Mycoses Associated with the Skin on Patients Attending Alupe KEMRI Clinic

Abstract

Globally, over 300 million people are afflicted with serious mycoses infections and out of these; 25 million are at a high risk of dying. Estimates for the global burden of mycoses diseases are based on population and disease demographics; age, gender, HIV infection and occupation. The aim of this study was to determine the most common mycoses associated with the skin on patients attending Alupe, KEMRI clinic. A cross-sectional study was conducted in 371 patients comprising 42.9% (159) males and 57.1% (212) females, from Alupe Kemri clinic in Busia Western Kenya. Skin scrapings were collected in coded envelopes from the active edges of the affected skin and preliminary identification was done by placing skin scraps on a labeled slide then 20% potassium hydroxide (KOH) solution was added, put a cover slip over the preparation and gently heated over flame then observed at a magnification of 400. Samples were cultured in Sabouraud dextrose agar (SDA) with chloramphenicol and incubated at 30oC for two weeks. Phenotypic identification was done based on macro-morphological, micro-morphological and physiological characteristics. Identification keys for species confirmation were done. By gender, 88.7% (141) males and 81.6% (173) females had fungal infections. The mycoses isolated were from the genera; Alternaria 3.8% (14), Aspergillus 12.1% (45), Cladosporium 2.2% (8) Penicillium 4.3% (16), Rhizopus 3.2% (12), yeast 2.7% (10), Trichopyton 27.8% (103) and others 6.7% (25) respectively. No significant growth was obtained in 24.8% (92). The HIV status for respondents were; sero negative 49.3% (183), sero positive 6.2% (23), and unknown status 44.5% (165) respectively. Out of 23 HIV positive patients, 91.3% (21) had mycoses infection, while HIV negative patients 52.6% (183) had mycoses infections. The difference was statistically significant, p<0.0023. This shows that HIV patients are more vulnerable to mycoses infections than the HIV negative patients. This study observed that fungal isolates were resistant to clotrimazole, griseofulvin and terbinafine but susceptible to itraconazole drug. Among the infected sites were; whole body 100% (4/4), scalp 94% (47/50), hand 87.7% (50/57), neck, scalp, hand 86.9% (40/46), genitals 85.7% (6/7), neck 83.3% (48/40), trunk 81.8% (27/33), legs 79.5% (78/98) and face 78.6% (22/28). Regarding occupation, farmers were most susceptible to mycoses infections 35.6% (132) followed by unemployed 30.7% (114), business 18.3% (68), employed 11.6% (43) and other 3.8% (14) respectively. The mean age for the study was 31.0±20.0 with two groups being mostly affected; 5-14 years 91.4% (74/81) and 55-64 years 89.4% (34/38). The study confirmed that mycoses are associated with the skin on patients attending Alupe KEMRI clinic with Trichophyton species and Cladosporium species being the most and least isolated mycoses respectively and has no predilection , for neither gender nor age. The study revealed that HIV positive patients were more likely to be infected by mycoses, and the drug sensitivity testing will make improve the prescription of the drug that actually cure the infections.