Finding and Fighting the Fungi in the Nails

Abstract

Background: Fungal infections of nails, one of the important skin appendages, can lead to chronicity. This study was conducted to formulate baseline data for various fungal etiological agents, its clinical correlation and to understand the risk factors associated to onychomycosis.

Materials and Methods: 113 clinically suspected cases of onychomycosis were subjected to mycological studies. Diagnosis was confirmed with help of microscopy and culture. 

Result: Overall isolation rate of onychomycosis in suspected cases was 75%.

Total direct microscopy positivity was 70% and total culture positivity was 52%. Most common age group affected was 21-40 years (53.9%). Males (60.1%) were more affected than females (39.8%). Majority of suspected patients were farmers (24.7%), followed by students (19.4%). Housewives contributed to 16.8% of cases. Disease was limited to fingers in 78.7% cases, followed by toes which amounted to 18.5% of the cases. 2.6% had both, fingers as well as toes affected. Distal Lateral Subungual Onychomycosis was the most prevalent clinical pattern found in 68.1% participants. This was followed by Proximal subungual Onychomycosis, Total Onychomycosis, Candidial onychomycosis, Superficial White Onychomycosis in 9.7%, 7.9%, 7% and 7% participants respectively. None of the participants were having endonyx. Risk factors such as trauma, use of occlusive footwear, diabetes were observed to be an important contributing factor. Positive family history was given by 2.6% cases. Most common organism turned out to be T.mentagrophytes followed by T.rubrum. Thus, dermatophytes were the leading causative agent with 86.4% of the total agents isolated. Nondermatophytes contributed to 3.3% and yeasts accounted for 10.1% cases.

Conclusion: The results show that relying only on the clinical manifestation in the diagnosis of onychomycosis is often misleading. The present study tries to highlight the need for microbiological confirmation in case of onychomycosis.