The Causative Pathogens of Onychomycosis in Southern Taiwan: a Study at a Regional Hospital in Chiayi County

• Main Authors: Ching-Chi Chi, 紀景琪
• Other Authors: Ming-Chih Chou
• Format: Others
• Language: zh-TW
• Published: 2004
• Online Access: http://ndltd.ncl.edu.tw/handle/01902598484025837968

碩士 === 中山醫學大學 === 醫學研究所 === 92 === Background: Onychomycosis is a common cutaneous fungal infection in Taiwan. Selecting an appropriate antifungal agent targeting the causative pathogens is among the most important factor for successfully curing the onychomycosis. There has been no investigation of the pathogens of onychomycosis previously in Taiwan, which could provide clinicians with an epidemiologic basis to choose antifungal agents. Objective: The purpose of this study was to survey the distribution of causative pathogens of onychomycosis in southern Taiwan. Materials and methods: A total of 380 patients diagnosed with established onychomycosis were enrolled. Histopathologic examination and fungus culture of the affected nail specimens were performed to confirm the diagnosis of onychomycosis and identify the pathogens. Results: The pathogens of onychomycosis were dermatophytes in 228 patients (60%), Candida in 118 (31.1%), and nondermatophyte molds in 34 (8.9%). Candida and nondermatophyte molds were not significantly more frequently seen in patients older than 60 years (36% and 11.6%, respectively, p = 0.099). The odds ratio (OR) for females to have non-dermatophyte onychomycosis was 2.29 compared with males (95% CI 1.47-3.56), and 11.20 for diabetic females compared with diabetic males (95% CI 1.04-120.36). The gender discrepancy was more prominent in diabetic patients. Compared with the general population, the OR for patients with paronychia to have non-dermatophyte onychomycosis was 6.19 (95% CI 3.34-11.59). The OR for patient with a wet occupation to have non-dermatophyte onychomycosis was 4.75 compared with patients with a non-wet occupation (95% CI 1.90-12.23). In females (43.1%), fingernail onychomycosis (65.6%), those with concomitant paronychia (64.6%), housewives, farmers, fishermen, and other wet occupation workers (29.4-63%), Candida occupied a significant higher proportion of the causative pathogens of onychomycosis. Conclusion: The following factors, including site, gender, presence of concomitant diabetes mellitus or paronychia, occupation, and geographic distribution, could have effects on the pathogens of onychomycosis. In southern Taiwan, 40% of onychomycosis was not caused by dermatophytes. We suggest that histopathologic examination and fungus culture of the nail specimen should be performed to confirm and to recognize the pathogen. Then, we can intelligently choose the most effective drug to treat onychomycosis accordingly and successfully.