An explanatory study of onychomycosis in the Maltese population.

Abstract

Aim

The purpose of this study was to examine the current method of diagnosis used by Maltese podiatrists (visual diagnosis). The accuracy of such diagnosis was compared to results obtained with laboratory diagnosis (KOH with microcopy and culture growth). The study also helped to identify and analyze the micro organisms found in fungal cultures of clinically suspected onychomycosis in the Maltese population.

Research Design and Methods

An exploratory same subject design study was carried out on Maltese patients who attend the podiatry clinic at the various Health Centers in Malta. The data collection took place between December 2009 and February 2010. Four podiatrists with a minimum ten year experience were selected using a non-probability convenient type of sampling. Each of the four chosen podiatrists identified ten newly diagnosed subjects suffering from onychomycosis. A data collection sheet regarding the subjects' demographic data, health and nail dystrophy was used by the researcher to obtain more information. Using the Mater Dei Mycology laboratory sampling protocol (Appendix X), the researcher took a nail sample from each subject, and later sent it to the Mater Dei Mycology laboratory. Each sample was subjected to microscopy with KOH solution and culture growth.

Results

The findings demonstrated a significant difference (z = 6.989) between the two diagnostic tests. Out of the forty nail samples, 37.5% (15 nail samples) had a positive KOH and culture growth, 55.5% ( 22 nail samples) had a negative KOH and no culture growth, 5% ( 3 nail samples) had a negative KOH and a culture growth whilst no samples had a positive KOH and a negative culture growth. The results show that although 100% of the nail samples were visually diagnosed as being mycotic, only 45 % of the samples were confirmed in the laboratory as being mycotic. The results showed that onychomycosis is more frequent in females (72%) then in males and that it is commonly found in patients aged between 71 and 85 years of age.

Conclusion

The current method of diagnosing onychomycosis in Malta was found to yield a high percentage (55%) of false-positives. A more accurate method of diagnosis should be considered. Moreover due to common presence of Aspergillus micro organisms found in the sample group, extreme care should be taken when handling suspected onyhcomycotic nails.