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Gupta AK, Wang T, Cooper EA, Summerbell RC, Piguet V, Tosti A, Piraccini BM. A comprehensive review of nondermatophyte mould onychomycosis: Epidemiology, diagnosis and management. J Eur Acad Dermatol Venereol 2024; 38:480-495. [PMID: 38010049 DOI: 10.1111/jdv.19644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/09/2023] [Indexed: 11/29/2023]
Abstract
Nondermatophyte moulds (NDMs) are widely distributed and can be detected in association with mycotic nails; however, sometimes it can be challenging to establish the role of NDMs in the pathogenesis of onychomycosis (i.e. causative vs. contaminant). In studies where the ongoing invasive presence of NDMs is confirmed through repeat cultures, the global prevalence of NDMs in onychomycosis patients is estimated at 6.9% with the 3 most common genus being: Aspergillus, Scopulariopsis and Fusarium. NDM onychomycosis can, in many cases, appear clinically indistinguishable from dermatophyte onychomycosis. Clinical features suggestive of NDMs include proximal subungual onychomycosis with paronychia associated with Aspergillus spp., Fusarium spp. and Scopulariopsis brevicaulis, as well as superficial white onychomycosis in a deep and diffused pattern associated with Aspergillus and Fusarium. Longitudinal streaks seen in patients with distal and lateral onychomycosis may serve as an additional indicator. For diagnosis, light microscopic examination should demonstrate fungal filaments consistent with an NDM with at least two independent isolations in the absence of a dermatophyte; the advent of molecular testing combined with histological assessment may serve as an alternative with improved sensitivity and turnover time. In most instances, antifungal susceptibility testing has limited value. Information on effective treatments for NDM onychomycosis is relatively scarce, unlike the situation in the study of dermatophyte onychomycosis. Terbinafine and itraconazole therapy (continuous and pulsed) appear effective to varying extents for treating onychomycosis caused by Aspergillus, Fusarium or Scopulariopsis. There is scant literature on oral treatments for Neoscytalidium.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Mediprobe Research Inc., London, Ontario, Canada
| | - Tong Wang
- Mediprobe Research Inc., London, Ontario, Canada
| | | | - Richard C Summerbell
- Sporometrics, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada
| | - Antonella Tosti
- Fredric Brandt Endowed Professor of Dermatology, University of Miami, Miami, Florida, USA
| | - Bianca Maria Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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2
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Haghani I, Hedayati MT, Shokohi T, Kermani F, Ghazanfari M, Javidnia J, Khojasteh S, Roohi B, Badali H, Fathi M, Amirizad K, Yahyazadeh Z, Abastabar M, Al-Hatmi AMS. Onychomycosis due to Fusarium species in different continents, literature review on diagnosis and treatment. Mycoses 2024; 67:e13652. [PMID: 37605217 DOI: 10.1111/myc.13652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
Fusarium species are an emerging cause of onychomycosis, and the number of cases has dramatically increased in recent decades worldwide. This review presents an overview of the onychomycosis cases caused by Fusarium species and diagnosis and treatment that have been reported in the literature. The most common causative agent of onychomycosis is F. solani species complex, which accounts for 11.68% of the cases of Fusarium onychomycosis, followed by the F. oxysporum species complex (164 out of 1669), which is accounted for 9.83% of the total. F. fujikuroi species complex (42 out of 1669) and F. dimerum species complex (7 out of 1669) are responsible for 2.52% and 0.42 cases, respectively. Fusarium nail infections were reported in patients aged range 1-98, accounting for 5.55% (1669 out of 30082) of all cases. Asia has the highest species diversity of Fusarium onychomycosis (31.51%). South America accounts for 21.09%, and the most common causative agent is F. solani (19.32%), followed by F. oxysporum species complex (15.63%). Europe accounts for 4.90% of cases caused by F. oxysporum, followed by F. solani. Africa accounts for 23.87% of the cases due to the F. solani species complex, followed by F. oxysporum and F. fujikuroi. Distal and lateral subungual onychomycosis was the most common clinical symptom accounting for 58.7% (135 out of 230) of the cases. Data analysis relieved that terbinafine and itraconazole are active treatments for Fusarium onychomycosis. For a definitive diagnosis, combining of direct examination, culture and sequencing of the elongation factor of translation 1α are recommended. Accurate identification of the causative agents of onychomycosis due to Fusarium species and antifungal susceptibility testing is essential in patient management.
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Affiliation(s)
- Iman Haghani
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Taghi Hedayati
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Shokohi
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Firoozeh Kermani
- Department of Medical Mycology and Parasitology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mona Ghazanfari
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Javad Javidnia
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shaghayegh Khojasteh
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Behrad Roohi
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamid Badali
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Fungus Testing Laboratory & Molecular Diagnostics Laboratory, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Maryam Fathi
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Kazem Amirizad
- Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Zahra Yahyazadeh
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahdi Abastabar
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abdullah M S Al-Hatmi
- Natural & Medical Sciences Research Centre, University of Nizwa, Nizwa, Oman
- Department of Biological Sciences & Chemistry, College of Arts and Sciences, University of Nizwa, Nizwa, Oman
- Center of Expertise in Mycology, Radboud University Medical Center/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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Futatsuya T, Ogawa A, Anzawa K, Mochizuki T, Shimizu A. First Isolation of Neoscytalidium dimidiatum from Human Dermatomycosis in Japan. Med Mycol J 2022; 63:71-75. [PMID: 36047185 DOI: 10.3314/mmj.22-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Neoscytalidium dimidiatum is a common fungus that causes non-dermatophyte dermatomycosis in tropical regions, but there have been no reports of infection with N. dimidiatum in Japan. Here, we report the first isolation of N. dimidiatum from human dermatomycosis in Japan. A 62-year-old healthy Japanese male had been treated with oral terbinafine for tinea pedis diagnosed from a microscopic examination in 2003 with a lesion that was intractable. In 2020, re-identification by sequencing the internal transcribed spacer regions and the D1/D2 domain of the large-subunit (LSU) ribosomal RNA gene revealed that the pathogen was N. dimidiatum. Antifungal susceptibility tests showed that the minimum inhibitory concentration of the drug luliconazole (LLCZ) against the pathogen was 0.00049 µg/mL. The patient's lesions were cured by topical LLCZ. The clinical course and drug susceptibility suggest that LLCZ is a suitable first-line drug for treatment.
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Affiliation(s)
| | | | | | | | - Akira Shimizu
- Department of Dermatology, Kanazawa Medical University
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4
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Hainsworth S, Hubka V, Lawrie AC, Carter D, Vanniasinkam T, Grando D. Predominance of Trichophyton interdigitale Revealed in Podiatric Nail Dust Collections in Eastern Australia. Mycopathologia 2019; 185:175-185. [PMID: 31332646 DOI: 10.1007/s11046-019-00363-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 07/16/2019] [Indexed: 12/13/2022]
Abstract
Toenail onychomycosis caused by dermatophytes is a significant medical and financial worldwide burden. Relatively scant research has been undertaken as to the predominant species and strains causing this condition in Australia, which is a unique isolated continent with diverse geographical, climatic and population regions. Four regions were selected in Eastern Australia: Far North Queensland, Rural Victoria, Melbourne Metropolitan and Tasmania. From each of these areas, communal nail dust bags from podiatric physicians' work were collected and analysed. A total of 32 dust bags were collected: 10 from Far North Queensland, 8 from Melbourne Metropolitan, 8 from Rural Victoria and 6 from Tasmania. Dermatophyte test medium was used to isolate dermatophytes from the dust, and the colonies were subcultured to Potato Dextrose Agar. Of the bags collected, in total 69% were positive for dermatophytes: 40% from Far North Queensland, 75% from Melbourne Metropolitan, 88% from Rural Victoria and 83% from Tasmania. The internal transcribed spacer (ITS) region of ribosomal DNA was used to identify and compare isolates. A total of 148 dermatophyte strains were identified. The predominant species isolated was Trichophyton interdigitale (125 isolates), which was found in all four regions. This species was further subdivided into four ITS genotypes: the first two were present in all regions, but the third was found only in the Melbourne Metropolitan area and the fourth only in Tasmania. Only one strain of Trichophyton rubrum was found and only in Rural Victoria. Eighteen isolates of Arthroderma quadrifidum were cultured from Rural Victoria and Tasmania and were further classified into three ITS genotypes. Some isolates rarely reported in clinical material were identified as Paraphyton cookei, Arthroderma tuberculatum and Arthroderma crocatum. A potentially new species of Arthroderma was also found in Melbourne Metropolitan. These findings reveal a unique dermatophyte fingerprint in toenails for Eastern Australia.
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Affiliation(s)
- Steven Hainsworth
- School of Science, RMIT University (Bundoora Campus), PO Box 71, Bundoora, VIC, 3083, Australia. .,School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, 2650, Australia.
| | - Vit Hubka
- Department of Botany, Faculty of Science, Charles University, Prague, Czech Republic.,Laboratory of Fungal Genetics and Metabolism, Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Ann C Lawrie
- School of Science, RMIT University (Bundoora Campus), PO Box 71, Bundoora, VIC, 3083, Australia
| | - Dee Carter
- School of Life and Environmental Sciences, Faculty of Science, Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Thiru Vanniasinkam
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, 2650, Australia
| | - Danilla Grando
- School of Science, RMIT University (Bundoora Campus), PO Box 71, Bundoora, VIC, 3083, Australia
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Rafat Z, Hashemi SJ, Saboor-Yaraghi AA, Pouragha B, Taheriniya A, Moosavi A, Roohi B, Arjmand R, Moradi A, Daie-Ghazvini R, Basiri S. A systematic review and meta-analysis on the epidemiology, casual agents and demographic characteristics of onychomycosis in Iran. J Mycol Med 2019; 29:265-272. [PMID: 31285126 DOI: 10.1016/j.mycmed.2019.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/02/2019] [Accepted: 05/13/2019] [Indexed: 01/29/2023]
Abstract
Onychomycosis or fungal nail infection is one of the most common fungal infections. Nearly 50% of all nail disorders are caused by fungi. This systematic review and meta-analysis was conducted to determine the prevalence of onychomycosis across Iran. We searched English and Persian databases for studies reporting the epidemiologic features of onychomycosis in Iranian people from January 2000 to December 2018. Literature search revealed 307 studies, of which 24 studies met the eligibility criteria. In order to identifying the existence of publication bias among studies, funnel plots were used. The results of the meta-analysis were visualized as a forest plot representing the prevalence estimates of each study. Heterogeneity was also analyzed using the I2, Chi2, and Tau2 statistics. A high level of I2 and Chi2 was obtained among studies, which provides evidence of notable heterogeneity between studies. The results of current study revealed that the highest prevalence of onychomycosis was related to Mazandaran and Tehran provinces, respectively. As in the literature hypothesized shift in etiologic agents from yeasts to dermatophytes or molds could not be confirmed. Females were affected more frequently than males and in both sexes the highest incidence of infection occurrence was at the ages of >50 years. It seems the highest prevalence of onychomycosis in Mazandaran and Tehran provinces is due to the concentration of specialist doctors and research centers in these two provinces compared with others which leads to more detection and more care of the disease. Therefore, further educational strategies in order to accurate diagnosis in other provinces is necessary to reduce the risk of onychomycosis in Iran.
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Affiliation(s)
- Z Rafat
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - S J Hashemi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - A-A Saboor-Yaraghi
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Iran
| | - B Pouragha
- School of Health, Alborz University of medical sciences, Karaj, Iran
| | - A Taheriniya
- Emergency Medicine, Alborz University of Medical Science, Madani Hospital, Karaj, Iran
| | - A Moosavi
- Department of Biochemistry, Faculty of Dentistry, Alborz University of Medical Sciences, Karaj, Iran
| | - B Roohi
- Laboratory of Microbiology and Immunology of Infectious Diseases, Paramedicine Faculty, Guilan University of Medical Sciences, Guilan, Iran
| | - R Arjmand
- Department of Pediatric, Emam-Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - A Moradi
- Department of Periodontics, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - R Daie-Ghazvini
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - S Basiri
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Tsang CC, Tang JYM, Chan KF, Lee CY, Chan JFW, Ngan AHY, Cheung M, Lau ECL, Li X, Ng RHY, Lai CKC, Fung KSC, Lau SKP, Woo PCY. Diversity of phenotypically non-dermatophyte, non-Aspergillus filamentous fungi causing nail infections: importance of accurate identification and antifungal susceptibility testing. Emerg Microbes Infect 2019; 8:531-541. [PMID: 30938262 PMCID: PMC6455232 DOI: 10.1080/22221751.2019.1598781] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Onychomycosis is most commonly caused by dermatophytes. In this study, we examined the spectrum of phenotypically non-dermatophyte and non-Aspergillus fungal isolates recovered over a 10-year period from nails of patients with onychomycosis in Hong Kong. A total of 24 non-duplicated isolates recovered from 24 patients were included. The median age of the patients was 51 years, and two-thirds of them were males. One-third and two-thirds had finger and toe nail infections respectively. Among these 24 nail isolates, 17 were confidently identified as 13 different known fungal species, using a polyphasic approach. These 13 species belonged to 11 genera and ≥9 families. For the remaining seven isolates, multilocus sequencing did not reveal their definite species identities. These seven potentially novel species belonged to four different known and three potentially novel genera of seven families. 33.3%, 41.7% and 95.8% of the 24 fungal isolates possessed minimum inhibitory concentrations of >1 µg/mL to terbinafine, itraconazole and fluconazole, respectively, the first line treatment of onychomycosis. A high diversity of moulds was associated with onychomycosis. A significant proportion of the isolates were potentially novel fungal species. To guide proper treatment, molecular identification and antifungal susceptibility testing should be performed for these uncommonly isolated fungal species.
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Affiliation(s)
- Chi-Ching Tsang
- a Department of Microbiology, Li Ka Shing Faculty of Medicine , The University of Hong Kong , Pokfulam, Hong Kong
| | - James Y M Tang
- a Department of Microbiology, Li Ka Shing Faculty of Medicine , The University of Hong Kong , Pokfulam, Hong Kong
| | - Ka-Fai Chan
- a Department of Microbiology, Li Ka Shing Faculty of Medicine , The University of Hong Kong , Pokfulam, Hong Kong
| | - Chun-Yi Lee
- a Department of Microbiology, Li Ka Shing Faculty of Medicine , The University of Hong Kong , Pokfulam, Hong Kong
| | - Jasper F W Chan
- a Department of Microbiology, Li Ka Shing Faculty of Medicine , The University of Hong Kong , Pokfulam, Hong Kong.,b State Key Laboratory of Emerging Infectious Diseases , The University of Hong Kong , Pokfulam, Hong Kong.,c Carol Yu Centre for Infection , The University of Hong Kong , Pokfulam, Hong Kong.,d Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases , The University of Hong Kong , Hong Kong
| | - Antonio H Y Ngan
- a Department of Microbiology, Li Ka Shing Faculty of Medicine , The University of Hong Kong , Pokfulam, Hong Kong
| | - Mei Cheung
- a Department of Microbiology, Li Ka Shing Faculty of Medicine , The University of Hong Kong , Pokfulam, Hong Kong.,e Department of Pathology , Queen Elizabeth Hospital , Pokfulam, King's Park, Hong Kong
| | - Eunice C L Lau
- a Department of Microbiology, Li Ka Shing Faculty of Medicine , The University of Hong Kong , Pokfulam, Hong Kong.,f Department of Pathology , United Christian Hospital , Kwun Tong, Hong Kong
| | - Xin Li
- a Department of Microbiology, Li Ka Shing Faculty of Medicine , The University of Hong Kong , Pokfulam, Hong Kong
| | - Ricky H Y Ng
- f Department of Pathology , United Christian Hospital , Kwun Tong, Hong Kong
| | - Christopher K C Lai
- e Department of Pathology , Queen Elizabeth Hospital , Pokfulam, King's Park, Hong Kong
| | - Kitty S C Fung
- f Department of Pathology , United Christian Hospital , Kwun Tong, Hong Kong
| | - Susanna K P Lau
- a Department of Microbiology, Li Ka Shing Faculty of Medicine , The University of Hong Kong , Pokfulam, Hong Kong.,b State Key Laboratory of Emerging Infectious Diseases , The University of Hong Kong , Pokfulam, Hong Kong.,c Carol Yu Centre for Infection , The University of Hong Kong , Pokfulam, Hong Kong.,d Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases , The University of Hong Kong , Hong Kong
| | - Patrick C Y Woo
- a Department of Microbiology, Li Ka Shing Faculty of Medicine , The University of Hong Kong , Pokfulam, Hong Kong.,b State Key Laboratory of Emerging Infectious Diseases , The University of Hong Kong , Pokfulam, Hong Kong.,c Carol Yu Centre for Infection , The University of Hong Kong , Pokfulam, Hong Kong.,d Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases , The University of Hong Kong , Hong Kong
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James JE, Santhanam J, Lee MC, Wong CX, Sabaratnam P, Yusoff H, Tzar MN, Razak MFA. In Vitro Antifungal Susceptibility of Neoscytalidium dimidiatum Clinical Isolates from Malaysia. Mycopathologia 2016; 182:305-313. [DOI: 10.1007/s11046-016-0085-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/24/2016] [Indexed: 11/29/2022]
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Motamedi M, Ghasemi Z, Shidfar MR, Hosseinpour L, Khodadadi H, Zomorodian K, Mirhendi H. Growing Incidence of Non-Dermatophyte Onychomycosis in Tehran, Iran. Jundishapur J Microbiol 2016; 9:e40543. [PMID: 27800138 PMCID: PMC5080915 DOI: 10.5812/jjm.40543] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 07/07/2016] [Accepted: 07/19/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Non-dermatophyte onychomycosis (NDO) is caused by a wide range of mold fungi other than dermatophytes, and has been reported at various rates in different countries worldwide. Studies on the incidence of NDO in the community are essential for understanding its epidemiology and control, as well as for the appropriate treatment of these infections. OBJECTIVES In this study, the incidence of NDO in Tehran, Iran, was compared to the incidence of onychomycoses due to dermatophytes and yeasts. METHODS From 2014 through 2015, samples from a total of 1,069 patients with suspected fungal nail diseases, who were referred to three medical mycology laboratories in Tehran, were collected and subjected to direct examination (all samples) and culture (788 samples). Differentiation of the causative agents of onychomycosis was based on microscopic observation of characteristic fungal elements in the nail samples and growth of a significant number of identical colonies on the culture plate. RESULTS Based on only direct microscopy, onychomycosis was diagnosed in 424 (39.6%) cases, among which 35.8% were caused by dermatophytes, 32.7% by yeasts, and 29.3% by non-dermatophyte molds (NDMs), while 2.2% were mixed infections. Direct exam was significantly more sensitive than culture for the diagnosis. The most commonly isolated NDMs were Aspergillus spp. (69.3%, n = 52), followed by Fusarium spp. (n = 7). The other isolated species were Paecilomyces spp., Scopulariopsis spp., Acremonium spp., Cladosporium spp., and Chrysosporium spp., with only one case of each. CONCLUSIONS An increasing frequency of NDO compared to onychomycosis due to other causative agents has been noticeable over the past few years in Iran. This epidemiological data may be useful in the development of preventive and educational strategies.
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Affiliation(s)
- Marjan Motamedi
- Department of Medical Parasitology and Mycology, School of Public Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Zeinab Ghasemi
- Department of Medical Parasitology and Mycology, School of Public Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Reza Shidfar
- Department of Medical Parasitology and Mycology, School of Public Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Leila Hosseinpour
- Department of Medical Parasitology and Mycology, School of Public Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Hossein Khodadadi
- Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Kamiar Zomorodian
- Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Hossein Mirhendi
- Department of Medical Parasitology and Mycology, School of Public Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, IR Iran
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IR Iran
- Corresponding author: Hossein Mirhendi, Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-3137929165, E-mail:
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Tranchida MC, Centeno ND, Stenglein SA, Cabello MN. First record of Talaromyces udagawae in soil related to decomposing human remains in Argentina. Rev Argent Microbiol 2016; 48:86-90. [PMID: 26766627 DOI: 10.1016/j.ram.2015.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/17/2015] [Accepted: 10/08/2015] [Indexed: 01/26/2023] Open
Abstract
The morphologic features of Talaromyces udagawae Stolk and Samson are here described and illustrated. This teleomorphic Ascomycota fungus was isolated from soil obtained in Buenos Aires province (Argentina) from beneath a human cadaver in an advanced state of decomposition. After washing and serial dilution of the soil along with moist-chamber techniques for fungal cultivation, T. udagawae formed very restricted colonies of bright yellow color on different growth media with 8-ascospored asci. The ascospores were ellipsoidal and ornamented. The anamorphic state was not observed. Molecular-genetic techniques identified the species. The present record is the first of the species in Argentina, pointing it as a tool to identify soils where cadaver decomposition occurs.
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Affiliation(s)
- María C Tranchida
- Instituto de Botánica C. Spegazzini, Facultad de Ciencias Naturales y Museo Universidad Nacional de La Plata, Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET-CCT La Plata), La Plata, Buenos Aires, Argentina.
| | - Néstor D Centeno
- Laboratorio de Entomología Aplicada y Forense Universidad Nacional de Quilmes, Bernal, Buenos Aires, Argentina
| | - Sebastián A Stenglein
- Laboratorio de Biología Funcional y Biotecnología (BIOLAB)-CICBA-INBIOTEC-CONICET, Cátedra de Microbiología, Facultad de Agronomía-UNCPBA, Azul, Buenos Aires, Argentina
| | - Marta N Cabello
- Instituto de Botánica C. Spegazzini, Facultad de Ciencias Naturales y Museo Universidad Nacional de La Plata, Comisión de Investigaciones Científicas de la Provincia de Buenos Aires (CIC), La Plata, Buenos Aires, Argentina
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10
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Ranawaka RR, Nagahawatte A, Gunasekara TA, Weerakoon HS, de Silva SHP. Randomized, double-blind, comparative study on efficacy and safety of itraconazole pulse therapy and terbinafine pulse therapy on nondermatophyte mold onychomycosis: A study with 90 patients. J DERMATOL TREAT 2015; 27:364-72. [PMID: 26651495 DOI: 10.3109/09546634.2015.1119781] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Nondermatophyte mold (NDM) onychomycosis shows poor response to current topical, oral or device-related antifungal therapies. This study was aimed to determine the efficacy and safety of itraconazole and terbinafine pulse therapy on NDM onychomycosis. METHODS Mycologically proven subjects were treated with itraconazole 400 mg daily or terbinafine 500 mg daily for 7 days/month; two pulses for fingernails and three pulses for toenails(SLCTR/2013/013). RESULTS One-hundred seventy-eight patients underwent mycological studies and 148 had positive fungal isolates. NDM were the prevailing fungi, 68.2%, followed by candida species 21.6%, and dermatophytes made up only 10.1%. Out of NDM Aspergillus spp (75.1%) predominated followed by 8.9% Fusarium spp and 4.95% Penicillium spp. The clinical cure at completion of pulse therapy was statistically significant 9.2% versus 2.0% (p < 0.05) in itraconazole group. But no statistically significant difference was detected between the two regimens at the end of 12 months; 65.1% versus 54.64%. Recurrences observed in both groups (6.5% vs. 4.1%) were not statistically significant. With itraconazole pulse 68.22% Aspergillus spp, 50.0% Fusarium spp and 84.6% Penicillium spp showed clinical cure, while terbinafine pulse cured 55.0% Aspergillus spp and 50.0% Fusarium spp. CONCLUSIONS NDM was the prevailing fungi in onychomycosis in Sri Lanka. Both itraconazole and terbinafine were partially effective on NDM onychomycosis showing a clinical cure of 54-65%. Future research should focus on searching more effective antifungal for NDM onychomycosis.
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Affiliation(s)
| | - Ajith Nagahawatte
- b Department of Microbiology , University of Ruhuna , Galle , Sri Lanka , and
| | | | - Hema S Weerakoon
- a Department of Dermatology , Base Hospital Homagama , Sri Lanka
| | - S H Padmal de Silva
- c Department of Evaluation and Research , National Institute of Health Sciences , Kalutara , Sri Lanka
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Tsang CC, Hui TWS, Lee KC, Chen JHK, Ngan AHY, Tam EWT, Chan JFW, Wu AL, Cheung M, Tse BPH, Wu AKL, Lai CKC, Tsang DNC, Que TL, Lam CW, Yuen KY, Lau SKP, Woo PCY. Genetic diversity of Aspergillus species isolated from onychomycosis and Aspergillus hongkongensis sp. nov., with implications to antifungal susceptibility testing. Diagn Microbiol Infect Dis 2015; 84:125-34. [PMID: 26658315 DOI: 10.1016/j.diagmicrobio.2015.10.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 10/27/2015] [Accepted: 10/30/2015] [Indexed: 11/30/2022]
Abstract
Thirteen Aspergillus isolates recovered from nails of 13 patients (fingernails, n=2; toenails, n=11) with onychomycosis were characterized. Twelve strains were identified by multilocus sequencing as Aspergillus spp. (Aspergillus sydowii [n=4], Aspergillus welwitschiae [n=3], Aspergillus terreus [n=2], Aspergillus flavus [n=1], Aspergillus tubingensis [n=1], and Aspergillus unguis [n=1]). Isolates of A. terreus, A. flavus, and A. unguis were also identifiable by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The 13th isolate (HKU49(T)) possessed unique morphological characteristics different from other Aspergillus spp. Molecular characterization also unambiguously showed that HKU49(T) was distinct from other Aspergillus spp. We propose the novel species Aspergillus hongkongensis to describe this previously unknown fungus. Antifungal susceptibility testing showed most Aspergillus isolates had low MICs against itraconazole and voriconazole, but all Aspergillus isolates had high MICs against fluconazole. A diverse spectrum of Aspergillus species is associated with onychomycosis. Itraconazole and voriconazole are probably better drug options for Aspergillus onychomycosis.
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Affiliation(s)
- Chi-Ching Tsang
- Department of Microbiology, The University of Hong Kong, Hong Kong
| | - Teresa W S Hui
- Department of Microbiology, The University of Hong Kong, Hong Kong; Department of Clinical Pathology, Tuen Mun Hospital, Hong Kong
| | - Kim-Chung Lee
- Department of Microbiology, The University of Hong Kong, Hong Kong
| | | | - Antonio H Y Ngan
- Department of Microbiology, The University of Hong Kong, Hong Kong
| | - Emily W T Tam
- Department of Microbiology, The University of Hong Kong, Hong Kong
| | - Jasper F W Chan
- Department of Microbiology, The University of Hong Kong, Hong Kong; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong
| | - Andrea L Wu
- Department of Microbiology, The University of Hong Kong, Hong Kong
| | - Mei Cheung
- Department of Microbiology, The University of Hong Kong, Hong Kong; Department of Pathology, Queen Elizabeth Hospital, Hong Kong
| | - Brian P H Tse
- Department of Microbiology, The University of Hong Kong, Hong Kong; Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Alan K L Wu
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | | | | | - Tak-Lun Que
- Department of Clinical Pathology, Tuen Mun Hospital, Hong Kong
| | - Ching-Wan Lam
- Department of Pathology, The University of Hong Kong, Hong Kong
| | - Kwok-Yung Yuen
- Department of Microbiology, The University of Hong Kong, Hong Kong; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong
| | - Susanna K P Lau
- Department of Microbiology, The University of Hong Kong, Hong Kong; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong.
| | - Patrick C Y Woo
- Department of Microbiology, The University of Hong Kong, Hong Kong; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong.
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12
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Ranawaka RR, Nagahawatte A, Gunasekara TA. Fusarium onychomycosis: prevalence, clinical presentations, response to itraconazole and terbinafine pulse therapy, and 1-year follow-up in nine cases. Int J Dermatol 2015. [PMID: 26223159 DOI: 10.1111/ijd.12906] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Invasive fusariosis is an infection with Fusarium spp. that primarily affects patients with hematologic malignancies and hematopoietic cell transplant recipients. Wounds, digital ulcers, onychomycosis, and paronychia are the typical cutaneous portals of entry. Early management of mycotic nails in immunocompromised and diabetic hosts is crucial to prevent life-threatening disease. OBJECTIVES We report nine cases of Fusarium onychomycosis (F. dimerum, n = 5; F. oxysporum, n = 3; Fusarium spp., n = 1) in immunocompetent hosts and their response to itraconazole and terbinafine pulse therapy. METHODS The patients received either itraconazole 400 mg daily or terbinafine 500 mg daily for 7 d/month; two pulses for fingernails and three pulses for toenails. RESULTS Of the 68 confirmed cases of onychomycosis, eight (11.7%) were Fusarium spp.; the ninth patient was culture positive but microscopy negative and responded well to itraconazole. Distal subungual onychomycosis was the commonest clinical manifestation (seven of nine), one had proximal subungual onychomycosis, and total onychodystrophy was noted on four patients. Associated paronychia was marked on 66.7% (six of eight) patients. Itraconazole was given to six patients/25 nails and terbinafine to three patients/20 nails. All nine patients completed treatments, but one defaulted at 12 months follow-up. The efficacy parameters were clinical cure (CC) and mycological cure (MC). At month 12 after the start of treatment, the response was itraconazole CC 13 of 25 (52%)/MC four of six (66.6%) and terbinafine CC four of eight (50%)/MC one of two (50%). Recurrence was noted in four of 13 (30.7%) and eight of 13 (61.5%) cured nails in the itraconazole group within 3 and 12 months, respectively. CONCLUSIONS Fusarium onychomycosis was clinically indistinguishable from other onychomycosis. Both itraconazole and terbinafine pulse therapy were only partially effective on Fusarium onychomycosis. Antifungals that are more effective should be sought.
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Affiliation(s)
| | - Ajith Nagahawatte
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
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Nouripour-Sisakht S, Mirhendi H, Shidfar MR, Ahmadi B, Rezaei-Matehkolaei A, Geramishoar M, Zarei F, Jalalizand N. Aspergillus species as emerging causative agents of onychomycosis. J Mycol Med 2015; 25:101-7. [PMID: 25656408 DOI: 10.1016/j.mycmed.2014.12.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 12/19/2014] [Accepted: 12/30/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Onychomycosis is a common nail infection caused by dermatophytes, non-dermatophyte molds (NDM), and yeasts. Aspergillus species are emerging as increasing causes of toenail onychomycosis. The purpose of this study was species delineation of Aspergillus spp. isolated from patients with onychomycosis. METHODS During a period of one year (2012-2013), nail samples were collected from patients clinically suspected of onychomycosis and subjected to microscopic examination and culture. Species identification was performed based on macro- and micro-morphology of colonies. For precise species identification, PCR-amplification and sequencing of the beta-tubulin gene followed by BLAST queries were performed where required. RESULTS A total of 463/2,292 (20.2%) tested nails were diagnosed with onychomycosis. Among the positive specimens, 154 cases (33.2%) were identified as saprophytic NDM onychomycosis, 135 (29.2%) of which were attributable to Aspergillus. Aspergillus species isolated from the infected nails included Aspergillus flavus (77.3%, n=119), Aspergillus niger (n=4), Aspergillus tubingensis (n=4), Aspergillus terreus (n=3), Aspergillus sydowii (n=2), Aspergillus spp. (n=2), and Aspergillus candidus (n=1). Among the patients diagnosed with onychomycosis due to Aspergillus (average patient age, 47.4 years), 40 had fingernail and 95 toenail involvement. The large toenails were most commonly affected. CONCLUSIONS This study identified a markedly high occurrence of A. flavus, and this fungus appears to be an emerging cause of saprophytic onychomycosis in Iran. The study moreover highlights the necessity of differentiating between dermatophytic and non-dermatophytic nail infections for informed decisions on appropriate therapy.
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Affiliation(s)
- S Nouripour-Sisakht
- Department of Medical Parasitology and Mycology, School of Public Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - H Mirhendi
- Department of Medical Parasitology and Mycology, School of Public Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.
| | - M R Shidfar
- Department of Medical Parasitology and Mycology, School of Public Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - B Ahmadi
- Department of Medical Parasitology and Mycology, School of Public Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - A Rezaei-Matehkolaei
- Department of Medical Mycology, School of Medicine, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - M Geramishoar
- Department of Medical Parasitology and Mycology, School of Public Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - F Zarei
- Department of Medical Parasitology and Mycology, School of Public Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - N Jalalizand
- Department of Medical Parasitology and Mycology, School of Public Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
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Haghani I, Shokohi T, Hajheidari Z, Khalilian A, Aghili SR. Comparison of diagnostic methods in the evaluation of onychomycosis. Mycopathologia 2013; 175:315-21. [PMID: 23371413 DOI: 10.1007/s11046-013-9620-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 01/21/2013] [Indexed: 10/27/2022]
Abstract
Onychomycosis is a common nail problem, accounting for up to half of all nail diseases. Several nail disorders may mimic the onychomycosis clinically. Therefore, a sensitive, quick, and inexpensive test is essential for screening nail specimens for the administration of the proper drug. The aim of this study was to compare 4 different diagnostic methods in the evaluation of onychomycosis and to determine their sensitivity, specificity, positive predictive value, and negative predictive value. In a cross-sectional study, nail specimens were collected from 101 patients suspected to have onychomycosis during a 14-month period. The nail specimens were examined using potassium hydroxide (KOH) 20 %, KOH-treated nail clipping stained with periodic acid-Schiff (KONCPA), and calcofluor white (CFW) stain, and grew a fungal culture. The culture was chosen as the gold standard for statistical analysis using the McNemar and chi-square tests. Out of 101 patients, 100 (99 %) patients had at least 1 of the 4 diagnostic methods positive for the presence of organisms. The positive rates for the fungal culture, KOH preparation, CFW, and KONCPA were 74.2, 85.1, 91.09, and 99.01 %, respectively. The sensitivity and negative predictive value of KONCPA was 100 %. KONCPA was the most sensitive among the tests and was also superior to other methods in its negative predictive value. KONCPA was easy to perform, rapid, and gave significantly higher rates of detection of onychomycosis compared to the standard methods of KOH preparation and fungal culture. Therefore, KONCPA should be the single method of choice for the evaluation of onychomycosis.
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Affiliation(s)
- Iman Haghani
- Department of Medical Mycology and Parasitology, Sari Medical School, Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Namitome K, Kano R, Sekiguchi M, Iwasaki T, Kaneshima T, Nishifuji K. Isolation of Fusarium sp. from a claw of a dog with onychomycosis. J Vet Med Sci 2011; 73:965-9. [PMID: 21441720 DOI: 10.1292/jvms.11-0012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
An 8-year-old male Golden Retriever had lameness and claw abnormality in the second digit of the left forelimb. Radiography revealed osteomyelitis in the distal phalanx bone of the affected limb. Microscopic examination of the claw revealed numerous hyphae in the claw matrix. Fungal DNA fragments coding the ribosomal internal transcribed spacer region (ITS) were detected from the claw matrix as well as fungal colonies of the clinical isolates by PCR. Nucleotide sequencing revealed that the amplicons shared > 99% homology with Fusarium sp. Therapy including oral itraconazole resulted in regrowth of a new claw, in which no hyphae were detected. To the authors' knowledge, this is the first case report of canine onychomycosis in which Fusarium sp. was isolated from the affected claw.
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Affiliation(s)
- Kazuko Namitome
- Laboratory of Veterinary Internal Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Tokyo, Japan
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16
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Weisenborn JLF, Kirschner R, Cáceres O, Piepenbring M. Talaromyces indigoticus Takada & Udagawa, the first record for Panama and the American continent. Mycopathologia 2010; 170:203-8. [PMID: 20349275 DOI: 10.1007/s11046-010-9305-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 03/13/2010] [Indexed: 11/30/2022]
Abstract
In a survey of mycotic human skin and nail lesions in Chiriquí, Western Panama, Talaromyces indigoticus was isolated in one case. This ascomycete is characterised by formation of gymnothecia containing oval, spinose and yellow ascospores, which become blue in mounting fluids, and by short monoverticillate or biverticillate penicilli. It is here reported the first time for Panama and the American continent. Because the strain was isolated from an onychomycosis together with a dermatophyte and other fungal strains, the pathological impact of Talaromyces indigoticus is not evident.
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Affiliation(s)
- Jascha L F Weisenborn
- Department of Mycology, Institute for Ecology, Evolution and Diversity, J W Goethe-Universität, Frankfurt am Main, Germany.
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Verweij PE, Varga J, Houbraken J, Rijs AJMM, Verduynlunel FM, Blijlevens NMA, Shea YR, Holland SM, Warris A, Melchers WJG, Samson RA. Emericella quadrilineata as cause of invasive aspergillosis. Emerg Infect Dis 2008; 14:566-72. [PMID: 18394273 PMCID: PMC2570940 DOI: 10.3201/eid1404.071157] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We noted a cluster of 4 cases of infection or colonization by Emericella spp., identified by sequence-based analysis as E. quadrilineata. Sequence-based analysis of an international collection of 33 Emericella isolates identified 12 as E. nidulans, all 12 of which had previously been identified by morphologic methods as E. nidulans. For 12 isolates classified as E. quadrilineata, only 6 had been previously identified accordingly. E. nidulans was less susceptible than E. quadrilineata to amphotericin B (median MICs 2.5 and 0.5 mg/L, respectively, p<0.05); E. quadrilineata was less susceptible than E. nidulans to caspofungin (median MICs, 1.83 and 0.32 mg/L, respectively, p<0.05). These data indicate that sequence-based identification is more accurate than morphologic examination for identifying Emericella spp. and that correct species demarcation and in vitro susceptibility testing may affect patient management.
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Affiliation(s)
- Paul E Verweij
- Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
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Guilhermetti E, Takahachi G, Shinobu CS, Svidzinski TIE. Fusarium spp. as agents of onychomycosis in immunocompetent hosts. Int J Dermatol 2007; 46:822-6. [PMID: 17651164 DOI: 10.1111/j.1365-4632.2007.03120.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fusarium spp. are nondermatophyte filamentous fungi, frequently reported as an etiologic agent of opportunistic infections in humans; however, their involvement in the etiology of cutaneous lesions is still debatable, especially in immunocompetent patients, where they are often considered as contaminant fungi. OBJECTIVE The aims of this study were to report the high prevalence of onychomycosis by Fusarium spp. in immunocompetent patients in the region of Maringá, Paraná, Brazil, to establish clinical and laboratory criteria for this genus as a causal agent of onychomycosis, and to determine the susceptibility profile to the systemic antifungal drugs most frequently used in Brazil (itraconazole, ketoconazole, terbinafine, and amphotericin B). METHODS The fungi were isolated and identified through the classical method, and sensitivity tests were carried out according to the National Committee for Clinical Laboratory Standards (NCCLS) M38-A protocol. RESULTS Of the 360 confirmed cases of onychomycosis, 27 (7.5%) were attributed to the genus Fusarium, and F. oxysporum was the most commonly isolated species. Nail lesions with paronychia and pain, combined with direct suggestive microscopy and a high concentration of microorganisms, were predictive of onychomycosis by Fusarium spp. The minimum inhibitory concentration was high for itraconazole, ketoconazole, and terbinafine, but low for amphotericin B. CONCLUSIONS It is recommended that more attention should be given to the interpretation and identification of species of the Fusarium genus in superficial clinical samples. This fungus may be considered as an agent of onychomycosis, even in immunocompetent individuals, by identifying criteria that separate situations of clinical significance from those of simple contamination.
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Affiliation(s)
- Eliana Guilhermetti
- Laboratory of Medical Mycology, Maringá State University, Maringá, Paraná, Brazil
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Abstract
BACKGROUND Dermatophytes, yeasts and moulds all are potential causative agents of onychomycosis. The aim of this study was to determine the percentage of cases of onychomycoses caused by each group. In addition, the responsible genus and species was identified for each nail infection. PATIENTS AND METHODS In a retrospective study performed at the Department of Dermatology of the Leipzig University, 5,077 nail samples from 4,177 patients--2,240 women and 1,937 men--with a variety of nail changes--not just onychomycosis--were investigated. 75% were toenails, 23% fingernails, and 2% from both sites. RESULTS Both microscopic and/or cultural detection of fungi (dermatophytes, yeasts and moulds) were successful in 54% of samples. Causative fungal agents were: 68% dermatophytes, 29% yeast, and 3% moulds. The most frequently detected dermatophyte species were T. rubrum (91%), and T. mentagrophytes (7.7%). Among yeasts, C. parapsilosis (42%) was most common,followed by C. guilliermondii (20.1%), C. albicans (14.2%), and Trichosporon spp. (10%). Scopulariopsis brevicaularis (43%) was the most frequent mould. The percentage of mixed fungal infections was 22%. CONCLUSIONS Dermatophytes, in particular T.rubrum, but also T. mentagrophytes, are the most frequently isolated causative agents in onychomycosis. In addition, yeasts may be isolated relatively frequently, while moulds are uncommon.
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Affiliation(s)
- Claudia Mügge
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig
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Abstract
Oral candidiasis (OC) is the most common mucosal manifestation of HIV infection. This workshop examined OC and other mycoses associated with HIV infection. Historically, blood CD4 cell numbers were the primary prognosticator for the development of OC. However, a study that statistically evaluated the predictive role of HIV viral load vs. CD4 cell counts revealed viral load to be a stronger predictor for OC. The role of biofilms and antifungal resistance in recalcitrant OC is unclear at present. In general, micro-organisms including yeasts in biofilms are more resistant to antifungals than their planktonic counterparts. When the remaining organisms are eliminated, the few resistant organisms may not be problematic, because they are present in low numbers. Unusual exotic mycoses in HIV-infected patients are more common in patients from the developing than the developed world. These infections may be recurrent and recalcitrant to therapy, be present in multiple and uncommon sites, increase with the progression of HIV disease, and may play a role similar to that of the more common mycoses. Typing and subtyping of yeasts are probably not critical to the clinical management of candidiasis caused by Candida albicans and non-albicans strains, including C. dubliniensis, because it is responsive to antifungal therapy. C. glabrata is probably the only exception. The presence of oral thrush in infants younger than 6 months of age is associated with an increased post-natal transmission risk of HIV infection. Thus, perinatal retroviral therapy should be combined with the treatment of oral thrush to prevent the post-natal acquisition of HIV.
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Affiliation(s)
- M M Coogan
- Division of Oral Microbiology, School of Dentistry, University of the Witwatersrand, Private Bag X6, Wits 2050, Johannesburg, South Africa.
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Abstract
BACKGROUND Onychomycosis results from invasion of the nail plate by dermatophytes, yeasts or mould species of fungi. This report documents the etiological agents of onychomycosis in Adana, Turkey. METHODS Results of mycological tests of nail clippings or subungal scrapings collected in the period between 1998 and 2002 were analyzed. Both the direct microscopy and the cultures of the nail material were performed to identify the causative agent. RESULTS Out of a total of 388 cases examined, finger (12.4%) and toenail (87.6%) involvement, 155 (39.9%), were mycologically proven cases of onychomycosis (15 finger, 140 toenail). Among the 98 specimens from positive fungal cultures, dermatophytes were isolated in 74 (75.5%), and yeasts in 24 (24.5%). Trichophyton rubrum was the most common causative agent (48.0%), followed by T. mentagophytes var. interdigitale (26.6%), Candida tropicalis (11.2%), C. albicans (9.2%), C. glabrata (2.0%), C. krusei (2.0%) and Epidermophyton floccosum (1.0%). CONCLUSIONS Dermatophyte fungi, especially T. rubrum and T. mentagrophytes var. interdigitale, were responsible for most of the infections.
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Affiliation(s)
- Macit Ilkit
- Department of Medical Microbiology, Faculty of Medicine, University of Cukurova, Adana, Turkey.
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Abstract
The pathogens of onychomycosis have implications in choosing therapy. We aimed to survey the pathogens of onychomycosis in Taiwan and further analyse the distribution of pathogens in various conditions. We also compared the distribution of pathogens in Taiwan with those in various countries. This study included 182 cases of onychomycosis who attended our clinic between January and December 2001. Histopathologic examination and fungus culture of the nail specimens were performed to confirm the diagnosis and identify the pathogens. The pathogens were dermatophytes in 101 patients (55.5%), Candida in 66 (36.3%), and non-dermatophyte moulds in 16 (8.2%). Candida was more frequently seen in patients older than 60 years (40.9%), females with fingernail onychomycosis (66.7%) or combined fingernail and toenail onychomycosis (58.3%), and presence of paronychia (57.9%). Dermatophytes are the predominant pathogens in temperate Western countries; meanwhile, Candida and non-dermatophyte moulds are prevailing in Mediterranean and tropical countries including Taiwan. Clinicians should appreciate that the pathogens of onychomycosis may vary in different patient groups and geographical locations, and choose optimal antifungal agents accordingly.
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Affiliation(s)
- S H Wang
- Department of Dermatology, Chang Gung Memorial Hospital-Chiayi, 6 Section West, Chia-Pu Road, Putz City, Chia Yi 61363, Taiwan
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Gianni C, Romano C. Clinical and Histological Aspects of Toenail Onychomycosis Caused by Aspergillus spp.: 34 Cases Treated with Weekly Intermittent Terbinafine. Dermatology 2004; 209:104-10. [PMID: 15316163 DOI: 10.1159/000079593] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2003] [Accepted: 03/27/2004] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-dermatophytic onychomycoses represent 1.45-17.6% of all fungal nail infections. Epidemiological studies have shown that Aspergillus spp. are emerging fungal agents of toenail onychomycosis. Indeed, after Scopulariopsis spp. the genus Aspergillus is the second most common agent of non-dermatophytic onychomycosis. The diagnosis and treatment of toenail onychomycosis caused by non-dermatophyte moulds are not always straightforward. OBJECTIVES The aims of this study were to describe the clinical appearance of toenail onychomycosis due to Aspergillus spp., to investigate the pathogenetic role of these agents and to evaluate the efficacy and safety of weekly intermittent terbinafine (500 mg/day for 1 week each month for 3 months) in the treatment of these patients. PATIENTS AND METHODS Mycological study of 2,154 patients with onychodystrophy revealed 1,228 onychomycoses (57%) including 71 cases due to non-dermatophytic fungi (5.6%). Non-dermatophytic onychomycosis caused by Aspergillus spp. represented 2.6% of all onychomycoses. The subjects were 34 patients (22 females, 12 males, age range 30-82 years) observed between September 1999 and December 2001, with toenail onychomycosis caused by Aspergillus spp. confirmed by standard techniques (microscopic examination and culture according to the criteria of English), histological examination of nail clippings and scanning electron microscope examination of the cultures whenever necessary. RESULTS The clinical features suggesting onychomycosis due to Aspergillus spp. are chalky deep white nail, rapid involvement of lamina and painful perionyxis without pus. Standard mycological tests (direct microscopy and fungal culture) and histological examination confirmed the pathogenetic role of Aspergillus spp. in onychomycoses. In particular, the histological examination was positive in 28 cases (82%) and useful in identifying typical aspects of Aspergillus spp. nail infections. At the follow-up, 12 months after the start of therapy with pulsed terbinafine, clinical and mycological recovery was confirmed in 30 of the 34 patients (88%). CONCLUSIONS Treatment of non-dermatophytic onychomycosis with terbinafine usually requires at least 3 months of continuous systemic therapy. Our study of 34 patients confirms that terbinafine is particularly effective in the treatment of Aspergillus spp. nail infections and that a pulsed regimen is more economical and less demanding.
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Affiliation(s)
- Claudia Gianni
- Department of Dermatology, Scientific Institute, S. Raffaele Hospital, Milan, Italy.
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Abstract
Fusarium species frequently implicated in human infections include F. solani, F. oxysporum and F. moniliforme. Among immunocompetent patients, tissue breakdown (as caused by trauma, severe burns or foreign body) is the risk factor for fusariosis. Infections include keratitis, onychomycosis and occasionally peritonitis and cellulitis. Treatment is usually successful and requires removal of the foreign body as well as antifungal therapy. Among immunocompromised patients, mainly patients with haematological malignancies, Fusarium spp. are the second most common pathogenic mould. Risk factors for disseminated fusariosis include severe immunosuppression (neutropenia, lymphopenia, graft-versus-host disease, corticosteroids), colonisation, tissue damage, and receipt of a graft from an HLA-mismatched or unrelated donor. Clinical presentation includes refractory fever (> 90%), skin lesions and sino-pulmonary infections ( approximately 75%). Type of skin lesions includes ecthyma-like, target, and multiple subcutaneous nodules. Skin lesions lead to diagnosis in > 50% of patients and precede fungemia by approximately 5 days. In contrast to disseminated aspergillosis, disseminated fusariosis can be diagnosed by blood cultures in 40% of patients. Histopathology reveals hyaline acute-branching septate hyphae similar to those found in aspergillosis. Mortality from fusarial infections in immunocompromised patients ranges from 50% to 80%. Host immune status is the single most important factor predicting outcome. Persistent neutropenia and corticosteroid therapy significantly affect survival. Optimal treatment has not been established. Anecdotal successes have been reported with various agents (high-dose amphotericin B, lipid-based amphotericin B formulations, itraconazole, voriconazole) and with cytokine-stimulated granulocyte transfusions. Preventing fusariosis relies on detection and treatment of cutaneous damage prior to commencing immunosuppression and decreasing environmental exposure to Fusaria (via air and water).
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Affiliation(s)
- M C Dignani
- FUNDALEU (Foundation for the Fight against Leukemia), Uriburu 1450, Buenos Aires, Argentina
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Ilkit M. Onychomycosis in Adana, Turkey: A 5-year study. Int J Dermatol 2004. [DOI: 10.1111/j.1365-4632.2004.02265.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ng KP, Soo-Hoo TS, Na SL, Ang LS. Dermatophytes isolated from patients in University Hospital, Kuala Lumpur, Malaysia. Mycopathologia 2003; 155:203-6. [PMID: 12650596 DOI: 10.1023/a:1021194025765] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A total of 576 dermatophytes were isolated from patients with a variety of skin infections from January 1993 to May 2000. Ten species of dermatophytes were identified: Epidermophyton floccosum (0.7%), Microsporum audouinii (1.1%), M. canis (3.1%), M. gypseum (0.3%), Trichophyton concentricum (3.5%), T. equinum (0.2%), T. mentagrophytes (36.1%), T. rubrum (53.8%), T. verrucosum (0.2) and T. violaceum (1.0%). The body sites most frequently affected by dermatophytes were the buttocks, nails and trunk. Anthropophilic dermatophytes made up 60.1% of the isolates; the most common species was T. rubrum, T. mentagrophytes and M. canis were the two main zoophilic dermatophytes. T. mentagrophytes was isolated from all body sites except the scalp. M. canis was found to be associated with domestic dogs and was not isolated from ethnic Malays. The only geophilic dermatophyte was M. gypseum, an uncommon dermatophyte associated with tinea pedis.
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Affiliation(s)
- K P Ng
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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Pushker N, Chra M, Bajaj MS, Ghose S, Naik N, Kashyap S, Satpathy G. Necrotizing periorbital Fusarium infection--an emerging pathogen in immunocompetent individuals. J Infect 2002; 44:236-9. [PMID: 12099730 DOI: 10.1053/jinf.2002.1005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fungal infections of the skin and deeper tissues of the periorbital region are quite rare. We report a case of a localized, deep periorbital necrotizing Fusarium infection in an otherwise healthy, elderly lady. Since the clinical features and histopathological findings of Fusarium infection are by no means characteristic, the definitive diagnosis was achieved with the help of microbiological examination of cultured organisms. A combined medical and surgical therapy led to adequate control of infection. To conclude, localized, deep periorbital necrotizing soft tissue infection by Fusarium in an immunocompetent lady is not reported in literature. One should have a high index of suspicion for emerging fungal pathogens in the differential diagnosis of necrotizing orbital or adnexal conditions, even in an immunocompetent patient. The histologic findings of septate, branching hyphae and vascular invasion cannot distinguish Fusarium species from various other moulds such as Aspergillus species; microbiologic studies are essential for confirming the diagnosis.
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Affiliation(s)
- N Pushker
- Oculoplastic and Paediatric Ophthalmology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110 029, India
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