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Balakirski G, Löser CR. [Common nail diseases in children and adolescents : Recognize, advise, treat]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:199-212. [PMID: 36745230 PMCID: PMC9900549 DOI: 10.1007/s00105-022-05106-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 06/18/2023]
Abstract
There are a number of nail diseases that primarily occur in children and adolescents. Many of these nail changes are physiologic and are only transient. Thus, they do not need any therapy. Infectious nail diseases or nail involvement in chronic inflammatory dermatoses can be found in both children and adults, and may require specific treatment. Nail pigmentation such as longitudinal melanonychia occur significantly less frequently in children than in adult patients, and have different causes and a better prognosis. Knowledge about these child-specific peculiarities of nail diseases is necessary in order to provide the best possible advice to parents and to offer appropriate treatment. This article focuses on the most common and important nail diseases in children and adolescents and their treatment.
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Affiliation(s)
- Galina Balakirski
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal, Deutschland
| | - Christoph R Löser
- Hautklinik, Hauttumorzentrum, Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Bremserstr. 79, 67063, Ludwigshafen, Deutschland.
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Rosalie S, Lize C, Laurence S, Rajae D, Caroline A, Katrien L, Marie-Pierre H. Epidemiology of Dermatophytes in Belgium: A 5 Years' Survey. Mycopathologia 2021; 186:399-409. [PMID: 33900539 DOI: 10.1007/s11046-021-00542-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 03/15/2021] [Indexed: 01/01/2023]
Abstract
Dermatophytes are among the most common fungal agents causing superficial skin infections worldwide. Epidemiology of these infections is evolving and variable in every country. This report presents the Belgian epidemiological data regarding the distribution of dermatophytes species isolated by the two national reference centers for mycosis during a period of 5 years (2012-2016). Trichophyton rubrum was the most frequently isolated species, considering all sampling sites (60.3% on average between 2012 and 2016). More precisely, this dermatophyte was the major agent of Tinea unguium and Tinea corporis during this period, followed by species of the Trichophyton mentagrophytes complex. Moreover, Microsporum audouinii was the main etiological agent of Tinea capitis (TC) with a frequency of 52.5% on average between 2012 and 2016. Other African dermatophytes species such as Trichophyton soudanense and Trichophyton violaceum were also agents of TC with a respective prevalence of 11.6% and 11.5% on average. This study highlights a different dermatophyte distribution in Belgium in comparison with other European countries.
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Affiliation(s)
- Sacheli Rosalie
- Department of Clinical Microbiology, Belgian National Reference Center, University Hospital of Liege, Liège, Belgium.
| | - Cuypers Lize
- Laboratory of Clinical Bacteriology and Mycology, Belgian National Reference Center, University Hospital of Leuven, Leuven, Belgium
| | - Seidel Laurence
- Department of Biostatistics, University Hospital of Liege, Liege, Belgium
| | - Darfouf Rajae
- Department of Clinical Microbiology, Belgian National Reference Center, University Hospital of Liege, Liège, Belgium
| | - Adjetey Caroline
- Department of Clinical Microbiology, Belgian National Reference Center, University Hospital of Liege, Liège, Belgium
| | - Lagrou Katrien
- Laboratory of Clinical Bacteriology and Mycology, Belgian National Reference Center, University Hospital of Leuven, Leuven, Belgium
| | - Hayette Marie-Pierre
- Department of Clinical Microbiology, Belgian National Reference Center, University Hospital of Liege, Liège, Belgium
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João AL, Lencastre A, Dutra E, Pessoa e Costa T, Formiga A, Neves J. Fusarium spp.—An Emerging Pathogen in Chronic Diabetic Ulcer: Case Report and Review of the Literature. INT J LOW EXTR WOUND 2019; 20:67-72. [DOI: 10.1177/1534734619879030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The genus Fusarium is ubiquitous in the environment and has been emerging as an opportunistic human pathogen. We report the case of a 65-year-old man with a history of neuroischemic, otherwise unamenable to revascularization, diabetic foot, who was admitted due to an infected deep foot ulcer. Despite conventional antibiotic and wound care treatment, no improvement was initially observed. A reappraisal of the diagnosis, with microbiological and histological analyses, documented infection of the foot ulcer with Fusarium oxysporum. Clinical improvement was noted under prolonged oral voriconazole therapy. The present case broadens the differential diagnosis of diabetic foot infection. Subcutaneous fusariosis should be considered in recalcitrant infected diabetic ulcers, as early diagnosis and management may help prevent amputation and life-threatening disease.
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Affiliation(s)
- Ana Luísa João
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de Lisboa Central
| | - André Lencastre
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de Lisboa Central
| | - Eduardo Dutra
- Pathology Department, Centro Hospitalar Universitário de Lisboa Central
| | - Tomás Pessoa e Costa
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de Lisboa Central
| | - Ana Formiga
- Diabetic Foot Unit, General Surgery Department, Centro Hospitalar Universitário de Lisboa Central
| | - José Neves
- Diabetic Foot Unit, General Surgery Department, Centro Hospitalar Universitário de Lisboa Central
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Baranová Z, Kampe T, Dorko E, Rimárová K. Epidemiological and clinical aspects of dermatophytoses in Eastern Slovakia: a retrospective three-year study. Cent Eur J Public Health 2018; 26 Suppl:S72-S75. [DOI: 10.21101/cejph.a5279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 08/27/2018] [Indexed: 11/15/2022]
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Abstract
Fusarium is an emerging human opportunistic pathogen of growing importance, especially among immunosuppressed haematology patients due to an increased incidence of disseminated infections over the past two decades. This trend is expected only to continue due to the advances in medical and surgical technologies that will prolong the lives of the severely ill, making these patients susceptible to rare opportunistic infections. Production of mycotoxins, enzymes such as proteases, angio-invasive property and an intrinsically resistant nature, makes this genus very difficult to treat. Fusarium is frequently isolated from the cornea and less commonly from nail, skin, blood, tissue, Continuous Ambulatory Peritoneal Dialysis (CAPD) fluid, urine and pleural fluid. Conventional microscopy establishes the genus, but accurate speciation requires multilocus sequence typing with housekeeping genes such as internal transcribed spacer, translation elongation factor-1α and RPB1 and 2 (largest and second largest subunits of RNA polymerase), for which expansive internet databases exist. Identifying pathogenic species is of epidemiological significance, and the treatment includes immune reconstitution by granulocyte-colony-stimulating factor, granulocyte macrophage-colony-stimulating factor and a combination of the most active species - specific antifungals, typically liposomal amphotericin-B and voriconazole. However, patient outcome is difficult to predict even with in vitro susceptibility with these drugs. Therefore, prevention methods and antifungal prophylaxis have to be taken seriously for these vulnerable patients by vigilant healthcare workers. The current available literature on PubMed and Google Scholar using search terms 'Fusarium', 'opportunistic invasive fungi' and 'invasive fusariosis' was summarised for this review.
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Affiliation(s)
- Ananya Tupaki-Sreepurna
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
| | - Anupma Jyoti Kindo
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
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Wollina U, Nenoff P, Haroske G, Haenssle HA. The Diagnosis and Treatment of Nail Disorders. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 113:509-18. [PMID: 27545710 DOI: 10.3238/arztebl.2016.0509] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/25/2016] [Accepted: 04/25/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Nail disorders can arise at any age. About half of all nail disorders are of infectious origin, 15% are due to inflammatory or metabolic conditions, and 5% are due to malignancies and pigment disturbances. The differential diagnosis of nail disorders is often an area of uncertainty. METHODS This review is based on publications and guidelines retrieved by a selective search in PubMed, including Cochrane reviews, meta-analyses, and AWMF guidelines. RESULTS Nail disorders are a common reason for derma - tologic consultation. They are assessed by clinical inspection, dermatoscopy, diagnostic imaging, microbiological (including mycological) testing, and histopathological examination. Some 10% of the overall population suffers from onychomycosis, with a point prevalence of around 15%. Bacterial infections of the nails are rarer than fungal colonization. High-risk groups for nail disorders include diabetics, dialysis patients, transplant recipients, and cancer patients. Malignant tumors of the nails are often not correctly diagnosed at first. For subungual melanoma, the mean time from the initial symptom to the correct diagnosis is approximately 2 years; this delay is partly responsible for the low 10-year survival rate of only 43%. CONCLUSION Evaluation of the nail organ is an important diagnostic instrument. Aside from onychomycosis, which is a common nail disorder, important differential diagnoses such as malignant diseases, drug side effects, and bacterial infections must be considered.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Dresden-Friedrichstadt Hospital, Academic Teaching Hospital of the Technical University of Dresden, Laboratory for Medical Microbiology, Mölbis, Georg Schmorl Institute of Pathology, Dresden-Friedrichstadt Hospital, Academic Teaching Hospital of the Technical University of Dresden, Department of Dermatology, Heidelberg University Hospital
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Zhong A, Li G, Wang D, Sun Y, Zou X, Li B. The risks and external effects of diabetic foot ulcer on diabetic patients: A hospital-based survey in Wuhan area, China. Wound Repair Regen 2017; 25:858-863. [PMID: 29052949 DOI: 10.1111/wrr.12589] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/18/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Aimei Zhong
- Department of Plastic Surgery; Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
| | - Gongchi Li
- Department of Hand Surgery; Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
| | - Dan Wang
- Department of Wound Repair Surgery; Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
| | - Yi Sun
- School of Public Health; Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
| | - Xinghua Zou
- Department of Wound Repair Surgery; Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
| | - Binghui Li
- Department of Wound Repair Surgery; Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
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Otašević S, Barac A, Pekmezovic M, Tasic S, Ignjatović A, Momčilović S, Stojanović P, Arsic Arsenijevic V, Hay R. The prevalence of Candida onychomycosis in Southeastern Serbia from 2011 to 2015. Mycoses 2015; 59:167-72. [PMID: 26710983 DOI: 10.1111/myc.12448] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 10/22/2015] [Accepted: 11/18/2015] [Indexed: 12/01/2022]
Abstract
Despite the increasing of onychomycosis caused by Candida spp., in referent literature, there is still data insufficiency about this nail infection. The objectives of this retrospective study were to determine epidemiological characteristics of Candida onychomycosis, the antifungal susceptibility of isolated species in vitro, and to compare the results of antifungal susceptibility testing with conducted treatment in period from 2011 to the end of March 2015. Out of 761 patients who were underwent clinical and mycological examinations, 137 had Candida species isolated from nails. The dominant species was Candida albicans (C. albicans) (36.59%) followed by C. parapsilosis (23.78%), C. krusei (9.76%), and C. guilliermondii (6.71%). Antifungal susceptibility in vitro testing showed good susceptibility to antimycotics, except C. krusei, which was resistance to fluconazole (FCZ) and isolates of C. tropicalis and C. glabrata which were dose dependent to itraconazole (ITZ) and fluconazole. Evaluation of medical histories determined that combined therapy, which included pulsed systemic regimen of ITZ with topical application of clotrimazole, had better clinical outcomes regarding the proscribed only topical application of clotrimazole. Multidisciplinary approach of dermatologists and mycologists is required in solving the problem of onychomycosis, which is the dominant nail disease.
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Affiliation(s)
- Suzana Otašević
- Center of Microbiology and Parasitology, Public Health Institute Niš, Niš, Serbia.,Department of Microbiology and Immunology, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Aleksandra Barac
- Department of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marina Pekmezovic
- Department of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sinisa Tasic
- Clinic for skin and veneral diseases, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Aleksandra Ignjatović
- Center of Microbiology and Parasitology, Public Health Institute Niš, Niš, Serbia.,Department of Medical Statistics, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Stefan Momčilović
- Department of Microbiology and Immunology, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Predrag Stojanović
- Center of Microbiology and Parasitology, Public Health Institute Niš, Niš, Serbia.,Department of Microbiology and Immunology, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Valentina Arsic Arsenijevic
- Department of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,National Medical Mycology Reference Laboratory, Department of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Roderick Hay
- Department of Dermatology, Skin Infection Clinic, Kings College Hospital NHS Trust, London, UK
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Papini M, Piraccini BM, Difonzo E, Brunoro A. Epidemiology of onychomycosis in Italy: prevalence data and risk factor identification. Mycoses 2015; 58:659-64. [DOI: 10.1111/myc.12396] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/04/2015] [Accepted: 08/17/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Manuela Papini
- Department of Surgery and Biomedicine; Dermatologic Clinic of Terni; University of Perugia; Perugia Italy
| | - Bianca Maria Piraccini
- Division of Dermatology; Department of Experimental Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - Elisa Difonzo
- Department of Surgery and Translational Medicine; Section of Dermatology; University of Florence; Florence Italy
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Ghannoum M, Isham N, Long L. In vitro antifungal activity of ME1111, a new topical agent for onychomycosis, against clinical isolates of dermatophytes. Antimicrob Agents Chemother 2015; 59:5154-8. [PMID: 26055386 PMCID: PMC4538469 DOI: 10.1128/aac.00992-15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 06/04/2015] [Indexed: 11/20/2022] Open
Abstract
The treatment of onychomycosis has improved considerably over the past several decades following the introduction of the oral antifungals terbinafine and itraconazole. However, these oral agents suffer from certain disadvantages, including drug interactions and potential liver toxicity. Thus, there is a need for new topical agents that are effective against onychomycosis. ME1111 is a novel selective inhibitor of succinate dehydrogenase (complex II) of dermatophyte species, whose small molecular weight enhances its ability to penetrate the nail plate. In this study, we determined the antifungal activity of ME1111 against dermatophyte strains, most of which are known to cause nail infections, as measured by the MIC (n = 400) and the minimum fungicidal concentration (MFC) (n = 300). Additionally, we examined the potential for resistance development in dermatophytes (n = 4) following repeated exposure to ME1111. Our data show that the MIC90 of ME1111 against dermatophyte strains was 0.25 μg/ml, which was equivalent to that of the comparators amorolfine and ciclopirox (0.25 and 0.5 μg/ml, respectively). ME1111 was fungicidal at clinically achievable concentrations against dermatophytes, and its MFC90s against Trichophyton rubrum and Trichophyton mentagrophytes were 8 μg/ml, comparable to those of ciclopirox. Furthermore, ME1111, as well as ciclopirox, did not induce resistance in 4 dermatophytes tested. Our studies show that ME1111 possesses potent antifungal activity and suggest that it has low potential for the development of resistance in dermatophytes.
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Affiliation(s)
- M Ghannoum
- Center for Medical Mycology, Case Western Reserve University, and University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - N Isham
- Center for Medical Mycology, Case Western Reserve University, and University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - L Long
- Center for Medical Mycology, Case Western Reserve University, and University Hospitals Case Medical Center, Cleveland, Ohio, USA
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Abstract
Infections of the finger and the toe nails are most frequently caused by fungi, primarily dermatophytes. Causative agents of tinea unguium are mostly anthropophilic dermatophytes. Both in Germany, and worldwide, Trichophyton rubrum represents the main important causative agent of onychomycoses. Yeasts are isolated from fungal nail infections, both paronychia and onychomycosis far more often than generally expected. This can represent either saprophytic colonization as well as acute or chronic infection of the nail organ. The main yeasts causing nail infections are Candida parapsilosis, and Candida guilliermondii; Candida albicans is only in third place. Onychomycosis due to molds, or so called non-dermatophyte molds (NDM), are being increasingly detected. Molds as cause of an onychomycosis are considered as emerging pathogens. Fusarium species are the most common cause of NDM onychomycosis; however, rare molds like Onychocola canadensis may be found. Bacterial infections of the nails are caused by gram negative bacteria, usually Pseudomonas aeruginosa (recognizable because of green or black coloration of the nails) but also Klebsiella spp. and gram positive bacteria like Staphylococcus aureus. Treatment of onychomycosis includes application of topical antifungal agents (amorolfine, ciclopirox). If more than 50 % of the nail plate is affected or if more than three out of ten nails are affected by the fungal infection, oral treatment using terbinafine (in case of dermatophyte infection), fluconazole (for yeast infections), or alternatively itraconazole are recommended. Bacterial infections are treated topically with antiseptic agents (octenidine), and in some cases with topical antibiotics (nadifloxacin, gentamicin). Pseudomonas infections of the nail organ are treated by ciprofloxacin; other bacteria are treated according to the results of culture and sensitivity testing.
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12
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Pires CAA, Cruz NFSD, Lobato AM, Sousa POD, Carneiro FRO, Mendes AMD. Clinical, epidemiological, and therapeutic profile of dermatophytosis. An Bras Dermatol 2014; 89:259-64. [PMID: 24770502 PMCID: PMC4008056 DOI: 10.1590/abd1806-4841.20142569] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 04/25/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The cutaneous mycoses, mainly caused by dermatophyte fungi, are among the most
common fungal infections worldwide. It is estimated that 10% to 15% of the
population will be infected by a dermatophyte at some point in their lives, thus
making this a group of diseases with great public health importance. OBJECTIVE To analyze the clinical, epidemiological, and therapeutic profile of
dermatophytosis in patients enrolled at the Dermatology service of Universidade do
Estado do Pará, Brazil, from July 2010 to September 2012. METHOD A total of 145 medical records of patients diagnosed with dermatophytosis were
surveyed. Data were collected and subsequently recorded according to a protocol
developed by the researchers. This protocol consisted of information regarding
epidemiological and clinical aspects of the disease and the therapy employed. RESULTS The main clinical form of dermatophyte infection was onychomycosis, followed by
tinea corporis, tinea pedis, and tinea capitis. Furthermore, the female population
and the age group of 51 to 60 years were the most affected. Regarding therapy,
there was a preference for treatments that combine topical and systemic drugs, and
the most widely used drugs were fluconazole (systemic) and ciclopirox olamine
(topical). CONCLUSION This study showed the importance of recurrent analysis of the epidemiological
profile of dermatophytosis to enable correct therapeutic and preventive management
of these conditions, which have significant clinical consequences, with chronic,
difficult-totreat lesions that can decrease patient quality of life and cause
disfigurement.
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Chegour H, El Ansari N, El Mghari G, Tali A, Zoughaghi L, Sebbani M, Amine M. [What agents incriminated in athlete's foot? Survey of consulting diabetic patients in CHU Mohammed VI Marrakech]. Pan Afr Med J 2014; 17:228. [PMID: 25170372 PMCID: PMC4145271 DOI: 10.11604/pamj.2014.17.228.3131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 03/05/2014] [Indexed: 11/11/2022] Open
Abstract
Les infections mycosiques du pied constituent un motif fréquent de consultation chez les diabétiques, le diabète constituant à la fois un facteur favorisant et aggravant les lésions cutanéomuqueuses. L'objectif de ce travail était d'identifier la flore mycologique locale responsable des lésions du pied chez le diabétique et déterminer les facteurs favorisant la survenue de mycoses. Il s'agissait d'une étude transversale intéressant des diabétiques suivis en consultation; un prélèvement mycologique, avec examen direct et culture, a été réalisé devant toute suspicion clinique de lésion mycosique. Quatre-vingt-deux patients ont été inclus. L'hémoglobine glycosylée moyenne a été de9,2% ± 2,23. Un intertrigo inter orteil a été noté dans 90,2% des cas; l'examen mycologique était positif dans 64,8% des cas, avec 18 cas de Trichophyton rubrum et 11 cas de Candida albicans. Une atteinte unguéale a été suspectée chez 65,9% patients; la culture a mis en évidence un Trichosporon pathogène chez sept patients, un Candida albicansdans six cas, un Trichophyton rubrum dans quatre cas, avec trois cas de Trichophyton mentagrophytes et deux cas de Scytalidium dimidiatum. L’étude analytique, après confirmation mycologique, en fonction des principales caractéristiques des patients a montré que l'atteinte mycosique du pied est significativement corrélée au déséquilibre glycémique. Ce travail a montré la prédominance du Trichophyton rubrum dans les lésions d'intertrigo inter orteil et du Trichosporon dans les onychomycoses, avec une prédominance globale plus globale plus élevée du TR.
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Affiliation(s)
- Hakima Chegour
- Service d''Endocrinologie Diabétologie et maladies Métaboliques, Maroc, Laboratoire de recherche de Pneumo-Cardio-Immunopathologie et Métabolisme, CHU Mohammed VI Marrakech, Faculté de Médecine et de Pharmacie de Marrakech, Université CaddiAyad, Marrakech, Maroc
| | - Nawal El Ansari
- Service d''Endocrinologie Diabétologie et maladies Métaboliques, Maroc, Laboratoire de recherche de Pneumo-Cardio-Immunopathologie et Métabolisme, CHU Mohammed VI Marrakech, Faculté de Médecine et de Pharmacie de Marrakech, Université CaddiAyad, Marrakech, Maroc
| | - Ghizlane El Mghari
- Service d''Endocrinologie Diabétologie et maladies Métaboliques, Maroc, Laboratoire de recherche de Pneumo-Cardio-Immunopathologie et Métabolisme, CHU Mohammed VI Marrakech, Faculté de Médecine et de Pharmacie de Marrakech, Université CaddiAyad, Marrakech, Maroc
| | - Abdelali Tali
- laboratoire de mycologie parasitologie, CHU Mohammed VI Marrakech, Maroc
| | - Laila Zoughaghi
- laboratoire de mycologie parasitologie, CHU Mohammed VI Marrakech, Maroc
| | - Majda Sebbani
- laboratoire d'épidémiologie, laboratoire de recherche de pneumo-cardio-immunopathologie et métabolisme, Faculté de Médecine et de Pharmacie de Marrakech, UCAM
| | - Mohamed Amine
- laboratoire d'épidémiologie, laboratoire de recherche de pneumo-cardio-immunopathologie et métabolisme, Faculté de Médecine et de Pharmacie de Marrakech, UCAM
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14
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Affiliation(s)
- Mahmoud Ghannoum
- Center for Medical Mycology, University Hospitals of Cleveland, Cleveland, Ohio, United States of America
- * E-mail:
| | - Nancy Isham
- Center for Medical Mycology, University Hospitals of Cleveland, Cleveland, Ohio, United States of America
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Nenoff P, Krüger C, Ginter-Hanselmayer G, Tietz HJ. Mycology - an update. Part 1: Dermatomycoses: causative agents, epidemiology and pathogenesis. J Dtsch Dermatol Ges 2014; 12:188-209; quiz 210, 188-211; quiz 212. [PMID: 24533779 DOI: 10.1111/ddg.12245] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 09/19/2013] [Indexed: 02/05/2023]
Abstract
Dermatomycoses are caused most commonly by dermatophytes. The anthropophilic dermatophyte Trichophyton rubrum is still the most frequent causative agent worldwide. Keratinolytic enzymes, e.g. hydrolases and keratinases, are important virulence factors of T. rubrum. Recently, the cysteine dioxygenase was found as new virulence factor. Predisposing host factors play a similarly important role for the development of dermatophytosis of the skin and nails. Chronic venous insufficiency, diabetes mellitus, disorders of cellular immunity, and genetic predisposition should be considered as risk factors for onychomycosis. A new alarming trend is the increasing number of cases of onychomycosis - mostly due to T. rubrum - in infancy. In Germany, tinea capitis is mostly caused by zoophilic dermatophytes, in particular Microsporum canis. New zoophilic fungi, primarily Trichophyton species of Arthroderma benhamiae, should be taken into differential diagnostic considerations of tinea capitis, tinea faciei, and tinea corporis. Source of infection are small household pets, particularly rodents, like guinea pigs. Anthropophilic dermatophytes may be introduced by families which immigrate from Africa or Asia to Europe. The anthropophilic dermatophytes T. violaceum, T. tonsurans (infections occurring in fighting sports clubs as "tinea gladiatorum capitis et corporis") and M. audouinii are causing outbreaks of small epidemics of tinea corporis and tinea capitis in kindergartens and schools. Superficial infections of the skin and mucous membranes due to yeasts are caused by Candida species. Also common are infections due to the lipophilic yeast fungus Malassezia. Today, within the genus Malassezia more than 10 different species are known. Malassezia globosa seems to play the crucial role in pityriasis versicolor. Molds (also designated non-dermatophyte molds, NDM) are increasingly found as causative agents in onychomycosis. Besides Scopulariopsis brevicaulis, several species of Fusarium and Aspergillus are found.
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Affiliation(s)
- Pietro Nenoff
- Laboratory for Medical Microbiology, Mölbis, Germany
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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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Nenoff P, Grunewald S, Paasch U. Laser therapy of onychomycosis. J Dtsch Dermatol Ges 2013; 12:33-8. [PMID: 24237592 DOI: 10.1111/ddg.12251] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 10/04/2013] [Indexed: 11/27/2022]
Abstract
Since 2010 the FDA has approved laser systems as capable of producing a "temporary increase in clear nails" in patients with onychomycosis. Fungal eradication is probably mediated by heat in infrared laser systems; their efficacy has been confirmed thermographically, histologically and in electron microscopy. Another approach to decontaminate the nail organ is to disrupt fungi and spores by q-switched pulse applications. Recently specific combinations of wavelengths have been tested for their ability to disrupt the mitochondrial transmembrane potential at physiological temperatures by generating ATP and ROS. While clinically extremely high clearance rates of approximately 87.5-95.8 % have been reported, in-vitro investigations have failed to confirm the clearance. The variety of systems and advised parameters hampers a systematic evaluation. Recommendations for safe and practical treatment protocols, informed consent items, and combination with conventional treatment options are all areas of active work. Currently there is a lack of data concerning the long-term efficacy of laser therapy of onychomycosis; certified treatment protocols are needed.
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Affiliation(s)
- Pietro Nenoff
- Laboratory of Medical Microbiology, partnership Prof. Pietro Nenoff & Dr. Constanze Krüger, Mölbis
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18
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Chacon A, Franca K, Fernandez A, Nouri K. Psychosocial impact of onychomycosis: a review. Int J Dermatol 2013; 52:1300-7. [DOI: 10.1111/ijd.12122] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anna Chacon
- Department of Dermatology and Cutaneous Surgery; Miller School of Medicine; University of Miami; Miami FL USA
| | - Katlein Franca
- Department of Dermatology and Cutaneous Surgery; Miller School of Medicine; University of Miami; Miami FL USA
| | - Alexandra Fernandez
- Department of Dermatology and Cutaneous Surgery; Miller School of Medicine; University of Miami; Miami FL USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery; Miller School of Medicine; University of Miami; Miami FL USA
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Paasch U, Mock A, Grunewald S, Bodendorf MO, Kendler M, Seitz AT, Simon JC, Nenoff P. Antifungal efficacy of lasers against dermatophytes and yeastsin vitro. Int J Hyperthermia 2013; 29:544-50. [DOI: 10.3109/02656736.2013.823672] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pankewitz F, Nenoff P, Uhrlaß S, Bezold G, Winter I, Gräser Y. Development of a novel polymerase chain reaction-enzyme-linked immunosorbent assay for the diagnosis ofTrichophyton rubrumonychomycosis. Br J Dermatol 2013; 168:1236-42. [DOI: 10.1111/bjd.12221] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mehlig L, Garve C, Ritschel A, Zeiler A, Brabetz W, Weber C, Bauer A. Clinical evaluation of a novel commercial multiplex-based PCR diagnostic test for differential diagnosis of dermatomycoses. Mycoses 2013; 57:27-34. [DOI: 10.1111/myc.12097] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 04/30/2013] [Accepted: 05/07/2013] [Indexed: 11/26/2022]
Affiliation(s)
- L. Mehlig
- Department of Dermatology; University Hospital Carl Gustav Carus, TU Dresden; Dresden Germany
| | - C. Garve
- Department of Dermatology; University Hospital Carl Gustav Carus, TU Dresden; Dresden Germany
| | - A. Ritschel
- Department of Dermatology; University Hospital Carl Gustav Carus, TU Dresden; Dresden Germany
| | - A. Zeiler
- Biotype Diagnostic GmbH; Dresden Germany
| | - W. Brabetz
- Biotype Diagnostic GmbH; Dresden Germany
| | - C. Weber
- Biotype Diagnostic GmbH; Dresden Germany
| | - A. Bauer
- Department of Dermatology; University Hospital Carl Gustav Carus, TU Dresden; Dresden Germany
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22
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Winter I, Uhrlaß S, Krüger C, Herrmann J, Bezold G, Winter A, Barth S, Simon J, Gräser Y, Nenoff P. Molekularbiologischer Direktnachweis von Dermatophyten im klinischen Material bei Verdacht auf Onychomykose und Tinea pedis. Hautarzt 2013; 64:283-9. [DOI: 10.1007/s00105-013-2562-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Onychomycosis: modern diagnostic and treatment approaches. Wien Med Wochenschr 2012; 163:1-12. [PMID: 23053563 DOI: 10.1007/s10354-012-0139-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 08/02/2012] [Indexed: 10/27/2022]
Abstract
The medical term onychomycosis should be understood as chronic infection of the nails caused by a fungus. The most common causative agents are the dermatophytes and Candida species. The less common are certain types of moulds (nondermatophyte moulds or NDMs). In approximately 60-80 % of the cases, onychomycosis is due to dermatophytes. Among dermatophytes, the most often isolated causative pathogen is Trichophyton (T.) rubrum. Other common species are T. interdigitale (formerly T. mentagrophytes), Epidermophyton floccosum, and T. tonsurans. The most significant yeasts causing onychomycosis are Candida albicans and Candida parapsilosis. Predisposing factors for onychomycosis include mainly diseases such as diabetes mellitus, peripheral vascular arterial disease, chronic venous insufficiency, polyneuropathies of diverse etiologies, and immunosuppression, e.g., myeloproliferative diseases (such as lymphoma and paraproteinemia), HIV/AIDS, etc. Other factors facilitating the fungal infection are frequent trauma in professional sportsmen, often accompanied by excessive perspiration. The diagnostic methods that are often applied in different dermatologic departments and ambulatory units are also different. This precludes the creation of a unified diagnostic algorithm that could be used everywhere as a possible standard. In most of the cases, the method of choice depends on the specialist's individual experience. The therapeutic approach depends mostly on the fungal organism identified by the dermatologist or mycologist. This review hereby includes the conventional as well as the newest and most reliable and modern methods used for the identification of the pathogens causing onychomycosis. Moreover, detailed information is suggested, about the choice of therapeutic scheme in case whether dermatophytes, moulds, or yeasts have been identified as causative agents. A thorough discussion of the schemes and duration of the antifungal therapy in certain groups of patients have been included.
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Rothmund G, Sattler EC, Kaestle R, Fischer C, Haas CJ, Starz H, Welzel J. Confocal laser scanning microscopy as a new valuable tool in the diagnosis of onychomycosis - comparison of six diagnostic methods. Mycoses 2012; 56:47-55. [PMID: 22524550 DOI: 10.1111/j.1439-0507.2012.02198.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Onychomycosis is common and can mimic several different nail disorders. Accurate diagnosis is essential to choose the optimum antifungal therapy. The aim of this study was to evaluate the use of confocal laser scanning microscopy (CLSM) and optical coherence tomography (OCT) as new non-invasive diagnostic tools in onychomycosis and to compare them with the established techniques. In a prospective trial, 50 patients with suspected onychomycosis and 10 controls were examined by CLSM and OCT. Parallel KOH preparation, culture, PAS-staining and PCR were performed. PCR showed the highest sensitivity, followed by CLSM, PAS and KOH preparation. OCT offered the second best sensitivity but displayed the lowest specificity. CLSM and KOH preparation showed a high specificity and CLSM offered the best positive predictive value, similar to KOH preparation and OCT. Fungal culture showed the lowest sensitivity and the worst negative predictive value, yet culture and PCR are the only techniques able to identify genus and species. In summary, CLSM was comparable to PAS staining and superior to KOH preparation. Due to the low specificity we assess OCT not as appropriate. In the differentiation of species PCR outplays the fungal culture in terms of time and sensitivity.
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Affiliation(s)
- G Rothmund
- Department of Dermatology and Allergology, General Hospital Augsburg, Augsburg, Germany
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