A study of scalp ringworm in the Western Cape

Abstract

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.