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Aspergillus species: An emerging pathogen in onychomycosis among diabetics
T M Wijesuriya1, J Kottahachchi1, T D C P Gunasekara1
1Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka.
Introduction:
Approximately, 33% patients with diabetes are afflicted with onychomycosis. In the past, nondermatophyte molds have been regarded as opportunistic pathogens; recently, Aspergillus species are considered as emerging pathogens of toenail infections. In Sri Lanka, the prevalence of Aspergillus species in onychomycosis among diabetics is not well documented.
Objective:
To determine the proportion of Aspergillus onychomycosis, risk factors and knowledge among diabetics.
Materials And Methods:
This was descriptive cross-sectional study. Three hundred diabetic patients were included. Clinical examinations of patients' toenails were performed by a clinical microbiologist. Laboratory identification was done, and pathogens were identified to the species level by morpho-physiological methods. All inferential statistics were tested at P < 0.05.
Results:
Among clinically suspected patients, 85% (255/300) were mycologically confirmed to have onychomycosis. Aspergillus species were most commonly isolated n = 180 (71%) followed by dermatophytes, yeasts, and other molds n = 75 (29%). Of the patients having Aspergillus onychomycosis, 149 (83%) were in the > age group. In men, Aspergillus onycomycosis was seen in 82%. Among patients who had Aspergillus nail infection, 114 (63%) had diabetes for a period of > years. Among patients who were engaged in agricultural activities, 77% were confirmed to have infected nails due to Aspergillus species.
Conclusion:
Aspergillus niger was the most common pathogen isolated from toenail infection. Aspergillus species should be considered as an important pathogen in toenail onychomycosis in diabetic patients. Risk factors associated with Aspergillus onychomycosis were age, gender, duration of diabetes, length of exposure to fungi, and occupation.
Insights
Aspergillus species are a common cause of toenail infections in diabetic patients, particularly older males with long-standing diabetes and agricultural occupations. This highlights the need to consider Aspergillus in diagnosing and treating onychomycosis in this vulnerable population.
Area of Science:
- Medical Mycology
- Dermatology
- Diabetology
Background:
- Onychomycosis affects approximately 33% of patients with diabetes.
- Nondermatophyte molds, especially Aspergillus species, are increasingly recognized as significant toenail pathogens.
- Data on Aspergillus prevalence in diabetic onychomycosis in Sri Lanka is limited.
Purpose of the Study:
- To determine the prevalence of Aspergillus onychomycosis among diabetic patients.
- To identify risk factors associated with Aspergillus onychomycosis.
- To assess knowledge regarding onychomycosis in this population.
Main Methods:
- A descriptive cross-sectional study involving 300 diabetic patients.
- Clinical toenail examinations conducted by a clinical microbiologist.
- Laboratory identification of fungal pathogens to the species level using morpho-physiological methods.
Main Results:
- Onychomycosis was confirmed in 85% of clinically suspected diabetic patients.
- Aspergillus species were the most frequently isolated pathogens (71%), followed by dermatophytes, yeasts, and other molds (29%).
- Key risk factors included advanced age, male gender, longer diabetes duration, and agricultural occupation.
Conclusions:
- Aspergillus niger was identified as the predominant species causing toenail infections.
- Aspergillus species represent a significant etiological agent in diabetic onychomycosis.
- Age, gender, diabetes duration, fungal exposure, and occupation are critical risk factors for Aspergillus onychomycosis.
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