The Value of Direct Microscopic Examination in the Diagnosis and Evaluation of Treatment Efficacy in Cases of Tinea Capitis
Abstract
Amaç: Tinea capitis, saç ve saçlı deriyi tutan, çocukluk çağının en sık rastlanan dermatofit enfeksiyonudur. Belirli toplumlarda daha sık görülmesi bu bölgelerde hastalığın klinik önemini artırmaktadır. Dermatolojide özellikle mantar enfeksiyonlarının tanısında kullanılan direkt mikroskobik inceleme, kullanımı kolay ve hızlı sonuç veren bir yöntemdir. Çalışmamızda tinea capitis olgularına ait demografik ve klinik özelliklerle birlikte tanı ve tedavi sürecinde direkt mikroskobik bulgulara vurgu yaparak literatüre katkı sunmayı amaçladık. Gereç ve Yöntem: Bu çalışmaya Yüzüncü Yıl Üniversitesi Dermatoloji Anabilim Dalı'na başvuran klinik olarak tinea capitis tanısı konan 45 çocuk olgu dahil edildi. Olgulara ait yaş, cinsiyet, enfeksiyonun klinik tipi, lezyonların yerleşim yeri, başvuru öncesi hastalık süresi, başvuruda lökosit ve CRP düzeyleri, aile öyküsü, başvuru öncesi antifungal kullanımı, hayvan teması, tinea corporis varlığı, lenfadenopati ve id reaksiyonu varlığı gibi özellikler kaydedildi. Olgulara başvuru sırasında Wood ışığı muayenesi yapıldı. Tüm olgulardan ilk başvuru sırasında, tedavi başlangıcından 4. hafta ve 8. hafta sonunda saç ve saçlı deri örnekleri alınarak direkt mikroskobik incelemede fungal elemanların varlığı araştırıldı. Elde edilen sonuçlar kaydedildi ve istatistiksel olarak analiz edildi. Bulgular: Olguların yaş ortalaması 6,36 saptanmış olup erkek/kız oranı 2,75:1 olarak bulundu. En sık görülen klinik tip 40 (%88,9) olgu ile tinea capitis profunda olurken 5 (%11,1) olguda tinea capitis superficialis kliniği görüldü. Olguların başvuru öncesi hastalık süresi ortalama 13,96 gündü. Başvuruda olguların %44,4'ünde lökositoz, %77,8'inde CRP yüksekliği görülürken tinea capitis profunda olgularında daha yüksek CRP düzeyleri saptandı. En sık lezyon yerleşim yeri parietal bölge (%35,6) olarak izlendi. Olguların %26,7'sinde aile öyküsü mevcuttu. 38 (%84,4) olguda hayvan teması öyküsü mevcutken tür olarak en sık (%35,6) küçükbaş hayvan teması görüldü. Klinik muayenede olguların %15,6'sında tinea corporis, %35,6'sında lenfadenopati, %17,8'inde id reaksiyonu varlığı saptandı. Wood ışığı muayenesinde 14 (%31,1) olguda floresans alındı. İlk başvuruda yapılan direkt mikroskobik incelemede 41 (%91,1) olguda pozitif sonuçlar alınırken bunların ii 24'ünde ektotriks kıl tutulumu, 17'sinde endotriks kıl tutulumu izlendi. Ülkemizde tinea capitis olgularında direkt mikroskobik inceleme yapılan çalışmalar olmasına rağmen kıl tutulumunu endotriks ve ektotriks olarak sınıflayan geniş kapsamlı bir çalışmaya rastlanmadı. Elde ettiğimiz bulgular çalışmamızın yapıldığı bölgede daha önceki çalışmalarda kültürde sık saptanmış dermatofit etkenlerinin kıl invazyon paterni düşünüldüğünde tahmin edilebilir sonuçlardı. Direkt mikroskobik bulgular ile olguların hayvan teması ve Wood muayenesi sonuçları arasında anlamlı ilişki saptandı (p<0,05). Tedavi başlanmasını takiben 4 hafta sonunda yapılan kontrol mikroskopide 6 hastada pozitif sonuçlar görülmye devam ederken, 8 hafta sonunda 1 hastada pozitif sonuçlar devam etmekteydi. Sonuç: Çalışmamızda olgulara ait demografik ve klinik özellikler daha önce yapılan çalışmaların sonuçları ile benzer bulundu. Elde edilen mikroskobik bulgular olgulara ait anamnez, klinik ve tanısal bulgular ile birlikte değerlendirildiğinde etken dermatofite yönelik tahmin yürütülmesine ve tedavi sürecinin öngörülmesine olanak sağladı. Klinik pratikte direkt mikroskopinin kullanımının yaygınlaşmasının, tanıda ve tedavi sırasında hastaların klinik yanıtının gözlemlenmesinde faydalı olacağını düşünmekteyiz. Anahtar kelimeler: Tinea capitis, tinea capitis profunda, tinea capitis superficialis, dermatofit, mikroskopi, hifa, spor.
Objective: Tinea capitis is the most common dermatophyte infection of childhood, affecting the hair and scalp. Its higher frequency in certain populations increases the clinical importance of the disease in these regions. Direct microscopic examination, used especially in the diagnosis of fungal infections in dermatology, is a method that is easy to use and provides rapid results. In our study, we aimed to contribute to the literature by emphasizing the demographic and clinical characteristics of tinea capitis cases as well as direct microscopic findings during the diagnosis and treatment process. Materials and Methods: 45 pediatric cases who were clinically diagnosed with tinea capitis and applied to Yüzüncü Yıl University Dermatology Department were included in this study. Characteristics of the cases such as age, gender, clinical type of infection, location of the lesions, disease duration before admission, leukocyte and CRP levels at admission, family history, antifungal use before admission, animal contact, presence of tinea corporis, lymphadenopathy and presence of ID reaction were recorded. Wood's light examination was performed on the cases at the time of admission. Hair and scalp samples were taken from all cases at the first admission, after 4 week and after 8th week from the beginning of treatment, and the presence of fungal elements was investigated by direct microscopic examination. The results obtained were recorded and statistically analyzed. Results: The average age of the cases was found to be 6.36 and the male/female ratio was 2.75:1. The most common clinical type was tinea capitis profunda in 40 (88.9%) cases, while tinea capitis superficialis was seen in 5 (11.1%) cases. The average duration of illness of the cases before admission was 13.96 days. At admission, leukocytosis was observed in 44.4% of the cases and CRP elevation was observed in 77.8%, while higher CRP levels were detected in tinea capitis profunda cases. The most common lesion location was the parietal region (35.6%). There was a family history in 26.7% of the cases. While there was a history of animal contact in 38 (84.4%) cases, the most common species was ovine contact iv (35.6%). During clinical examination, the presence of tinea corporis was detected in 15.6% of the cases, lymphadenopathy in 35.6%, and id reaction in 17.8%. Fluorescence was detected in 14 (31.1%) cases during Wood's light examination. In the direct microscopic examination performed at the first admission, positive results were obtained in 41 (91.1%) cases, while ectothrix hair involvement was observed in 24 of them and endothrix hair involvement was observed in 17 cases. Although there are studies in our country that performed direct microscopic examination of tinea capitis cases, no comprehensive study classifying hair invasion as endothrix and ectothrix was found. The findings we obtained were predictable considering the hair invasion pattern of dermatophyte agents that were frequently detected in culture in previous studies in the region where our study was conducted. A significant relationship was found between direct microscopic findings and the results of animal contact and Wood examination of the cases (p<0.05). While positive results continued to be seen in 6 patients in the control microscopy performed at the end of 4 weeks following the start of treatment, positive results continued in 1 patient at the end of 8 weeks. Conclusion: The demographic and clinical characteristics of the cases in our study were found to be similar to the results of previous studies. When the microscopic findings obtained were evaluated together with the anamnesis, clinical and diagnostic findings of the cases, it allowed making predictions about the causative dermatophyte and predicting the treatment process. We think that the widespread use of direct microscopy in clinical practice will be beneficial in diagnosis and monitoring the clinical response of patients during treatment. Key words: Tinea capitis, tinea capitis profunda, tinea capitis superficialis, dermatophyte, microscopy, hyphae, spore.
Objective: Tinea capitis is the most common dermatophyte infection of childhood, affecting the hair and scalp. Its higher frequency in certain populations increases the clinical importance of the disease in these regions. Direct microscopic examination, used especially in the diagnosis of fungal infections in dermatology, is a method that is easy to use and provides rapid results. In our study, we aimed to contribute to the literature by emphasizing the demographic and clinical characteristics of tinea capitis cases as well as direct microscopic findings during the diagnosis and treatment process. Materials and Methods: 45 pediatric cases who were clinically diagnosed with tinea capitis and applied to Yüzüncü Yıl University Dermatology Department were included in this study. Characteristics of the cases such as age, gender, clinical type of infection, location of the lesions, disease duration before admission, leukocyte and CRP levels at admission, family history, antifungal use before admission, animal contact, presence of tinea corporis, lymphadenopathy and presence of ID reaction were recorded. Wood's light examination was performed on the cases at the time of admission. Hair and scalp samples were taken from all cases at the first admission, after 4 week and after 8th week from the beginning of treatment, and the presence of fungal elements was investigated by direct microscopic examination. The results obtained were recorded and statistically analyzed. Results: The average age of the cases was found to be 6.36 and the male/female ratio was 2.75:1. The most common clinical type was tinea capitis profunda in 40 (88.9%) cases, while tinea capitis superficialis was seen in 5 (11.1%) cases. The average duration of illness of the cases before admission was 13.96 days. At admission, leukocytosis was observed in 44.4% of the cases and CRP elevation was observed in 77.8%, while higher CRP levels were detected in tinea capitis profunda cases. The most common lesion location was the parietal region (35.6%). There was a family history in 26.7% of the cases. While there was a history of animal contact in 38 (84.4%) cases, the most common species was ovine contact iv (35.6%). During clinical examination, the presence of tinea corporis was detected in 15.6% of the cases, lymphadenopathy in 35.6%, and id reaction in 17.8%. Fluorescence was detected in 14 (31.1%) cases during Wood's light examination. In the direct microscopic examination performed at the first admission, positive results were obtained in 41 (91.1%) cases, while ectothrix hair involvement was observed in 24 of them and endothrix hair involvement was observed in 17 cases. Although there are studies in our country that performed direct microscopic examination of tinea capitis cases, no comprehensive study classifying hair invasion as endothrix and ectothrix was found. The findings we obtained were predictable considering the hair invasion pattern of dermatophyte agents that were frequently detected in culture in previous studies in the region where our study was conducted. A significant relationship was found between direct microscopic findings and the results of animal contact and Wood examination of the cases (p<0.05). While positive results continued to be seen in 6 patients in the control microscopy performed at the end of 4 weeks following the start of treatment, positive results continued in 1 patient at the end of 8 weeks. Conclusion: The demographic and clinical characteristics of the cases in our study were found to be similar to the results of previous studies. When the microscopic findings obtained were evaluated together with the anamnesis, clinical and diagnostic findings of the cases, it allowed making predictions about the causative dermatophyte and predicting the treatment process. We think that the widespread use of direct microscopy in clinical practice will be beneficial in diagnosis and monitoring the clinical response of patients during treatment. Key words: Tinea capitis, tinea capitis profunda, tinea capitis superficialis, dermatophyte, microscopy, hyphae, spore.
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Dermatoloji, Dermatology
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