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Gupta AK, Wang T, Polla Ravi S, Mann A, Bamimore MA. Global prevalence of onychomycosis in general and special populations: An updated perspective. Mycoses 2024; 67:e13725. [PMID: 38606891 DOI: 10.1111/myc.13725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Onychomycosis is a chronic nail disorder commonly seen by healthcare providers; toenail involvement in particular presents a treatment challenge. OBJECTIVE To provide an updated estimate on the prevalence of toenail onychomycosis. METHODS We conducted a literature search using PubMed, Embase and Web of Science. Studies reporting mycology-confirmed diagnoses were included and stratified into (a) populations-based studies, and studies that included (b) clinically un-suspected and (c) clinically suspected patients. RESULTS A total of 108 studies were included. Based on studies that examined clinically un-suspected patients (i.e., with or without clinical features suggestive of onychomycosis), the pooled prevalence rate of toenail onychomycosis caused by dermatophytes was 4% (95% CI: 3-5) among the general population; special populations with a heightened risk include knee osteoarthritis patients (RR: 14.6 [95% CI: 13.0-16.5]), chronic venous disease patients (RR: 5.6 [95% CI: 3.7-8.1]), renal transplant patients (RR: 4.7 [95% CI: 3.3-6.5]), geriatric patients (RR: 4.7 [95% CI: 4.4-4.9]), HIV-positive patients (RR: 3.7 [95% CI: 2.9-4.7]), lupus erythematosus patients (RR: 3.1 [95% CI: 1.2-6.3]), diabetic patients (RR: 2.8 [95% CI: 2.4-3.3]) and hemodialysis patients (RR: 2.8 [95% CI: 1.9-4.0]). The prevalence of onychomycosis in clinically suspected patients was significantly higher likely due to sampling bias. A high degree of variability was found in a limited number of population-based studies indicating that certain pockets of the population may be more predisposed to onychomycosis. The diagnosis of non-dermatophyte mould onychomycosis requires repeat sampling to rule out contaminants or commensal organisms; a significant difference was found between studies that performed single sampling versus repeat sampling. The advent of PCR diagnosis results in improved detection rates for dermatophytes compared to culture. CONCLUSION Onychomycosis is an underrecognized healthcare burden. Further population-based studies using standardized PCR methods are warranted.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
- Mediprobe Research Inc., London, Ontario, Canada
| | - Tong Wang
- Mediprobe Research Inc., London, Ontario, Canada
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Colosi IA, Cognet O, Colosi HA, Sabou M, Costache C. Dermatophytes and Dermatophytosis in Cluj-Napoca, Romania-A 4-Year Cross-Sectional Study. J Fungi (Basel) 2020; 6:E154. [PMID: 32872110 PMCID: PMC7558200 DOI: 10.3390/jof6030154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/23/2020] [Accepted: 08/27/2020] [Indexed: 12/28/2022] Open
Abstract
Dermatophytes are filamentous keratinophilic fungi which affect nails, skin, and hair. Their variable distribution in the world justifies local epidemiological studies. During recent decades, few studies have been published regarding the epidemiology and etiology of dermatophytosis in Romania. The aim of this study was to identify the dermatophytes isolated from superficial fungal infections. To the best of our knowledge, this is the first such study conducted in the area of North-Western Romania. Over the past four years, samples collected from outpatients with suggestive lesions for dermatophytoses (nails, skin, hair), who addressed several private practice dermatologists from Cluj-Napoca, Romania, were sent to a specialized laboratory and examined by microscopy and culture. A total of 350 samples from 322 patients were examined. One hundred samples (28.6%) collected from 90 patients (27.9%) were positive by direct microscopy and/or culture. Among the 63 positive cultures (18%), 44 dermatophytes (69.8%), 2 molds (3.2%), and 17 yeasts (27%) were isolated. The main dermatophyte species identified were Trichophyton rubrum (mostly from onychomycosis) and Microsporum canis (from tinea capitis and tinea corporis in children). Yeasts (Candida species) were isolated from nails, especially from women.
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Affiliation(s)
- Ioana Alina Colosi
- Department of Microbiology, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (I.A.C.); (C.C.)
- Department of Laboratory Medicine, Regina Maria Private Health Network, Unirea Medical Center, 400117 Cluj-Napoca, Romania
| | - Odile Cognet
- Parasitology-Mycology Laboratory, Grenoble Alpes University Hospital, 38043 Grenoble CEDEX 9, France;
| | - Horațiu Alexandru Colosi
- Division of Medical Informatics and Biostatistics, Department of Medical Education, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Marcela Sabou
- Dynamique des Interactions Hôte-Pathogène UR 7292, Université de Strasbourg, F-67000 Strasbourg, France;
| | - Carmen Costache
- Department of Microbiology, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (I.A.C.); (C.C.)
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Mendek S, Lugović-Mihić L, Ferček I, Japundžić I, Šitum M, Abram M. THE PREVALENCE OF ONYCHOMYCOSIS IN THE ZAGREB AREA - THE ROLE OF SABOURAUD AGAR WITHOUT CYCLOHEXIMIDE IN DIAGNOSIS AND THERAPY. Acta Clin Croat 2018; 57:726-735. [PMID: 31168210 PMCID: PMC6544114 DOI: 10.20471/acc.2018.57.04.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
SUMMARY – Mycological analysis is considered the gold standard in the diagnosis of very common fungal diseases of nails. The purpose of the article is to present the prevalence of onychomycosis obtained by using direct microscopic examination (DME) and cultivation on Sabouraud media without cycloheximide. The quantitative retrospective research was conducted on 2706 patients of both sexes (mostly middle-aged to elderly) with various toenail lesions, who had undergone mycological analyses in the Mycological Laboratory of our Department of Dermatovenereology in 2013 and 2014. Analysis of the results obtained revealed that there were 35.4% of positive DME results; of these, there were 39.2% of dermatophytes, 59.1% of yeasts and 1.7% of molds. The percentage of dermatophytes (Trichophyton spp.) was twice as high in men as in women. A considerable percentage (12%) of mixed isolates was also observed. Particularly worrisome was the high percentage (one-third) of suppressed and insufficiently developed dermatophytes (a possible indicator of inappropriate preparation of patients for mycological analysis). Cultivation on culture media without cycloheximide requires frequent inspections because of the fast-growing molds while not allowing sporulation for a great number of dermatophytes. However, it has certain advantages, i.e. it offers an insight into the wide range of the present fungi. As part of the biofilm, they can be potentially pathogenic in dystrophic nails under certain circumstances because, according to our results, the percentage of dermatophytes does not change substantially with aging; however, what does change is the percentage of molds, yeasts and mixed isolates.
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Affiliation(s)
| | - Liborija Lugović-Mihić
- 1Department of Dermatovenereology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Microbiology, School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Iva Ferček
- 1Department of Dermatovenereology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Microbiology, School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Iva Japundžić
- 1Department of Dermatovenereology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Microbiology, School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Mirna Šitum
- 1Department of Dermatovenereology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Microbiology, School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Maja Abram
- 1Department of Dermatovenereology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Microbiology, School of Medicine, University of Rijeka, Rijeka, Croatia
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Bouksir K, Kazzaz M, Fassi Fehri H, Bouziane H, Bouksir H, El Haskouri F. Monascus ruber: A new of onychomycosis in the north of Morocco (Tetouan). J Mycol Med 2018; 28:502-509. [PMID: 30098908 DOI: 10.1016/j.mycmed.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 07/05/2018] [Accepted: 07/08/2018] [Indexed: 11/15/2022]
Abstract
We report a case of onychomycosis caused by Monascus ruber from 57-year old women. The diagnosis was based on culture morphological characteristics on Sabouraud's Dextrose agar one with antibacterial (chloramphenicol) and the other with cycloheximide. The identification of specie was confirmed by DNA sequencing.
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Affiliation(s)
- Khadija Bouksir
- Department of biology, Laboratory of Applied Botany, Faculty of Sciences, University Abdelmalek-Essaâdi, Tetouan, Morocco; Department of Microbiology, Laboratory Fassi-Fehri of Medical analysis, Tetouan, Morocco.
| | - Mohamed Kazzaz
- Department of biology, Laboratory of Applied Botany, Faculty of Sciences, University Abdelmalek-Essaâdi, Tetouan, Morocco
| | - Hanie Fassi Fehri
- Department of Microbiology, Laboratory Fassi-Fehri of Medical analysis, Tetouan, Morocco
| | - Hassan Bouziane
- Department of biology, Laboratory of Applied Botany, Faculty of Sciences, University Abdelmalek-Essaâdi, Tetouan, Morocco
| | - Hajar Bouksir
- Department of biology, Laboratory of Applied Botany, Faculty of Sciences, University Abdelmalek-Essaâdi, Tetouan, Morocco
| | - Fatima El Haskouri
- Department of biology, Laboratory of Applied Botany, Faculty of Sciences, University Abdelmalek-Essaâdi, Tetouan, Morocco; Department of Microbiology, Laboratory Fassi-Fehri of Medical analysis, Tetouan, Morocco
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Prevalence, Etiology, and Risk Factors of Tinea Pedis and Tinea Unguium in Tunisia. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2017; 2017:6835725. [PMID: 28852411 PMCID: PMC5567446 DOI: 10.1155/2017/6835725] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/06/2017] [Accepted: 06/22/2017] [Indexed: 11/18/2022]
Abstract
Background Foot mycoses are a frequent disease that represents a public health problem worldwide. Objectives This study aims to evaluate the epidemiology of foot mycoses among Tunisian patients, in order to determine the fungal etiological agents and to identify possible risk factors. Patients and Methods A prospective study of three hundred and ninety-two patients was undertaken during one year (2013-2014). All subjects were asked to collect demographic data related to the risk factors of foot mycoses. A complete mycological diagnosis was carried out on all patients. Results A total of 485 samples were collected; tinea pedis and tinea unguium were confirmed in 88.2% of cases. Dermatophytes were isolated in 70.5% and the most frequent pathogen was Trichophyton rubrum (98.1%), followed by yeasts (17.7%) commonly Candida parapsilosis. Non-dermatophyte molds (NDMs) were observed in 8.02% cases and Fusarium sp. was the frequent genus (29.1%). The main predisposing factors of fungal foot infections were practicing ritual washing (56.6%) and frequentation of communal showers (50.5%). Conclusion This is a recent survey of foot mycoses in Tunisia. Epidemiological studies can be useful to eradicate these infections and to provide further measures of hygiene and education.
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Mahtab A, Anwar M, Mallick N, Naz Z, Jain GK, Ahmad FJ. Transungual Delivery of Ketoconazole Nanoemulgel for the Effective Management of Onychomycosis. AAPS PharmSciTech 2016; 17:1477-1490. [PMID: 26857516 DOI: 10.1208/s12249-016-0488-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/22/2016] [Indexed: 11/30/2022] Open
Abstract
Ketoconazole (KCZ) nanoemulgel containing permeation enhancer was formulated as a vehicle for transungual drug delivery, and its efficacy to inhibit the growth of onychomycotic dermatophytes was investigated in vitro. Different components of oil-in-water nanoemulsions were moderately agitated by classical titration method and passed through a high-pressure homogenizer to formulate various nanoemulsions, which were further identified by constructing pseudo-ternary phase diagrams. Stress-stability testing was carried out for the nanoemulsions, and those that passed these tests were characterized for mean droplet size, zeta potential, morphology, pH, refractive index, viscosity and transmittance. Mean droplet size and zeta potential of the optimized nanoemulsion (NE3) were found to be 77.52 ± 0.92 nm (polydispersity index (PDI) = 0.128 ± 0.035) and -5.44 ± 0.67 mV, respectively. Optimized nanoemulsion was converted into nanoemulgel (NEG1) with 1% (w/w) of gelling agent (Carbopol® Ultrez 21) and 1%-2% (v/v) thioglycolic acid as permeation enhancer, and evaluated for pH, viscosity, spreadability, extrudability, tensile strength and bio-adhesion measurement. In vitro cumulative drug released at the end of 24 h from NE3, NEG1 and drug suspension were found to be 98.87 ± 1.29, 84.42 ± 2.78% and 54.86 ± 2.19%, respectively. Ex vivo transungual permeation values for KCZ through goat hooves from NE3, NEG1 and drug suspension were found to be 62.49 ± 2.98, 77.54 ± 2.88% and 38.54 ± 2.54%, respectively, in 24 h. The antifungal effect of NEG1 on Trichophyton rubrum and Candida albicans showed a significant (p < 0.05) zone of inhibition as compared to drug solution. Skin irritation and histopathology studies on rat skin showed the safe topical use and enhanced permeation of formulated nanoemulgel.
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Tlish MM, Kuznetsova TG, Psavok FA. Etiological features of onychomycosis in the Krasnodar territory. Choice of method systemic therapy. VESTNIK DERMATOLOGII I VENEROLOGII 2016. [DOI: 10.25208/0042-4609-2016-92-5-84-89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Successful treatment of onychomycosis associated with the necessity of microbiological research aimed at the selection of culture with proven etiological significance. Features of morphological and functional characteristics of the nail, poly etiology of onychomycosis, the availability of labor input in the use of topical antifungal drugs and irrational approaches to the treatment of various forms of the disease, as well as the duration and high cost of treatment create difficulties in the treatment of this contingent of patients . Goal. To study the etiology of onychomycosis in the Krasnodar region, and a comparative analysis of the efficacy and tolerability of antifungal drug regimens "Irunine". Materials and methods. A total of 64 patients (39 men and 25 women) with complaints about the change of nail plates in the hands and feet. The diagnosis of onychomycosis was established for 46 (71.88%) patients, of which 2 patients in the study group were not included. The rest were randomly selected and divided into 2 equivalent groups of 22 patients. Patients of the 1st group received "Irunine" by the method of pulse - therapy, and the patients in group 2 on continuous therapy scheme. Results. In the study of the samples from the nail plates, the major causative agent of onychomycosis was T. rubrum - 61,37%. Candida spp. was diagnosed in 11%. Equally often - at 9.09%, were the growth of T. mentagrophytes var. interdigitale and T. tonsurans. Furthermore, associations have been identified T. rubrum and Candida albicans - 6,82%, T. rubrum and Aspergillus versicolor - 2,27%. The result of our study showed a high clinical and mycological efficacy of the drug "Irunine" in the treatment of onychomycosis. Comparative analysis of this drug therapy results showed that the method of pulse therapy, compared with continuous therapy scheme is more efficient and economically advantageous, since it allows to reduce the amount of drugs, and therefore significantly reduce the risk of adverse reactions and improve its tolerability. Conclusion. The findings suggest that the leading position in patients with onychomycosis mycobiota hold dermatomitsetami genus Trichophyton. Pulse therapy with "Irunine" is a priority and can be recommended for use as a systemic drug for the treatment of onychomycosis, as a highly effective and safe drug.
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Bombace F, Iovene MR, Galdiero M, Martora F, Nicoletti GF, D'Andrea M, Della Pepa ME, Vitiello M. Non-dermatophytic onychomycosis diagnostic criteria: an unresolved question. Mycoses 2016; 59:558-65. [DOI: 10.1111/myc.12504] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Francesca Bombace
- Department of Experimental Medicine; Division of Microbiology; Second University of Naples; Naples Italy
| | - Maria Rosaria Iovene
- Department of Experimental Medicine; Division of Microbiology; Second University of Naples; Naples Italy
| | - Marilena Galdiero
- Department of Experimental Medicine; Division of Microbiology; Second University of Naples; Naples Italy
| | - Francesca Martora
- Department of Experimental Medicine; Division of Microbiology; Second University of Naples; Naples Italy
| | - Giovanni Francesco Nicoletti
- Multidisciplinary Department of Medical-Surgical and Dental Specialties; Second University of Naples; Naples Italy
| | - Mirella D'Andrea
- Multidisciplinary Department of Medical-Surgical and Dental Specialties; Second University of Naples; Naples Italy
| | - Maria Elena Della Pepa
- Department of Experimental Medicine; Division of Microbiology; Second University of Naples; Naples Italy
| | - Mariateresa Vitiello
- Department of Clinical Pathology; Virology Unit; “San Giovanni di Dio e Ruggi d'Aragona Hospital”; Salerno Italy
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Yadav P, Singal A, Pandhi D, Das S. Clinico-mycological study of dermatophyte toenail onychomycosis in new delhi, India. Indian J Dermatol 2015; 60:153-8. [PMID: 25814703 PMCID: PMC4372907 DOI: 10.4103/0019-5154.152511] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Introduction: There is a constant need to define the epidemiological and mycological characteristics of onychomycosis (OM) for optimal management strategies. Objectives: To define the epidemiological and mycological characteristics of patients with dermatophyte toenail OM in a tertiary care hospital. Materials and Methods: Hundred consecutive patients of KOH and culture-positive dermatophyte toenail OM were subjected to detailed history, clinical examination and investigations. Results: Maximum number of patients (40%) belonged to 31-45 years age group and there was a male preponderance (M:F = 6.7:1). The mean duration of disease was 54 months. Thirty-three patients had fingernail involvement in addition to the toenail OM and 37% had co-existent cutaneous dermatophyte infection. Discoloration was the most common symptom (98%). Ninety-four (94%) patients had distal lateral subungual onychomycosis (DSLO) while two had superficial onychomycosis (SO) and only one had proximal superficial onychomycosis (PSO). Trichophyton interdigitale was the most common etiological agent (61%) followed by Trichophyton rubrum and Trichophyton verrucosum. Conclusions: Toenail OM is more common in males. DSLO was the most common clinical variant and T. interdigitale the most common etiological fungus responsible for toenail OM in our region. The importance of early diagnosis and treatment is highlighted as long-standing toenail OM predisposes to fingernail onychomycosis and recurrent tinea pedis.
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Affiliation(s)
- Pravesh Yadav
- Department of Dermatology and STD, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Deepika Pandhi
- Department of Dermatology and STD, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Shukla Das
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
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Zaikovska O, Pilmane M, Kisis J. Morphopathological aspects of healthy nails and nails affected by onychomycosis. Mycoses 2014; 57:531-6. [PMID: 24661598 DOI: 10.1111/myc.12191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 02/08/2014] [Accepted: 02/23/2014] [Indexed: 01/17/2023]
Abstract
Patients of onychomycosis are common in the dermatology practice. Contemporary morphology creates opportunities to study the functional units of the nail when such infections occur from morphopathological point of view. There were 22 nails biopsies from onychomycosis patients taken for the research of morphopathological changes in the thickened nail plate affected by onychomycosis. Samples of cadaverous' nails were used as a control material. The material was stained with haematoxylin and eosin and immunohistochemical methods. Terminal deoxynucleotidyl transferase dUTP nick end labelling reaction and periodic acid-Schiff reaction were also performed. We found patchy hypertrophy in the granulose layer of the epidermis, with focal acanthosis. In the horn layer, we identified nests of parakeratosis of various sizes, with incorporations of homogenous and eosinophil masses. We found high levels of interleukin 6 and interleukin 10 positive cells in the nail bed and in the bloodstream. Interleukin 1, however, was not a part of any of the functional units of any of the nails. Significant amount of fibres containing human beta defensin-2 were found in the bed and plate of the nail. Therefore one can conclude that as regards the nails affected by onychomycosis, the most effective morphopathogenical processes include cytokine and defensin excretion occurrence in the nail bed.
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Affiliation(s)
- Olga Zaikovska
- RSU Doctoral Department, Riga Stradins University, Riga, Latvia
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Kozhichkina NV. Etiology of foot mycosis and onychomycosis. VESTNIK DERMATOLOGII I VENEROLOGII 2013. [DOI: 10.25208/vdv573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article presents data from Russian and foreign sources related to the etiology of foot mycosis and onychomycosis. In spite of the substantial spread of data by countries and regions of the world, dermatophytes play a leading part in the etiology of foot mycosis and onychomycosis, and Trichophyton rubrum is found in most studies in more than one half of all cases. Yeast-like fungi of the Candida genus as well as mold fungi belong to less frequent pathogens of foot mycosis. However, they play a greater role in countries with hot and humid climate such as Brazil, Indonesia, Columbia and India. These data are important for the determination of organizational measures aimed at the early diagnostics of patients, timely treatment and implementation of anti-epidemic and disinfectant measures.
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El Fekih N, Belghith I, Trabelsi S, Skhiri-Aounallah H, Khaled S, Fazaa B. Epidemiological and Etiological Study of Foot Mycosis in Tunisia. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:520-4. [DOI: 10.1016/j.ad.2011.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 12/23/2011] [Accepted: 12/23/2011] [Indexed: 11/16/2022] Open
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Identification of infectious agents in onychomycoses by PCR-terminal restriction fragment length polymorphism. J Clin Microbiol 2011; 50:553-61. [PMID: 22170903 DOI: 10.1128/jcm.05164-11] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A fast and reliable assay for the identification of dermatophyte fungi and nondermatophyte fungi (NDF) in onychomycosis is essential, since NDF are especially difficult to cure using standard treatment. Diagnosis is usually based on both direct microscopic examination of nail scrapings and macroscopic and microscopic identification of the infectious fungus in culture assays. In the last decade, PCR assays have been developed for the direct detection of fungi in nail samples. In this study, we describe a PCR-terminal restriction fragment length polymorphism (TRFLP) assay to directly and routinely identify the infecting fungi in nails. Fungal DNA was easily extracted using a commercial kit after dissolving nail fragments in an Na(2)S solution. Trichophyton spp., as well as 12 NDF, could be unambiguously identified by the specific restriction fragment size of 5'-end-labeled amplified 28S DNA. This assay enables the distinction of different fungal infectious agents and their identification in mixed infections. Infectious agents could be identified in 74% (162/219) of cases in which the culture results were negative. The PCR-TRFLP assay described here is simple and reliable. Furthermore, it has the possibility to be automated and thus routinely applied to the rapid diagnosis of a large number of clinical specimens in dermatology laboratories.
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Calado NB, de Sousa Júnior FC, Diniz MG, Fernandes ACS, Cardoso FJR, Zaror LC, Ferreira MÂF, Milan EP. A 7-year survey of superficial and cutaneous mycoses in a public hospital in Natal, Northeast Brazil. Braz J Microbiol 2011; 42:1296-9. [PMID: 24031755 PMCID: PMC3768716 DOI: 10.1590/s1517-83822011000400008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 01/10/2011] [Accepted: 05/30/2011] [Indexed: 11/24/2022] Open
Abstract
In the present study, we determined the frequency of superficial and cutaneous mycoses and their etiologic agents during a 7-year period (2002–2008) in Natal, Brazil. A total of 1,717 specimens of skin, nail, and hair were collected from 1,382 patients with suspected mycoses lesions and were then subjected to direct microscopy and culture.
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Affiliation(s)
- Nicácia Barbosa Calado
- Departamento de Infectologia, Universidade Federal do Rio Grande do Norte , Natal, RN , Brasil
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Bassiri-Jahromi S, Khaksar AA. Nondermatophytic moulds as a causative agent of onychomycosis in tehran. Indian J Dermatol 2011; 55:140-3. [PMID: 20606881 PMCID: PMC2887516 DOI: 10.4103/0019-5154.62743] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: In the last few years the number of cases of nondermatophytic onychomycosis has greatly increased. Aim: To evaluate the incidence, the clinic characteristics, and predisposing factors of nondermatophytic onychomycosis. Materials and Methods: All collected specimens were analyzed by direct microscopy and culture. Microscopic examination of these specimens was carried out in potassium hydroxide solution (20%) with dimethyl sulfoxide (4%). These specimens were cultured on sabouraud's glucose agar with chloramphenicol and sabouraud's glucose agar with chloramphenicol and cycloheximide. Cultures were incubated at 25°C for up to 28 days and checked twice weekly for growth. Results: Nondermatophytic onychomycosis were 11.5% of all onychomycosis. We found that Aspergillus spp. were the more responsible etiologic agents of nondermatophytic onychomycosis, resulting in a total of 28 patients (59.6%). In our study other causative agents were Acremonium spp. (17%), Fusarium spp. (12.7%), Geotrichum spp. (4.2%), Trichosporun spp., (4.2%) and Scopulariopsis spp (2.1%). In our patients moulds onychomycosis developed mainly in toenails (74.5%). Conclusion: Knowing the exact pathogen is important and has implications in therapy and prognosis.
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Akcaglar S, Ener B, Toker SC, Ediz B, Tunali S, Tore O. A comparative study of dermatophyte infections in Bursa, Turkey. Med Mycol 2011; 49:602-7. [PMID: 21198349 DOI: 10.3109/13693786.2010.547879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A total of 555 specimens from 372 patients with symptoms compatible with superficial mycosis were included in this study. Those from patients clinically diagnosed as having dermatomycosis were thoroughly investigated by mycological examinations in the laboratory, including microscopic studies of KOH mounts and cultivation of the samples in culture. The results of this study and a previous study in our hospital conducted in 1980 were compared with respect to clinical presentation and etiological agents. Onychomycosis was the most common clinical form of dermatomycoses, and Trichophyton rubrum was the most common pathogen in this study.
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Affiliation(s)
- Sevim Akcaglar
- Department of Microbiology and Infectious Diseases, Uludag University School of Medicine, Bursa, Turkey
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Yenişehirli G, Bulut Y, Sezer E, Günday E. Onychomycosis infections in the Middle Black Sea Region, Turkey. Int J Dermatol 2009; 48:956-9. [DOI: 10.1111/j.1365-4632.2009.04126.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sigurgeirsson B, Elewski BE, Rich PA, Opper C, Cai B, Nyirady J, Bakshi R. Intermittent versus continuous terbinafine in the treatment of toenail onychomycosis: A randomized, double‐blind comparison. J DERMATOL TREAT 2009; 17:38-44. [PMID: 16467022 DOI: 10.1080/09546630500504713] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Terbinafine is an established drug for the treatment of toenail onychomycosis. Minimizing the total dose of terbinafine and giving it intermittently could improve tolerability as well as compliance, provided efficacy is not compromised. OBJECTIVE Two identical trials were conducted to compare the efficacy, safety and tolerability of the current standard regimen of terbinafine 250 mg daily with a new formulation of terbinafine given intermittently for three cycles of 2 weeks of treatment (350 mg daily) followed by 2 weeks off treatment. METHODS A total of 2005 patients with a clinical diagnosis of subungual onychomycosis of the large toenail confirmed by microscopy and culture for a dermatophyte were recruited into the two trials and treated for 12 weeks. RESULTS Patients with onychomycosis of prolonged duration (mean 9 years) and a median nail involvement of 63% with or without spikes, lateral involvement and white superficial onychomycosis (WSO) were included in the trial. The studies found a significant difference (p<0.05) in favour of standard daily dosing with terbinafine. Response rates for the primary variable complete cure (mycological and clinical cure) were lower with the new formulation in both Trial I (-5.8%; 95% CI -11.8, 0.07) and Trial II (difference -5.9%; 95% CI -12, 0.1). Both treatments were equally well tolerated, with approximately 11% of patients in both groups reporting at least one treatment-related adverse event. CONCLUSIONS Pulsed dosing with terbinafine did not provide any clear safety advantages and was significantly less effective. Consequently, continuous treatment with terbinafine tablets remains the optimal therapy for onychomycosis.
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Mousavi S, Esfandiarpour I, Salari S, Shokri H. Onychomycosis due to Fusarium spp. in patient with squamous cell carcinoma: A case report from Kerman, Iran. J Mycol Med 2009. [DOI: 10.1016/j.mycmed.2009.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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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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Hilmioğlu-Polat S, Metin DY, Inci R, Dereli T, Kilinç I, Tümbay E. Non-dermatophytic molds as agents of onychomycosis in Izmir, Turkey - a prospective study. Mycopathologia 2006; 160:125-8. [PMID: 16170607 DOI: 10.1007/s11046-005-6872-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Accepted: 05/03/2005] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to determine the prevalence of causative non-dermatophytic filamentous fungi in onychomycosis. Totally 1,222 (1,222 x 3 = 3,666) samples of nail scrapings from 1,146 patients (from 76 patients two specimens: both from finger- and toe-nails) with prediagnosis of onychomycosis sent to the Mycology Laboratory from the Clinic of Dermatology, Ege University Hospital, Izmir, Turkey, July 2001-December 2003, were prospectively studied with conventional mycological procedures. The set criteria for the diagnosis of onychomycosis due to non-dermatophytic molds were: (1) Observation of fungal elements in 15% KOH-preparations made from nail scrapings, (2) growth of the same mold in all three consecutive cultures of the specimens taken three times from the same patient with one-week intervals, (3) no growth of a dermatophyte or yeast in three consecutive cultures. As agents of onychomycosis molds were detected in 33 (9%), dermatophytes in 175 (48%), yeasts in 150 (41%), and mixed (two different fungi) in 8 (2%) patients. In cases of mold onychomycosis, 11 (33%) had finger-nail and 22 (67%) toe-nail infection; 25 (76%) were female and 8 (24%) male; and 27 (82%) were above 40 years of age. The agents of mold onychomycosis, in order of frequency, were Aspergillus niger (7), Acremonium spp. (6), Fusarium spp. (6), Ulocladium spp. (4), sterile mycelia (2), Alternaria sp. (1), Aspergillus flavus (1), Aspergillus fumigatus (1), Aspergillus terreus (1), Cladosporium sp. (1), Paecilomyces spp. (1), Scopulariopsis sp. (1) and Trichoderma sp. (1). In conclusion, this study showed that non-dermatophytic molds were responsible for nearly 10% of onychomycoses cases attending the dermatology outpatient clinic of a university hospital in Izmir, Turkey. Since molds are common contaminants in the laboratory, cultures from consecutively taken nail scrapings should be made and carefully evaluated in order to diagnose a "mold onychomycosis".
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Affiliation(s)
- S Hilmioğlu-Polat
- Department of Microbiology & Clinical Microbiology, Mycology Laboratory, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey.
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