PREVALENCE OF DERMATOPHYTOSIS AMONG PRIMARY SCHOOL CHILDREN IN UMUAHIA NORTH LOCAL GOVERNMENT AREA IN ABIA STATE

 ABSTRACT

This study aims at investigating the existence and distribution of dermatophytosis among pupils in four randomly selected schools in Umuahia North L.G.A. of Abia state, Nigeria, as well as determining the age and sex relationship. Samples of hair, nail, feet and skin scrapings collected from 200 pupils were investigated, cultured on Sabouraud agar and microscopically for fungal agents using 10% KOH and lactophenol cotton blue. Ethical approval was obtained from the Schools’ head teachers. Statistical analyses was by percentage. One hundred and twenty-four(124) (62.0%) were positive for dermatophytosis, while  76(38.0%) were negative. Identified fungi include: Microsporum audounii (32.3%), M. canis (10.5%), M. gypseum(5.6%), Trichophyton soudanense(4.0%), T. mentagrophytes (10.5%), T. rubrum (12.1%) and T. tansurans (25.0%). Study revealed that Trichophyton spp. predominated (51.6%), than Micosporum spp. (48.4%) and infection is age and sex dependent. It decreased with increased age. Male children had a higher prevalence rate (53.2%) than females (46.8%). Poor infrastructure, contact with soil, animal pets and infected peer mates; poor personal hygiene and inadequate environmental sanitation play major roles in the dissemination of dermatophytosis among these children. Consequently, proper health education, personal and environmental sanitation, infrastructure, primary health care and regular epidemiological/clinical studies are necessary in these rural primary Schools.

TABLE OF CONTENTS

Title page ………………………………………………………………………………………….i

Certification ……………………………………………………………………………………....ii

Dedication ………………………………………………………………………………………..iii

Acknowledgements ………………………………………….….…………………………….….iv

Table of contents ……………………………………………..…………………………………...v

List of tables ……………………………………………………………….……………………vii

Abstract ………………………………………………………………………………………....viii

CHAPTER ONE

1.0       INTRODUCTION ……………………….……………………………………………...1

1.1       Aim Of Study .………………...……….………………………………………………….4

1.2       Objectives Of Study ............................................................................................................4

CHAPTER TWO

2.0       LITERATURE REVIEW.……………………………..………………………………..5

2.1       About Fungi ……………………………………..………………………………………..5

2.2       Background information ……………………...…………………………………………..5

2.3       Etiological agents of dermatophytosis ……………………………………………...…….8

2.4       Pathophysiology of dermatophytes infections …………………………………..………12

2.5       Clinical manifestations of dermatophytosis ……………………………………………..13

2.6       Complications of dermatophyte infections ………………………………………….......16        

CHAPTER THREE

3.0       MATERIALS AND METHOD …………...…………………………………………..18

3.1       Ethical consideration …………………………………………………………………….18

3.2       Collection and transport of specimens …………………………………………………..18

3.3       Direct microscopy ……………………………………………………………………….19

3.4       Culture …………………………………………………………………………………...19

CHAPTER FOUR

4.0 RESULT…………………………..………………………………………….... ……….20

CHAPTER FIVE

5.0       DISCUSSION AND CONCLUSION  ………………………………………………...25

5.1       Discussion ……………………………………………………………………………….25

5.2       Conclusion ………………………………………………………………………………27

5.3       Recommendation ………………………………………………………………………..28

REFERENCES ………………………………………………………………………………...29

APPENDIX 1 …………………………………………………………………………...35

LIST OF TABLES

Table 2.1: classification of dermatophytes based on ecology and host preference                        11

Table 4.1: Seven fungi species belonging to two genera: Microsporum and Trichophyton that were identified                   15

Table 4.2: Percentage distribution of dermatophytosis among Sampled Schools in relation to age groups.                        17

Table 4.3: Distribution of etiologic agents based on sex and age           18

Table 4.4: Presence of etiologic agents according to site of infection          19

                                                             CHAPTER ONE

1.0       INTRODUCTION               

Dermatophyte is a parasitic fungus(mycosis) that infects the skin (tinea, ringworm, jock itch, athlete's foot). Dermatophytosis is a fungal infection of the skin caused by dermatophyte. Dermatophytes requires keratin for growth, they are a group of closely related fungi that have the capacity to invade keratinized tissue (skin, hair, and nails) of humans and other animals to produce an infection, dermatophytosis, commonly referred to as ringworm and it has a worldwide distribution, with prepubertal children at a higher risk. Dermatophytosis is one of the most common cutaneous infections all over the world (Ameen, 2010; Nweze and Okafor, 2005). They cause superficial fungal infections that pose public health to both man and animals (Havlickova et al, 2008) Dermatophytosis is highly contagious; (Fatini and Al-Samarai, 2000; Omar, 2000; Higgins et al., 2000), it presents a significant public health problem and unpleasant aesthetic status among pupils.  These infections are usually known based on the specific body part they are located. Those that infest the skin are named Tinea corporis, the scalp are called Tinea capitis, those for the foot are Tinea pedis or athlete’s foot, the beard for Tinea barbae and nails Tinea unguium or Onchomycosis (Cheesbrough,2000). Dermatophytes are known to grow best in warm and humid environment. The causative species vary with geographic region and vice versa (Nweze, 2001,2005,2006; Nweze and Okafor, 2005,2007; Ngwogu and Otokunefor, 2007). In recent decade, the prevalence of dermatophytosis has significantly reduced in many developed nations of the world compared to the developing ones due to improved social, economic, health care and hygiene practice factors evident in the former (Havlickova et al., 2008; Ilkit, 2010). Nigeria being a developing nation located in the tropic with wet humid climate fell into the category of regions with high prevalence of dermatophytosis, especially in school children of rural, suburban and urban extract (Gugnani and Njoku-Obi, 1995; Rudy, 1999).

This distribution pattern of dermatophytes infection in different part of the world has been attributed to factors of climate, life-style, and prevalence of immunodeficiency diseases in the community and also the reluctance of patients to seek treatment because of embarrassment or minor nature of disease unless the condition becomes sufficiently serious to affect the quality of life (Hashem al sheikh 2009)). Tinea capitis remained the most common form of dermatophytosis in Nigeria with astounding level of prevalence (Ngwogu and Otokunefor, 2007; Mbata and Nwajagu, 2007). The current state of dermatophytic infections encourages collective search for sustainable ethnopharmacological control alternative to chemical antidermatophytic formulations or drugs which became unsatisfactory for clinical treatment of dermatophytoses (Vonshak et al., 2003; Awoderu et al., 2005).

On the skin and scalp, the lesions are often roughly circular with a raised border, but may coalesce to form confluent areas of dry, scaling skin, itching and scratching, which in severe cases may ulcerate. Dermatophytes have been reported worldwide, though with variation in distribution, incidence, epidemiology, etiology and target hosts from one location to another with the passage of time.  Literature abounds on the health problems such as superficial disfigurement and deep invasion of human tissues due to symptomatic dermatophytoses, spectrum of etiological agents and epidemiology of dermatophytic infections from different parts of the world especially Nigeria (Weitzman and Summerbell 1995; Sahin et al 2004; Ngwogu and Otokunefor; 2007; Nweze 2010b).

Children are vulnerable because of inadequate amounts of inhibitory fatty acids usually produced by an adult’s skin. This makes them highly predisposed to dermatophyte infections. Children’s interaction patterns too, increases the risks of acquiring the infections through contact. Poor living conditions marked by poor; sanitation, housing (congestion), limited water supply as well as limited economic power heightens the possibility of acquiring and harboring such infections.

Dermatophytes are usually classified into three groups based on their normal habitat  (Midgley et al., 1997). These groups are:

      i.         Anthropophilic Dermatophytes: These are dermatophytes that are natural pathogens that are restricted to human host. Transmission is by close contact with infected host or contaminated objects. They include: T. rubrum, T. mentagrophytes, Tinea tonsurans, Tinea violaceum, Tinea schoenleinii and M .audounii which cause T. corporis, T. capitis, T. pedis, T. unguium and T. cruris (Philpot, 1978).

     ii.         Zoophilic Dermatophytes: These are associated with animals. Among common zoophilic dermatophytes are: M. canis which is prevalent worldwide. They are responsible for infections in cats and dogs. T. verrucosum is the causative agent of Tinea in cattle. They infect cattle breeders and veterinarians and are mostly present in temperate countries (Ghannoum et al.,2003).

   iii.         Geophilic Dermatophytes: These are usually found in the soil and are transmitted to man by direct exposure (Disalvo, 2008). Dermatophytes involved is M. gypseum, which is commonly seen in certain parts of the Tropics (Philpot, 1978).

1.1       AIM OF STUDY

To determine the prevalence and etiology of different fungal dermatological conditions in relation to age and sex among primary school children in Umuahia North Local Government Area Abia State.

1.2       OBJECTIVES OF STUDY

        i.         To determine the occurrence of dermatophytoses among primary school children in Umuahia North L.G.A.

      ii.          To isolate and identify the dermatophytes associated with the infections.

    iii.          To determine the correlation between the type of dermatophyte infection with age and sex.

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