Generic placeholder image

Current Diabetes Reviews

Editor-in-Chief

ISSN (Print): 1573-3998
ISSN (Online): 1875-6417

Cross-Sectional Study

Prevalence and Associated Factors of Toenail Onychomycosis Among Patients with Diabetes in Jordan

Author(s): Hesham Alrauosh, Anas Ababneh*, Faris G. Bakri, Mousa Abujbara, Hashem Kanaan and Nidal A. Younes

Volume 20, Issue 1, 2024

Published on: 12 May, 2023

Article ID: e030423215425 Pages: 9

DOI: 10.2174/1573399819666230403132241

Price: $65

Abstract

Background: Toenail onychomycosis is common in patients with diabetes and it can increase the risk of secondary infections and foot complications. Despite several studies investigating the prevalence and associated factors of toenail onychomycosis from different parts of the world, there are no data from Jordan.

Objective: To determine the prevalence and the associated factors of toenail onychomycosis among patients with diabetes in Jordan.

Methods: A cross-sectional study was conducted on 375 patients with diabetes at the National Centre for Diabetes, Endocrinology, and Genetics in Amman, Jordan. Several socio-demographic and health-independent variables including foot self-care practices were collected. Toenail onychomycosis was assessed by a specimen culture and microscopic examinations. Descriptive and inferential statistics were used for data analysis.

Results: The prevalence of toenail onychomycosis was 57.6% (n=216). Multiple logistic regression revealed four significant associated factors; the presence of neuropathy (β=1.87, p=0.02), being an ex-smoker (β=2.69, p=0.01), being treated by both insulin and oral hypoglycemics drugs (β=1.32, p=0.03), and using antibiotics in the last year (β=1.78, p=0.02).

Conclusion: The prevalence of toenail onychomycosis among patients with diabetes in Jordan is high. Regular foot screening and podiatric care are recommended especially among patients with diabetic neuropathy, current treatment by insulin and oral hypoglycemics drugs, previous history of smoking, and previous use of antibiotics.

[1]
Sun H, Saeedi P, Karuranga S, et al. IDF diabetes atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract 2022; 183: 109119.
[http://dx.doi.org/10.1016/j.diabres.2021.109119] [PMID: 34879977]
[2]
Alqahtani B, Elnaggar RK, Alshehri MM, Khunti K, Alenazi A. National and regional prevalence rates of diabetes in Saudi Arabia: Analysis of national survey data. Int J Diabetes Dev Ctries 2022; 1-6.
[http://dx.doi.org/10.1007/s13410-022-01092-1]
[3]
Ajlouni K, Batieha A, Jaddou H, et al. Time trends in diabetes mellitus in Jordan between 1994 and 2017. Diabet Med 2019; 36(9): 1176-82.
[http://dx.doi.org/10.1111/dme.13894] [PMID: 30614070]
[4]
Susan VD, Beulens JW, Yvonne T, et al. The global burden of diabetes and its complications: An emerging pandemic. Eur J Cardiovasc Prev Rehabil 2010; 17(1): s3-8.
[5]
Pal R, Banerjee M. Are people with uncontrolled diabetes mellitus at high risk of reinfections with COVID-19? Prim Care Diabetes 2021; 15(1): 18-20.
[http://dx.doi.org/10.1016/j.pcd.2020.08.002] [PMID: 32800450]
[6]
Rosenblatt R, Atteberry P, Tafesh Z, et al. Uncontrolled diabetes mellitus increases risk of infection in patients with advanced cirrhosis. Dig Liver Dis 2021; 53(4): 445-51.
[http://dx.doi.org/10.1016/j.dld.2020.10.022] [PMID: 33153928]
[7]
Cathcart S, Cantrell W, Elewski BE. Onychomycosis and diabetes. J Eur Acad Dermatol Venereol 2009; 23(10): 1119-22.
[http://dx.doi.org/10.1111/j.1468-3083.2009.03225.x] [PMID: 19309423]
[8]
Oz Y, Qoraan I, Oz A, Balta I. Prevalence and epidemiology of tinea pedis and toenail onychomycosis and antifungal susceptibility of the causative agents in patients with type 2 diabetes in Turkey. Int J Dermatol 2017; 56(1): 68-74.
[http://dx.doi.org/10.1111/ijd.13402] [PMID: 27667305]
[9]
Kaur R, Kashyap B, Bhalla P. Onychomycosis--epidemiology, diagnosis and management. Indian J Med Microbiol 2008; 26(2): 108-16.
[http://dx.doi.org/10.1016/S0255-0857(21)01924-1] [PMID: 18445944]
[10]
Cunha N, Galhardas C, Apetato M, Lencastre A. Toenail changes in patients with diabetes mellitus with and without onychomycosis. J Am Podiatr Med Assoc 2018; 108(5): 370-4.
[http://dx.doi.org/10.7547/17-006] [PMID: 34670337]
[11]
Armstrong DG, Swerdlow MA, Armstrong AA, Conte MS, Padula WV, Bus SA. Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. J Foot Ankle Res 2020; 13(1): 16.
[http://dx.doi.org/10.1186/s13047-020-00383-2] [PMID: 32209136]
[12]
Gupta AK, Daigle D, Foley KA. The prevalence of culture-confirmed toenail onychomycosis in at-risk patient populations. J Eur Acad Dermatol Venereol 2015; 29(6): 1039-44.
[http://dx.doi.org/10.1111/jdv.12873] [PMID: 25413984]
[13]
Al-Mutairi N, Eassa BI, Al-Rqobah DA. Clinical and mycologic characteristics of onychomycosis in diabetic patients. Acta Dermatovenerol Croat 2010; 18(2): 84-91.
[PMID: 20624357]
[14]
Aronson R, Chu L, Joseph N, Brown R. Prevalence and risk evaluation of diabetic complications of the foot among adults with type 1 and type 2 diabetes in a large Canadian population (PEDAL study). Can J Diabetes 2021; 45(7): 588-93.
[http://dx.doi.org/10.1016/j.jcjd.2020.11.011] [PMID: 33582042]
[15]
Assadamongkol R, Lertwattanarak R, Wannachalee T, Bunyaratavej S, Leeyaphan C, Matthapan L. Prevalence, risk factors, and type of organism in fungal foot infection and toenail onychomycosis in Thai diabetic patients. J Med Assoc Thai 2016; 99(6): 659-64.
[PMID: 29900728]
[16]
Akkus G, Evran M, Gungor D, Karakas M, Sert M, Tetiker T. Tinea pedis and onychomycosis frequency in diabetes mellitus patients and diabetic foot ulcers. A cross sectional - observational study. Pak J Med Sci 2016; 32(4): 891-5.
[PMID: 27648034]
[17]
Baiu SH, Bridan WM, Kalfa HMK. Fungi as pathogens of onychomycosis among diabetic patients. J Appl Environ Microbiol 2016; 4(2): 30-3.
[18]
Cha BY, Son HS, Lee JM, Kang SK. Prevalence of fungal infection on foot in diabetic patients and correlation between diabetic ulcer and fungal infection on foot. Journal of Korean Diabetes Association 2006; 30(1): 64-72.
[http://dx.doi.org/10.4093/jkda.2006.30.1.64]
[19]
de Macedo GMC, Nunes S, Barreto T. Skin disorders in diabetes mellitus: An epidemiology and physiopathology review. Diabetol Metab Syndr 2016; 8(1): 63.
[http://dx.doi.org/10.1186/s13098-016-0176-y] [PMID: 27583022]
[20]
Eba M, Njunda AL, Mouliom RN, et al. Onychomycosis in diabetic patients in Fako Division of Cameroon: Prevalence, causative agents, associated factors and antifungal sensitivity patterns. BMC Res Notes 2016; 9(1): 494.
[http://dx.doi.org/10.1186/s13104-016-2302-1] [PMID: 27876085]
[21]
Elbendary A, El Tawdy A, Zaki N, Alfishawy M, Rateb A. Subclinical onychomycosis in patients with type II diabetes. Dermatol Rep 2015; 7(3): 6099.
[http://dx.doi.org/10.4081/dr.2015.6099] [PMID: 26734120]
[22]
Gulcan A, Gulcan E, Oksuz S, Sahin I, Kaya D. Prevalence of toenail onychomycosis in patients with type 2 diabetes mellitus and evaluation of risk factors. J Am Podiatr Med Assoc 2011; 101(1): 49-54.
[http://dx.doi.org/10.7547/1010049] [PMID: 21242470]
[23]
Leelavathi M, Azimah MN, Kharuddin NF, Tzar MN. Prevalence of toenail onychomycosis among diabetics at a primary care facility in Malaysia. Southeast Asian J Trop Med Public Health 2013; 44(3): 479-83.
[PMID: 24050080]
[24]
Parada H, Veríssimo C, Brandão J, et al. Dermatomycosis in lower limbs of diabetic patients followed by podiatry consultation. Rev Iberoam Micol 2013; 30(2): 103-8.
[http://dx.doi.org/10.1016/j.riam.2012.09.007] [PMID: 23147514]
[25]
Rathur H, Housley A. The incidence of asymptomatic onychomycosis in diabetes mellitus. Clin Res Foot Ankle 2015; 3(2): 1-3.
[26]
Saunte DML, Holgersen JB, Hædersdal M, et al. Prevalence of toe nail onychomycosis in diabetic patients. Acta Derm Venereol 2006; 86(5): 425-8.
[http://dx.doi.org/10.2340/00015555-0113] [PMID: 16955188]
[27]
Al-Amer RM, Khader Y, Malas S, Abu-Yaghi N, Al-Bdour M, Ajlouni K. Prevalence and risk factors of diabetic retinopathy among Jordanian patients with type 2 diabetes. Digit J Ophthalmol 2008; 14: 42-9.
[http://dx.doi.org/10.5693/djo.01.2008.013] [PMID: 29440980]
[28]
AlAyed M, Younes N, Al-Smady M, Khader Y, Robert A, Ajlouni K. Prevalence of foot ulcers, foot at risk and associated risk factors among Jordanian diabetics. Curr Diabetes Rev 2017; 13(2): 182-91.
[http://dx.doi.org/10.2174/1573399812666151210143140] [PMID: 26652612]
[29]
Khawaja N, Abu-Shennar J, Saleh M, Dahbour SS, Khader YS, Ajlouni KM. The prevalence and risk factors of peripheral neuropathy among patients with type 2 diabetes mellitus; the case of Jordan. Diabetol Metab Syndr 2018; 10(1): 1-10.
[30]
Ababneh A, Bakri FG, Khader Y, Lazzarini P, Ajlouni K. Prevalence and associates of foot deformities among patients with diabetes in Jordan. Curr Diabetes Rev 2020; 16(5): 471-82.
[http://dx.doi.org/10.2174/1573399815666191001101910] [PMID: 31573891]
[31]
Bakri FG, Allan AH, Khader YS, Younes NA, Ajlouni KM. Prevalence of diabetic foot ulcer and its associated risk factors among diabetic patients in Jordan. J Med J 2012; 46(2): 118-25.
[32]
Naing L, Winn T, Rusli B. Practical issues in calculating the sample size for prevalence studies. Arch Orofac Sci 2006; 1: 9-14.
[33]
American Diabetes Association. (2) Classification and diagnosis of diabetes. Diabetes Care 2015; 38 (Suppl. 1): S8-S16.
[http://dx.doi.org/10.2337/dc15-S005] [PMID: 25537714]
[34]
World Health Organization/International Diabetes Federation. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: report of a WHO/IDF consultation. Geneva: WHO 2006.
[35]
Apelqvist J, Bakker K, van Houtum WH, Schaper NC. Practical guidelines on the management and prevention of the diabetic foot. Diabetes Metab Res Rev 2008; 24(S1): S181-7.
[http://dx.doi.org/10.1002/dmrr.848] [PMID: 18442189]
[36]
Lawry MA, Haneke E, Strobeck K, Martin S, Zimmer B, Romano PS. Methods for diagnosing onychomycosis: A comparative study and review of the literature. Arch Dermatol 2000; 136(9): 1112-6.
[http://dx.doi.org/10.1001/archderm.136.9.1112] [PMID: 10987866]
[37]
Gupta A, Jain H, Lynde C, Watteel G, Summerbell R. Prevalence and epidemiology of unsuspected onychomycosis in patients visiting dermatologists’ offices in Ontario, Canada - a multicenter survey of 2001 patients. Int J Dermatol 1997; 36(10): 783-7.
[http://dx.doi.org/10.1046/j.1365-4362.1997.00349.x] [PMID: 9372358]
[38]
Arnson Y, Shoenfeld Y, Amital H. Effects of tobacco smoke on immunity, inflammation and autoimmunity. J Autoimmun 2010; 34(3): J258-65.
[http://dx.doi.org/10.1016/j.jaut.2009.12.003] [PMID: 20042314]
[39]
Erener S. Diabetes, infection risk and COVID-19. Mol Metab 2020; 39: 101044.
[http://dx.doi.org/10.1016/j.molmet.2020.101044] [PMID: 32585364]
[40]
Atreja A, Kalra S. Infections in diabetes. J Pak Med Assoc 2015; 65(9): 1028-30.
[PMID: 26338758]
[41]
Martin ET, Kaye KS, Knott C, et al. Diabetes and risk of surgical site infection: A systematic review and meta-analysis. Infect Control Hosp Epidemiol 2016; 37(1): 88-99.
[http://dx.doi.org/10.1017/ice.2015.249] [PMID: 26503187]
[42]
Torack RM. Fungus infections associated with antibiotic and steroid therapy. Am J Med 1957; 22(6): 872-82.
[http://dx.doi.org/10.1016/0002-9343(57)90023-2] [PMID: 13424552]
[43]
Mohsen S, Dickinson JA, Somayaji R. Update on the adverse effects of antimicrobial therapies in community practice. Can Fam Physician 2020; 66(9): 651-9.
[PMID: 32933978]
[44]
Montrucchio G, Lupia T, Lombardo D, et al. Risk factors for invasive aspergillosis in ICU patients with COVID-19: Current insights and new key elements. Ann Intensive Care 2021; 11(1): 136.
[http://dx.doi.org/10.1186/s13613-021-00923-4] [PMID: 34524562]
[45]
Li X, Leonardi I, Semon A, Doron I, et al. Response to fungal dysbiosis by gut-resident CX3CR1+ mononuclear phagocytes aggravates allergic airway disease. Cell Host & Microbe 2018; 24(6): 847-56.

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy