Prevalence and Pattern of Superficial Fungal Infections Among Patients Attending a Tertiary Care Hospital in Midwestern Nepal: A Potassium Hydroxide Wet-Mount Based Study

Abstract

Introduction: Superficial fungal infections are among the most common cutaneous infections globally, with limited data from midwestern Nepal. These infections primarily involve keratinized tissues such as the skin, hair, and nails and are mainly caused by dermatophytes, Candida species, and Malassezia species.

Aims: To determine the prevalence and clinical patterns of superficial fungal infections among patients attending a tertiary care hospital in midwestern Nepal using potassium hydroxide wet-mount microscopy.

Methods: A hospital-based cross-sectional study was conducted between August 2024 to July 2025. A total of 714  clinically suspected cases were enrolled using consecutive sampling. Skin scrapings, nail clippings, and hair samples were examined  using 10% potassium hydroxide wet-mount microscopy. Data were analyzed using descriptive statistics and Chi-square test (p < 0.05 significant).

Results: Out of 714 suspected cases, 421 (58.96%; 95% CI: 55.3–62.6%) were potassium hydroxide microscopy positive. Positivity was similar in males (58.9%) and females (59.0%) (p = 0.974). The most affected age group was 16–30 years (47.0%). Tinea cruris was the most common clinical presentation (32.8%), followed by Tinea corporis /manuum (21.4%). Dermatophytes were the predominant organisms (87.1%), followed by Candida spp. (10.0%) and Malassezia spp. (2.9%).

Conclusion: Superficial fungal infections are highly prevalent in midwestern Nepal, affecting nearly 60% of suspected cases, with dermatophytes and Tinea cruris being most common. Young adults are predominantly affected, with no significant sex difference. Strengthening diagnostic facilities, including fungal culture and antifungal susceptibility testing, is essential to address emerging antifungal resistance.