Prevalence of Dermatophytosis Infection Among Patients Attending National Obstetric Fistula Centre Babbar-Ruga Hospital, Katsina State JOURNAL OF BIOCHEMISTRY, MICROBIOLOGY AND BIOTECHNOLOGY

This study aimed to determine the prevalence of dermatophytosis infections among patients attending National obstetrics fistula center hospital, Katsina state. A total number of 100 patients were diagnosed, (40/100) were males and 60% (60/100) were females, giving a gender ratio of 3:2 (males: females), 40% of the participants were of the age range 10-29 years and 60% of age from 14-21 years respectively. Out of 60 cases, a total of 53 dermatophytes were isolated belonging to the genera Trichophyton and Microsporum . The most frequently isolated dermatophytes were Trichophyton mentagrophyte (26.41% 14/53), followed by Microsporum audouinii (22.64% 12/53), Trichophyton rubrum (15.09% 8/53), Trichophyton schoenleinii (7.547% 4/53), Microsporum gypseum (5.660% 3/53) and the least were Microsporum canis (9.433% 5/53) and Trichophyton tonsurans (9.433% 5/53), Trichophyton verrucosum (3.77% 2/53). Although 38 cases (63.33%) had single infections with dermatophytes, mixed infections with 2-4 dermatophytes of the genera Microsporum and Trichophyton were observed in 15 cases (36.67%). 67% (10/15) of the mixed infections were with Microsporum and Trichophyton species, 20% (3/15) were with Microsporum species alone, and 13.3 %( 2/15) were with Trichophyton species alone. This study indicates an outstanding prevalence of dermatophytosis infection among patients who shared combs and scarves and who owned pets; this suggests a thriving animal-human transmission route of dermatophytes and the potentiality of the fomites. The research proposes intensive health promotion and education interventions to promote hygiene practices among patients.


INTRODUCTION
There are numerous accounts of dermatophytes infections in the medical and mycological literature from all over the world, with some developing nations in the tropical and subtropical areas of the planet recording an exceptional prevalence rate [1]. They are distinguished by their innate ability to infiltrate the stratum corneum and other superficial layers of the epidermis, as well as by the significant concentration of keratin in the appendages, hair, and nails of the living host [2]. The distribution of dermatophytoses on the African continents, which accurately mirrored the ratio of the causative agents, was tested in nations that kept track of variations in the leading etiological species [3]. According to the geographic region analyzed, climatic differences, population socioeconomic status, the time of the study, and the etiological agents that cause dermatophytosis, there are variations in the distribution, frequency, and etiological agents of the disease. The geographic area analyzed, climatic differences, population socioeconomic status, period of the study, the presence of domestic animals, and the age of the subjects all have an impact on the distribution, frequency, and etiological agents of dermatophytosis [4]. Patients are more prone to dermatophytic infections because of their bad personal hygiene practices and occasionally dirty surroundings [5].
Between the ages of 4 and 16, humans are more prevalent, putting this age group at a higher risk of catching an infectious disease. There are very few studies that have looked at the prevalence of dermatophytes infection among patients, thus it is important to know the precise quantity among the population that HISTORY visits hospitals for medical treatment. Dermatophytes can be divided into three groups based on their genera: Microsporum (which causes infections on skin and hair), Epidermophyton (which causes infections on skin and nails), and Trichophyton (which causes infections on skin, hair, and nails) [6]. Clinically, these are divided into Tinea capitis (head), Tinea faciei (face), Tinea barbae (beard), Tinea corporis (body), Tinea manus (hand), Tinea cruris (groin), Tinea pedis (foot), and Tinea unguis (depending on the route of transmission and the affected place) (nail). Tinea imbricata, Tinea pseudo imbricate, and Majocchi granuloma are other clinical variations [7].
Despite having a global distribution, dermatophytosis is indigenous to tropical areas because warm, humid weather promotes the growth of dermatophytes [8]. In addition to climate, the distribution's variability of dermatophytes worldwide is attributed to other factors such as population migration patterns, lifestyle, primary host range, secondary host immunity, presence of immunodeficiency diseases, and patient attitude to prompt treatment following clinical presentation and standard of living [8]. The disease is infectious and can be transmitted by humans, animals, or objects that harbor the fungus [9].

Research Design
This research work adopted a descriptive research design which is considered more appropriate in this study, secondary mode of data was laboratory work because the subjects were on observation setting while a questionnaire was used to collect data from the population involved in the research.

Study Area
The study was conducted at the National Obstetric Fistula Center, Babbar-ruga laboratory, located at Babbar-ruga Katsina state. Some patients attending the hospital agreed to participate in the study.

The population of the Study
Ethical approval was obtained from the National Obstetric Fistula Center Babbar-ruga hospital, Katsina state, before the commencement of laboratory work. One hundred (100) patients gave consent to participate in the study. Patients had signed the permission forms. They were interviewed and screened accordingly.

Sample Size and Sampling Technique
The sample size of the study was one hundred (100) patients. A simple random sampling technique was used in which a subset of individuals was chosen randomly, all with the same probability. Selecting enough subjects completely at random from the larger population being selected.

Sample collection and questionnaire administration
One hundred patients altogether (100) for each patient, a sample was taken by scraping the diseased area of the head with a sterile scalpel. Before collecting the sample, the collection site was swabbed with 70% ethanol [10]. To avoid exposure to moisture and sunlight, as well as to stop the accumulation of contaminants, the scrapings were collected into sterile paper and folded in a clearly labeled envelope.
The patient's name was written on the envelope [11]. Sociodemographic information, including age, gender, and details on the sharing of foodstuffs, was collected through the administration of the questionnaire.

Microscopy
Alcohol was used to remove any ointments or other local treatments from the affected area [12]. By gently scraping the diseased area with a surgical blade, the patients' scalp scrapings were obtained [13]. On the glass slide, the sample was inserted. After 3-5 minutes, the skin scrapings were dissolved and examined under a microscope after being treated with 25% KOH. Low (×10) and high (×40) power magnifications of the wet mount were used to check for the presence of fungi [14].
Media preparation 1000 ml of distilled water was mixed with 65.0g of SDA Sabouraud dextrose agar. The medium was heated and boiled until it was fully dissolved. The media was then autoclaved at 121°C for 15 minutes to sterilize it, and it was then allowed to cool at 45-50°C. The medium was thoroughly combined before being placed onto Petri dishes [15].

Culture
In Sabraud's dextrose agar plates with 0.05 g of chloramphenicol and 5 percent NaCl, the scrapings were cultivated. The samples are plated onto a medium that has been prepared, cultured for 3-4 weeks at room temperature, and checked every week for growth. [16] Statistical analysis Data were analyzed using simple percentage and odd ratios using epi info statistical software for epidemiology developed by the centers for disease control and prevention (CDC).

RESULTS
A total of (100) skin scrapings were collected and analyzed for dermatophytes. The characteristics of the study participants are shown in Table 1. The age range of study participants was 10-30 years. Of the 100 participants, 40% (40/100) were male and 60% (60/100) were females, giving a gender ratio of 2:3 (males: females). 40% and 60% of the participants were of the age range 10-30 years and 14-29 years respectively. The current study ( Table 1) shows that the female sex was more highly infected with dermatophytosis than their male counterparts clinically. The 10-30 years age group was the most infected age group with dermatophytoses. After the incubation period and examining the microscopic features of fungal growth, there were 53 cases of dermatophytosis of which Microsporum cases and Trichophyton cases had single and mixed dermatophytes, respectively. The overall prevalence of dermatophytes in the study population is 6.0% cases were more prevalent among females (60%) Than in males (40%). There was an association between dermatophytosis infections and variables such as sharing of combs, sharing of caps/scarves, sharing of towels, hair cut at a barbing salon, keeping and playing with pets, and carrying objects on the bare head.    Table 3 shows that Out of 60 cases, a total of 53 dermatophytes were isolated belonging to the genera Trichophyton and Microsporum. Although 38 cases (63.33%) had single infections with dermatophytes, mixed infections with 2-4 dermatophytes of the genera Microsporum and Trichophyton were observed in 15 cases (36.67%) This is presented about the age group and gender, 67% (10/15) of the mixed infections were with Microsporum and Trichophyton species, 20% (3/15) were with Microsporum species alone, and 13.3% (2/15) was with Trichophyton species alone.

DISCUSSION
With a higher frequency among females (42.0%) than males (21.0%) and endemicity in numerous locations of Nigeria, dermatophytic infection is a frequent infection that poses a public health hazard for patients in Nigeria [17]. The dermatophytes that induced dermatophytosis among patients at the National Obstetrics Fistula Center Babbar-ruga Hospital in Katsina state were isolated and identified in this study. We discovered a significant incidence of the infection among patients aged 14 to 21 years, which is in contrast to research [17] that claimed participants in the study who were high-aged had dermatophytosis at a higher rate than those who were younger. The dermatophytoses that were isolated were T. mentagrophytes In terms of gender, girls had a higher incidence than males, yet there is a substantial correlation (odds ratio 0.6707). The results of some earlier research, which indicated increased infections among females in Nigeria [18], support this. The prevalence rate of culture-proven dermatophytes infection was 5.0 percent (30/60 percent) in a study of 602 children from 2 public schools in the Oke-Oyi community, which indicates that the most common dermatophytes producing dermatophytosis in this study context are quite uncommon. Given factors that are known to favor person-to-person transmissions, such as the current practice of sharing personal items that can spread dermatophytosis infection directly through human or animal contact, or directly from contaminated articles on floors, the high prevalence of dermatophytes in this study was unexpected. While some objects, like towels, scissors, and scarves, may act as the breeding ground of the organisms because to the microscopic skin present, shared changing rooms and showers are frequently a source of dermatophytosis [19]. A small quantity of dermatophytosis can persist in the environment and infect someone else if it is present in the minute skin fragments that people constantly shed. The patients identified have a history of pet ownership as well as indicators of inadequate personal hygiene. The discovery that T. mentagrophytes is the most widespread dermatophyte in this region is in contrast to past research that identified select strains as being common in particular regions of the nation. Trichophyton shoeleinii was found in Northern Nigeria, and Microsporum audouinii was found to be common in Eastern and Western Nigeria [20].
While the "Sudanese"-like variety Trichophyton violaceum occurs in the middle belt. A recent update from the Southeastern part of Nigeria suggests changing epidemiology from M. audouinii to Trichophyton tonsurans in Anambra and Trichophyton sudanese in Delta states [21]. In the North Central to which the community surveyed belonged, this reason can also be advanced for the observation of T. mentagrophytes as the commonest infecting species of dermatophytes. However, because no such study had been previously carried out in the community or this area, the assertion of a change in etiology must be taken with caution.