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Year : 2013  |  Volume : 5  |  Issue : 4  |  Page : 189-195

Prediction of dermatophyte culture by clinical features: Saving time and cost in resource-poor settings

1 Dermatology Unit, Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso and LAUTECH Teaching Hospital, Ogbomoso, Oyo State, Nigeria
2 Department of Dermatology and Venereology, Obafemi Awolowo University and OAUTHC, Ile-Ife, Osun State, Nigeria
3 Department of Medical microbiology and Parasitology, Ladoke Akintola University Teaching Hospital, Ogbomoso, Oyo State, Nigeria

Correspondence Address:
Adeolu Oladayo Akinboro
Dermatology Unit, Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso and LAUTECH Teaching Hospital, Ogbomoso, Oyo State
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1947-489X.210544

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Background: Tinea capitis is common among children worldwide. Confirmation of diagnosis for early commencement of therapy and control has continued to be a major challenge in resource-poor settings. Patients and Methods: This cross-sectional study recruited 185 children in the rural community of Osogbo, Nigeria. Two thirds of the study population were children aged 5 to 8 years. Clinical history was documented and scalp scrapping of scales and hairs was obtained for microscopy and culture. Two sided fisher exact test was employed in the bivariate analysis. Results: The mean ± SD age for the culture positive and the negative children were 7.2 ± 2.2 years and 7.8 ± 2.7 years respectively. Dermatophyte culture positivity was found in 123 (66.5%) of the children. For the culture-positive children, the positive predictive values were high at 95%, 91%, 88%, and 87% and negative predictive values were low at 16%, 24%, 18% and 0% respectively for adenopathy, alopecia, pruritus, and scalp scaling as single symptom and sign respectively. For various combinations of any two symptoms, positive predictive values ranged from 73-82%, for three symptoms 81% and for four symptoms 77%. The combinations also demonstrated higher negative predictive values 67 – 86% for two, 64% for three and 78% for four symptoms, the absence of which diagnosis could be held in doubt. Similarly, positive likelihood ratios were 2.7, 1.5,1.1, and 1.0 for adenopathy, alopecia, pruritus, and scalp scaling respectively. The positive likelihood ratios ranges from 1.6 – 2.8 for various combinations of two cardinal symptoms; highest for adenopathy and alopecia, and 2.0 for three symptoms and 1.8 for all the four symptoms. Conclusions: Among pre adolescent children, culture positivity is well predicted when adenopathy and alopecia are present or in combination with scalp scaling. Consequently, control of infection may be further enhanced with omission of culture and early commencement of treatment.

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