SPECTRUM OF DERMATOPHYTOSIS IN HIV INFECTED CHILDREN IN NATIONAL HOSPITAL, ABUJA, NIGERIA

Abstract

Human immunodeficiency virus (HIV) infection reduces the body’s capability for immune
response therefore predisposing the individual to infections including fungal skin infections
especially dermatophytosis. Although dermatophytosis may appear trivial, in the immune
deficient, there may be risk of atypical, extensive and invasive infection.
There is limited knowledge on dermatophytosis in children with HIV infection in Nigeria.
This observational cross-sectional study of 206 HIV positive children who met the study
criteria (subjects) and 206 HIV-negative children matched for age and sex (controls) was
therefore conducted. This study was aimed at finding out the prevalence, clinical features,
aetiological agents and the association if any between the prevalence of dermatophytosis with
the immunological or clinical stages in HIV seropositive children aged 2months to 15years at
the National Hospital Abuja, Nigeria.
Sociodemographic data, anthropometric measurements and clinical staging of HIV disease
were obtained. Dermatologic examinations were carried out and blood samples for full blood
count and CD4 were obtained. Scrapings from clinically identified lesions were subjected to
culture and microscopic examinations which also included species identification. All data
obtained were analysed using SPSS version 21.
The prevalence of clinically diagnosed dermatophytosis was 13.1% and 10.2% in the subjects
and controls respectively. There was no statistically significant difference in prevalence (p =
0.44). There was no sex predilection to the disease among the subjects though prevalence was
significantly higher in males among the controls (p = 0.01). Highest prevalence rate was
noted in the 5 – <10 years age range in both the subjects and the controls.

Dermatophyte infections affecting different parts of the body were seen among the subjects.
These included tinea capitis (66.7%), tinea unguium (11.1%), tinea pedis (7.4%), tinea faciei
(3.7%) and tinea corporis (11.1%). The control group had fewer array which included; tinea
capitis (90.4%), tinea faciei (4.8%), and tinea corporis (4.8%). Tinea pedis and tinea unguium
were not encountered in the control group. The commonest site of infection was the scalp in
both groups (66.7% in the subjects and 90.4% in the controls). Multiple sites of infection and
atypical skin lesions were encountered only among the subjects.
Aetiological agents causing infection in both groups were similar with Trichophyton rubrum
as the most prevalent organism in both groups (29.6% in the subjects and 19.0% in the
controls). The other dermatophytes isolated included; M. auduoinii, M. canis, T. violaceum,
T. mentagrophyte, T. schoeleinii and E. floccosum.
There was no statistically significant difference in the prevalence of dermatophytosis in the
immunological or clinical stages of HIV among the subjects though prevalence rate of
dermatophytosis was highest in the severely immunosuppressed and those with Paediatric
AIDS stage IV disease.
In conclusion, the prevalence of dermatophytosis in children with HIV infection was 13.1%.
There was no significant increase in prevalence in HIV seropositive children. Morphology of
tinea capitis was significantly different on account of atypical lesions seen only in the
subjects. Atypical lesions, multiple sites of infection and presence of tinea pedis or tinea
unguium may be pointers to the possible HIV infection in children.

SPECTRUM OF DERMATOPHYTOSIS IN HIV INFECTED CHILDREN IN NATIONAL HOSPITAL, ABUJA, NIGERIA