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Sains Malaysiana 42(3)(2013):
359–363
Mikrorganisma
(Microorganisms
Responsible for Onychomycosis Among Diabetic Patients)
M. Leelavathi*, M.N.
Azimah & N.F. Kharuddin
Department of Family
Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia
Jalan Yaacob Latif,
Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
M.N. Tzar
Department of Medical
Microbiology and Immunology, Faculty of Medicine
Universiti Kebangsaan
Malaysia, Jalan Yaacob Latif, Bandar Tun Razak
56000 Cheras, Kuala
Lumpur, Malaysia
Diserahkan: 7 Mac 2012/Diterima: 4
Oktober 2012
ABSTRAK
Pesakit kencing manis lebih mudah mendapat jangkitan disebabkan oleh sistem imun yang lemah. Antara jangkitan yang dialami adalah infeksi kulat kuku yang lebih
dikenali sebagai onikomikosis. Satu kajian keratan rentas telah
dijalankan di Pusat Perubatan Primer, Universiti Kebangsaan Malaysia untuk
mengenalpasti prevalen onikomikosis dan patogen penyebab utama onikomikosis
dalam kalangan pesakit kencing manis. Kajian ini dijalankan sepanjang bulan Oktober 2010 hingga bulan Mei
2011. Keratan kuku diambil dari kuku kaki yang tidak
normal. Sekiranya kuku adalah normal, sampel diambil daripada ibu jari
kaki kanan. Sampel kuku diketip selepas dibersihkan dengan 70% alkohol, dimasukkan
ke dalam sampul kertas dan diproses dalam masa dua jam. Sebahagian sampel
diproses dengan larutan kalium hidroksida (20%) (KOH)
dan sebahagian lagi dikultur pada plat media agar Sabouraud dekstros. Seramai 78 (51.7%) pesakit perempuan dan 73 (48.3%) pesakit lelaki
telah menyertai kajian ini. Purata umur pesakit adalah
60.7 ± 9.1 tahun. Kebanyakan pesakit terdiri daripada etnik Melayu
(60.3%, n=91), diikuti oleh Cina (24.5%, n=37), India (13.9%, n=21) dan
lain-lain (1.3% n=2). Prevalen jangkitan kulat kuku dalam
kalangan subjek adalah 81.5%. Kebanyakan spesies kulat yang dikesan
adalah kulapuk selain dermatofit (39.7%, n=60), terutamanya Aspergillus (12.6%,
n=19) diikuti dengan yis (20.5%, n=31) dan dermatofit (0.7%, n=1). Keputusan kajian ini berbeza daripada kajian-kajian negara barat
kerana spesies dermatofit dan yis lebih kerap ditemui. Kesimpulannya,
prevalen jangkitan kulat kuku dalam kalangan pesakit kencing manis dalam kajian ini adalah tinggi. Jangkitan ini perlu dikesan
dengan lebih awal dan seterusnya dirawat untuk mengelak daripada komplikasi
diabetes pada kaki berlaku. Organisma penyebab utama onikomikosis dalam
kalangan pesakit kencing manis dalam kajian ini adalah
kulat selain dermatofit dan ini adalah sama dalam kalangan pesakit diabetes
dan populasi umum.
Kata kunci: Kencing manis; kulapuk selain dermatofit; kulat; onikomikosis
ABSTRACT
Diabetic patients are susceptible to
infections due to compromised immune system. Among common infections include
fungal infection of the nail, also known as onychomycosis. A cross sectional
study was done to determine the prevalence and the common fungal element
responsible of onychomycosis among patients with types 1 and 2 diabetes at the
Pusat Perubatan Primer, Universiti Kebangsaan Malaysia. This study was
conducted from October 2010 to May 2011. Nail clippings were taken from
discolored or structurally abnormal toenail and from the right first toe nail
if the nail appeared normal. The nail was first cleaned using 70% alcohol then
clipped into small pieces using nail clipper. Nail sample was processed within
2 h of collection for microscopic examination using potassium hydroxide (KOH) and cultured on sabouraud
dextrose agar. A total of 78 (51.7%) female and 73 (48.3%) male patients
participated in this study. Most (60.3%, n=91) of them belong to Malay ethnic
group followed by Chinese (24.5%, n=37), Indian (13.9%, n=21) and other (1.3%,
n=2) ethnicities. The prevalence of onychomycosis among subjects was 81.5%. The
most commonly isolated fungi from diabetic patient’s toenails were
non-dermatophyte moulds (39.7%, n=60,) especially Aspergillus (12.6%, n=19) followed
by yeast (20.5%, n=31) and dermatophytes (0.7%, n=1). In contrast, Western
studies demonstrate dermatophytes and yeasts as organisms commonly responsible
for onychomycosis among diabetics. In conclusion, the prevalence of
onychomycosis among diabetics in this study is high hence they are at high risk
of developing diabetic foot complications and amputations. The common causative
microorganism for onychomycosis among diabetics in this study is
non-dermatophyte mould.
Keywords:
Diabetes; fungus; non-dermatophyte mould; onychomycosis
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*Pengarang untuk surat-menyurat; email: drleelaraj@gmail.com
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