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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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Gupta AK, Wang T, Cooper EA, Lincoln SA, Foreman HC, Scherer WP, Bakotic WL. Clinical Diagnosis and Laboratory Testing of Abnormal Appearing Toenails: A Retrospective Assessment of Confirmatory Testing for Onychomycosis in the United States, 2022-2023. J Fungi (Basel) 2024; 10:149. [PMID: 38392821 PMCID: PMC10890116 DOI: 10.3390/jof10020149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/15/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Onychomycosis is an under-recognized healthcare burden. Despite the risk of misdiagnosis, confirmatory laboratory testing is under-utilized. Histopathologic examination with polymerase chain reaction (PCR) is currently the most effective diagnostic method; it offers direct detection and identification of a fungal invasion. In this retrospective cohort study, we assessed confirmatory testing results, with matching clinical diagnoses, in 96,293 nail specimens submitted during a 9-month period from 2022 to 2023. Toenail specimens were examined using fungal culture, histopathology and/or PCR. Clinical diagnoses were identified using the International Classification of Diseases 10th Revision codes. For clinically diagnosed onychomycosis patients, the overall positivity rate was 59.4%; a similar positivity rate (59.5%) was found in patients with clinically diagnosed non-fungal nail dystrophy. Performing a histopathologic examination with PCR was more likely to provide pathogen identification results than using fungal culture. Male patients had a higher rate of onychomycosis overall; however, female patients had more non-dermatophyte mold onychomycosis caused by Aspergillus. Clinically diagnosed onychomycosis patients with a co-diagnosis of tinea pedis were more likely to test positive for onychomycosis by PCR (odds ratio [OR]: 4.2; 95% confidence interval [CI]: 2.7-6.4), histopathology (OR: 2.5; 95% CI: 2.0-3.1) and fungal culture (OR: 3.2; 95% CI: 1.5-6.6). Our results support the use of confirmatory laboratory testing when there is a clinical diagnosis of onychomycosis.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada
- Mediprobe Research Inc., London, ON N5X 2P1, Canada
| | - Tong Wang
- Mediprobe Research Inc., London, ON N5X 2P1, Canada
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3
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Falotico JM, Lipner SR. Updated Perspectives on the Diagnosis and Management of Onychomycosis. Clin Cosmet Investig Dermatol 2022; 15:1933-1957. [PMID: 36133401 PMCID: PMC9484770 DOI: 10.2147/ccid.s362635] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/08/2022] [Indexed: 12/02/2022]
Abstract
Onychomycosis is the most common nail disease encountered in clinical practice and can cause pain, difficulty with ambulation, and psycho-social problems. A thorough history and physical examination, including dermoscopy, should be performed for each patient presenting with nail findings suggestive of onychomycosis. Several approaches are available for definitive diagnostic testing, including potassium hydroxide and microscopy, fungal culture, histopathology, polymerase chain reaction, or a combination of techniques. Confirmatory testing should be performed for each patient prior to initiating any antifungal therapies. There are several different therapeutic options available, including oral and topical medications as well as device-based treatments. Oral antifungals are generally recommended for moderate to severe onychomycosis and have higher cure rates, while topical antifungals are recommended for mild to moderate disease and have more favorable safety profiles. Oral terbinafine, itraconazole, and griseofulvin and topical ciclopirox 8% nail lacquer, efinaconazole 10% solution, and tavaborole 5% solution are approved by the Food and Drug Administration for treatment of onychomycosis in the United States and amorolfine 5% nail lacquer is approved in Europe. Laser treatment is approved in the United States for temporary increases in clear nail, but clinical results are suboptimal. Oral fluconazole is not approved in the United States for onychomycosis treatment, but is frequently used off-label with good efficacy. Several novel oral, topical, and over-the-counter therapies are currently under investigation. Physicians should consider the disease severity, infecting pathogen, medication safety, efficacy and cost, and patient age, comorbidities, medication history, and likelihood of compliance when determining management plans. Onychomycosis is a chronic disease with high recurrence rates and patients should be counseled on an appropriate plan to minimize recurrence risk following effective antifungal therapy.
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Affiliation(s)
- Julianne M Falotico
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Shari R Lipner
- Weill Cornell Medicine, Department of Dermatology, New York, NY, USA
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4
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Assessment of the properties of terbinafine hydrochloride and the search route for antifungal agents. J Mol Struct 2022. [DOI: 10.1016/j.molstruc.2021.132225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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5
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Trave I, Cozzani E, Canepa P, Verdiani S, Parodi A. Real-life applicability of the Euroarray Dermatomycosis Kit in the diagnosis of onychomycosis. Mycoses 2021; 65:317-322. [PMID: 34843133 DOI: 10.1111/myc.13405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Traditionally, KOH microscopy and fungal culture are the two preferred tests as gold standard for diagnosis of onychomycosis. Recently, other diagnostic methods have been developed to improve the microbiological diagnosis. The EUROArray dermatomycosis kit is a PCR-based microarray test system for the detection and direct identification of species that are most frequently involved in skin and nail infections. OBJECTIVES Our primary aim was to evaluate the real-life applicability of the EUROArray dermatomycosis kit in the diagnosis of onychomycoses. In addition, we compared the etiology of onychomycoses found in our patients with those described in the literature. PATIENTS/METHODS We prospectively studied consecutive 100 patients with suspected onychomycoses. Samples of suspect toenails were taken as part of routine medical management. Nail specimens were evaluated by means of 3 diagnostic methods: KOH preparation, culture and EUROArray dermatomycosis kit. RESULTS Onychomycosis was diagnosed in 47/100 patients who proved positive on at least one reference diagnostic test and in 49/100 patients who proved positive on PCR. The combination of microscopy and PCR had better sensitivity than microscopy (p=0.0397), fungal culture (p=0.0061) and PCR alone (p=0 .0117). Molds were more frequently positive in culture than in PCR (p=0.033). Dermatophytes proved positive more frequent than molds and yeasts in both culture and PCR; in particular, Trichophyton interdigitale was the most frequent pathogen. CONCLUSIONS In conclusion, introducing EUROArray dermatomycosis kit into the diagnostic algorithm of onychomycosis increases the sensitivity of direct microscopy and yields more rapid results than culture.
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Affiliation(s)
- I Trave
- Section of Dermatology - Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
| | - E Cozzani
- Section of Dermatology - Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
| | - P Canepa
- Section of Dermatology - Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
| | - S Verdiani
- Section of Dermatology - Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
| | - A Parodi
- Section of Dermatology - Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
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6
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Gupta AK, Summerbell RC, Venkataraman M, Quinlan EM. Nondermatophyte mould onychomycosis. J Eur Acad Dermatol Venereol 2021; 35:1628-1641. [PMID: 33763903 DOI: 10.1111/jdv.17240] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/09/2021] [Indexed: 01/21/2023]
Abstract
Nondermatophyte moulds (NDMs) onychomycosis is often difficult to diagnose as NDMs have been considered contaminants of nails. There are several diagnostic methods used to identify NDMs, however, repeated laboratory isolation is recommended to validate pathogenicity. With NDM and mixed infection (dermatophytes plus NDM) onychomycosis on the rise, accurate clinical diagnosis along with mycological tests is recommended. Systemic antifungal agents such as itraconazole and terbinafine (e.g. pulse regimen: 1 pulse = every day for one week, followed by no treatment for three weeks) have shown efficacy in treating onychomycosis caused by various NDMs such as Aspergillus spp., Fusarium spp., Scopulariopsis brevicaulis, and Onychocola canadensis. Studies investigating topical therapy and devices for NDM onychomycosis are limited. The emergence of antifungal resistance necessitates the incorporation of antifungal susceptibility testing into diagnosis when possible, for the management of recalcitrant infections. Case studies documented in the literature show newer azoles such as posaconazole and voriconazole as sometimes effective in treating resistant NDM onychomycosis. Treatment with broad-spectrum antifungal agents (e.g. itraconazole and efinaconazole) and other combination therapy (oral + oral and/or oral + topical) may be considerations in the management of NDM onychomycosis.
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Affiliation(s)
- A K Gupta
- Mediprobe Research Inc., London, ON, Canada.,Department of Dermatology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - R C Summerbell
- Sporometrics, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Sakkas H, Kittas C, Kapnisi G, Priavali E, Kallinteri A, Bassukas ID, Gartzonika K. Onychomycosis in Northwestern Greece Over a 7-Year Period. Pathogens 2020; 9:pathogens9100851. [PMID: 33080905 PMCID: PMC7603248 DOI: 10.3390/pathogens9100851] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
Onychomycosis is considered as one of the major public health problems with a global distribution associated with geographic, demographic and environmental factors, underlying comorbidities and immunodeficiency disorders. This study was conducted to investigate the etiological agents of onychomycosis, in Northwestern Greece during a 7-year period. The study population included 1095 outpatients with clinically suspected onychomycosis that presented to the University Hospital of Ioannina, NW Greece (2011–2017). Samples were examined for causative fungi, and mycological identification was established using standard mycological methods. Demographic data of each patient, comorbidities, localization of infection and history of previous fungal infection were collected. Onychomycosis was diagnosed in 317 of the 1095 suspected cases (28.9%) and the most frequently isolated pathogens were yeasts (50.8%) followed by dermatophytes (36.9%) and non-dermatophyte molds (NDMs) (12.3%). Dermatophytes were mostly involved in toenail onychomycosis (90.6%) and more commonly affected males than females (57.3% vs. 42.7%), while the predominantly isolated pathogen was Τrichophyton rubrum (74.4%) followed by Τrichophyton interdigitale (21.4%). Candida albicans was the most prevalent isolated yeast (82%), whereas among the cases with onychomycosis due to NDMs, Aspergillus spp. were isolated as the principal species (59%). Continuous monitoring should be performed in order to identify possible trends and shifts in species isolation rates and to evaluate the impact of onychomycosis among the general population and high-risk groups.
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Affiliation(s)
- Hercules Sakkas
- Microbiology Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
- Department of Microbiology, University Hospital of Ioannina, 45110 Ioannina, Greece; (C.K.); (G.K.); (E.P.); (A.K.)
- Correspondence: (H.S.); (K.G.); Tel.: +30-265-100-7769 (H.S.); +30-265-100-7716 (K.G.)
| | - Christos Kittas
- Department of Microbiology, University Hospital of Ioannina, 45110 Ioannina, Greece; (C.K.); (G.K.); (E.P.); (A.K.)
| | - Georgia Kapnisi
- Department of Microbiology, University Hospital of Ioannina, 45110 Ioannina, Greece; (C.K.); (G.K.); (E.P.); (A.K.)
| | - Efthalia Priavali
- Department of Microbiology, University Hospital of Ioannina, 45110 Ioannina, Greece; (C.K.); (G.K.); (E.P.); (A.K.)
| | - Amalia Kallinteri
- Department of Microbiology, University Hospital of Ioannina, 45110 Ioannina, Greece; (C.K.); (G.K.); (E.P.); (A.K.)
| | - Ioannis D. Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Konstantina Gartzonika
- Microbiology Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
- Department of Microbiology, University Hospital of Ioannina, 45110 Ioannina, Greece; (C.K.); (G.K.); (E.P.); (A.K.)
- Correspondence: (H.S.); (K.G.); Tel.: +30-265-100-7769 (H.S.); +30-265-100-7716 (K.G.)
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Gupta A, Stec N, Summerbell R, Shear N, Piguet V, Tosti A, Piraccini B. Onychomycosis: a review. J Eur Acad Dermatol Venereol 2020; 34:1972-1990. [DOI: 10.1111/jdv.16394] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/25/2020] [Indexed: 01/25/2023]
Affiliation(s)
- A.K. Gupta
- Division of Dermatology Department of Medicine University of Toronto Toronto ON Canada
- Mediprobe Research Inc. London ON Canada
| | - N. Stec
- Mediprobe Research Inc. London ON Canada
| | - R.C. Summerbell
- Sporometrics Toronto ON Canada
- Dalla Lana School of Public Health University of Toronto Toronto ON Canada
| | - N.H. Shear
- Division of Dermatology Department of Medicine University of Toronto Toronto ON Canada
- Division of Dermatology Sunnybrook Health Sciences Centre Toronto ON Canada
| | - V. Piguet
- Division of Dermatology Department of Medicine University of Toronto Toronto ON Canada
- Division of Dermatology Women's College Hospital Toronto ON Canada
| | - A. Tosti
- Department of Dermatology and Cutaneous Surgery Leonard Miller School of Medicine University of Miami Miami FL USA
| | - B.M. Piraccini
- Dermatology Unit Department of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna Italy
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Aggarwal R, Targhotra M, Kumar B, Sahoo PK, Chauhan MK. Treatment and management strategies of onychomycosis. J Mycol Med 2020; 30:100949. [PMID: 32234349 DOI: 10.1016/j.mycmed.2020.100949] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/15/2020] [Accepted: 03/05/2020] [Indexed: 12/12/2022]
Abstract
Onychomycosis is one of the most prevalent and severe nail fungal infections, which is affecting a wide population across the globe. It leads to variations like nail thickening, disintegration and hardening. Oral and topical drug delivery systems are the most desirable in treating onychomycosis, but the efficacy of the results is low, resulting in a relapse rate of 25-30%. Due to systemic toxicity and various other disadvantages associated with oral therapy like gastrointestinal, hepatotoxicity, topical therapy is commonly used. Topical therapy improves patient compliance and reduces the cost of treatment. However, due to poor penetration of topical therapy across the nail plate, research is focused on different chemical, mechanical and physical methods to improve drug delivery. Penetration enhancers like Thioglycolic acid, Hydroxypropyl-β-cyclodextrin (HP-β-CD), Sodium lauryl sulfate (SLS), carbocysteine, N-acetylcysteine etc. have shown results enhancing the drug penetration across the nail plate. Results with physical techniques such as iontophoresis, laser and Photodynamic therapy are quite promising, but the long-term suitability of these devices is in need to be determined. In this article, a brief analysis of the treatment procedures, factors affecting drug permeation across nail plate, chemical, mechanical and physical devices used to increase the drug delivery through nails for the onychomycosis management has been achieved.
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Affiliation(s)
- R Aggarwal
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Mehrauli - Badarpur Rd, Sector 3, Pushp Vihar, New Delhi 110017, India.
| | - M Targhotra
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Mehrauli - Badarpur Rd, Sector 3, Pushp Vihar, New Delhi 110017, India
| | - B Kumar
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Mehrauli - Badarpur Rd, Sector 3, Pushp Vihar, New Delhi 110017, India
| | - P K Sahoo
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Mehrauli - Badarpur Rd, Sector 3, Pushp Vihar, New Delhi 110017, India
| | - M K Chauhan
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Mehrauli - Badarpur Rd, Sector 3, Pushp Vihar, New Delhi 110017, India
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Shemer A, Gupta AK, Kamshov S, Babaev M, Hermush V, Farhi R, Daniel CR, Foley KA. Continuous terbinafine and pulse itraconazole for the treatment of non-dermatophyte mold toenail onychomycosis. J DERMATOL TREAT 2019; 32:310-313. [PMID: 31415182 DOI: 10.1080/09546634.2019.1654598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Although dermatophytes are considered the predominant causative organisms in onychomycosis, non-dermatophyte mold (NDM) infections may be more prevalent than originally thought and may be more difficult to treat. There are limited data of oral antifungal efficacy in treating NDM onychomycosis. METHOD A retrospective chart review (2009-2016) was conducted in patients receiving continuous oral terbinafine or pulse itraconazole for toenail onychomycosis due to NDMs. Mycology results and percent nail affected were recorded with patient characteristics including demographics and concurrent diseases. Complete, clinical, and mycological cure were tabulated. RESULTS Data from 176 patients were collected. Mycological and complete cure rates for terbinafine (69.8% and 17%) and itraconazole (67.5% and 22%) were not significantly different from each other. Regardless of oral treatment, age (p = .013), baseline severity (p = .016), and presence of atherosclerosis (p = .040) or hyperlipidemia (p = .033) decreased the likelihood of mycological cure, while age decreased the likelihood of complete cure (p = .001). CONCLUSION Continuous terbinafine and pulse itraconazole were similar in efficacy for curing NDM onychomycosis. Age was the most consistent prognostic factor affecting likelihood of cure, with factors that may influence drug reaching the site of infection also decreasing likelihood of mycological cure.
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Affiliation(s)
- Avner Shemer
- Department of Dermatology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, Canada.,Mediprobe Research Inc., London, Canada
| | - Shoni Kamshov
- Department of Dermatology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Meir Babaev
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Vered Hermush
- Department of Geriatrics, Laniado Medical Center, Netanya, Israel
| | - Renata Farhi
- Hospital Nossa Senhora da Saude, University Fundação Tecnico Educacional Souza Marques, Rio De Janeiro, Brazil
| | - C Ralph Daniel
- Department of Dermatology, University of Mississippi School of Medicine, Jackson, MS, USA.,Department of Dermatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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Lipner SR, Scher RK. Onychomycosis. J Am Acad Dermatol 2019; 80:835-851. [DOI: 10.1016/j.jaad.2018.03.062] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/05/2018] [Accepted: 03/06/2018] [Indexed: 02/03/2023]
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12
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Lipner SR. Pharmacotherapy for onychomycosis: new and emerging treatments. Expert Opin Pharmacother 2019; 20:725-735. [DOI: 10.1080/14656566.2019.1571039] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Shari R. Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
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13
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Joyce A, Gupta AK, Koenig L, Wolcott R, Carviel J. Fungal Diversity and Onychomycosis An Analysis of 8,816 Toenail Samples Using Quantitative PCR and Next-Generation Sequencing. J Am Podiatr Med Assoc 2019; 109:57-63. [PMID: 30964314 DOI: 10.7547/17-070] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Onychomycosis is a fungal infection of the nail that is often recalcitrant to treatment and prone to relapse. Traditional potassium hydroxide and culture diagnosis is costly and time-consuming. Therefore, molecular methods were investigated to demonstrate effectiveness in diagnosis and to quantify the microbial flora present that may be contributing to disease. METHODS A total of 8,816 clinically suspicious toenail samples were collected by podiatric physicians across the United States from patients aged 0 to 103 years and compared with a control population (N = 20). Next-generation sequencing and quantitative polymerase chain reaction were used to identify and quantify dermatophytes, nondermatophyte molds, and bacteria. RESULTS Approximately 50% of suspicious toenails contained both fungi and bacteria, with the dermatophyte Trichophyton rubrum contributing the highest relative abundance and presence in 40% of these samples. Of the remaining 50% of samples, 34% had bacterial species present and 16% had neither. Fungi only were present in less than 1% of samples. Nondermatophyte molds contributed to 11.0% of occurrences in fungus-positive samples. All of the control samples were negative for fungi, with commensal bacterial species composing most of the flora population. CONCLUSIONS Molecular methods were successful in efficiently quantifying microbial and mycologic presence in the nail. Contributions from dermatophytes were lower than expected, whereas the opposite was true for nondermatophyte molds. The clinical significance of these results is currently unknown.
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Affiliation(s)
- Annette Joyce
- Joyce Podiatry, Westminster, MD. Dr. Joyce is now with Dermfoot Educational Ventures, LLC, Pawley's Island, SC
| | | | - Lars Koenig
- Research and Testing Laboratory, Lubbock, TX
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Shemer A, Gupta AK, Babaev M, Barzilai A, Farhi R, Daniel Iii CR. A Retrospective Study Comparing K101 Nail Solution as a Monotherapy and in Combination with Oral Terbinafine or Itraconazole for the Treatment of Toenail Onychomycosis. Skin Appendage Disord 2017; 4:166-170. [PMID: 30197895 DOI: 10.1159/000484211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/12/2017] [Indexed: 11/19/2022] Open
Abstract
Background Onychomycosis is a difficult-to-treat fungal infection of the nails. The efficacy of monotherapy is not ideal, and combination therapies provide an alternative that may increase treatment efficacy. Method A retrospective analysis of data from 91 patients was undertaken. Treatment for toenail onychomycosis occurred between 2014 and 2016 and consisted of combination therapy with oral terbinafine (250 mg/day for 12 weeks) or itraconazole (3 pulses, 400 mg/day for 7 days) + K101 nail solution daily, or K101 nail solution monotherapy. Efficacy outcomes at 12 and 15 months were analyzed. Results At 12 months, the clinical cure rate for combination of terbinafine + K101 solution was significantly higher than that for K101 monotherapy (p = 0.008). Patients receiving this combination also showed significant improvement in percent of affected nail at 3 months (p = 0.029), while patients receiving itraconazole + K101 solution demonstrated improvement in percent of affected nail at 6 months (p = 0.037). At 15 months, there was no significant difference between treatments for complete, clinical, and mycological cure. Conclusion Combination therapy with oral terbinafine or itraconazole and K101 nail solution results in clearance of infected nail earlier than that with topical K101 alone. These combinations may encourage compliance and be effective for patients with moderate onychomycosis.
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Affiliation(s)
- Avner Shemer
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aditya K Gupta
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Mediprobe Research Inc., London, ON, Canada
| | - Meir Babaev
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Aviv Barzilai
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Renata Farhi
- Hospital Nossa Senhora da Saude, University Fundação Tecnico Educacional Souza Marques, Rio de Janeiro, Brazil
| | - C Ralph Daniel Iii
- Department of Dermatology, University of Mississippi School of Medicine, Jackson, MS.,Department of Dermatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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15
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Abstract
Dermatophytoses are among the most frequently diagnosed skin infections worldwide. However, the distribution of pathogenic species and the predominating anatomical sites of infection vary with geographical location and change over time. The aim of this study was to determine the epidemiological and aetiological factors of dermatophytoses in Crete, Greece over the last 5-year period (2011-2015) and their incidence in relation to the gender and the age of the patients. We compared our findings with those previously reported from the same area and from other parts of the world. A total of 2,910 clinical specimens (skin scrapings, nail clippings, and hair specimens) obtained from 2,751 patients with signs of dermatomycoses were examined using direct microscopy and culture. Overall, 294 specimens (10.1%) were proved mycologically positive for dermatophytes. The age of the patients ranged from 2 to 86 years (mean age, 37 years). Tinea corporis was the predominant clinical type of infection, followed by tinea unguium, tinea pedis, tinea capitis, tinea faciei, tinea cruris and tinea manuum. Among dermatophytes, eight species were isolated: Microsporum canis (35.8%), Trichophyton rubrum (35.1%), Trichophyton mentagrophytes (23.3%), Epidermophyton floccosum (2.5%), Microsporum gypseum (1.8%), Trichophyton violaceum (0.7%), Trichophyton verrucosum (0.4%), and Trichophyton tonsurans (0.4%). In our area, the most common dermatophyte was M. canis followed by T. rubrum. Increased migration, mass tourism, and climate changes will contribute to further changes in the epidemiology of dermatophytoses in our area. Continuing studies are necessary for determining the new epidemiological trends and to implement the appropriate control measures.
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Affiliation(s)
- Sofia Maraki
- Department of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine
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16
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Wlodek C, Trickey A, Berker D, Johnson E. Trends in laboratory‐diagnosed onychomycosis between 2006 and 2014 in the South West of England. Br J Dermatol 2016; 176:237-240. [DOI: 10.1111/bjd.14804] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C. Wlodek
- Bristol Royal Infirmary Upper Maudlin Street Bristol BS2 8HW U.K
| | - A. Trickey
- School of Social and Community Medicine University of Bristol Bristol U.K
| | - D. Berker
- Bristol Royal Infirmary Upper Maudlin Street Bristol BS2 8HW U.K
| | - E.M. Johnson
- Public Health England Mycology Reference Laboratory Bristol U.K
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17
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Maraki S, Mavromanolaki VE. Epidemiology of onychomycosis in Crete, Greece: a 12-year study. Mycoses 2016; 59:798-802. [DOI: 10.1111/myc.12533] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/25/2016] [Accepted: 06/13/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Sofia Maraki
- Department of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine; University Hospital of Heraklion; Heraklion Greece
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18
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Gupta AK, Gupta G, Jain HC, Lynde CW, Foley KA, Daigle D, Cooper EA, Summerbell RC. The prevalence of unsuspected onychomycosis and its causative organisms in a multicentre Canadian sample of 30 000 patients visiting physicians' offices. J Eur Acad Dermatol Venereol 2016; 30:1567-72. [PMID: 27168494 DOI: 10.1111/jdv.13677] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 03/03/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Onychomycosis is difficult to treat and a concern for many patients. Prevalence estimates of onychomycosis in North American clinic samples have been higher than what has been reported for general populations. OBJECTIVE A large, multicentre study was conducted to estimate the prevalence of toenail onychomycosis in the Canadian population. METHODS Patients were recruited from the offices of three dermatologists and one family physician in Ontario, Canada. Nail samples for mycological testing were obtained from normal and abnormal-looking nails. This sample of 32 193 patients includes our previous published study of 15 000 patients. RESULTS Abnormal nails were observed in 4350 patients. Of these, the prevalence of culture-confirmed toenail onychomycosis was estimated to be 6.7% (95% CI, 6.41-6.96%). Following sex and age adjustments for the general population, the estimated prevalence of toenail onychomycosis in Canada was 6.4% (95% CI, 6.12%-6.65%). The distribution of fungal organisms in culture-confirmed onychomycosis was 71.9% dermatophytes, 20.4% non-dermatophyte moulds and 7.6% yeasts. Toenail onychomycosis was four times more prevalent in those over the age of 60 years than below the age of 60 years. CONCLUSION The present data highlights that onychomycosis may be a growing medical concern among ageing patients.
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Affiliation(s)
- A K Gupta
- University of Toronto Department of Medicine, Toronto, ON, Canada.,Mediprobe Research Inc., London, ON, Canada
| | - G Gupta
- Wayne State University, Detroit, MI, USA
| | - H C Jain
- Private Dermatology Practice, Cambridge, ON, Canada
| | - C W Lynde
- University of Toronto Department of Medicine, Toronto, ON, Canada.,Lynde Institute for Dermatology, Markham, ON, Canada
| | - K A Foley
- Mediprobe Research Inc., London, ON, Canada
| | - D Daigle
- Mediprobe Research Inc., London, ON, Canada
| | - E A Cooper
- Mediprobe Research Inc., London, ON, Canada
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19
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Gupta AK, Paquet M. Efinaconazole 10% nail solution: a new topical treatment with broad antifungal activity for onychomycosis monotherapy. J Cutan Med Surg 2016; 18:151-5. [PMID: 24800702 DOI: 10.2310/7750.2013.13095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Topical therapies for onychomycosis are associated with less adverse events than systemic therapies, but poor nail penetration limits their efficacy. Consequently, an efinaconazole 10% nail solution was developed. OBJECTIVE To review the evidence supporting the usefulness of efinaconazole monotherapy in onychomycosis management. METHODS PubMed and clinicaltrials.gov databases and abstracts from the 2013 annual meeting of the American Academy of Dermatology were searched in April 2013 using the terms "efinaconazole," "IDP-108," and "KP-103." RESULTS In vitro, efinaconazole possesses a broad antifungal activity similar or superior to that of other antifungals. Its low affinity for keratin results in good nail penetration. Efinaconazole 10% nail solution administered daily for 36 or 48 weeks to treat mild to moderate toenail onychomycosis caused by dermatophytes results in complete and mycologic cure rates of 15 to 25% and 53 to 87%, respectively. No serious skin reaction is associated with its use. CONCLUSION Efinaconazole 10% nail solution is a promising new treatment for onychomycosis.
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20
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Gupta AK, Daigle D, Foley KA. The prevalence of culture-confirmed toenail onychomycosis in at-risk patient populations. J Eur Acad Dermatol Venereol 2014; 29:1039-44. [PMID: 25413984 DOI: 10.1111/jdv.12873] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/22/2014] [Indexed: 11/30/2022]
Abstract
Onychomycosis is a fungal infection of the nail and is the most common nail affliction in the general population. Certain patient populations are at greater risk of infection and the prevalence of onychomycosis reported in the literature has yet to be summarized across these at-risk groups. We performed a systematic review of the literature and calculated pooled prevalence estimates of onychomycosis in at-risk patient populations. The prevalence of dermatophyte toenail onychomycosis was as follows: general population 3.22% (3.07, 3.38), children 0.14% (0.11, 0.18), the elderly 10.28% (8.63, 12.18), diabetic patients 8.75% (7.48, 10.21), psoriatic patients 10.22% (8.61, 12.09), HIV positive patients 10.40% (8.02, 13.38), dialysis patients 11.93% (7.11, 19.35) and renal transplant patients 5.17% (1.77, 14.14). Dialysis patients had the highest prevalence of onychomycosis caused by dermatophytes, elderly individuals had the highest prevalence of onychomycosis caused by yeasts (6.07%; 95% CI = 3.58, 10.11) and psoriatic patients had the highest prevalence of onychomycosis caused by non-dermatophyte moulds (2.49%; 95% CI = 1.74, 3.55). An increased prevalence of onychomycosis in certain patient populations may be attributed to impaired immunity, reduced peripheral circulation and alterations to the nail plate which render these patients more susceptible to infection.
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Affiliation(s)
- A K Gupta
- University of Toronto, Toronto, ON, Canada.,Mediprobe Research Inc., London, ON, Canada
| | - D Daigle
- Mediprobe Research Inc., London, ON, Canada
| | - K A Foley
- Mediprobe Research Inc., London, ON, Canada
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21
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Sigurgeirsson B, Baran R. The prevalence of onychomycosis in the global population: a literature study. J Eur Acad Dermatol Venereol 2013; 28:1480-91. [PMID: 24283696 DOI: 10.1111/jdv.12323] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 10/28/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Onychomycosis is a common disorder, and high prevalence figures are commonly cited in the literature. OBJECTIVES Evaluate the prevalence of onychomycosis based on published studies. METHODS Relevant studies were identified in Medline by using specific search criteria. RESULTS Eleven population-based and 21 hospital-based studies were identified. The mean prevalence in Europe and North America was 4.3% [95% Confidence Interval (CI): 1.9-6.8] in the population-based studies, but it was 8.9% (95% CI: 4.3-13.6) for the hospital-based studies. Both population-based and hospital-based studies showed that onychomycosis is more common in toenails and is seen more frequently in males. The main causative agent was a dermatophyte in 65.0% (95% CI: 51.9-78.1) of the cases. Trichophyton rubrum was the single most common fungus and was cultured on average in 44.9% of the cases (95% CI: 33.8-56.0). Moulds were found on average in 13.3% (95% CI: 4.6-22.1) and yeasts in 21.1% (95% CI: 11.0-31.3). LIMITATIONS We may not have been able to locate all studies. CONCLUSIONS Onychomycosis is a common disorder, but it may not be as common as cited in the literature, because hospital-based studies might overestimate the prevalence of onychomycosis. It is more frequent in males, and toenails are more commonly affected. Dermatophytes, particularly T. rubrum, are the main causative agents.
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Affiliation(s)
- B Sigurgeirsson
- Faculty of Medicine, Department of Dermatology, University of Iceland, Reykjavík, Iceland
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22
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Morales-Cardona CA, Valbuena-Mesa MC, Alvarado Z, Solorzano-Amador A. Non-dermatophyte mould onychomycosis: a clinical and epidemiological study at a dermatology referral centre in Bogota, Colombia. Mycoses 2013; 57:284-93. [PMID: 24279435 DOI: 10.1111/myc.12157] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/22/2013] [Accepted: 10/26/2013] [Indexed: 11/30/2022]
Abstract
Worldwide prevalence of non-dermatophyte mould onychomycosis has increased in recent years; however, available information on the topic is confusing and oftentimes contradictory, probably due to the small number of reported cases. The aim of this study was to determine and describe the aetiological agents, as well as the epidemiological and clinical characteristics of non-dermatophyte mould onychomycosis in a dermatology referral centre in Bogota, Colombia. A cross-sectional descriptive study was conducted between January 2001 and December 2011 among patients who attend the National Institute of Dermatology with a confirmed diagnosis of onychomycosis by non-dermatophytes moulds. There were 317 confirmed cases of non-dermatophyte mould onychomycosis in 196 women and 121 men whose average age was 43 years. Twenty-seven per cent of them had a history of systemic disease. The habit of walking and showering barefoot was the major infection-related factor. Distal and lateral subungual presentation was the most common pattern of clinical presentation. The most frequent non-dermatophyte mould was Neoscytalidium dimidiatum followed by Fusarium spp. No relationship was observed with predisposing factors previously reported in the literature. Clinical features found in this population are indistinguishable from onychomycosis caused by dermatophytes. High prevalence of N. dimidiatum found here was in contrast to a large number of studies where other types of moulds predominate.
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Affiliation(s)
- Camilo A Morales-Cardona
- Centro Dermatológico Federico Lleras Acosta, National Institute of Dermatology of Colombia, Bogotá D.C, Colombia
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23
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Sigurgeirsson B, van Rossem K, Malahias S, Raterink K. A phase II, randomized, double-blind, placebo-controlled, parallel group, dose-ranging study to investigate the efficacy and safety of 4 dose regimens of oral albaconazole in patients with distal subungual onychomycosis. J Am Acad Dermatol 2013; 69:416-25. [DOI: 10.1016/j.jaad.2013.03.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 02/22/2013] [Accepted: 03/02/2013] [Indexed: 11/29/2022]
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24
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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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25
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Khosravi AR, Shokri H, Nikaein D, Mansouri P, Erfanmanesh A, Chalangari R, Katalin M. Yeasts as Important Agents of Onychomycosis:In VitroActivity of Propolis Against Yeasts Isolated from Patients with Nail Infection. J Altern Complement Med 2013; 19:57-62. [DOI: 10.1089/acm.2011.0722] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ali Reza Khosravi
- Mycology Research Center, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | | | - Donya Nikaein
- Mycology Research Center, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Parvin Mansouri
- Dermatology Clinic, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Erfanmanesh
- Academic Center of Education, Culture and Research (ACECR), Tehran, Iran
| | - Reza Chalangari
- Dermatology Clinic, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Martis Katalin
- Dermatology Clinic, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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26
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Faizullina YV, Silina LV, Faizullin VA. Efficiency of the therapy of onychomycosis with irunine (based on the results of a multicenter study conducted in 2010 and 2011). VESTNIK DERMATOLOGII I VENEROLOGII 2012. [DOI: 10.25208/vdv670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article presents the results of a multi-center study of the clinical efficiency of the use of Irunine ® (itraconazole) for the treatment of 1,340 patients with onychomycosis. Patients were administered two capsules (100 mg) of Irunine ® twice a day after a meal for 7 days (as a pulse therapy) with a three-week break. The duration of treatment was 3—5 months. Clinical recovery was achieved in 74.9% of cases, and stable improvement was observed in 23.4% of patients.
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27
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Gupta AK, Drummond-Main C, Cooper EA, Brintnell W, Piraccini BM, Tosti A. Systematic review of nondermatophyte mold onychomycosis: Diagnosis, clinical types, epidemiology, and treatment. J Am Acad Dermatol 2012; 66:494-502. [DOI: 10.1016/j.jaad.2011.02.038] [Citation(s) in RCA: 175] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 02/03/2011] [Accepted: 02/13/2011] [Indexed: 11/28/2022]
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28
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황성민, 김동민, 권경술, 김기홍, 조백기, Keechan Moon, 안규중, 원영호, 유희준, 이광훈, 서무규, 노병인. Epidemiologic Survey of Onychomycosis in Koreans: Multicenter Study. ACTA ACUST UNITED AC 2011. [DOI: 10.17966/kjmm.2011.16.2.35] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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29
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Kubanova AA, Kozhichkina NV, Kubanova AA, Kozhichkina NV. Binafin in treatment of nail mycosis. VESTNIK DERMATOLOGII I VENEROLOGII 2010. [DOI: 10.25208/vdv850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article presents the results of a direct open-label study of the efficacy and safety of BINAFIN® for treatment of foot and hand
nail mycoses in 30 patients. Patients were administered one pill (250 mg) of BINAFIN® a day on a daily basis for 3-5 months.
Clinical and anti-mycosis efficacy was achieved in 92.6% cases of foot and hand nail mycoses.
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30
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Aghamirian MR, Ghiasian SA. Onychomycosis in Iran: epidemiology, causative agents and clinical features. ACTA ACUST UNITED AC 2010; 51:23-9. [PMID: 20185868 DOI: 10.3314/jjmm.51.23] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Onychomycosis represents the most frequently encountered nail disease, which is difficult to eradicate with drug treatment. AIM This study was undertaken to document the clinico-mycological pattern of onychomycosis in Iran. Results of mycological tests of nail scrapings collected over a 4-year period were analyzed. METHODS Both direct microscopy and cultures of the nail material were performed to identify the causative agents. RESULTS The microscopic and/or cultural detection of fungi was positive in 40.2% of samples. The most common clinical type noted was distolateral subungual onychomycosis in 48.4% of cases. Etiological fungal agents were 50% dermatophytes, 46.8% yeasts, and 3.2% saprophytic moulds. The most frequently detected dermatophyte species were Trichophyton rubrum (48.4%) and T. mentagrophytes (41.9%). Among yeasts, Candida albicans (58.6) was most common, followed by C. parapsilosis (17.2%), C. glabrata (10.3%), C. krusei and C. tropicalis (each 6.9%). Aspergillus niger and A. flavus were the most frequent saprophytic moulds. Females were affected more frequently than males, and in both sexes those most infected were between 40-49 years of age. Fingernails were affected more frequently than toenails. CONCLUSIONS The clinico-epidemiological data collected can serve as reference for future research and may be useful in the development of preventive and educational strategies.
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Affiliation(s)
- Mohammad Reza Aghamirian
- Medical Parasitology and Mycology Department, Qazvin University of Medical Sciences and Health Services, Qazvin, Iran
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31
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Koksal F, Er E, Samasti M. Causative agents of superficial mycoses in Istanbul, Turkey: retrospective study. Mycopathologia 2009; 168:117-23. [PMID: 19544086 DOI: 10.1007/s11046-009-9210-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 05/06/2009] [Indexed: 10/20/2022]
Abstract
The aim of the present study was to determine the percentage of agents, which can give rise to superficial fungal infections in Istanbul, Turkey. Between 2000 and 2007, the clinical samples collected from 8,200 patients attending the outpatient Dermatology Clinic at Mihrimahsultan Medical Center were examined by direct microscopy and culture. Pathogen fungi were detected in 5,722 of the patients. Of the isolates were 4,218 (74%) dermatophytes, 1,196 (21%) Candida sp., 170 (3%) Malassezia furfur, and 138 (2%) Trichosporon sp. Among the dermatophytes, Trichophyton sp. was the most common isolate followed by Epidermophyton floccosum (243) and Microsporum sp. Among the Candida species, C. albicans (549) was also frequently found. Onychomycosis was the most prevalent type of infection, followed by tinea pedis, tinea cruris, tinea corporis, and tinea capitis. In conclusion, our study showed that the most common isolated agents from superficial infections were T. rubrum being Candida sp. the second most prevalent.
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Affiliation(s)
- Fatma Koksal
- Cerrahpasa Medical Faculty, Department of Microbiology and Clinical Microbiology, Istanbul University, Istanbul, Turkey.
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32
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Godoy-Martinez P, Nunes FG, Tomimori-Yamashita J, Urrutia M, Zaror L, Silva V, Fischman O. Onychomycosis in São Paulo, Brazil. Mycopathologia 2009; 168:111-6. [PMID: 19424818 DOI: 10.1007/s11046-009-9209-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 04/13/2009] [Indexed: 01/19/2023]
Abstract
Onychomycosis is a fungal infection of the nails with broad aetiological scope, and it represents 18-40% of all onychopathies and 39% of all superficial mycotic infections. From July 1996 to December 1999, samples of nails were collected from 588 patients with presumptive diagnosis of onychomycosis at the Dermatology and Mycology Divisions EPM\UNIFESP, Brazil, and the diagnosis was confirmed in 247 of these cases. The most common pathogens isolated in this study were yeasts in 52% of positive cultures (Candida albicans 18.3%, Candida parapsilosis 13.8%, other species of Candida 15.4% and other yeasts 4.6%), followed by dermatophytes in 40.6% of positive cultures (the most commonly isolated organisms were Trichophyton rubrum in 33.2%, followed by Trichophyton mentagrophytes in 6.3% and others 1.2%). Non-dermatophyte moulds were isolated in 7.4% of positive cultures (Fusarium spp. 4.5%, Nattrassia mangiferae 2.3% and Aspergillus spp. 0.6%). Distal and lateral subungual onychomycosis (DLSO) was the commonest clinical pattern 44.6% followed by free edge onycholysis (FEO) 38.8% and others. In conclusion, this study demonstrated that T. rubrum is the main agent causing onychomycosis in toenails, and species of genus Candida were the main agents isolated in fingernail onychomycosis in our region.
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33
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Maraki S, Nioti E, Mantadakis E, Tselentis Y. A 7-year survey of dermatophytoses in Crete, Greece. Mycoses 2007; 50:481-4. [DOI: 10.1111/j.1439-0507.2007.01403.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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34
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Alvarez MI, Caicedo LD. Medically important fungi found in hallux nails of university students from Cali, Colombia. Mycopathologia 2007; 163:321-5. [PMID: 17473987 DOI: 10.1007/s11046-007-9016-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Accepted: 03/27/2007] [Indexed: 11/29/2022]
Abstract
The presence of medically important fungi was studied in hallux nails scrapings obtained from 504 students (204 males, 300 females) of three universities in Cali. Specimens were examined by direct microscopic examination and fungal culture. Medically important fungi were found in 49 (9.7%) students, 24 (4.8%) had onychomycosis while the rest did not have nail lesions. Trichophyton rubrum was the most commonly isolated fungi in students with lesions, where as T. mentagrophytes predominated in healthy nails. Most of the students with fungi were males. The prevalence of fungi was higher in individuals between 26 and 35 years. No association was observed between fungi and practicing sports or undergoing pedicures. These results suggest that dermatophytes can be found in healthy hallux nails, which can be reservoirs of pathogenic fungi.
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Affiliation(s)
- María Inés Alvarez
- Department of Microbiology, Facultad de Salud, Universidad del Valle, Cali, Colombia.
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35
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Janusz I, Sysa-Jedrzejowska A, Zalewska A. Epidemiology of onychomycosis in central Poland. J Eur Acad Dermatol Venereol 2007; 21:704-5. [PMID: 17448001 DOI: 10.1111/j.1468-3083.2006.01999.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Oliveira ACP, Shinobu CS, Longhini R, Franco SL, Svidzinski TIE. Antifungal activity of propolis extract against yeasts isolated from onychomycosis lesions. Mem Inst Oswaldo Cruz 2006; 101:493-7. [PMID: 17072451 DOI: 10.1590/s0074-02762006000500002] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 05/15/2006] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to determine the in vitro activity of propolis extract against 67 yeasts isolated from onychomycosis in patients attending at the Teaching and Research Laboratory of Clinical Analysis of the State University of Maringá. The method used was an adaptation made from the protocol approved by the National Committee for Clinical Laboratory Standards. The yeasts tested were: Candida parapsilosis 35%, C. tropicalis 23%, C. albicans 13%, and other species 29%. The propolis extract showed excellent performance regarding its antifungal activity: the concentration capable of inhibiting the all of the yeasts was 5 x 10(-2) mg/ml of flavonoids and 2 x 10(-2) mg/ml of flavonoids stimulated their cellular death. Trichosporon sp. were the most sensitive species, showing MIC50 and MIC90 of 1.25 x 10(-2) mg/ml of flavonoids, and C. tropicalis was the most resistant, with CFM50 of 5 x 10(-2) mg/ml of flavonoids and MFC90 of 10 x 10(-2) mg/ml. In view of the fact that propolis is a natural, low cost, nontoxic product with proven antifungal activity, it should be considered as another option in the onychomycosis treatment.
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Affiliation(s)
- Ana Carla Pozzi Oliveira
- Laboratório de Micologia, Departamento de Análises Clînicas, Centro de Ciências da Saúde, Universidade Estadual de Maringá, Maringá, PR, Brasil
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