A Survey Of Dermatophytes Isolated From Iraqi Patients In Baghdad City

Dermatophytes infection is a common problem worldwide and frequent in Iraq. Several reports and articles were published on prevalence, distribution, causes and treatment of dermatophytosis . This case study was conducted on fifty patients(31males and 19 females) with suspected dermatophytes were studied . Their ages ranged from one year to fifty years .Patients admitted to Baghdad Teaching Hospital , Dept . of Dermatology , Baghdad during September 2010 to March 2011.Hairs and scales were collected and microscopicall examination using 20% KOH were done. Hair and scales from active outer border of the lesion were inoculated on modified Sabouraud's dextrose agar. Culture was incubated at room temperature(28C°) for 4 5 weeks. The identification of dermatophyte species was based on the gross , and microscopical and cultural characteristic according to standard mycological references . The infection of dermatophyte was much higher in children below 10 years of age. Males 31(62%) were affected more than females 19(38%).Tinea capitis 19(47.5%) was the predominant clinical type .The main etiological agents was Trichophyton rubrum 20(50%) followed by Trichophyton mentagrophytes 13(32.5%). The predominant anthropophilic dermatophytic species was Trichophyton rubrum. This study was carried out to determine the prevalence, causative agents of dermatophytosis in group of Iraqi patients in Baghdad.

. Dermatophytes are fungi that require keratin for growth. These fungi can cause superficial infections of the skin, hair and nails. Dermatophytes comprise a group of closely related fungi made up of three genera : Trichophyton , Microsporum and Epidermophyton ( 2 ) . Each of the dermatophytes ( Anthropophilic , Zoophilic , Geophilic ) has its own epidemiological importance not only to people and the animals but also to the environment .Most important to people and animals are the anthropophilic and zoophilic dermatophytes ( 3 ) .Dermatophytosis are the most common cutaneous infection all over the world( 4 -7) and vary from country to country and region to region , creating a specific spectrum of the region ( 8 -12 ).
Fungal infections in Iraq are the most common infections encountered in dermatological practice (13 .The etiological pattern of dermatophytosis believed to have been changed in the recent years from an etiology dependent on anthropophilic fungi to zoophilic fungi ( 5 -14 ). The incidence and distribution of dermatophytes have been studied in various geographical areas of the world including Iraq ( 15 , 16), Jordan ( 17) , Kuwait ( 18) , Saudi Arabia ( 19 ), Europe and Greece ( 21 ). So the aim of the present study is to determine the frequency of dermatophyte infection and identify the causative agents in Iraqi patients.

Patients and Methods
Fifty patients (31 male and 19 females) with suspected dermatophytes were studied . Their ages ranged from one year to fifty years. This work was carried out in Baghdad Teaching Hospital ,Department of Dermatology, Baghdad during the period of September 2010 to March 2011 . All patients were carefully assessed clinically. Hair and skin scales were collected by skin scraping to be submitted to direct microscopical examination after immersion in 20% potassium Hydroxide Solution . Hair and scales from active outer border of the lesions of all patients were inoculated on Modified Sabouraud's dextrose agar containing chloramphenicol( 0.05 mg / ml) and cycloheximide ( 0.5 mg / ml ) . Cultures were incubated at 28 c with daily observation for a period of 4 -5 weeks before they were considered negative .Colonies were Subcultured on the same medium and kept at 4 C for farther studies .The identification of the dermatophyte species was based on the gross and microscopic cultural characteristics produced on this standard medium according to Emmon's et al ( 22 ) and Rippon ( 23 ) .

Results
Out of the fifty cases of which clinically diagnosed as dermatophytes 34 (68%) cases were positive in both direct microscopical examination and culture ,10 (20%) cases yield a negative culture although the direct KOH mount examination was positive and the remaining 6 ( 12%) cases gave a positive culture results while the direct microscopical examination was negative ( Table 1 ) . The infections with dermatophytes were much higher in children below 10 years of age .Males 31 ( 62%) were affected more than females 19 ( 38%) as shown in (Table 2 ).

Discussion
Although all dermatophytes are closely related , each species has certain characteristics in its geographical distribution .The changes in distribution of dermatophytes during the Century all over the world are striking and several explanations have been discussed . A true increase of a certain species and altered distribution would be a result of increased exposure to fungi , change in human habits , change in the pattern of the animal houseshold , a change in pathogenicity , and Intensive use of antimycotics (24) . From the result of this study, majority of the organism isolated belong to the genera Trichophyton and Microsporum and one Isolate belong to genus Epidermophyton . Furthermore , it was clearly showed from the results of this study (Figure1) that Tinea capitis was the commonest form of the dermatophytes infection with (47.5%) incidence. This finding was in agreement with the result obtained from Amehand and Okolo (25) ; Enemuor and Amedue ( 26 ) and Kalifa et .al in Iraq ( 16 ).
In the present study the anthropophilic species was more prevalent than zoophilic species as etiologic agents of dermatophytosis . This coincides with the findings of others (29 , 30 ).
It was previously reported that Tinea capitis is the most clinical form of dermatophytosis in both Liberia and the Republic of Chad where Trichophyton sudanese was the main etiological agent (31) .
Trichphyton rubrum is cosmopolitan but appears to have had a more restricted distribution in the past, having been transported widely as a result of human migration ( the anthropophiles travel with their human hosts ( 1 ) .
The incidence of Trichophyton rubrum has increased significantly during the past 40 years in Europe and now Trichophyton rubrum is the most frequently Isolated dermatophytic species in Europe (30) as well as in Baghdad .
In conclusion the predominant anthropophilic dermatophytic infection was caused by .Trichophyton rubrum which is the most frequently isolated species .