Gürcan Saban, Tikveşli Melek, Eskiocak Muzaffer, Kiliç Haluk, Otkun Metin
Trakya Universitesi Tip Fakültesi, Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dali, Edirne.
Mikrobiyol Bul. 2008 Jan;42(1):95-102.
The aims of this study were the detection of distribution of dermatophyte species isolated from the clinical samples of patients with dermatophytosis and the evaluation of risk factors for the development of dermatophytosis. A total of 441 skin, nail and scalp/hair specimens obtained from 301 patients (151 were male; age range 2 months-80 years, median 42 years) and 884 foot and hand skin and nail specimens obtained from 221 control subjects (110 were male; age range 5-75 years, median 36 years) were included to the study between the period of January to December 2005. All the samples have been evaluated by direct microscopic (DM) examination and by culture. A total of 121 (40.2%) patients yielded positivity for dermatophytes, of them 63 were positive by both DM and culture methods, seven were only culture positive, and 51 were only DM positive. Nine (9.8%) of 92 culture positive samples from 70 patients were found negative in DM, while 85 (50.6%) of 168 DM positive samples from 114 patients were negative in culture. 23.5% (12/51) of DM positive but culture negative patients were given antifungal therapy previously. The most prominent species isolated from the cultures were Trichophyton rubrum with a rate of 68.4% (63/92), followed by T. mentagrophytes (18.4%); T. violaceum (3.3%); T. verrucosum, T. tonsurans and Epidermophyton floccosum (2.2% for each); T. schoenleini, Microsporum canis and Trichophyton sp. (1.1% for each). Of the patient samples whose cultures were positive, 45% were from the foot skin. The presence rate of dermatophytes in controls was found as 3.2% (7/221); T. rubrum was isolated from the foot skin of five and T. mentagrophytes was isolated in toenail of two control subjects. About 42% of the samples belonged to the patients who admitted to hospital between December to February period. The evaluation of the risk factors revealed that presence of trauma, pet contact, ritual cleansing and diabetes mellitus had no effect on the development of dermatophytoses, however the presence of fungal infection in the family, male gender, some professions (being farmer, worker and retired), and the use of immunosupressive drugs have been found to increase the risk of dermatophytosis. The number of cases with dermatophytoses started to increase beginning from the age of 20 and peaked in the ages between 40-59 years old. As a result T. rubrum was determined as the most frequently isolated dermatophyte and tinea pedis was the most frequently observed clinical form in our hospital, emphasizing the importance of early diagnosis and effective treatment in superficial fungal infections which have high morbidity.
本研究的目的是检测从皮肤癣菌病患者临床样本中分离出的皮肤癣菌种类分布，并评估皮肤癣菌病发生的危险因素。2005年1月至12月期间，共纳入了301例患者（151例男性；年龄范围2个月至80岁，中位数42岁）的441份皮肤、指甲和头皮/毛发标本，以及221名对照者（110例男性；年龄范围5至75岁，中位数36岁）的884份手足皮肤和指甲标本。所有样本均通过直接显微镜检查（DM）和培养进行评估。共有121例（40.2%）患者皮肤癣菌检测呈阳性，其中63例通过DM和培养方法均为阳性，7例仅培养阳性，51例仅DM阳性。70例患者的92份培养阳性样本中有9份（9.8%）在DM检查中为阴性，而114例患者的168份DM阳性样本中有85份（50.6%）培养阴性。51例DM阳性但培养阴性的患者中有23.5%（12/51）曾接受过抗真菌治疗。从培养物中分离出的最主要菌种是红色毛癣菌，占68.4%（63/92），其次是须癣毛癣菌（18.4%）；紫色毛癣菌（3.3%）；疣状毛癣菌、断发毛癣菌和絮状表皮癣菌（各占2.2%）；许兰毛癣菌、犬小孢子菌和毛癣菌属（各占1.1%）。培养阳性的患者样本中，45%来自足部皮肤。对照者中皮肤癣菌的检出率为3.2%（7/221）；从5名对照者的足部皮肤分离出红色毛癣菌，从2名对照者的趾甲中分离出须癣毛癣菌。约42%的样本来自12月至2月期间入院的患者。对危险因素的评估显示，创伤、宠物接触、仪式性清洁和糖尿病对皮肤癣菌病的发生没有影响，然而，家庭中存在真菌感染、男性、某些职业（农民、工人和退休人员）以及使用免疫抑制药物被发现会增加皮肤癣菌病的风险。皮肤癣菌病病例数从20岁开始增加，并在40至59岁之间达到峰值。结果表明，红色毛癣菌是最常分离出的皮肤癣菌，足癣是我院最常观察到的临床类型，强调了早期诊断和有效治疗在发病率高的浅表真菌感染中的重要性。
