Investigation And Analysis On Onychomycosis In Dermatovenereology Department Of The Forth Hospital Of Hebei Medical University

Objective: Onychomycosis is chronic infection of nails or tissue undernails caused by various fungi. Dermatophytes, yeasts and nondermatophytemoulds all can cause onychomycosis. Onychomycosis caused bydermatophytes is called tinea unguium. Onychomycosis is popular in thegeneral population, and investigation revealed that the prevalence ofonychomycosis was5.69%in China.Epidemiology of onychomycosis is related to a variety of internal andexternal factors, such as the patient's age, gender, genetic background,lifestyle, and a different time, geographic, and climatic environment.Epidemiological investigation is very important for the prevention andtreatment of onychomycosis. Investigation of affecting factors will help tocarry out disease prevention work. Clinical classification, and the compositionand distribution of the pathogen contribute to formulation of individualizedtreatment plans.Located in the center of North China Plain, Shijiazhuang City has atemperate continental climate and high population mobility with largefloating population. There were few onychomycosis epidemiological studiesin the past. In this paper, the author illustrates part of the epidemiology ofonychomycosis in the region by researching the clinical and pathogenclassification, and related factors with regard to the disease of cases withinone in our hospital.Method:1Choose the patients from dermatovenereology outpatient treatment ofthe Fourth Hospital of Hebei Medical University within the period fromJanuary2011to December2011whose initial diagnosis is onychomycosis. Two conditions are required.①Clinical signs of the nail: thickening,discoloration, delamination or embrittlement.②a positive result of fungalculture.2Select the most serious nail as the target nail. Adopt multiple pointfungal culture method to culture the infected nail. Culture-positive strainswere identified to species. The specific identification method, includesobservation of colony morphology, lactophenol cotton blue stain, urease test,germ tube test, CHROMagar significant color test, microculturing fungi andso on.3Distinguish the target nail with clinical classification by a fixeddermatologist, asking onychomycosis-related factors, and log into thequestionnaire.4Summary of all data, analysis of data and making conclusion withSPSS software.Results:1In this study, a total of106cases of patients with positive fungalculture results were including30males and76females. The patients ranged inage from2to79years, with a median age of38years. The shortest course ofdisease was1month, and the longest40years, and median duration was12months.2Among the patients25cases involve only nails,73cases only foot nailsand8cases both hand nail and foot nail were infected. Of the patients themaximum number of infected nails is20, and the minimum is one. Patientswith1~2infected nails account for55.66%, with3~5infected nails accountfor27.36%and with over5account for16.98%.3The patient's age (year), disease duration (month) and the number ofinfected nails any two of the correlation analysis. Obtained:①Age anddisease duration are positive correlation, the older, the longer the duration.②The number and duration are positive correlation, that is, longer duration,with increasing numbers of infected nails.4Clinical classification: distal and lateral subungual onychomycosis (47.52%)and total dystrophic onychomycosi(s44.55%)were more common,but proximal subungual onychomycosis (4.95%) and superficial whiteonychomycosis(2.97%)were rarely seen.5Nail changes and concomitant symptoms: the common nail changeswere discoloration, thickening, embrittlement, hardening and onycholysis.Discoloration is the most common symptom, which can be found in84.91%cases of the total sample. White, black and yellow are the most frequent to beseen, and part of nail have no color changes. Onychomycosis' commonconcomitant symptoms and the constituent ratio: pain(15.09%), tenderness(16.98%).6Strains composition: there were111stains fagul, includingdermatophytes72(64.9%), yeast34(30.6%), and NDM5(4.5%),Trichophyton rubrum47(42.34%), Trichophyton mentagrophyte19(17.12%),Candida albicans14(12.61%). Single infection is found in101cases, accounting for95.28%; mixed infection is found in5cases those aretwo kinds of fungi, the composition of the strains were Trichophyton rubrumwith Candida albicans, Trichophyton rubrum with Candida glabrata,Trichophyton rubrum with Candida Krusei, Trichophyton mentagrophyte withCandida glabrata, Candida tropicalis with rhodotorula glutinis.Conclusion:1Age of outpatients range from20to50years, there is a big differencebetween the disease duration, and more than80%of cases have less than fiveaffected nails. Patients' age was positively correlated with the course so didthe number of affected nails and disease duration.2The study of onychomycosis clinical classification: distal and lateralsubungual onychomycosis and total dystrophic onychomycosis were morecommon,while proximal subungual onychomycosis and superficial whiteonychomycosis were rarely seen.3Pathogenic strains isolated from onychomycosis are mostlydermatophytes, followed by yeast and nondermatophyte moulds is lesscommon. Single infection accounted for the vast majority and mixed infection is less common. The majority of mixed infection is mix of dermatophytes andyeast.4Social factors, the epidemiology of onychomycosis could not beignored.