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Print version ISSN 0365-0596On-line version ISSN 1806-4841
An. Bras. Dermatol. vol.78 no.6 Rio de Janeiro Nov./Dec. 2003
CLINICAL, LABORATORY AND THERAPEUTIC INVESTIGATION
Tinea Capitis in João Pessoa: a social and economic view*
Patrícia Marques Lima Pessoa de AquinoI; Edeltrudes de Oliveira LimaII; Nilma Maria Porto de FariasIII
Professor, UFPB; Ph.D. student in Health Sciences, UFPB; MD at the Dermatology
Ambulatory Clinic, HU/UFPB
IIAdjunct Professor, Mycology, UFPB
IIIMedical student, UFPB
The distribution of dermatophyte species varies according to time and place,
and shows the social and economical conditions of the population.
OBJECTIVE: This study was undertaken to determine the dermatophyte species in relation to the sex, age and race of patients with Tinea capitis in Paraiba state, Brazil. A comparison was established with disease data from the most affluent regions of Brazil.
METHOD: We studied the mycological examinations and clinical variants of 82 patients with Tinea capitis in João Pessoa, Paraiba state.
RESULTS: The frequency of Tinea capitis corresponded to 64.6% of clinical suspicion. T. Rubrum was the most frequently isolated dermatophyte (37.7%), followed by T. Tonsurans (28.3%), M. Canis (24.5%), T. Verrucosum (7.5%) and T. Mentagrophytes (1.9%). As for sex, no predilection was found. The highest incidence was in the 0 to 10-year-old age group. 71.7% of the patients were Caucasian.
CONCLUSION: Comparing our results with previous publications from the Southeast region, the authors highlight the differences arising from social and economical variants in the disease epidemiology.
Key-words: epidemilogy; tinea capitis.
Tinea capitis refers to the dermatophytosis of the scalp most often caused by two genera of fungi: Microsporum or Trichophyton.
Tinea capitis has sparked the interest of researchers concerned with social tendencies, bearing in mind its high incidence in poor populations and its possibly endemic behavior.1
The present study classifies Tinea capitis in terms of its etiological agent as well as patient sex, age and ethnic affiliation. The importance of the study for public health policy is unquestionable given the need for knowledge of the etiological agents of superficial mycoses in a determined medium, which varies according to time and socioeconomic conditions.
MATERIAL AND METHOD
From October 1999 to February 2000, 82 patients with a suspected clinical diagnosis of Tinea capitis were referred to the Mycology Laboratory of the Universidade Federal da Paraíba Health Sciences Center.
A mycological examination was performed on the infected scales and hairs, which were cleared in 20% potassium hydroxide. The culture was prepared in Sabouraud Dextrose Agar C medium for up to the fourth agar-chloramphenicol and Mycobiotic agar (DIFCO) and incubated for 28-30 weeks.
The dermatophytes were identified by the Rebell and Taplin key.2
Nominal scales were used to analyze the questions, with the exception of the age group for which an interval scale was used.
To treat the exploratory study, the technique chosen to analyze the data was descriptive statistics by means of tables, frequencies and percentages. To describe the sample, central tendency measures were applied: average and median.
Statistical treatment of the data went through three steps: collection, setting up a database, and tabulation and analysis.
Of the 82 clinical suspects of the disease, 53 (64.3%) cases of Tinea capitis were confirmed through a mycological examination.
The etiological agents identified as causing Tinea capitis were distributed as follows: T. rubrum in 20 patients (37.7%); T. tonsurans in 15 (28.3%); M. canis in 13 (24.5%); T. verrucosum in four (7.55%) and T. mentagrophytes in one (1.9%).
All fungal species fell within the 0-to-10 year old age group (Table 1).
Regarding sex, 28 (52.8%) were female, and 25 (47.2%) male. Among the 0-10 year olds, a higher incidence of Tinea capitis was observed in males, while in the 11-20 year olds, the highest number of cases occurred in females (Table 2).
The age group of highest incidence for the disease was 0-to-10 year olds, in which 29 cases (54.7%) were registered, followed by 14 cases (26.4%) for the group ranging between ages 11 and 20 years. There were four (7.5%) cases between ages 21 and 30 years, two (3.8%) between 31 and 40 years, and two (3.8%) between ages 41 and 50 years. Also registered were two cases (3.8%) above 60 years of age. There were no cases registered in the 51-to-60 year old age group.
Regarding ethnicity, 38 (71.7%) patients were Caucasian, 14 (26.4%) Pardo and one (1.9%) Negroid.
In an earlier study, researchers from Paraiba State detected 23.3% incidence for dermatophytosis.22 Of these cases, 29.6% corresponded to hair dye tint, whose most frequent agent was T. rubrum.22 A similar study, carried out during the same period in Sao Paulo, revealed 55.1% of dermatophytoses, of which barely 17.1% corresponded to T. capitis. The predominant fungus was M. canis.24
In another study of 369 dermatophytoses cases done in Vitoria, ES State, barely 10% of cases were Tinea capitis.23
The incidence of the nosological entity in Paraiba was nonetheless higher than in the Southeast region. These results have led the authors to value the socioeconomic influence of this kind of study. Whereas in the most affluent regions of the country the greatest cause of the disease is a zoophilic fungus, the prevalent species in the Northeast is anthropophilic.
When an anthropophilic fungus is being dealt with, more sizeable epidemics may be expected given that the fungi are more adapted to human beings and yet show greater virulence toward them. 14 In such cases, contagion occurs from person to person, which explains the higher disease incidence in the Northeast.
T. rubrum was the predominant species in this study. The literature revealed that this fungus is relatively common, and is responsible for a 4-to-81% variation in worldwide dermatophytoses.3-8 In Brazil, it appears to be responsible for dermatophytoses in the South, Central-West and Southeast regions (35-59%).9-16
The second most frequent species was T. tonsurans, which stood out previously as the prevalent species in the North and Northeast.10,15,17-19 In the town of Joao Pessoa, Paraiba state, six cases of T. capitis caused by T. tonsurans were recorded in children of up to ten years of age.
The disease incidence proved to be indifferent toward patients' sex, given that in the 0-10 year old age group there were more cases in males, whereas among 11-20 year olds, females were more predominantly affected. These data coincide with the literature.1
The higher incidence of T. capitis cases among younger than 10 year olds is also compatible with earlier studies. It is worth pointing out that all of the fungus species prevailed in this age group. Among the dermatophytoses, scalp affections remained as the major form during infancy.20,21
The distribution of T. capitis does not discriminately affect a determined ethnic group. The present study reveals the main contaminating species, and the profile of the T. capitis carrier patients in the town of Joao Pessoa, Paraiba state. Moreover, this study correlates the results to the socioeconomic conditions of the population.
Despite how sparse the medical literature from the Northeast is on the topic, it may be inferred that there is more Tinea capitis in Paraiba than in the Southeast, i.e. the most affluent region of the country. The main causative species of T. capitis in Paraiba is T. rubrum. Epidemiology of the disease differs from the Tinea capitis found in the Southeast of Brazil, especially regarding the main causative agent.
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Patrícia Marques Lima Pessoa de Aquino
Rua Flávio de Melo Uchoa 50/402 - Ed. Antônio E. Mendes - Bessa
João Pessoa PB 58037-100
Tel/Fax: (83) 246 6091
Received in February,
25th of 2002
Approved by the Consultive Council and accepted for publication in December, 19th of 2002
* Work done at "Hospital Universitário Lauro Wanderley, Universidade Federal da Paraíba/UFPB".