Onychomycosis in Taiwan

Global prevalence of onychomycosis in general and special populations: An updated perspective

BACKGROUND

Onychomycosis is a chronic nail disorder commonly seen by healthcare providers; toenail involvement in particular presents a treatment challenge.

OBJECTIVE

To provide an updated estimate on the prevalence of toenail onychomycosis.

METHODS

We conducted a literature search using PubMed, Embase and Web of Science. Studies reporting mycology-confirmed diagnoses were included and stratified into (a) populations-based studies, and studies that included (b) clinically un-suspected and (c) clinically suspected patients.

RESULTS

A total of 108 studies were included. Based on studies that examined clinically un-suspected patients (i.e., with or without clinical features suggestive of onychomycosis), the pooled prevalence rate of toenail onychomycosis caused by dermatophytes was 4% (95% CI: 3-5) among the general population; special populations with a heightened risk include knee osteoarthritis patients (RR: 14.6 [95% CI: 13.0-16.5]), chronic venous disease patients (RR: 5.6 [95% CI: 3.7-8.1]), renal transplant patients (RR: 4.7 [95% CI: 3.3-6.5]), geriatric patients (RR: 4.7 [95% CI: 4.4-4.9]), HIV-positive patients (RR: 3.7 [95% CI: 2.9-4.7]), lupus erythematosus patients (RR: 3.1 [95% CI: 1.2-6.3]), diabetic patients (RR: 2.8 [95% CI: 2.4-3.3]) and hemodialysis patients (RR: 2.8 [95% CI: 1.9-4.0]). The prevalence of onychomycosis in clinically suspected patients was significantly higher likely due to sampling bias. A high degree of variability was found in a limited number of population-based studies indicating that certain pockets of the population may be more predisposed to onychomycosis. The diagnosis of non-dermatophyte mould onychomycosis requires repeat sampling to rule out contaminants or commensal organisms; a significant difference was found between studies that performed single sampling versus repeat sampling. The advent of PCR diagnosis results in improved detection rates for dermatophytes compared to culture.

CONCLUSION

Onychomycosis is an underrecognized healthcare burden. Further population-based studies using standardized PCR methods are warranted.

A Study of Onychomycosis at a Tertiary Care Hospital in Eastern Bihar

Background:

Onychomycosis (OM) is a major public health problem which is increasing worldwide. It is associated with high morbidity and causes physical, psychological, and occupational problems in patients.

Aims:

This study aims to study the pattern of etiological agents, clinical features, and severity assessment of OM in this part of India.

Materials and Methods:

Sixty eight clinically suspected patients with positive potassium hydroxide and fungal culture were studied.

Results:

Males were infected more often than females (1.61:1). The most common age group affected was 21–40 years. Finger nails were affected more frequently than toe nails. Distal and lateral subungual OM was the most common (48 cases, 70.59%) clinical pattern. For most of the patients (66.18%), nail involvement was severe. Discoloration was the most common (67 cases, 98.53%) change, followed by subungual hyperkeratosis (51 cases, 75%). Principal causative agents were dermatophytes (55 cases, 80.88%) with Trichophyton rubrum being the most common one (35 cases, 51.47%). In 9 (13.23%) cases, Candida albicans, in 6 (8.82%) Aspergillus niger and in 1 (1.47%) case Acremonium sp. (AC) have been isolated as the sole causative agent. In 2 (2.94%) cases, mixed infection with dermatophyte and Aspergillus and in 1 (1.47%) case dermatophyte and Candida were noted.

Conclusion:

Although dermatophytes were the most common causative agent of OM, nondermatophytic molds, and yeasts were also encountered. The genus and species identification helps in the proper diagnosis and management. Morphological changes in nail may help in presumptive diagnosis of OM.

Clinico-aetiologic profile of Onychomycoses in a tertiary care centre in northeast India

Onychomycosis refers to fungal nail infection. Despite a clearly diseased appearance, it is often deemed a merely cosmetic problem of relatively minor importance. However, it may result in much psychological or occupational turmoil, diminished self-esteem and resulting reluctance for public interaction. A wide number of factors determine the treatment outcome and its prevalence varies greatly. Our study was conducted between January 2011 and December 2014 in northeast India. Of 243 patients presenting with nail abnormalities, 158 (65%) were positively diagnosed by either direct microscopy or culture or both. A distal lateral subungual infection was the most predominant clinical pattern observed, and the most frequent aetiological agents were dermatophytes, of which Trichophyton rubrum was predominant.

A comparative study of dermatophyte infections in Bursa, Turkey

A total of 555 specimens from 372 patients with symptoms compatible with superficial mycosis were included in this study. Those from patients clinically diagnosed as having dermatomycosis were thoroughly investigated by mycological examinations in the laboratory, including microscopic studies of KOH mounts and cultivation of the samples in culture. The results of this study and a previous study in our hospital conducted in 1980 were compared with respect to clinical presentation and etiological agents. Onychomycosis was the most common clinical form of dermatomycoses, and Trichophyton rubrum was the most common pathogen in this study.

A study on the etiological agent and clinico-mycological correlation of fingernail onychomycosis in eastern India

Background:

Onychomycosis manifests itself in various forms, notably onychodystrophy, onycholysis, subungual hyperkeratosis, or nail-plate discoloration. Not necessarily nail changes mentioned here should always be of fungal origin.

Objective:

The present study is planned to get an idea about etiological agent and clinical correlation in fingernail onychomycosis.

Materials and Methods:

Nail-clipping and subungual debris of patients with above mentioned nail changes were subjected to KOH preparation. Culture was done on SDA and SDCCA media. Species identification was done by colony character, pigment production, LCB staining, and some special tests like germ tube test, etc.

Results:

Out of 85 cases, 44 cases showed the growth of fungus, amounting to 51.76% positivity. Among those 44 cases, the infective fungal agents were predominantly dermatophytes (50%), and the rest were due to yeasts (27.27%) and moulds (22.72%). Among the different species, Trichophyton rubrum (29.54%) accounted for the majority of dermatophytes; Candida albicans (11.78%) was the predominant yeast; and Aspergillus niger (18.18%) the commonest mold. No significant association could be established between the different fungal species and various clinical manifestations. Positive results were found more with fungal culture (95.45%) than KOH preparation (63.64%).

Conclusion:

The results show that nail changes are not always a reliable marker for predicting the causative organism, and relying only on the clinical manifestation (i.e., pattern of nail changes) in the diagnosis of onychomycosis is often misleading. The present study highlights the need for microbiological confirmation in case of onychomycosis.

Medically important fungi found in hallux nails of university students from Cali, Colombia

The presence of medically important fungi was studied in hallux nails scrapings obtained from 504 students (204 males, 300 females) of three universities in Cali. Specimens were examined by direct microscopic examination and fungal culture. Medically important fungi were found in 49 (9.7%) students, 24 (4.8%) had onychomycosis while the rest did not have nail lesions. Trichophyton rubrum was the most commonly isolated fungi in students with lesions, where as T. mentagrophytes predominated in healthy nails. Most of the students with fungi were males. The prevalence of fungi was higher in individuals between 26 and 35 years. No association was observed between fungi and practicing sports or undergoing pedicures. These results suggest that dermatophytes can be found in healthy hallux nails, which can be reservoirs of pathogenic fungi.

Onychomycosis: a 3-year clinicomycologic hospital-based study

BACKGROUND

Despite onychomycosis being an established entity, only a few studies are available from the Indian subcontinent. The authors investigated the comprehensive pattern of the condition.

AIM

To investigate the epidemiologic, clinical, and mycologic factors associated with onychomycosis in 50 patients using a prospective study design.

METHODS

Fifty patients with potassium hydroxide-positive tests were evaluated according to a predetermined protocal recording details of epidemiologic, clinical, and mycologic characteristics. The collected data were analyzed to determine the correlation of various parameters.

RESULTS

Distal and lateral subungual onychomycosis, total dystrophic onychomycosis, and superficial white onychomycosis variants of onychomycosis were identified, mostly in men 21-30 years of age (mean age, 34.5 years). Epidemiologic characteristics were instrumental to either initiate, perpetuate, or disseminate the disease process. Trichophyton rubrum and Trichophyton mentagrophytes were the main causative dermatophytes; yeasts and molds were less common.

CONCLUSIONS

Recognition of onychomycosis is less difficult providing the clinician is aware of the entity. Should the etiologic diagnosis be made, its eradication is desirable to surmount its implication in the society at large.