Mycological study of onychomycosis in diabetic patients

Background: Onychomycosis refers to fungal infection of nails with various etiological agents, involving dermatophytes, yeasts and moulds. Onychomycosis continues to be worldwide problem constituting a large bulk of cases attending the dermatology outpatient department. Diabetics are more prone to onychomycosis, most of the time the infection is subclinical and may lead to secondary infections and bad prognosis. Hence this study was undertaken to diagnose onychomycosis earlier in diabetics which will help to start suitable antifungal therapy and prevent further complications. Objectives: 1. To identify the most predominant fungus isolated from diabetics suffering from onychomycosis. 2. To know the percentage of diabetics suffering from onychomycosis. 3. To identify the age and sex group of people at a higher risk of acquiring onychomycosis in diabetes mellitus patients. Methods: The study was conducted from July 2015 to August 2015, in the department of Microbiology of a tertiary care hospital in Bangalore, including 50 patients clinically suspected of onychomycosis. Nail scrapings and clippings were collected depending upon site, type of nail involvement and subjected for microscopic examination using 40% KOH, followed by fungal culture. Species identification was done based on colony characteristics, pigment production, LPCB mount and slide culture. Results: Out of 50 patients, 22 (44%) were diagnosed having onychomycosis. The common isolates were non-albicans Candida (n=8/22, 36.36%) followed by Aspergillus niger (n= 5/22, 22.72%), Penicillium (4/22, 18.18%) and others being Paecilomyces, Gliocladium and Rhizopus species each being 4.54%. Mixed infection with Aspergillus niger and non-albicans Candida species was seen in 2/22 (9.09%) of cases. Conclusion: The present study concludes that screening test for fungal infections on regular basis is important for long term diabetic patients and they should be started on the suitable antifungal therapy as soon as possible. Early diagnosis of onychomycosis in diabetics helps in the prevention of further complications.