6th June 2025

Nail Changes Associated with Infections

A change in colour, size, shape or texture of finger- and toenails can be an indicator of underlying systemic infection. An appreciation of these nail signs, and an ability to interpret them when found, can help guide diagnosis and management of a general medical patient.

Examples can include:

• Bacterial Endocarditis: Splinter haemorrhages are small, linear subungual structures, normally red, purple or brown in colour, most frequently located in the distal third of the nail plate.
• Untreated HIV or AIDs can present with nail infections; bacterial, viral and fungal. Proximal white onychomycosis is a pattern of fungal nail infection that is rarely seen without a diagnosis of immunosuppression, where HIV is an example; trichophyton rubrum is commonly the underlying pathogen.

Leprosy and Malaria infections can be associated with Mees Lines. Mees’ lines are white lines or bands that appear on the fingernails or toenails.