A clinicomycological study of onychomycosis in a rural hospital in Central India

Background: Onychomycosis; fungal infection of nails account for about half of the nail diseases. Common site of involvement is toenails. Various etiological agents including dermatophytes, yeasts and non-dermatophytic moulds (NDM) are responsible. It is difficult to treat onychomycosis as compare to other dermatophytic infections because of the inherent slow growth of the nail. Aim: To diagnose etiological agents of onychomycosis on KOH, Calcofluor white (CFW), KOH treated Nail Clipping with Periodic Acid Schiff (KONCPA) and SDA culture. Objectives: 1) To determine the fungal etiological agents of onychomycosis. 1) To correlate clinical parameters with the mycological findings.Methods: The study was carried out in department of Microbiology, MGIMS, Sewagram, Wardha. A total of 44 cases with signs of onychomycosis were enrolled in the study which were subjected for microscopic examination by 20% KOH, CFW and KONCPA. Mycological culture was done on Sabouraud’s dextrose agar (with and without antibiotics).Results: On analysis, the positivity by 20% KOH andCFW was 45.5%, 63.4% respectively while by KONCPA it was found to be 25%. In 38.6% fungal cultures revealed growth. At present, the etiological agents were dermatophytes (12.5%), especially Trichophyton rubrum, nondermatophytic isolates (75%) include Aspergillus spp., Penicillium species, Rhizopus and Candida spp. (8.3%). In our study toenails were affected in 84% and distolateral subungual onychomycosis (DLSO) was the commonest clinical presentation.  Conclusion: Along with dermatophytes, NDM and yeasts are also important etiological agents of onychomycosis in our set up.