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Clinical and Microbiological Study of Tinea Unguium in A Tertiary Care Centre
Clinical and Microbiological Study of Tinea Unguium in A Tertiary Care Centre
Arti Agrawal1*, Uma Shanker2, Ankur Goyal1, P.K.Singh2, Suneel Bhooshan1 and D.N.Pandey3
1
Department of Microbiology, S.N.Medical College, Agra, India
2
Department of skin and VD, S.N.Medical College, Agra, India
3
Department of Obs and Gynae, S.N. Medical College, Agra, India
*Corresponding author
ABSTRACT
Introduction
Onychomycosis accounts for about 20-40% Its presentation varies according to the route
of all onychopathies and about 30% of all of invasion [7, 8] which may be distal and
cutaneous fungal infections [1]. Worldwide it lateral subungual onychomycosis, proximal
affects about 5% population [2]. In India, subungual onychomycosis, superficial white
incidence of infection varies from 0.5 to 5% onychomycosis, total dystrophic
[3, 4]
. Prevalence in HIV patients is higher as onychomycosis and endonyx. These types
compared to others [5]. Its incidence is can clinically present as subungual
increasing worldwide due to changes in hyperkeratosis, onycholysis, discolouration,
living style like occlusive footwear usage, thickening or dystrophy of nail plate. This
sports club facilities etc [6]. condition needs to be differentiated from
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Fungal infection at a site other than nail (like because fungi grow proximally and sample
tinea mannum, tinea pedis, etc) was found to is taken from the distal part of nail where
be more associated with tinea unguium and chances of getting viable fungus are very
this association was statistically significant. low.
Jesudanam TM [11] reported the same
association in 21.07% patients. Disease (as diagnosed by KOH and/or
culture) was found in 65% cases while Nilay
In our study, professionals, shop owners and et al [19] found disease in only 51.76%. We
clerks were found to be most commonly propose that KOH should be coupled with
affected because they use to wear shoes and culture to avoid false positive clinical
socks for long durations. Mashkoor et al [13] diagnosis of onychomycosis, as also
found infection to be more common in suggested by Fueilhade [20]. In our study,
students (24%), housewives (13%), farmers dermatophytes (57%) were found to be the
(11%) and labourers (6%). most common causative agent followed by
non-dermatophytes (21.40%) and yeast
Contact with animals and soil was found to (6.20%). Similarly, in most cases,
be more associated with infection. Gupta M dermatophytic infection was found in 50%
[18]
also reported association of cases by Nilay et al [19], while Jesudanam
onychomycosis with soil contact in 60.78% TM [11] reported Candida in maximum
cases. (56.74%) and Sujatha V [12] reported
Aspergillus niger in maximum (28.5%)
Distal and lateral subungual onychomycosis cases.
(DLSO) was the commonest type of
onychomycosis accounting for 61.54% of Most common isolate in culture in the study
cases in our study. Same results were was found to be Trichophyton rubrum
reported in studies by Aghamirian M[10] (30.80%). This species is reported
(48.4%), Sujatha V[12] (90.57%) while worldwide as most common causative agent,
Jesudanam TM[11] found candidal as supported by Mashkoor et al [13]
onychomycosis (58.82%) to be the most (44.44%), and Grover S [14] (42.9%). Within
common type followed by DLSO (38.72%) non-dermatophytes, Aspergillus species
type. (9.20%) is the most common isolate in our
study, while Nilay et al [19] reported Candida
Most patients presented to us with as the most common non-dermatophyte in
subungual hyperkeratosis (38.46%), 22.72%.
followed by dystrophic changes (26.20%).
While Gupta M [18] found discoloration in Conclusion: Clinical diagnosis of
92.3% and subungual hyperkeratosis in onychomycosis should be confirmed by
68.5% cases. KOH and fungal culture to minimize error in
clinical diagnosis. Culture helps in
KOH showed more sensitivity (89.23%) as prescribing species specific antifungal for
compared to culture (84.62%).This finding optimal results. Exophiala speices which
is in concordance with the results of was isolated in culture in a patient of
Jesudanam TM et al [11] (KOH 93%, Culture onychomycosis in this study is a rare
87.2%), Sujatha V[12] (KOH 77.14%, culture finding. Further studies need to be done to
60%)and Gupta M[18] et al (KOH 59.2%, establish an association of Exophiala spieces
Culture 37.4%). Culture positivity is low in causation of onychomycosis.
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Table.3 Distribution of patients according to the type of footwear worn by the patient.
Diseased Non-diseased
Footwear Total
No. % No. %
Shoes 34 52.31 15 47.69 49
Slippers 31 42.86 20 57.14 51
Total 65 65.00 35 35.00 100
²=0.813 df=1 p>0.05
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