The study of 101 cases of onychomycosis and associate factors in patients referred to Boali Sina Hospital and Toba dermatology outpatient clinics in Sari

Background and Onychomycosis is a nail fungal infection caused by various species of dermatophytes, yeasts and non-dermatophytic molds and represents about 30% of cutaneous mycotic infections. The goal of this study was to investigate the frequency of onychomycosis and its associated factors in patients referred to Boali Sina Hospital and Toba dermatology outpatient clinics, Sari. In this cross-sectional study, nail specimens were collected from 101 patients suspected of onychomycosis during a 14 month period. Nail specimens were examined by direct microscopy, using potassium hydroxide (KOH) 20%, KOH + CFW, KONCPA (KOH treated nail clipping+PAS) and also culturing on sabouraud’s dextrose agar, containing chloramphenicol (SC), and sabouraud’s dextrose agar containing cyclohexamide and chloramphenicol (SCC) mediums. In this study, 79 (78%) of patients were female and 22 (22%) were male. Yeasts were isolated in 30% cases of onychomycosis, mainly from fingernails. Candida albicans, and C.krusei was the most prevalent species. Non-dermatophytic filamentous fungi were yielded at 24%, especially from toenails, with Aspergillus terreus being the most prevalent species. Dermatophytes were found in 7% of the samples, especially from toenails. Trichophyton mentagrophytes was the predominant species. Unknown filamentous fungi were identified in 19% of samples, while mixed infections were identified in 20% of samples. The highest prevalence rate of onychomycosis was identified in the patients within the 30 to 49 years of age group. Distal and lateral subfungual onychomycosis (DLSO) was the most prevalent clinical types with (88%), followed by WSO (5%), PSO (5%), TDO (1%) and DLSO + PSO (1%). The results of our study showed that onychomycosis is one of the most prevalent infections in patients who are suffering from nail disorders. Yeast and yeast like organisms cause these infections more than other fungus in this region. Women are more infected, as they are in daily contact with detergents and moisture.