Onychomycosis in a Group of Patients Presented to a Tertiary Care Hospital in Sri Lanka

Background: Onychomycosis is increasingly found in tropical populations. Objectives: To investigate the incidence and etiology of onychomycosis in a group of patients presented to the Teaching Hospital, Kurunegala, Sri Lanka. Methods: A total of 47 patients (8 males, 39 females clinically diagnosed with onychomycosis were randomly selected as study participants. After obtaining written informed consent from the participants, demographics and onychomycosis-associated factors were recorded using an interviewer-administered questionnaire. Nail specimens were subjected to direct microscopy (DM) after 20% KOH digestion and were cultured on Sabourauds Dextrose Agar (SDA) containing chloramphenicol alone and SDA with chloramphenicol and cycloheximide. Fungi were identified macroscopically and microscopically.  Results: Out of 47 patients clinically diagnosed with onychomycosis, only 30 (63.8%) were confirmed as onychomycosis mycologically. Overall, 93.4% of confirmed onychomycosis patients (28/30) aged between 20-69 years. Onychomycosis was common among housewives 36.7% (11/30), health care workers 23.3% (7/30) and farmers 16.7% (5/30). Further, 53.3% (16/30) had onychomycosis only in toe nails, 30% (9/30) had only in finger nails. Both toe and finger nails were affected in 16.7% (5/30). Commonest etiology of onychomycosis was dermatophytes 12 (40%) followed by nondermatophytic moulds (NDM) 10 (33%) and Candida 8 (27%). Leading pathogenic dermatophytes were T. mentagrophytes (41.7%; 5/12) and T. rubrum (25%; 3/12). Commonest NDM was Fusarium species 60% (6/10). Conclusions: Onychomycosis was common in adults (20-69 years) particularly among housewives, health care workers and farmers in our sample. Toe nails were the most affected. Etiology of onychomycosis was mainly dermatophytes followed by NDMs and Candida. Common dermatophytes associated with onychomycosis were T. mentagrophytes and T. rubrum. Fusarium species was the leading NDM associated with onychomycosis.