A clinicomycological study of onychomycosis in a rural hospital in Central India

Ruchita Omprakashji Attal, Rasika Ashok Chaudhary, Vijayshri Suresh Deotale, Sonia Pramod Jain

Abstract


Background: Onychomycosis; fungal infection of nails account for about half of the nail diseases. Common site of involvement is toenails. Various etiological agents including dermatophytes, yeasts and non-dermatophytic moulds (NDM) are responsible. It is difficult to treat onychomycosis as compare to other dermatophytic infections because of the inherent slow growth of the nail. Aim: To diagnose etiological agents of onychomycosis on KOH, Calcofluor white (CFW), KOH treated Nail Clipping with Periodic Acid Schiff (KONCPA) and SDA culture. Objectives: 1) To determine the fungal etiological agents of onychomycosis. 1) To correlate clinical parameters with the mycological findings.

Methods: The study was carried out in department of Microbiology, MGIMS, Sewagram, Wardha. A total of 44 cases with signs of onychomycosis were enrolled in the study which were subjected for microscopic examination by 20% KOH, CFW and KONCPA. Mycological culture was done on Sabouraud’s dextrose agar (with and without antibiotics).

Results: On analysis, the positivity by 20% KOH andCFW was 45.5%, 63.4% respectively while by KONCPA it was found to be 25%. In 38.6% fungal cultures revealed growth. At present, the etiological agents were dermatophytes (12.5%), especially Trichophyton rubrum, nondermatophytic isolates (75%) include Aspergillus spp., Penicillium species, Rhizopus and Candida spp. (8.3%). In our study toenails were affected in 84% and distolateral subungual onychomycosis (DLSO) was the commonest clinical presentation.  

Conclusion: Along with dermatophytes, NDM and yeasts are also important etiological agents of onychomycosis in our set up.

 


Keywords


Non-dermatophytic moulds (NDM), Calcoflour white, KOH treated nail clipping (KONCPA)

Full Text:

PDF

References


Haghani I, Shokohi T, Hajheidari Z, Khalilian A, Aghili SR. Comparison of diagnostic methods in the evaluation of onychomycosis. Mycopathologia. 2013 Apr;175(3-4):315-21.

Sarma S, Kapoor MR, Deb M, Ramesh V, Aggrawal P. Epidemiologic & clinicomycologic profile of onychomycosis from north India. Int J Dermatol. 2008;98:224-8.

Lange M, Roszkiewicz J, Szczerkowska-Dobosz A, Jasiel-Walikowska E, Bykowska B. Onychomycosis is no longer a rare finding in children. Mycoses. 2006;49:55-9.

Gunduz T, Metin DY, Sacar T, Hilmioglu S, Baydur H, Inci R, et al. Onychomycosis in primary school children: association with socioeconomic conditions. Mycoses. 2006;49:431-3.

Yenişehirli G, Bulut Y, Sezer E, Günday E. Onychomycosis infections in the middle black sea region, Turkey. Int J Dermatol. 2009;48:956-9.

Thomas J, Jacobson GA, Narkowicz CK, Peterson GM, Burnet H, Sharpe C. Toenail onychomycosis: An important global disease burden. J Clin Pharm Ther. 2010;35:497-519.

Sujatha V, Grover S, Dash K, Singh G. A clinico-mycological evaluation of onychomycosis. Indian J Dermatol Venereol Leprol. 2000;66:238-40.

Scher RK. Onychomycosis: a significant medical disorder. J Am Acad Dermatol. 1996;35:S2-5.

Midgley G, Moore MK. Nail infections. Dermatol Clin. 1996;14:41-9.

Baran R, Hay RJ, Tosti A, Haneke E. A new classification of onychomycosis. Br J Dermatol. 1998;139:567-71.

Koksal F, Er E, Samasti M. Causative agents of superficial mycoses in Istanbul, Turkey: retrospective study. Mycopathologia. 2009;168:117-23.

Gupta AK, Zaman M, Singh J. Diagnosis of Trichophyton rubrum from onychomycotic nail samples using polymerase chain reaction and calcofluor white microscopy. J Am Podiatr Med Assoc. 2008;98:224-8.

Elewski BE. Onychomycosis: pathogenesis, diagnosis and management. Clin Microbiol Rev. 1998;11:415-29.

Grover S. Clinico-mycological evaluation of onychomycosis at Bangalore and Jorhat. Indian J Dermatol Venereol Leprol. 2003;69:284-6.

Ploysangam T, Lucky AW. Childhood white superficial onychomycosis caused by Trichophyton rubrum: report of seven cases and review of the literature. J Am Acad Dermatol. 1997;36:29-32.

Suarez SM, Silvers DM, Scher RK, Pearlstein HH, Auerbach R. Histopathologic evaluation of nail clippings for diagnosing onychomycosis. Arch Dermatol. 1991;127:1517-9.

Binstock JM. Molecular biology techniques for identifying dermatophytes and their possible use in diagnosing onychomycosis in human toenail. J Am Podiatr Med Assoc. 2007;97:134-44.

Weinberg JM, Koestenblatt EK, Tutrone W, Tishler HR, Najarian L. Comparison of diagnostic methods in the evaluation of onychomycosis. J Am Acad Dermatol. 2003;49:193-7.

Gianni C, Morelli V, Cerri A, Greco C, Rossini P, Guiducci A, et al. Usefulness of histological examination for the diagnosis of onychomycosis. Dermatology. 2001;202:283-8.

Lilly KK, Koshnick RL, Grill JP, Khalil ZM, Nelson DB, Warshaw EM. Cost-effectiveness of diagnostic tests for toenail onychomycosis: a repeated-measure, single-blinded, cross-sectional evaluation of 7 diagnostic tests. J Am Acad Dermatol. 2006;55:620-6.

Lawry MA, Haneke E, Strobeck K, Martin S, Zimmer B, Romano PS. Methods for diagnosing onychomycosis: a comparative study and review of the literature. Arch Dermatol. 2000;136:1112-6.

Kaur R, Kashyap B, Bhalla P. A five year survey of onychomycosis in New Delhi, India: epidemiological and laboratory aspects. Indian J Dermatolol. 2007;52:39-42.

Jesudanam TM, Rao GR, Lakshmi DJ, Kumari GR. Onychomycosis: a significant medical problem. Indian J Dermatol Venereol Leprol. 2002;68:326-9.

Aghamirian MR, Ghiasian SA. Onychomycosis in Iran: epidemiology, causative agents and clinical features. Jpn J Med Mycol. 2010;51:23-9.

Shenoy MM, Teerthnath S, Karnaker VK, Girisha BS, Krishna Prasad MS, Pinto J. Comparison of potassium hydroxide mount and mycological culture with histopathologic examination using periodic acid-Schiff staining of nail clippings in the diagnosis of onychomycosis. Indian J Dermatolol Veneorol Leprol. 2008;74:226-9.

Das NK, Ghosh P, Das S, Bhattacharya S, Dutta RN, Sengupta SR. A study on the etiological agent and clinico-mycological correlation of fingernail onychomycosis in Eastern India. Indian J Dermatol. 2008;53(2):75-9.

Gupta M, Sharma NL, Kanga AK, Mahajan VK, Tegta GR. Onychomycosis: clinico-mycologic study of 130 patients from Himachal Pradesh, India. Indian J Dermatol Venereol Leprol. 2007;73(6):389-92.

Sachin Yadav, A. K. Saxena, Malini R. Capoor, V. Ramesh. Comparison of direct microscopic methods using potassium hydroxide, periodic acid Schiff, and calcofluor white with culture in the diagnosis of onychomycosis. Indian J Dermatol Venereol Leprol. 2013 Mar-Apr;79:2.

Machler BC, Kirsner RS, Elgart GW. Routine histologic examination for the diagnosis of onychomycosis: an evaluation of sensitivity and specificity. Cutis. 1998;61:217-9.

Liu HN, Lee DD, Wong CK. KONCPA: a new method for diagnosing tinea unguium. Dermatology. 1993;187:166-8.

Reisberger EM, Abels C, Landthaler M, Szeimies RM. Histological diagnosis of onychomycosis by PAS stained nail clipping. Br J Dermatol. 2003;148:749.

Singh G, Lavanya M. The reliability of periodic acid-Schiff staining in the diagnosis of onychomycosis. Indian J Dermatol Venereol Leprol. 2009;75(1):73.54.

Madhuri JT, Rao GR, Laxmi DJ. Onychomycosis: a significant medical problem. Indian J Dermatol. 2002;68:326-9.

Bokhari MA, Hussain I, Jahangir M, Haroon TS, Aman S, Khurshid K. Onychomycosis in Lahore, Pakistan. Int J Dermatol. 1999;38:591-5.

Alvarez MI, Gonzalez LA, Castro LA. Onychomycosis in Cali, Colombia. Mycopathologia. 2004;158:181-6.

Velez A, Linares MJ, Fernandez-Roldan JC. Study of onychomysis in Corboda, Spain. Prevaling fungi and pattern of infection. Mycopathalgia. 1997;137:1-8.

Williams HC. Epidemiology of onychomycosis in Britain. Br J Dermatol. 1993;129:101-9.