Journal of Enam Medical College

Vol 8 No 1 January 2018

Original Article
Prevalence of Dermatophytic Infection and Detection of
Dermatophytes by Microscopic and Culture Methods
Tashmin Afroz Binte Islam1, Farjana Majid2, Mushtaque Ahmed3, Samia Afrin4, Tahmina
Jhumky5, Faria Ferdouse6
Received: January 31, 2017 Accepted: December 31, 2017
doi: http://dx.doi.org/10.3329/jemc.v8i1.35429

Abstract
Background: Dermatophytosis is considered as one of the major public health problems in the world
and is the most commonly diagnosed skin disease in Bangladesh. The prevalence and characteristics
of dermatophytic infections vary with climatic conditions, age, lifestyle and population migration
patterns. Objective: To determine the prevalence of dermatophytic infection and sensitivity of
different diagnostic procedures among the patients visiting dermatology outpatient department of
Tairunnessa Memorial Medical College & Hospital, Gazipur, Bangladesh (TMMCH). Materials
and Methods: This cross-sectional study was done during a period of 12 months from July 2015 to
June 2016. Total 80 specimens were collected based on clinical presentations irrespective of age
and sex. The diagnosis was confirmed by microscopic examination using 20% potassium hydroxide
(KOH) and culture on Sabouraud’s dextrose agor medium. Results: Out of 80 samples, 31(38.75%)
were found positive by culture and 21 (26.25%) were found positive by microscopic method which
were also found positive by culture. This study found that most (51.62%) of the dermatophyte-
infected cases were in the age group of 21−40 years followed by 41−60 years (29.03%) with male
and female distribution 58.06% and 41.94% respectively The maximum number of infections was
reported from groin followed by hands/legs and feet. Conclusion: The result of this study shows
higher prevalence of dermatophytosis in both genders in this area. An accurate diagnosis can help
in proper and effective treatment of dermatophytosis.
Key words: Dermatophytic infection; TMMCH; Microscopy; Culture
J Enam Med Col 2018; 8(1): 11−15

Introduction Dermatophytes are a group of closely related

Dermatophytosis is a common skin disease, affecting keratinophilic fungi that can invade keratinized
millions of people worldwide.1 These infections occur tissues of humans and animals such as skin, hair and
in both healthy and immunocompromised patients. nails causing dermatophytosis.4 Dermatophytosis
Dermatophytes are responsible for most cutaneous includes several distinct clinical manifestations. The
fungal infections and the estimated lifetime risk of severity of the disease depends on strain or species of
acquiring dermatophytic infection is between 10– infecting fungus, the sensitivity of the host and the site
20%.2,3 of infection.5 Dermatophytes consist of three genera−

1. Assistant Professor of Microbiology, Tairunnessa Memorial Medical College, Gazipur

2. Associate Professor (current charge) of Microbiology, Tairunnessa Memorial Medical College, Gazipur
3. Professor of Microbiology, Popular Medical College, Dhaka
4. Assistant Professor of Microbiology, Central Medical College, Comilla
5. Assistant Professor of Pathology, Central Medical College, Comilla
6. Assistant Professor of Microbiology, Shaheed Monsur Ali Medical College, Dhaka
Correspondence Tashmin Afroz Binte Islam, Email: [email protected]

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Trichophyton, Microsporum, and Epidermophyton.6 Specimens from clinically abnormal nails were
Worldwide the most common cause of tinea pedis, tinea collected by clipping of the distal portion of nail,
unguium (onychomycosis), tinea cruris, tinea mannum, the underside area, and the nail bed. The scrapings
tinea corporis, and tinea faciei is Trichophyton were collected on a piece of sterile brown paper and
rubrum.2 Other frequently implicated agents include then folded, labelled and brought to the laboratory
Trichophyton mentagrophytes, Microsporum for further processing. Confirmation of the clinical
diagnosis was based on microscopic examination and
canis, Microsporum gypseum and Epidermophyton
culture. All necessary precautions were taken to avoid
floccosum.7
any contamination during collection, transport, and
The laboratory diagnosis of dermatophytosis routinely identification of pathogens.14
involves direct microscopic examination of clinical
Isolation of dermatophytes: The collected specimens
specimen followed by in vitro culture techniques.
were divided into two portions. The first portion of
Microscopic identification of fungal elements directly
the specimens was examined microscopically using
from clinical specimen is a rapid diagnostic method,
20% potassium hydroxide (KOH) for the presence
but it lacks specificity and sensitivity, with false
of filamentous, septate, branched hyphae with or
negative results in up to 15% cases.8 In vitro culture
without arthrospores.15 The second portion was
is a specific diagnostic test, but it is a slow technique.9
cultured on Sabouraud’s dextrose agar medium with
The advent of molecular technology has enabled the
antibiotics (Oxoid, UK) and incubated at 25°C for
development of techniques like polymerase chain
2−3 weeks. Identification of fungi was made on the
reaction which is a highly sensitive and specific test
basis of phenotypic characteristics of the colonies and
and can be used for diagnosis of fungal infections.
microscopic examination.15
The prevalence of disease varies in different
Data analysis: Data were analyzed using Microsoft
geographical areas. Many studies have investigated
Excel 2007 and comparisons were performed using
the prevalence of dermatophytosis in different
chi-square test.
regions of the world including Bangladesh.10-13 The
aim of this study was to determine the prevalence of Results
dermatophytic infections and diagnosis by microscopy Out of total 80 specimens 31(38.75%) showed
and culture methods in Gazipur, Bangladesh. positive growth of dermatophytes. Among the 75 skin
Materials and Methods specimens 29 (38.67%) were positive and among the 5
nail specimens 2 (40%) were positive (Table I).
This cross-sectional study was done over a period of
12 months from July 2015 to June 2016 in Tairunnessa This study found that most (51.62%) of the
Memorial Medical College Hospital (TMMCH), dermatophyte-infected cases were in the age group of
Gazipur, Bangladesh. Total 80 samples were collected 21−40 years followed by 41−60 years (29.03%) with
from clinically suspected dermatophytosis patients male and female distribution 58.06% and 41.94%
who visited Dermatology Outpatient Department. respectively (Table II).
Specimen collection and processing: Skin samples In this study, out of 80 specimens, 31(38.75%) were
were collected carefully by scraping, after disinfection found positive by culture and among the 31 culture
with 70% alcohol solution using a sterile scalpel. positive specimens 21 (26.25%) were found positive

Table I: Isolation rate of dermatophytes from skin and nail samples (n=80)
Types of specimens Number (%) Positive growth No growth
n (%) n (%)
Skin 75 (93.75) 29 (38.67) 46 (61.33)
Nail 5 (6.25) 2 (40) 3 (60)
Total 80 (100.00) 31 (38.75) 49 (61.25)

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Table II: Age and sex distribution of dermatophyte-positive cases (n=31)

Age group in years Male Female Total
n (%) n (%) n (%)
≤ 20 3 (9.68) 1 (3.23) 4 (12.91)
21−40 10 (32.26) 6 (19.36) 16 (51.62)
41−60 4 (12.90) 5 (16.13) 9 (29.03)
≥ 60 1 (3.22) 1 (3.22) 2 (6.44)
Total 18 (58.06) 13 (41.94) 31 (100.00)

Table III: Detection rate of dermatophytes by culture and microscopy

Methods Positive Negative Total
n (%) n (%) n (%)
Culture 31 (38.75) 49 (61.25) 80 (100.00)
Microscopy 21 (26.25) 59 (73.75) 80 (100.00)

Table IV: Comparison between microscopic examination and culture method for
detection of dermatophytes
Microscopic Culture method Total
method Positive Negative
Positive 21 0 21
Negative 10 49 59
Total 31 49 80

by microscopic method (Table III). After comparing positive dermatophytic infection, which is higher than
between microscopy and culture methods we found findings in our study.19 The discrepancy of the findings
that the sensitivity of microscopic method was 67.74% of different studies may be due to the variation
and specificity was 100% (Table IV). of prevalence with time as well as from country to
country, city to city and even hospital to hospital in
Discussion
same city.
Dermatophytosis is one of the most common cutaneous In our study, dermatophytosis was more prevalent
infections all over the world and is cosmopolitan in
in men (58.06%) than in women (41.94%). This is
distribution, but previously most dermatophyte strains
similar with the studies of other researchers from
had relatively restricted geographical distribution.16
India, Bangladesh and Iraq.19-21 Most of the patients
Dermatophytosis cannot be easily diagnosed on
in the present study were in the age group of 21−40
the basis of clinical manifestations as a number of
years (51.62%) followed by 41−50 years (29.03%).
other conditions mimic the clinical presentation.
The differential diagnoses of dermatophytosis This finding is in accordance with the results of other
includes seborrhoeic dermatitis, atopic dermatitis, researchers.20,22 But the disease occurs in all ages and
contact dermatitis, psoriasis, eczema etc.16 Further is common in young adults of both sexes. Overall,
it is more difficult to diagnose dermatophytosis in many factors such as weather conditions, occupation,
immunocompromised patients as clinical presentation social class, living environment and frequency of
is often atypical.17 travel are implicated in dermatophytic infections.22
The lower incidence in females in present study may
In the present study, the prevalence of dermatophytic
be also due to underreporting of the female patients to
infection was 38.75% which correlates with the
the hospitals as in Bangladeshi community.
findings of another study that found 29.64%
positive.18 A study carried out in India reported 84% Fungi are the causative agents of various types of

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