title: Growing Incidence of Non-Dermatophyte Onychomycosis in Tehran, Iran.
abstract: BACKGROUND
  Non-dermatophyte onychomycosis (NDO) is caused by a wide range of mold fungi other than dermatophytes, and has been reported at various rates in different countries worldwide. Studies on the incidence of NDO in the community are essential for understanding its epidemiology and control, as well as for the appropriate treatment of these infections.
  
  
  OBJECTIVE
  In this study, the incidence of NDO in Tehran, Iran, was compared to the incidence of onychomycoses due to dermatophytes and yeasts.
  
  
  METHODS
  From 2014 through 2015, samples from a total of 1,069 patients with suspected fungal nail diseases, who were referred to three medical mycology laboratories in Tehran, were collected and subjected to direct examination (all samples) and culture (788 samples). Differentiation of the causative agents of onychomycosis was based on microscopic observation of characteristic fungal elements in the nail samples and growth of a significant number of identical colonies on the culture plate.
  
  
  RESULTS
  Based on only direct microscopy, onychomycosis was diagnosed in 424 (39.6%) cases, among which 35.8% were caused by dermatophytes, 32.7% by yeasts, and 29.3% by non-dermatophyte molds (NDMs), while 2.2% were mixed infections. Direct exam was significantly more sensitive than culture for the diagnosis. The most commonly isolated NDMs wereAspergillusspp. (69.3%, n = 52), followed byFusariumspp. (n = 7). The other isolated species werePaecilomycesspp.,Scopulariopsisspp.,Acremoniumspp.,Cladosporiumspp., andChrysosporiumspp., with only one case of each.
  
  
  CONCLUSIONS
  An increasing frequency of NDO compared to onychomycosis due to other causative agents has been noticeable over the past few years in Iran. This epidemiological data may be useful in the development of preventive and educational strategies.
authors: Department of Medical Parasitology and Mycology, School of Public Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, IR Iran.
authors: Marjan
authors: M
authors: Motamedi
authors: Department of Medical Parasitology and Mycology, School of Public Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, IR Iran.
authors: Zeinab
authors: Z
authors: Ghasemi
authors: Department of Medical Parasitology and Mycology, School of Public Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, IR Iran.
authors: Mohammad Reza
authors: MR
authors: Shidfar
authors: Department of Medical Parasitology and Mycology, School of Public Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, IR Iran.
authors: Leila
authors: L
authors: Hosseinpour
authors: Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors: Hossein
authors: H
authors: Khodadadi
authors: Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors: Kamiar
authors: K
authors: Zomorodian
authors: Department of Medical Parasitology and Mycology, School of Public Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, IR Iran; Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IR Iran.
authors: Hossein
authors: H
authors: Mirhendi
keywords: Epidemiology; Non-Dermatophyte Molds; Onychomycosis