Non-Dermatophyte Mold Dominated Onychomycosis in Patients Attending a Rank Higher Specialized Dermatology Clinic in Addis Ababa, Ethiopia

Abstract

Background Onychomycosis is a common refractory fungal infection associated with significant morbidity. The objective of this study was to determine the prevalence of onychomycosis, and the diversity and species composition of fungal etiological agents. Materials and Methods A clinic-based, prospective, non-randomized cross-sectional study was carried out between October 2018 and June 2019 at Rank Higher Specialized Dermatology Clinic, Addis Ababa, Ethiopia. Nail scrapings were collected aseptically from 200 patients clinically identified with nail disorders of fungal origin by dermatologists. Fungal etiological agents were identified microscopically and by culture method following standard procedures. Results Among 200 nail scrapings, 161 (80.5%) samples were found out to be culture positive. Of these, 135 (83.9%) samples yielded single colonies while 26 (16.1%) mixed colonies gave a total of 190 isolates. Among the isolates, 25.8% were dermatophytes while 61.1% were non- dermatophytes molds, and 13.1% were yeasts. Females were more likely to present dystrophic nails than men. Patients in the middle age group were more affected. Trichophyton interdigitale, Aspergillus spp, and Candida albicans were the dominant species. Conclusion The prevalence rate of onychomycosis in the present study was high. The isolation rate of non-dermatophyte molds was higher than dermatophytes and yeasts. Trichophyton interdigitale, Aspergillus spp, and Candida albicans were the dominant etiological agents. Females and patients in the middle age group were more affected. An increase in the prevalence of non-dermatophyte molds in nail infections dictates further investigation demonstrating how this group of fungi causes onychomycosis.

A 5‐year single‐center study about onychomycosis with a focus on Aspergillus spp. in Albania

“…Onychomycosis is a common infectious disease that dermatologists face in daily practice. It significantly impacts the patient's quality of life and public health, especially in developing countries 1 . Albania is a Mediterranean country with a wet, humid climate, unfavorable socioeconomic conditions in some areas, and aging population with an increased incidence of comorbidities.…”

“…are increasingly being reported as primary causative agents of NDM onychomycosis worldwide, with prevalence as high as 34.4% in Guatemala and 69.3% in Iran 4,6,7 . Variable prevalence rates may be explained by differences in lifestyle, socioeconomic conditions, risk factors associated with study subjects, and environmental factors of study areas 1 …”

“…As for age, it can occur in any age group, including pediatric and geriatric patients 8 . There are still inconsistent reports about the epidemiology of onychomycosis in different age groups 1 . However, the most affected group is the one between 30 and over 60 years 8 .…”

“…Onychomycosis is the most common nail abnormality experienced globally. It is caused by dermatophytes, nondermatophyte mycelial fungi, and yeast 1 . The prevalence of onychomycosis and its etiological agents vary by geographic, environmental, and demographic factors 2 .…”

Total Dystrophic Onychomycosis of All the Nails Caused by Non-dermatophyte Fungal Species: A Case Report

“…More than 60% of OM cases are attributed to dermatophytes and up to 40% of OM cases may involve mixed infections with dermatophytes and NDM [ 5 ]. NDM causes OM of toenails in elderly individuals with a history of trauma and has been recently showing an increasing trend [ 6 ]. According to the available evidence, they have become the main causative organism in patients with OM and HIV infection.…”