Onychomycosis in Eastern India - study in a peripheral tertiary care centre
Keywords:
KOH, onychomycosis, nondermatophytesAbstract
Objective To find out various clinical patterns, etiologic agents and to evaluate the clinicomycologic correlation. Patients and methods Two hundred and forty nine cases of clinically suspected onychomycosis were included in this study. Clinical patterns were noted and sample collected from most severely affected nail. They were subjected to direct microscopy and culture. Results Distal and lateral subungual onychomycosis was the commonest clinical pattern (56.6%) followed by proximal subungual onychomycosis (15.7%), total dystrophic onychomycosis (12.1%), white superficial onychomycosis (10.8%) and chronic paronychia (4.8%). 126 cases (50.6%) were confirmed by either microscopy or culture whereas 123 cases (49.4%) were negative by both. Dermatophytes were most common (55.9%) cause of onychomycosis. Amongst them Trichophyton rubrum was the most common isolate (65.9%). Candida albicans was important (79.2%) amongst the yeast isolates. Nondermatophytic moulds were involved in 15.5% of cases. Conclusion Onychomycosis might be an important cause of absenteeism amongst the working classes in this part of India. Yeasts and nondermatophytic moulds are gradually becoming an important cause of onychomycosis in different areas of the world. So, early diagnosis and initiation of antifungal treatment should be the approach to safeguard the social, emotional and physical well being of the patients.References
Weitzman I, Summerbell RC. The dermatophytes. Clin Microb Rev. 1995;8:240-59.
Scher P. Onycomycosis: A significant medical disorder. J Am Acad Dermatol. 1996;35:S2-S5.
Sharma S, Capoor MR, Deb M, Ramesh V, Agrawal P. Epidemiologic and clinicomycologic profile of onychomycosis from north India. Int J Dermatol. 2008;47:584-7.
Veer P, Patwardhan NS, Damle AS. Study of onychomycosis: Prevailing fungi and pattern of infection. Indian J Med Microbiol. 2007;25:53-6.
Chander J. Dermatophytosis. In: Chander J, editor. Textbook of Medical Mycology. 2nd ed. New Delhi: Mehta Publishers; 2002. p.100-101.
Kaur R, Kashyap B, Bhalla P. Onychomycosis--epidemiology, diagnosis and management. Indian J Med Microbiol. 2008;26:108-16.
Ahuja S, Malhotra S, Charoo H. Etiological agents of onychomycosis from a tertiary care Hospital in central Delhi, India. Indian J Fundamental and Appl Life Sci. 2011;1:11-4.
Gupta M, Sharma N, Kanga AK et al. Onychomycosis, clinicomycologic study of 130 patients from Himachal Pradesh, India. Indian J Dermatol Venereal Leprol. 2007;73:389-92.
Vinod S, Grover S, Dash K, Singh G. A clinico-mycological evaluation of onychomycosis. Indian J Dermatol Venereal Leprol. 2006;66:238-40.
Rippon JW. Dermatophytosis and dermatomycosis. In: Rippon JW, editor. Medical Mycology. 3rd ed. Philadelphia: WB Saunders; 1988. p.169-275.
Madhuri JT, Rao GR, Lakshmi DJ. Onychomycosis. A significant medical problem. Indian J Dermatol. 2002;68:326-9.
Bokhari AM, Hussain I, Jahangir M et al. Onychomycosis in Lahore, Pakistan. Int J Dermatol. 1999;38:591-5.
Garg A, Venkatesh V, Singh M. Onychomycosis in central India. A clinicoetiological correlation. Int J Dermatol. 2004;43:498-502.
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.
Gupta AK, Jain HC, Lynde CW et al. Prevalence and epidemiology of onychomycosis. J Am Acad Dermatol. 2000;43:244-8.
Illikit M. Onychomycosis in Adana, Turkey: A five year study. Int J Dermatol. 2005;44:851-4.
Adhikari L, Dasgupta A, Pal R, Singh TSK. Clinico-etiological correlates of onychomycosis in Sikkim. Indian J Pathol Microbiol. 2009;52:194-7.
Karmakar S, Kalla G, Joshi KR, Karmakar S. Dermatophytes in a desert district of western Rajasthsan. Indian J Dermatol Venereal Leprol. 1995;61:280-3.
Malik NA, Raja N, Nasiruddin. Nondermatophyte moulds and yeast as causative agents in onychomycosis. J Pak Assoc Dermatol. 2009;19:74-8.
Yehia MA, El-Ammawai TS, Al-Majidi KM et al. The spectrum of fungal infection with reference of dermatophytosis in the capital area of Kuwait- a retrospective analysis. Mycopathologia. 2010;169:241-6.
Heikkila H, Stubb S. The prevalence of onychomycosis in Finland. Br J Dermatol. 1995;133:699-703.
Sias G, Juggla A, Peyri J. Prevalence of dermatophytic onychomycosis in Spain: a cross sectional study. Br J Dermatol. 1995;132:758-61.
Roberts DT. Prevalence of dermatophyte onychomycosis in United Kingdom: result of an omnibus survey. Br J Dermatol. 1992;126:23-7.
Williams HC. The epidemiology of onychomycosis in Britain. Br J Dermatol. 1993;129:101-9.
Kemma ME, Elewski BE. Epidemiologic study of superficial fungal diseases. J Am Acad Dermatol. 1996;35:539-42.