Dermatophyte infections in children: a prospective study in a tertiary care hospital

Abstract

BACKGROUND: The prevalence of dermatophytic infections has recently surged worldwide, particularly in tropical nations like India. This is associated with change in the clinical pattern and mycological profile with poor response to treatment. This clinico-epidemiologic study helps to clarify the determinants of the trends associated with these dermatophytosis and the health burden of illness in the pediatric population. AIMS AND OBJECTIVES: 1. To determine the epidemiological profile of dermatophytosis among children (less than 15 years of age) attending dermatology OPD at tertiary care hospital. 2. To assess clinico-mycological characteristics of dermatophytosis in pediatric population. MATERIALS AND METHODS: It is a hospital-based cross-sectional study. Children below 15 years of age clinically diagnosed to have dermatophytosis were be enrolled for the study. Detailed history about duration of disease, socioeconomic status, past history of medication and consultation, personal and family history were recorded. 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 Docusign Envelope ID: 224F113D-B089-4DB4-B39B-674406D6C125 (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. RESULTS The most commonly affected age group in this study was 13-15 years with male predominance. Maximum patients (39.9%) presented with 1-2 months duration of the lesion with 27.5% of the patients having history of self-medication. Past history of similar complaints was observed in 21.6 % of the patients and 41.8 % of the patients had similar complaints among family members or close contacts. Tinea Corporis was the most common clinical diagnosis followed by tinea Capitis. Tinea Corporis with tinea Capitis was the commonest presentation among the mixed type of dermatophytosis. Direct microscopy of a 10% KOH mount demonstrated fungal hyphae in 81 % of patient’s samples and culture positivity for dermatophytes seen was in 51 %. Trichophyton mentagrophyte (32.7 %) was the most common specie isolated followed by Trichophyton rubrum (12.4%). CONCLUSION: • Topical corticosteroids in combination with antifungal agents available over counter are grossly abused leading to chronic treatment resistant dermatophytosis. • Clinical failure from antifungal medication due to the persistence of risk factors, poor personal hygiene and inadequate knowledge of the infection and its features of treatment in the general population contribute to treatment resistant dermatophytosis. • This clinic-epidemiologic study helps to determine the epidemiological trends, the nature of the disease, the predisposing factors and the causative species of dermatophytosis in the pediatric population.