Onychomycosis by Candida ciferrii caused fatal multisystemic dissemination in a patient with diabetes mellitus type 2

Onychomycosis in Patients with Diabetes Mellitus in Africa: A Global Scoping Review, 2000-2021

Onychomycosis is commonly studied in Africa but not in patients with diabetics despite having a significant number of her population living with diabetes mellitus (DM). Our review highlights a total of 15 studies with only two from Africa over the past two decades; 8 (53.3%) from Asia, 4 (26.7%) from Europe, 2 (13.3%) from Africa and 1 (6.7%) from North America. A total number of 4321 participants were involved with onychomycosis prevalence of 35.3% (1527/4321). Seven studies documented preponderance of onychomycosis in males, one showed preponderance in females, one showed no statistically significant difference in gender, while correlation with gender was unclear in the remainder. The risk factors identified were duration of diabetes, increasing age, occupation (agriculture), subclinical atherosclerosis, metabolic syndrome, obesity, triglyceride levels, and glycosylated haemoglobin. Three case control studies showed a statistically significant correlation between onychomycosis and individuals with DM. Diagnosis was mainly by microscopy and culture with Trichophyton (T) rubrum as the predominant isolate. Fungal nail infections are grossly underdiagnosed and/or underreported in Africa and hence the need for improved awareness and diagnosis especially in patients with DM. Although focused on Africa, this study also revealed paucity of data on onychomycosis in diabetic patients living in the Americas despite evidence from the literature showing a significant number of individuals from that region are living with diabetes. The need to evaluate this at-risk population for onychomycosis cannot be over emphasized.

Prevalence and Antifungal Susceptibility of Clinically Relevant Candida Species, Identification of Candida auris and Kodamaea ohmeri in Bangladesh

Candida species are major fungal pathogens in humans. The aim of this study was to determine the prevalence of individual Candida species and their susceptibility to antifungal drugs among clinical isolates in a tertiary care hospital in Bangladesh. During a 10-month period in 2021, high vaginal swabs (HVSs), blood, and aural swabs were collected from 360 patients. From these specimens, Candida spp. was isolated from cultures on Sabouraud dextrose agar media, and phenotypic and genetic analyses were performed. A total of 109 isolates were recovered, and C. albicans accounted for 37%, being derived mostly from HVSs. Among non-albicans Candida (NAC), C. parapsilosis was the most frequent, followed by C. ciferrii, C. tropicalis, and C. glabrata. Three isolates from blood and two isolates from aural discharge were genetically identified as C. auris and Kodamaea ohmeri, respectively. NAC isolates were more resistant to fluconazole (overall rate, 29%) than C. albicans (10%). Candida isolates from blood showed 95% susceptibility to voriconazole and less susceptibility to fluconazole (67%). Two or three amino acid substitutions were detected in the ERG11 of two fluconazole-resistant C. albicans isolates. The present study is the first to reveal the prevalence of Candida species and their antifungal susceptibility in Bangladesh.