1
|
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.
Collapse
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
| | | | | | | |
Collapse
|
2
|
Gupta AK, Wang T, Cooper EA, Summerbell RC, Piguet V, Tosti A, Piraccini BM. A comprehensive review of nondermatophyte mould onychomycosis: Epidemiology, diagnosis and management. J Eur Acad Dermatol Venereol 2024; 38:480-495. [PMID: 38010049 DOI: 10.1111/jdv.19644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/09/2023] [Indexed: 11/29/2023]
Abstract
Nondermatophyte moulds (NDMs) are widely distributed and can be detected in association with mycotic nails; however, sometimes it can be challenging to establish the role of NDMs in the pathogenesis of onychomycosis (i.e. causative vs. contaminant). In studies where the ongoing invasive presence of NDMs is confirmed through repeat cultures, the global prevalence of NDMs in onychomycosis patients is estimated at 6.9% with the 3 most common genus being: Aspergillus, Scopulariopsis and Fusarium. NDM onychomycosis can, in many cases, appear clinically indistinguishable from dermatophyte onychomycosis. Clinical features suggestive of NDMs include proximal subungual onychomycosis with paronychia associated with Aspergillus spp., Fusarium spp. and Scopulariopsis brevicaulis, as well as superficial white onychomycosis in a deep and diffused pattern associated with Aspergillus and Fusarium. Longitudinal streaks seen in patients with distal and lateral onychomycosis may serve as an additional indicator. For diagnosis, light microscopic examination should demonstrate fungal filaments consistent with an NDM with at least two independent isolations in the absence of a dermatophyte; the advent of molecular testing combined with histological assessment may serve as an alternative with improved sensitivity and turnover time. In most instances, antifungal susceptibility testing has limited value. Information on effective treatments for NDM onychomycosis is relatively scarce, unlike the situation in the study of dermatophyte onychomycosis. Terbinafine and itraconazole therapy (continuous and pulsed) appear effective to varying extents for treating onychomycosis caused by Aspergillus, Fusarium or Scopulariopsis. There is scant literature on oral treatments for Neoscytalidium.
Collapse
Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Mediprobe Research Inc., London, Ontario, Canada
| | - Tong Wang
- Mediprobe Research Inc., London, Ontario, Canada
| | | | - Richard C Summerbell
- Sporometrics, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada
| | - Antonella Tosti
- Fredric Brandt Endowed Professor of Dermatology, University of Miami, Miami, Florida, USA
| | - Bianca Maria Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| |
Collapse
|
3
|
Ion A, Popa LG, Porumb-Andrese E, Dorobanțu AM, Tătar R, Giurcăneanu C, Orzan OA. A Current Diagnostic and Therapeutic Challenge: Tinea Capitis. J Clin Med 2024; 13:376. [PMID: 38256510 PMCID: PMC10816672 DOI: 10.3390/jcm13020376] [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: 11/26/2023] [Revised: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Tinea capitis is a dermatophyte scalp infection with a marked prevalence among the pediatric population. However, in the last few years, its epidemiology has changed due to increasing population migration worldwide. Host-specific and environmental factors contribute to the pathogenesis of tinea capitis. Clinically, tinea capitis may present as a subtle hair loss accompanied by scalp scaling, alopecia with scaly patches, or alopecia with black dots. A more severe form of tinea capitis is represented by kerion celsi, which clinically presents as a tender plaque covered by pustules and crusts. If left untreated, this dermatophytic infection may resolve with permanent scarring and alopecia. The pathological changes found in tinea capitis are reflected by a spectrum of clinical changes. Zoophilic infections typically prompt an extensive inflammatory reaction, while anthropophilic dermatophytoses often lack inflammation and result in more persistent lesions. Tinea capitis typically requires systemic antifungal therapy. Griseofulvin, terbinafine, itraconazole, and fluconazole are the main antifungal agents used. Currently, the duration of antifungal therapy varies based on the clinical presentation and type of dermatophyte involved. Through the reported cases and literature review, we aim to emphasize the importance of the early recognition of atypical variants of tinea capitis in immunocompetent children for the prompt initiation of systemic antifungal therapy, minimizing the need for prolonged treatment. Additionally, we emphasize the importance of regular laboratory testing during systemic antifungal therapy, particularly liver enzyme tests, to prevent adverse events, especially in cases requiring long-term treatment.
Collapse
Affiliation(s)
- Ana Ion
- Department of Dermatology, ‘Elias’ University Emergency Hospital, 011461 Bucharest, Romania; (A.I.); (A.M.D.)
| | - Liliana Gabriela Popa
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.T.); (C.G.); (O.A.O.)
- Department of Dermatology, ‘Elias’ University Emergency Hospital, 011461 Bucharest, Romania; (A.I.); (A.M.D.)
| | - Elena Porumb-Andrese
- Department of Dermatology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Alexandra Maria Dorobanțu
- Department of Dermatology, ‘Elias’ University Emergency Hospital, 011461 Bucharest, Romania; (A.I.); (A.M.D.)
| | - Raluca Tătar
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.T.); (C.G.); (O.A.O.)
- Department of Plastic Reconstructive Surgery and Burns, ‘Grigore Alexandrescu’ Clinical Emergency Hospital for Children, 011743 Bucharest, Romania
| | - Călin Giurcăneanu
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.T.); (C.G.); (O.A.O.)
- Department of Dermatology, ‘Elias’ University Emergency Hospital, 011461 Bucharest, Romania; (A.I.); (A.M.D.)
| | - Olguța Anca Orzan
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.T.); (C.G.); (O.A.O.)
- Department of Dermatology, ‘Elias’ University Emergency Hospital, 011461 Bucharest, Romania; (A.I.); (A.M.D.)
| |
Collapse
|
4
|
Fida M, Prendushi XF, Gjylameti N, Dedej S, Zenelaj V, Toçi E, Vasili E. A 5-year single-center study about onychomycosis with a focus on Aspergillus spp. in Albania. Int J Dermatol 2023; 62:1365-1370. [PMID: 37735716 DOI: 10.1111/ijd.16836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/08/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Onychomycosis is a common nail infection caused by dermatophytes, nondermatophytes molds (NDM), and yeasts. The prevalence of Aspergillus spp. is increasing worldwide. This study aims to describe the epidemiological and microbiological features of onychomycosis, especially for Aspergillus spp. METHODS This is a 5-year retrospective study of clinically suspected onychomycosis in one microbiological clinic in Albania. The mycological examination, which included direct microscopic examination of nail scrapings with 20% KOH and culture, was performed on 411 patients. After incubation, we studied the macroscopic characteristics of the colonies, size, shape, and color, and their microscopic examination. We evaluated positive cases for Aspergillus, all cases where Aspergillus was grown in the culture, the microscopy was positive, and the culture was negative for dermatophyte. RESULTS Onychomycosis resulted positive in 267 patients (52.9% females vs. 47.1% males). A total of 62.2% resulted infected by dermatophytes, 29.6% by yeasts, and 8.2% by NDM. Onychomycosis resulted more frequent in the age group 15-64 years old (63%). Aspergillus spp. were found in 19 patients from 22 patients with NDM onychomycosis. Males (11 patients) and the age group 15-64 years old (14 patients) were more vulnerable to Aspergillus spp. A. niger, A. flavus, and A. terreus isolated from the nail cultures in our study. The culture resulted more superior to KOH examinations. CONCLUSIONS Our study indicates that NDM, including Aspergillus spp., are still rare findings from fungal examinations. However, dermatologist's clinical suspicion and microbiologist's skills are mandatory in diagnosing and properly managing patients with Aspergillus spp.
Collapse
Affiliation(s)
- Monika Fida
- Dermatology Department, University of Medicine of Tirana, Tirana, Albania
- University of Medicine of Tirana, Tirana, Albania
- University Hospital Center "Mother Teresa", Tirana, Albania
| | | | - Najada Gjylameti
- Alpha Diagnostic Center, University of Medicine of Tirana, Tirana, Albania
| | - Sabina Dedej
- University Hospital Center "Mother Teresa", Tirana, Albania
| | | | - Ervin Toçi
- University of Medicine of Tirana, Tirana, Albania
| | - Ermira Vasili
- Dermatology Department, University of Medicine of Tirana, Tirana, Albania
- University of Medicine of Tirana, Tirana, Albania
- University Hospital Center "Mother Teresa", Tirana, Albania
| |
Collapse
|
5
|
Lipner SR, Falotico JM, Konda A. On the Basis of Sex: Impact and Treatment of Toenail Onychomycosis in Female Patients. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2023; 16:52-57. [PMID: 37915332 PMCID: PMC10617899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Onychomycosis is a fungal infection of the nail unit affecting approximately five percent of the global population and representing 50 percent of all nail dystrophies seen in clinical practice. Patients with onychomycosis can suffer significant pain in addition to physical and psychological distress, which may seriously impair their quality of life (QoL). It is well established that onychomycosis prevalence is impacted by patient characteristics, including age and systemic comorbidities. However, the impact of patient sex on onychomycosis occurrence and treatment is not well characterized. This narrative review of the literature was conducted to address a dearth of published information on epidemiology, QoL, clinical trial participation, and treatment success specifically in female patients with onychomycosis. Additionally, an analysis of real-world treatment of onychomycosis in female patients is reported, including prescription patterns and the impact of toenail polish on topical treatments for onychomycosis. Understanding sex as a clinically relevant variable may inform onychomycosis treatment strategies and improve treatment outcomes.
Collapse
Affiliation(s)
- Shari R Lipner
- Dr. Lipner is with the Department of Dermatology at Weill Cornell Medicine in New York, New York
| | - Julianne M Falotico
- Dr. Falotico is with the Renaissance School of Medicine at Stony Brook University in Stony Brook, New York
| | - Adarsh Konda
- Dr. Konda is with Ortho Dermatologics, a division of Bausch Health US, LLC, in Bridgewater, New Jersey
| |
Collapse
|
6
|
Petrokilidou C, Gaitanis G, Velegraki A, Bassukas ID, Kourkoumelis N. Treatment of nail clippings with ethyl alcohol improves the efficacy of Raman spectroscopy in the diagnosis of Trichophyton rubrum onychomycosis. JOURNAL OF BIOPHOTONICS 2023:e202300040. [PMID: 37071082 DOI: 10.1002/jbio.202300040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 06/19/2023]
Abstract
The purpose of this work was to enhance the diagnostic accuracy of nail Raman spectroscopy for fungal nail infections, specifically onychomycosis caused by Trichophyton rubrum. The study assessed the different ethyl alcohol retention rates between control and infected nails after soaking nail clippings in ethanolic solutions and drying. Results revealed that ethyl alcohol completely evaporated from infected nail samples, while significant amounts were still present in control samples. Principal component analysis (PCA) was applied to discriminate control from infected nails and showed superior group separation when nails were treated with ethyl alcohol. PCA loadings plot attributed the efficient classification to the νs (CCO) Raman vibrational mode of ethyl alcohol. As Raman spectroscopy can detect minute concentration changes of ethyl alcohol in nails and the deterioration caused by onychomycosis accelerates its evaporation, a simple and rapid method for detecting T. rubrum onychomycosis is proposed.
Collapse
Affiliation(s)
- Chrysoula Petrokilidou
- Department of Medical Physics, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Aristea Velegraki
- Mycology Research Laboratory and UOA/HCPF Culture Collection, Microbiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Mycology Laboratory, BIOMEDICINE S.A., Athens, Greece
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Nikolaos Kourkoumelis
- Department of Medical Physics, School of Health Sciences, University of Ioannina, Ioannina, Greece
| |
Collapse
|
7
|
Villar Rodríguez J, Pérez Pico AM, García Blázquez FM, Morán Cortés JF, Mayordomo Acevedo R. Evaluation of Thermography as a Diagnostic Technique in Asymptomatic or Incipient Onychomycosis. J Fungi (Basel) 2023; 9:jof9040444. [PMID: 37108899 PMCID: PMC10144260 DOI: 10.3390/jof9040444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/16/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
Onychomycosis is usually diagnosed symptomatically due to the very clear signs caused by the fungus on the nail surface and structure, although the growth of the infecting agent must also be verified by culture in an enriched medium. This procedure is normally lengthy (four weeks), and samples can be contaminated, delaying the prescription of appropriate and effective treatment. Only one previous study has addressed the possibility of using thermography as a diagnostic method for onychomycosis in older people (31–70 years). The present study confirms this use but in individuals aged 18–31 years with incipient mycosis and no pathological signs. Using an FLIR E60 BX camera in a study with 214 samples, we found that men had more onychomycosis than women. We observed a relation between the presence of infection and nail temperature, with a higher temperature in yeast infections (+1 °C) and a lower temperature in dermatophyte infections (−2 °C). A higher temperature by almost 1 °C was also observed in older participants. Thermography can be viewed as a new diagnostic method in asymptomatic or incipient onychomycosis, providing the thermographic camera is sufficiently sensitive and the appropriate procedure is followed, although fungal culture is always necessary to confirm recovery after treatment.
Collapse
Affiliation(s)
- Julia Villar Rodríguez
- Department of Anatomy, Cellular Biology and Zoology, Centro Universitario de Plasencia, Universidad de Extremadura, 10600 Plasencia, Spain
| | - Ana María Pérez Pico
- Department of Nursing, Centro Universitario de Plasencia, Universidad de Extremadura, 10600 Plasencia, Spain
| | | | - Juan Francisco Morán Cortés
- Department of Nursing, Centro Universitario de Plasencia, Universidad de Extremadura, 10600 Plasencia, Spain
| | - Raquel Mayordomo Acevedo
- Department of Anatomy, Cellular Biology and Zoology, Centro Universitario de Plasencia, Universidad de Extremadura, 10600 Plasencia, Spain
| |
Collapse
|
8
|
Song G, Zhang M, Liu W, Liang G. Epidemiology of Onychomycosis in Chinese Mainland: A 30-year Retrospective Study. Mycopathologia 2022; 187:323-331. [PMID: 35819711 DOI: 10.1007/s11046-022-00647-4] [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: 11/24/2021] [Accepted: 06/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Onychomycosis was a common nail disease caused by dermatophytes, yeasts or molds. The prevalence of onychomycosis varied in different counties and it was necessary to understand the epidemiology in China. OBJECTIVES This study was conducted to investigate the epidemiology of onychomycosis in Chinese mainland in the past 30 years. METHODS A 30-year systemic review was carried out by searching publications investigating the prevalence of onychomycosis in Chinese mainland from 1991 to 2020. RESULTS A total of 90 articles involving more than 40,000 onychomycosis patients were enrolled in this study. The ratio of males to females was 1:1.32. Fingernail onychomycosis was found in 36.12% cases, toenail onychomycosis in 48.31%, and both fingernail and toenail onychomycosis in 15.57%. The most common clinical type of onychomycosis was distal lateral subungual onychomycosis (60.99%), followed by total dystrophic onychomycosis (18.91%), proximal subungual onychomycosis (10.19%) and superficial white onychomycosis (9.92%). Dermatophytes (60.59%) were the most frequently isolated pathogens, followed by yeasts (30.09%), molds (7.91%) and mixed infection (1.41%). The primary pathogens in dermatophytes, yeasts and molds were Trichophyton rubrum (49.93%), Candida albicans (10.99%) and Aspergillus (3.11%), respectively. Additionally, dermatophytes were more commonly affected males than females (63.69% vs. 51.57%), and mostly involved in toenail onychomycosis (75.63%). The infection of yeasts was higher in females than males (40.97% vs. 29.52%), often causing onychomycosis in fingernail than toenail (41.03% vs. 17.08%), and it was more common in warm and humid southern regions than northern area (34.07% vs. 24.41%). CONCLUSION The proportion of the causative agents changed over time, dermatophytes, especially T. rubrum had always been the predominant pathogen, followed by yeasts and molds. The distribution of fungal pathogens varied among clinical types, gender, infection sites and geography gender.
Collapse
Affiliation(s)
- Ge Song
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, 210042, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.,CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China.,Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China
| | - Meijie Zhang
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, 210042, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.,CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China.,Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China
| | - Weida Liu
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, 210042, China. .,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China. .,CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China. .,Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China.
| | - Guanzhao Liang
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, 210042, China. .,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China. .,CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China. .,Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China.
| |
Collapse
|
9
|
Bitew A, Osman F, Yassin S. Non-Dermatophyte Mold Dominated Onychomycosis in Patients Attending a Rank Higher Specialized Dermatology Clinic in Addis Ababa, Ethiopia. Clin Cosmet Investig Dermatol 2022; 15:507-518. [PMID: 35356385 PMCID: PMC8958195 DOI: 10.2147/ccid.s357738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/12/2022] [Indexed: 01/19/2023]
Abstract
Background Onychomycosis is a common refractory fungal infection associated with significant morbidity. The objective of this study was to determine the prevalence of onychomycosis, and the diversity and species composition of fungal etiological agents. Materials and Methods A clinic-based, prospective, non-randomized cross-sectional study was carried out between October 2018 and June 2019 at Rank Higher Specialized Dermatology Clinic, Addis Ababa, Ethiopia. Nail scrapings were collected aseptically from 200 patients clinically identified with nail disorders of fungal origin by dermatologists. Fungal etiological agents were identified microscopically and by culture method following standard procedures. Results Among 200 nail scrapings, 161 (80.5%) samples were found out to be culture positive. Of these, 135 (83.9%) samples yielded single colonies while 26 (16.1%) mixed colonies gave a total of 190 isolates. Among the isolates, 25.8% were dermatophytes while 61.1% were non- dermatophytes molds, and 13.1% were yeasts. Females were more likely to present dystrophic nails than men. Patients in the middle age group were more affected. Trichophyton interdigitale, Aspergillus spp, and Candida albicans were the dominant species. Conclusion The prevalence rate of onychomycosis in the present study was high. The isolation rate of non-dermatophyte molds was higher than dermatophytes and yeasts. Trichophyton interdigitale, Aspergillus spp, and Candida albicans were the dominant etiological agents. Females and patients in the middle age group were more affected. An increase in the prevalence of non-dermatophyte molds in nail infections dictates further investigation demonstrating how this group of fungi causes onychomycosis.
Collapse
Affiliation(s)
- Adane Bitew
- Department of Medical Laboratory Science, College Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Feruza Osman
- Saint Peter's Specialized Tuberculosis Referral Hospital, Addis Ababa, Addis Ababa Administrative Region, Ethiopia
| | - Seid Yassin
- International Care and Treatment for HIV/AIDS Program, Emergency Operation Center, Addis Ababa, Ethiopia
| |
Collapse
|
10
|
Razavyoon T, Hashemi SJ, Mansouri P, Rafat Z, Saboor-Yaraghi AA, Kamali Sarvestani H, Ghasemi Z. The epidemiology and etiology of onychomycosis in 2 laboratory centers affiliated to Tehran university of medical sciences during 2019-2020. IRANIAN JOURNAL OF MICROBIOLOGY 2022; 14:268-275. [PMID: 35765553 PMCID: PMC9168250 DOI: 10.18502/ijm.v14i2.9196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background and Objectives Onychomycosis is caused by dermatophyte species, non-dermatophyte moulds (NDMs), and accounts for roughly 50% of all nail diseases. As the prevalence of onychomycosis is increasing, new epidemiologic documents may help with treatment and prevention. The present investigation aims to determine the epidemiological profile of onychomycosis in 2 mycology laboratories. Materials and Methods A cross-sectional study conducted during eight months (2019-2020) on 169 patients with positive nail mycology tests referred to two mycological laboratory centers affiliated with Tehran University of Medical Science. The nail clippings were examined by direct smear and culture. Also, molecular assays were performed if needed. Results 10% of nail lesions referred to Razi Hospital (RH), and 30% of nail lesions referred to TUMS mycology laboratory were positive. Middle age (40-60) suffer more from onychomycosis. Aspergillus flavus, Trichophyton mentagrophytes, and Candida albicans were the most common etiologic agents in each of the three main classes of fungi causing onychomycosis. Females were more infected. NDMs were the predominant etiologic agents, and toenails were the most common site of onychomycosis. Conclusion The pattern of etiologic agents and clinical signs of onychomycosis differs according to geographical region and age, so repeated epidemiological surveys of onychomycosis seem to be fundamental.
Collapse
Affiliation(s)
- Taraneh Razavyoon
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Jamal Hashemi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvin Mansouri
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Rafat
- Department of Medical Parasitology and Mycology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Akbar Saboor-Yaraghi
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hasti Kamali Sarvestani
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Ghasemi
- Department of Medical Mycology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
11
|
Gupta AK, Venkataraman M, Talukder M. Onychomycosis in Older Adults: Prevalence, Diagnosis, and Management. Drugs Aging 2022; 39:191-198. [PMID: 35102533 DOI: 10.1007/s40266-021-00917-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/03/2022]
Abstract
The risk of having onychomycosis increases with age. Data suggest that the prevalence of onychomycosis may be ≥ 20% in subjects aged ≥ 60 years and ≥ 50% in those aged ≥ 70 years. Older males are 2.1 times more prone to onychomycosis than are females. Although most nail dystrophies (approximately 50%) are caused by onychomycosis, proper clinical assessment followed by mycological examination is recommended to exclude other conditions such as nail trauma, lichen planus, and psoriasis. The US FDA-approved onychomycosis treatments are systemic antifungals (terbinafine and itraconazole) for severe onychomycosis and topical antifungals (ciclopirox 8%, efinaconazole 10%, and tavaborole 5%) for mild-to-moderate onychomycosis. Oral fluconazole is used off-label, and itraconazole may be considered for non-dermatophyte onychomycosis. Recently, fosravuconazole was approved in Japan for onychomycosis treatment. Although the treatment options and durations are the same for older patients as for other age groups, a clinical decision should take into account various age-related factors such as comorbidities, polypharmacy, hepatic and renal insufficiency, and noncompliance. Clinicians should also consider possible drug interactions and side effects when choosing a particular antifungal. Since the recurrence rate of onychomycosis is high, older patients should practice sanitization techniques, consider lifestyle changes, and perhaps consider using a topical antifungal as long-term maintenance therapy one to three times per week to prevent the recurrence of onychomycosis or to treat early disease.
Collapse
Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc., 645 Windermere Road, London, ON, N5X 2P1, Canada. .,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | | | - Mesbah Talukder
- Mediprobe Research Inc., 645 Windermere Road, London, ON, N5X 2P1, Canada
| |
Collapse
|
12
|
Segal E, Elad D. Human and Zoonotic Dermatophytoses: Epidemiological Aspects. Front Microbiol 2021; 12:713532. [PMID: 34421872 PMCID: PMC8378940 DOI: 10.3389/fmicb.2021.713532] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/09/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction Dermatophytes are a group of molds characterized by the ability to produce keratinases, thereby carving out for themselves specific ecological niches. Their traditional division into three genera, Trichophyton, Microsporum, and Epidermophyton has been expanded to nine and the species in each genus were modified. Dermatophytes are among the most prevalent causes of human and animal mycoses. Their epidemiology is influenced by various factors. These factors may be evolutive such as the predilected environment of the fungus, namely, humans (anthropophilic), animals (zoophilic), or environment (geophilic), is evolutionary and thus may require centuries to develop. Many other factors, however, result from a variety of causes, affecting the epidemiology of dermatophytoses within a shorter time frame. Objective This review aims at summarizing the factors that have modified the epidemiology of dermatophytoses during the last decades. Results Geographic and climatic conditions, demography such as age and gender, migration, socio-economic conditions, lifestyle, and the environment have had an impact on changes in the epidemiology of dermatophytoses, as have changes in the pattern of human interaction with animals, including pets, farm, and wild animals. A typical example of such changes is the increased prevalence of Trichophyton tonsurans, which spread from Latin America to the United States and subsequently becoming a frequent etiological agent of tinea capitis in Africa, Middle East, and other areas. Conclusion The comprehension of the epidemiology of dermatophytoses has a major bearing on their prevention and treatment. Since it is undergoing continuous changes, periodic assessments of the most recent developments of this topic are required. This article aims at providing such an overview.
Collapse
Affiliation(s)
- Esther Segal
- Sackler School of Medicine, Department of Clinical Microbiology and Immunology, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Elad
- Department of Clinical Bacteriology and Mycology, Kimron Veterinary Institute, Bet Dagan, Israel
| |
Collapse
|