Dermatophytosis; Aetiological Agents , Risk Factors and Susceptibility of the Isolated Dermatophyte to Some Antifungals , Ziziphus nummalaria and Curcuma domestica Extracts

Abstract

Abstract Dermatophyte are the most common causes of superficial or cutaneous fungal infections around the world and remain a major public health problem in spite of the presence of some numbers of antifungal drugs. The difficulties associated with the treatment of dermatophytosis and antifungal drugs resistance remain challenges to select an effective antifungal agents. This study was aimed to investigate the etiological agents and risk factors associated with dermatophytosis , determined the activity of some antifungal and the extracts of chloroform and ethanol of Ziziphus nummalaria and Curcuma domistica against the isolated species of dermatophyte and investigate the ability of these dermatophyte to produce urease, lipase and keratinase enzymes in addition to investgate the effect of temperature and storage period on their growth. Three hundred patients clinically diagnosed as having Tinea infections and referred to different Dermatology Clinics were investigated using questionnaire (Face to Face Interview). The questionnaire was designed for each patient with specific emphasis to age, sex, residence, animal exposure, family history of skin diseases, type of infection in addition to the season of infection. Each collected sample was divided into two portions, one portion was used for direct microscopic examination, while the second portion was used for culturing on Sabouraud’s Dextrose Agar supplemented with chloramphenicol and cyclohexamide. The recovered dermatophyte were identified based on macroscopic and microscopic examination. The isolated dermatophyte were examined for their susceptibility to three antifungal drugs (Clotrimazole, Itraconazole and Fluconazole) which were dissolved in appropriate solvent. Rhizomes of Curcuma domestica and leaves of Ziziphus nummalaria were extracted using ethanol and chloroform as solvents. Suspension of each tested isolate was inoculated and distributed onto the surface of Sabouraud's Dextrose Agar medium plates. Disks were performed then soaked into the extractions and were put onto the inoculated plates. The inhibition zones were measured after incubation period. A total of 83 isolates of dermatophyte were screened for their abilities to produce extracellular urease, lipase and keratinase enzymes using solid media. The most common isolated dermatophyte were selected to study the effect of different temperature degree (14, 21, 28, 35°C) and different incubation period (7, 14, 21, 28 days) on their growth using Sabroud’s 19Dextrose Broth medium. One hundered and eighty (60%) of cases were revealed of fungal elements on microscpical examination and dermatophyte growth. Tinea corporis was found as the most common type of dermatophytosis. The highest prevalence of dermatophytosis was found in male and age group of 11-20 (children and youth). Other parameters such as living in rural area, infected with chronic diseases, exposed to animals, infection in summer season, people who had no family history of skin diseases showed the highest number and percentage of isolation of dermatophyte. In this study, fourteen dermatophyte species belonging to three genera Epidermophyton, Microsporum and Trichophyton were recovered as following: Epidermophyton floccosum, Microsporum audouini, Microsporum canis, Microsporum ferrugineum, Microsporum gypseum, Microsporum nanum, Trichophyton concentricum, Trichophyton mentagrophytes, Trichophyton rubrum, Trichophyton schoenleinii, Trichophyton tonsurans, Trichophyton soudanense, Trichophyton verrucosum and Trichophyton violaceum. The most common isolated species were E. floccosum, T.mentagrophytes and M. canis. In Tinea corporis M. canis was the most isolated species. In Tinea ungiuum and Tinea pedis E. floccosum was the most common species. In Tinea capitis M. audouini and M. canis were the most encountered species. In Tinea manuum, T. mentagrophytes was of the highest isolated species, while T. rubrum was proved to be the main causative agent of Tinea cruris. On the other hand; it was found that most of isolates could produce more than one enzyme. It was observed that the enzymes producing abilities of these isolates were varied even among isolates of the same dermatophyte species. In addition, it was observed that the ability of the tested isolates to produce keratinase were less than their ability to produce urease and lipase. T. tonsurans, T. soudanense and M. canis exhibited higher activity to produce urease, lipase and keratinase than the other tested dermatophyte. E. floccosum, T. mentagrophytes and M. canis that grown on liquid medium showed optimum temperature of growth 28°C after 28 days of incubation. Among the three antifungal drugs Clotrimazole was the most effective antifungal drug against the tested species. The two plants extracts, Ziziphus numalaria and Curcuma domestica exhibited high pronounced antidermatophytic activity. This study concluded that the type of dermatophyte are differ according to the dermatophytosis and there are risk factors that 20facilitate the infection by dermatophytosis. Clotrimazole has high activity as antidermatophyte drug. Antifungal activity of Ziziphus nummaularia and Curcuma domestica against dermatophyte correlates well with the claims of traditional uses for skin infections. Since some of these plants appeared to have broad spectrum activity and are cheap, they could be useful in antiseptic or disinfectant formulations. However., further studies for Ziziphus nummaularia and Curcuma domestica are recommended including in vivo investigations and toxicity evaluation.