Prevalence of toenail onychomycosis in type 2 diabetic patients at Queen Savang Vadhana Memorial Hospital: a study in Outpatient Clinic in 2014

Korawan Chakkaphak; Phonpen Akarawatcharangura; Ariya Chindamporn; Sai Tusgate

Authors

Korawan Chakkaphak DIVISION OF FAMILY MEDICINE, QUEEN SAVANG VADHANA MEMORIAL, CHONBURI, THAILAND
Phonpen Akarawatcharangura DIVISION OF FAMILY MEDICINE, QUEEN SAVANG VADHANA MEMORIAL, CHONBURI, THAILAND
Ariya Chindamporn DIVISION OF MICROBIOLOGY, FACULTY OF MEDICINE, CHULALONGKORN UNIVERSITY, BANGKOK, THAILAND
Sai Tusgate DIVISION OF DERMATOLOGY, QUEEN SAVANG VADHANA MEMORIAL, CHONBURI, THAILAND

Keywords:

Onychomycosis, Diabetic foot, Fungal foot infection

Abstract

Objective: To study the prevalence of toenail onychomycosis, associated risk factors, and self-awareness of the disease in diabetic patients.

Study design: Observational descriptive cross sectional study

Setting: Outpatient clinic at Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand

Material and Methods: Diabetic patients were recruited from outpatient clinic during March 2013 to December 2014. Eighty-six patients with diabetes were enrolled. All clinical data and questionnaire were recorded by attending doctor. Samples from the most affected nail of participants were evaluated for fungal infection with potassium hydroxide preparation and fungal culture. In case of patients with grossly normal toenails, samplings from right big toes were tested. The photographs of the nails were reviewed by the dermatologists to confirm the diagnosis.

Main outcome measures: The primary outcome was the prevalence of onychomycosis in diabetic patients. Secondary outcomes were its associated risk factors.

Results: Eighty-six diabetes patients were studied. Clinical signs of presumed fungal infection were found in 74% of patients, but mycosis was confirmed only in 20.9% of all patients (positive result of fungal culture and potassium hydroxide test). The leading cause of the infection was yeasts (44.4%). Candida albicans (22.2%) was the main fungal pathogen in this group. The presence of onychomycosis was significantly associated with lack of daily foot washing and drying (p = 0.03).

Conclusion: The prevalence of onychomycosis in diabetic patients was 20.9%, significantly associated with poor foot hygiene. Routine foot examination in diabetic patients and foot hygiene should be promoted.

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