Onychomycosis in Northwestern Greece Over a 7-Year Period.

Hercules Sakkas,Ioannis D Bassukas,Konstantina Gartzonika,Georgia Kapnisi,Christos Kittas,Efthalia Priavali,Amalia Kallinteri

doi:10.3390/pathogens9100851

Hercules Sakkas, Ioannis D Bassukas + Show 5 more

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https://doi.org/10.3390/pathogens9100851

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Abstract

Onychomycosis is considered as one of the major public health problems with a global distribution associated with geographic, demographic and environmental factors, underlying comorbidities and immunodeficiency disorders. This study was conducted to investigate the etiological agents of onychomycosis, in Northwestern Greece during a 7-year period. The study population included 1095 outpatients with clinically suspected onychomycosis that presented to the University Hospital of Ioannina, NW Greece (2011–2017). Samples were examined for causative fungi, and mycological identification was established using standard mycological methods. Demographic data of each patient, comorbidities, localization of infection and history of previous fungal infection were collected. Onychomycosis was diagnosed in 317 of the 1095 suspected cases (28.9%) and the most frequently isolated pathogens were yeasts (50.8%) followed by dermatophytes (36.9%) and non-dermatophyte molds (NDMs) (12.3%). Dermatophytes were mostly involved in toenail onychomycosis (90.6%) and more commonly affected males than females (57.3% vs. 42.7%), while the predominantly isolated pathogen was Τrichophyton rubrum (74.4%) followed by Τrichophyton interdigitale (21.4%). Candida albicans was the most prevalent isolated yeast (82%), whereas among the cases with onychomycosis due to NDMs, Aspergillus spp. were isolated as the principal species (59%). Continuous monitoring should be performed in order to identify possible trends and shifts in species isolation rates and to evaluate the impact of onychomycosis among the general population and high-risk groups.

Highlights

Onychomycosis is a common fungal infection of the nails, which is responsible for up to 50%of all nail abnormalities, usually caused by dermatophytes, non-dermatophyte molds (NDMs) and yeasts [1]
Toenail onychomycosis was present in 80.6% of total positive male cases and compared to fingernail was more frequent in total (Figure 1)
Regarding the main etiological agent involved in onychomycosis, the most frequently isolated pathogens in our study were yeasts (50.8%), followed by dermatophytes (36.9%) and NDMs (12.3%)

Summary

Introduction

Onychomycosis is a common fungal infection of the nails, which is responsible for up to 50%of all nail abnormalities, usually caused by dermatophytes, non-dermatophyte molds (NDMs) and yeasts [1]. Onychomycosis is a common fungal infection of the nails, which is responsible for up to 50%. The infection is more common in toenails than fingernails and among dermatophytoses the most common causative agent is the anthropophilic species Trichophyton rubrum [2]. An effective treatment approach is rather difficult, especially in toenail onychomycosis, which is considered one of the most frequently encountered superficial mycoses worldwide affecting both the patient’s health and quality of life [3]. Onychomycosis is characterized clinically by disorganized, fragile, thick and discolored nails. Four different clinical patterns of onychomycosis are distinguished according to the direction of the invasion of the pathogen relative to the anatomy of the nail apparatus: distal subungual, (the most common type), proximal subungual, superficial, and total dystrophic onychomycosis [4]. Several molecular assays based on polymerase chain reaction have been developed and evaluated, since mycological identification and species’ determination is rather difficult to obtain by microscopy [6]

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