A Study on Clinico-Mycological Profile, Aetiological Agents and Diagnosis of Onychomycosis at a Government Medical College Hospital in Kashmir

Onychomycosis is a term which is used to describe a fungal infection of one or more of nail units and it can be caused by dermatophytes, yeasts or non-dermatophyte moulds.It represents upto 30% of mycotic cutaneous infections [1].Clinically, onychomycosis is classified into various types; Disto-Lateral Subungal Onychomycosis (DLSO), Superficial White Onychomycosis (SWO), Proximal Subungal Onychomycosis (PSO), Endonyx Onychomycosis EO), Candidal Onychomycosis (CO), and Total Dystrophic Onychomycosis (TDO) [2][3][4].The prevalence of onychomycosis is determined by age, predisposing factors, social class, occupation, climate, living environment and frequency of travel [5].The worldwide incidence of onychomycosis is increasing and a number of factors contribute to its rise, like an immunocompromised status which is caused by HIV, immunosuppresive therapy and cancer chemotherapy or increased antibiotic usage [6].Although onychomycosis is often regarded as merely a cosmetic problem which is rarely life threatening, its high prevalence and the associated morbidity makes it an important public health problem [1].Onychomycosis resembles several diseases in the field of dermatology and medicine, so it is necessary to diagnose the infection with some laboratory evidence before treatment with anti-fungal agents, whose duration of treatment is long and may have some serious side effects [7].The incidence of onychomycosis is high in Indian sub-continent because warm and humid climate, poverty, overcrowding and lack of medical facilities contribute to high prevalence of disease.Since the patients with dystrophic nails who seek medical advice is increasing, the present study was carried out to determine the prevalence of various Microbiology Section Rubeena Lone 1 , Deeba baShiR 2 , ShabiR ahMaD 3 , aRShi SyeD 4 , SyeD KhuRShiD 5 causative agents of onychomycosis, to identify the clinical pattern of this disease in our part of world and to analyze the potential risk factors. MAtErIAL And MEtHOdS Study Population and PeriodThis study was conducted over a period of one year, from Ist Feb 2011 to 31 st Jan 2012, on samples from 150 patients with clinically suspected nail infections, who attended the Dermatology Out-Patients Department of SKIMS Medical College, Srinagar, India. Inclusion criteriaAll patients with a clinical diagnosis of onychomycosis were included in the study. Exclusion criteriaThe samples of patients who had taken anti fungal drugs were excluded from the study.Detailed history of patients was taken.The clinical pattern and location of disease was also documented. Sample collection and ProcessingThe specimens were collected for microbiological analysis, on the basis of the results of clinical evaluations.Samples from clinical abnormal nails were collected by vigorously scraping the distal portion of the nail, the nail undersurface as well as nail bed, after cleaning the area with 80 % alcohol, to remove contaminants with Key Words: Onychomycosis, dermatophytes, non-dermatophyte moulds, yeasts ABStrActBackground: Onychomycosis is a major public health problem with a high incidence, associated morbidity and a long lasting treatment with anti-fungal agents.This study was carried out to know the clinico-mycological pattern of onychomycosis, which could help in the control of this infection.Aims: The aim of this study was to determine the prevalence of various causative agents of onychomycosis and to study the clinical and mycological patterns of onychomycosis.