Abstract
Background: Onychomycosis is the most common disease of the nails. Objective: This retrospective study aimed at evaluating the epidemiology of onychomycosis in adult patients in South Greece during the 2015–2017 period. Material and Methods: A total of 3,226 patients with clinical signs of possible onychomycosis were included. Diagnosis was confirmed by microscopy with KOH 20% and by culture in Sabouraud agar with and without actidione. Results: Diagnosis of onychomycosis was confirmed in 27.99% of the patients. Men were infected more often (40.04%) than women (23.30%). Toenails (68.77%) were infected more than fingernails (31.23%) in both sexes. Onychomycosis in fingernails was more common among women (39.74%) than men (18.51%). Men were more often diagnosed with onychomycosis in toenails (81.49%) than women (60.26%). Dermatophytes were the most frequently isolated fungi (34.11%), followed by Candida(29.79%) and non-dermatophyte molds (NDM) (7.20%). In fingernails, the most frequently isolated fungus was Candida spp. (84.04%), followed by dermatophytes (3.55%) and NDM (0.71%). In toenails, dermatophytes (47.99%) were more commonly identified, followed by NDM (10.14%) and Candida spp. (5.15%). Conclusion: Onychomycosis in Greece follows a pattern of higher incidence in males, with toenails more frequently infected with T. rubrum and fingernails more frequently infected with C. albicans in the present era.
Journal Section:
Clinical Investigations – Research Article
References
1.
Bedaiwy
MY
, Metwally
MA
, El Zawawy
NA
, saba
HA
. Epidemiology, Causative Agents and Clinical Features of Onychomycosis in El-Gharbia Governorate
. Egypt J Bot
. 2017
;15
(0
):187
–96
. 0375-92372.
Husain
A
, Alam
NM
, Joarder
Y
, et al.. Correlation between clinical and mycological diagnosis of onychomycosis
. J Pak Assoc Dermatol
. 2017
;27
(3
):220
–5
.1560-90143.
Sigurgeirsson
B
, Baran
R
. The prevalence of onychomycosis in the global population: a literature study
. J Eur Acad Dermatol Venereol
. 2014
Nov
;28
(11
):1480
–91
.
[PubMed]
0926-99594.
Thomas
J
, Jacobson
GA
, Narkowicz
CK
, Peterson
GM
, Burnet
H
, Sharpe
C
. Toenail onychomycosis: an important global disease burden
. J Clin Pharm Ther
. 2010
Oct
;35
(5
):497
–519
.
[PubMed]
0269-47275.
Ameen
M
. Epidemiology of superficial fungal infections
. Clin Dermatol
. 2010
Mar
;28
(2
):197
–201
.
[PubMed]
0738-081X6.
Faergemann
J
, Baran
R
. Epidemiology, clinical presentation and diagnosis of onychomycosis
. Br J Dermatol
. 2003
Sep
;149
(65
Suppl 65
):1
–4
.
[PubMed]
0007-09637.
Gupta
AK
, Versteeg
SG
, Shear
NH
. Onychomycosis in the 21st Century: An Update on Diagnosis, Epidemiology, and Treatment
. J Cutan Med Surg
. 2017
Nov/Dec
;21
(6
):525
–39
.
[PubMed]
1203-47548.
Maraki
S
, Mavromanolaki
VE
. Epidemiology of onychomycosis in Crete, Greece: a 12-year study
. Mycoses
. 2016
Dec
;59
(12
):798
–802
.
[PubMed]
0933-74079.
Silva-Rocha
WP
, de Azevedo
MF
, Chaves
GM
. Epidemiology and fungal species distribution of superficial mycoses in Northeast Brazil
. J Mycol Med
. 2017
Mar
;27
(1
):57
–64
.
[PubMed]
1156-523310.
Otašević
S
, Barac
A
, Pekmezovic
M
, Tasic
S
, Ignjatović
A
, Momčilović
S
, et al.. The prevalence of Candida onychomycosis in Southeastern Serbia from 2011 to 2015
. Mycoses
. 2016
Mar
;59
(3
):167
–72
.
[PubMed]
0933-740711.
Gupta
C
, Jongman
M
, Das
S
, Snehaa
K
, Bhattacharya
SN
, Seyedmousavi
S
, et al.. Genotyping and In Vitro Antifungal Susceptibility Testing of Fusarium Isolates from Onychomycosis in India
. Mycopathologia
. 2016
Aug
;181
(7-8
):497
–504
.
[PubMed]
0301-486X12.
Effendy
I
, Lecha
M
, Feuilhade de Chauvin
M
, Di Chiacchio
N
, Baran
R
; European Onychomycosis Observatory
. Epidemiology and clinical classification of onychomycosis
. J Eur Acad Dermatol Venereol
. 2005
Sep
;19
(1
Suppl 1
):8
–12
.
[PubMed]
0926-995913.
Gupta
AK
, Gupta
G
, Jain
HC
, Lynde
CW
, Foley
KA
, Daigle
D
, et al.. The prevalence of unsuspected onychomycosis and its causative organisms in a multicentre Canadian sample of 30 000 patients visiting physicians’ offices
. J Eur Acad Dermatol Venereol
. 2016
Sep
;30
(9
):1567
–72
.
[PubMed]
0926-995914.
Rana
M
, Altaf
F
, Bashir
B
, et al.. Frequency of associated factors of onychomycosis
. J Pak Assoc Dermatol
. 2017
;27
(3
):226
–31
.1560-901415.
Ghannoum
M
, Isham
N
. Fungal nail infections (onychomycosis): a never-ending story
. PLoS Pathog
. 2014
Jun
;10
(6
):e1004105
.
[PubMed]
1553-736616.
Mahmoud
AG
, Salem
I
, Christensen
L
. Epidemiology of Onychomycosis. Onychomycosis: Diagnosis and Effective Management
. 1st ed.John Wiley & Sons Ltd.
; 2018
. pp. 13
–20
.17.
Rigopoulos
D
, Katsiboulas
V
, Koumantaki
E
, Emmanouil
P
, Papanicolaou
A
, Katsambas
A
. Epidemiology of onychomycosis in southern Greece
. Int J Dermatol
. 1998
Dec
;37
(12
):925
–8
.
[PubMed]
0011-905918.
Koussidou
T
, Devliotou-Panagiotidou
D
, Karakatsanis
G
, Minas
A
, Mourellou
O
, Samara
K
. Onychomycosis in Northern Greece during 1994-1998
. Mycoses
. 2002
Feb
;45
(1-2
):29
–37
.
[PubMed]
0933-740719.
Cramer
W
, Guiot
J
, Fader
M
et al.. Climate change and interconnected risks to sustainable development in the Mediterranean Nature Clim change
2018
;8;972-98020.
Chacon
A
, Franca
K
, Fernandez
A
, Nouri
K
. Psychosocial impact of onychomycosis: a review
. Int J Dermatol
. 2013
Nov
;52
(11
):1300
–7
.
[PubMed]
0011-905921.
Jacobsen
A
, Tosti
A
. Predisposing Factors of Onychomycosis. Onychomycosis
. Springer International Publishing
; 2017
. pp. 11
–9
.22.
Adams
C
, Athanasoula
E
, Lee
W
, Mahmudova
N
, Vlahovic
TC
. Environmental and Genetic Factors on the Development of Onychomycosis
. J Fungi (Basel)
. 2015
Aug
;1
(2
):211
–6
.
[PubMed]
2309-608X23.
Godoy-Martinez
P
, Nunes
FG
, Tomimori-Yamashita
J
, Urrutia
M
, Zaror
L
, Silva
V
, et al.. Onychomycosis in São Paulo, Brazil
. Mycopathologia
. 2009
Sep
;168
(3
):111
–6
.
[PubMed]
0301-486X24.
Satpathi
P
, Acahr
A
, Banerjee
D
, et al.. Onychomycosis in Eastern India-study in a peripheral tertiary care centre
. J Pak Assoc Dermatol
. 2013
;23
(1
):14
–9
.1560-901425.
Sarma
S
, Capoor
MR
, Deb
M
, Ramesh
V
, Aggarwal
P
. Epidemiologic and clinicomycologic profile of onychomycosis from north India
. Int J Dermatol
. 2008
Jun
;47
(6
):584
–7
.
[PubMed]
0011-905926.
Hashemi
SJ
, Gerami
M
, Zibafar
E
, Daei
M
, Moazeni
M
, Nasrollahi
A
. Onychomycosis in Tehran: mycological study of 504 patients
. Mycoses
. 2010
May
;53
(3
):251
–5
.
[PubMed]
0933-740727.
Papini
M
, Piraccini
BM
, Difonzo
E
, Brunoro
A
. Epidemiology of onychomycosis in Italy: prevalence data and risk factor identification
. Mycoses
. 2015
Nov
;58
(11
):659
–64
.
[PubMed]
0933-740728.
Shemer
A
, Babaev
M
. Fungal Infections (Onychomycosis, Tinea Pedis, Tinea Cruris, Tinea Capitis, Tinea Manuum, Tinea Corporis, different Candida Infections, and Pityriasis Versicolor) and Mycological Laboratory Analyses. Gender and Dermatology
. Springer International Publishing
; 2018
. pp. 235
–42
. 29.
Babayani
M
, Salari
S
, Hashemi
SJ
, Ghasemi Nejad Almani
P
, Fattahi
A
. Onychomycosis due to dermatophytes species in Iran: prevalence rates, causative agents, predisposing factors and diagnosis based on microscopic morphometric findings
. J Mycol Med
. 2018
Mar
;28
(1
):45
–50
.
[PubMed]
1156-523330.
Shafritz
AB
, Coppage
JM
. Acute and chronic paronychia of the hand
. J Am Acad Orthop Surg
. 2014
Mar
;22
(3
):165
–74
.
[PubMed]
1067-151X31.
Amartya
D
, Bala
NN
, Taher
A
. Onychomycosis and Its Treatment
. Inter J Adv Pharm Biol Chem
. 2013
;2
(1
):123
–9
.32.
Segal
R
, Shemer
A
, Hochberg
M
, Keness
Y
, Shvarzman
R
, Mandelblat
M
, et al.. Onychomycosis in Israel: epidemiological aspects
. Mycoses
. 2015
Mar
;58
(3
):133
–9
.
[PubMed]
0933-740733.
Cengiz
FP
, Cemil
BC
, Emiroglu
N
, Bahali
AG
, Ozkaya
DB
, Su
O
, et al.. Etiology of Onychomycosis in Patients in Turkey
. J Am Podiatr Med Assoc
. 2018
May
;108
(3
):253
–6
.
[PubMed]
8750-731534.
Chadeganipour
M
, Mohammadi
R
. Causative Agents of Onychomycosis: A 7-Year Study
. J Clin Lab Anal
. 2016
Nov
;30
(6
):1013
–20
.
[PubMed]
0887-801335.
Raghavendra
KR
, Yadav
D
, Kumar
A
, Sharma
M
, Bhuria
J
, Chand
AE
. The nondermatophyte molds: emerging as leading cause of onychomycosis in south-east Rajasthan
. Indian Dermatol Online J
. 2015
Mar-Apr
;6
(2
):92
–7
.
[PubMed]
2229-517836.
37.
Youssef
AB
, Kallel
A
, Azaiz
Z
, Jemel
S
, Bada
N
, Chouchen
A
, et al.. Onychomycosis: which fungal species are involved? Experience of the Laboratory of Parasitology-Mycology of the Rabta Hospital of Tunis
. J Mycol Med
. 2018
Dec
;28
(4
):651
–4
.
[PubMed]
1156-523338.
Feng
X
, Ling
B
, Yang
X
, Liao
W
, Pan
W
, Yao
Z
. Molecular Identification of Candida Species Isolated from Onychomycosis in Shanghai, China
. Mycopathologia
. 2015
Dec
;180
(5-6
):365
–71
.
[PubMed]
0301-486X39.
Tosti
A
, Piraccini
BM
, Ghetti
E
, Colombo
MD
. Topical steroids versus systemic antifungals in the treatment of chronic paronychia: an open, randomized double-blind and double dummy study
. J Am Acad Dermatol
. 2002
Jul
;47
(1
):73
–6
.
[PubMed]
0190-962240.
Nenoff
P
, Krüger
C
, Schaller
J
, Ginter-Hanselmayer
G
, Schulte-Beerbühl
R
, Tietz
HJ
. Mycology - an update part 2: dermatomycoses: clinical picture and diagnostics
. J Dtsch Dermatol Ges
. 2014
Sep
;12
(9
):749
–77
.
[PubMed]
1610-0379© 2019 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2019
You do not currently have access to this content.
