Clinico-mycological study of onychomycosis


  • Sumedha Ballal Department of Dermatology, St John’s Medical College Hospital, Bangalore, Karnataka, India
  • Ishwara Bhat P. Department of Dermatology, St John’s Medical College Hospital, Bangalore, Karnataka, India
  • Anil Abraham Department of Dermatology, St John’s Medical College Hospital, Bangalore, Karnataka, India
  • Jayanthi Savio Department of Microbiology, St John’s Medical College Hospital, Bangalore, Karnataka, India



Non-dermatophyte moulds, Non dermatophyte onychomycosis, Onychomycosis, Dermatophytes


Background: Onychomycosis is the most common infective nail disorder accounting for 30% of cutaneous mycoses. Though predominantly caused by dermatophytes, yeast and non-dermatophyte moulds have also been implicated. Aim of this study was to describe and analyse clinical and mycological pattern of onychomycosis.

Methods: One hundred patients with onychomycosis diagnosed by direct potassium hydroxide microscopy and culture were included. Nail specimens were collected for fungal culture as per standard procedure. An analysis of demographic data, clinical features and mycological results was made.

Results: Majority of the affected cases were between 19 to 85 years of age. Fingernail onychomycosis was seen in 41 patients, toenail was seen in 46 patients, concurrent involvement was seen in 13 patients. The predominant clinical pattern seen was distal lateral subungual type (70%). Culture was positive among 49% patients. Among these patients non dermatophyte growth was predominant (72%) showing. Aspergillus species (31%) and Fusarium species (31%), Cladosporium species (4%) and Scytalidium species (2%). Trichophyton species (16%) and Candida species (16%) were also isolated. The clinico-etiological correlation revealed that a single pathogen could give rise to more than one clinical type of onychomycosis. Non-Dermatophyte moulds were the most common isolate followed by yeasts and dermatophytes. This is in contrast to earlier studies from a similar geographical region where dermatophytes were the commonest pathogen.

Conclusions: Non-dermatophyte moulds are emerging as the predominant isolate in onychomycosis. The clinical pattern of nail involvement showed no correlation with the fungal isolate.


Williams HC. The epidemiology of onychomycosis in Britain. Brit J Dermatol. 1993;129(2):101-9.

Elewski BE. Onychomycosis: pathogenesis, diagnosis, and management. Clini Microbiol Rev. 1998;11(3):415-29.

Tosti A, Piraccini BM, Lorenzi S. Onychomycosis caused by nondermatophytic molds: clinical features and response to treatment of 59 cases. J Am Acad Dermatol. 2000;42(2):217-24.

Ghannoum MA, Hajjeh RA, Scher R, Konnikov N, Gupta AK, Summerbell R, et al. A large-scale North American study of fungal isolates from nails: the frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns. J Am Acad Dermatol. 2000;43(4):641-8.

Motamedi M, Ghasemi Z, Shidfar MR, Hosseinpour L, Khodadadi H, Zomorodian K, et al. Growing incidence of non-dermatophyte onychomycosis in Tehran, Iran. Jundishapur J Microbiol. 2016;9(8).

Farwa U, Abbasi SA, Mirza IA, Amjad A, Ikram A, Malik N, et al. Non-dermatophyte moulds as pathogens of onychomycosis. J Coll Physicians Surg Pak. 2011 Oct 1;21(10):597-600.

Veer P, Patwardhan NS, Damle AS. Study of onychomycosis: Prevailing fungi and pattern of infection. Ind J Med Microbiol. 2007;25:53-6.

Lone R, Bashir D, Ahmad S, Syed A, Khurshid S. A Study on Clinico- Mycological Profile, Aetiological Agents and Diagnosis of Onychomycosis Government Medical College Hospital in Kashmir. J Clini Diagnostic Res: JCDR. 2013;7(9):1983-5.

Sharma P, Sharma S. Non-dermatophytes emerging as predominant cause of onychomycosis in a tertiary care centre in rural part of Punjab, India. J Acad Clini Microbiol. 2016;18(1):36-9.

Gianni C, Cerri A, Crosti C. Non-dermatophytic onychomycosis. An understimated entity? A study of 51 cases. Mycoses. 2000;43(1-2):29-33.

S, Ramos MJ, Garau M, Gonzalez A, Noriega AR, del Palacio A. Prevalence and risk factors of tinea unguium and tinea pedis in the general population in Spain. J Clin Microbiol.2000;38(9):3226-30.

Grover S. Clinico-mycological evaluation of onychomycosis at Bangalore and Jorhat. Ind J Dermatol Venereol Leprol. 2003;69:284-6.

Garg A, Venkatesh V, Singh M, Pathak KP, Kaushal GP, Agrawal SK. Onychomycosis in central India: A clinico-etiologic correlation. Int J Dermatol. 2004;43:498-502.

Jain S, Sehgal VN. Onychomycosis: an epidemio-etiologic perspective. Int J Dermatol. 2000:39;100-3.

Cheng S, Chong L. A prospective epidemiological study on tinea pedis and onychomycosis in Hong Kong. Chin Med J. 2002;115(6):860-5.

Gelotar P, Vachhani S, Patel B, Makwana N. The prevalence of fungi in fingernail onychomycosis. J Clini Diagnostic Res. 2013;7(2):250.

Bokhari MA, Hussain I, Jahangir M, Haroon TS, Aman S, Khurshi K. Onychomycosis in Lahore, Pakistan. Int J Dermatol. 1999;38:591-5.

Leelavathi M, Tzar MN, Aawiah J. Common Microorganisms Causing Onychomycosis in Tropical Climate. Sains Malaysiana. 2012:41(6):697-700.

Das NK, Ghosh P, Das S, Bhattacharya S, Dutta RN, Sengupta SR. A study on the etiological agent and clinico-mycological correlation of fingernail onychomycosis eastern India. Ind J Dermatol. 2008;53(2):75.

Rafiq AN, Zakaria AS, Khondker L, Khan MS, Doulah S, Hazra SC. Clinico-mycological correlation in onychomycosis in a tertiary level hospital. J Pak Assoc Dermatol. 2016;15(23):277-83

Yuil R, Manuel J, Castro MR. Clinico-etiological correlation and factors associated with onychomycosis. Dermatología Cosmética, Médica y Quirúrgica. 2011;9(3):221-7.

Kaur R, Kashyap B, Bhalla P. Onychomycosis - epidemiology, diagnosis and management. Ind J Med Microbiol. 2008;26:108-16.

Ungpakorn R, Lahaprathan S, Reangchainam S. Prevalence of foot diseases in outpatients attending the Institute of dermatology, Bangkok, Thailand. Clin Exp Dermatol. 2004;29:87-90.

Bassiri-Jahromi S, Khaksar AA. Nondermatophytic moulds as a causative agent of onychomycosis in Tehran. Indian J Dermatol. 2010;55:140-3.

Ranawaka RR, de Silva N, Ragunathan RW. Non-dermatophyte mold onychomycosis in Sri Lanka. Dermatol Online J. 2012;18(1):7.

Bonifaz A, Cruz-Aguilar P, Ponce RM. Onychomycosis by molds. Report of 78 cases. Eur J Dermatol. 2007;17(1):70-2

Moreno G, Arenas R. Other fungi causing onychomycosis. Clin Dermatol. 2010;28(2):160-3.

Ahmadi B, Hashemi SJ, Zaini F, Shidfar MR, Moazeni M, Mousavi B, et al. A case of onychomycosis caused by Aspergillus candidus. Med Mycol Case Rep.2012;1(1):45-8.

Zarei F, Mirhendi H, Fakhim H, Geramishoar M. The first case of onychomycosis due to Aspergillus uvarum. Mycoses. 2015;58(4):239-42.

Nouripour-Sisakht S, Mirhendi H, Shidfar MR, Ahmadi B, Rezaei- Matehkolaei A, Geramishoar M, et al. Aspergillus species as emerging causative agents of onychomycosis. J Mycol Med. 2015;25(2):101-7.






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