mycoses Diagnosis,Therapy and Prophylaxis of Fungal Diseases

Review article

Dermatophytosis in northern Africa

E. I. Nweze and I. Eke

Department of Microbiology, University of Nigeria, Nsukka, Enugu State, Nigeria

Summary Infections caused by dermatophytes are a global problem and a major public health
burden in the world today. In Africa, especially in the northern geographical zone,
dermatophytic infections are being reported at an alarming rate. This is mostly
because of some local but unique cultural practices, socioeconomic and environmen-
tal conditions, lack of reliable diagnostic personnel and facilities and ineffective treat-
ment. Interestingly, the pathogen spectrum and the clinical manifestation are most
times different from what is seen in other continents. Several epidemiological studies
have been performed on the incidence and aetiology of dermatophytoses in northern
Africa. However, there is currently no review article with up-to-date information on
the relevant findings reported so far in this region. This information is necessary for
clinicians who treat dermatophytic infections all over the world since agents of der-
matophytes are no longer restricted because of the rapid mobility of humans from
one part of the world to another. Moreover, the epidemiology of dermatophytoses is
known to change over time, thus requiring the update of information from time to
time. A review of relevant studies published on dermatophytoses in northern Africa
is presented. This covers all of old Sudan, Algeria, Egypt, Libya, Tunisia and
Morocco.

Key words: Dermatophytes, dermatophytoses, northern Africa, epidemiology, aetiology.

the mucous layers of the mammalian system.2 They

Introduction
Dermatophytes are group of taxonomically related fila-
mentous fungi which have a unique enzyme capacity
that enable them to utilise keratin as a nutrient
source. Diseases caused by dermatophytes are gener-
ally regarded as dermatophytosis or superficial myco-
sis.1 Dermatophytosis is a clinical condition which is
not opportunistic in activity, rather it is a superficial
fungal infection which affects keratin-rich regions of
the body such as hair, skin and nails.2,3 Dermato-
phytes invade the stratum corneum and other kera-
tinised tissues of the body4 but generally do not attack
Correspondence: E. I. Nweze, Department of Microbiology, University of
Nigeria, Nsukka 410001, Enugu State, Nigeria.
Tel.: +234 80 68535841.
E-mail: nwezemeka@yahoo.com
Submitted for publication 24 September 2015
Revised 7 November 2015
Accepted for publication 18 November 2015
are usually restricted to the cutaneous and non-living
cornified layers of the system.1 Due to their adaptation
to the main host and their prevalence/asymptomatic
carriage, dermatophytes are chronic in nature. How-
ever, Cheikhrouhou et al. attribute dermatophytes’
severe nature to the possibility of potentially life-threa-
tening visceral involvement and resistance to antifun-
gal agents.5 One major diagnostic feature of this
infection is the presence of concentric ring-shaped
lesions at the superficial areas; thus, dermatophytes
are also known as ringworm fungi or tinea fungi.6,7
Dermatophytes can be divided into three ecological
distributions. Their natural habitat can be humans
(anthropophilic), soil (geophilic) or animal bodies (zoo-
philic).6,8 They are generally classified into three gen-
era with over 40 different species.4,8 The genera are
Epidermophyton, Trichophyton and Microsporum. The
severity of their infection depends on the pathogenic
attributes of the invading species, socioeconomic fac-
tors and the local environmental conditions. It is

© 2015 Blackwell Verlag GmbH

Mycoses, 2016, 59, 137–144 doi:10.1111/myc.12447
E. I. Nweze and I. Eke
generally agreed that they infect 20–25% of the
world’s population.3 Nweze suggested that such skin
diseases are found in tropical and subtropical regions
of the world due to the ability of the fungi to grow sig-
nificantly in a humid and warm environment.8 Inade-
quate hygiene and socioeconomic status can also be a
contributing factor to the prevalence of dermatophyto-
sis in North Africa.
Northern Africa is a geopolitical classification. This
region is separated from the rest of Africa by the
Sahara desert. This region usually has a unique envi-
ronmental condition, and thus its special microbiota.
There are many published findings in literature on the
occurrence of dermatophytes in this region’s soil, ani-
mal and humans. However, to the best of our knowl-
edge, there is no current review article with up-to-date
information on the relevant findings reported so far in
this region.
The purpose of this article is to review relevant
research findings published on dermatophytosis in
northern Africa so as to create a comprehensive and
articulated view of the subject in this region. First, epi-
demiological data are important tools for effective con-
trol of infections within an area.9 Second, this
information is necessary especially for clinicians who
treat dermatophytic infections all over the world since
agents of dermatophytes are no longer restricted
within any area because of the rapid mobility of
humans from one part of the world to another. More-
over, the epidemiology of dermatophytoses is known
to change over time, thus requiring the update of
information from time to time in any given geographi-
cal area. For the purpose of clarity and organisation,
the northern African nations considered in this present
work are Sudan (South Sudan and Sudan), Algeria,
Egypt, Libya, Tunisia and Morocco.
Dermatophytoses in Sudan (South Sudan and Sudan)
Sudan has a hot and humid climate, and this promotes
superficial fungal infection caused by dermatophytes in
this country.10 Researchers in Sudan have reported the
occurrence of dermatophytosis in animals and in
humans. For instance, Ali surveyed 3605 animals from
four provinces of Sudan and reported the presence of
ringworm lesions in 343 of the animals.11 Of the 81
dogs’ hair samples collected from the Police Dogs
Department in Khartoum and analysed, two (2.4%)
were suggestive of dermatophytes and were later con-
firmed to be M. canis (1.2%) and M. gypseum (1.2%).12
Eljack et al. [6] reported the isolation of T. verruco-
sum in a 1-year-old female Saanen goat that had some
138
clinical manifestations such as rounded raised scaly
skin lesions in the ears, eyelids and under the base of
the tail. They noted that their work had strong veteri-
nary and public health significance since it was the
first time T. verrucosum was reported in Saanen goat –
an exotic breed of goat reared commonly in Omdur-
man locality of Khartoum state.6 Another study which
was perhaps of a more public health significance is the
study by Saadabi et al. [13]. This group carried out a
critical clinical evaluation of Sudanese banknotes of
different values. They reported high prevalence of Epi-
dermophyton and Trichophyton species in one and two
Sudanese currency notes. No isolate of dermatophyte
was recovered in 20 pound currency notes. They
noted that there was a negative correlation between
microbial contamination and the value of banknotes.
This is perhaps because those in the low socioeco-
nomic class often did more monetary transactions
with lower currency notes. The authors concluded
that Sudanese banknotes can serve as vehicles for the
transfer of pathogens and suggested the use of plastic
banknotes and coin currency in the Sudan.13
Mohammed et al. clinically examined 584 children in
the Sudan and reported high incidence of dermato-
phyte infection, which they presumed to be as a result
of ignorance, high household density and body contact
with asymptomatic individuals.14
In the Sudan, laboratory diagnosis of dermatophyto-
sis has always been a major challenge due to the inad-
equacy of test facility, lack of diagnostic fungal
specialists and time cost of routine culture media. Due
to this problem, Osman et al. carried out a compara-
tive study between the use of direct microscopy and
culture in the detection of dermatophytes in test sam-
ples in Sudan. They found out that direct microscopy
has high detection power than culture and advised
clinicians to rely on results from microscopy when
diagnosing samples suspected to be infected with der-
matophytes.10 An epidemiological investigation of
Camel dermatophytosis in Al-Showak and Elobied
areas of Sudan has been conducted. The researchers
collected 136 samples of skin scrapings from suspected
cases of ringworm with suggestive lesions in camels
and reported the isolation of T. verrucosum from
56.62% (77) of the samples, T. mentagrophytes (now
replaced by T. interdigitale based on the new classifica-
tion) from 34.56% (47), T. schoenlenii from 6.62% (9)
and T. tonsurans from 2.21% (3) of the samples.15
They observed no significant difference in the suscepti-
bility of male and female camels to dermatophytosis.
They also showed that camel dermatophytosis had a
higher prevalence during rainy than hot dry seasons.
© 2015 Blackwell Verlag GmbH
Mycoses, 2016, 59, 137–144

Abdalla and Elgabbar have also recovered T. verruco-
sum from the ringworm lesions observed in two Suda-
nese desert sheep.16 In El-Khuway (North Kordofan),
T. verrucosum has been documented as an aetiological
agent of donkey ringworm.17 There are still many
cities and localities in Sudan without any published
epidemiological data on dermatophytes to date. Such
studies are needed to give a clearer view of dermato-
phytosis in Sudan.
Dermatophytoses in Tunisia
Ringworm infections have been widely reported in
Tunisia.18 Drira et al. implicated the taxonomically
controversial T. erinacei as the aetiologic agent of tinea
manuum in a Tunisian patient.19 Dhib et al. investi-
gated the incidence of onychomycosis cases which
were reported within a 22-year period (1986–2007)
in central Tunisia.20 Out of the 7151 patients exam-
ined, 78.6% were diagnosed of onychomycosis, with
dermatophytes being the major aetiologic agents
(49.9%). T. rubrum was the predominant species
(88.1%) found in toenail infections.20 Anane analysed
141 soil samples from different sites in Djerba (south
of Tunisia) and found that 20.6% of the soil samples
had keratinophilic fungi, with M. gypseum (41.4%)
being the only dermatophyte isolated in the study.21
Of the 148 patients examined by El Fekih et al. for the
presence of fungal foot diseases, microscopy and cul-
tural examination confirmed 45.3% (67 cases) to be
positive. However, 57.1% of the positive cases were
caused by dermatophytes, with T. rubrum being the
predominant species.22
Usually, dermatophytes are keratin loving and are
always found in the corneal layer of the epidermis.
However, Trabelsi et al. noted that solid-organ trans-
plant in patient can lead to immunosuppression which
will in turn promote the invasion of the subcutaneous
layers by dermatophytes.23 They supported this argu-
ment by describing the development of subcutaneous
dermatophytosis in a Tunisia patient who had under-
gone a renal transplant.23 Furthermore, Saghrouni
et al. carried out a 26-year (1983–2008) retrospective
study on the epidemiological aspects of tinea capitis
reported in a mycology laboratory located in Sousse
region (Central Tunisia). Out of the 10 505 cases
screened and analysed, 175 cases of adult tinea capitis
were recorded, while 89.3% of the infection was
observed in children less than 12 years. T. violaceum
was the predominant aetiologic agent (66.7%), fol-
lowed by M. canis (29.3%) and T. schoenleinii (1.6%).
Other dermatophytes recovered in this study included
© 2015 Blackwell Verlag GmbH
Mycoses, 2016, 59, 137–144
Dermatophytosis in northern Africa
T. mentagrophytes (1.1%), T. verrucosum (0.6%), T. ton-
surans (0.2%), T. rubrum (0.2%), M. gypseum (0.1%),
M. audouinii (0.03%) and M. nanum (0.01%).24 A fatal
case of dermatophytosis was reported in a 26-year-old
Tunisian woman which led to the development of a
strong retropharyngeal abscess in the woman. Cross-
examination of the skin lesions and lymph node biopsy
samples revealed the presence of T. violaceum. This
study prompts dermatophytosis to be life threatening
in some cases.5
Out of 1137 reported cases of tinea capitis in Tuni-
sia from 1990 to 2005, Mebazaa et al. [25] noted that
5.2% of the patients were diagnosed of adult capitis.
They also investigated the aetiology of the adult capitis
and found that T. violaceum was the dominant causa-
tive agent (60%), followed by M. canis (20%),
T. schoenleinii (12%), T. verrucosum (3.5%), T. menta-
grophytes (1.77%) and T. rubrum (1.77%).25 Neji et al.
[26] reported the novel isolation of M. ferrugineum
from a Tunisian patient. Clinical examination of the
patient showed presence of diffuse erythematic and
perifollicular pustules in the beard area. Another retro-
spective study covering the period 1991–2005 on
4559 reported cases of children dermatomycosis in
Sfax University hospital confirmed that 49.3% were
infected with dermatomycosis. Dermatophytes were
the most prevalent fungal agents (80.6%), with T. vio-
laceum (54.1%) and M. canis (24.5%) being the most
implicated species.27
Khaled et al. [18] reported a special case of tinea
capitis caused by T. schoenleinii in a 6-year-old Tuni-
sian boy. The boy had a diffuse scaling of the scalp,
which was misdiagnosed as psoriasis and was treated
unsuccessfully with keratinolytic shampoos for
2 years. The occurrence of a special case of dermato-
phytic disease in three sisters of consanguineous par-
ents living in a rural area of northern Tunisia has also
been described.28 M. canis was the implicated organ-
ism. The authors presumed that dermatophytosis
might be an autosomal recessive trait in North
Africa.28 Out of the 512 persons with confirmed cases
of tinea capitis in Sfax area over a 5-year period
(1995–2000), fingernail samples were collected from
211 of the patients and cultural examination showed
38% of the patients to be positive. M. canis was iso-
lated in 82% of the samples and T. violaceum was
recovered in the remaining 18% of the nail samples.
T. quinckeanum also grew in one of the samples.29 In
the Tunis area, Anane et al. analysed 292 nail sam-
ples from 255 patients that were suspected to have
onychomycosis. Sixty-seven per cent of the sample
was found positive, with women accounting for 63.5%
139
E. I. Nweze and I. Eke
of those infected. In the study, T. rubrum was found to
be the predominant dermatophyte affecting the toe
nails of the patients.30 In an update on the clinical
profile of superficial mycoses reported in the Monastir
region of Tunisia between 1991 and 1994, it was
noted that tinea corporis and tinea pedis were the
most observed ringworm pattern (40.3%), followed by
tinea versicolor (21.6%), tinea capitis (9.7%), dermato-
phytosis of the hairless skin (9.6%) and onychomyco-
sis (8.6%).31
Dermatophytoses in Egypt
Several studies have been carried out on the incidence
of dermatophytosis in some governorates and cities in
Egypt. Bedir et al. investigated the incidence of der-
matophytosis in 112 patients attending an outdoor
dermatology service at Mansoura University Hospital
in Egypt. They observed various clinical lesions and
reported onychomycosis to have the highest incidence
(35.7%), followed by tinea capitis (17.86%), tinea cor-
poris (16.96%) and tinea cruris (10.7%). The most
recovered dermatophytes in their study were T. menta-
grophytes (34.07%) and T. rubrum (16.48%).32
The public health significance of anthropophilic and
zoophilic dermatophytes in the Ismailia and Port Said
provinces of Egypt have also been described by
Aboueisha and El-Mahallaway [33]. They observed
that the incidence of tinea capitis and tinea corporis
was both higher in males (74% and 56.7%) than in
females (26.0% and 43.3%), respectively, while infec-
tions such as tinea cruris, tinea faciei and tinea man-
uum were found to occur mostly in females (91.3%,
73.3% and 80%) than in males (8.7%, 26.7% and
20%), respectively. Tinea axillaris and tinea barbae
were found only in males, while tinea pedis was found
only in females. In their 260 sampled patients, the
overall occurrence of dermatophytosis was 52.2% for
males and 47.8% for females. T. verrucosum was the
most isolated organism (50%) in patients who had a
history of contact with farm animals, followed by T.
violaceum (16.7%), M. canis (16.7%) and T. Tonsurans
(16.7%).33 In the Minufiya and Shargia governorates,
Tarabees et al. recently studied the incidence of fun-
galysin virulence genes (MEP1-5) in T. verrucosum iso-
lated from the ringworm lesions of cattle and horses
reared in various localities.34 They showed that the
occurrence of genes coding for the keratin-specific
metalloproteases (MEP1-4 and MEP5) in T. verrucosum
was 10% and 20%, respectively, and concluded that
further studies are need to be carried out to unveil the
roles of these genes in the pathogenicity of
140
dermatophytes in Egypt.34 In a study carried out by
Mohammed (2013), the incidence of tinea capitis
among children of school age in Fayoum city was
0.4%, while M. canis was the most common aetiologic
agent (40%) in the study.35
Zaki et al. carried out a study on 506 patients sus-
pected to have superficial fungal infection in Cairo, the
capital city of Egypt.36 Out of this number, 79.6%
were diagnosed of dermatophytosis. The incidence of
tinea capitis lesions was the highest (76.4%), followed
by tinea corporis (22.3%) and tinea unguium (1.2%).
The authors also noted that T. violaceum was the most
isolated dermatophyte in the study (71.1%), followed
by M. canis (21.09%), T. rubrum (6.2%), M. boullardi
(0.49%), E. floccosum (0.24%) and T. tonsurans
(0.24%). In another study, Youssef et al. screened 120
soil samples from different sites in Cairo and reported
M. gypseum as one of the most occurring ker-
atinophilic fungi in Egypt.37 Abdel-Halim et al. also
screened soil samples collected from different animal
houses located in Giza and its neighbouring environs.
The incidences of M. gypseum recovered from soil sam-
ples in animal enclosures of horse, cattle, sheep, tigers,
camels, pony and zebra were, respectively, 37.5%,
40%, 35.71%, 25%, 33.33%, 46.66% and 33.33%.38
Abdel-Rady and Kotb also carried out an epidemio-
logical study on the occurrence of dermatophytosis
among cattle reared in different localities of Assiut
governorate.39 They examined 1350 cattle and
showed that 230 (17.04%) had ringworm infection. A
higher prevalence (18.7%) was observed in calves
under the age of 6 months compared with those more
than 6 months old (14.5%). Interestingly, cattle were
mostly affected by dermatophytic infections in cold
season (28%) than during hot season (10.6%). The
infection was seen mostly in males (28.3%) than in
female cattle (8%). T. verrucosum (98%) and T. menta-
grophytes (2%) were the two aetiological agents recov-
ered in this study.39 In the Suez Canal area (Ismailia,
Port Said and Suez provinces), Abou-Eisha et al. exam-
ined 142 apparently healthy animals and isolated der-
matophytes in 7.04% of the screened animals.40
T. mentagrophytes was isolated from 4% each of the
apparently healthy sheep, goat and cattle, while
M. gypseum and M. canis were, respectively, recovered
from cats serving as healthy carriers. These findings
tend to show that apparently healthy animals can
serve as important source and reservoir of dermato-
phytes. These authors also examined 175 animals,
which were clinically diagnosed of dermatophytosis.
Their data showed that the incidence of T. verrucosum
in cattle, buffaloes, sheep, goats and horses were 75%,
© 2015 Blackwell Verlag GmbH
Mycoses, 2016, 59, 137–144

50%, 71.4%, 65% and 25%, respectively. M. canis was
the only dermatophyte isolated from cats and dogs at
the frequency of 56.7% and 41.7%, respectively.40
The incidence of tinea capitis and its causative spe-
cies in Assiut governorate have also been reported.41
One hundred patients made up of 75% males and
25% females who were examined and suspected to
have tinea capitis between the year 2003 and 2005
were screened. Sixty percent of the cases were seen in
school children between the ages of 5 and 10 years.
Aetiological agents recovered from patients diagnosed
of tinea capitis in this study included M. canis (55%),
T. violaceum (20%), T. rubrum (12.8%), M. gypseum
(10%) and T. soudanense (2.2%).41 Maghazy et al. also
took 50 water samples from two public swimming
pools located in Assiut town and reported the
incidence of T. terrestre, T. mentagrophytes and
M. gypseum in the samples to be 14%, 10% and 6%,
respectively.42
In a related study performed in Alexandria among
510 primary school children, Omar [43] found that
the prevalence of scalp dermatophytosis (tinea capitis)
was 7.4%, with T. violaceum being the only implicated
dermatophyte. Zeid et al. [44] also studied tinea cruris
cases in Alexandria (Egypt). Their data showed that
T. rubrum accounted for 79% of the studied samples,
followed by T. mentagrophytes (10%), E. floccosum
(2%), T. violaceum (2%) and T. menginii (1%). In 250
cases of tinea capitis examined by Fattah et al. [45],
T. violaceum was the most implicated cause of scalp
ringworm (53.3%), followed by T. schoenleinii (26.7%),
M. canis (18.8%), T. tonsurans (0.6%) and T. mentagro-
phytes (0.6%).
In El-Minia and Assiut governorates in Upper Egypt,
Mahmoud [46] examined hair and skin scrapings from
60 horses suspected of ringworm and noted that 42%
of the total samples were positive for fungal infection.
Recovered dermatophytes in this study were
T. equinum (32%), T. verrucosum (15%), T. mentagro-
phytes (8%), M. gypseum (7%) and M. persicolor
(3%).46 Out of the 640 cases of tinea capitis reported
from the year 1973–1975 in Upper Egypt (Assiut),
Abdel-Hafez et al. [47] were able to isolate dermato-
phytes from 82.2% of the samples, with T. violaceum
being the most implicated species (42%), followed by
T. schoenleinii (29.5%), M. canis (25.5%), M. audouinii
(2.1%) and T. mentagrophytes (0.9%).
In another study involving 228 patients attending
an outdoor dermatology service at Zagazig, Amer et al.
[48] reported T. violaceum to be among the most
prevalent dermatophytes in this part of Egypt (45.6%).
The incidence of other dermatophytes such as
© 2015 Blackwell Verlag GmbH
Mycoses, 2016, 59, 137–144
Dermatophytosis in northern Africa
T. rubrum (5.3%), T. schoenleinii (4.8%), T. mentagro-
phytes (3.9%) and E. floccosum (1.8%) was reported.48
In Minia governorate, Moubasher et al. [49] studied
the incidence of dermatophytosis in relation to the sex
of the patients who participated in their study. Out of
the 127 confirmed cases of tinea corporis, 84 were
males while 53 were females. T. violaceum was the
major cause of tinea corporis since it was recovered
from 42 patients, followed by M. canis (12 cases).
Also, out of the 22 confirmed cases of tinea pedis, 13
were males, while the rest (9) were females. Moreover,
the incidence of tinea cruris in males was 76.2%,
while 23.8% was reported for females. E. floccosum
was the most prevalent species implicated in the stud-
ied cases of tinea cruris.49
Dermatophytoses in Morocco
A retrospective study on cases of onychomycosis
reported in Casablanca within a 5-year period (2006–
2010) showed that of the 2070 nail samples analysed,
mycological aetiology was confirmed in 64.5% of the
cases. Dermatophytes were the predominant aetiologic
agents and were recovered in 65% of the cases.
T. rubrum was isolated in 75% of all foot cases of
onychomycosis.50
El-maataoui et al. [51] reviewed the epidemiological
profile of tinea capitis in Morocco. They investigated
125 cases of tinea capitis and reported the isolation of
T. violaceum from 76 cases (60.8%) and M. canis from
21.6% of the patients. T. verrucosum was isolated only
in males with a rural origin.
In Rabat, an epidemiological study on cases of tinea
capitis reported between 1993 and 2007 was carried
out by Oudaina et al. [52]. Out of the 2962 patients
examined, scalp ringworm was detected in 1299
(43.83%). The authors also observed that the majority
of the tinea capitis cases were caused by T. mentagro-
phytes (76.4%) and M. canis (13.4%).52 Another group
performed a retrospective investigation on the occur-
rence of onychomycosis in Rabat on cases reported
within a 22-year period (1982–2003).53 According to
their findings, dermatophytes accounted for 61.46% of
the implicated aetiologic agents and were isolated in
4940 patients. The most isolated dermatophyte was
T. rubrum (83.6%), followed by T. violaceum var. glab-
rum (9%) and T. mentagrophytes var. interdigitale
(6.9%).53 Pandey reported the occurrence of T. verru-
cosum infection in dairy farms located in the province
of Kenitra.54 Out of the 430 cattle examined, 130
(30.23%) had T. verrucosum infection. The incidence
was higher in males (59.8%) compared with females
141
E. I. Nweze and I. Eke
(23.8%).54 T. verrucosum has also been isolated from
goats in Morocco.55 In a different study, Pandey and
his group also examined 426 sheep which were
housed in High Central Atlas mountains of Morocco
and found out that 93 (22%) were infected with ring-
worm caused by T. verrucosum.56 They suggested that
the high incidence of ringworm infection in sheep
housed in this area might be due to the poor nutri-
tional and housing conditions associated with the win-
ter conditions of this part of Morocco.
Dermatophytoses in Algeria
Despite the improved living conditions in Algeria, scalp
dermatophytosis remains a very big challenge to the
public health system in this country.57,58 To clarify
this observation, Bendjaballah-Laliam and Djazer car-
ried out an epidemiological study on tinea capitis cases
reported within 3 years (2010–2013) in a hospital
located in Tipasa.57 Out of the 213 hair samples
screened, microscopy and cultural examinations of the
samples showed that 133 people were positive for
tinea capitis. Children under the age of 12 years
accounted for 91% of those examined. Of the three
dermatophytes implicated in the study, T. violaceum
had the highest frequency (66%), followed by M. canis
(32.5%) and T. mentagrophytes (1.5%).
Djeridane et al. described the prevalence and aetiol-
ogy of superficial mycoses of the foot among Algerian
military personnel. Nail and skin samples from 650
male military personnel were collected, and cultural
examination showed that 119 samples were positive
for superficial fungal infection of the foot. Tinea pedis
and Candida interdigital infection were the most preva-
lent superficial foot mycoses (68%), with T. rubrum
being the most isolated dermatophyte (20.9%).59
Kheira et al. carried out a study to characterise the
dermatophyte flora in 121 persons living in the north-
west region of Algeria (Oran) who attended an out-
door dermatology service in Oran.60 They observed
that tinea pedis was the predominant dermatophytosis
found in people of this area (45.24%), followed by
tinea capitis (41.46%), tinea corporis (33.33%) and
tinea unguinum (20%). The most implicated dermato-
phytes in the study were T. rubrum (27.08%), M. canis
(20.83%) and T. violaceum (18.76%). Other isolated
species included E. floccosum (8.33%), T. gourvillii
(6.26%), T. schoenleinii (6.26%), T. tonsurans (4.10%),
M. audouinii (2.08%), T. soudanense (2.08%) and
M. equinum (2.8%). They also concluded that dermato-
phytoses was endemic in this region and advocated
the use of individual care and hygiene to curtail the
142
spread of the infection.60 Furthermore, Djeridane et al.
collected clinical and epidemiological data on foot
mycoses predominant in Algeria. Out of the 249 and
72 suspected cases of tinea capitis and onychomycosis,
197 and 60 samples were confirmed positive, respec-
tively. T. rubrum was the predominant species of der-
matophyte found in tinea capitis and onychomycosis
with occurrence rates of 17% and 35%, respectively.61
Dermatophytoses in Libya
The aetiology and distribution of dermatophytosis
among camels, cattle, sheep, goats, dogs and cats in
El-Bieda region of Libya was investigated by Eissa et al.
[62]. Microscopic examination of the 185 hair samples
collected from animals showed that dermatophytes
had an incidence of 89.2%, while cultural studies indi-
cate an incidence of 45.9% (85 positive cultures) for
dermatophytes. T. verrucosum had an incidence of
67.1% of all fungal isolates recovered, followed by
T. mentagrophytes (24.7%), while M. canis had a fre-
quency of 8.2%. Discussing further on the various der-
matophytes found on specific animals, these authors
noted that T. verrucosum had an incidence of 22.4%
and 25.9% in camels and calves, respectively; while
that of T. mentagrophytes was 11.8% and 9.4% in
camels and calves, respectively. In this study, M. canis
was the most implicated cause of dermatophytosis in
dogs and cats with an incidence of 8.2%.62 El Said
et al. have also isolated T. rubrum and T. terrestre from
the hairs of goats reared in Libya.63 Ellabib and his
group carried out a study on the aetiology and preva-
lence of skin infections in Libya.64 They analysed hair
and skin scrapings from 2224 patients who attended
the dermatology clinic at Tripoli Medical Centre
between 1997 and 1999. Tinea corporis accounted for
45.9% of the cases, followed by tinea pedis (8.1%),
tinea manuum (2.6%), tinea barbae (2.2%) and some
other skin infections. Eighty-five per cent of tinea cor-
poris was found in children below 15 years of age.
T. violaceum was isolated in 300 cases (44% of the
total isolated fungi), T. rubrum (13.8%), M. canis
(8.1%), E. floccosum (6.6%) and T. mentagrophytes
(3.1%). Fungi such as Candida albicans and Malassezia
furfur were also implicated in the study.64
Ellabib et al. also reported the prevalence of some
dermatophytes in specific types of ringworm.64 For
instance, T. violaceum (38.5%) and M. canis (38.5%)
were the most implicated species in tinea barbae, while
T. rubrum was the predominant dermatophyte (40%)
in tinea manuum. They also suggested that the high
incidence of T. violaceum as an aetiologic agent of
© 2015 Blackwell Verlag GmbH
Mycoses, 2016, 59, 137–144

tinea corporis (50.8%) might be due to the fact that
the fungus is naturally found in North Africa. In
another 2-year survey (1987–1989) carried out in
Libya, Ellabib et al. collected hair and scalp scrapings
from 940 patients who were suspected of tinea capi-
tis.65 Clinical examination confirmed 584 patients to
be positive for it, with higher percentage of the infec-
tion (94.8%) found in children who were not up to
12 years of age. T. violaceum was the predominant
aetiologic agent (64.4%), followed by M. canis (24.7%)
and T. mentagrophytes (5.5%).
The high prevalence of tinea capitis in children was
further clarified by Gargoom et al. who carried out a
study of tinea capitis cases in Benghazi.66 They found
that 92% of the infection occurred in children who
were below the age of 10 years. T. violaceum was also
the predominant species (49.4%), followed by M. canis
(38.6%) and T. verrucosum (7.8%).
References
1 Sharma V, Kumawat TK, Sharma A, Seth R, Chandra S. Dermato-
phytes: diagnosis of dermatophytosis and its treatment. Afr J Micro-
biol Res 2015; 9: 1286–93.
2 Balakumar S, Rajan S, Thirunalasundari T, Jeeva S. Epidemiology of
dermatophytosis in and around Tiruchirapalli, Tamilnadu, India.
Asian Pac J Trop Dis 2012; 2: 286–9.
3 
Venturini J, Alvares AM, de Camargo MR, Marchetti MC, Fraga-Silva
TF, Luchini AN, de Arruda MS. Dermatophyte-host relationship of a
murine model of experimental invasive dermatophytosis. Microbes
Infect 2012; 14: 1144–51.
4 Rinaldi MG. Dermatophytosis: epidemiological and microbiological
update. J Am Acad Dermatol 2000; 43: 120–4.
5 Cheikhrouhou F, Makni F, Masmoudi A, Sellami A, Turki H, Ayadi
A. A fatal case of dermatomycoses with retropharyngeal abscess.
Ann Dermatol Venereol 2010; 137: 208–11.
6 Eljack H, Elgabbar MA, Shuaib YA, Elham AS. Trichophyton verruco-
sum infection in a saanen goat (Capra aegagrus hircus). Univ K J Vet
Med Anim Prod 2011; 2: 131–14.
7 Verma R, Satsangi GP, Shrivastava JN. Susceptibility of a weed Calo-
tropis procera (Ait) against clinical isolates of dermatophytes. J Med
Plan Res 2011; 5: 4731–9.
8 Nweze EI. Dermatophytosis in Western Africa: a review. Pak J Biol
Sci 2010; 13: 649–56.
9 Neji S, Makni F, Cheikhrouhou F, Sellami A et al. Epidemiology of
dermatophytoses in Sfax, Tunisia. Mycoses 2009; 52: 534–8.
10 Osman NA, Altrifi BE, Anon CV, Elsanosi MM. Comparative study
between microscopic examination and cultural media in diagnosis of
dermatophytosis among school age children. Int J Med Pharm Res
2015; 1: 14–17. (Accepted)
11 Ali KE. Studies on Common Animal Superficial Mycoses in the
Sudan. URI: http://www.khartoumspace.uofk.edu/handle/
123456789/14457. [accessed on 23 June 2015].
12 Mobashir SYM. Identification of fungi from police dogs in Borri,
Khartoum, Sudan. Master Thesis (Microbiology), Faculty of Veteri-
nary Medicine, University of Khartoum, 2014.
13 Saadabi AM, Ali LF, Omer AB, Ahmed GA, Al Asa RK. Isolation and
identification of pathogenic bacteria and fungi from some Sudanense
banknote currency. J App Sci Res 2011; 7: 129–33.
14 Mohammed SA, Elhassan MM, Hussien K. The pattern of paediatric
dermatoses among primary school children in Khartoum North,
2007. Sud J Pub Health 2010; 5: 1–5.
© 2015 Blackwell Verlag GmbH
Mycoses, 2016, 59, 137–144
Dermatophytosis in northern Africa
15 Abdalla WG, Salim MO. Isolation and Identification of Dermatophytes
from Infected Camels. Sudan J Vet Res 2010; 25: 49–53.
16 Abdalla WG, Elgabbar MA. Ringworm caused by T. verrucosum in
two Sudanese desert sheep. Sudan J Vet Res 2009; 24: 57–59.
17 Abdalla WG, Suliman EA, El Gabbar MA. A report on Trichophyton
verrucosum in donkeys in the Sudan. Sudan J Vet Res 2005; 20:
83–85.
18 Khaled A, Mbarek B, Kharfi M et al. Tinea capitis favosa due to Tri-
chophyton schoenleinii. Acta Dermatovenerol Alp Pannonica Adriat 2007;
16: 34–36.
19 Drira I, Neji S, Hadrich I, Sellami H, Makni F, Ayadi A. Tinea man-
uum due to Trichophyton erinacei from Tunisia. J Mycol Med 2015;
25: 200–3.
20 Dhib I, Fathallah A, Yaacoub A, Zemni R, Gaha R, Said MB. Clinical
and mycological features of onychomycosis in central Tunisia: a
22 years retrospective study (1986-2007). Mycoses 2013; 56:
273–80.
21 Anane S. Epidemiological investigation of keratinophilic fungi from
soils of Djerba (Tunisia). J Mycol Med 2012; 22: 225–9.
22 El Fekih N, Belghith I, Trabelsi S, Skhiri-Aounallah H, Khaled S,
Fazaa B. Epidemiological and etiological study of foot mycosis in
Tunisia. Actas Dermosifiliogr 2012; 103: 520–4.
23 Trabelsi S, Aouinet A, Abderrahim E, Abdallah T, Khedher A, Khaled
S. First case of subcutaneous dermatomycoses in a Tunisian trans-
plant patient. Tunis Med 2012; 90: 196–9.
24 Saghrouni F, Bougmiza I, Gheith S et al. Mycological and epidemo-
logical aspects of tinea capitis in the Sousse region of Tunisia. Ann
Dermatol Venereol 2011; 138: 557–63.
25 Mebazaa A, Oumari KEL, Said MB et al. Tinea capitis in adults in
Tunisia. Int J Dermatol 2010; 49: 513–16.
26 Neji S, Makni F, Sellami H, Cheikhrouhou F, Sellami A, Ayadi A.
First case of Microsporum ferrugineum from Tunisia. Mycopathologia
2009; 167: 351–3.
27 Sellami A, Sellami H, Makni F et al. Childhood dermatomycoses study
in Sfax hospital, Tunis. Mycoses 2008; 51: 451–4.
28 Souissi A, Sebai N, Benmously R et al. Dermatophytic disease in a
Tunisian family. Med Trop (Mars) 2005; 65: 482–6.
29 Cheikhrouhou F, Makni F, Sellami H, Beshes M, Ayadi A. Presence
of dermatophytes on the nails of Tinea capitis patients: prospective
study in the area of Sfax (Tunisia). Mycoses 2003; 46: 316–17.
30 Anane S, Aoun K, Zallagua N, Bouratbine A. Onychomycosis in
Tunis area: epidemological and mycological data. Ann Dermatol
Venereol 2001; 128: 733–6.
31 Khorchani H, Haouet H, Amir M, Zanned I, Babba H, Azaiz R. Epi-
demiological and clinical profile of superficial mycoses in the Monas-
tir region (Tunisia): retrospective study (1991-1994) of 3578 cases.
Arch Inst Pasteur Tunis 1996; 73: 179–84.
32 Bedir T, Badawy W, Gouda NS, Ghanem BM. Evaluation of dermato-
phyte identification medium for recovery of keratinophilic fungi from
clinical samples. Egypt J Med Microbiol 2014; 23: 67–74.
33 Aboueisha AM, El-Mahallawy H. Public health significance of der-
matophytes in Ismaila and Port Said provinces, Egypt. Med Mycol J
2013; 54: 123–9.
34 Tarabees R, Sabry M, Abdeen E. Incidence of fungalysins virulence
genes (MEPS1-5) in dermatophytes isolated from infected cases in
Egypt. Int J Microbiol Res 2013; 4: 180–7.
35 Mohammed BH. Tinea capitis in Fayoum City elementary school:
incidence and aetiology. M.B.B.Ch Thesis (Dermatology and Venerol-
ogy), Faculty of Med, Fayoum University, 2013.
36 Zaki SM, Ibrahim N, Aoyama K, Shetaia YM, Abdel-Ghany K,
Mikami Y. Dermatophyte infections in Cairo, Egypt. Mycopathologia
2009; 167: 133–7.
37 Youssef YA, El-Din AAK, Hassanein SM. Occurrence of keratinolytic
fungi and related dermatophytes in soils in Cairo, Egypt. Zentralblatt
for Mikrobiologie 1992; 147: 80–85.
38 Abdel-Halim MM, Zeid AA, Reda WW, Refai MK. Occurrence of M.
gypseum in some Egyptian soil inhabited by animals. Vet Med J Giza
1990; 38: 173–81.
143
E. I. Nweze and I. Eke
39 Abdel-Rady A, Kotb S. Some epidemiological studies on ringworm in
cattle at Assiut governorate, Egypt. SCVMJ 2008; 8: 327–35.
40 Abou-Eisha AM, Sobih MA, Fadel HM, El-Mahallawy HS. Dermato-
phytosis in animals and their zoonotic importance in Suez canal
area. SCVMJ 2008; 8: 625–42.
41 El-Enin AA, Khedr M, El-Ata AA. Tinea capitis in Assiut governorate
(A Clinical and Mycological Study). Egypt J Hosp Med 2007; 29:
738–44.
42 Maghazy SMN, Abdel-Mallek AY, Bagy MMK. Fungi in two swim-
ming pools in Assiut Town, Egypt. Zentralblatt for Mikrobiologie 1989;
144: 213–16.
43 Omar AA. Ringworm of the scalp in primary school children in
Alexandria: infection and carriage. East Mediterr Health J 2000; 6:
961–7.
44 Zeid SAA, Kamel MN, Embabi MH, El-Ramly MS, Salama MN, Zaki
SA. A clinicomycologic study of tinea cruris in Alexandria, Egypt.
Bull Alexandria Fac Med 1980; 6: 289–94.
45 Fattah AA, Refai M, El-Gothamy Z. Tinea capitis in Egypt. Mykosen
1967; 10: 189–94.
46 Mahmoud ALE. Dermatophytes and other keratinophilic fungi caus-
ing ringworm of horses. Folia Microbiol 1995; 40: 293–6.
47 Abdel-Hafez K, Abdel-Rahim D, Abdallah AR, Abdel-Magid E. Myco-
logical study of tinea capitis in Assiut (Upper Egypt). J Kuwait Med
Assoc 1980; 14: 219–23.
48 Amer M, Refai M, Hegazi A, Rashid A. Dermatophytosis in Egypt
with special refernce to immunological studies on patients with
Trichophyton violaceum infection. Biotechnol Biotechnol Equip 1995; 9:
52–54.
49 Moubasher AH, El-Naghy MA, Maghazy SM, El-Gendy Z. Prevalence
and distribution of some dermatophytosis in relation to age and sex
of patients in Minia, Egypt. Korean J Mycol 1993; 21: 133–9.
50 Halim I, El Kadioui F, Soussi AM. Onychomycosis in Casablanca
(Morocco). J Mycol Med 2013; 23: 9–14.
51 El-Maataoui A, Zeroual Z, Lyagoubi M, Aoufi S. Tinea capitis etiology
in Ibn Sina Hospital in Rabat (Morocco). J Mycol Med 2012; 22:
261–4.
52 Oudaina W, Biougnach H, Riane S et al. Epidemiology of tinea capitis
in outpatients at the children’s hospital in Rabat (Morocco). J Mycol
Med 2011; 21: 1–5.
144
53 Boukachabine K, Agoumi A. Onychomycosis in Morocco: experience
of the parasitiology and medical mycology laboratory from Rabat
children hospital (1982-2003). Ann Biol Clin 2005; 63: 639–42.
54 Pandey VS. Some observations on Trichophyton verrucosum infection
in cattle in Morocco. Ann Soc Belg Med Trop 1979; 59: 127–31.
55 Pandey VS, Mahin L. Observation on ringworm in goats caused by
Trichophyton verrucosum. Br Vet J 1980; 136: 198–9.
56 Pandey VS, Mahin L, Vanbreuseghem R. Prevalence and distribution
of ringworm by T. verrucosum in the high atlas of Morocco. Ann Soc
Belge Med Trop 1979; 59: 385–9.
57 Bendjaballah-Laliam A, Djazer H. Epidemiology of tinea capitis in the
suburbs of Tipasa, Algeria. J Mycol Med 2014; 24: 141–3.
58 Benmezdad A, Moulahem T, Benyezzar M, Djaballah M, Beldjoudi W,
Fendri AH. Tinea capitis in the university hospital of Constantine
(Algeria). J Mycol Med 2012; 22: 354–6.
59 Djeridane A, Djeridane Y, Amar-Khodja A. A clinicomycological
study of fungal foot infections among Algerian military personnel.
Clin Exp Dermatol 2007; 32: 60–63.
60 Kheira H, Selselet AG, Bensoltane SA. Dermatophytes in North
West of Algeria. A Prospective Study. Middle East J Sci Res 2007; 2:
104–6.
61 Djeridane A, Djeridane Y, Ammar-khodja A. Epidemiological and
aetiological study of tinea pedis and onychomycosis in Algeria.
Mycoses 2006; 49: 190–6.
62 Eissa NB, Ezzat M, El-Sawah A, El-Hamoly M. Survey on common
causative agents of dermatophytosis in different animals in El-Beida-
Libya. Benha Vet Med J 2013; 24: 108–15.
63 El-Said AHM, Sohair TH, El-Hadi AG. Fungi associated with the hairs
of goats and sheep in Libya. Mycobiology 2009; 37: 82–88.
64 Ellabib MS, Khalifa Z, Kavanagh K. Dermatophytes and other Fungi
associated with Skin Mycoses in Tripoli, Libya. Mycoses 2002; 45:
101–4.
65 Ellabib MS, Agaj M, Khalifa Z, Kavanagh K. T. violaceum is the domi-
nant cause of tinea capitis in children in Tripoli, Libya: results of a
two year survey. Mycopathologia 2002; 153: 145–7.
66 Gargoom AM, Elyazachi MB, Al-Ani SM, Duweb GA. Tinea capitis in
Benghazi, Libya. Int J Dermatol 2000; 39: 263–5.
© 2015 Blackwell Verlag GmbH
Mycoses, 2016, 59, 137–144