ABSTRACT
BACKGROUND : Superficial mycosis has been recognized as a common fungal condition worldwide, including India. It refers to fungal infection of skin and its appendages. AIM & OBJECTIVES : 1) To determine the frequency of fungal agents isolated from clinically suspected cases of superficial mycoses, in a tertiary health care hospital. 2) To access the risk factors associated with it. 3) To analyse the demographic profile associated with superficial mycosis. MATERIAL & METHODS: The prospective study was carried out, over a period of 12 months (January 2021 to December 2021), samples such as skin scarping, hair plugs and nail clipping obtained from patients were submitted to Department of Microbiology for the fungal etiology. Samples were subjected to direct microscopy by KOH mount and fungal culture as per standard convectional technique. RESULTS: A total of 63 clinically suspected cases of superficial mycosis were enrolled in the study. Among the isolates recovered the most common were Dermatophytes(41.26%) followed by Candida(14.28%), Aspergillus(6.3%), Mucor(3.1%) and remaining 23.80% were sterile. Among the Dermatophytes, T.rubrum 42.30% was the predominant pathogen followed by T.mentagrophytes 34.61%. The most common age group affected was 21-40 years of age with male predominance of male to female ratio of 1.5:1. Out of total of 48 samples of superficial mycosis 26 were positive by direct microscopy and 48 samples were positive both by microscopy and culture. Most of the positive cases were recovered from immunocompromised individuals suffering from diabetes (37.5%) followed by prolonged antibiotic therapy (25.02%), long steroid therapy (12.5%) and chemotherapeutic agents (10.41%). The cases were mainly seen in the months between April to July which correlates the infection with the humid season. CONCLUSION: The study pinpointed dermatophytes as the most common clinical pattern of superficial mycosis with a male predominance. Dermatophytic infection is one of the emerging fungal disease along with non dermatophytic molds, especially in immunocompromised individuals prompt treatment and management can herald the onset of ensuing complications, thereby limiting the morbidity and thus improving the quality of life.
ABSTRACT
Onychomycosis is a common nail ailment associated with significant physical and psychological morbidity. Increased prevalence in the recent years is attributed to enhanced longevity, comorbid conditions such as diabetes, avid sports participation, and emergence of HIV. Dermatophytes are the most commonly implicated etiologic agents, particularly Trichophyton rubrum and Trichophyton mentagrophytes var. interdigitale, followed by Candida species and non dermatophytic molds (NDMs). Several clinical variants have been recognized. Candida onychomycosis affects fingernails more often and is accompanied by paronychia. NDM molds should be suspected in patients with history of trauma and associated periungual inflammation. Diagnosis is primarily based upon KOH examination, culture and histopathological examinations of nail clippings and nail biopsy. Adequate and appropriate sample collection is vital to pinpoint the exact etiological fungus. Various improvisations have been adopted to improve the fungal isolation. Culture is the gold standard, while histopathology is often performed to diagnose and differentiate onychomycosis from other nail disorders such as psoriasis and lichen planus. Though rarely used, DNA-based methods are effective for identifying mixed infections and quantification of fungal load. Various treatment modalities including topical, systemic and surgical have been used.Topically, drugs (ciclopirox and amorolfine nail lacquers) are delivered through specialized transungual drug delivery systems ensuring high concentration and prolonged contact. Commonly used oral therapeutic agents include terbinafine, fluconazole, and itraconazole. Terbinafine and itraconazole are given as continuous as well as intermittent regimes. Continuous terbinafine appears to be the most effective regime for dermatophyte onychomycosis. Despite good therapeutic response to newer modalities, long-term outcome is unsatisfactory due to therapeutic failure, relapse, and reinfection. To combat the poor response, newer strategies such as combination, sequential, and supplementary therapies have been suggested. In the end, treatment of special populations such as diabetic, elderly, and children is outlined.
ABSTRACT
Antedecentes: Estudios recientes alrededor del mundo indican que la prevalencia de la onicomicosis está aumentando en la población pediátrica, sobre todo en adolescentes. Los dermatófitos son los agentes etiológicos más frecuentes. Material y métodos: Revisión retrospectiva de 12 años de los expedientes de 332 niños con sospecha clínica de onicomicosis. Se analizaron variables como sexo, edad, factores predisponentes, uñas afectadas, otras micosis superficiales y los resultados del estudio micológico. Resultados: Se identificaron 233 casos de onicomicosis, que representan 33% de las micosis superficiales en nuestro departamento. Dos terceras partes correspondieron a adolescentes, sin encontrar diferencia significativa en sexo. Las uñas de los pies se afectaron con mayor frecuencia (94%) que las de las manos (4.2%) y la variedad clínica predominante fue la onicomicosis subungueal distal y lateral. Los dermatófitos (sobre todo Trichophyton rubrum) fueron los responsables de la infección en 70%. Conclusiones: Las onicomicosis constituyen 33% de las micosis superficiales en niños. Corroboramos el aumento en su frecuencia, el predominio en uñas de pies (94%) y la etiología dermatofítica (70%). Recomendamos a médicos que atienden niños y adolescentes, la implementación de medidas de diagnóstico y tratamiento.
BACKGROUND: Worldwide recent reports point towards a rising prevalence ofonychomycosis in the pediatric population, especially among adolescents. Dermatophytes are the most common etiologic agents. MATERIAL AND METHODS: We carried out a retrospective review of the last 12 years, comprising 332 medical records from children with clinical suspicion of onychomycosis. We analyzed the following variables: gender, age, predisposing factors, affected nails, other concurrent superficial mycoses and potassium hydroxide direct examination and culture. RESULTS: A total of 233 onychomycosis cases were identified, cases constituted 33% of superficial mycoses of children seen at our unit. Two thirds were adolescents with no significant difference among the sexes. Toenails were more affected (94%) than fingernails (4.2%) with distal and lateral subungueal onychomycosis being the most common clinical presentation. In 70% of cases infection was caused by dermatophytes (mainly Trichophyton rubrum). CONCLUSIONS: Onychomycosis constitute 33% of superficial mycoses among children seen at our medical facility. We confirm a rise in prevalence, toenails were the most common (94%) and had a dermatophytic etiology (70%). We suggest to all physicians caring for children and adolescents, to become familiar with diagnostic and therapeutic tools for this type of mycosis.