Clinico-Mycological Study of Onychomycosis and Pattern of Drug Resistance

Introduction: Onychomycosis is a fungal infection of thetoenails or fingernails that may involve any component of thenail unit, including the matrix, bed, or plate. Onychomycosisis caused by dermatophyte fungi, non dermatophyte mouldsand yeasts. Prevalence rates for OM varying from 3 to 5%have been found in most studies; however, a few reportssuggest a higher prevalence of even up to 26% in the generalpopulation. Hence through this study an attempt was made toidentify the various clinical patterns of onychomycosis and toidentify pattern of drug resistance in onychomycosis.Material and methods: The proposed study was carriedout in Outpatient Department of Dermatology Venereologyand Leprosy, Rohilkhand Medical College and Hospital,Bareilly, a tertiary care hospital in western Uttar Pradeshfor one year (November 2017- October 2018) on patientshowing nail changes suggestive of onychomycosis, usingdirect microscopy using potassium hydroxide. The culturemedium SDA with chloramphenicol was used. Sensitivity toTerbinafine, Fluconazole, Itraconazole and Griseofulvine wasstudied.Result: The most common pattern of onychomycosis seenwas distal lateral subungual onychomycosis. Pattern of drugresistance is maximum with Griseofulvin (49%) and least withTerbinafine (20%).Conclusion: A total of 104 patients were enrolled, withmean age 35.93 years. Males were more commonly involvedcompared to females. The culture results were positive among55 patients and negative in 49 patients. The most commoncausative agent isolated was dermatophyte moulds followedby non-dermatophytes and yeasts.

Visual Outcome among Patients Undergone Manual Small Incision Cataract Surgery Following their Identification in Screening Eye Camp in Jammu Province.

Introduction: One of the documented leading cause ofblindness in India is cataract as many patients with cataract donot have access to hospitals and surgery and to avoid blindnessdue to cataract, the only remedy is to perform hospital basedcataract surgery on a large scale. There is an increase in anumber of cataract patients due to improved quality of life,health indices and increased life expectancy. Study aimedto see the visual outcome and complications among patientsundergone manual SICS with PC-IOL implantation.Material and Methods: The present prospectiveobservational study was conducted on 72 patients who wereselected in various screening eye camps to undergo cataractextraction surgery by manual small incision cataract surgerytechnique with posterior chamber IOL implantation (MSICSwith PC-IOL).Results: Total of 72 eyes of patients who underwent manualsmall incision cataract surgery were studied. Best correctedpreoperative visual acuity of ≥ 6/60 was found in 13 patientswhile postoperatively on day1 total of 60 patients had visualacuity of ≥ 6/60. The final 6th week postoperative bestcorrected visual acuity of 6/12-6/9 was found in 65 patients.Iris prolapse was seen in 3 patients followed by posteriorcapsule rent which was seen in 2 patients. Mild postoperativeuveitis was seen in 20 followed by striate keratopathy in 8patients while hyphaema was seen in 2 patients.Conclusion: MSICS is a safe and effective procedure, due toits low rates of intraoperative and postoperative complicationswhich are easily treatable. Visual acuity is only one measureof the functional success of cataract surgery and the goodpostoperative visual outcomes achieved by our patientsfurther adds on to its benefits as a good surgical technique.MSICS can be performed as procedure of choice for largevolume cataract surgeries

Mixed dermatophytic infections: a learning perspective and report of ten cases

Background: Isolation of two or more than two pathogenic fungi from the same body site in a patient is considered as a rare entity and very few cases have been reported in literature. These types of infections are called as mixed/ combined fungal infections. Author are enumerating ten cases of superficial mycoses in which two different dermatophytes were grown from the same focus.Methods: From clinically suspected cases of dermatophytosis, skin and hair samples were collected from the affected sites and examined by standard mycological procedures. Microscopy was done by using 10% KOH wet mount. Culture was put on Sabouraud’s dextrose agar with cyclohexamide medium. Growth was identified by lactophenol cotton blue mount.Results: Mixed dermatophytes were obtained from tinea corporis (five cases), tinea capitis (four cases) and tinea cruris (one case) patients. Fungal combinations from given cases involved two different species of genus Trichophyton which were as follows: T. violaceum+T. tonsurans, T. verrucosum+T. tonsurans, T. violaceum (violet) and T. violaceum (white), T. mentagrophytes+T. Violaceum, T. rubrum+T. tonsurans, T. violaceum+T. rubrum, T. rubrum+T. mentagrophytes, T. verrucosum+T. mentagrophytes, T. mentagrophytes+T. tonsurans, Malassezia+T. mentagrophytes.Conclusions: Inspite of the frequent occurrence of dermatophytic infections worldwide, reports on mixed dermatophytes are very few. With proper sample collection and proper identification procedures, more cases can be identified and added to the existing literature.

Prevalence and Etiological Agents of Onychomycosis.

Onychomycosis is a common nail infection caused by dermatophytes, yeast or other non-dermatophyte molds and have been known to be associated with significant physical and psychological morbidity. This study was performed to determine the prevalence and the etiologic agents of onychomycosis in patients attending RIMS, Imphal, Manipur for a period of two years (January 2010 to December 2012). Nail samples of 347 clinically suspected cases of onycomycosis attending dermatology OPD RIMS, Manipur were collected and were subjected to potassium hydroxide (KOH) mounts for direct microscopy and fungal culture on Sabouraud’s dextrose agar (SDA). The male female ratio of the participants was 1:1.81 (165 male and 302 female). Out of 467, 399 (85.44.%) were positive by culture and KOH mount. Young adults in the age group of 21-30 years were commonly affected. In female patients finger nail infection was more common than toe nail infection. Both toe and finger nails involvement were noticed in nine patients of which two were male and seven were female. The most frequently isolated fungus was dermatophytes, in 107 (40.38%) patients followed by Aspergillus spp in 101 (38.11%) and Candida spp in 17 (6.4%). This study demonstrated that dermatophytes, as well as moulds especially Aspergillus spp are commonly isolated from onychomycosis patients in our region.

Fungal spectrum in otomycosis at tertiary care hospital.

Introduction: Otomycosis is a superficial mycotic infection of the external auditory canal that is caused by opportunistic fungi. It is a common fungal infection of the ear that is worldwide in distribution. The infection usually characterized by inflammation, pruritus, trauma to external auditory canal, scaling and severe discomfort such as suppuration and pain. We have tried to clarify the different causative factors & predisposing factors for otomycosis in our environment. Material & Methods: In this study we were including 100 patients (53 female and 47 male) with presumptive diagnosis of otomycosis. We performed mycological analysis on swab or fungal ball from external auditory canal of 100 patients. The diagnosis was confirmed micro biologically by direct microscopy (10% KOH mount) and fungal culture methods. Results: Otomycosis was more common among females as compared to males & also common in age groups of 20-35 yrs. The most common fungal pathogens isolated were Aspergillus niger (75.82%) followed by Aspergillus fumigatus( 13.19 %), Candida albicans ( 7.69 %) & Aspergillus flavus ( 3.3 %). while bacterial co infection/ super infection was detected in 6 cases. Conclusion: In this study we observe that otomycosis is unilateral condition more common in young age housewives and farmers particularly during summer and rainy season.