Onychomycosis caused by dematiaceous fungi: A four-year study among agricultural workers of Assam, India

Background and Purpose: Onychomycosis due to dematiaceous fungi is rarely reported and the identification is also quite tricky due to poor sporulation.The recent emergence of dematiaceous fungi as a cause major of onychomycosis is a matter of concern in the field of mycology.  Therefore, this study aimed to understand the dematiaceous fungi as a possible cause of onychomycosis, especially among agricultural workers. In addition, the evaluation of the antifungal susceptibility patterns gave an idea of the accurate drug that will help in the treatment challenge and prevent antifungal resistance. Materials and Methods: The standard procedure was followed for direct microscopic examination and isolating fungi. Furthermore, antifungal susceptibility testing (AFST) was conducted in accordance with the Clinical and Laboratory Standards Institute (CLSI) M-۳۸-A۲ protocol.Results: Both KOH and fungal positivity were recovered in ۲۷۵ workers out of ۳۵۶ suspected cases, of which ۵۲% were NDMs, ۴.۳% were yeast, ۲۸.۷% were dermatophytes and ۱۴.۹% were sterile hyphae. Among NDMs (۵۲%, n=۱۴۳), ۴۵.۵% (n=۶۵) were hyaline hyphomycetes and ۵۴.۵% (n=۷۸) were dematiaceous hyphomycetes. Among dematiaceous fungi, Pestalotiopsis spp., Arthrinium spp., etc. were commonly isolated. Additionally, azoles, amphotericin-B and anidulafungin showed excellent antifungal activity against tested isolates. Conclusion: Dematiaceous fungi are now becoming a potential cause of onychomycosis. A more detailed study is needed on the identification of these emerging isolates and the mode of action of antifungal drugs for a better treatment strategy.

Keywords:

Nail infection , Non-dermatophytes , phaeoid fungi , Phytopathogens