title: Aspergillus species: An emerging pathogen in onychomycosis among diabetics.
abstract: BACKGROUND
  Approximately, 33% patients with diabetes are afflicted with onychomycosis. In the past, nondermatophyte molds have been regarded as opportunistic pathogens; recently, Aspergillus species are considered as emerging pathogens of toenail infections. In Sri Lanka, the prevalence of Aspergillus species in onychomycosis among diabetics is not well documented.
  
  
  OBJECTIVE
  To determine the proportion of Aspergillus onychomycosis, risk factors and knowledge among diabetics.
  
  
  METHODS
  This was descriptive cross-sectional study. Three hundred diabetic patients were included. Clinical examinations of patients' toenails were performed by a clinical microbiologist. Laboratory identification was done, and pathogens were identified to the species level by morpho-physiological methods. All inferential statistics were tested at P < 0.05.
  
  
  RESULTS
  Among clinically suspected patients, 85% (255/300) were mycologically confirmed to have onychomycosis. Aspergillus species were most commonly isolated n = 180 (71%) followed by dermatophytes, yeasts, and other molds n = 75 (29%). Of the patients having Aspergillus onychomycosis, 149 (83%) were in the > age group. In men, Aspergillus onycomycosis was seen in 82%. Among patients who had Aspergillus nail infection, 114 (63%) had diabetes for a period of > years. Among patients who were engaged in agricultural activities, 77% were confirmed to have infected nails due to Aspergillus species.
  
  
  CONCLUSIONS
  Aspergillus niger was the most common pathogen isolated from toenail infection. Aspergillus species should be considered as an important pathogen in toenail onychomycosis in diabetic patients. Risk factors associated with Aspergillus onychomycosis were age, gender, duration of diabetes, length of exposure to fungi, and occupation.
authors.affiliation: Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka.
authors.forename: T M
authors.initials: TM
authors.lastname: Wijesuriya
authors.affiliation: Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka.
authors.forename: J
authors.initials: J
authors.lastname: Kottahachchi
authors.affiliation: Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka.
authors.forename: T D C P
authors.initials: TD
authors.lastname: Gunasekara
authors.affiliation: Diabetic Clinic, Colombo South Teaching Hospital, Kalubowila, Sri Lanka.
authors.forename: U
authors.initials: U
authors.lastname: Bulugahapitiya
authors.affiliation: Tan-Galle Base Hospital, Tangalle, Hambantota, Sri Lanka.
authors.forename: K N P
authors.initials: KN
authors.lastname: Ranasinghe
authors.affiliation: Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka.
authors.forename: S S
authors.initials: SS
authors.lastname: Neluka Fernando
authors.affiliation: Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka.
authors.forename: M M
authors.initials: MM
authors.lastname: Weerasekara
keywords: Aspergillus species; Sri Lanka; diabetics; onychomycosis