Abstract

Onychomycosis is a common fungal foot infection in diabetic patients in tropical countries, and its complications may cause morbidity and lead to amputation. Despite a presumed increased risk in Côte d’Ivoire due to climatic and socio-environmental conditions, data on its prevalence, mycological profile, and risk factors are scarce. A cross-sectional study was conducted among type 2 diabetic patients attending the outpatient clinic of the National Institute of Public Health in Abidjan from June to October 2020. Consecutively recruited participants underwent systematic foot and nail examination. Nail samples from suspected cases were analyzed by microscopy and culture, and isolates were identified using morphological and chromogenic methods, without molecular techniques. Multivariate logistic regression assessed associations between sociodemographic, behavioral, and glycemic factors and onychomycosis.  A total of 1,292 adult patients with type 2 diabetes were included. The prevalence of onychomycosis was 4.5%. Among the 58 patients with mycologically confirmed onychomycosis, 64 fungal isolates were identified. Yeasts predominated (43.8%), mainly Candida albicans (28.1%). Dermatophytes accounted for 32.8%, while molds represented 23.4%. Significant risk factors identified included toe-web intertrigo (17.1%, OR?=?6.41, 95%?CI: 3.68 to 11.17), fingernail onychodystrophy (11.1%, OR?=?4.40, 95%?CI: 2.21 to 8.75), glycated hemoglobin?>?7% (5.8%, OR?=?2.65, 95%?CI: 1.34 to 5.21), contact with animals (11.3%, OR?=?3.06, 95%?CI: 1.28 to 7.29), and ablution practices (11.1%, OR?=?2.53, 95%?CI: 1.34 to 4.79). These findings highlight the need for early diagnosis, targeted antifungal treatment, and preventive education to reduce fungal foot complications in diabetic patients.

Key words: Toe-nail onychomycosis, type 2 diabetes, prevalence, risk factors, Côte d’ivoire.