Prevalence of onychomycosis among diabetic population of District Doda (UT of J&K, India) - a five year survey

Abstract

Onychomycosis, which is the chronic fungal infection of finger and toe nails, is too prevalent in persons suffering with diabetes mellitus. Diabetes generally make a person more prone to a number of diseases due to their weakened immune system. Diabetics are almost three times more likely to develop onychomycosis than non-diabetics. In our present study, out of the 370 detected diabetic patients (190 males and 180 females), a total of 45 cases were found to be positive for onychomycosis, which showed a prevalence percentage of 12.16%. 35 onychomycotic male patients with a prevalence percentage of 9.46% and 10 onychomycotic female patients with a prevalence percentage of 2.70% with different clinical symptoms viz., Distal lateral subungual onychomycosis (DLSO), Proximal subungual onychomycosis (PSO), White superficial onychomycosis (WSO) and Total dystrophic onychomycosis (TDO) were reported. A total of 5 dermatophytes, 12 non-dermatophytes (yeast-like fungi) and 28 non-dermatophytes (filamentous fungi) were isolated from the nails of detected diabetic patients. The study also indicates that diabetic males are 3.5 times more prone to onychomycosis than diabetic females. This high prevalence of onychomycosis in diabetics is attributed to a combination of host factors including impaired glycaemic index, ischaemia, neuropathy and local immune-suppression. Onychomycosis can be especially important for some specific occupational groups because of their regular contact with soil, dirt and dust. Such people of the society, which depend upon physical labour for earning, such as, the farmers, gardeners, sweepers, maidservants, labourers, miners, etc., may be more prone to dermatophytic and non-dermatophytic onychomycosis and if they are diabetic then situation will become more complicated for them. This study also found that among detected diabetic patients highest prevalence rate of onychomycosis was found in employees (35.6%), farmers (24.4%), house-wives (17.8%), business-men (11.1%) and labourers (11.1%). Onychomycosis is a significant predictor for the development of secondary infections and foot ulcers in diabetes. Since, diabetics have vascular and nerve impairment, any minor injury to feet including a nail fungal infection can lead to more serious complications. Diabetics may have increased difficulty in doing regular foot check-ups due to obesity or retinopathy or cataracts, which may contribute to higher risk of developing complications from onychomycosis. In addition, symptoms go away very slowly and may take a year or more for the entire replacement of the old and infected nail. The study also found a correlation between the increasing age, diabetes and onychomycosis.