Accurate diagnosis based on the clinical symptoms alone is nearly impossible. Currently, the diagnosis of dermatophytosis is confirmed by clinical examination and screening of the collected clinical specimen by direct microscopy and fungal culture [13]. The risk of developing adverse drug reactions, the cost and long duration of the therapy, and possible interactions with concomitant medications all affects the importance of accurate diagnosis of the condition before commencing therapy [13, 14]. In the present study, direct microscopy positivity rate is 133/318(41.8%) and culture positivity rate is 148/318(46.5 %) (Table: 1). This was in line with a study conducted in Addis Ababa, Ethiopia, 42.6% [9]. This occurrence is due to that; Ethiopia is a tropical country with wet humid climate, large population size, and low socioeconomic status and this is supported by other studies conducted on dermatophytosis etiologies and risk factors [9, 15, 16, 34].
In this study; tinea capitis was the most common clinical disease followed by tinea ungium and tinea corporis and this is in line with studies conducted in Addis Ababa, Ethiopia (9, 21, 34). And this is due to low socioeconomic status, overcrowding and poor personal hygiene. T. tonsurans, T. mentagrophytes, T. violaceum, and M. audouinii species are causal agents of tinea capitis. Studies also revealed that the zoophilic Trichophyton and Microsporum species are seldom responsible for more than minor outbreaks of human scalp infections [24, 25]. The most susceptible persons to tinea capitis were among patients 1–14 years 115/170 (67.6%) and this is because of the lack of protective fatty acids in their scalp. Earlier, several authors have supported this finding [17, 18]. Many cases occurring in adults is involved with hormonal disorders resulting in carryover of tinea capitis from childhood or in patients with severe immune depression due to HIV/AIDS, leukemia, lymphoma, or treatment with immunosuppressant drugs [15, 19, 20]. T. tonsurans 26/46(56.5%) were the most abundant dermatophyte causing tinea capitis followed by M. audouinii 8/46(17.3%) and T. verrucosum 4/46(8.6%). Even though it is not in line with the current finding; a similar study in Ethiopia showed that the prevalence of T.tonsurans in the rate 5.8% & 18.4% [9, 21]. T.tonsurans had been reported in developing countries such as Kenya and other sub-Saharan countries as among the most common agent followed to M. canis and due to its ubiquitous in nature, abundance among human carriers, and Social phenomena of today on the continent could explain T.tonsurans are circulating in the population [20–23,26, 27].
Tinea corporis (33/318(10.8%) was the second most common infection with a significant incidence among age groups of 25–44. The site of infection was mostly restricted to face and neck. T. mentagrophytes, T.rubrum and M.audionii were the main causative agents and this is in line with study conducted in Harari regional state, Ethiopia [28].
Tinea unguium 51/318(16%) was observed mainly on the age of 25–44; 19/51(30.1%) (Table 3). Since onychomycosis infections in children is not common due to many reasons such as; rapid growth of the nail, have less exposure to fungal infection risk factors than adults such as pedicure and manicure repeated aggressiveness, frequent housework and cosmetic reasons [16,29].
Non dermatophytic molds were isolated from 63/148(42.56%) cases, with Cladosporium spp.as a major isolate accounting 21/63(33.3%) of the total non dermatophyte mold isolates followed by Neoscytalidium dimidiatum 11/63(17.4%). A study in Addis Ababa, Ethiopia found a similar finding to our current study [21]. Cladosporium species are the most widely spread fungi in the world. It is true also; most of the time appears as a contaminant. But some studies showed that they are associated as opportunistic infection in subcutaneous and disseminated form, especially among immune depressed individuals [32]. Neoscytalidum dimidatum was isolated from skin and nail scrapings predominantly of toenails. Neoscytalidium dimidiatum and Scytalidium hyalinum are common causative agents of human superficial infections in different parts of the world especially in tropical and subtropical region [21]. Similarly, yeasts were isolated from 13/148(8.78%) cases with C. albicans as a major isolate accounting 5/13(38.4%) of the total yeast isolated and this study was similar with study conducted in Saudi Arabia [33]. Non dermatophyte fungi were isolated as a cause of dermatophytosis in many studies [9, 13, 33, 34].
Conclusion: This study showed that the prevalence of dermatophytosis was 46.5% which is more or less similar to study conducted in Ethiopia [9] but in developed countries showed that less than 5% [35] which indicates that dermatophytosis is still a common problem in developing countries. Tinea capitis was identified as the most prevalent clinical presentation and children’s are the most vulnerable group. This study found that T. tonsurans was the most common etiologic agent followed by M.audoouinii and T.mentagrophytes. We recommend further research on the possible risk factors and spectrum for dermatophytes and Non dermatophyte Molds in large clinical setting and the community.