Non-dermatophytic Onychomycosis: The Etiological Agents and their Antifungal Susceptibility Response to Plain Ciclopirox Versus Ciclopirox Coated on Silver Nanoparticles – An In vitro Study

Onychomycosis is a fungal infection of the fingernails or toenails caused by fungi. Ciclopirox nail lacquer is generally used for the treatment of patients with onychomycosis, but the duration of treatment is long and indefinite. Hence, Silver nanoparticles were coated with 8% Ciclopirox, and In vitro antifungal susceptibility was done to check its effectiveness over plain 8% Ciclopirox. This Analytical study included a total of 100 nail-clipping/Nail scrapping specimens from patients attending DVL OPD, MGMCRI, with suspected Onychomycosis for a period of one year. The sample was subjected to microscopy and culture identification of the pathogen. In vitro Antifungal susceptibility testing was performed against plain 8% Ciclopirox and 8% Ciclopirox coated on silver Nanoparticles by broth dilution method as per CLSI M38-A. The overall prevalence of Onychomycosis was 39%, caused by 6% of dermatophytes and 33% of non-dermatophytes. The incidence was 65% in toe nail and 35% in fingernail. The female is more predominant than male. Distal and lateral onychomycosis are the commonest clinical types. Aspergillus niger (13%) was the etiologic agent of onychomycosis due to NDOM. The MICs with 8% Ciclopirox coated on silver nanoparticles ranged from 0.4-0.7 μg/ml and the rate of growth inhibition was better when compared to plain 8% Ciclopirox MICs which ranged from 0.5-0.8 μg/ml. The study concludes that A. niger is the agent of NDOM and our findings hold implications of Onychomycosis for both the clinicians and researchers, to improve the clinical outcomes of the patients.