Epidemiological and diagnostic study of onychomycosis

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.