| Abstract: | 背景：在台灣，甲癬為一相當常見的皮膚黴菌病。在影響甲癬治癒率的因素之中，最重要的為根據致病的菌種，選擇適宜的抗黴菌藥物。但迄今尚未有台灣的甲癬致病菌種之研究，做為臨床醫師選擇抗黴菌藥物的流行病學依據。
目的：本研究之目的為調查南台灣甲癬致病菌種的分佈。
材料與方法：本研究共收集指甲皆接受取樣並能以病理檢查及黴菌培養確認甲癬的診斷及其致病菌種的380位甲癬病患。
結果：甲癬的致病菌種在228位病患（60%）為皮癬菌，118位（31.1%）為念珠菌，34位（8.9%）為非皮癬菌的黴菌。在年齡大於60歲者，念珠菌及非皮癬菌的黴菌較常見（36%及11.6%），但未達顯著性（p = 0.099）。相較於男性病患，女性病患的甲癬由非皮癬菌類（念珠菌與非皮癬菌的黴菌）引起的勝算比為2.29（95%信賴區間：1.47-3.56）。在合併糖尿病的患者，此勝算比更高達11.20（95%信賴區間：1.04-120.36），性別的致病菌種差異性更為明顯。相較於一般病患，合併甲溝炎者之甲癬由非皮癬菌類引起的勝算比為6.19（95%信賴區間：3.34-11.59）。相較於從事不常接觸水職業者，從事常接觸水職業者得到非皮癬菌類所引起的甲癬之勝算比為4.75（95%信賴區間：1.90-12.23）。在女性（43.1%）、手指甲癬（65.6%）、合併甲溝炎者（64.6%）、和家庭主婦、農漁民及從事其它經常接觸水職業的病患（29.4-63%），念珠菌所占致病菌種的比例較高。
結論：患部位置、性別、是否合併糖尿病或甲溝炎、職業、地理分佈等因素都會影響甲癬的致病菌種。在南台灣，高達40%的甲癬不是皮癬菌所引起的。我們建議應施行指甲的組織病理檢查與黴菌培養，確認診斷並辨認其致病菌種後，藉此以選擇最有效的抗黴菌藥物並予以成功治療。
Background: Onychomycosis is a common cutaneous fungal infection in Taiwan. Selecting an appropriate antifungal agent targeting the causative pathogens is among the most important factor for successfully curing the onychomycosis. There has been no investigation of the pathogens of onychomycosis previously in Taiwan, which could provide clinicians with an epidemiologic basis to choose antifungal agents.
Objective: The purpose of this study was to survey the distribution of causative pathogens of onychomycosis in southern Taiwan.
Materials and methods: A total of 380 patients diagnosed with established onychomycosis were enrolled. Histopathologic examination and fungus culture of the affected nail specimens were performed to confirm the diagnosis of onychomycosis and identify the pathogens.
Results: The pathogens of onychomycosis were dermatophytes in 228 patients (60%), Candida in 118 (31.1%), and nondermatophyte molds in 34 (8.9%). Candida and nondermatophyte molds were not significantly more frequently seen in patients older than 60 years (36% and 11.6%, respectively, p = 0.099). The odds ratio (OR) for females to have non-dermatophyte onychomycosis was 2.29 compared with males (95% CI 1.47-3.56), and 11.20 for diabetic females compared with diabetic males (95% CI 1.04-120.36). The gender discrepancy was more prominent in diabetic patients. Compared with the general population, the OR for patients with paronychia to have non-dermatophyte onychomycosis was 6.19 (95% CI 3.34-11.59). The OR for patient with a wet occupation to have non-dermatophyte onychomycosis was 4.75 compared with patients with a non-wet occupation (95% CI 1.90-12.23). In females (43.1%), fingernail onychomycosis (65.6%), those with concomitant paronychia (64.6%), housewives, farmers, fishermen, and other wet occupation workers (29.4-63%), Candida occupied a significant higher proportion of the causative pathogens of onychomycosis.
Conclusion: The following factors, including site, gender, presence of concomitant diabetes mellitus or paronychia, occupation, and geographic distribution, could have effects on the pathogens of onychomycosis. In southern Taiwan, 40% of onychomycosis was not caused by dermatophytes. We suggest that histopathologic examination and fungus culture of the nail specimen should be performed to confirm and to recognize the pathogen. Then, we can intelligently choose the most effective drug to treat onychomycosis accordingly and successfully. |
