Prevalência de dermatomicoses em pacientes atendidos no ambulatório de dermatologia da Santa Casa de Misericórdia de Belo Horizonte, MG

Abstract

We examined 233 clinical samples collected from 189 patients with suspected dermatomycosis at Santa Casa de Misericordia of Belo Horizonte, MG, Brazil from December 2009 to May 2010. The samples were examined by direct microscopy and cultivated on Sabouraud agar with chloramphenicol and Mycosel media. The culture was regarded as conclusive diagnosis of mycosis, with the exception of two patients with pityriasis versicolor, in which the diagnosis was made only by direct examination plus clinical characteristics of individuals. Of the 233 samples, 82 samples (35.19%) were positive and among them, 2 (2.4%) were presumptively identified as belonging to the genus Malassezia. The others were identified by traditional and molecular methods. Most of the infected patients were aged between 41 and 70 years (68.29%). There were no statiscally significant between occurrence of fungal infections and gender, visits to swimming pools and saunas, disease and contact with animals. There was a predominance of female patients (77.2%) if compared to males (22.8%). The 233 clinical specimens examined came from 10 different anatomic sites and the largest number of tests occurred in samples from the toenails, which resulted in 50% of positive samples, followed by the fingernails (26.83%) and plantar ( 7.32%). The species isolated from 82 positive cultures were: Candida albicans, C. dubliniensis, C. guilliermondii, C. lusitaniae, C. parapsilosis, C. tropicalis, Trichosporon spp., Microsporum gypseum, Trichophyton interdigitale, T. rubrum, Malassezia spp. and Scopulariopsis brevicaulis. Candida spp. predominated as agents of dermatomycosis in many anatomical sites. C. parapsilosis was the most frequent species (40.24%) in the nails, feet and hands, followed by C. tropicalis (20.73%) and T. rubrum (10.98%), regardless of sex and disease, contact with animals or not. Among the dermatophytes, Trichophyton genus accounted for more than 80% of the isolates and T. rubrum accounted for 64.29% of the three species, followed by T. interdigitale (21.43%) and M. gypseum (14.29%). T. rubrum was most common in toenails than in any other anatomical site. Regarding the diagnostic methods employed, the identification of dermatophytes were used only traditional methods, while the identification of Candida species were also used CHROMagar Candida and molecular methods. All methods used for identification of yeasts and filamentous fungi seemed efficient and high rate of agreement and the methodology used was obtained, suggesting that the classic method is still suitable for use in routine clinical laboratories.