Sarma Smita, Capoor Malini R, Deb Monorama, Ramesh V, Aggarwal Pushpa
Department of Microbiology, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India.
Int J Dermatol. 2008 Jun;47(6):584-7. doi: 10.1111/j.1365-4632.2008.03674.x.
Onychomycosis is an important public health problem because of the increase in immunosuppressive states. Large-scale studies in India are scarce, and so the baseline incidence of onychomycosis is not firmly established.
Three hundred and two clinically suspected cases of onychomycosis were included in this study. Nail samples were collected for direct microscopic examination and culture. Clinical patterns and associated relevant factors were noted according to a predetermined protocol.
The associated predisposing conditions included diabetes mellitus (3.9%) and systemic lupus erythematosus (2.3%). Distal and lateral subungual onychomycosis was the most common clinical pattern (62%), followed by total dystrophic onychomycosis (20.2%). The most common fungal isolates were dermatophytes (49.5%), followed by Candida spp. (40.4%) and nondermatophyte molds (10.1%). Of the dermatophytes, Trichophyton rubrum (47%) was the most common isolate, followed by Trichophyton tonsurans (20.4%). Of the Candida spp., Candida albicans was the most common (60%).
Until recently, yeasts and nondermatophyte molds were regarded as contaminants, but their emergence as a significant cause of onychomycosis in immunocompromised patients calls for mycologic diagnosis and antifungal susceptibility testing in onychomycosis. The recognition of the changing patterns of onychomycosis will aid in the therapeutic approach and the implementation of control measures.
由于免疫抑制状态的增加，甲癣是一个重要的公共卫生问题。印度缺乏大规模研究，因此甲癣的基线发病率尚未完全确定。
本研究纳入了302例临床疑似甲癣病例。采集指甲样本进行直接显微镜检查和培养。根据预定方案记录临床模式和相关因素。
相关的诱发因素包括糖尿病（3.9%）和系统性红斑狼疮（2.3%）。远端和侧位甲下甲癣是最常见的临床模式（62%），其次是全甲营养不良型甲癣（20.2%）。最常见的真菌分离株是皮肤癣菌（49.5%），其次是念珠菌属（40.4%）和非皮肤癣菌霉菌（10.1%）。在皮肤癣菌中，红色毛癣菌（47%）是最常见的分离株，其次是断发毛癣菌（20.4%）。在念珠菌属中，白色念珠菌最为常见（60%）。
直到最近，酵母和非皮肤癣菌霉菌还被视为污染物，但它们作为免疫功能低下患者甲癣的重要病因出现，这就要求对甲癣进行真菌学诊断和抗真菌药敏试验。认识到甲癣模式的变化将有助于治疗方法的选择和控制措施的实施。
