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The epidemiological features of fungal infections of the face in patients admitted the Medical Mycology Laboratory of the special clinic of Kermanshah University of Medical Sciences, during 1994-2011.

The fungal infections of the face skin mainly include Tinea Faciei and Pityriasis Versicolor. These superficial cutaneous fungal infections are the most prevalent fungal diseases and are mostly observed in adults. Tinea Faciei is caused by Dermatophyte species. Dermatophytes have diverse species of three genera including Epidermophyton, Microsporum and Trichophyton genera. Dermatophytes have Human, Animal and Terricolous caches.

Pityriasis Versicolor is one of the most rampant superficial cutaneous fungal infections of the skin. It is highly frequent among youth and middle-age people living in environments with the presence of humidity and fat. Pityriasis Versicolor lesions are the spots paler or darker than the host skin complexion, without any itching irritation or inflammation. Pityriasis Versicolor is mostly witnessed on the upper parts of the body including face, neck, back, chest (breast), arms and shoulders while it is less observed in the lower parts of the body. Pityriasis Versicolor often cause dandruff on the scalp of the patients. This disease is usually caused by Malassezia Furfur (Zaini & Mehbod, 2004; Aghamirian et al, 2007).

METHODOLOGY

The lesions were antisepticised using an alcohol-soaked cotton wool. Then, the skin lesions were gently collected using a sterile scalpel blade. The collected samples were prepared for a direct microscopic vision using a slide of Potassium Hydroxide (%10) in order to identify and detect the Dermatophytosis. In addition to the moist slide of Potassium Hydroxide, a scotch tape (transparent cellophane tape) slide was collected as well from the patients suspected to Pityriasis Versicolor. Next, the prepared slides were scrutinized under light microscopic lenses 10 and 40.

The observation of the circle or ovalshaped yeast fascicles (clump) together with short and curved Hyphae on either the potassium slide or scotch tape slide were indicative of Pityriasis Versicolor disease in the suspected patients. On the other hand, the observations of fungal filaments with Arthroconidia, Ectothrix or Endothrix, and the fungal filaments in hair shaft were indicative of the Dermatophytosis and Tinea Faciei.

Furthermore, the lesion samples collected from the patients were cultivated in Mycology culture media, Sabouraud Dextrose Agar containing or lacking Cycloheximide, and the incidence of any kind of the fungal colony growth was identified and detected for four weeks. Otherwise the result of the cultivation would be negative.

In addition to the results of the direct microscopic vision and cultivation, the other information about the patients' clinical conditions were collected using questionnaires and interviewing the patients.

RESULTS

According to the results, out of 2290 patients suspected to Tinea Faciei (Face Fungus), almost 780 (%34) patients suffered from Tinea Faciei among which %56 were male and %44 were female patients, nonetheless, %92 and %0.8 of the patients lived respectively in urban and rural areas.

Tinea Faciei (Face Fungus) was most prevalent (%43.8) among students; whereas the Unemployed individuals (%32), Housewives (%12.5), Self-employed (%3), Employees and Farmers, Militaries and Drivers, Workers and Ranchers got the successive ranks in the classification of disease risk frequency occurrence.

Tinea Faciei had the highest risk of incidence in winter (%34) and autumn (%32) while spring (%21) and summer (%14) got the other levels of occurrence. In the current study, the prevalent Dermatophyte species isolated from Tinea Faciei showed that Trichophyton Verrucosum with a frequency of (%45.32) indicated the most cases of Tinea. However, the other consecutive levels of risks belonged to Trichophyton Mentagrophytes (%22), Trichophyton Rubrum (%17.12), Trichophyton Violaceum (% 6.4), Microsporum Canis (%5.42) and Epidermophyton Floccosum (%3.45) in succession.

Findings showed that out of the 2290 patients under study, almost 101 patients (%41.04) sufferedfrom Pityriasis Versicolor among which %73 were male, %27 were female and %97 of patients lived in urban areas while only %3 lived in rural areas. The most cases of the disease was reported to be prevalent in the age group 10 to 19 years old (%46.15) (Table 1). In terms of the employment, the disease cases were observed to be most frequent in students' group (%58.28). Unemployed, employees, farmers, drivers, housewives, self-employed, soldiers, and other types of employment got the lower ranks in the classification of disease risk frequency occurrence.

Nevertheless, it was concluded that, in terms of the frequency of the seasonal patient visitors, Pityriasis Versicolor was most prevalent in autumn (%28) whereas summer, winter and spring were placed at the other ranks as %27, %23 and %22 respectively.

DISCUSSION

The prevalence of the fungal infections is different at different age groups. Pityriasis Versicolor mostly occurs and/is prevalent during puberty and middle-age (15-45) (Zaini & Mehbod, 2004).

The results of the present study revealed that the most frequent cases of Pityriasis Versicolor was observed in age group 10-19 while the age group 60 and above (A60) had the least frequent cases of disease. In a study in Hamedan, it was concluded that Tinea Faciei (Face Fungus/Tinea) had got the fifth place after the other frequent cases such as Tinea Cruris (Groin), Tinea Corporis (Body), Tinea Unguium (Nails) and Tinea Pedis (Feet) (Aghamirian et al, 2007).

Age factor plays the most crucial role in catching the types of Tineas; for instance, a research investigation on children has shown that Tinea Capitis (Head/Scalp) was the most prevalent disease among children age group (Basiri Jahromi, 2009). Studies done in India and Venezuela concluded that Face and Chest (Breast) were consecutively the most susceptible parts of the body to this disease i.e. Tinea (Jena et al, 2005; Acosta Quintero & Cazorlperfetti, 2004).

A study in Ahwaz showed that the frequency of Tinea Faciei was only %4 (Omidian, 1999). In the current study, %24 of the patients had lesions on the face i.e. they suffered from Tinea Faciei (Face).

In a study conducted by Alizadeh et al. (2004) in Guilan, Tinea Faciei (Face ringworm) was reported to be the least frequent cases of disease amongst the diverse types of Tinea infections.

Pityriasis Versicolor was mostly common in autumn while it was the least common disease in spring; the results of a study in India indicated that the most cases of this disease was observed in summer (Jena et al, 2005).

Asadi et al (1999) found that Trichophyton Mentagrophytes were the most prevalent species whereas the results of the present research showed that the most isolated factor was Trichophyton Verrucosum.

The most common cases of Pityriasis Versicolor were observed amongst students, in terms of employment, which is remarkably justified probably due to the outbreak of this disease in puberty and adolescence and that most population of the society include the young age range. Yaghoobi et al. (2000) concluded that almost half of the slaughterhouse workers in Ahwaz suffered from either Tinea or Pityriasis Versicolor. Fortina et al (2005) in Italy found that Pityriasis Versicolor was the second disease amongst transplant recipients.

Raci (2001) studied 100 cases of Pityriasis Versicolor patients whose average age was 24, he found that there was not any statistically significant difference between patients' sex and their vulnerability to the disease.

According to Talary et al. (2000), amongst 213 patients with Dermatophytosis, 3 patients (%1.4) had Tinea Faciei. Rahmati et al (2006) studied 1270 dormitory students in the University of Shahid Behesti, they found that %8 of the students suffered from Pityriasis. The frequency of Pityriasis Versicolor reach to %30-%40 in tropical areas. Research has shown that Geographical factors have significant effects on the occurrence of the diverse species isolated form Pityriasis Versicolor (Nazeri et al., 2011).

Occupation has a critical role in the incidence of the Skin Infections. For instance, in military centers, due to the predisposing factors, the patterns of skin infections differ from the patterns in society (Davari et al., 2011). Bassiri et al. (2006) found that Tinea was more frequent in the age range 10-20. Salari (2002) studied the textile workers in Yazd, he concluded that Pityriasis Versicolor was almost %21.3 widespread.

It has been approved that occupation plays the most crucial role in the occurrence of the Superficial Cutaneous Infections/diseases. Accordingly, Qaedinia et al. (2001) found that fishermen and shrimp farmers who are always in direct contact with seas and the shrimp farming pools and are working in the southern regions of the country in summer are more prone to the superficial cutaneous fungal infections.

Even though the most opportunistic fungal infections observed in patients taking immunosuppressive drugs are associated with urinary tract and kidney infections, the outbreak of superficial cutaneous fungal infections are also noticeable in these patients (Diba et al., 2002). Living in the crowded environments such as camps increase the incidence of many diseases including superficial cutaneous fungal infections (Bineshian, 2006).

Nasrolahi et al. (2010) found that after Dermatophytosis, the second superficial cutaneous fungal infection is Pityriasis Versicolor.

CONCLUSION

According to the aforementioned reports, it seems that superficial cutaneous fungal infections yield different frequencies under different geographical, occupational, age, sex and other predisposing factors and circumstances. Consequently, further similar studies are recommended to be conducted in other different regions of the country.

ACKNOWLEDGEMENT

Sincere thanks to the University Research Council which provided the opportunity of investigating such a study, and honest gratitude to Ms. Amiri, the technician of medical Myology Laboratory.

REFERENCES

(1.) Acosta Quintero M.E. & Cazorlperfetti D.J. Clinical Epidemiological Aspects of Pityriasis Versicolor in a Fishing Community of the Semiarid Region in F alcon State, Venezuela. Rev IberoamMicol, 2004; 21(4): 191-194.

(2.) Aghamirian, M. R., Keshavarz, D. & Jahani Hashemi, H. Clinical Evaluation of Dermatophytosis in Patients Referred to Dermatologic Department of Bu-Ali Sina Hospital in Qazvin in Iran during 2004-2005. Iranian South Medical Journal, 2007; 9(2): 175-181.

(3.) Alizadeh, N., Sadr Ashkevary, Sh. Golchai, J. Maboodi, A. & Falahati, A.A. Descriptive Study of Dermatophytosis in Guilan. Iranian Journal of Dermatology, 2004; 7(28): 255-260.

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(5.) Basiri Jahromi, S. & Khaksar, A. A. Surveillance of Dermatophytosis and the Causative Agents among Children Referred to Pasteur Institute of Iran from 2005 to 2006. Journal of the Shaheed Beheshti University of Medical Sciences and Health Services, 2009; 32(4): 321-326.

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(9.) Diba, K., Naghizadeh, A. & Rashidi, T. Cutaneous Fungal infections among Kidney Transplant Patients. Journal of Kordestan University of Medical Sciences, 2002; 6(24): 12-16.

(10.) Fortina, A. B., Piasevico, S., Alaibac, M., Cfovio, A. L., Brando Lisio, L., Zacchello, G., Zanon, G. F., Zancan, L. & Peserico, A. Skin disorders in patients Transplanted in Childhood. Department of Pediatrics, University of Padua, via Giastiniani 3 .Transplant, 2005; 18(3): 360-365.

(11.) Jena, D. k. Sengupta, S., Dwari, B. C. & Ram, M. K. Pityriasis Versicolor in the Pediatric Age Group. Indian J Dermatol VenerealLeproi, 2005; 71(4): 256-261.

(12.) Nasrolahi, O., Hashemi, S. J. & Hashemi, F. The Epidemiological Study of 5500 Cases of Cutaneous Fungal Infections in Tehran. Tehran School of Medicine Journal, 2010; 68(1): 45-53.

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(20.) Yaghoobi. R., Hoghooghi Rad, N. & Latifi S.M. Prevalence of Skin Diseases among Slaughterhouse Workers and Personnel of Two Hospitals inAhwaz during 1996-1997. Scientific Medical Journal of Ahwaz University of Medical Sciences, 2000; 28: 31-39.

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Ali Mikaeili* and Hakimeh Hashemi

[1] Deparment of Medical Mycology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran, member of dermatophytosis research Centre Kermanshah, Iran. [2] Hashemi, Hakimeh. Medical student of Kermanshah University of medical sciences, Kermanshah, Iran.

(Received: 08 February 2016; accepted: 06 April 2016)

* To whom all correspondence should be addressed. E-mail: dramikaeli@yahoo.com
Table 1. The Frequency Distribution of Tinea Faciei and Pityriasis
Versicolor in terms of Age Group

Disease Age Group         0-9    10-19   20-29   30-39

Tinea Faciei             42.56   32.56   13.58   5.51
Pityriasis Versicolor     20     46.15    20       5

Disease Age Group        40-49   50-59   >60    Total (%)

Tinea Faciei              2.3    1.79    1.53      100
Pityriasis Versicolor      4       3     1.20      100
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Author:Mikaeili, Ali; Hashemi, Hakimeh
Publication:Journal of Pure and Applied Microbiology
Article Type:Report
Geographic Code:9INDI
Date:Mar 1, 2016
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