Superficial mycoses in Paraíba: a comparative analysis and bibliographical revision

Araújo, Guilherme de Medeiros Lins de; Araújo, Nilberto Dias de; Farias, Rodrigo Pessoa de; Cavalcanti, Francinete Carla Nunes; Lima, Maria do Livramento Ferreira; Braz, Ricardo Antonio Faustino da Silva

doi:10.1590/S0365-05962010000600031

Abstracts

A survey of the incidence of clinically diagnosed cases of superficial mycosis was carried out using individual report cards in four Family Health units in Patos-PB, in 2007. We had a sample of 197 positive records with Pityriasis and Tinea as the most incident mycoses. There was a higher prevalence among female patients who were between 11 - 20 years of age. A high number of non-identified infections was found: 46,19%. The identification of the agents of such non-identified infections is not possible as they are not infections of compulsory notification.

Incidence; Mycoses; Pityriasis; Tinea

A partir de fichas individuais, fizemos um levantamento da incidência de casos de micose superficial, diagnosticadas sob o ponto de vista clínico em quatro Unidades de Saúde da Família de Patos-PB, no ano de 2007. Tivemos uma amostra de 197 notificações positivas, onde as mais incidentes foram: Pitiríase e Tínea, sendo a maior prevalência na faixa etária de 11 a 20 anos e o sexo feminino, o mais acometido. Um número elevado de infecções não identificadas foi encontrado: 46,19%, no entanto, a identificação destes agentes torna-se inacessível, por não serem infecções de notificação obrigatória.

Incidência; Micoses; Pitiríase; Tinha

COMUNICATION

^IAuthor responsible for the academic summary of the baccalaureate course of Biomedicine from the Integrated Faculties of Patos (FIP) - João Pessoa (PB), Brazil

^IIStudent from the baccalaureate course of Biomedicine from the Integrated Faculties of Patos (FIP) - João Pessoa (PB), Brazil

^IIIStudent from the baccalaureate course of Biomedicine from the Integrated Faculties of Patos (FIP) - João Pessoa (PB), Brazil

^IVMaster degree, professor of the Integrated Faculties of Patos (FIP) - João Pessoa (PB), Brazil

^VPhd degree, professor of the Integrated Faculties of Patos (FIP) - João Pessoa (PB), Brazil

^VIMaster degree, professor of the Integrated Faculties of Patos (FIP) - João Pessoa (PB), Brazil

Mailing address

ABSTRACT

A survey of the incidence of clinically diagnosed cases of superficial mycosis was carried out using individual report cards in four Family Health units in Patos-PB, in 2007. We had a sample of 197 positive records with Pityriasis and Tinea as the most incident mycoses. There was a higher prevalence among female patients who were between 11 - 20 years of age. A high number of non-identified infections was found: 46,19%. The identification of the agents of such non-identified infections is not possible as they are not infections of compulsory notification.

Keywords: Incidence, Mycoses, Pityriasis, Tinea

Brazil is a country that has high rates of infections caused by fungi, mainly superficial mycoses, due to its tropical climate and this factor added to others are determinant to the uprising of micro epidemics.^1,2Superficial mycoses develop alterations only in the most superficial layer of the stratum corneum and do not induce, most of the time, any inflammatory response in the host. The fungi that cause these infections prefer the most external part of the skin, around the hair or nails, nourishing from a protein called keratin. The main defense mechanism against fungi is developed by the phagocytes. Some family diseases facilitate the clinical development of mycosis, due to deficiency of the immune system, such as in diabetes, HIV and depression. The use of some drugs such as immunosuppressants and antibiotics^1,3,4also facilitates the developmen of them. The main superficial mycoses in men are: Piedra negra (Piedrae hortae), Piedra branca (Trichosporon sp.), Pityriasis versicolor (Malassezia sp.) and Tinea nigra (Phaeoannellomyces werneckii).

Particularly, in the northweast region of Brazil, dermatoses are more frequent, on the coastal regions, represented by dermatophytoses and Pityriasis Versicolor (PV), due to the high temperatures and humidity of such regions. Researches are still insufficient in Paraíba although it is known that there are factors in the state that contribute for the development of such microorganisms.⁵

Such infections are not diseases of compulsory notification so, it is not known exactly, the extension of the problem. This fact shows the need to carry out periodic surveys to know exactly the frequency of the diseases and its etiologic agents, considering socioeconomic, geographic and climatic factors as a preventive epidemiological measure.^1,4

Piedra negra (Piedraia hortae)

It is an asymptomatic and not very frequent infection caused by fungi, restricted to the beard, moustache, hair and hardly on the axillae. It is characterized by dense and black nodules, of variable size and usually easily visible.¹

Piedra branca (Trichosporon sp)

Piedra branca is caused by a fungus of the Trichosporon type, characterized by the presence of light nodules, loosely adehering to the hair, localized mainly by the pubic and scrotal hair and hardly by the beard, moustache, axillae and hair.⁶

Pityriasis versicolor (Malassezia sp.)

Species of this genus are part of the normal microbiota of the skin, in its yeast phase and by mechanisms not well known yet they would change to a filamentous form becoming pathogenic.^1,6Clinically, the PV is characterized by nummular or guttate macules or plaques, yellowish, greyish or hypochromic, especially affecting shoulders and the upper part of the chest of young adults (thorax, abdomen, neck and less frequently axillae,groins and thighs) that markedly transpire.⁷

Onychomycoses

Having as main etiologic agents Candida spp. and the Trichophyton rubrum, onychomycosis is a nail fungal infection that can be caused by dermatophytes, yeast or non-dermatophyte filamentous fungi that affect the nails of the hands and feet.⁸

Dermathophytosis

Dermatophites constitute the group of fungi more frequently isolated in mycology laboratories.⁹In parasitic life they have the capacity to invade keratinized tissues of human beings and other animals causing infections named dermatophytoses. The etiologic agents of dermatophytoses belong to the genus Trichophyton, Microsporum and Epidermophyton and constitute one of the most frequent groups of fungal infections in dermatology practice.

It was carried out an exploratory study with qualitative and quantitative outline and involving individuals who were cared for in the Family Health Units chosen for this study (Aderban Martins, Dircê Xavie, Horácio Nóbrega e Rita Palmeira) from the municipality of Patos-PB, from January to December, 2007 and with confirmed diagnosis of superficial mycosis based exclusively in clinical exams carried out by health professionals of each health unit researched.

Gráfico 1

Gráfico 2

Our sample had 197 individuals with 45,18% (89 cases) of them from the male sex and 54,82% (108 cases) from the female sex. Women were more affected by the mycoses studied corroborating further studies.^4,9There was a greater number of positive diagnosis for Pityriasis - 27,92% (55 cases). From this total number, 63,64% (35 cases) are female patients and 36,36% (20 cases) are male patients. As for Tinea, we had a total number of 12,18% (24 cases). From this number 62,50% (15 cases) were male patients and 37,50% (9 cases) were female patients (Graph 1), in accordance with previous works.¹⁰Age varied from early months of life until 83 years. Mycoses accured in the age groups that varies from 11 to 20 years of age (23,86% - 47 cases) and from 0 to 10 years of age (20,30% - 40 cases). These 2 groups are responsible for almost 50% of the cases (44,16% - 87 cases) showing the susceptibility of children and young people to contagion (Graph 2). It was also observed a higher incidence of Pityriasis among men within the age group that varies from 0 to 10 years (Graph 2). Whithin the group of mycoses which were not compared according to genus the dermathophytoses had higher prevalence (6,09% - 12 cases) followed by onychomycoses (3,05% - 6 cases), dermatomycoses (2,54% - 5 cases) and lastly by dematoses (2,03% - 4 cases). From this group 46,19% of the infections (91 cases) were identified only as mycosis. There is no information about genus or species which shows us that a laboratorial diagnosis would be indicated in such cases to confirm which mycosis we are dealing with and therefore to make use of specific drugs for specific mycosis in accordance with medical literature.¹

REFERENCES

1. Somenzi CC, Ribeiro TS, Menezes A. Características Particulares da Micologia Clínica e o Diagnóstico Laboratorial de Micoses Superficiais. NewsLab. 2006;77:106-18.
2. Almeida MM, Moraes MAP. Micoses superficiais e profundas na Amazônia. Instituto Evandro Chagas. In: Fundação Serviços de Saúde Pública. Instituto Evandro Chagas: 50 anos de contribuição às ciências biológicas e à medicina tropical. Ministério da Saúde, Belém: Fundação Serviços de Saúde Pública; 1986. p.787-91.
3. Zampronha VC, Oliveira IP, Monteiro MSR, Souza H, Santos KJG, Araújo AA. Isolamento e identificação de dermatófitos de animais presentes no campus II da Universidade Católica de Goiás. Revista Eletrônica Faculdade Montes Belos. 2005;1:22-36.
4. Oliveira JAA, Barros JA, Cortez ACA, Oliveira JSRL. Micoses Superficiais na Cidade de Manaus / AM, entre Marco e Novembro/2003. An Bras Dermatol. 2006;81:238-43.
5. Lima EO, Pontes ZBVS, Oliveira NMC, Carvalho MFFP, Guerra MFL, Santos JP. Frequência de dermatofitoses em João Pessoa - Paraíba - Brasil. An Bras Dermatol. 1999;74:127-32.
6. Trabulsi RL, Alterthum F. Microbiologia. 4 ed. - São Paulo: Editora Atheneu; 2005. p. 473-4.
7. Arnold HL, Odom RB, James WD. Andrews'disases of the skin: clinical dermatology. Diseases due to fungi and yeasts. 8 ed. Philadelphia: Ed. W.B. Sauders Company; 1990. p.15:347.
8. Souza EAF, Almeida LMM, Guilhermetti E, Mota VA, Rossi RM, Svidzinski TIE. Frequência de onicomicoses por leveduras em Maringá, Paraná, Brasil. An Bras Dermatol. 2007;82:151-6.
9. Araújo AJG, Bastos OMP, Souza MAJ, Oliveira JC. Ocorrência de onicomicose em pacientes atendidos em consultórios dermatológicos da cidade do Rio de Janeiro, Brasil. An Bras Dermatol. 2003;78:299-308.
10. Marques AS, Camargo RMP, Fares AHG, Takashi RM, Stolf HO. Tinea capitis: epidemiologia e ecologia dos casos observados entre 1983 e 2003 na Faculdade de Medicina de Botucatu, Estado de São Paulo, Brasil. An Bras Dermatol. 2005;80:597-602.