Sains Malaysiana 43(11)(2014): 1737–1742

Dermatomycoses in Kuala Lumpur, Malaysia

(Dermatomikosis di Kuala Lumpur, Malaysia)

M.N. TZAR¹*, Z.R. ZETTI¹, R. RAMLIZA¹, A.S. SHARIFAH¹ & M. LEELAVATHI²

¹Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia

Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur

Malaysia

²Department of Family Medicine (Dermatology Unit), Universiti Kebangsaan Malaysia

Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur

Malaysia

Diserahkan: 27 Februari 2013/Diterima: 7 April 2014

ABSTRACT

Prevalence of dermatomycoses varies from one centre to another due to many factors. Knowledge of local prevalence is useful to aid clinical diagnosis and treatment. Due to lack of data in Malaysia, this study aimed to look at the causes of dermatomycoses in Kuala Lumpur, Malaysia. Dermatological specimens including skin scrapings, hair and nail clippings were collected carefully from clinically suspected cases of dermatomycoses between 2008 and 2010. All cultures of skin, hair and nails that yielded positive fungal growth were included. Any fungal growth outside the streaking area, duplicate and incomplete data were excluded from the study. Three-hundred-fifty-eight patients were included. Male patients were slightly more than females with a ratio of 1.2:1. The median age was 53 years old with interquartile range of 38-64 years. More than half (53.6%) belonged to 20-60 years age group. Rates of culture isolation were 89.0% for nails, 56.2% for hair and 55.6% for skin. Five-hundred-twenty-two fungi were isolated from 358 clinical specimens. Non-dermatophyte moulds (NDMs) represented the largest group (50.5%; mainly Aspergillus species 18.7%), followed by yeasts (41.6%; mainly Candida species 26.8%) and dermatophytes (7.9%; mainly Trichophyton species 7.7%). In conclusion, NDMs and yeasts were more commonly isolated than dermatophytes from dermatological specimens in this centre. Current treatment regime that focuses on dermatophytes may be ineffective to treat dermatomycoses caused by NDMs or yeasts. Antifungal susceptibility study may be needed to guide therapy in recalcitrant cases.

Keywords: Dermatology; dermatomycoses; dermatophytes; fungi; mould

ABSTRAK

Prevalen dermatomikosis adalah berbeza dari satu-satu tempat disebabkan pelbagai faktor. Pengetahuan mengenai prevalen setempat adalah berguna bagi membantu diagnosis dan rawatan klinikal. Berikutan ketiadaan data di Malaysia, kajian ini ingin mencari penyebab dermatomikosis di Kuala Lumpur, Malaysia. Spesimen dermatologi seperti kikisan kulit, rambut dan ketipan kuku dikumpul berhati-hati daripada kes-kes dermatomikosis yang disyaki secara klinikal antara tahun 2008 dan 2010. Semua kultur kulit, rambut dan kuku yang positif telah dipilih. Sebarang pertumbuhan kulat di luar kawasan goresan kultur, data yang berulang atau tidak lengkap telah dikeluarkan daripada kajian. Tiga ratus lima puluh lapan pesakit telah dipilih. Lelaki lebih ramai daripada perempuan dengan nisbah 1.2:1. Umur pertengahan adalah 53 tahun dengan julat antara suku 38-64 tahun. Lebih daripada separuh (53.6%) berumur 20-60 tahun. Kadar pemencilan kultur adalah 89.0% untuk kuku, 56.2% untuk rambut dan 55.6% untuk kulit. Lima ratus dua puluh dua kulat telah dipencil daripada 358 spesimen klinikal. Kulapuk bukan dermatofit (NDMs) mewakili kumpulan terbesar (50.5%; terutamanya Aspergillus species 18.7%), diikuti oleh yis (41.6%; terutamanya Candida species 26.8%) dan dermatofit (7.9%; terutamanya Trichophyton species 7.7%). Kesimpulannya, NDMs dan yis adalah lebih kerap dipencil berbanding dermatofit daripada spesimen dermatologi di pusat perubatan ini. Cara rawatan kini yang memfokus pada dermatofit mungkin tidak berkesan untuk merawat dermatofit yang disebabkan oleh NDMs atau yis. Kajian kerentanan antikulat mungkin diperlukan untuk membantu rawatan dalam kes-kes yang sukar.

Kata kunci: Dermatofit; dermatologi; dermatomikosis; kulapuk; kulat

RUJUKAN

Borman, A.M., Campbell, C.K., Fraser, M. & Johnson, E.M. 2007. Analysis of the dermatophyte species isolated in the British Isles between 1980 and 2005 and review of worldwide dermatophyte trends over the last three decades. Med. Mycol. 45(2): 131-141.

Brajac, I., Prpic-Massari, L., Stojnic-Sosa, L. & Gruber, F. 2003. Dermatomycoses in the Rijeka area, Croatia, before, during and after the war 1990-1999. Mycoses 46(5-6): 213-217.

Clayton, Y.M. & Hay, R.J. 1994. Epidemiology of fungal skin and nail disease. Roundtable discussion held at Dermatology 2000, Vienna, 17 May 1993. Br. J. Dermatol. 130(Suppl. 43): 9-11.

Das, S., Goyal, R. & Bhattacharya, S.N. 2007. Laboratory-based epidemiological study of superficial fungal infections. J. Dermatol. 34(4): 248-253.

Ellabib, M.S., Khalifa, Z. & Kavanagh, K. 2002. Dermatophytes and other fungi associated with skin mycoses in Tripoli, Libya. Mycoses 45(3-4): 101-104.

Ergin, C., Erhin, S. & Arikan, S. 2002. Prevalence of dermatomycoses in mal de Meleda patients: A field study. Scand. J. Infect. Dis. 34(10): 753-755.

Havlickova, B., Czaika, V. & Friedrich, M. 2008. Epidemiological trends in skin mycoses worldwide. Mycoses 51(1): 2-15.

Jacobson, E.S. 2000. Pathogenic roles for fungal melanins. Clin. Microbiol. Rev. 13(4): 708-717.

Khardori, N., Hayat, S., Rolston, K. & Bodey, G. 1989. Cutaneous Rhizopus and Aspergillus infections in five patients with cancer. Arch. Dermatol. 125(7): 952-956.

Lange, M., Nowicki, R., Baran´ska-Rybak, W. & Bykowska, B. 2004. Dermatophytosis in children and adolescents in Gdansk, Poland. Mycoses 47(7): 326-329.

Larone, D.H. 2002. Medically Important Fungi - A Guide to Identification. 4th ed. Washington D.C.: ASM Press.

Lo´pez-Martinez, R., Neumann, L. & Gonza´lez-Mendoza, A. 1999. Case Report: Cutaneous penicilliosis due to Penicillium chrysogenum. Mycoses 42(4): 347-349.

Lohoué Petmy, J., Lando, A.J., Kaptue, L., Tchinda, V. & Folefack, M. 2004. Superficial mycoses and HIV infection in Yaounde. J. Eur. Acad. Dermatol. Venereol. 18(3): 301-304.

Lyratzopoulos, G., Ellis, M., Nerringer, R. & Denning, D.W. 2002. Invasive infection due to Penicillium species other than P. marneffei. J. Infect. 45(3): 184-207.

Mathur, M., Baradkar, V.P., De, A., Taklikar, S. & Gaikwad, S. 2008. Dermatomycosis caused by common and rare fungi in Mumbai. Indian J. Dermatol. Venereol. Leprol. 74(4): 402-403.

McAleer, R. 1980. Fungal infection as a cause of skin disease in Western Australia. Australas. J. Dermatol. 21(1): 25-46.

Ng, K.P., Saw, T.L., Madasamy, M. & Soo Hoo, T.S. 1999. Onychomycosis in Malaysia. Mycopathologia 147(1): 29-32.

Ng, K.P., Soo-Hoo, T.S., Na, S.L. & Ang, L.S. 2001. Dermatophytes isolated from patients in University Hospital, Kuala Lumpur, Malaysia. Mycopathologia 155(4): 203-206.

Nucci, M. & Anaissie, E. 2002. Cutaneous infection by Fusarium species in healthy and immunocompromised hosts: implications for diagnosis and management. Clin. Infect. Dis. 35(8): 909-920.

Oyeka, C.A. & Eze, I.I. 2007. Fungal skin infections among prison inmates in Abakaliki, Nigeria. Mycoses 51(1): 50-54.

Popoola, T.O.S., Ojo, D.A. & Alabi, R.O. 2006. Prevalence of dermatophytosis in junior secondary schoolchildren in Ogun State, Nigeria. Mycoses 49(6): 499-503.

Prevost, E. 1983. The rise and fall of fluorescent tinea capitis. Pediatr. Dermatol. 1(2): 127-133.

Ramani, R., Ramani, A. & Shivananda, P.G. 1994. Penicillium species causing onychomycosis. J. Postgrad. Med. 40(2): 87-88.

Revankar, S.G. 2006. Phaeohyphomycosis. Infect. Dis. Clin. North Am. 20(3): 609-620.

Rodwell, G.E.J., Bayles, C.L., Towersey, L. & Aly, R. 2008. The prevalence of dermatophyte infection in patients infected with human immunodeficiency virus. Int. J. Dermatol. 47(4): 339-343.

Sahin, I., Kaya, D., Parlak, A.H., Oksuz, S. & Behcet, M. 2005. Dermatophytoses in forestry workers and farmers. Mycoses 48(4): 260-264.

Sellami, A., Sellami, H., Makni, F., Mezghani, S., Cheikh- Rouhou, F., Marrekchi, S., Turki, H. & Ayadi, A. 2008. Childhood dermatomycoses study in Sfax hospital, Tunisia. Mycoses 51(5): 451-454.

Selvi, G.S., Kamalam, A., Ajithados, K., Janaki, C. & Thambiah, A.S. 1999. Clinical and mycological features of dermatophytosis in renal transplant recipients. Mycoses 42(1-2): 75-78.

Seneczko, F., Lupa, S., Jeske, J., Głowacka, A. & Oche?cka- Szyman´ska, A. 1999. Epidemiology of dermatomycoses of humans in Central Poland. Part I—Superficial infections caused by yeasts and moulds. Mycoses 42(4): 297-305.

Singh, D., Patel, D.C., Rogers, K., Wood, N., Riley, D. & Morris, A.J. 2003. Epidemiology of dermatophyte infection in Auckland, New Zealand. Australas. J. Dermatol. 44(4): 263-266.

Sirisanthana, T. & Supparatpinyo, K. 1998. Epidemiology and management of penicillosis in HIV infected patients. Int. J. Infect. Dis. 3(1): 48-53.

Tzar, M.N. & Shamim, A.S. 2009. Candidaemia and antifungal susceptibility testing in a teaching hospital. Med. J. Malaysia 64(1): 61-64.

Welsh, O., Welsh, E., Ocampo-Candiani, J., Gomez, M. & Vera- Cabrera, L. 2006. Dermatophytoses in Monterrey, Mexico. Mycoses 49(2): 119-123.

WHO. 2013. Definition of key terms. http://www.who.int/hiv/ pub/guidelines/arv2013/intro/keyterms/en/ Accessed on 10 December 2013.

*Pengarang untuk surat-menyurat; email: tzar@ppukm.ukm.edu.my