Onychomycosis: clinical pattern and prevailing fungi in Kathmandu.

Onychomycosis is a chronic mycotic infection of finger and toe nails that affects the quality of life in a significant proportion. The study was aimed to identify the clinical patterns and etiological agents of onychomycosis. The study population comprised of the suspected cases of onychomycosis, attending the outpatients department of Dermatology of Tribhuvan University Teaching Hospital, Kathmandu, during November 2006 to March 2008. Detailed history was taken and clinical pattern was noted. Nail sample was obtained from patients with suspected onychomycosis and was subjected for direct microscopy and fungal culture. After first inoculation, the culture tubes were examined every day for one week and thereafter weekly and the fungus was identified. A total of 218 patients were included in the study. The age of the patients ranged from 4 to 88 years with mean of 32.8 +/- 15.4. Maximum of the patients were in the age group of 21-30 years. M: F ratio was 1.05:1. Duration of the disease varied from 1 month to 15 years. Direct microscopy was positive in 64.22% and culture was positive in 41.7%. Dermatophytes were isolated in 54.9%, yeasts in 39.6% and non-dermatophyte molds in 5.5%. As a whole, Trichophyton rubrum was the most common fungal isolate (82%). Yeast infection was more common in females. Yeast was significantly more commonly implicated as a pathogen in finger nail onychomycosis. Dermatophytes were more frequently isolated from toe nail onychomycosis. In conclusion, T rubrum was the most common fungal isolate.