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Mehlhorn C, Uhrlaß S, Klonowski E, Krüger C, Paasch U, Simon JC, Nenoff P. [Conventional and molecular diagnostics in onychomycosis-part 1 : Conventional differentiation of dermatophytes-Trichophyton rubrum, Trichophyton interdigitale]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:134-146. [PMID: 38066287 DOI: 10.1007/s00105-023-05260-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 01/23/2024]
Abstract
Onychomycosis is a common infectious nail disease occurring worldwide. The mycological diagnosis of onychomycosis is primarily used for differential diagnostic differentiation from other, mostly inflammatory nail diseases, such as nail psoriasis or onychodystrophies of other causes. Conventional laboratory diagnostics when onychomycosis is suspected is based on microscopic detection of fungi in the nail material using fluorescence-optical potassium hydroxide preparations and culture of the pathogen. Molecular amplification methods allow a more sensitive and specific identification of the causative dermatophyte. Here, in 108 patients with onychomycosis, the dermatophytes were identified by culture and/or molecular biology using polymerase chain reaction (PCR) and the species identification was confirmed with subsequent sequencing. The dermatophytes were analyzed based on macromorphological and microscopic features. A dermatophyte was cultured in 56 of the 108 patients. Among them were 31 isolates of Trichophyton (T.) rubrum and 25 of T. interdigitale. All species identifications were subsequently confirmed by rDNA sequencing with concordant results in 54 of 56 patients. Two primarily as T. interdigitale identified specimens were revealed to be T. quinckeanum and T. tonsurans by molecular methods. T. quinckeanum, which is a zoophilic dermatophyte and a so-called emerging pathogen in dermatomycology, was isolated here for the first time as the causative agent of onychomycosis. The other dermatophyte, initially thought to be T. interdigitale, turned out to be T. tonsurans on molecular biology. This anthropophilic dermatophyte is also a rarity in onychomycosis. In addition, T. rubrum was identified by PCR in 34 of the 52 nail specimens that did not grow culture, and T. interdigitale in 18 nail specimens. However, the morphological identification of the four different dermatophytes species proved problematic. Neither the colony morphology nor the microscopic features of the dermatophytes allow clear differentiation of the pathogens. Microconidia, macroconidia, chlamydospores, and arthrospores are inconsistent in occurrence, number, microscopic distribution, and shape. The urease activity also did not allow an assignment of the dermatophyte species. These results indicate that the most sensitive detection and reliable identification of causative dermatophytes in onychomycosis is only possible by molecular methods.
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Affiliation(s)
- Carolin Mehlhorn
- labopart - Medizinische Laboratorien, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland
| | - Silke Uhrlaß
- labopart - Medizinische Laboratorien, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland
| | - Esther Klonowski
- labopart - Medizinische Laboratorien, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland
| | - Constanze Krüger
- labopart - Medizinische Laboratorien, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland
| | - Uwe Paasch
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR und Medizinische Fakultät der Universität Leipzig, Leipzig, Deutschland
| | - Jan C Simon
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR und Medizinische Fakultät der Universität Leipzig, Leipzig, Deutschland
| | - Pietro Nenoff
- labopart - Medizinische Laboratorien, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland.
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Ribeiro CSDC, Zaitz C, Framil VMDS, Ottoboni TSDC, Tonoli MSDC, Ribeiro RP. Descriptive study of onychomycosis in a hospital in São Paulo. Braz J Microbiol 2015; 46:485-92. [PMID: 26273263 PMCID: PMC4507540 DOI: 10.1590/s1517-838246220130541] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 08/19/2014] [Indexed: 12/02/2022] Open
Abstract
Onychomychosis, a nail fungus infection is the most frequent nail ailment, constituting about half of all nail disorders. It can be caused by dermatophytes, non-dermatophytes, yeasts and Prothoteca spp. Methods include 5407 samples of patients with suspected onychomycosis, studied from January 2002 to December 2006, by direct mycological examination and fungi culture. The diagnosis of onychomycosis was confirmed in samples from 3822 direct mycological and/or culture positive. The diagnosis was established by culture for fungi. Among the 1.428 identified agents, the dermatophytes were responsible for 68.6% (N = 980) of cases, followed by yeasts with 27.6% (N = 394), non-dermatophytes fungi with 2.2% (N = 31), Prothoteca spp with 0.1% (N = 2), and associations with 1.5% (N = 22). Females were more affected, with 66% (N = 2527) of cases, and the most affected age group ranged from 31 to 60 years of age (median 47 years). Fungal microbiota is often changed in the world, both quantitatively and qualitatively, and is affected by several environmental factors. Thus, the periodic review of the composition of this microbiota is important to evaluate the epidemiology and thus proportion a better therapeutic response.
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Affiliation(s)
- Clarissa Santos de Carvalho Ribeiro
- Faculdade de Ciências Médicas da Santa Casa
São Paulo, Departamento de Dermatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil, Departamento de Dermatologia, Faculdade de
Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Clarisse Zaitz
- Faculdade de Ciências Médicas da Santa Casa
São Paulo, Departamento de Dermatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil, Departamento de Dermatologia, Faculdade de
Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Valéria Maria de Souza Framil
- Faculdade de Ciências Médicas da Santa Casa
São Paulo, Departamento de Dermatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil, Departamento de Dermatologia, Faculdade de
Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Thaíssa Santos de Carvalho Ottoboni
- Faculdade de Medicina de
Itajubá, Faculdade de Medicina de Itajubá, Itajubá, MG, Brasil, Faculdade de Medicina de Itajubá, Itajubá, MG,
Brazil
| | - Melissa Santos de Carvalho Tonoli
- Universidade Estadual Paulista, Universidade Estadual Paulista, São José dos Campos, SP, Brasil, Universidade Estadual Paulista, São José dos
Campos, SP, Brazil
| | - Renata Pinheiro Ribeiro
- Universidade Federal de Alfenas, Universidade Federal de Alfenas, Alfenas, MG, Brasil, Universidade Federal de Alfenas, Alfenas, MG,
Brazil
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Zhang H, Xiong X, Liu T, Ran Y. Generalized superficial mycosis caused by Trichophyton raubitschekii in China: case report and review of the literature. Mycopathologia 2014; 179:279-84. [PMID: 25502847 DOI: 10.1007/s11046-014-9835-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 11/13/2014] [Indexed: 11/26/2022]
Abstract
This is a generalized superficial mycosis case from which Trichophyton raubitschekii was isolated. A male adult was presented with a 3-year history of fingernail and toenail changes, and a 50-day history of severe and multiple skin lesions. He also complained of intense itching. T. raubitschekii was identified from every skin lesion (trunk, extremities and nail) through microscopic examination, physiological experiment and DNA sequencing. Generalized superficial mycosis was diagnosed and treated by administering a combination of oral (terbinafine tablets) and topical (naftifine hydrochloride and ketoconazole cream) antimycotic drugs. After treatment, the patient was cured and no recurrence has been observed.
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Affiliation(s)
- Hao Zhang
- Department of Dermatovenerology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China,
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Adamski Z, Kowalczyk MJ, Adamska K, Kubisiak-Rzepczyk H, Bowszyc-Dmochowska M, Banaszak A, Bartkiewicz P, Zaba R. The first non-African case of Trichophyton rubrum var. raubitschekii or a urease-positive Trichophyton rubrum in Central Europe? Mycopathologia 2014; 178:91-6. [PMID: 24792359 PMCID: PMC4097339 DOI: 10.1007/s11046-014-9751-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 04/18/2014] [Indexed: 12/05/2022]
Abstract
We report a case of a 34-year-old Polish Caucasian male who was diagnosed with tinea manuum caused by Trichophyton rubrum var. raubitschekii. It would be the first described case of a dermatophytosis caused by this fungus in Poland and one of a few cases in Central Europe described so far. Admittedly, it would be the first case in Central Europe with no evidence pointing to African origin. The clinical condition improved after administering itraconazole (daily dose 100 mg orally) supplemented with a topical treatment, while the patient was totally cured after 2 months. The histopathological examination turned out to be highly useful in the diagnostic process. The genetic analysis of the urease gene pointed to a urease-positive T. rubrum rather than T. rubrum var. raubitschekii.
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Affiliation(s)
- Zygmunt Adamski
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
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The Use of Albino Adult Hair and Blond Prepubertal Hair Yields Equivalent Results in an In Vitro Hair Perforation Test to Differentiate Between Different Dermatophytic Fungi. Mycopathologia 2013; 176:23-31. [DOI: 10.1007/s11046-013-9647-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/06/2013] [Indexed: 02/01/2023]
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Hiruma M, Kano R, Sugita T, Mochizuki T, Hasegawa A, Hiruma M. Epidemiological aspects of Trichophyton rubrum var. raubitschekii in Japan. J Dermatol 2012; 39:1000-1. [PMID: 22900925 DOI: 10.1111/j.1346-8138.2012.01635.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 06/13/2012] [Indexed: 11/29/2022]
Abstract
Trichophyton rubrum var. raubitschekii is a rare anthropophilic dermatophyte isolated around the world from tinea corporis, tinea cruris, tinea pedis and tinea unguium. In this study, the isolation rate of T. rubrum var. raubitschekii was studied in 200 cases of tinea pedis and tinea unguium in Japan. The 200 clinical isolates were shown to be of downy type as their colonies on Sabouraud's dextrose agar were white to cream, suede-like to downy, with a yellow-brown to wine-red reverse, and they produced few macroconidia. The type strain of T. rubrum var. raubitschekii (CBS 100084) and one clinical isolate (KMU 8337; isolated at Kanazawa) of downy type tested positive for urease, but the reference strain of T. rubrum (CBS 392.58) and the remaining 199 clinical isolates tested negative. Further epidemiological investigations are required to study human cases of infection with the granular type of T. rubrum and T. rubrum var. raubitschekii in Japan.
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Affiliation(s)
- Midori Hiruma
- Department of Dermatology and Allergology, Juntendo University Nerima Hospital, Tokyo, Japan
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Ilkit M, Saraclı MA, Yuksel T. Trichophyton Rubrum with the ‘raubitschekii’ Morphotype: The First Report from Turkey. Mycopathologia 2010; 171:119-22. [DOI: 10.1007/s11046-010-9355-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 08/05/2010] [Indexed: 11/29/2022]
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Kano R, Nagata M, Suzuki T, Watanabe S, Kamata H, Hasegawa A. Isolation ofTrichophyton rubrumvar. raubitschekii from a dog. Med Mycol 2010; 48:653-5. [DOI: 10.3109/13693780903403043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gómez Moyano E, Crespo-Erchiga V, Samaniego González E, del Boz González J, Martínez García S. Tinea cruris (glutealis) de importación por Trichophyton rubrum var. raubitschekii en España. Rev Iberoam Micol 2008; 25:250-3. [DOI: 10.1016/s1130-1406(08)70059-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ma L, Li R, Yu J, Wang C, Wan Z, Wang X. Majocchi's granuloma in a liver transplant recipient caused by a Trichophyton spp., phenotypically consistent with Trichophyton rubrum var. raubitschekii. Med Mycol 2008; 47:312-6. [PMID: 19212894 DOI: 10.1080/13693780802562951] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The authors report a case of Majocchi's granuloma and onychomycosis in a liver transplant recipient caused by a Trichophyton spp., phenotypically consistent with Trichophyton rubrum var. raubitschekii. A 48-year-old female patient who had undergone liver transplantation nine months earlier, presented with red papules and nodular lesions on her back, buttock and thigh of two months duration. She also had onychomycosis of toe nails for a few years, which worsened post transplant. Two fungal isolates were derived from her infected toe nails and nodular tissue. Physical, pathological and mycological examination, including KOH preparation, fungal culture and DNA sequencing of the internal transcribed spacer(ITS) of rRNA were performed. The clinical diagnosis was Majocchi's granuloma and onychomycosis caused by the Trichophyton rubrum var. raubitschekii. This is the first case report of this organism from China.
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Affiliation(s)
- Lei Ma
- Department of Dermatology/Research Center for Medical Mycology, Peking University First Hospital, Beijing, PR China
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