Prevalence Of Onychomycosis Research Articles

Prevalence of Onychomycosis in Diabetic Patients: A Case-Control Study Performed at University Hospital Policlinico in Catania.

Diabetes is characterized by an increased rate of serum glucose due to defects in insulin secretion, insulin action or both conditions. Glucose excesses can lead to extended cellular damage, with the consequence of several infectious and non-infectious skin disorders. The aim of the present study was to evaluate the toenail onychomycosis incidence in diabetic patients and healthy ones. The non-interventional, retrospective study was performed at the mycology laboratory of the University hospital “Policlinico-San Marco” in Catania, Italy, for over one year. Nail clippings were collected to perform microscopic and cultural exams, which allowed for the identification of fungal aetiological agents. A total of 715 patients (47 diabetic and 668 non-diabetic patients) were enrolled. In diabetic patients, dermatophytes were the most common cultural isolates (50%), followed by yeasts and moulds in 30.8% and 19.2%, respectively. In non-diabetic patients, the distribution of dermatophytes, yeasts and non-dermatophytic moulds was 67.4%, 5.3% and 27.3%, respectively. According to our results, diabetic patients are more predisposed to nail fungal infection. Our data suggest that dermatological follow-ups should always be performed for diabetic patients. All skin and nail disorders should be carefully monitored to perform a diagnostic confirmation and correct management of diabetic patients.

Epidemiology of Onychomycosis in Chinese Mainland: A 30-year Retrospective Study.

Onychomycosis was a common nail disease caused by dermatophytes, yeasts or molds. The prevalence of onychomycosis varied in different counties and it was necessary to understand the epidemiology in China. This study was conducted to investigate the epidemiology of onychomycosis in Chinese mainland in the past 30years. A 30-year systemic review was carried out by searching publications investigating the prevalence of onychomycosis in Chinese mainland from 1991 to 2020. A total of 90 articles involving more than 40,000 onychomycosis patients were enrolled in this study. The ratio of males to females was 1:1.32. Fingernail onychomycosis was found in 36.12% cases, toenail onychomycosis in 48.31%, and both fingernail and toenail onychomycosis in 15.57%. The most common clinical type of onychomycosis was distal lateral subungual onychomycosis (60.99%), followed by total dystrophic onychomycosis (18.91%), proximal subungual onychomycosis (10.19%) and superficial white onychomycosis (9.92%). Dermatophytes (60.59%) were the most frequently isolated pathogens, followed by yeasts (30.09%), molds (7.91%) and mixed infection (1.41%). The primary pathogens in dermatophytes, yeasts and molds were Trichophyton rubrum (49.93%), Candida albicans (10.99%) and Aspergillus (3.11%), respectively. Additionally, dermatophytes were more commonly affected males than females (63.69% vs. 51.57%), and mostly involved in toenail onychomycosis (75.63%). The infection of yeasts was higher in females than males (40.97% vs. 29.52%), often causing onychomycosis in fingernail than toenail (41.03% vs. 17.08%), and it was more common in warm and humid southern regions than northern area (34.07% vs. 24.41%). The proportion of the causative agents changed over time, dermatophytes, especially T. rubrum had always been the predominant pathogen, followed by yeasts and molds. The distribution of fungal pathogens varied among clinical types, gender, infection sites and geography gender.

Opportunities to improve guideline adherence for the diagnosis and treatment of onychomycosis: Analysis of commercial insurance claims data, United States

To the Editor: Onychomycosis, a fungal nail infection most frequently caused by dermatophytes, is an underrecognized public health problem, particularly given the global emergence of terbinafine resistance.1,2 We estimated onychomycosis prevalence, described risk factors, and assessed adherence to American Academy of Dermatology (AAD) guidelines that recommend confirmatory testing (eg, direct microscopy, histopathology, fungal culture) before prescribing oral antifungal therapy.3

Factors affecting onychomycosis in patients with psoriasis.

Prevalence of onychomycosis increases in patients with psoriasis and that psoriasis predisposes to onychomycosis. It was aimed to determine the frequency of onychomycosis and responsible pathogens in patients with psoriasis, to reveal their differences compared to the population without psoriasis, and to determine the factors in this study. The study included 81 patients with nail disorder diagnosed with psoriasis. Clinical findings, psoriasis area and severity index (PASI), nail psoriasis severity index (NAPSI) scores, body mass indexes (BMI) and laboratory characteristics were recorded. Mycological examination by direct microscopy and fungal culture was performed both on nails that were considered onychomycosis and on nails with any of the psoriatic nail findings. The prevalence of onychomycosis was 27.2% in psoriasis patients. Nail involvement of psoriasis was found in 31.3% of the patients using biologic agents, 5.9% of those receiving conventional treatment, and 31.3% of those receiving topical treatment and 68.8% of the patients who did not receive treatment at all. The difference between the patients who did not receive treatment and those who received conventional treatment was significant (p < 0.05). There was growth in the fungal culture in 23.5% of the patients with psoriasis. There was no statistically significant relationship between onychomycosis and PASI, NAPSI score, and BMI (p > 0.05). Since the prevalence of onychomycosis in psoriasis patients receiving conventional and anti-TNF-α therapy is higher than in patients not receiving treatment, nail changes in these patients should be evaluated in more detail for the presence of onychomycosis. In addition, since more than one fungal agent can grow and non-dermatophyte molds are seen more frequently in patients with psoriasis, it should be taken into account that native and fungal culture examinations should be performed together.

The epidemiology and etiology of onychomycosis in 2 laboratory centers affiliated to Tehran university of medical sciences during 2019-2020.

Background and Objectives:Onychomycosis is caused by dermatophyte species, non-dermatophyte moulds (NDMs), and accounts for roughly 50% of all nail diseases. As the prevalence of onychomycosis is increasing, new epidemiologic documents may help with treatment and prevention. The present investigation aims to determine the epidemiological profile of onychomycosis in 2 mycology laboratories.Materials and Methods:A cross-sectional study conducted during eight months (2019–2020) on 169 patients with positive nail mycology tests referred to two mycological laboratory centers affiliated with Tehran University of Medical Science. The nail clippings were examined by direct smear and culture. Also, molecular assays were performed if needed.Results:10% of nail lesions referred to Razi Hospital (RH), and 30% of nail lesions referred to TUMS mycology laboratory were positive. Middle age (40–60) suffer more from onychomycosis. Aspergillus flavus, Trichophyton mentagrophytes, and Candida albicans were the most common etiologic agents in each of the three main classes of fungi causing onychomycosis. Females were more infected. NDMs were the predominant etiologic agents, and toenails were the most common site of onychomycosis.Conclusion:The pattern of etiologic agents and clinical signs of onychomycosis differs according to geographical region and age, so repeated epidemiological surveys of onychomycosis seem to be fundamental.

Non-Dermatophyte Mold Dominated Onychomycosis in Patients Attending a Rank Higher Specialized Dermatology Clinic in Addis Ababa, Ethiopia.

BackgroundOnychomycosis is a common refractory fungal infection associated with significant morbidity. The objective of this study was to determine the prevalence of onychomycosis, and the diversity and species composition of fungal etiological agents.Materials and MethodsA clinic-based, prospective, non-randomized cross-sectional study was carried out between October 2018 and June 2019 at Rank Higher Specialized Dermatology Clinic, Addis Ababa, Ethiopia. Nail scrapings were collected aseptically from 200 patients clinically identified with nail disorders of fungal origin by dermatologists. Fungal etiological agents were identified microscopically and by culture method following standard procedures.ResultsAmong 200 nail scrapings, 161 (80.5%) samples were found out to be culture positive. Of these, 135 (83.9%) samples yielded single colonies while 26 (16.1%) mixed colonies gave a total of 190 isolates. Among the isolates, 25.8% were dermatophytes while 61.1% were non- dermatophytes molds, and 13.1% were yeasts. Females were more likely to present dystrophic nails than men. Patients in the middle age group were more affected. Trichophyton interdigitale, Aspergillus spp, and Candida albicans were the dominant species.ConclusionThe prevalence rate of onychomycosis in the present study was high. The isolation rate of non-dermatophyte molds was higher than dermatophytes and yeasts. Trichophyton interdigitale, Aspergillus spp, and Candida albicans were the dominant etiological agents. Females and patients in the middle age group were more affected. An increase in the prevalence of non-dermatophyte molds in nail infections dictates further investigation demonstrating how this group of fungi causes onychomycosis.

Onychomycosis in Older Adults: Prevalence, Diagnosis, and Management.

The risk of having onychomycosis increases with age. Data suggest that the prevalence of onychomycosis may be ≥20% in subjects aged ≥60 years and ≥50% in those aged ≥70 years. Older males are 2.1 times more prone to onychomycosis than are females. Although most nail dystrophies (approximately 50%) are caused by onychomycosis, proper clinical assessment followed by mycological examination is recommended to exclude other conditions such as nail trauma, lichen planus, and psoriasis. The US FDA-approved onychomycosis treatments are systemic antifungals (terbinafine and itraconazole) for severe onychomycosis and topical antifungals (ciclopirox 8%, efinaconazole 10%, and tavaborole 5%) for mild-to-moderate onychomycosis. Oral fluconazole is used off-label, and itraconazole may be considered for non-dermatophyte onychomycosis. Recently, fosravuconazole was approved in Japan for onychomycosis treatment. Although the treatment options and durations are the same for older patients as for other age groups, a clinical decision should take into account various age-related factors such as comorbidities, polypharmacy, hepatic and renal insufficiency, and noncompliance. Clinicians should also consider possible drug interactions and side effects when choosing a particular antifungal. Since the recurrence rate of onychomycosis is high, older patients should practice sanitization techniques, consider lifestyle changes, and perhaps consider using a topical antifungal as long-term maintenance therapy one to three times per week to prevent the recurrence of onychomycosis or to treat early disease.

POSB157 Demographics and Treatment Patterns of Onychomycosis Patients Claiming Efinaconazole: A Canadian Retrospective Claims Analysis Stratified By Diabetes Status

Onychomycosis is a fungal infection that begins in the nail bed and progresses to the nail plate, and with time may involve the nail matrix. The prevalence of onychomycosis is higher among patients with diabetes, a special population for which foot complications are a major cause of morbidity and mortality. Currently there are four onychomycosis treatments available in Canada (ciclopirox, efinaconazole, itraconazole and terbinafine). This research aims to compare the utilization of topical efinaconazole for onychomycosis between diabetic and non-diabetic patients in Canada.

Onychomycosis Prevalence in Rice Farmers in Seginim District, South Bengkulu Regency.

Onychomycosis is a common infection that occurs in the nail plate. Infections can be caused by the dermatophyte, non-dermatophyte or yeast groups of fungi. The fungus gets into the nails and causes thickening of the nails, leaving the nails glowing. The purpose of this study was to determine the prevalence of wetland farmers in Seginim Subdistrict, Bengkulu Selatan Regency infected with onychomycosis and to identify the types of fungi that cause onychomycosis in the nail scraps of rice farmers. This type of research uses descriptive cross sectional method with purposive sampling technique. The examination technique used direct preparations and culture in SDA media. The samples used in the examination were 40 samples of scraped nails of rice farmers in Seginim sub-district, South Bengkulu Regency. The results of this study showed that from 40 samples of nail scrapings that had the criteria of thickened, brittle, and yellowish brown nails, 16 samples were positive for Onychomycosis-causing fungi, namely 5 (12.5%) people infected with the fungus Trichophyton mentagrophytes and 11 (27.5%). ) people were infected with the fungus Trichophyton rubrum and 24 (60%) samples were negative.

Overall Prevalence and Prevalence Compared among Psoriasis Treatments of Onychomycosis in Patients with Nail Psoriasis and Fungal Involvement.

Background Whether nail psoriasis can increase the risk of onychomycosis is still being debated, and data relating to the prevalence of onychomycosis among psoriasis patients receiving different treatments is limited. Objectives To investigate the overall prevalence and prevalence compared among psoriasis treatments of onychomycosis in patients with nail psoriasis and fungal involvement. Methods A prospective study of three groups of nail psoriasis being treated with only topical medication, methotrexate, or biologics (25 patients per group, 150 nails) was conducted at Siriraj Hospital (Bangkok, Thailand) during November 2018 to September 2020. Demographic data, psoriasis severity, and nail psoriasis severity were recorded. The nail most severely affected with psoriasis on each hand was selected for mycological testing. Potassium hydroxide, periodic acid-Schiff stain, and fungal culture were performed. Results The prevalence of onychomycosis in nail psoriasis was 35.3%. Among the treatment groups, the prevalence of onychomycosis was significantly higher in the methotrexate group than in the topical treatment and biologic treatment groups (p = 0.014). Candida spp. was the main causative organism, followed by Trichophyton rubrum. Thumb was most commonly affected (59.3%). The most common abnormality of the nail matrix and the nail bed was pitted nail (71.3%) and onycholysis (91.3%), respectively. Multivariate analysis revealed diabetes, wet-work exposure, and methotrexate treatment to be predictors of onychomycosis. Conclusions Several factors, including psoriasis treatment, were shown to increase the risk of onychomycosis in nail psoriasis. Further research is needed to determine whether biologic agents, especially interleukin-17 inhibitors, can increase risk of onychomycosis and Candida infection/colonization of the nails.

Onychomycosis in patients with diabetes mellitus: Etiology, clinical features, and treatment response

Background: Onychomycosis accounts for 30% of all superficial mycoses and 50% of all nail diseases. One of the most studied predisposing factors is diabetes mellitus, with a frequency of onychomycosis of 31.5% in these patients. Many show resistance to standard therapeutics and have “polypharmacy”, which represents a risk for pharmacological interactions. Objective: The objective was to assess the clinical response to therapy, evaluate with histopathology, direct examination with KOH and white-calcofluor, and culture the most frequent etiologic agents associated with the development of onychomycosis in patients with diabetes mellitus. Materials and Methods: A non-randomized, uncontrolled, open-ended, prospective cohort study was conducted on 46 patients with onychomycosis and diabetes mellitus. Treatment was assigned according to clinical findings and specific indications for treatment. Results: From the samples taken for direct examination with KOH and calcofluor-white, culture, and histopathological study, positive results were: 39 (84.1%) patients to the direct examination, 32 (69.6%) to the culture, 27 (65.2%) with a positive histopathological study, and 17 (54.86%) to the calcofluor-white. On clinical evaluation, we found no treatment response in 8 patients (20%), a partial response in 14 patients (25%), and a complete response in 18 patients (45%). Out of the 46 patients evaluated initially, 25 persisted with onychomycosis after six months of follow-up. Conclusion: The prevalence of onychomycosis is increasing and requires correct diagnosis since there are other non-fungal diseases of the nails that resemble onychomycosis. Presumably, the immunosuppression of diabetes, its systemic affection, and the foot abnormalities of a diabetic patient cause more nail dystrophy, an increased fungal load, and treatment resistance.

Identification of Fungi Involved in Onychomycosis in Patients of a Spanish Rural Area.

Onychomycosis is one of the most frequent reasons for visiting podiatrist clinics. Complementary tests and the accurate identification of the infectious agents are key issues for a successful treatment of onychomycosis. This is particularly important when lifestyle, age and immunodepressed patients increase the prevalence of non-dermatophyte fungal infection. In this paper, we describe issues related to onychomycosis prevalence in a population of patients, mostly with rural lifestyles, visiting a podiatry clinic in a rural area of Spain. A total of 51 cases were studied with an average age of 65.96 ± 21.28 years (the youngest being 16 years and the oldest being 95 years). Fungal agents were isolated using conventional sampling and microbiological culture techniques. The results obtained with these techniques were compared with the results obtained with a direct methodology using molecular biology, by PCR and nucleotide sequencing of the ITS-5.8S rDNA fragment. The classical culture methodology confirmed the infection in 76.5% of the samples (n = 39), while the PCR confirmed the infection in 84.3% (n = 51) of the nails, although the difference between these results did not show statistical significance (p = 0.388). We found a high variability in agents, with more yeasts than dermatophytes as etiological agents of onychomycosis. However, only among individuals older than 65 years, was the difference between yeasts (82%) and dermatophytes (18%) was statistically significant (p = 0.004). Among the agents of non-dermatophyte onychomycosis, we found predominantly fungi (yeasts) of the Candida genus, interestingly with no isolates of Candida albicans, and moulds of the Aspergillus genus.

A Mycological and Molecular Epidemiologic Study on Onychomycosis and Determination In Vitro Susceptibilities of Isolated Fungal Strains to Conventional and New Antifungals.

BackgroundOnychomycosis is one of the most common and recurrent dermatological diseases worldwide. The antimycotic activity of prescribed medications varies according to the causative agents, and treatment failure rates exceeding 30%. This study aimed to assess the epidemiological profile of onychomycosis in Iran. Also, the susceptibilities to conventional and new antifungals were investigated.MethodsIn this descriptive cross-sectional study, during the period of 18 months starting from September 2019 until March 2020, 594 nail specimens were obtained from patients who presented nail changes compatible with a clinical diagnosis of onychomycosis. The patients were referred from different cities, including Tehran, Kermanshah, Arak, Kashan, Rasht, Qom, Urmia, Zahedan, Hamadan, Zanjan, Borujerd, Bushehr, and Yazd. All the samples were subjected to microscopic examination and fungal culture. Fungi identified were confirmed through the PCR-sequencing method. The susceptibility to itraconazole, fluconazole, terbinafine, griseofulvin, posaconazole, ravuconazole, efinaconazole, luliconazole, and tavaborole was evaluated according to the Clinical and Laboratory Standards Institute (CLSI) guidelines, document M38-A2 for filamentous fungi, and document M27-A3 for yeasts.Results594 patients were included. Of these, in 179 cases (30.1%) (95% CI:0.3 ± 0.037) onychomycosis was confirmed. The majority of patients were ≥ 60 years of age (n=58, 32.6%) and female (n=113, 63.1%). Saprophytic fungi accounted for the vast majority of the nail isolates (n=92, 51.4%) (95% CI:0.051 ± 0.0.073), followed by dermatophytes (n=45, 25.1%) (95% CI:0.25 ± 0.063), and yeasts (n=42, 23.5%) (95% CI:0.23 ± 0.061). Diabetes mellitus (77.3%), hypothyroidism (18.2%), and solid tumors (4.5%) were documented as the most prevalent underlying conditions. Antifungal susceptibility testing was performed against 60 fungal isolates (20 each of Candida species, saprophytic fungi, and dermatophytes). Efinaconazole, ravuconazole, and luliconazole were the most active agents against Candida species. Also, luliconazole, posaconazole, and efinaconazole were most potent against dermatophytes. Luliconazole had the greatest antifungal activity against saprophytic fungi.ConclusionsThe prevalence of onychomycosis in Iranian patients was relatively high. LUL exhibited potent antifungal activity against the three groups of fungi tested, determining its broad-spectrum antimycotic activity and its probable use as the first-line therapy for onychomycosis.

Onychomycosis among Clinically Suspected Cases Attending the Dermatology Out-patient Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Onychomycosis is a fungal disease of the nail apparatus caused by dermatophytes, non-dermatophytes and yeasts. Although onychomycosis is rarely life threatening, its high incidence and the associated morbidity makes it an important public health problem. This study was aimed to find the prevalence of onychomycosis among clinically suspected patients attending the outpatient department of Dermatology and Venereology. A descriptive cross-sectional study was done in a total of 200 clinically suspected cases of onychomycosis attending the Dermatology outpatient department of a tertiary care hospital within the period of one year from 1st September 2019 to 31st August 2020. Ethical approval (Reference: 150320196) was taken and convenience sampling was done. Data were analyzed using Statistical Package for Social Sciences version 19. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Out of 200 clinically suspected cases prevalence of onychomycosis was found to be 40 (20%) (Confidence Interval = 19.94-20.06) by both direct microscopy and culture. Onychomycosis was commonest among age group of 21-40 years and more predominant among male patients 60 (65.21%). The fingernails were frequently involved i.e., 58 (63%) cases followed by toenails 34 (21%). Dermatophytes were the most common type of fungal infection accounting for 25 (62.5%). The study highlighted dermatophytes as the most common clinical pattern of onychomycosis and Trichophyton rubrum as the most common aetiological agent causing onychomycosis.

Onychomycosis in onychodystrophy: a hospital-based clinico-mycological study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Onychomycosis and onychodystrophy are both characterised clinically as disruption of nail plate characterised by thickening, disfiguration and discolouration. Onychomycosis in onychodystrophy is a diagnostic challenge. Similarly, onychodystrophy could also be treated unwarrantedly for fungus. Hence this study was carried out to determine the prevalence of onychomycosis in patients with onychodystrophy and to study the risk factors associated with the same.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This descriptive study was done in 50 patients with onychodystrophy attending DVL OPD in a tertiary care hospital. After getting informed consent the nails were cleansed with absolute alcohol and nail clipping was taken for KOH and culture. The results were entered in a master sheet and analyzed.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Onycholysis, onychomadesis, chromonychia, thickened nail plate and loss of cuticle were the common features observed. Culture from 13/50 (26%) patients were found to be positive for fungal growth. In 13 patients with onychomycosis, 5 patients belonged to more than 50 years, seven patients (53.8%) were housewives. Three patients with onychodystrophy had psoriasis of which 2 (15.4%) patients proved positive for onychomycosis&lt;em&gt;. Aspergillus niger&lt;/em&gt; 10 (76.9%) was the most common organism followed by &lt;em&gt;Rhizopus&lt;/em&gt; 2 (15.4%) patients and 1 (7.7%) patient with &lt;em&gt;Geotrichium candidum&lt;/em&gt;.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We concluded that prevalence of onychomycosis in patients with onychodystrophy was 26%. Male gender, age &amp;gt;50, household activities and wetworks were associated risk factors of onychomycosis. Since clinical diagnosis of onychomycosis in onychodystrophy is difficult, appropriate lab investigations like KOH mount and fungal culture should be made mandatory to enable better patient care and clinical outcome.&lt;/p&gt;

Onychomycosis and Tinea Pedis in the Feet of Patients With Diabetes.

This study aimed to determine the prevalence of onychomycosis and interdigital tinea pedis in a cohort of Spanish patients with diabetes in whom onychomycosis was clinically suspected (n = 101). Samples from a first toenail scraping and the fourth toe clefts were subjected to potassium hydroxide direct vision and incubated in Sabouraud and dermatophyte test medium. Fifty-eight samples were also analyzed by a pathologist using periodic acid-Schiff staining and Calcofluor white direct fluorescence microscopy. Onychomycosis was only confirmed in 41 patients (40.6%). The most frequent aetiological agent was Trichophyton rubrum, isolated in 10 patients (36%), followed by Candida parapsilosis in 7 patients (25%). Tests on the fourth toe cleft samples were only positive in 11 patients (10.9%), and in all cases, onychomycosis was also diagnosed. Neuroischemic foot was the only significant variable associated with onychomycosis in the univariate analysis (P < .01). A positive result for mycosis in the fourth toe cleft was found in 11 cases (10.9%) and was associated with a history of myocardial infarction (P< .01; odds ratio [OR]: 84.2, confidence interval [CI]: 6.8-1036.4) and neuroischemic foot (P< .01; OR: 13.7, CI: 12.6-71.6) in the multivariate model. In conclusion, the prevalence of onychomycosis and tinea pedis in patients with diabetes in whom onychomycosis was clinically suspected was 40.6% and 10.9%, respectively. In addition, onychomycosis was not always associated with tinea pedis. These results show that clinical diagnosis has low accuracy in people with diabetes mellitus, and that diagnosis should not be based on clinical toenail characteristics alone.

Prevalence and Characteristics of Onychomycosis in Patients with Knee Osteoarthritis: A Single-centre Prospective Cross-sectional Study.

Knee disorders that compromise patients’ lower leg movements and self-care may put these patients at greater risk of onychomycosis. However, little is known about the prevalence of onychomycosis in patients with knee diseases. This study evaluated the prevalence and characteristics of onychomycosis in patients with knee osteoarthritis. A total of 520 consecutive patients with symptomatic knee osteoarthritis who visited the Department of Orthopedics for a potential knee surgery were evaluated for onychomycosis by PCR-based reverse blot hybridization assay. Of the 520 patients, 308 (59.2%) were diagnosed with onychomycosis. Age (p = 0.004), male sex (p = 0.015), and being barefooted (p = 0.031) were statistically significant risk factors for onychomycosis. Knee disease severity, based on Kellgren-Lawrence grade, was associated with severity of onychomycosis. The impairment of physical function and self-care caused by knee disorders may increase the prevalence of onychomycosis in these patients.

Prevalence of Onychomycosis among food handlers in Owerri, southeast Nigeria

Prevalence of Onychomycosis among food handlers in Owerri, southeast Nigeria

Epidemiological and Microbiological Study of Onychomycosis

Introduction: Onychomycosis is a common fungal infection of nail. It may be caused by dermatophytes, non-dermatophytic moulds or yeasts involving nail bed, nail plate or matrix of nail. As the fungi show variable susceptibility to antifungal drugs and treatment requires long duration of antifungal therapy, so it’s prevalence as well as proper laboratory diagnosis and antifungal susceptibility testing is essential for effective therapy. Aim: To find the prevalence of onychomycosis with demography along with various aetiology and the suitable antifungal drugs used for treatment. Materials and Methods: For this prospective study, over a period of two years a total of 300 nail samples were processed in the Department of Microbiology at IMS and SUM Hospital, Bhubaneswar, Odisha, India. The wet mount for microscopic examination was prepared using 20% Potassium Hydroxide (KOH) and examined after overnight incubation. Culture was done in duplicate in Sabouraud’s Dextrose Agar (SDA) tubes; one with actidione and another without it and both were incubated at 25°C in Biological Oxygen Demand (BOD) incubator. Culture tubes growing yeasts were further subjected to speciation by germ tube test, culture on Chromogenic (CHROM) agar and on cornmeal agar. In-vitro antifungal susceptibility testing was performed against Candida species using disc diffusion method on Muller Hinton agar. Chi-square test was used for statistical analysis of the results. Results: Onychomycosis can affect a wide age group though seen commonly at 31-40 years equally in both male and females. Fingernail infection was observed mostly in female cases. It was caused by Candida species (66%), moulds (24%) and dermatophytes (10%) and out of Candida sp. C.albicans was the main culprit. Although all the Candida strains were susceptible to amphotericin B, still some of them showed resistance to the commonly used antifungals like fluconazole and itraconazole. Conclusion:Candida albicans was the most common aetiological agent which contributed for onychomycosis and showed a variable resistance pattern to the commonly used antifungals. Proper laboratory diagnosis and selection of antifungal drug is essential prior to institution of therapy for successful treatment of this disease.

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