An Epidemiological Study of Onychomycosis in Kashmir Valley

Background: Onychomycosis is a common fungal infection of the nails that apart from causing disfigurement of the nails acts as a source of other fungal infections. Prompt diagnosis along with appropriate antifungal therapy can help prevent such complications.

Aims: To find out the prevalence and fungal aetiology of onychomycosis in patients presenting to the Department of Dermatology Sher-i-Kashmir Institute of Medical Sciences Medical College/ Hospital Srinagar.

Settings and Design: This prospective study was carried out in the Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar in collaboration with the Department of Dermatology Sher-i- of Kashmir Institute of Medical Sciences College, Bemina for a period of two years (August 2010 to September 2012).

Materials and Methods: A total of 300 samples from patients attending the Dermatology OPD with features suggestive of onychomycosis were included in this study. Microscopy of the samples was done in 20% potassium hydroxide (KOH) and culture on Sabouraud dextrose agar (SDA) with chloramphenicol and SDA with chloramphenicol and cyclohexamide. Tubes were incubated at 37°C and 25°C for 4-6 weeks and examined biweekly for growth. Microscopic analysis of the growth was done using lactophenol cotton blue (LCB).

Results: Age of cases ranged from 3 months to 85 years with female preponderance. Distal and lateral subungual onychomycosis (DLSO) was the most common clinical type. Overall, positivity of microscopy was 73.5% and of culture was 29%. Sensitivity and specificity of KOH as compared to culture was 83.9% and 30.3% respectively. Among the fungi isolated, 98% were dermatophytes and 2% were non-dermatophytic fungi (Fusarium spp.). Commonest dermatophytes isolated were Trichophyton rubrum followed by Trichophyton violaceum.

Conclusion: KOH and culture are complementary to each other and should be included in the diagnostic evaluation of onychomycosis which is commoner in our population.