DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20210442

A study of etiology and epidemiology of onychomycosis from a tertiary care hospital in North India

Shivani Tyagi, Neha ., Ravinder Kaur, Deepti Rawat

Abstract


Background: Onychomycosis is the fungal infec­tion of nail of which the incidence varies from 0.5-12% in India and around 5% worldwide.Onychomycosis is considered to be gender and age-related disease, being commoner in males and older adults in both genders. Apart from dermatophytes, other fungal agents like yeasts and non-dermatophyte moulds are increasingly being acknowledged as important etiological agents for the same. Our aim was to study the etiology of the nail infections in patients presenting to a dermatology department in a tertiary care hospital in central Delhi.

Methods: This study included nail samples from patients of various age groups with suspected onychomycosis attending dermatology clinics in our hospital over a period of 2 years. For all samples, KOH wet mount microscopic examination followed by culture on Sabouraud’s dextrose agar was done. Growth of filamentous fungi and yeast obtained on SDA were identified using conventional microbiology techniques. Statistical analysis was performed using Epitools.

Results: Of the total 1061 nail samples received, maximum prevalence seen in patients of age group 21 to 50 years. The positivity of onychomycosis was 57.02%. Out of culture positive samples, 24.62% grew dermatophytes and 75.37% grew non-dermatophytes (31.40% yeasts and 43.97% non-dermatophyte moulds). Trichophyton mentagrophytes was the most common (59.73%) dermatophyte followed by T. rubrum (23.49%) while among non-dermatophyte moulds; Aspergillus niger (20.68%) was the most common followed by A. flavus (16.54%) and others. Common yeasts included Candida spp. (65.79%) and Trichosporon spp. (28.95%).

Conclusions: Non- dermatophytes are emerging as major etiological agents of onychomycosis which may be accounted various host factors. So, it becomes important to correctly identify the causative fungi to ensure appropriate treatment.


Keywords


Onychomycosis, Non-dermatophyte moulds, Dermatophytes

Full Text:

PDF

References


Banik A, Durairaj E, Lyngdoh WV, Khyriem AB, Sabhapandit D. Clinico aetiologic profile of Onychomycoses in a tertiary care centre in northeast India. Trop Doct. 2018;48:136-2.

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.

Kaur R, Kashyap B, Bhalla P. Onychomycosis-Epidemiology, diagnosis and management. Indian J Med Microbiol. 2008;26:108 16.

Zaias N. Onychomycosis. Dermatol Clin. 1985;3:445 60.

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

Murray SC, Dawber RP. Onychomycosis of toenails: Orthopaedic and podiatric considerations. Australas J Dermatol. 2002;43:105 12.

Karmakar S, Kalla G, Joshi KR, Karmakar S. Dermatophytoses in a desert district of Western Rajasthan. Indian J Dermatol Venereol Leprol. 1995;61:280 3.

Veer P, Patwardhan NS, Damle AS. Study of onychomycosis: Prevailing fungi and pattern of infection. Indian J Med Microbiol. 2007;25:53 6.

Heikkla H, Stubb S. The prevalence of onychomycosis in Finland. Br J Dermatol. 1995;133:699-703.

Yadav P, Singal A, Pandhi D, Das S. Clinico-mycological study of dermatophyte toenail onychomycosis in New Delhi, India. Indian J Deramatol. 2015;60:153-8.

Asifa N, Farhath K. Current mycological profile of onychomycosis in Kashmir valley: A hospital-based study. J Lab Physicians. 2017;9:190-4.

Gupta AK, Daniel CR. Factors that may affect the response of onychomycosis to oral antifungal therapy. Australas J Dermatol. 1998;39:222-4.

Tosti A, Piraccini BM, Lorenzi S. Onychomycosis caused by nondermatophyte molds: clinical features and response to treatment of 59 cases. J Am Acad Dermatol. 2000;42:217-24.

Veer P, Patwardhan NS, Damle AS. Study of onychomycosis: prevailing fungi and pattern of infection. Indian J Med Microbiol. 2007;25:53-6.

Kaur R, Kashyap B, Bhalla P. A Five-Year Survey of Onychomycosis in New Delhi, India: Epidemiological and Laboratory aspects. Indian J Dermatol. 2007;52:39-42.

Niranjan HP, Padmaja N, Priyanka BV. Study of Onychomycosis at a Tertiary Care Hospital in South India. J Evol Med Dent Sci. 2012;1:823-9.

Chetana K, Menon R, David BG, Ramya MR. Clinicomycological and histopathological profile of onychomycosis: A cross-sectional study from South India. Indian J Dermatol. 2019;64:272-6.

Chiacchio ND, Suarez MV, Madeira CL, Loureiro WR. An observational and descriptive study of the epidemiology of and therapeutic approach to onychomycosis in dermatology offices in Brazil. An Bras Dermatol. 2013;88:1-12.

Soltani M, Khosravi AR, Shokri H, Sharifzadeh A, Balal A. A study of onychomycosis in patients attending a dermatology center in Tehran, Iran. J Mycol Med. 2015;25:e81-7.

Bitew A, Wolde S. Prevalence, Risk Factors, and Spectrum of Fungi in Patients with Onychomycosis in Addis Ababa, Ethiopia: A Prospective Study. J Trop Med. 2019;6.

Welsh O, Welsh E, Ocampo-Candiani J, Gomez M, Vera Cabrera L. Dermatophytoses in Monterrey, Mexico. Mycoses. 2006;49:119-23.

Rudy SJ. Superficial fungal infections in children, adolescents. Nurse Pract Forum. 1999;10:56-66.

Narain U, Bajaj AK. Onychomycosis: role of non dermatiophytes. Int J Adv Med. 2016;3:643-7.

Motamedi M, Ghasemi Z, Shidfar MR, Hosseinpour L, Khodadadi H, Zomorodian K et al. Growing incidence of Non- dermatophyte Onychomycosis in Tehran, Iran. Jundishapur J Microbiol. 2016;9:e40543.

Nouripour-Sisakht S, Mirhendi H, Shidfar MR, Ahmadi B, Rezaei-Matehkolaei A, Geramishoar M et al. Aspergillus species as emerging causative agents of onychomycosis. J Mycol Med. 2015;25:101-7.

Grover WCS, Roy CP. Clinico-mycological profile of superficial mycosis in a hospital in north east India. Med J Armed Forces India. 2003;59:114-6.