Onychomycosis Research Articles

Comparative Evaluation of Potassium Hydroxide Mount, Fungal Culture, and Histopathology of Nail Clipping with Periodic Acid–Schiff Stain in the Diagnosis of Onychomycosis

Context: Onychomycosis (OM) is a commonly encountered problem in clinical practice, which needs to be differentiated from other causes of dystrophic nails as its treatment is long-term and may have potential side effects. Routinely used laboratory tests like direct microscopy with potassium hydroxide (KOH) and fungal culture (FC) show inconsistent sensitivity. Hence, newer methods of diagnosis are required. Aim: This study aims to compare the efficacy of KOH mount, fungal culture, and histopathology of nail clippings with periodic acid–Schiff stain for the diagnosis of onychomycosis. Settings and Design: This was a cross-sectional study conducted in the Dermatology Outpatient Department of a tertiary care center in Navi Mumbai from September 2013 to September 2014. Subjects and Methods: A total of 102 patients with clinically suspected OM were included in the study and evaluated for the following three methods: KOH mount, FC, and HP/PAS stain. To determine the efficacy and performance characteristics of each test, FC was chosen as the gold standard for statistical analysis. Statistical Analysis Used: Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each test. Association among the study group was assessed with the help of Chi-square test. Results: Of the 102 patients, direct microscopy with KOH mount was positive in 47, FC in 30, and HP/PAS in 71 patients. Ninety-one out of the 102 patients had at least one of the three diagnostic tests positive. Using this as the denominator, KOH mount, culture, and HP/PAS had sensitivities of 51.64%, 32.96%, and 78.02%, respectively. Diagnostic sensitivity increased to 89.38% when both KOH and HP/PAS were combined. For calculation of specificity of KOH and HP/PAS, we used FC as the gold standard because it gives precise identification of the pathogen. Specificity for KOH and HP/PAS was 59.7% and 34.7%, respectively. It increased to 73.7% if both KOH and HP/PAS were positive. Conclusion: Using PAS on nail scraping can yield higher diagnostic sensitivity with no loss of specificity and hence can be considered as the method of choice for the diagnosis of OM. Accuracy of diagnosis can be increased by combining the two tests (KOH and HP/PAS) instead of one test (HP/PAS).

Clinical, Dermoscopic, and Mycological Association in Onychomycosis in a Tertiary Care Hospital

Background: Onychomycosis (OM) refers to fungal infection of the nail unit. It is one of the most common nail disorders, accounting for 50% of all nail disorders and about 30% of all cutaneous fungal infections. OM is mostly diagnosed clinically, but Dermoscopic (DS) examination aids in diagnosis. Objectives: The purpose of the study is to study the association between clinical, dermoscopic, and mycological patterns of OM. Materials and Methods: A total of 200 patients with clinical suspicion of OM were included in the study. All patients underwent clinical examination, dermoscopic examination with a handheld dermoscope Dermlite II pro (3 Gen, San Juan, Capistrano, CA, USA) with a ×10 magnification, KOH assessment, and culture analysis. The most frequent dermoscopic patterns were identified and their associations with the clinical subtype of OM were analyzed. Results: Out of the 200 cases, 65 cases were male and 135 cases were female. The most common findings seen on clinical examination of nails were discoloration of nail plates (178) and onycholysis (109). Distal irregular termination (91) was the most common dermoscopic finding seen followed by spike pattern (76). A significant association was seen between dermoscopic patterns such as superficial transverse striation, spike pattern, and different types of OM (P < 0.05). Eighty-two cases were positive for fungal elements by direct microscopy, 68 were positive by culture, and 18 patients showed positive result for both. The most common causative organism found on culture examination was Candida albicans (24). Conclusion: Dermoscopy is an easy-to-perform, noninvasive, and cost-effective method which aids in early diagnosis of OM.

Efficacy and safety of fosravuconazole in patients with onychomycosis in our clinic

目的と方法：実臨床における爪白癬患者に対するホスラブコナゾールL-リシンエタノール付加物（ネイリンⓇカプセル，以下ホスラブコナゾール）の有効性および安全性を検討する目的で，2018年8月～2020年2月に当院を受診し，爪白癬の診断の下にホスラブコナゾールを処方された患者を対象としてカルテ情報を収集した． 結果：対象は爪白癬患者360例（足爪白癬340例，手爪白癬28例，そのうち両者の重複例8例）で，男女とも70歳台が最も多かった．ホスラブコナゾール12週投与を終了し投与開始から1年以上経過した足爪白癬84例における治療成績は完全治癒59例（70.2％），転帰不明22例（26.2％），無効3例（3.6％）であった．完全治癒は治療開始後3カ月と6～12カ月に確認できた例が多く，転帰不明例の多くはドロップアウト（最終来院）時に改善傾向を示していた．360例中ホスラブコナゾール12週の投与を完結できた症例は249例（69.2％）で，治験で除外されていた高齢者や若年者，手の爪白癬または難治な爪白癬に対しても本薬の高い有効性が認められた．投薬中の臨床検査にて260例中ALT/ASTは18例（6.9%）に，γ-GTPは61例（23.5％）に異常値を認めたが，皮膚症状など他の副作用を含め重篤な例はなかった． 結論：ホスラブコナゾールは実臨床においても完全治癒率と投与継続率が高く，肝機能検査など適切な対処により重篤な副作用を回避できることから，合併症などで内服が困難な例や外用薬で早期完治が期待できる例を除き，すべての爪白癬症例において早く確実に治すための第一選択薬として用いられるべき薬剤と思われる．

Epidemiological Characterization of Dermatomycosis in Ethiopia.

BackgroundSuperficial mycosis is common worldwide and their epidemiological characteristics are different in different geographical areas and have shown variations in the last decades. The aim of this study was to analyze and characterize the epidemiology of dermatomycosis and their causative fungi species in Ethiopia between 2015 and 2019.MethodsA laboratory-based cross-sectional study was conducted using the data of mycological examination and culture findings from all patients who visited the Dermatology Department of Arsho Advanced Medical Laboratory, Addis Ababa, Ethiopia. The direct wet mount microscopy and culture data of the isolates were collected from the database of the dermatology unit from 2015 to 2019 after permission was obtained from the laboratory head. The data were double-entered into Microsoft Excel, exported and analyzed using SPSS version 20.ResultsThe total prevalence of fungi causing dermatomycosis was 67.7% (760/1122 cases) using direct wet mount microscopy and from these 489/1122 (43.5%) were culture positive. Dermatomycosis was found to be higher among females 694/1122 (61.9%) than male participants. Age group 25–44 years was the most affected 442/1122 (39.4%) followed by 1–14 years old 291/1122 (25.94%). Tinea unguium (50.8%) is the most common type of dermatomycosis followed by tinea capitis (24.1%) and tinea corporis (13.9%). Trichophyton spp. (32%) was the most highly distributed causative agent, followed by Epidermophyton spp. (20.2%) and Aspergillus fumigatus (8.3%).ConclusionThe retrospective analysis of epidemiological data collected at Arsho Advanced Medical Laboratory since 2015 showed a gradual increase in the frequency of tinea unguium and tinea pedis. However, during the past years, there was a gradual decline in the frequency of tinea corporis. In parallel with this variable pattern, the rate of isolation of non-dermatophytes especially Aspergillus fumigates and Candida species has shown a gradual increment during the past five years.

Chronic Dermatophytosis: Clinico-Mycological Determinants and Antifungal Susceptibility Pattern.

Background:Recent years have witnessed a dramatic increase in chronic unresponsive dermatophytosis. A study was conducted to quantify the proportion of patients with chronic dermatophytosis and to determine the clinico-mycological predictors of chronicity including antifungal susceptibility.Methods:Hospital-based cross-sectional study design was adopted. Four hundred and twenty-five patients were studied. The outcome variable was chronic dermatophytosis and the determinants were clinico-mycological characteristics. Chi-square and odds ratio (OR) with 95% confidence interval (CI) were calculated.Results:Chronic dermatophytosis was seen in 29.4%. Past history of dermatophytosis, OR 0.44 (95% CI 0.28–0.68); family history of dermatophytosis, OR 1.66 (95% CI 1.06–2.56); HIV infection, OR 9.88 (95% CI 1.09–89.33); treatment with topical antifungals, OR 2.4 (95% CI 1.5–3.9); systemic antifungals, OR 3.9 (95% CI 2.5–6.1); topical steroids, OR 2.02 (95% CI 1.25–3.25); multiple-site infection, OR 1.97 (95% CI 1.24–3.13); and tinea unguium, OR 6.52 (95% CI 2.89–14.7) were the significant determinants. Trichophyton mentagrophytes (73.6%) was the most common isolate followed by Trichophyton rubrum and Microsporum gypseum (13.2%) each. A percentage of 77.4 of the isolates were resistant—73.6% isolates to terbinafine and 3.8% isolates to fluconazole. None of the isolates were resistant to itraconazole.Conclusion:Significant determinants were host-related factors. Thorough history taking, patient examination, and education can improve the present scenario. Microbiological resistance was not a significant predictor. High proportion of resistant strains should be an eye opener. Developing and adopting a standard uniform treatment protocol throughout the country should be the need of the hour.

Melaleuca alternifolia Australian Tea Tree oil as an effective antifungal agent topically for Tinea unguium (onychomycosis)

The evolution of modern medical advances is often underestimated and that as little as a hundred years ago, none of the formulated antibiotics currently available existed. The germ theory was only substantiated because bacteria had been identified with the refining of microscopic technol-ogy and organisms that did not exist in context or conjunction to human disease. The connection between what appeared through the lens of a microscope slowly became the basis of the medical theories of human health and illness. This included the causative agents within all states of hu-man wellness. Humans started using plants and their essences long before they were able to rec-ord it. The scientific renaissance started the medical movement towards concrete concepts and reproducible results all bound by the scientific methods. This left little room for combinations of chemicals or plant constituents and compartmentalized human health into systems that worked best under strict control negating the concept of synergy. Human medicine is now moving out of the realm of being solely dependent on synthetic chemical formulations. Alternative and modern medical healers alike are starting to understand that both paths to human healing are needed to care for the many microbial assaults caused by bacteria, viruses, and fungi. Combing herbal folk-lore with modern chemistry is not a compromise but a middle way for better human health and illustrated with the use of Melaleuca alternifolia (Australian Tea Tree Oil) and modern antifungal agents used in conjunction to definitively cure the fungal infection starting with the causative fungi Tinea unguim and the condition of onychomycosis as an example.

Epidemiological and diagnostic study of onychomycosis

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

Prospective clinico mycological study of superficial mycosis in coastal Andhra Pradesh

Introduction: Indian continent has remarkable topographical variation between tropical and subtropical regions of the world. For this reasons, superficial mycoses is common in our country. There are other predisposing factors, like socioeconomic condition, overcrowded, poor hygiene, and contact with animal, and in the absence of proper medical care skin mycoses spread epidemically. In addition to its epidemic nature, the spectrum of dermatophytosis is also not static. Konaseema region is costal part of Andhra Pradesh, and no such study has been conducted in this region, so present study has been designed to study the clinical pattern of superficial mycoses among the patients who are attending outpatient department of Dermatology, venereology and leprosy and also to study the variations of species causing different morphological forms of superficial mycoses. Materials and Methods: Present study is a randomized cross sectional prospective study conducted in the dermatology, venereology and leprology department Konaseema institute of medical sciences Amalapuram from February 2016 to May 2018.The study population include 1200 patients diagnosed clinically having superficial mycoses randomly selected for this study based on exclusion and inclusion criteria. Result: Out of 1200 patients 786 (65.5%) were diagnosed as dermatophytosis 146 (12.1%) patients were diagnosed as pityriasis versicolor, 224 (18.666%) patients were diagnosed to be candidiasis and 44 (3.66%) patients were having tinea nigra. Out of 786 dermatophytes, 320 (49.10%) were clinically diagnosed as T. Cruris, 240 (30.53%) patients were clinically diagnosed as tinea. corporis, 104 patients (13.23%) were diagnosed as tinea Unguium, tinea mannum patients were 44 in number (5.59%), T capitis patients were 26, (3.3%). 20 patients that is 2.5% were diagnosed to be tinea. Barbae and 12 (1.5%) patients were diagnosed to be tinea. Faciei 2.5% patients were diagnosed to have tinea pedis. Discussion and Conclusion: We

Clinico-aetiological profile of onychomycosis at a tertiary care centre in northeast India

Onychomycosis (OM) represents nearly 50 percent of all nail disorders and accounts for about 30 percent of all superficial fungal infections of the skin. Often it becomes a nidus for recurrent superficial skin infections. Aims and Objectives: To study the clinico- aetiological profile of onychomycosis and identify various predisposing factors. Materials and Methods: A hospital-based, cross-sectional prospective study from October 2010 to March 2012 in Department of Dermatology, Venereology and Leprology in collaboration with Department of Microbiology at a tertiary hospital in Imphal, Manipur. Demographic profile, detailed history, risk factors, clinical examinations, investigations which consisted of direct microscopy with 10% potassium hydroxide (KOH), culture in Sebouraud’s dextrose agar (SDA), SDA incorporated with chloramphenicol (0.05mgs/ml) and cyclohexamide (0.5mg/ml) were taken. Results: A total of 122 (54 male and 68 female) patients diagnosed with onychomycosis were included in this study. Maximum number of our patients (56.6%) was between 21 and 40 years of age. Male to female ratio was 1:1.3. Housewives form the predominant group accounting for 41.9%, followed by students (28.7%) and farmer (13.9%). Some of the predisposing factors associated were smoking (25.4%), trauma (31.2%), concomitant fungal infection (59%) and family history of superficial mycosis (16.4%). DLSO (82%) was the commonest morphological pattern of OM, followed by TDO (9.8%). Trichophyton sp (44.3%) forms the commonest aetiological agent of OM. NDMs constituted 36.9% of the total nail cases in our study. Aspergillus sp (73.3%) was the most common isolate among the nondermatophyte molds (NDM), followed by Mucor sp (11.1%). Dermatophytes (45%) were the commonest cause of DLSO, Candida sp were responsible for all the cases of PSO. Conclusion: Dermatophytes are still the commonest cause of onychomycosis but NDMs and yeast can no longer be ignored as one of the causative organisms of OM.

16235 An investigation of prevalence, risk factors, and health services utilization for onychomycosis in South Korea fishing villages

There have been many studies about onychomycosis (OM) with various populations. However, no study was conducted on people living in fishing villages who seem to be susceptible to OM. The aim of this study was to investigate the prevalence, risk factor of OM in population in fishing villages in South Korea. Subjects who lived in three different fishing village in Geoje island located off the southern coast of South Korea were included in this study. Inspection was performed and mycologic examination was done for those with clinically diagnosed OM. Questionnaires regarding type of occlusive wear, hygiene habits, treatment history were surveyed. Among 94 subjects enrolled, 64 (68.1%) were diagnosed as OM with inspection and causative organisms were identified in 47. Among clinically diagnosed OM, DLSO was the most common clinical type (70.3%), followed by TDO (25%). The first finger and toenail were the most common, and more than 5 nails were involved more than half of them. Trichophyton rubrum was identified the most commonly. Wearing rubber boots was significantly related to OM (P = .019). Among patients who experienced OM treatment, most of them answered ineffectiveness and indifference. Many of them had tried to cure only with conventional topical agents. The prevalence and severity of onychomycosis in fishing villages were high. Wearing occlusive footwear may be one of the risk factors. Insufficient way of treatment and unawareness hindered them to be cured. Therefore, proper education and medical service for onychomycosis should be provided in association with specific occupational background.

Fosravuconazole to treat severe onychomycosis in the elderly.

Fosravuconazole is a novel oral antifungal drug developed in Japan and used to treat tinea unguium since 2018. Its excellent oral absorbability and systemic bioavailability has enabled short-duration therapy of 3months. Furthermore, no concomitant drugs are contraindicated due to the presence of the mild inhibitor of cytochrome P450 enzyme which is responsible for polypharmacy adverse effects. Therefore, it can be safely administrated to elderly patients. Elderly patients (≥65years old) with severe onychomycosis (≥50% nail involvement) were treated with oral fosravuconazole 100mg once daily for 12weeks. The rate of involvement improved from 86.6% to 28.1% (P<0.01). The efficacy (i.e. percentage of those rated as "improved" and better) and cure rate was 83.8% (31/37) and 29.7% (11/37), respectively. Furthermore, when focusing on the thin nail group (<3mm), the efficacy and cure rate was 88.2% (15/17) and 58.8% (10/17), respectively. Although the serum γ-glutamyltransferase levels increased in 21.6% (8/37), all patients recovered without any specific treatments.

Dermatophytes, dermatophytosis in the Caribbean and potential for herbal therapy

Introduction: Dermatophytes are a group of morphologically related keratinophilic fungi that invade keratinized tissue (skin, hair, and nails) of humans and warm-blooded animals to produce clinical lesions (dermatophytosis). Clinical lesions are traditionally divided according to the site infected, namely, scalp (tinea capitis), feet (tinea pedis, commonly called “athletes’ foot”), groin, inner thighs, or buttocks (tinea cruris, commonly called “jock itch”), beard (tinea barbae), hands (tinea manuum, toe nails or finger nails (tinea unguium, also called onychomycosis), face, non-bearded area (tinea faciei) and other parts of the body, such as arms, abdomen, or legs (tinea corporis). Dermatophytosis is common world-wide and is caused by species of three genera of dermatophytes, namely Microsporum, Trichophyton, and Epidermophyton. This study presents an update of ecology of different species of dermatophytes and epidemiology of infections caused by them in the Caribbean. Possibility of herbal therapy of these infections as an alternative treatment is also dealt with.&#x0D; Methods: A thorough search of literature was made using PubMed, MEDLINE, Biomed Lib, Med Facts, and different sets of key words, viz. dermatophytes, tineas in Caribbean, occurrence in animals, soil etc.&#x0D; Results: It was revealed that incidence of dermatophytic infections and their epidemiologic characteristics depend on social, geographic, and environmental factors and may change with passage of time. For instance, prior to year 2000, the major cause of tinea capitis in North America for 100 years was Microsporum canis followed by M. audouinii; Since 1950 Trichophyton tonsurans has advanced from Mexico and the Caribbean to be currently a major cause of tinea capitis in North America. The two dermatophytes Microsporum gypseum and M. fulvum, and several Chrysosporium species have been frequently isolated form soils in different countries in the Caribbean.&#x0D; Conclusions: There is almost complete lack of information on human infections due to dermatophytes in several Caribbean countries. The preponderant occurrence of M. fulvum in Anguilla soils with comparatively rare isolation of M. gypseum is a significant observation. The need for further epidemiological studies on dermatophyosis in the Caribbean countries cannot be overemphasized.

Comparative study between the effect of topical tazarotene 0.1 gel alone vs its combination with tioconazole nail paint in treatment of onychomycosis.

Onychomycosis (OM) is a chronic fungal infection of the nail caused by dermatophytes, yeasts, and nondermatophytes. Tioconazole is one of the topical antifungal belonging to imidazole derivatives. Tazarotene is a synthetic retinoid, with immunomodulating properties and anti-inflammatory activity. To evaluate the efficacy of tazarotene 0.1% gel alone in comparison with its combination with tioconazole nail paint in the treatment of onychomycosis. Forty patients presented with onychomycosis, subjected to a full history taking, clinical examination, and nail examination, which includes a clinical, dermoscopic, assessment of severity by using Onychomycosis Severity Index (OSI), KOH examination, and fungal culture. There was a statistically significant increase in the response of treatment in patients treated by a combination of tazarotene and tioconazole compared to tazarotene alone through (decrease in OSI, dermoscopic features, and mycological clearance). Tazarotene had antifungal activity specially against Aspergillus niger while its combination with tioconazole gave better results and can be used as an adjuvant to the standard systemic or topical antifungal treatment for OM.

Clinicoepidemiological Trends and Features of Epidermophyton floccosum Infections in Korea: Between Year 1998~2007 and 2008~2019

Background: The knowledge of the clinical features and changing epidemiology of dermatophytes helps in better managing them. Objective: This study investigated the recent epidemiologic characters of Epidermophyton floccosum from January 2008 to December 2019 and attempted to compare these with previous studies. Methods: The current study included 57 patients who visited our clinic and were diagnosed with E. floccosum infection through fungal culture between January 2008 and December 2019. Data on the date of visit, gender, age at onset, and site of infection were collected through a review of medical charts and were compared with previously reported studies. Results: The frequency of isolation of E. floccosum decreased gradually, and the infections caused by E. floccosum were 33 cases of tinea cruris, 20 of tinea pedis, and 2 each of tinea corporis and tinea unguium. The male to female ratio was 10.4:1, and most infections occurred in the 10~29 year age group. Conclusion: E. floccosum infections in Korea have been decreasing rapidly since 1987. However, the clinical features of E. floccosum infections remained unchanged even at a low incidence.

Evaluation of Zinc and Copper Levels in Superficial Fungal Infections

Objective: Superficial fungal infections are one of the common skin diseases. Zinc and copper are essential elements for humans, and concentrations of these trace elements may vary in various inflammatory conditions. Our aim in this study is to measure serum zinc and copper levels in patients with superficial fungal infection and to evaluate its relationship with clinical types of the disease.&#x0D; Materials and Methods: This study included 81 patients diagnosed with superficial fungal infection (tinea capitis, faciei, pedis, unguim, corporis, and versicolor) who applied to the Department of Skin and Venereal Diseases, Faculty of Medicine, Selcuk University. Serum zinc and copper levels were measured in all patients.&#x0D; Results: The mean age of the patients was 36.68 ± 17.12, and 54 (66.6%) of patients were male and 27 (33.3%) were female. There were tinea versicolor in 32 (39.5%) of the patients and other dermatophytosis infections (tinea capitis, faciei, pedis, unguium and corporis) in 49 (60.5%) of the patients. The mean serum zinc levels of the patients were determined close to the lower limit of the normal reference range with 11.41 ± 2.07 µmol / L, but zinc and copper levels were within the normal reference range (normal reference values of zinc and copper; 11-19.5 µmol / L, 80-155 µg / dL, respectively). There was no statistically significant difference in zinc and copper levels between patients with tinea versicolor and patients with other dermatophyte infections (p = 0.348, p = 0.173, respectively). In addition, there was a negative correlation between serum zinc levels and age, serum copper levels showed a statistically significant negative relationship with male sex and smoking (r = -0.359, p = 0.001; r = -0.343, p = 0.002, r = -0.283 , p = 0.033, respectively).&#x0D; Discussion: In our study, the majority of patients with superficial fungal infections were men. It was determined that the frequency of dermatophyte infections increased as the mean age of the patients increased. Although serum zinc and copper levels measured in patients were within the normal reference range, especially zinc levels were close to the lower limit of reference values. In addition, it was observed that various factors such as age, gender and smoking affect zinc and copper levels. As a result of these data, we think that irregularities in serum zinc and copper levels may predispose to the development of fungal infections.

Perceptions Surrounding Onychomycosis in the Health Professions Student Population: The Disease, Treatments, and Quality of Life.

Discolored toenails is a common complaint presented to podiatric physicians, dermatologists, and primary-care physicians. Although various local and systemic conditions influence changes in nails, nearly 50% is due to fungal infections. We surveyed the health professions student population to gain insight into how future medical professionals may approach this condition and to explore perceptions of onychomycosis, treatments, and effects on quality of life. The primary outcome measure was a self-reported online Google Forms survey developed by the authors and sent to podiatric, allopathic, and osteopathic medical students and nursing students in Philadelphia, Pennsylvania. Of the 245 respondents, 92% agreed that toenail fungus is both a health and a cosmetic concern. Seventy-seven percent of respondents said "yes" when asked if they would seek treatment, and 67% would wait 1 month to 1 year to see a medical professional. When seeking treatment, 57% reported that they would see a primary-care physician initially, and 27% and 5% would seek care from a podiatric physician or dermatologist, respectively. A total of 91% would spend up to $300 annually for treatment, with only 4% willing to spend more than $500 per year. Respondents' greatest concern would be physical appearance. Although agreement exists among the health professions students surveyed that toenail fungus presents both a cosmetic and a health concern, inconsistencies regarding time to treatment, treating professional, and effects on quality of life persist. It is not reasonable for all medical professionals to effectively recognize and treat nail disease, but it is paramount that patients are directed to medical professionals who can accurately exclude other conditions to alleviate social and financial burdens patients may face due to onychomycosis.

INFEKSI JAMUR KUKU (ONYCHOMYCOSIS) PADA LANSIA DI PANTI SOSIAL TRESNA WERDHA WANA SERAYA

Onychomycosis merupakan infeksi pada lempeng kuku yang dapat disebabkan oleh jamur dermatofita (Tinea unguium), non dermatofita atau yeast. Infeksi onychomycosis menyebabkan kerusakan pada kuku yang menyebabkan lempeng kuku menebal, rapuh dan mudah hancur. Penelitian ini bertujuan untuk gambaran onychomycosis pada lansia di Panti Sosial Tresna Werdha (PSTW) Wana Seraya. Jenis penelitian yang digunakan adalah penelitian deskriptif. Pengambilan sampel penelitian dilakukan di Panti Sosial Tresna Werdha (PSTW) Wana Seraya di Jl. Gemitir No.66, Kesiman Kertalangu, Denpasar Timur, Kota Denpasar, Bali. Sampel dianalisa di Lab. Parasitologi Teknologi Laboratorium Medis STIKes Wira Medika Bali. Pemeriksaan menggunakan teknik pengamatan langsung menggunakan pewarna kalium hidroksida (KOH) 10% pada kerokan kuku 15 orang responden yang memenuhi kriteria inklusi dan eksklusi. Hasil pemeriksaan menunjukkan terdapat 1 responden (6,67%) yang positif onychomycosis dengan ditemukannya hifa pada pengamatan mikroskopis preparat kerokan kuku. Sementara itu 14 sampel lainnya (93,33%) dinyatakan negatif. Hasil screening pada penelitian ini menunjukkan lansia di PSTW Wana Seraya telah memiliki hygiene diri yang baik khususnya dalam memelihara kebersihan kuku kaki dan tangan sehingga mengurangi faktor resiko terjadinya infeksi jamur kuku.

Google search trends in onychomycosis: Influences of flip flops and advertising.

Onychomycosis is a fungal infection of the nail, affecting 5.5% of the population. Individuals affected by this disease experience increased anxiety about this disorder and a decreased quality of life. There are multiple available treatments across the globe, leading people to search online for information on the various therapies. To analyze Google search trends of fungal infection and treatment keywords and the influence of different geographical locations, season, regulatory decisions, and advertisements on these trends. In May, 2020 we used Google Trends to determine the relative interest of various fungal infection and treatment keywords worldwide and in the US, the UK, Canada, and Australia. Notable peaks were investigated for contemporaneous news events. In general, searches for toenail fungus and associated treatment terms peak during the summer months. Interest in individual treatments peaks when a product is launched, is the subject of an advertising campaign, or becomes more available to the public through approval or reclassification. Yeast infection, thrush, and ringworm terms are consistently searched more often than toenail fungus, jock itch, or foot fungus; all terms are most popular in the summer months, with toenail fungus reaching annual popularity one month prior to jock itch. In general, interest in toenail fungus and treatments is the highest when social anxiety about toenail appearance and the occurrence of fungal infection is the greatest. Curiosity about treatment products increases with their availability and visibility to the public. Combining the power of seasonal interest and advertising generates the greatest search profile for onychomycosis treatments.

Diagnosis of dermatophytoses: Comparison of mycological techniques

Background: Dermatophytes are a group of closely related fungi that have the capacity to invade keratinized tissue (skin, hair, and nails) of humans and other animals to produce an infection. Infection by this fungi are restricted to the non-living cornified layers as they lack the ability to penetrate the deeper tissues of immuno competent hosts. The great variation in clinical presentation is related to the involved species of fungus, size of the inoculum, involved site and immune status of the host. There are three genera of dermatophyte fungi: Trichophyton, Microsporum and Epidermophyton based on microscopic features. Each genus is characterized by a specific pattern of growth in culture and by the production of macroconidia or microconidia. The Trichophyton species usually infect the skin, hair and nails. Microsporum species infect the skin and hair but not the nails. Epidermophyton species infect the skin as well as nails but not hair. This study was carried out to determine the etiological agents in different forms of dermatophytosis and to compare the various laboratory techniques in the diagnosis of dermatophytosis. Materials and method: The study was conducted at the department of Microbiology, Srinivas Institute of Medical Sciences and Research Centre, Mangalore, India. 270 specimens obtained from clinically suspected cases of dermatophytoses between December 2017 to December 2019 were included in the study. The samples included skin scraping, nail clipping and plucked hair. The specimen was then subjected to Microscopic examinations like KOH, PAS, and Calcofluor white stain and Culture on SDA, SDA with Chloramphenicol and DTM. Results: Male patients infected were found to be 48.88% and female patients were 51.11%. The most common affected age group was 21-30 years (25.1%). More than 92.59% of samples were from Tinea unguium. Fungi was demonstrated in 31.85% of cases, by KOH wet mount, 41.48% by calcofluor white stain and 49.62% by PAS. Out of 135 specimens, 48 specimen yielded growth giving 35.55% culture positivity on SDA with chloramphenicol. Conclusion: A success rate of 41.48% was achieved for detecting fungal elements by microscopy as compared to culture. PAS Stain shows high reliability and sensitivity for detecting onychomycosis compared to KOH and mycological culture. PAS and the culture combination is superior to combined KOH and culture for detection of dermatophyte infection. Ninety six isolates were obtained from 270 patients which shows the prevalence of the isolate in and around Mangalore

Prevalence of Tinea unguium (Onychomycosis) in Toe Nails of boot wearing group (The Footballers) in Owerri, Imo State. Nigeria

Foot mycoses are a frequent disease that represents a public health problem worldwide. This study aims to evaluate the epidemiology of foot mycoses among footballers in Owerri, Imo State, in order to determine the fungal etiological agents and to identify possible risk factors. To investigate the treatment and preventive measures for the susceptible groups. A total of 485 samples were collected; tinea unguium were confirmed in 88.2% of cases. A prospective study of fifty footballers was undertaken during one year (2018-2019). A complete mycological diagnosis was carried out on all footballers. The results obtained showed that out of the 50 toe nails samples of footballers examined, 28(56.0%) had positive cases of the infection on direct microscopy which served as the screening test. The causative pathogens of Onychomycosis isolated from fungal culture are dermatophytes , and the most frequent pathogen was Trichophyton rubrum 15(30.0%), yeast Candida albicans 9(18.0%). Non-dermatophyte molds were observed in 8(16.0%) cases and Fusarium sp. was the frequent genus 14(28.0%)and Aspergillus sp. 4(8.0%). The main predisposing factors of fungal foot infections were practicing ritual washing (56.6%) and frequentation of communal showers (50.5%). Confirmatory test such as germ-tube test was done on the Candida albicans isolate for proper identification. The age group 31- 35 years had the highest prevalence of onychomycosis 12(92.31%) and age group 16-20 years presented the lowest prevalence of onychomycosis 4(28.57%). Proper care of toe nails and boots is necessary to prevent the increasing rate of this infection.