Epidemiology of onychomycosis in Serbia: a laboratory‐based survey and risk factor identification

Abstract

Onychomycosis is a fungal infection of the fingernails and/or toenails caused by dermatophytes, yeasts and non-dermatophyte moulds. The epidemiology of onychomycosis in Serbia is yet to be fully established. This epidemiological study was aimed at evaluating the epidemiology of onychomycosis in a sample of the Serbian patients at risk of onychomycosis, to determine the fungal aetiological agents and to identify the possible risk factors. The study population included 374 patients from six centres in Serbia with suspected onychomycosis. Demographic data, data about comorbidities, lifestyle, clinical aspects of onychomycosis, trauma, excessive perspiration and personal and family history of previous onychomycosis were studied. Laboratory confirmation of diagnosis was done by direct microscopy, fungal culture and PCR. Diagnosis of onychomycosis was confirmed in 50.8% of patients, who tested positive to at least one laboratory test (direct microscopy, fungal culture or PCR). Trichophyton rubrum was predominant both on toenails (85.98%) and on fingernails (38.46%). Independent risk factors for onychomycosis were: old age (OR = 2.285; P < 0.001), family history of previous onychomycosis and/or tinea pedis (OR = 2.452; P = 0.005), excessive perspiration (OR = 2.165; P = 0.002) and higher degree of hyperkeratosis (OR = 1.755; P = 0.020). This is a first epidemiological study of onychomycosis from Serbia.

Epidemiological survey of dermatophytosis in Damascus, Syria, from 2008 to 2016

“…As we have noted, the genus Trichophyton was the most common genera of dermatophytes isolated in our study. The prevalence of this causative agent was similar to reports from several regions of the world [12, 13, 18, 20, 26-29]. …”

“…The positive rate of toenail onychomycosis in our study was 20.33% (CI: 0.18-0.23) by direct exam, while in Serbia this rate was 85.98% [26]. However, this rate was 14.2% in Italy [8] and 23.7% in Japan [18].…”

Global perspectives for the management of onychomycosis

“…The high prevalence of fungal infections in North America is largely due to the immigration of dermatophytes from other areas of the world such as West Africa and Southeast Asia. The global prevalence of onychomycosis is estimated to be around 5.5%, attributing to 50.0% of all nail disease cases . The risk of onychomycosis increases with age due to poor peripheral circulation, diabetes, repeated nail trauma, longer exposure to pathogenic fungi, suboptimal immune function, inactivity, and/or the inability to maintain good foot care .…”

“…The global prevalence of onychomycosis is estimated to be around 5.5%, attributing to 50.0% of all nail disease cases. [8][9][10][11][12][13][14][15] The risk of onychomycosis increases with age due to poor peripheral circulation, diabetes, repeated nail trauma, longer exposure to pathogenic fungi, suboptimal immune function, inactivity, and/or the inability to maintain good foot care. 4,15-17 Figure 1 Global prevalence of onychomycosis 3,100 Toenail onychomycosis is more common in males 15,18,19 with Candida fingernail onychomycosis more common in women.…”

A practical application of onychomycosis cure – combining patient, physician and regulatory body perspectives

“…Onychomycosis is a fungal infection of the nail unit commonly caused by dermatophytes . Recent studies suggest that onychomycosis has a worldwide prevalence of 5.5%, with a 8.9% prevalence in hospital‐based studies and 4.3% in population‐based studies . Recurrence and relapse are frequently (10–53%) associated with this infection despite the use of treatment, with relapse likely to occur within 2.5 years after successful treatment .…”