Journal of Applied & Environmental Microbiology
ISSN (Print): 2373-6747 ISSN (Online): 2373-6712 Website: Editor-in-chief: Sankar Narayan Sinha
Open Access
Journal Browser
Journal of Applied & Environmental Microbiology. 2016, 4(2), 30-33
DOI: 10.12691/jaem-4-2-1
Open AccessArticle

Fungi as Pathogens of Onychomycosis among Diabetic Patients

Saleh. H. Baiu1, , Warda M.B. Bridan2 and Hanan. M – K. Kalfa3

1Department of Botany, Faculty of Science, Benghazi University- Libya

2Department of Microbiology, the Libyan Academy, Benghazi- Libya

3Department of Dermatology, Jumhuria Hospital, Benghazi – Libya

Pub. Date: May 04, 2016

Cite this paper:
Saleh. H. Baiu, Warda M.B. Bridan and Hanan. M – K. Kalfa. Fungi as Pathogens of Onychomycosis among Diabetic Patients. Journal of Applied & Environmental Microbiology. 2016; 4(2):30-33. doi: 10.12691/jaem-4-2-1


The purpose of the study was to determine the role of dermatophytes, yeasts, and non-dermatophytic moulds as causative agents of onychomycosis among diabetic patients during the months September 2013 to January 2014 in202 diabetic patients suspected to having onychomycosis. The study included each patient from type 2 diabetes mellitus (T2DM) from all patients who were registered at the Sedee Hussein Polyclinic of Benghazi city. The study group equally consisted of 101(50%) male patients and 101(50%) female patients. Methods: The specimens were tested by direct microscopic examination using potassium hydroxide(20%) and culturing on Sabouraud’s dextrose agar and fungobiotic agar containing cyclohexamide and chloramphenicol. Results: The prevalence of onychomycosis among diabetic patients in our study was high (77.2%) in type 2 diabetes mellitus (T2DM). Culture was positive in 156 of 202 diabetic patients with onychomycosis of non-dermatophytic moulds isolated from 91 cases (58%). While Candida species have emerged as second-line pathogens, were isolated from fourty one patients (26%). Dermatophytes were detected in only nine patients (6%), and mixed fungi 15 (10%). Distal and lateral subungual onychomycosis was the commonest clinical type (69.2%) followed in decreasing order by total dystrophic onychomycosis (20.5%), and then superficial white onychomycosis (7.7%) and proximal subungual onychomycosis (2.6%). Conclusion: This study had confirmed that diabetic patients are at a high risk of having onychomycosis. Managing onychomycosis in diabetic patients may require systemic antifungal treatment, physical measures and patient education.

Non-dermatophytes dermatophytes Onychomycosis Diabetes mellitus

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Rich, P. Onychomycosis and tinea pedis in patients with diabetes. J Am Acad Dermatol, (2000), 43: 130-134.
[2]  Summerbell, R.C., Kane, J., Krajden SOnychomycosis, tinea pedis and tinea manuum caused by non-dermatophytic filamentous fungi. Mycoses; (1989), 32:609-19.
[3]  Agarwalla, A., Agrawal, S., Khanal, B., Onychomycosis in eastern Nepal. Nepal Med Coll J, (2006), 8:1-7.
[4]  Jarve, H., Naaber, P., Kaur, SToe nail onychomycosis in Estonia. Mycosis 2004, 47:57-61.
[5]  Scher PK. Onychomycosis: a significant medical disorder. J Amer Acad Dermato (1996); 35: S2-S5
[6]  Tosti, A., Piraccini, B.M., Lorenzi, SOnychomycosis caused by non-dermatophytic molds. J Am Acad Dermatol; (2000). 42: 217-24.
[7]  Weeks, J., Elewski, B., Management of superficial infections. In: Merz WG, Hay RJ, editors. Topley and Wilson's microbiology and microbial infections. 10th ed. London: Hodder Arnold, (2005). p. 182-9.
[8]  Lim, J. T.; Chua, H. C. and Goh, C. L. Dermatophyte and non dermatophyte onychomycosis in Singapore. Australas. J. Dermatol; (1992). 33: 159-163.
[9]  Ramani, R.; Srinivas, C. R.; Ramani, A.; Kumari, T. G. and Shivananda, P. G. Molds in onychomycosis, Int. J. Dermatol; (1993).32: 877-878.
[10]  Kampfer, P.; Rauhof, F. O.; and Dott, W. (1991). Glycosidase Profiles of Members of the Family Enterobacteriaceae, J. Clin. Microbiol. 29:2877-2879.
[11]  Dogra, S., Kumar, B., Bhansali, A., Chakrabarty, A., Epidemiology of onychomycosis in patients with diabetes mellitus in India. Int. J. Dermatol, (2002), 41: 647-51.
[12]  Chang, S. J., Hsu, S. C, Tien, K. J., Hsiao, J. Y., Lin, S. R. and Chen, H. C. Metabolic syndrome associated with toenail onychomycosis in Taiwanese with diabetes mellitus. Int. J. Dermatol, (2008), 47: 467-72.
[13]  Leelavathi, M.; Azimah, M. N.; Kharuddin, N. F.; Tzar, M. N.. Prevalence of toenail onychomycosis among diabetics at a primary care facility in Malaysia. J. Trop. Med. Public. Health, (2013), 44(3):479-483.
[14]  Gupta, A. K., Konnikov, N., MacDonald, P., Rich, P.; Rodger, N. W., Edmond s, M. W.; and et al. Prevalence and epidemiology of toenail onychomycosis in diabetic subjects: a multicentre survey. Br. J.Dermato, (1998), 139:665-71.
[15]  Saunte, D. M., Holgersen, J.B., Haedersdal, M.; Strauss, G. and Bitsch, M. Svendsen OL. Prevalence of toenail onychomycosis in diabetic patients, Acta Derm Venereol; (2006), 86: 425-8.
[16]  Kafaie, P.; Noorbala, M. T. Evaluation of onychomycosis among diabetic patients of Yazd diabetic centre. J. Pakistan. Assoc Dermatol,, (2010), 20: 217-21.
[17]  Manzano-Gayosso, P., Hernández-Hernández, F., Méndez-Tovar, L. J., Palacios-Morales, Y., Córdova-Martínez, E.; Bazán –[Mora, E., Onychomycosis incidence in type 2 diabetes mellitus patients. Mycopathologia; (2008)., 166: 41-5.
[18]  Berker, D. Clinical practice. Fungal nail disease, N. Engl. J.Med,, (2009), 360: 2108-16.
[19]  El Batawi MM, Arnaot H, Shoeib S, Bosseila M, El Fangary M, Helmy AS. Prevalence of non-dermatophyte molds in patients with abnormal nails. Egyptian Dermatol Online J(2006); 2:11
[20]  Hanif, F., Ikram, A.; Butt, T., Malik, N., Qadir, I.H., Faiz, UTrends of fungal isolates in our set up. Infect Dis J Pak.(2009)., 18:3-5.
[21]  Ghannoum MA, Hajjeh RA, Scher R, Konnikov N, Gupta AK, Summerbell R, et al. A large scale North American study of fungal isolates from nails: the frequency of onychomycosis, fungal distribution, and anti-fungal susceptibility patterns. J Am Acad Dermatol(2000); 43:641-8.
[22]  Ranawaka, R.R., De Silva, N., Ragunathan, R.W Onychomycosis caused by Fusarium spp. in Sri Lanka: prevalence, clinical features and response to itraconazole pulse therapy in six cases. J Dermatolog Treat.(2008).; 19:308-12.
[23]  Castro, L.N., Casas, C, Sopo, L.;Rojas, A., Del Portillo, P.; Cepero MC, et al.,Fusarium species detected in onychomycosis in Colombia. Mycoses; (2008). 23:121-4.
[24]  English MP. Comment. Nails and fungi. Brit J Dermatol 1998; 94: 481-90.
[25]  Bonifaz A, Angular CP, Ponce RM. Onychomycosis by molds: report of 78 cases. Eur J Dermatol(2007); 17:70-2.
[26]  Dogra, S.; Kumar, B.; Bhansali, A. and Chakrabarty, A. (2002). Epidemiology of onychomycosis in patients with diabetes mellitus in India. Int. J. Dermatol; 41: 647-51.
[27]  Sogair, S. M.; Moawad, M. K. and Al-Humadan,Y. M. (1991). Fungal infection as a cause of skin disease in the eastern province of Saudi Arabia: prevailing fungi and pattern of infection. Mycoses;34:333-7.
[28]  Baran R, Hay RJ, Tosti A, Haneke R. A new classification of onychomycosis. Br J Dermatol(1998);139:567-71.
[29]  Faergemann J, Baran R. Epidemiology, clinical presentation and diagnosis of onychomycosis; BrJDermatol(2003),149. (Suppl 65):1-4.
[30]  Romano C, Gianni C, Difonzo EM. Retrospective study of onychomycosis in Italy: 1985-2000.Mycose(2005);48:42-4.