Prevalence of dermatophytic fungal infections at Al-Kindi Hospital in Baghdad

Background: Dermatophytes are types of fungal infections affect skin, nails and hairs. These infections are predominant in moist and warm climate by which the growth of these organisms are sustained. Aim: find out the prevalence of dermatophytic infection among patients attending dermatological outpatient clinic at Al-Kindi Hospital in Baghdad. Result : Tinea .pedis was the most predominant clinical presentation reported in 31% of the sample.

diseases or under immunosuppressive therapy had been excluded from the study. Patients with bacterial infection or fungal in the skin folds and nails such as paronychia etc. were excluded. Ethical issue for conducting the study approved from Director of outpatient clinic with verbal consent from the patients. Information from patients were taken including age, sex, playing habit, socio-economic status and association with domestic animals.

Culture and Microscopic Examination
After identification of the infected sites, cleaning of the lesion with 70% alcohol. Collection of samples were done by scrapings the edge of the skin lesion; the infected hair is collected through plucking with sterile forceps. In nail infection; samples were collected by clippings along with subungual debris. Scrapping was taken from the edge of the lesion using sterile razor blade.
Samples were divided into two parts; the first one used for microscopic examination by applying 10-40% KOH with a cover slip then sample was warmed for 5 minutes over a flame (Hainer, 2003) in which the slide was examined for the existence of fungal hyphae then cultured of the second part of the sample on "sabourauds dextrose" agar which slopes with "chloramphenicol (0.05%) and cycloheximide (0.05%)" (Ajello et al, 1966). Incubation of the cultures at 25 0 C for 4-6 weeks was done. Checking of the culture done twice a week for the existence of the growth.
Fungal isolates were examined visually and microscopically. Macroscopically by examining rate of the growth, morphology of the colony and pigment production. Microscopic examination done with "lactophenol cotton blue mount" for the existence, arrangement and shape of macro or micro-conidia. Tests like urease test and "hair perforation" test, had been done for differentiation of dermatophyte species (Weitzman & Summerbell, 1995).

RESULTS:
From the whole fortyfive patients included in the study, higher rate of Dermatophytes infections found in male (60%) than in female (40%) with more occurrence of infection within age group (21-30) and (31-40) years. The current study showed that Tinea .pedis was the most predominant clinical presentation reported in 31% percent of the sample followed by Tinea cruris (26.7 %) and Tinea capitus   Dermatophytosis have been recorded all over the world but vary in distribution and target hosts from one location to another. Geographic location, overcrowding, climate as temperature, humidity, wind ; also health care, environmental hygiene culture, immigration, and socioeconomic conditions have been considerd as major factors for these variations.
In this study, males had higher percentage of dermatophytes than female (60% versus 40% ) which reported that females were more affected. The reason behind that may be attributed to the fact the male had more outdoor exposure, more physical work which increased sweating furthermore; males have less cosmetic consciousness compared to females. (Kumar et al , 2007) As clinical manifestations of dermatophytosis vary considerably in different studies , the current study showed that Tinea pedis and Tinea cruris then Tinea capitis were the common forms of clinical manifestations ; same finding reported by ( Sarika et al , 2014) . A study conducted in Diyala revealed that Tinea corporis was the most predominant dermatophytic infection (23.8%) (Al-Kayalli et al, 2011) while that in Baghdad, showed that Tinea capitis was the commonest one with (47.5%) incidence (Mohammed et al, 2013).
In India, Ramaraj et al , 2016 ; found that Tinea corporis was the predominant clinical type (63.27%) and Tinea cruris was the next one (13.86%).
It had been found that the Common age affected by Tinea pedis and Tinea cruris in this study was (21)(22)(23)(24)(25)(26)(27)(28)(29)(30) and (31-40) year. The reason for this may be due to increased level of physical activity in these particular age groups that leads to excessive sweating which favors the growth of dermatophytes ( Kumar et al , 2007). Wearing socks and shoes for a long period providing excessive moisture and sweating, occlusive foot wear, or frequent usage of public showers and pools may enhanced the infections with Tinea pedis while using of tightly worn synthetic clothes particularly in males provide damp conditions resulting in increased humidity and temperature of the body which makes skin as a suitable growth for Tinea cruris ( Venkatesan et al , 2007;Sarika et al , 2014).
Tinea capitis was predominant clinical presentation among children (<=10 year) in this study; similar results by (Peerapur et al , 2004) and Bindu (Bindu , 2002) , this is because , Tinea is directly transmitted by contact with infected person or animals as well as infectivity occur through contamination of fomites or soil (Andrew's & Burns , 2008) , Infection also occur as result of frequent shaving of the scalp , sharing combs, caps ,brushes, and pillows among children ( Hay et al , 1996). The scope of T.capitis is decrease with increasing age due to changes in post puberty hormones that results in acidic sebaceous gland secretions (Philpot , 1997).
Trichophyton rubrum is the common species isolated in the studied patients . Incidence of Trichophyton rubrum has increased significantly in Asia as in Europe (Hayette & Sacheli, 2015). Some strains of T.rubrum have higher capacity to spread than others in socially and economically developed countries; in addition; evolution of the life-style which remarkable by more widespread travel (economic migration and mass tourism), increased use of public sports facilities and increased ownership of companion animals, all these are contributing factors in the development of dermatomytosis (Male, 1990).