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   Abstract
   Introduction
   Materials and Me...
   Results
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STUDIES
Year : 1994  |  Volume : 60  |  Issue : 2  |  Page : 68-71

A clinico-cycological study on tinea pedis at Ranchi




Correspondence Address:
Kumar Arun Singh


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  Abstract 

Clinical diagnosis of tinea pedis was made in 51(0.45%) of 11,386 consecutive patients, attending the skin OPD of Rajendra Medical College and Hospital, Ranchi. Direct microscopy revealed fungus in 66.6% of cases, while, 37(72.5%) were positive by culture, which included 8(15.5%) KOH negative cases also. This disparity as well as the factors responsible for low prevalence of tinea pedis have been discussed. Trichophyton rubrum was recovered predominantly from the dry, scaly lesions, and also constituted the bulk (48.6%) of isolates as a whole. Trichophyton mentagrophytes lay next to it, and was isolated mostly from the vesicular or macerated lesions. Candida sp. and Epidermophyton floccosum happened to be the other causatives identified.


Keywords: Tinea pedis, Dermatophytosis, Causative agents


How to cite this article:
Singh KA, Srivastava KS. A clinico-cycological study on tinea pedis at Ranchi. Indian J Dermatol Venereol Leprol 1994;60:68-71

How to cite this URL:
Singh KA, Srivastava KS. A clinico-cycological study on tinea pedis at Ranchi. Indian J Dermatol Venereol Leprol [serial online] 1994 [cited 2019 Dec 8];60:68-71. Available from: http://www.ijdvl.com/text.asp?1994/60/2/68/3995



  Introduction Top


Tinea pedis has been documented to be the commonest dermatophytosis in western countries. It does not comply, however, with Indian reports. [1],[2],[3],[4] These are available from different parts of India, but excepting one from Chhotanagpur, [1] there are none from and around Ranchi (Bihar) till date. The present study has been undertaken to fill this very gap in our knowledge of tinea pedis at Ranchi.


  Materials and Methods Top


Unselected 51 cases of tinea pedis were studied clinically, and investigated by direct microscopy and culture.

Following the usual standard procedure of collection, the material was examined in 20% fresh KOH by direct microscopy. Part of each specimen, collected in a black packet was planted on media slants of modified Sabouraud's dextrose agar supplemented with chloramphenicol (0.04 mg/ml) and cycloheximide (0.5% mg/ml). The inoculated tubes were incubated at room temperature and examined thrice weekly upto 4 weeks before discarding as negative.

The fungi isolated were identified on the basis of the colony grown and microscopic characters in lactophenol cotton blue stained smears. [5]


  Results Top


Intertriginous scaling (with slight extension to the adjacent plantar and/or dorsal surface) type was the commonest presentation observed in this series. Males outnumbered females by a ratio of 4:1 in 51 (0.45% of total 11,386 skin patients and 6.78% of 752 tinea cases in toto) cases of tinea pedis studied.

More or less all age groups were affected, but the group of 21-30 years recorded maximum number of cases [Table - 1]. Foot wearing habit was discovered in most of the cases.

Culture positivity was recorded in 37 (72.55%) out of 51 specimens studied. It included 29 (56.86%) KOI--P positive and 8 (15.69%) KOH negative cases. Despite KOH positivity in 5 (9.8%) samples, culture failed to yield any growth in them. Thirty four (66.66%) in all were positive by direct examination of KOH wet mount [Table - 2].

Sharing 18 (48.65%) of 37 isolates, Trichophyton rubrum happened to be the chief isolate among all. 94.4% (17 isolates) of it belonged to either dry squamous or interdigital scaling type. Seven (63.6%) out of 11 isolates of Trichophyton mentagrophytes were recovered from wet vesicular or macerated type, on the other hand Candida sp. and Epidermophyton floccosum ranked third by sharing 3 (8.11%) cases each. Identity of the rest 2 colonies could not be established in this series [Table - 3].

Amongst various associated diseases, hyperhidrosis (9 cases) and atopic dermatitis (5 cases) appeared to be consistent to some extent, while others displayed nothing more than casual coincidences.


  Comments Top


Compared to several report [3],[4],[6 ] the lower incidence of tinea pedis in the present series need to be explained by taking certain facts into consideration. Large section of the native tribals and others do not wear shoes regularly. Secondly, Ranchi, at an altitude of about 2000 feet above the sea level is relatively temperate in comparison to high humid coastal areas like Bombay, Calcutta, Kerala etc. which are suitable for the growth of fungus. Again, many of the actual sufferers do not attend the hospital due to lack of health awareness, illiteracy, poverty and also due to the absence of troublesome and embarrassing symptoms in most of the cases. And lastly the hospital percentage of such cases is diluted by the high incidence of leprosy and scabies, prevalent in this area.

Indoor dwelling and lack of shoe wearing in female section, explains to some extent, the male predominance in incidence observed here. The age group of 21-30 years covering maximum number of patients agrees with many reports. [2],[7] It may be attributed to more participation in active field work, high incidence of hyperhidrosis, and shoe wearing encountered in this age group.

Supported by various reports, 15.69% (8 cases) of KOH negative cases yielding growth in culture in our study suggest that both direct as well as culture examination should be undertaken simultaneously in any doubtful case of dermatophytosis. To explain the differences in the results of culture and KOH examination, the presence or absence of infecting agent in the particular specimen examined, may be taken into account. The culture results also depend upon, whether the nutritional and other requirements like optimum temperature for growth etc. are adequately met or not. The role of contaminants also, can not be ruled out in this context.

Some worker s [6][8],[9] have revealed Trichophyton mentagrophytes as the chief isolate from tinea pedis cases, but most others [2],[3],[4],[10] reports are in keeping with the trend observed in the present series led by Trichophyton rubrum in 48.65% cases as a whole. Some [3], [11 ] have correlated the dry squamous or hyperkeratotic lesions of T.pedis with Trichophyton rubrum on one hand, and wet vesicular or macerated lesions with Trichophyton mentagrophytes on the other. We have recorded the isolates almost in complete agreement with it [Table - 3]. In sharp contrast to it an unusual case of bullous tinea pedis in a 2-year-old girl has been reported by Maroon and Miller (1989) caused by T.rubrum. We, also have come across a case of 2-year-old girl presenting with sodden, macerated lesions in 2nd and 3rd toeweb spaces of the right foot, but could not isolate the fungus in culture seen in direct microscopy. The second unusual presentation of this series was the typical ringworm (not seen in T.pedis usually) fashion of Tinea pedis lesion in a young adult caused by Epidermophyton floccosum.[12]

 
  References Top

1.Prasad VB, Prakash APS. Dermatophytic profile of Chhottanagpur. Ind J Dermatol Venereol Leprol 1979; 45 : 103-10.  Back to cited text no. 1    
2.Banerjee U, Sharma AK. A study on dermatophytosis in Delhi. Ind J Derrnatol Venereol Leprol 1984; 50 : 41-4.  Back to cited text no. 2    
3.Ramanan C, Singh G, Kaur P. A clinico­mycological study of tinea pedis in north eastern India. Ind J Dermatol Venereol Leprol 1985; 51 : 40-1.  Back to cited text no. 3    
4.Mohapatra LN. Study of medical mycology in India- an overview. Ind J Med Res 1989; 89 351-61.  Back to cited text no. 4    
5.Elewski BE, Hazen PG. The superficial mycoses and the dermatophytes. J Am Acad Dermatol 1989; 21 : 655-73.  Back to cited text no. 5  [PUBMED]  
6.Allen S, Christmas TI, McKinney W, et al. The Auckland skin clinic tinea pedis and erythrasma study. NZ Med J 1990; 103 391-3.  Back to cited text no. 6    
7.Maheshwari A, Paniker CK, Gopinathan T. Studies on dermatomycoses in Calicut (Kerala). Ind J Pathol Microbiol 1982; 25: 11-7.  Back to cited text no. 7    
8.Sharma NL, Gupta ML, Sharma RC, et al. Superficial mycoses in Simla. Ind J Dermatol Venereol Leprol 1983; 49 : 266-9.  Back to cited text no. 8    
9.Attye A, Auger P, Joly J. Incidence of occult athlete's foot in swimmers. Eur J Epidemiol 1990; 6 : 244-7.  Back to cited text no. 9  [PUBMED]  
10.Champion RH, Burton JL, Ebling FJG. Tinea pedis. In : Textbook of Dermatology, 5th edn. London : Blackwell Scientific, 1992; 1154-6.  Back to cited text no. 10    
11.Maroon MS, Miller OF. Trichophyton rubrum bullous Tinea pedis in a child. Arch Dermatol 1989; 125: 1716.  Back to cited text no. 11    
12.Terrence CO, Eleanor ES. Investigation of asymptomatic tinea pedis in children. J Am Acad Dermatol 1991; 24 : 660-1.  Back to cited text no. 12    


    Tables

[Table - 1], [Table - 2], [Table - 3]

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