Clinicodemographic Profile, Mycological Spectrum, and Associated Factors of Culture-Confirmed Onychomycosis in a Tertiary Care Hospital in Gqeberha, South Africa

Abstract

Background: Onychomycosis is a common nail disorder caused by a wide range of pathogenic organisms and is often associated with underlying non-dermatological conditions and lifestyle-related factors. Emerging evidence suggests an increasing role of non-dermatophyte moulds (NDMs), previously regarded as contaminants. However, data describing the epidemiology and causative organisms of onychomycosis in South Africa remain limited. Methods: A retrospective cross-sectional study was conducted in the Department of Dermatology at Livingstone Hospital, Gqeberha, from 1 January 2019 to 31 December 2023. Clinical and laboratory records of 103 patients with culture-confirmed onychomycosis were reviewed and analyzed for demographic, clinical, and mycological characteristics. Results: The median age was 57 years, with a slight female predominance (54.4%). Toenail involvement (70.9%) was more frequent than fingernail involvement (43.7%). Almost all patients (95.1%) had at least one clinical risk factor or comorbidity. Nail discoloration (98.1%), particularly hyperpigmentation, was the most consistent clinical feature, followed by subungual hyperkeratosis (77.7%), onycholysis (59.2%), and nail dystrophy (52.4%). NDMs were the predominant pathogens (51.8%, n = 57/110), followed by yeasts (40.0%, n = 44/110) and dermatophytes (8.2%, n = 9/110). Alternaria, Penicillium, and Aspergillus were the most common NDMs, while Candida parapsilosis, Candida albicans, and Trichosporon species predominated among yeasts. Non-dermatophyte infections were significantly associated with subungual hyperkeratosis (p = 0.031), whereas yeast onychomycosis was associated with lower odds of subungual hyperkeratosis (p = 0.048). Conclusions: Nail discoloration was the most common clinical feature observed among patients with onychomycosis. The high prevalence of comorbidities suggests a possible association between onychomycosis and underlying health conditions. NDMs were the predominant fungal isolates in this study, highlighting the importance of accurate laboratory diagnosis for appropriate patient management.

The authors' abstract, as published at the source. Journal of Fungi, 2026 · DOI ↗