Asymptomatic dermatophyte scalp carriage in school children in Erzincan, Turkey

Background: This study aimed to investigate the prevalence of symptomatic tinea capitis infections of the scalp and its asymptomatic carriage in students attending primary schools in Erzincan, Turkey. Materials and Methods: Eighteen primary schools were visited; 1 located in the central district and 17 located in other districts of the Erzincan province. From 2015 November to 2016 April, scalp scrapings were obtained from a total of 1879 students aged 6 to 13 years (mean age: 9.37±1.69) 924 (49.2%) male and 955 (50.8%) female using sterile hairbrushes, and assessed for tinea capitis and asymptomatic fungal carriage. The hairbrushes were used to seed Sabouraud Dextrose Agar containing cycloheximide, chloramphenicol and gentamycin. A questionnaire was students to collect epidemiological data on carriage and infection development. Results and Discussions: In our study, symptomatic cases were not detected but dermatophyte carriage was detected in a 13-year-old girl of foreign descent (Meskhetian Turk), who had migrated to Erzincan province. The fungal sample was identified as Trichophyton tonsurans using the DNA sequencing of the ITS region. When the underlying factors were explored, it was found that the girl was a national wrestler. In the literature, T. tonsurans outbreaks have been widely reported in people engaged in combat sports, particularly wrestling and judo. Asymptomatic carriage is that it is mostly caused by anthropophilic dermatophytes (T. tonsurans, T. violaceum, Microsporum audouinii). Our results are consistent with the literature. The prevalence of dermatophyte-positive scalp carriage generally correlates well with the incidence of tinea capitis in community. Symptomatic tinea capitis studies targeting primary school children performed in Adana, Erzurum, Istanbul, Izmir, Diyarbakır, Batman and Afyon reported prevalence of 0.05%, 0.08%, 0.08%, 0.1%, 0.1%, 0.2% and 0.4% respectively. In Erzincan province, the prevalence of asymptomatic dermatophyte carriage observed is 0.05%. Conclusions: In our study, the prevalence of asymptomatic carrier state was similar with the prevalence of symptomatic cases in Turkey. This study is significant for being the first to investigate tinea capitis infections and carriage in Erzincan, Turkey. Keywords: Tinea capitis, asymptomatic dermatophyte scalp carriage, Trichophyton tonsurans, DNA sequencing analysis.