Onychomycosis in Qassim Region of Saudi Arabia: A Clinicoaetiologic Correlation

Abstract

Background: Onychomycosis is mainly caused by dermatophytes, but yeasts and nondermatophyte molds have also been implicated, giving rise to diverse clinical presentations. The aetiological agents of the disease may show geographic variation. Aim:The aim of the present study was to isolate the causative pathogens and to correlate the various clinical patterns of onychomycosis with causative pathogens. Materials and Methods:The study population comprised 170 patients with clinical suspicion of onychomycosis. Nail samples were collected for direct microscopic examination and culture. Clinical patterns were noted and correlated with causative pathogens.Results: Out of total 170 cases included in the study, 140 (82.4%) were positive by microscopy and 77 (45.3%) showed positive mycological findings by both microscopy and culture. The male: female ratio was 1:2.5 and the mean age was 35.29 ± 16.47 years. Fingernails were involved in 51.9%, toenails in 28.6% and both fingernails and toenails in 19.5% of the 77 patients. The clinical types noted were distal lateral subungual onychomycosis (71.4%), proximal subungual onychomycosis (10.4%), total dystrophic onychomycosis (10.4%), superficial white onychomycosis (3.9%) and mixed pattern onychomycosis (3.9%). Yeasts were the most common pathogens isolated, being found in 36 patients (46.8%) followed by nondermatophyte molds which were isolated from 28 patients (36.4%) followed by dermatophytes which were isolated from 13 patients (16.9%). Conclusion:Distal lateral subungual onychomycosis was the most common clinical presentation. Candida albicans, Aspergillus species and Tricophyton rubrum were the major pathogens. A single pathogen can give rise to more than one clinical type.

Mycological Aspects of Onychomycosis in Khuzestan Province, Iran, a New Scenario as Shift from Dermatophytes towards Yeasts

“…In view of etiology, yeasts were the main infectious agents in Khuzestan Province and in fingernail onychomycosis, of which C. albicans , C. parapsilosis , and C. tropicalis were the most common species, respectively. Such results were in agreement with reports from Brazil, India, Saudi Arabia, and Iran [ 5 , 9 , 10 , 21 , 23 ]. The frequency of Candida albicans (50%) as the main Candida species causing onychomycosis in this study was lower than 58-68% reported from Qazvin and Isfahan provinces [ 9 , 11 ], but was higher than 23-45% from Shiraz, Tehran, and Kermanshah [ 12 , 13 , 26 ].…”

“…Onychomycosis is known to occur at any age, but more frequently in the 40+ years age group and less commonly prior to puberty [ 4 ]. In line with this fact and results of several former studies [ 9 , 21 , 23 , 24 ], the majority of the patients (57.8%) in this study were in the age groups of 41-50 and >50 years, which was statistically significant. A large number of patients in this study (33.7%) were aged between 21 to 40 years.…”

“…To the best of our knowledge, this study provided the first dataset regarding the clinical and mycological aspects of this infection in this area of Iran. The prevalence rate of onychomycosis in this study (35.6%) was almost similar to that described from Isfahan Province, Iran [ 10 ], but it was less than the prevalence rates of 40.2-45% reported in other parts of the country [ 9 , 12 , 13 ], 68.8% from Taiwan [ 20 ], 42% from Brazil [ 21 ], 50.8% from Serbia [ 22 ], and 82% from Saudi Arabia [ 23 ].…”

“…Review of the literature and the data from this study point out that contrary to the popular belief emphasizing on the dermatophytes as the leading causes of onychomycosis worldwide, it is at least from one decade ago that yeasts (alone or in combination with NDMs) are the main agents of onychomycosis in most areas of Iran [ 11 , 12 - 14 , 30 ], and even other parts of the world [ 5 , 21 , 23 ].…”

Magnitude and Associated Factors of Superficial Fungal Infections on HIV/AIDS Patients Who Attends in Debretabor General Hospital ART Clinic, Debretabor, North West Ethiopia, 2015/16

“…In addition, it affects 2.6% of children younger than 18 years; prevalence of 9.4% tinea capitis amongst school children, age over 60 is nearer 20%. Fungal colonization among the age the age ranges of 31-40 years and 21-32 years had the highest rate of fungal colonization for males and females respectively [39,41]. Incidence was significantly higher in young children aged 7-11 years and 4-6 years than in older children aged 12-16 years.…”