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ORIGINAL ARTICLE
Year : 2000  |  Volume : 66  |  Issue : 5  |  Page : 238-240

A clinico - Mycological evaluation of onychomycosis




Correspondence Address:
Vinod Sujatha


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Source of Support: None, Conflict of Interest: None


PMID: 20877087

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  Abstract 

Even though dermatophytes, especially Trichophyton rubrum, are most frequently implicated as the causative agents in onychomycosis, yeasts and moulds are increasingly recognised as causative pathogens. A study to analyse the morphological variants and mycological and cultural positivity of onychomycosis was carried out in 35 patients attending the Dermatology outpatient department of Command Hospital, Air Force, Banglore.


Keywords: Onychomycosis, Nail


How to cite this article:
Sujatha V, Grover S, Dash K, Singh G. A clinico - Mycological evaluation of onychomycosis. Indian J Dermatol Venereol Leprol 2000;66:238-40

How to cite this URL:
Sujatha V, Grover S, Dash K, Singh G. A clinico - Mycological evaluation of onychomycosis. Indian J Dermatol Venereol Leprol [serial online] 2000 [cited 2020 Jun 5];66:238-40. Available from: http://www.ijdvl.com/text.asp?2000/66/5/238/4932



  Introduction Top


Onychomycosis refers to fungal infection of nails with various aetiological agents, involving dermatophytes, yeasts and moulds. It represents 18.4% of onychopathies and about 30% of mycotic cuta­neous infections. [1]

Dermatophytes, especially Trichophyton rubrum are the most frequently implicated caus­ative agents in onychomycosis. Previously regarded as contaminants, yeasts are now increasingly rec­ognized as pathogens in finger nail infections, as are some moulds. [2] In view of this, a study was car­ried out to analyse the common morphologic pat­tern of onychomycosis and to evaluate the myco­logical and cultural positivity.


  Materials and Methods Top


Patients with clinical features of onychomy­cosis, attending the Dermatology out patient de­partment of Command hospital, Air Force, Banga­lore from September 1997 to June 1998 were in­cluded in the study.

A detailed history with particular emphasis on history of trauma, infections, occupation, diabe­tes mellitus and personal habits were taken.

The morphological types of onychomycosis were documented as DLSO, PSO, SWO & TDO. All of them were examined for evidence of other fun­gal infections or coexistent cutaneous diseases.

Hematological and urine examination and blood sugar estimation were done in all cases.

Nail clippings treated with 10% KOH for 24 hrs were examined under light microscope for the presence of fungal mycelia and spores. Fungal cul­ture of the nail material was done on Sabourauds peptone glucose agar, with cycloheximide, chloram­phenicol and gentamicin in all cases.


  Results Top


The age of the patients studied varied from 22-68yrs. 18 patients (51.43%) were within 20-40 yrs of age, 3 (8.5%) within 41-50yrs, 7(20%) within 51-60 yrs and 7 from 61-71 yrs age group.

The study group comprised 20 males and 15 females in the male to female ratio of 1.33: 1.

Duration of the disease at the time of pre­sentation varied from 2 months to 3 years. 24 pa­tients (68.57%) had complaints of < 1 year dura­tion, 6(17.14%) had complaints of 1-1'/ 2 years, 3 (8.58%) had 1 1 /2 2 years and 2(5.71%) had>2 years duration of complaints [Table - 1]

Finger nails only were involved in 17 cases (48.57%), toe nails only were involved in 11 (31.43%) cases. Both toe and finger nail involve­ment were present in 7 cases (20%). DLSO was the commonest morphological pattern seen in 32 (90.57%) cases, followed by PSO in 6 cases (17.14%). TDO was observed in 3 cases (8.58%), paronychia in 2 (5.71%) cases and SWO in 1 (2.86%) case respectively [Table - 1].

Right thumb was the commonest finger nail involved and it was seen in 17 cases (48.5%). Among the toe nails rt. big toe nail involvement was the commonest, which was observed in 14 (40%) cases.

KOH smear examination of nail material un­der microscope was positive for fungal filaments in 27 (77.14%) patients. 2 (5.71%) patients showed spores and pseudomycelia, indicating the presence of candida. In 6 patients (17.14%) the smear was negative [Table - 2].

Culture of nail material revealed growth in 21 (60%) samples. Aspergillus niger was grown in 10 (28.57%) cultures, Z. rubrum in 6 (17.14%), E. floccosum in 3 (8.58%) and Candida albicans in 2 (5.71%) cultures each. 14 (40%) patients had no growth on culture.

7 (20%) cases had associated diabetes mel­litus. Tinea pedis was co-existent in 5 (14.29%) cases, and Tcruris and Tmanum in 3 (8.58%) cases each. There were no immuno compromised cases.


  Discussion Top


Recently there had been a noticeable world­wide increase in the incidence of onychomycosis. This has been related to a variety of aetiologic fac­tors, including the rise in immunocompromised pa­tients, an aging world wide population and a rise in environmental risk factors secondary to life style changes. [3]

Prevalence of onychomycosis has been reported to increase with advancing age. 15-20% of the occurrence is found in patients aged 40-60 yrs and the incidence rises in those over 60 yrs of age. [4] In our study 18 patients were within 20-40 yrs age group (51.43%). This increased incidence in younger population could be because they are more often exposed to occupation related trauma, predispos­ing them to onychomycosis. They may also be com­paratively more cosmetic conscious than the older age group.

Various studies have shown no sex differ­ences in the prevalence of onychomycosis. [5] A higher incidence in males in our study may be because of the result of increased trauma and the greater use of occlusive footwear in males compared to females.

A high incidence of onychomycosis of the toe nails have been reported by various authors. [6] The increased incidence of finger nail involvement in our study may be because of the increased incidence of occupation related trauma or because the finger nail infection is more likely than the toe nail infection to arouse the patients concern, driving them to seek medical attention.

In the present study, the big toe nail was the commonest toe nail involved. This is in agree­ment with other studies [6] possibly because of its greater size predisposing to increased trauma.

The high incidence of DLSO pattern in our study (90.57%) is in accordance with other studies also. [6],[7]

Our study revealed a mycological positivity of 82.82% on direct microscopic examination. An­other study had reported a mycologic positivity of 63.3% in clinically suspected cases of onychomyco­sis. [6]

A 70% incidence of dermatophytes especially T.rubrum in the culture positive cases has been reported by some authors. [8],[9] In our study, although dermatophytes have been isolated from 42.86% of culture positive cases, majority (47.6%) showed the growth of Aspergillus niger . This higher incidence of Aspergillus niger may not be significant, as these organisms are ubiquitous in nature and a common contaminant in cultures. [10]

Candida albicans is reported as the com­monest cause of paronychial onychomycosis. [7] This is reflected in our study where all the paronychia cases grew Candida albicans on culture.

To conclude, our study has revealed a high relative incidence of male preponderance, finger nail onychomycosis, DLSO morphological pattern and T.rubrum among dermatophyte infections. However a longer study from a more representable popula­tion, preferably by including non-dermatology out patients, could reinforce or re-modulate the true picture of this fairly common condition.



 
  References Top

1.Achten G, Wanet Rouard J. Onychomycosis in the laboratory. Mykosen 1978; 21: 125-127.  Back to cited text no. 1    
2.Midgley G, Moore MK, Cook IC. Mycology of nail disorders. J Am Acad Dermatol 68-74.  Back to cited text no. 2    
3.Odom RB. Common superficial fungal infections in immunocompromised patients. J Am Dermatol 1994; 31: 56-59.  Back to cited text no. 3  [PUBMED]  
4.Proceeding & Transactions - 2nd international symposium on Onycho­mycosis. Florence, Italy. Int J Dermatol 1997; 36: 266-233.  Back to cited text no. 4    
5.Roberts DT. Prevalence of dermatophyte onychomycosis in UK: Re­sults of an omnibus survey. Brit 3 Dermatol 1992;126: 23-27.  Back to cited text no. 5    
6.AK Gupta, HC lain, Lynde CW, et al. Epidemiology of unsuspected onychomycosis in patients visiting dermatologists offices in Ontario, Canada - a multicentre survey of 2001 patients. Int J Dermat 1997; 36 783-787.  Back to cited text no. 6    
7.Zaug M, Bergstrasser N. Amrolfine in the treatment of Onychomycosis and dermatomycosis - an overview. Clin exp Dermatol 1992 ; 17: 61 - 70.  Back to cited text no. 7    
8.HC Williams. Epidemiology of onychomycosis in Britain. Br J Dermatol 1993; 129: 101-109.  Back to cited text no. 8    
9.Banerjee U, Sethi M, Pasricha IS. Study of onychomycosis in India. Mycoses 1990; 33: 411-415.  Back to cited text no. 9    
10.Jean Shadmy H, Pertz J. Deep fungal infections. Dermatology in General Medicine - Vol - II, Eds: Fitzpatrick, Arther I. Eisen, 4 th Edn, Mc Graw Hill Inc 1993; 2486.  Back to cited text no. 10    


Tables

[Table - 1], [Table - 2]



 

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