الفهرس 
Mycological aspectOnly 14 pages are availabe for public view
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Abstract
Fungal nail infection (onychomycosis) is a common chronic disease with a substantial negative effect on the quality of life to those who suffer from it and traditionally been difficult to diagnose and treat and has physical and psychological consequences for the patient.
Onychomycosis is the most common nail disorder and probably represents about 30% of all cutaneous fungal infections. Although not life-threating; onychomycosis constitutes an important public health problem because of its high prevalence and the associated morbidity. The prevalence of onychomycosis increases with age .Several predisposing factors increase the prevalence of onychomycosis as excessive sweating, occlusive foot wear, trauma, poor peripheral circulation, diabetes and immunodeficiency.
Onychomycosis is caused by dermatophytes such as: T.rubrum, E. floccosum, M.canis; non dermatophytes as acremonium, scopulariopsis ansd aspergillus spp. And yeasts as C. albicans and C. parapsilosis.When it is caused by dermatophytes, it is termed tinea unguim or ring worm of the nail. The relative percentages of cases due to these etiologic agents vary with geographic location; however, molds infection in onychomycosis is increasing in incidence.
Acquired onychomycosis is governed by virulence of the fungal organism, the ability of the host to defend itself and the anatomic site and kind of tissue selected for invasion.
Clinically onychomycosis is divided into: distal and lateral subungual onychomycosis (DLSO), proximal subungual onychomycosis (PSO), superficial white onychomycosis (SWO), candidal onychomycosis and total dystrophic onychomycosis (TDO).
Onychomycosis can be diagnosed by:
1) Direct microscopy using potassium hydroxide preparations with or without stain such as methylene blue.
2) Culture on different media to aid the identification of the causative organisms by its macroscopic and microscopic picture.
3) Histopathological examination which can evaluate the topographic distribution, density and nature of fungi present within the nail plate.
4) Flow cytometry provides information about the amount of fungal pathogens in the nail and the family to which it belongs and also helps monitoring the course of the disease during therapy.
5) Immunohistochemistry enabling the identification of distinct type of fungi within the nail, and with image analysis allows quantification of fungal load.
6) Polymerase chain reaction (PCR) amplification and restriction enzyme analysis are reliable and reproducible assays for the detection of pathogenic fungi of onychomycosis.
7) Confocal microscopy, which is a non-invasive technique that uses YAG laser for optical sectioning through intact tissues.
The aim of this work was to study onychomycosis as regards etiology, clinical types, diagnosis and differential diagnosis.
This study was carried out on 177 patients attending the Dermatology outpatient Clinic of hayaat El Nakl hospital/ Cairo. Their age ranged from 18 years to 60 years. The patients were clinically diagnosed as having onychomycosis of finger nails, toe-nails or both were included in this study.Thirty patient chosen depending on the presence of 3 or more nail affection and they were: 5 patients (16.7%) with both finger and toenails affected; 18 patients (60.0%) presented with toenail affection only; and 7 patients (23.3%) with fingernail affection. The specimens were subjected to the following: direct microscopic examination using 10%-20% KOH solution with methylene blue stain and primary culture on Sabouraud dextrose agar medium with add chloramphenicol only and another culture on Sabouraud dextrose agar with chloramphenicol and cyc
Our results showed that positive direct microscopy was found in (30) cases. By the culture, it was found that (28) cases gave positive culture while (2) cases gave no growth and by histopatholgy using PAS, it was found that (26) cases gave positive result while (4) cases gave negative result.
Identification of isolates was done by observing the macroscopic and microscopic pictures of the organism on different media. Identification of the isolates showed no dermatophyte, 21 non dermatophyte molds and 18 yeasts. Also it was found that mixed infections were present in 11 cases.