Dermatophytes and other fungi associated with skin mycoses in Tripoli, Libya

Abstract

Background: Our objective in this study was to obtain information on the prevalence of fungi responsible for superficial mycoses in the region of Tripoli, Libya.

Patients and methods: Skin scrapings collected from 2224 patients attending the Dermatology Clinic at Tripoli Medical Center with suspected clinical symptoms of fungal involvement were investigated in a 28-month study period, from August 1997 to December 1999. Direct microscopy was carried out with a 20% KOH preparation, and cultures were performed in petri dishes on Sabouraud dextrose agar (SDA) with cycloheximide 0.5 mg/mL and chloramphenicol 0.05 mg/mL, and SDA with chloramphenicol 0.05 mg/mL. Olive oil (2%) was added to the SDA without cycloheximide when pityriasis versicolor was suspected.

Results: Diagnosis was confirmed by microscopic examination in 1180 cases (53.1%), and the causal agents were isolated in 1160 cases (52.2%). Dermatophytes, Malassezia furfur (tinea versicolor) and Candida albicans were the major etiological agents isolated. Tinea corporis accounted for 45.9% (85% occurred in children below 15 years of age). The frequency of other clinical types in descending order was pityriasis versicolor 27.8% (322 cases), candidosis 13.4% (156 cases), tinea pedis 8.1% (94 cases), tinea manuum 2.6% (30 cases), and tinea barbae 2.2% (26 cases). Trichophyton violaceum was the most common etiological agent, and was responsible for 44% (300 cases) of dermatophyte infections. Malassezia furfur was ranked second in frequency with 27.8% (322 cases), followed by Trichophyton rubrum 13.8% (160 cases), and Candida albicans 10% (116 cases). Other species found were Microsporum canis 8.1% (94 cases), Epidermophyton floccosum 6.6% (76 cases), and Trichophyton mentagrophytes 3.1% (36 cases).

Conclusion: Dermatophytes, in particular Trichophyton violaceum, Trichophyton rubrum and Microsporum canis, are an important cause of tinea corporis in Libya. Malassezia furfur and Candida albicans are the most commonly encountered fungi in superficial mycoses.