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Clinical and Etiological Study of Onychomycosis in Institutionalized ISSN: 2469-5858 Oliveira et al. J Geriatr Med Gerontol 2019, 5:062 DOI: 10.23937/2469-5858/1510062 Volume 5 | Issue 1 Journal of Open Access Geriatric Medicine and Gerontology ReSeARCH ARTiCLe Clinical and Etiological Study of Onychomycosis in Institutionalized Elderly in Goiânia City, Goiás State, Brazil Jefferson Teixeira Oliveira1, Mateus Silva Santos2, Wesley Vieira Naves3, Hygor Lima Costa1, Andressa Santana Santos4, Vivianny Aparecida Queiroz Freitas4, Maria do Rosário Rodrigues Silva4, Milton Camplesi Junior1, Antonio Márcio Teodoro Cordeiro Silva1 and Fábio Silvestre Ataides1* 1Institute of Health Sciences, University Paulista Campus Flamboyant, Brazil 2Postgraduate Program in Genetic, MGene, Pontifical Catholic University of Goiás, Brazil Check for 3Postgraduate Program in Environmental Sciences and Health, Pontifical Catholic University of Goiás, Brazil updates 4Postgraduate Program in Tropical Medicine and Public Health, Federal University of Goiás, Brazil *Corresponding author: Prof Dr. Fábio Silvestre Ataides, Institute of Health Sciences, University Paulista Campus Flam- boyant, Rua Beijuaçu Q.168, Lt.14, Setor Parque Amazonas, Goiânia, Goiás, Brazil, CEP: 74835-340, Tel: 55-62-99631- 8545 Abstract Conclusions: This study found a higher frequency of onychomycosis in women, and the main etiological agents Background: Onychomycosis is fungal nail infection, which were Candida spp. and Fusarium spp. The onychomycosis can be associated with some factors, such as decreased significantly changes the routine of its patients, with most nail growth and immunodeficiency, makes the elderly participants reporting that people find it unpleasant to look at predisposed to onychomycosis. The objective of this study their nails and note the problem and they are uncomfortable was to investigate the frequency of onychomycosis in elderly with the appearance of the lesion. In clinical question, the institutionalized, and to verify the effects that the infection participants also notice the change in the characteristics of had in their daily routine. their nails, difficulty in cutting and, nail and finger/toe pain. Methods: This study was carried in gerontological complex- es of Goiânia, Goiás, Brazil, with 58 elderly who exhibited Keywords clinical suspicion of onychomycosis and a questionnaire Onychomycosis, Elderly, Dermatophytes, Fusarium, was provided to the elderly regarding the effects that the Candida parapsilosis infection had in their daily routine. Results: Among the 33 cases of the onychomycosis confirmed, 63.6% were female and 36.4% male. The Introduction participant ages ranged from 55 to 86 years (51.3 years Onychomycosis is an infectious cutaneous disease ± SD = 32.8). In this study, no statistically significant between age (p = 0.362) and sex (p = 0.234) associated caused by fungi and occurs in fingernails and toenails. of Onychomycosis in institutionalized elderly. The etiological The etiological agents come from three distinct groups agents Trichophyton rubrum were isolated in 9.1% and of fungi: Dermatophytes, yeasts, or non-dermatophytic Fusarium spp. in 15% of the positive samples. The genus filamentous fungi (NDFF) [1,2]. This infection is common Candida was identified in 46.5% of the samples, and in the world population, accounting for about 50% of Candida parapsilosis (30.3%) was the most frequent species. The applied questionnaire verified that more than the nail disorders [3]. 90% of participants answered that other people notice the Knowledge of the frequency of onychomycosis is presence of the nail lesion; That the of nail injuries influences their choice of shoes; and that perceive the difference in nail important due to the clinical damage that it inflicts characteristics, such as thickness and discoloration. on patients. Although this infection does not cause mortality, the inflammatory process in the nail plate Citation: Oliveira JT, Santos MS, Naves WV, Costa HL, Santos AS, et al. (2019) Clinical and Etiological Study of Onychomycosis in Institutionalized Elderly in Goiânia City, Goiás State, Brazil. J Geriatr Med Gerontol 5:062. doi.org/10.23937/2469-5858/1510062 Accepted: February 13, 2019: Published: February 15, 2019 Copyright: © 2019 Oliveira JT, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Oliveira et al. J Geriatr Med Gerontol 2019, 5:062 • Page 1 of 8 • DOI: 10.23937/2469-5858/1510062 ISSN: 2469-5858 can cause pain, lead to difficulties in carrying out daily extensive experience in medical mycology carried out activities that generate discomforts. Two main types the inclusion of the elderly participants in the research, of discomforts may be associated with this ailment: where they established clinical criteria such as subungual Physical, which mostly related to aesthetics, and hyperkeratosis, inflammatory reaction, color change, psychological, due to the constant constraints, which dystrophy and onycholysis and destruction of the entire can lead to depression and anxiety that significantly nails plate, so that subungueal scraping was performed. interferes with individual’s well-being and daily life [4,5]. After completing the work all, the participants received the results of the mycological examination and then The occurrence of onychomycosis increases they were referred to the responsible doctor for each according to the age of the studied population, with unit for that is prescribed the appropriate treatment. a predominance in elderly people over 60-years- old [1]. This fact can be explained by the presence of This study included individuals in the gerontological some predisposing factors that are more frequent in complexes, 55 years of age or older, and presenting individuals at this age and older, such as angiopathy, clinical manifestations characteristic of onychomycosis peripheral neuropathy, use of closed shoes, nail in their fingernails or toenails. In addition, severity deformity, recurrent traumas, and metabolic disorders of fungal infection damage was classified as mild (< such as diabetes mellitus [2]. An example that explains 4 nails involved), moderate (5-8 nails involved) and the importance of the knowledge of onychomycosis in severe (≥ 9 nails involved) [6]. Individuals who did not the elderly consists of a clinical complication with the accept the terms established in the ICF were excluded evolution for uncontrolled diabetes mellitus. In this from the survey. During the collection of biological case, the evolution of the infection can associated with material, a questionnaire was given to the participants altered vascular supply, and reduced capacity for tissue to verify their main complaints against onychomycosis repair leading to complications such as gangrene and/ in their daily routine. The questions were grouped into or foot ulcer with consequence limb lower amputations social, emotional, and clinical; and the answers were [5,6]. standardized as “yes” or “no”. Therefore, to avoid a worse prognosis of Collection subungual scraping and identification comorbidities in the elderly, a laboratory diagnosis of of etiologic agents onychomycosis is considered very important, because The material was obtained by subungual scraping fungal infections cannot be solely defined by the clinical using blunt scalpels. An antisepsis was performed on characteristics of the lesions [2,7]. In addition, the the nail with 70% alcohol, and then the material was correct identification of the etiological agent can help removed from the more peripheral regions of the determine the most appropriate choice of treatment, lesion, in the transition limit between the normal and avoiding the relapses of this fungal infection [7]. infected nail. The clinical material was then sent to the Thus, the objective of this study was to investigate Instituto de Patologia Tropical e Saúde Pública of the the frequency of onychomycosis in elderly patients Universidade Federal de Goiás for the isolation and institutionalized in two gerontological complexes in the identification of etiological agents. city of Goiânia, Goiás, Brazil, in addition to verified using a questionnaire, the effects that the infection had in the The subungual scraping material was treated with daily routine of those elderly participants. 20% KOH for 20 min and visualized under optical microscope for direct examination. It was seeded in Methods sabouraud dextrose agar (SAD) plus chloramphenicol Study design and selective agar for contaminating fungi and then incubated at room temperature for up to 30 days. A prospective study was conducted in 2016 with Macroscopic observation of the obtained colonies individuals institutionalized in two gerontological was the first criterion used to distinguish between complexes, located in the Southern and Western filamentous fungi and yeasts. Characteristics such as: regions of the city of Goiânia, in the state of Goiás, Color, texture, surface, and diffusible pigment in the Brazil, after approval of the Research Ethics Committee culture medium were analyzed. Microscopic structures, of the University Paulista, number 1,438,062. The such as hyphae, conidia, yeast (morphology and gerontological complexes included in the research are disposition), and reproduction structures, were made institutions in which the elderly are independent during with fragments of the colony between slide and cover the daily routine.
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