MYCOSES 35,

371-374 (1992)

ACCEPTED: JANUARY 20, 1992

Dermatomycoses among industrial workers in Cross River State, Nigeria Dermatomykosen bei Industriearbeitern in der Region Cross River State, Nigeria L. E. Akpata', H. C. Gugnani2, R. Srivastava3 and S. J. Utsalo' Key words. Dermatomycosis, dermatophytosis, pityriasis, epidemiology, industrial workers, Nigeria. Schliisselworter. Dermatomykosen, Dermatophytosen, Pityriasis, Epidemiologie, Industriearbeiter, Nigeria.

Summary. A survey of dermatomycoses was carried out amongst industrial workers in three different factories during the period 1987-1988. A total of 194 workers were screened, out of which 54 proved to be mycologically positive by microscopy and/or culture. Incidence was apparently highest amongst workers in a cement factory (Calcemco, 33.3%) followed by those in a wood factory (Seromwood, 30.8%) and a rubber factory (CREL, 26.2%). Pityriasis versicolor was the predominant clinical type of dermatomycosis, followed by tinea pedis. A total of 51 fungal organisms were identified. Malassezia furfur was the most prevalent causative agent (74.4%) followed by Trichophyton soudanense (5.8y0), 7. rubrum (3.9%) and Epidermophyton Jloccosum (3.9%).Other species identified were one isolate each of T. tonsurans, T. mentagrophytes, T. verrucosum, Candida tropicalis, Candida spec. and Geotrichum candidum. Zusammenfassung. An Industriearbeitern dreier unterschiedlicher Industriebetriebe wurde in der Zeit von 1987-1988 eine Erhebung von Dermatomykosen vorgenommen. Insgesamt wurden 194 Arbeiter untersucht, von denen sich 54 als mikroskopisch oder kulturell positiv fur

'Department of Medical Microbiology, University of Calabar College of Medical Sciences, Calabar, Nigeria, *Department of Microbiology, University of Nigeria, Nsukka, Nigeria, and 3KurukushetraUniversity, India. Correspondence: Professor Dr H. C. Gugnani, Department of Microbiology, University of Nigeria, Nsukka, Nigeria.

Pilze erwiesen. Die Pilzbefalls-Inzidenz war am hochsten bei Arbeitern einer Zementfabrik (Calcemco, 33.3y0), gefolgt von Arbeitern einer Holzfabrik (Seromwood, 30.8%) und einer Gummifabrik (CREL, 26.2%). Pityriasis versicolor stand bei den Dermatomykosen in der Haufigkeit an erster Stelle vor Tinea pedis. Insgesamt wurden 5 1 pilzliche Erreger identifiziert. Malassezia f u f u r stand an erster Stelle (74.4y0), gefolgt von Trichophyton soudanense (5.8y0), T. rubrum (3.9%) und Epidermophyton Joccosum (3.9%). An anderen Erregern wurde jeweils einmal T. tonsuTans, T. mentagrophytes, T. verrucosum, Candida tropicalis, Candida spec. und Geotrichum candidum gefunden.

Introduction Dermatomycoses, i.e. superficial infections of the skin and its appendages caused by dermatophytes and other fungi, are the most common mycotic infections [ l , 21 and constitute a major public health problem in Africa, including Nigeria [3, 4.1. Several reports on such infections are available from different parts of Nigeria [5- 121. Studies on the occurrence of different types of dermatomycoses in industrial workers in Nigeria have been lacking. Very recently Gugnani & Oyeka [13] reported on foot infections due to Hendersonula toruloidea, Scytalidium hyalinum and dermatophytes in coal miners in Anambra State. The present study was initiated to analyse the incidence and causative agents of dermatomycoses among industrial workers in Cross River State, Nigeria.

372

L. E. AKPATAET AL.

Table 1. Incidence of dermatomycoses amongst factory workers Type of factory

CREL (rubber) Seromwood (wood) Calcemco (cement) Total

Workers examined

Clinically suggestive lesions

Mycologically positive'

(4

n

YO

n

YO

145

51

35.2 61.5 47.2 39.2

38 4 12 54

26.2 30.8 33.3 27.8

13

a

36 194

17 76

I

I

"Positive by microscopy, culture or both.

Materials and methods

Results

Subjects examined

Incidence of dermatomycoses

The study group comprised workers from three different factories: Calabar Cement Company Limited - Calcemco - a cement-producing factory; Seromwood Limited - a wood processing factory; and Cross River Estates Limited (CREL)-a rubber processing factory. Subjects were drawn from factory lines that are in direct contact with the processing products.

Out of 76 workers showing clinically suggestive lesions, 54 were proven to be mycologically positive by microscopy and/or culture, giving an incidence rate of 27.8% (Table 1). The incidence rate was apparently higher among workers in the cement factory followed by the wood plant, and least in the rubber factory. Statistically there was no significant difference between the incidence rates among the various factories (I" 0.05). Table 2 shows a significantly higher incidence of dermatomycoses in males (43.2%) than in females (13.1yo), even though two of the factories surveyed (cement and wood plants) did not present any female subject with clinically suggestive lesions.

Collection and processing of specimens A total number of 194 workers were examined. Of these 76 presented clinically suggestive lesions. Specimens of skin scrapings were aseptically collected for mycological investigations in presterilized paper envelopes. A portion of each clinical specimen was mounted in 20% KOH and examined microscopically. The remaining portion was inoculated on two slopes of Sabouraud glucose agar, one supplemented with chloramphenicol (0.05 mg ml-') and the other with chloramphenicol and cycloheximide (0.5 mg ml-I). All slopes were incubated at room temperature (24-29 "C) and examined every other day for up to 3-4 weeks for growth of dermatophytes and other fungi. Identification was based on the criteria enumerated by Rebel1 & Taplin [I41 and McGinnis [15]. Slide cultures using potato glucose agar were used where necessary to facilitate identification. Cases of pityriasis (tinea) versicolor were diagnosed on the clinical presentation and microscopical demonstration of clustered round yeast cells together with short stout hyphae which may be curved and occasionally branched [7]. Cultivation of the causal agent is not essential for diagnosis [15] and hence no attempts were made at culture.

Distribution of clinical types and causative agents As shown in Table 3, the most common dermato-

mycosis encountered was pityriasis (tinea) versicolor (70.3%) followed by tinea pedis (12.9%) and tinea corporis (7.4%). Other clinical types presented one case each. The rubber plant accounted for most of the infections seen in the study (70.3%) followed by the cement factory Table 2. Sex

Incidence of dermatomycoses according to sex Probands examined

(4 Male Female Total

95 99 194

Clinically suggestive lesions

Mycologically positive'

n

%

n

%

52 24 76

54.7 24.2 39.2

41 13 54

43.2 13.1 27.8

'Positive by microscopy, culture or both.

mycoses 35, 371-374 (1992)

DERMATOMYCOSES IN NIGERIA 373

Table 3. Distribution of clinical types of mycologically proven lesions of dermatomycoses amongst workers in different factories No. of cases in different factories

Clinical types

Pityriasis versicolor Tinea pedis and similar infections' Tinea capitis Tinea corporis Tinea unguium/onychomycosis Tinea cruris Total n

%

n

CREL" (n)

Seromwood

Cdcemcob

(4

(4

30

3

5

38

10.4

4

-

4

8 1

-

1 1 1

14.8 1.9 7.4 3.7 1.9

-

-

3

-

1

1

38 10.3

%

Total

-

-

4

12 22.3

7.4

4 2 1 54

100.0

'Cross River Estates Ltd rubber processing factory. 'Calabar Cement Company. 'Infection of the feet due to non-dermatophytic fungi.

(22.2%), with Seromwood giving the lowest percentage. The causative fungal species could be identified in 51 cases; three of the cases caused by dermatophytes though microscopically positive were culture negative. The distribution of etiological agents according to body sites of lesions is shown in Table 4. Most of the organisms identified were recovered from the trunk (52.9%) followed equally by the leg/feet web and hand/arms (1 1.8%) and face (9.8%). The scalp lesion (tinea capitis) was found in a 9-year-old male child of one of the factory workers.

Discussion This study represents the first of its kind amongst factory workers in Cross River State, Nigeria. The incidence of dermatomycoses (27.8%) was much higher than those reported in previous studies. This may be due to the fact that the incidence in most previous studies was based on dermatophytoses in school children and skin clinics [5, 6, 8, 12, 161. Even when cases of dermatophytoses, i.e. tinea pedis, tinea corporis, tinea capitis, tinea unguium and tinea cruris (see Table 3), are taken into consideration, they will

Table 4. Distribution of causal agents according to body sites Species

Lesions on different body sites Trunk (n)

Leg/ feet web

Hand/ arms (n)

(4 Malesscria furjiuf.p Trichophyton rubrum 1.soudanense T. tonsurans 1.mentagrophytes 7.uerrucosum Epidermophyton Joccosum Candida tropicalis Candida albicans Geotrichum candidum Total n

%

23

Finger/ toenails

(4

Face (n)

Neck (n)

Others

(4

(n)

1

38 2 3

1

1

1

1 1

-

1 -

27 52.9

'Cultures not done; identified on the basis of microscopy.

mycoses 35, 371-374 (1992)

Total of isolates

2 1

1

1 51

%

14.4 3.9 5.8 2.0 2.0 2.0 3.9 2.0 2.0 2.0 00.0

374

L. E. AKPATA ET AL. ~

account for an incidence of 7.2y0,which is still slightly higher when compared with previous studies [ l l , 121. Incidence of tinea versicolor (19.6%) was also higher when compared with 5.5% and 4% reported by Lieske [17] and Shrank & Harman [ 161 respectively. Increased sebacaeous activity among adults in tropical weather and among these classes of workers could account for the high incidence of pityriasis versicolor. A much higher incidence of infections in males than in females may be due to fact that the majority of the females examined were from one factory (the rubber plant) and they all worked in the nursery section of the factory which does not require much manual labour compared with other sections of the factory which explains less sebacaeous activity. An interesting finding was the isolation of Trichopbton verrucosum, a zoophilic dermatophyte, from a case of tinea corporis. This constitutes the first report of human infection due to this dermatophyte from Southern Nigeria. This species has been reported in Northern Nigeria [ 101 where it might be relatively more common due to frequent animal contact as a result of cattle rearing, which is a major occupation of the peasants in that part of the country. It is also noteworthy to record isolation of Geotrichum candidum from a foot lesion which was microscopically positive for the fungus. Acknowledgements

prevention and control of dennatophytoses in man and animals. WHO/CDS/VPH/8667, Geneva, Switzerland. 2 Rippon, J. W. (1974) Medical Mycology. The pathogenic fungi and the pathogenic actinomycetes. Saunders & Company, DD. 96-174. Philadebhia W. B. 3 Gugnani, H. C. Mycoses as a public health problem in Nigeria. Nig. 3. Microbial. 2, 47-60. 4 Verhagen, A. R. (1974) Distribution of dermatophytes causing tinea capitis in Africa (Review) Trop. Geog. Med. 1.

26, 101-120. 5 Egere, J. U. & Gugnani, H. C. (1982) Etiology of dermatophytosis in Eastern Nigeria: A 7 year study. Mykosen 25, 178-181. 6 Ekanem, L. S. & Gugnani, H. C. (1987) Etiology of dermatophytoses amongst school children in Cross River State of Nigeria. Mykosen 30, 493-498. 7 Evans, E. G. & Gentles, J. C. (1985) Essentials of Mcdical Mycology. Edinburgh: Churchill Livingstone, pp. 70-74. 8 Gugnani, H. C. & Njoku-Obi, A. N. U. (1986) Tinea capitis in school children in Eastern Nigeria. Mykosen 29, 132-144. 9, Gugnani, H. C., Njoku-Obi, A. N. U. & Okoro, A. N. (1973) The causal agents of superficial mycoses isolated at the University Teaching Hospital, Enugu. West Afr. Med. 3. 7, 284-291. 10I Jacyk, W. K., Baran, E., Lawande, R. V. & Walon, B. (1982) Tinea capitis in Northern Nigeria. Mykosen 25, 221-226. 11 Somorin, A. O., Jungblut, J. R., Stier, B., Obembe, B. A. & Hunpoun-Wusu, 0. 0. (1977) Fungus diseases

12

13

14

The authors are extremely grateful to the management of the factories for their permission and cooperation during sample collection.

15

References

17

1 Mackenzie, D. W. R., Loeffler, W., Montovani, A. & Fujikura, T. (Eds) (1986) Guidelines for the diagnosis,

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in Nigeria: Observations on the pattern of tinea infections in Lagos school children. Nig. Med. J . 9, 61-64. Soyinka, F. (1978) Epidemiologic study of dermatophyte infections in Nigeria (Clinical Survey and Laboratory investigation). Mycopathologia 63, 99- 103. Gugnani, H. C. & Oyeka, C. (1989) Foot infections due to Hendersonula toruloidea and Scytalidium in coal miners 3. Med. Vet. Mycol. 27, 164-179. Rebell, G. & Taplin, D. (1974) Dennatophytes, Their Recognition and Identification. Coral Gables, University of Miami Press. McGinnis, M. R. (1980) Laboratory Handbook of Medical Mycology. New York: Academic Press, pp. 296-302, 493-494. Shrank, A. B. & Harman, R. R. M. (1966) Incidence ofskin diseases in a Nigerian teaching hospital. Dermatological Clinic. Br. J. Derm. 78, 235-241. Lieske, K. (1982) Dermatomycoses in the tropical rain forest of Nigeria. +'tschriJ f u r Hautkrankheiten 57, 321-325.

mycoses 35, 3 7 1-3 74 ( 1992)

Dermatomycoses among industrial workers in Cross River State, Nigeria.

A survey of dermatomycoses was carried out amongst industrial workers in three different factories during the period 1987-1988. A total of 194 workers...
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