Pattern of onychomycosis--a RIMS study

Onychomycosis is a fungal infection of nails caused by dermatophytes, yeasts or non-dermatophytes moulds. In this study, 500 patients suspected of having onychomycosis reffered from the out patient department (OPD), Dermatology, Regional Institute of Medical Sciences (RIMS) Hospital Imphal Manipur during the period from January 2007 to December 2008 were processed in the Department of Microbiology RIMS. Nail clippings or scrapings depending on the variety of onychomycosis were collected with sterile blades under all aseptic measures. Specimens were put up for 10% KOH mount, fungal cultures on two sets of SDA (Sabouraud's dextrose agar) incorporated with antibiotics and lactophenol cotton blue preparation (LCB) from the cultures and examined microscopically. Slide cultures were also put up if necessary. Out of 500 samples processed, a total of 444 (88.8%) were positive for the various fungi. The positive fungi were dermatophytes 258 (58.1%), non-dermatophytes 139 (31.3%), yeasts and yeast-like 17 (3.8%) and mixed fungal isolates 30 (6.7%). Of the 230 males and 270 females studied,193 (83.9%) males and 251 (92.9%) females respectively were positive for various fungi causing onychomycosis. Maximum number of suspected cases were in the age group of 21-30 years. Among the dermatophytes, Trichophyton species (spp.) 250 (50%) was the commonest isolate followed by Epidermophyton spp. 8 (1.6%). Among the non-dermatophytes, Aspergillus spp. 70 (14%) was the commonest followed by Penicillium spp. 24 (4.8%), Acremonium spp. 9 (1.8%), Fusarium spp. 8 (1.6%), Curvularia spp. 7 (1.4%), Alternaria spp. 5 (1%), Scopulariopsis spp. 4 (0.8%), Cladosporium spp. 4 (0.8%), Nigrospora spp. 2 (0.4%), Mucor spp. 1 (0.2%), Paecilomyces spp. 1 (0.2%), Pseudallescheria spp. (0.2%), Rhizopus spp. 1 (0.2%), Verticillium spp. 1 (0.2%), Exophiala jeanselmei 1 (0.2%). Among the yeast and yeast-like i.e. Candida spp. 15, Geotrichum spp. 1, Rhodotorula spp. 1 were 17 (3.8%), mixed fungal isolates 30 (6.7%), respectively. Reports were given to the patient for follow up and treatment. Health awareness and suggestions were given for prevention and further spread of onychomycosis.