Clinical features of onychomycosis and its causative organisms: a retrospective, single-centre analysis

Onychomycosis is a common nail infection caused by dermatophytes, non-dermatophyte moulds (NDMs) and yeasts. Contrary to global data, numerous studies conducted in Malaysia have identified NDMs as the most predominant causative organisms. We performed a retrospective analysis to determine the clinical features of onychomycosis, identify the common causative organisms and assess treatment outcomes in our centre. Materials and Methods: Data were collected from all patients with clinical suspicion of onychomycosis who had nail clippings cultured between January 2011 and December 2015. The data were subsequently analysed. Results: A total of 225 nail specimens were collected. Toenails were the most common site affected ( n = 93, 41.3%), followed by fingernails ( n = 71, 31.6%), both toenails and fingernails ( n = 42, 18.7%) and not stated ( n = 19, 8.4%). The median age of patients was 60 years (interquartile range: 26). Of the 104 positive cultures, NDMs ( n = 46, 44.2%) were most frequently identified, followed by yeasts ( n = 33, 31.7%) and dermatophytes ( n = 25, 24.0%). Of 68 patients who received oral antifungals, 45.6% ( n = 31) still had dystrophic nails, while improvement was seen in 19.1% ( n = 13) of patients. In addition, 29.4% ( n = 20) of patients required a second pulse of antifungal treatment within a year after the first treatment. Conclusion: As previously published, onychomycosis is more commonly seen in the elderly and typically affects the toenails. The causative organisms were predominantly NDMs. A large proportion of patients had persistent dystrophic nails despite antifungal treatment. Hence, treatment may be challenging, as non-dermatophyte onychomycosis is more resistant to treatment.

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