre and also to study the clinical types and its relation to lifestyle, occupation, and co-morbidities. Methodology It is a hospital-based cross sectional study. A total of 384 patients with clinical suspicion of dermatophytosis were enrolled in the study irrespective of age and gender. Detailed history about age, duration of disease, occupation, socioeconomic status, past history of medication and consultation, personal and family history were recorded from the patients. The Patients were examined to determine the clinical type of dermatophytosis. Specimen(skin scraping, hair, or nail clippings) for microbiological investigations was collected from the lesion. It was utilized for preparing a 10% KOH mount for direct microscopy for visualization of fungal hyphae. Irrespective of KOH mount result, the specimen was also inoculated in 3 media, Sabouraud dextrose agar without chloramphenicol and cycloheximide(SDA), Sabouraud dextrose agar with Chloramphenicol, and cycloheximide(SDA with antibiotics) and Dermatophyte test media(DTM). It was further sent to the microbiology laboratory for the purpose of incubation and isolation of species. DocuSign Envelope ID: AC954922ED4035B--DB96D240--4486FF7F--880572B0-70E667584E7678A34ADB8CB Result The most commonly affected age group in this study was 30-39 years with male predominance. Maximum patients (42.2%) presented with 1-2 months duration of the lesion with half of the patients having history of self-medication. Past history of similar complaints was observed in 20% of the patients and One third (1/3rd) of the patients had similar complaints among family members or close contacts. Tinea corporis was the most common clinical diagnosis followed by tinea cruris. Tinea corporis with tinea cruris was the commonest presentation among the mixed type of dermatophytosis. Direct microscopy of a 10% KOH mount demonstrated fungal hyphae in 82.6% of patient’s samples and culture positivity seen was 57%. Trichophyton mentagrophyte(43.84%) was the most common specie isolated followed by Trichophyton rubrum(37.90%). Conclusion An epidemiological study helps to understand the complex interplay betweeen host, environment, and agent factors. Dermatophytoses has emerged as a rampant infection in the recent past with many atypical, recalcitrant and difficult to treat cases. This study helps to determine the epidemiological trends, the nature of the disease, the predisposing factors and the causative species.. Hence, a mycological study helps in identifying and understanding the various factors related to the disease as it varies from place to place and time to time, thereby helps in containing the epidemic of an infectious diseases such as dermatophytosis