JOURNAL READING

INCREASED RISK OF TINEA PEDIS AND

ONYCHOMYCOSIS AMONG SWIMMING POOL
EMPLOYEES IN NETANYA AREA, ISRAEL

Dyas Modesty (1102013090)

ABSTRACT

 Tinea pedis and onychomycosis often cooccur in individuals

 This study sought to examine the prevalence of tinea pedis and onychomycosis
among swimming pool employees, a population that may be at risk of tinea
infections
 Samples were taken from 169 employees at 21 swimming pools in the Netanya
area, Israel
 The present results are in agreement with previous research and support that
swimming pools remain an important source of fungal contamination
 More attention to hygienic guidelines and preventative measures may be needed
in these settings.
INTRODUCTION

 Tinea pedis (athlete’s foot) and onychomycosis (tinea unguium) are communicable fungal
infections of the foot and nail, respectively, which have a high potential for being
transmitted in swimming pools
 Both of these conditions are primarily caused by Trichophyton rubrum and T.
mentagrophytes, but can also be caused by other types of fungi
 The warm, moist environment and bathers walking barefoot may help spread fungal
contamination in pools
 previous research has found that swimming pool employees whose duties involved
entering the water (i.e., lifeguards, swimming instructors) had a higher incidence of tinea
pedis than swimming pool employees whodidnotenterthe water (i.e.,clericaland cleaning
staff)
 The aims of this study were to examine whether the association between swimming pools
and tinea pedis still exists and to examine the relationship between onychomycosis and
swimming pools, which appears to have been given limited attention.
MATERIAL & METHODS

 Adults 18 years of age and older were asked to participate in the study

 Environmental samples were taken from swimming pools in Netanya area, Israel.
Sampled areas included both men’s and women’s shower entrances and sinks, the
entrance to the pool, around the pool, both men’s and women’s changing room
floor and bench, the passageway between the public shower and the pool, the
lawn around the pool, the gym, the sauna, the Jacuzzi water, and the pool water.
 At the time of this data collection (May 2010), the pools had been operating
between 8 and 34 years
 From these pools, samples were obtained via wet swab from the feet and nails of
swimming pool employees; samples then underwent direct smear with KOH
microscopy and cultures, with samples plated on Sabouraud dextrose agar plates
with chloramphenicol and actidione.
 509 participants included as controls, people who do not frequent swimming
pools. These controls were sampled from one author’s (AS) medical office,
another general practitioner’s office, and from a seaside beach
 Statistical analyses comparing swimming pool employees to controls were
conducted in SPSS 20. Bivariate analyses included Chi-square tests for categorical
variables and independent sample t tests for continuous variables
 The presence of tinea pedis and/or onychomycosis was measured with the
following groups: (a) neither tinea pedis nor onychomycosis, (b) tinea pedis only,
(c) onychomycosis only, and (d) both tinea pedis and onychomycosis
RESULT (DEMOGRAPHICS)

 One hundred sixty-nine swimming pool employees from 21 swimming pools in

Netanya area, Israel, were sampled, with the majority being male (77.5 %). Five
hundred nine patients were sampled as controls (53 % male).
 The average age of the overall sample was about42 years (SD = 14), with no
difference between swimming pool employees and controls (Table 1).
RESULT
(PREVALENCE OF ONYCHOMYCOSIS AND TINEA PEDIS)
RESULT
(INFECTING AGENTS AMONG SWIMMING POOL EMPLOYEES)

 The most common infecting agents found among swimming pool employees
positive for tinea pedis were T. mentagrophytes (29 %), molds (26 %), T. rubrum
(10 %), and E. floccosum (7 %)

 Among swimming pool employees with onychomycosis, the most common

infecting agents were T. mentagrophytes (19 %), molds (13 %), T. rubrum (7 %),
and a combination of fungi (10 %).
RESULT (ORGANISMS IN THE ENVIRONMENT)

 The most common types of fungi found in and around the swimming pools were
Aspergillus (12 %), Penicillium (7 %), and Alternaria (6 %)

 However, Candida species, Chrysosporium, Scopulariopsis, Acremonium,

Cladosporium, Rhizopus, Hendersonula toruloidea, Fusarium, Phialophora, T.
rubrum, T. mentagrophytes, E. floccosum, and T. tonsurans were also isolated,
albeit in less than 1 % of samples.
DISCUSSION

 This study found that swimming pool employees in a Mediterranean climate were
at greater risk of having tinea pedis and/or onychomycosis compared to people
who do not frequent swimming pools.
 The pools included in our study tested positive T. rubrum and T. mentagrophytes,
the two most common causative agents of tinea pedis and onychomycosis
 However, the most prevalent types of fungi sampled from the pools were
Aspergillus, Penicillium, and Alternaria, whereas the most prevalent causative
organism cultured from swimming pool employees was T. mentagrophytes.
 This is unusual as T. rubrum is generally more prevalent, but T. mentagrophytes
has been previously found to be more prevalent in a swimming environment
DISCUSSION

 Fungi predominantly found in swimming pools are not necessarily pathogenic

organisms in human fungal infections. Additionally, dermatophyte infections have
been noted to be more severe and persistent, and thus, they are more commonly
seen in practice
DISCUSSION

 There are several postulated ways that fungi present in swimming pools could
cause tinea pedis and/or onychomycosis :
 The most likely explanation is that pieces of infected skin and scale from bathers
become pressed against other bathers’ feet when walking across contaminated floors
 Infection could occur, albeit less frequently, through infected fragments of skin floating
in the water or through direct contact with the fungi growing saprophytically
 The hot and humid climate of facilities (either geographic climate or artificial indoor
conditions) may also facilitate fungal growth and communicability of tinea pedis
CONCLUTION

 Swimming pool employees are likely at greater risk of infection as they spend
more time in these settings
 Swimming pool employees may need to actively encourage people to follow
hygienic guidelines (e.g., showering before using the pool, wearing footwear in
change rooms and on deck, not swimming if they have open sores)
 Educating visitors and swimming pool employees about preventative measures of
tinea infections, including wearing sandals or footwear to minimize the amount of
time walking barefoot, keeping the skin cool and dry, washing with soap and
water after using the pool, and avoiding sharing towels and articles of clothing
with infected individuals may also help limit risk