Candidal onychomycosis: Clinicoepidemiological profile, prevailing strains, and antifungal susceptibility pattern–a study from a tertiary care hospital

Abstract

Background: Despite an increasing trend of onychomycosis caused by Candida species in recent years, there is a scarcity of published data. Objective: To determine the epidemiological and clinical characteristics of Candida onychomycosis, to identify the prevalent, and perform in-vitro antifungal susceptibility testing (AFST) of the isolates. Methodology: A total of 506 consecutive patients with a clinical suspicion of onychomycosis were included in a cross-sectional clinical study. Nail scrapings and clippings were subjected to KOH examination and culture. Species identification and antifungal drug sensitivity testing were done for Candida isolates using Vitek 2YST Compact system using Vitek 2 cards. Results: Out of 384 (75.88%) culture-positive cases, dermatophytes were isolated in 58.08%, yeast in 26.30%, and NDM in 12.24%. Of the yeast, Candida albicans was isolated in 59.4% and non-albicans species in 40.59%. AFST showed that most of Candida species exhibited 100% susceptibility to most of the antifungal drugs tested, while intermediate resistance to fluconazole and flucytosine was seen in some non-albicans species (C. krusei, C. glabrata, and C. guilliermondii). Time taken for species identification was 14–18 h (average 15.5 h), while determination of minimum inhibitory concentration took 9–27 h (average 13 h). Conclusions: Our study showcases the present scenario of Candida distribution and the resistance patterns of various species afflicting the nail unit. Furthermore, our findings clearly indicate that the carriage of this pathogenic yeast is seen in both healthy individuals as well as with immunosuppression.

Keywords

• antifungal susceptibility test
• candida
• onychomycosis
• vitek 2yst