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Epidemiology of Onychomycosis in the United States Characterized Using Molecular Methods, 2015–2024

Summary

This large study examined over 710,000 nail samples to identify which fungi cause nail infections in the United States. Using modern molecular testing combined with microscopic analysis, researchers found that while the fungus T. rubrum is most common, other molds and yeasts cause many infections too. Importantly, women and older adults are more likely to have infections from these other organisms, which are often harder to treat with standard antifungal medications.

Background

Onychomycosis is a recalcitrant fungal infection of the nail unit that can lead to secondary infections and foot complications. Traditional diagnosis by fungal culture has significant limitations due to slow turnaround time and low sensitivity. Accurate pathogen identification through confirmatory testing is recommended to improve treatment outcomes.

Objective

To update the epidemiology of onychomycosis in the United States by using multiplex real-time PCR combined with histopathologic examination to comprehensively characterize the spectrum of fungal pathogens causing nail infections.

Results

The Trichophyton rubrum complex was detected in 54.3% of mycology-confirmed cases, with significant contributions from T. mentagrophytes complex (6.5%), Aspergillus (7.0%), and Fusarium (4.5%). Females were more likely to be infected with non-dermatophytes and yeasts. Patients aged ≥65 years showed higher likelihood of contracting NDM and yeast onychomycosis.

Conclusion

Molecular diagnostics enabling timely and accurate pathogen identification can better inform healthcare providers of appropriate treatment selections. NDMs and yeasts disproportionately affect females and the elderly, warranting updated clinical understanding and evidence-based treatment recommendations.
  • Published in:Journal of Fungi,
  • Study Type:Epidemiological Retrospective Study,
  • Source: PMID: 39330393, DOI: 10.3390/jof10090633
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