Fungal Nail Infections: Spectrum of Aetiologic Agents and Pattern of Lesions

Abstract

Objective: Worldwide, fungal nail infections have been on the increase, with social, cultural and economic factors contributing to it. Information on the spectrum of fungal nail infection is sparse in Nigeria. This study was carried out to establish the infection rates, aetiology and clinical types of onychomycosis in Calabar. Methods: Subjects were drawn from manicure and pedicure salons, farming settlements, mechanic workshops and dermatology clinic. A structured questionnaire was administered to participants for demographic data. Nail scrapings and clippings were obtained from subjects under standard aseptic procedure. Samples were pulverized and subjected to microscopy and culture. Standard mycological techniques were used to identify and characterize isolates. Results: Out of the 32.7% infection rates in the study, males 33.8%% were more infected than females 32.3% and subjects aged 41-50 years had the highest rate of infections. Candida species were more prevalent 63.6% than dermatophytic moulds 36.4%. Trichophyton rubrum was the most prevalent 18.2% dermatophyte. The distribution of pathogenic isolates on fingernails 45.5% and toenails 42.4% was statistically significant (χ2 =7.2, p= 0.03). Disto-lateral subungual onychomycosis (DLSO) 51(50.5%) was the most common type of nail lesion but most of the isolates 14(42.4%) were recovered from TDO.

Conclusion: Onychomycosis affected more adults than adolescents of both sexes in our locality. Candida species are becoming prevalent aetiologic agents of these infections, and their importance should not be overlooked in the management of patients. J Microbiol Infect Dis 2016;6(1): 23-27

Keywords

• Onychomycosis,aetiologic agents,lesion types

References

1. 1. Reiss E, Shadomy HJ, Lyod GM. Dermatophytosis and dermatomycoses (Superficial cutaneous mycoses): In: Fundamental medical mycology 2012; 1st ed. John Wiley & Sons, Inc. Pp. 525-563.
2. 2. Gupta AK, Ricci MJ. Diagnosing onychomycosis. Dermatol Clin 2006; 24(3): 365–9.
3. 3. De Berker D. Clinical practice. Fungal nail disease. N Engl J Med 2009;360:2108-2116.
4. 4. Havlickova A, Czaika VA, Friedrich M. Epidemiological trends in skin mycoses worldwide. Mycoses. 2008;51S4:2–15.
5. 5. Grover C, Khurana A. Onychomycosis: newer insights in pathogenesis and diagnosis. Indian J Dermatol Venereol Leprol 2012;78:263-270.
6. 6. Tosti A. Onychomycosis, Medscape, Apr 2012.
7. 7. Gupta AK, Paquet M, Simpson FC. Therapies for the treatment of onychomycosis. Clin Dermatol 2013;31:544-554.
8. 8. Friedlander SF, Chan YC, Chan YH, Eichenfield LF. Onychomycosis does not always require systemic treatment for cure: a trial using topical therapy. Pediatr Dermatol 2013;30:316- 322.

9. 9. Ghannoum MA, Hajjeh RA, Scher R, et al. A large-scale North American study of fungal isolates from nails: the frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns. J Am Acad Dermatol 2000;43:641–648
10. 10. Faergemann J, Correia O, Nowicki R, Ro BI. Genetic predisposition - understanding underlying mechanisms of onychomycosis. J Eur Acad Dermatol Venerol 2005;19:17-19.
11. 11. Walid MS. A Simple and Affordable Technique for Treating Fungal Nail Infection: Case Report. WebmedCentral DERMATOLOGY 2012;3:WMC003594 .
12. 12. Faergemann J, Baran R: Epidemiology, clinical presentation and diagnosis of onychomycosis. Br J Dermatol; 2003; 149 Suppl. 65:1-4.
13. 13. Elewski BE. Clinical pearl: diagnosis of onychomycosis. J Am Acad Dermatol. 1995;32:500-501.
14. 14. Carney C, Tosti A, Daniel R, et al. A new classification system for grading the severity of onychomycosis: Onychomycosis Severity Index. Arch Dermatol 2011;147:1277-1282.
15. 15. Singh G, Haneef NS, Uday A. Nail changes and disorders among the elderly. Indian J Dermatol Venereol Leprol 2005;71:386-392.
16. 16. Tosti A, Piraccini BM, Lorenzi S, Iorizzo M. Treatment of non dermatophyte mold and Candida onychomycosis. Dermatol Clin 2003;21:491-497.
17. 17. Harvey A. Fungal Nails (Onychomycosis, Tinea Unguium) Causes, Symptoms, Signs and Treatment on MedicineNet. com 2010; http://www.medicinenet.com/fungal_nails/article
18. 18. Gupta AK, Jain HC, Lynde CW, et al. Prevalence and epidemiology of onychomycosis in patients visiting physicians’ offices: a multicenter Canadian survey of 15,000 patients. J Am Acad Dermatol 2000;43:244–248.
19. 19. Golia S, Hittinahalli V, Vasudha C. L, et al. A study on the mycological profile of onychomycosis. Journal of Evolution of Medical and Dental Sciences 2012;1:1247-1255.
20. 20. Malik NA, Raza N and Nasiruddin. Nondermatophyte moulds and yeasts as causative agents in onychomycosis. J Pakist Assoc Dermatol 2009;19:74-78.
21. 21. Yehia MA, El-Ammawi TS, Al-Mazidi KM, et al. The Spectrum of fungal infections with a special reference of dermatophytoses in the capital area of Kuwait during. 2000-2005: A retrospective analysis. Mycopathol 2010;169:241-246.
22. 22. Ghannoum M, Isham N. Fungal Nail Infections (Onychomycosis): A Never-Ending Story? PLoS Pathog 2014;10:e1004105.
23. 23. Federal Ministry of Health (2005). Technical report: National HIV/syphilis sero-prevalance sentinels survey among pregnant women attending ante-natal clinics in Nigeria. Lagos: FMH Press.