- Visibility 188 Views
- Downloads 24 Downloads
- Permissions
- DOI 10.18231/2581-4729.2018.0053
-
CrossMark
- Citation
Epidemiological and diagnostic study of onychomycosis
- Author Details:
-
R. Sandeep Kumar
-
A. Vijaya Mohan Rao
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 floccosum and 2.43% each positivity with Fusarium and Trichophyton violaceum.
Conclusions: If there is any delay in the diagnosis of onychomycosis, it can lead to total nail dystrophy which may not allow the nail to regain its normal architecture in spite of adequate treatment. Results indicate that the combination of PAS and KOH were superior. By knowing various epidemiological profiles of onychomycosis, various clinical forms of onychomycosis and the role of different species to prevent morbidity.
Keywords: Onychomycosis, KOH mount, PAS staining, Fungal culture.
References
- Madhuri T. Jesudasam, Raghu Rama Rao G, Loga Lakshmi D, Ratna Kumari G. Onychomycosis: A significant medical problem. IJDVL. 2002;68:326-9. Chaitra P, Bala NK. Onychomycosis: Insights in disease development. Muller J Med Sci Res. 2014;5:101-5.
- M. Manjunath Shenoy, S. Teerthanath, Vimal K. Karnaker, B.S. Girisha, M.S. Krishna Prasad, Jerome Pinto. Comparison of potassium hydroxide mount and mycological culture with histopathologic examination using periodic acid-Schiff staining of the nail clippings in the diagnosis of onychomycosis. Indian J Dermatol Venereol Leprol. 2008;74(3):226-229.
- Liu HN, Lee DD, Wong CK, KONCPA: A new method for diagnosing tinea unguium. Dermatology. 1993;187:166 -68.
- Mulay DN, Garg AK. A study on the Trichophyton simii Infections in Man at Delhi. IJDVL. 1970;36:176-81.
- Kaur IS. Incidence of Dernatophytosis in Chandigarh and Surrounding Areasx. IJDVL. 1970;36:143-46.
- Maheswari Amma S. Paniker CKJ., Gopinathan. T Studies of dermatomycoses in Calicut (Kerala)(Clinical and mycological investigation). Ind J Pathol Microbiol. 1982;25:11-7.
- Karmakar S. Kalla G, Joshi KR. Karmakar S. Dermatophytosis in a desert district of western Rajasthan. Indian J. Dermatol Venereal Leprol. 1995;61:280-3.
- 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.
- Mohammad Reza Aghamirian, Seyed Amir Ghiasian. Onychomycosis in Iran: Epidemiology, causative agents and clinical features. J Med Mycol. 2010;51:23-29.
- Mohammad Reza Aghamirian, Seyed Amir Ghiasian.
- Onychomycosis in Iran: Epidemiology, causative agents and clinical features. J Med Mycol. 2010;51:23-29.
- Mohammad Reza Aghamirian, Seyed Amir Ghiasian. Onychomycosis in Iran: Epidemiology, causative agents and clinical features. J Med Mycol. 2010;51:23-29.
- Bokhari MA, Hussain I, Jahangir M, Haroon TS, Aman S, Khurshid K. Onychomycosis in Lahore, Pakistan. Int J Dermatol. 1999;38:591-5.
- Yadav P, Singal A, Pandhi D, Das S. Clinicomycological study of dermatophyte toenail onychomycosis in New Delhi, India. Indian J Dermatol. 2015;60:153-8.
- Amit Garg, Vimala Venkatesh, Mastan Singh, Kushal P. Pathak, Gyan P. Kaushal, Surendra K. Agrawal. Onychomycosis in central India: Aclinic etiological correlation. IJD. 2004;43:498-502.
- Raghavendra KR, Yadav D, Kumar A, Sharma M, Bhuria J, Chand AE. The nondermatophyte molds: Emerging as leading cause of onychomycosis in south-east Rajasthan. Indian Dermatol Online J. 2015;6:92-7.
- 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;389-92.
- Macit IIkit. Onychomycosis in Adana, Turkey: A 5 year study. IJD. 2005;44:851-854.
- Dogra S, Bhushan Kumar, Anil Bhansali, Anenaloke Chakrabarty. Epidemiology of onychomycosis in patients with diabetes mellitus in India. IJD. 2002;41:647-651.
- Veer P, Patwardhan NS, Damle AS. Study of onychomycosis: prevailing fungi and pattern of infection. Indian J Med Microbiol. 2007;25:53-6.
- Mohanty JC, Mohanty SK, Sahoo RC, et al. Diagnosis of superficial mycoses by direct microscopy – A statistical evaluation. IJDVL. 1999;65:72-4.
- Das NK, Ghosh P, et al. A study on the aetiological agent and clinico- mycological correlation of finger nail onychomycosis in eastern India. Indian J Dermatol. 2008;53:75-9. R. Sandeep Kumar et al. Epidemiological and diagnostic study of onychomycosis IP Indian Journal of Clinical and Experimental Dermatology, July-September, 2018;4(3):250-259 259
- Niranjan H. P., N. Padmaja, Priyanka. B. Study of onychomycosis at a tertiary care hospital in South India, Journal of Evolution of Medical and Dental Sciences. 1;5;2012;823-829.
- Vijaya D, Anandkumar BH, Geetha SH. Study of onychomycosis. Indian J Dermatol Venereol Leprol. 2004;70:185-6.
- Lawry MA, Haneke E, Strobeck K, Martin S, Zimmer B, Romano PS. Methods for diagnosing onychomycosis – A comparative study and review of literature. Arch Dermatol. 2000;136:1112-1115.
- Hana Alkhayat, Nourah Al-Sulaili, Elizabeth O’Brein, Catherine McCuaig, Kevin Watters. The PAS stain for routine diagnosis of onychomycosis. Bahrain Med Bull. 2009;31(2):1 -7.
- Machler BC, Kirsner RS, Elgart GW. Routine histologic examination for the diagnosis of onychomycosis: An evaluation of sensitivity and specificity. Cutis. 1998;6:217-9.
- Hussein MM, Hassab-EL-Naby, Ibrahim Mohamed Ibrahim Shaheen, Hamed Mohammed Abdo, Hazem Ahmed Mohamed EL- Shafey. Comparative study for the reliability of potassium hydroxide mount versus nail clipping biopsy in diagnosis of onychomycosis. The Gulf J of Dermatol & Venereol. 2011;18:14-22.
- Jeffrey M. Weinberg, Evelyn K. Koestenblatt, William D. Tutrone, Hillarie R. Tishler, Lily Najarian. Comparison of diagnostic methods in the evaluation of onychomycosis. J Am Acad Dermatol. 2003;49:193-7.
- Reisberger EM, Abels C, Landthaler M, Szeimies RM. Histopathological diagnosis of onychomycosis by periodic acid Schiff stained nail clippings. BJD. 2003;148:749-54.
- Jung, M Y; Shim, J H; Lee, J H; Yang, J M; Lee, DY; Jang, KT; Lee, N Y; Lee, JH; Park, JH; ark, K k ;Comparison of diagnostic methods for onychomycosis, and proposal of a diagnostic algorithm, Clinical and Experimental Dermatology. 2015;40(5):479-484.
- Hull PR, Gupta AK, Summerbell RC. Onychomycosis: An evaluation of three sampling methods. JAM Acad Dermatol. 1998;39:105-17.
How to Cite This Article
Vancouver
Kumar RS, Rao AVM. Epidemiological and diagnostic study of onychomycosis [Internet]. IP Indian J Clin Exp Dermatol. 2018 [cited 2025 Oct 23];4(3):250-259. Available from: https://doi.org/10.18231/2581-4729.2018.0053
APA
Kumar, R. S., Rao, A. V. M. (2018). Epidemiological and diagnostic study of onychomycosis. IP Indian J Clin Exp Dermatol, 4(3), 250-259. https://doi.org/10.18231/2581-4729.2018.0053
MLA
Kumar, R. Sandeep, Rao, A. Vijaya Mohan. "Epidemiological and diagnostic study of onychomycosis." IP Indian J Clin Exp Dermatol, vol. 4, no. 3, 2018, pp. 250-259. https://doi.org/10.18231/2581-4729.2018.0053
Chicago
Kumar, R. S., Rao, A. V. M.. "Epidemiological and diagnostic study of onychomycosis." IP Indian J Clin Exp Dermatol 4, no. 3 (2018): 250-259. https://doi.org/10.18231/2581-4729.2018.0053