title: Onychomycosis in diabetic patients in Fako Division of Cameroon: prevalence, causative agents, associated factors and antifungal sensitivity patterns.
abstract: BACKGROUND
  Onychomycosis is an infection of the nail unit by a fungus. This is a very common infection amongst diabetics. Its occurrence among diabetics in Fako division is unknown. In this study we provide information on the characteristics of onychomycosis in diabetics in Fako division, Cameroon.
  
  
  METHODS
  A cross-sectional descriptive and analytical hospital-based study was conducted in two diabetic clinics in the Buea and Limbe regional hospitals. We recruited 152 consenting diabetics into the study. Demographic, behavioural, and clinical data of patients were obtained through the use of structured questionnaires. Toenail, finger nail, skin scrapings and nail clippings were collected from participants, KOH mounts were prepared and observed under the microscope and cultured on Sabouraud Dextrose Agar supplemented with chloramphenicol to isolate causative fungi. Identification of isolates was done to species level using the cello tape flag method and slide culture. The presence of a dermatophyte by either microscopy or culture or both methods was considered positive for onychomycosis. Antifungal susceptibility testing was carried out using selected antifungals by the Kirby-Bauer disk diffusion method on Sabouraud Dextrose Agar.
  
  
  RESULTS
  Clinical onychomycosis was found in 77 of the 152 diabetics tested giving a prevalence of 50.7% (95% CI 42.4-58.9) in diabetics in Fako. No socio-demographic or clinical factor studied was significantly associated with onychomycosis. Trichophyton rubrum was the most common isolate (62%). Other isolates included Trichophyton metagraphyte (22%) and Trichophyton tonsurans (16%). Dermatophytes were sensitive to miconazole (66%), amphotericin B (19%) and ketoconazole (14%).
  
  
  CONCLUSIONS
  Onychomycosis is common in diabetics in Fako signifying the need for regular screening by either microscopy or culture. Infected nails could be treated with miconazole.
authors.affiliation: Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, Cameroon.
authors.forename: Marvlyn
authors.initials: M
authors.lastname: Eba
authors.affiliation: Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, Cameroon.
authors.forename: Anna Longdoh
authors.initials: AL
authors.lastname: Njunda
authors.affiliation: Regional Hospital Limbe, Limbe, South West Region, Cameroon.
authors.forename: Rene Njikam
authors.initials: RN
authors.lastname: Mouliom
authors.affiliation: Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, Cameroon. kwentitebit@yahoo.com.|Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, Cameroon. kwentitebit@yahoo.com.
authors.forename: Emmanuel Tebit
authors.initials: ET
authors.lastname: Kwenti
authors.affiliation: Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, Cameroon.
authors.forename: Anold Nsoh
authors.initials: AN
authors.lastname: Fuh
authors.affiliation: Department of Microbiology and Parasitology, Faculty of Science, University of Buea, P.O. Box 63, Buea, Cameroon.
authors.forename: Gordon Takop
authors.initials: GT
authors.lastname: Nchanji
authors.affiliation: Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, Cameroon.
authors.forename: Julius
authors.initials: J
authors.lastname: Atashili
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D002163:Cameroon / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D025141:Drug Resistance, Fungal; D005260:Female; D006801:Humans; D007654:Ketoconazole / Q000627:therapeutic use; D008297:Male; D008825:Miconazole / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009262:Nails / Q000382:microbiology / Q000473:pathology; D014009:Onychomycosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D015995:Prevalence; D014249:Trichophyton / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification*
chemical_list: D000935:Antifungal Agents; D008825:Miconazole; D000666:Amphotericin B; D007654:Ketoconazole
keywords: Antifungal susceptibility; Cameroon; Diabetic; Fako; Onychomycosis; Prevalence; Risk factors