Article Clinico-aetiologic profile of Onychomycoses in a tertiary care centre in northeast India Amit Banik 1 , Elantamilan Durairaj 2 , WV Lyngdoh 3 , Annie B Khyriem 4 and Debahuti Sabhapandit 5 Abstract Onychomycosis refers to fungal nail infection. Despite a clearly diseased appearance, it is often deemed a merely cosmetic problem of relatively minor importance. However, it may result in much psychological or occupational turmoil, diminished self-esteem and resulting reluctance for public interaction. A wide number of factors determine the treatment outcome and its prevalence varies greatly. Our study was conducted between January 2011 and December 2014 in northeast India. Of 243 patients presenting with nail abnormalities, 158 (65%) were positively diagnosed by either direct microscopy or culture or both. A distal lateral subungual infection was the most predominant clinical pattern observed, and the most frequent aetiological agents were dermatophytes, of which Trichophyton rubrum was predominant. Keywords Onychomycosis, distal lateral subungual onychomycosis (DLSO), dermatophytes, fingernails, Trichophyton rubrum Introduction Onychomycoses, traditionally referred to as infection of nail by non-dermatophytes, is now used as a general term for any fungal nail infection. 1 It may involve any component of the nail apparatus, i.e. the nail matrix, cuticle, nail folds, lunula, hyponychium, nail bed as well as mesenchymal tissue. Persistence of the infection in nails may serve as a chronic reservoir, which can give rise to fungal infections elsewhere in the body. Causative factors are dermatophytes, non-dermatophytes and yeasts alike. Dermatophytes are keratinophilic fungi which cause cutaneous fungal infections. They derive their nutrients from the outermost layers of skin and hence also cause skin, hair and nail infections. Non-der- matophytes are filamentous fungi which grow as moulds, which can be either hyaline or phaeoid. Yeasts are creamy mucoid pasty growths with a fruity odour. Factors that determine the treatment outcome depends on patient’s age, the type of infecting fungus, the treatment regime, and type and degree of nail involvement. Recurrence may be related to the patient’s family history, occupation, lifestyle, underlying physi- ology or immunosuppression. 2 The prevalence of the entity differs according to geo- graphical, racial, environmental, economic and cultural variations. Thus, clinico-mycologic studies are required to identify the disease pattern in different locations. Ours is a study from the northeast state of Meghalaya, which is a small hilly state representing a distinct cohort of people with lifestyle, climate and environmental conditions differing substantially from others in India. Materials and methods Study population and period of study Our study was conducted over a period of four years from January 2011 to December 2014 in the Department of Clinical Microbiology at a tertiary care centre in Shillong. Samples from 243 patients 1 Assistant Professor (Microbiology), ANIIMS, Port Blair. (Ex Senior Resident, NEIGRIHMS), Shillong, India 2 Senior Resident (Microbiology), NEIGRIHMS, Shillong, India 3 Associate Professor (Microbiology), NEIGRIHMS, Shillong, India 4 Associate Professor (Microbiology), NEIGRIHMS, Shillong, India 5 Senior Resident (Microbiology), NEIGRIHMS, Shillong, India Corresponding author: Amit Banik, Room 29, GB Pant Hospital, ANIIMS, Port Blair, India. Email: dramitbanik@gmail.com Tropical Doctor 0(0) 1–7 ! The Author(s) 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0049475517735979 journals.sagepub.com/home/tdo