A Study of Onychomycosis at a Tertiary Care Hospital in Eastern Bihar

Onychomycosis (OM) is a major public health problem which is increasing worldwide. It is associated with high morbidity and causes physical, psychological, and occupational problems in patients.

This study aims to study the pattern of etiological agents, clinical features, and severity assessment of OM in this part of India.

Sixty eight clinically suspected patients with positive potassium hydroxide and fungal culture were studied.

Males were infected more often than females (1.61:1). The most common age group affected was 21-40 years. Finger nails were affected more frequently than toe nails. Distal and lateral subungual OM was the most common (48 cases, 70.59%) clinical pattern. For most of the patients (66.18%), nail involvement was severe. Discoloration was the most common (67 cases, 98.53%) change, followed by subungual hyperkeratosis (51 cases, 75%). Principal causative agents were dermatophytes (55 cases, 80.88%) with Trichophyton rubrum being the most common one (35 cases, 51.47%). In 9 (13.23%) cases, Candida albicans, in 6 (8.82%) Aspergillus niger and in 1 (1.47%) case Acremonium sp. (AC) have been isolated as the sole causative agent. In 2 (2.94%) cases, mixed infection with dermatophyte and Aspergillus and in 1 (1.47%) case dermatophyte and Candida were noted.

Although dermatophytes were the most common causative agent of OM, nondermatophytic molds, and yeasts were also encountered. The genus and species identification helps in the proper diagnosis and management. Morphological changes in nail may help in presumptive diagnosis of OM.