Fungi as Pathogens of Onychomycosis among Diabetic Patients

Abstract

The purpose of the study was to determine the role of dermatophytes, yeasts, and non-dermatophytic moulds as causative agents of onychomycosis among diabetic patients during the months September 2013 to January 2014 in202 diabetic patients suspected to having onychomycosis. The study included each patient from type 2 diabetes mellitus (T2DM) from all patients who were registered at the Sedee Hussein Polyclinic of Benghazi city. The study group equally consisted of 101(50%) male patients and 101(50%) female patients. Methods: The specimens were tested by direct microscopic examination using potassium hydroxide(20%) and culturing on Sabouraud’s dextrose agar and fungobiotic agar containing cyclohexamide and chloramphenicol. Results: The prevalence of onychomycosis among diabetic patients in our study was high (77.2%) in type 2 diabetes mellitus (T2DM). Culture was positive in 156 of 202 diabetic patients with onychomycosis of non-dermatophytic moulds isolated from 91 cases (58%). While Candida species have emerged as second-line pathogens, were isolated from fourty one patients (26%). Dermatophytes were detected in only nine patients (6%), and mixed fungi 15 (10%). Distal and lateral subungual onychomycosis was the commonest clinical type (69.2%) followed in decreasing order by total dystrophic onychomycosis (20.5%), and then superficial white onychomycosis (7.7%) and proximal subungual onychomycosis (2.6%). Conclusion: This study had confirmed that diabetic patients are at a high risk of having onychomycosis. Managing onychomycosis in diabetic patients may require systemic antifungal treatment, physical measures and patient education.