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A study of scalp ringworm in the Western Cape

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dc.creator Neil, Gail
dc.date 2012-09-07T10:44:17Z
dc.date 2012-09-07T10:44:17Z
dc.date 1991
dc.date.accessioned 2017-05-10T10:21:15Z
dc.date.available 2017-05-10T10:21:15Z
dc.identifier http://hdl.handle.net/11189/372
dc.identifier.uri http://hdl.handle.net/11189/372
dc.description Thesis (M. Dip. Technology (Medical Technology) -- Cape Technikon, 1991
dc.description Scalp ringworm, a potentially disfiguring and emotionally traumatic disease of childhood, appears to have attained an unacceptably high incidence in the southern and Western Cape. This study examined aspects of tinea capitis and was undertaken in four distinct sections, each evolving from the prior study. Attempts were made to establish the local incidence, the clinical presentation and the causative dermatophytes; to ascertain the effects of geographical influences on this spectrum of organisms; to determine the number of fungal carriers within certain communities and to examine both in-vivo and in-vitro effects of easy-to-use, topical preparations on this group. On examining the incidence, it was shown that approximately 3% of children seen at the Red Cross Children's Hospital in Rondebosch attend specifically for scalp ringworm but many more, particularly of low socio-economic backgrounds remain untreated (Neil, 1987). Random visits to primary schools along the West Coast and to childcare institutions in the Cape Peninsula revealed an infection rate as high as 53% and 29% respectively. Following examination of the varied clinical presentations evoked by infection with T.violaceum, the predominant manifestation of disease was shown to be various degrees of scalp scaling. The findings highlighted the often subtle and easily overlooked clinical presentations which presumably contributed to the high prevalence of this disease amongst the community. Laboratory investigation revealed the major aetiological agent to be the anthropophilic fungus, T.violaceum (92%). This was followed by M.canis and M.audouinii constituting only 2,8% and 1,7% of isolates respectively. Small numbers of seven other dermatophytes, including T.verrucosum, T.yaoundei, T.mentagrophytes, T.schoenleinii, T.tonsurans, M.gypseum and E.floccosum, were also isolated. Examination of geographical influences showed that none of the associated factors, with particular reference to altitude and climate, appeared to exert any discernible effect on the prevailing dermatophyte species in any particular region. T.violaceum was isolated with overwhelming frequency from both the South Western Cape and the Western Cape Coast in spite of vastly different climates and altitudes (Mediterranean and semi-desert, and sea-level and up to 1322m respectively). Other dermatophyte species were similarly isolated from both areas but numbers were to small to allow meaningful analysis. Research into the possible sources of tinea capitis revealed that in addition to the high incidence of clinical infection approximately 24% of children in 8 local childcare institutions were fungal carriers with no discernible clinical symptoms. All were colonised with T.violaceum and served as reservoirs for the spread and persistence of tinea capitis. Following studies spanning various time periods (6 weeks to 8 months), it was shown that only 14% of carriers were likely to develop clinical disease while the chance of remaining a carrier or becoming "negative" was approximately equal in the remaining patient sample. Thus a significant number of carriers remained a constant threat to susceptible individuals. In-vivo trials on the effects of three antifungal preparations on the carrier state showed that all produced some degree of beneficial effect by reducing the fungal load of carriers as well as infected children. The shampoos used in the trial included econazole nitrate (pevaryl; Fison's Laboratories), selenium-sulphide (2,5% Selsun; Abbott Laboratories), povidone-iodine (Betadine; Adcock-Ingram Laboratories) and Johnson's Baby Shampoo (Johnson & Johnson), a bland preparation, as a control. Although small improvement was noted following the use of each preparation, the povidone-iodine shampoo significantly reduced the fungal load of infected children (p Cultural and ultrustructural examination of the effects of the preparations on the spores of T.violaceum supported these in-vivo findings. Mild to moderate effects on growth patterns and cellular changes were noted following the use of econazole nitrate, selenium-sulphide and the control shampoos but total suppression of germination and gross degeneration of cells by the povidone-iodine preparation was clearly demonstrated. These studies have served to highlight the incidence of tinea capitis and the role of fungal carriers in our community. Greater knowledge and awareness of the many clinical manifestations of the disease as well as the eradication or control of the carrier state should be considered vital in our efforts to effectively reduce the numbers of clinically infected children. Regular use of a suitable shampoo and improved hair hygiene practice in local institutions and the community at large would be a positive contribution towards achieving these aims. Although further studies are clearly necessary, this study has revealed that the availability, ease of application and minimal side-effects of the povidoneiodine preparation make Betadine Shampoo an ideal product for regular use as a prophylactic measure. Minimising opportunities for contracting this potentially disfiguring and psychologically traumatic disease would be a valuable contribution towards improving the quality of life in our third world society.
dc.language en
dc.publisher Cape Technikon
dc.rights http://creativecommons.org/licenses/by-nc-sa/3.0/za/
dc.subject Medical technology
dc.title A study of scalp ringworm in the Western Cape
dc.type Thesis

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