Onychomycosis in diabetic patients in Fako Division of Cameroon: prevalence, causative agents, associated factors and antifungal sensitivity patterns

Abstract

BackgroundOnychomycosis is an infection of the nail unit by a fungus. This is a very common infection amongst diabetics. Its occurrence among diabetics in Fako division is unknown. In this study we provide information on the characteristics of onychomycosis in diabetics in Fako division, Cameroon.MethodsA cross-sectional descriptive and analytical hospital-based study was conducted in two diabetic clinics in the Buea and Limbe regional hospitals. We recruited 152 consenting diabetics into the study. Demographic, behavioural, and clinical data of patients were obtained through the use of structured questionnaires. Toenail, finger nail, skin scrapings and nail clippings were collected from participants, KOH mounts were prepared and observed under the microscope and cultured on Sabouraud Dextrose Agar supplemented with chloramphenicol to isolate causative fungi. Identification of isolates was done to species level using the cello tape flag method and slide culture. The presence of a dermatophyte by either microscopy or culture or both methods was considered positive for onychomycosis. Antifungal susceptibility testing was carried out using selected antifungals by the Kirby–Bauer disk diffusion method on Sabouraud Dextrose Agar.ResultsClinical onychomycosis was found in 77 of the 152 diabetics tested giving a prevalence of 50.7% (95% CI 42.4–58.9) in diabetics in Fako. No socio-demographic or clinical factor studied was significantly associated with onychomycosis. Trichophyton rubrum was the most common isolate (62%). Other isolates included Trichophyton metagraphyte (22%) and Trichophyton tonsurans (16%). Dermatophytes were sensitive to miconazole (66%), amphotericin B (19%) and ketoconazole (14%).ConclusionOnychomycosis is common in diabetics in Fako signifying the need for regular screening by either microscopy or culture. Infected nails could be treated with miconazole.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-016-2302-1) contains supplementary material, which is available to authorized users.

The Burden of Serious Fungal Infections in Cameroon

“…Our estimate is that ~721,000 children have tinea capitis, a rate of 3240/100,000. Onychomycosis was also found at high rate (51%) especially in diabetic patients [ 5 ].…”

“…Limited studies and some unpublished studies record frequencies of mild superficial mycosis [ 2 , 3 , 4 , 5 ] or life-threatening invasive fungal infections in the HIV-infected population in Cameroon [ 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. Ignorance of serious fungal infections, lack of awareness or involvement of practicing clinicians and the government, together with limited technical and structural health capabilities in Cameroon, have meant there is no register for any fungal disease.…”

Manifestação De Stress E Burnout Em Profissionais De Saúde Durante a Pandemia Por Covid-19: Uma Revisão Integrativa

“…Um estudo realizado em Camarões (África) mostrou que onicomicose foi encontrada em 50.7% dos diabéticos avaliados e Trichophyton rubrum foi o agente fúngico mais isolado (23). Contudo, nesse estudo, nenhum fator socio-demográfico ou clínico avaliado, foi significativamente associado.…”

Challenges and Opportunities in the Management of Onychomycosis

“…If left untreated, the infection can act as a reservoir for other skin conditions, including atopic dermatitis, urticaria and erythema nodosum, as well as fungal infections in other parts of the body. Onychomycosis can also exacerbate foot problems resulting from other illnesses like diabetes, and in extreme cases can ultimately necessitate lower extremity amputation [ 9 ].…”