Epidemiological and diagnostic study of onychomycosis

Abstract

Objective: The present study aimed to identify the epidemiological factors, determinants and diagnostic methods of onychomycosis which helps in preventing morbidity. Materials and Methods: An epidemiological and diagnostic study of patients with clinically diagnosed onychomycosis attending the DVL was undertaken and Samples were collected from the diseased nails for microscopy, culture and histopathological staining. Results: The prevalence of onychomycosis was 1.06% of total outpatient attendance, mostly in men than women, with ratio 1.12:1 with age group 51-60 years. Housewives and agriculturists constituted 32% and 16% respectively. 48% of the patients had ?1 year disease duration. Moisture (42%), tight footwear (6%), trauma (15%), excessive sweating (4%) and warmth (2%) predisposed to onychomycosis. Concurrent superficial fungal infection of skin was noted in 17% cases, in particular tinea corporis predisposing to the development of onychomycosis. Out of 100 patients, 10 were found to have diabetes. Distal lateral subungual onychomycosis (65%) was the most common pattern of onychomycosis followed by total dystrophic onychomycosis (15%), Mixed onychomycosis (12%), Proximal subungual onychomycosis (6%), Endonyx (1%) and Superficial Onychomycosis (1%). Among 100 cases, 86 showed positivity to any one of the three diagnostic methods. KOH mount demonstrated fungal elements in 55% of patients. The culture positivity rate was 41%. Histopathological PAS staining showed positivity in 71% patients. The sensitivity of KOH mount, culture and HP/PAS was 63.22%, 47.13% and 81.61% respectively. There was a very significant difference between culture and PAS staining (p=0.0001). Among the 41 culture positive cases, 15 cases (36.59%) positivity with trichophyton rubrum, followed by 19.51% positivity with Candida albicans, 17.07% positivity with Trichophyton mentagrophytes, 12.19% positivity with Aspergillus niger, 4.87% each positivity with Aspergillus flavus and Epidermophyton