Clinico-aetiological profile of onychomycosis at a tertiary care centre in northeast India

Onychomycosis (OM) represents nearly 50 percent of all nail disorders and accounts for about 30 percent of all superficial fungal infections of the skin. Often it becomes a nidus for recurrent superficial skin infections. Aims and Objectives: To study the clinico- aetiological profile of onychomycosis and identify various predisposing factors. Materials and Methods: A hospital-based, cross-sectional prospective study from October 2010 to March 2012 in Department of Dermatology, Venereology and Leprology in collaboration with Department of Microbiology at a tertiary hospital in Imphal, Manipur. Demographic profile, detailed history, risk factors, clinical examinations, investigations which consisted of direct microscopy with 10% potassium hydroxide (KOH), culture in Sebouraud's dextrose agar (SDA), SDA incorporated with chloramphenicol (0.05mgs/ml) and cyclohexamide (0.5mg/ml) were taken. Results: A total of 122 (54 male and 68 female) patients diagnosed with onychomycosis were included in this study. Maximum number of our patients (56.6%) was between 21 and 40 years of age. Male to female ratio was 1:1.3. Housewives form the predominant group accounting for 41.9%, followed by students (28.7%) and farmer (13.9%). Some of the predisposing factors associated were smoking (25.4%), trauma (31.2%), concomitant fungal infection (59%) and family history of superficial mycosis (16.4%). DLSO (82%) was the commonest morphological pattern of OM, followed by TDO (9.8%). Trichophyton sp (44.3%) forms the commonest aetiological agent of OM. NDMs constituted 36.9% of the total nail cases in our study. Aspergillus sp (73.3%) was the most common isolate among the nondermatophyte molds (NDM), followed by Mucor sp (11.1%). Dermatophytes (45%) were the commonest cause of DLSO, Candida sp were responsible for all the cases of PSO. Conclusion: Dermatophytes are still the commonest cause of onychomycosis but NDMs and yeast can no longer be ignored as one of the causative organisms of OM.