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Kamali M, Ghaderi A, Tamimi P, Firooz A, Nasiri Kashani M, Ayatollahi A, Valizadeh F, Fattahi M, Fattahi M. Reactive oxygen species-inducing itraconazole and its anti-biofilm activity against resistant Candida parapsilosis sensu lato biofilm cells isolated from patients with recalcitrant onychomycosis. Arch Dermatol Res 2024; 316:642. [PMID: 39325271 DOI: 10.1007/s00403-024-03382-6] [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: 08/03/2024] [Revised: 08/31/2024] [Accepted: 09/14/2024] [Indexed: 09/27/2024]
Abstract
Candida parapsilosis was introduced as the second most responsible for nail involvement. The colonization of biotic and abiotic surfaces by Candida spp. can result in the formation of biofilms, which possess a high level of resistance to typical antifungal agents. Since Candida spp. can produce biofilm mass on the surface of the nails, dermatologists should consider appropriate antifungals to eliminate both the planktonic and biofilm cells. The aim of this research was to determine the antifungal efficacy of itraconazole against C. parapsilosis sensu lato biofilm formations, in addition to its static effects. Ten C. parapsilosis sensu lato isolates were enrolled in this study. The use of itraconazole results in the accumulation of reactive oxygen species (ROS) during treatment. In order to verify the correlation between ROS and itraconazole-induced cell death, the viability of cells was analyzed by administering the ROS scavenger Ascorbic acid. The apoptotic features of itraconazole were analyzed using the Annexin V-FITC method. Based on current data, it was found that the generation of intracellular stresses by itraconazole is not observed in cells upon ROS inhibition, emphasizing the importance of intracellular ROS in the apoptotic mechanism of itraconazole. Targeting the oxidative defense system is a powerful point to use ROS-inducing antifungals as a superior choice for more effective therapies in case of recalcitrant onychomycosis.
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Affiliation(s)
- Monireh Kamali
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Rafsanjani Hwy, No.1115119969, +982123921, Tehran, Iran
| | - Aliasghar Ghaderi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Tamimi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Firooz
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Taleqani Ave. No.415, Tehran, 1416613675, Iran
| | - Mansour Nasiri Kashani
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Taleqani Ave. No.415, Tehran, 1416613675, Iran
| | - Azin Ayatollahi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Taleqani Ave. No.415, Tehran, 1416613675, Iran
| | - Farnaz Valizadeh
- Department of Cell and Molecular Biology, Kish International Campus, University of Tehran, Keshavarz Blvd No.15, Tehran, +982188962128, Iran
| | | | - Mahsa Fattahi
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Pediatric Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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Evrard S, Minon C, Lamtiri Laarif M, De Backer B, Paridaens H, Hayette MP, Frère J, Senterre JM, Minon JM. New Diagnostic Strategy for Onychomycosis: First-Line Utilization of DermaGenius ® PCR and Calcofluor Microscopy Combined with Selective Culturing. J Fungi (Basel) 2024; 10:515. [PMID: 39194841 DOI: 10.3390/jof10080515] [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: 05/24/2024] [Revised: 07/05/2024] [Accepted: 07/17/2024] [Indexed: 08/29/2024] Open
Abstract
Onychomycosis (OM) is a widespread infection requiring prolonged treatment with potential side effects. Diagnostic certainty is therefore essential before initiating antifungal therapy. Molecular biology has already shown benefits in reducing the time to diagnosis, providing technical ease, and increasing sensitivity for the respective species that molecular tests can detect. Nevertheless, causative agents are numerous, and culture remains essential, particularly for detecting non-dermatophytes mold infections. This study compared the performance of three different diagnostic strategies: conventional culture technique, the multiplex DermaGenius® 2.0 PCR (DG), and a mixed PCR/culture algorithm guided by the result of direct examination with calcofluor (DEC). The mixed algorithm (MA) prioritizes DG PCR and DEC as the primary diagnostic tools, supplemented by selective sample inoculation when mycelial elements are visualized in DEC and when DG PCR fails to detect any fungus or identifies a fungus with morphology differing from that observed in DEC (filamentous fungi versus yeasts). With only 13% of samples requiring inoculation, MA emerged as the most effective strategy, demonstrating significantly higher sensitivity (98.18%; p < 0.001) compared to single-method approaches (78.18% for DG PCR alone and 74.55% for culture alone) while maintaining a specificity comparable to DG PCR (100%). This new approach saves time in result delivery, requires fewer human resources, and increases diagnostic accuracy to better meet the needs of clinicians.
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Affiliation(s)
- Séverine Evrard
- Laboratory Medicine Department, Centre Hospitalier Régional de la Citadelle, 4000 Liege, Belgium
| | - Caroline Minon
- Laboratory Medicine Department, Centre Hospitalier Régional de la Citadelle, 4000 Liege, Belgium
| | - Mouhsine Lamtiri Laarif
- Laboratory Medicine Department, Centre Hospitalier Régional de la Citadelle, 4000 Liege, Belgium
| | - Benjamin De Backer
- Laboratory Medicine Department, Centre Hospitalier Régional de la Citadelle, 4000 Liege, Belgium
| | - Henry Paridaens
- Laboratory Medicine Department, Centre Hospitalier Régional de la Citadelle, 4000 Liege, Belgium
| | - Marie-Pierre Hayette
- Department of Clinical Microbiology, Centre Hospitalier Universitaire du Sart-Tilman, 4000 Liege, Belgium
| | - Julie Frère
- Pediatrics Department, Centre Hospitalier Régional de la Citadelle, 4000 Liege, Belgium
| | - Jean-Marc Senterre
- Laboratory Medicine Department, Centre Hospitalier Régional de la Citadelle, 4000 Liege, Belgium
| | - Jean-Marc Minon
- Laboratory Medicine Department, Centre Hospitalier Régional de la Citadelle, 4000 Liege, Belgium
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Yazdanpanah S, Jabrodini A, Motamedi M, Zomorodian K, Kharazi M, Shabanzadeh S, Ghasemi F, Shariat S, Rezaei Arab M. Species distribution and antifungal susceptibility profiles of yeasts isolated from onychomycosis: a cross-sectional study with insights into emerging species. Antonie Van Leeuwenhoek 2023; 117:6. [PMID: 38153531 DOI: 10.1007/s10482-023-01914-0] [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: 10/19/2023] [Accepted: 12/01/2023] [Indexed: 12/29/2023]
Abstract
Candida onychomycosis is a common fungal infection affecting the nails, primarily caused by Candida (C.) species. Regarding the increasing trend of Candida onychomycosis and the antifungal resistant phenomenon in recent years, this study aims to evaluate the epidemiological characteristics of Candida onychomycosis, the distribution of emerging species, and the antifungal susceptibility profiles of isolates. Onychomycosis caused by yeast species was confirmed through direct examination and culture of nail scraping among all individuals suspected to have onychomycosis and referred to a medical mycology laboratory between June 2019 and March 2022. Species of yeast isolates were identified using the multiplex PCR and PCR-RFLP methods. The antifungal susceptibility of isolates to common antifungal agents and imidazole drugs was evaluated according to the M-27-A3 CLSI protocol. Among 101 yeast strains isolated from onychomycosis, Candida parapsilosis complex (50.49%) was the most common species, followed by C. albicans (20.79%) and C. tropicalis (10.89%). Rare species of yeasts such as C. guilliermondii and Saccharomyces cerevisiae were also identified by molecular methods. Results obtained from antifungal susceptibility testing showed significant differences in MIC values of isoconazole, fenticonazole, and sertaconazole among different species. Overall, a fluconazole-resistant rate of 3% was found among Candida species. Moreover, there was a statistically significant difference in MICs of fenticonazole and clotrimazole between the two most prevalent causative species, C. parapsilosis complex and C. albicans. Correct identification of the causative agents of onychomycosis and performing susceptibility testing could be helpful in choosing the most appropriate antifungal therapy.
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Affiliation(s)
- Somayeh Yazdanpanah
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Jabrodini
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marjan Motamedi
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Kamiar Zomorodian
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahboobeh Kharazi
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shafigheh Shabanzadeh
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farnia Ghasemi
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahar Shariat
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Rezaei Arab
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Agrawal S, Singal A, Grover C, Das S, Madhu SV. Clinico-Mycological Study of Onychomycosis in Indian Diabetic Patients. Indian Dermatol Online J 2023; 14:807-813. [PMID: 38099045 PMCID: PMC10718108 DOI: 10.4103/idoj.idoj_642_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 12/17/2023] Open
Abstract
Background Onychomycosis (OM) is the most common nail disorder accounting for 40-50% of all onychopathies. Onychomycosis is caused by dermatophytes in majority, mostly Trichophyton (T.) rubrum followed by T. mentragrophytes var. interdigitale. However, there is a variation in the etiological profile with the subset of population, time, and geographical location. In immunocompromised hosts, non-dermatophytic molds (NDMs) and yeasts like Candida albicans and Candida parapsilosis are the main causative agents. Diabetes mellitus (DM) is a well-established risk factor for OM. Aim and Objectives This study was conducted to determine the clinical and mycological characteristics of OM in diabetic patients and to evaluate the clinico-etiological correlation, if any. Materials and Methods Three hundred consecutive diabetic patients were screened, of whom 102 (34%) patients were diagnosed with OM based on clinical, mycological, dermoscopic, and histological criteria. Results Distal lateral subungual onychomycosis was the most common clinical variant seen in 80 (78.43%) patients. Fungal culture was positive in 57 (55.88%) of which NDMs constituted approximately half (47.61%) of the isolates, followed by Candida species (30.15%) and dermatophytes (22.22%). The clinico-mycological correlation was performed to look for the association of various fungi with the clinical type of OM. Distal lateral subungual onychomycosis was majorly caused by NDMs (51.02%), followed by Candida species (28.57%), and dermatophytes (20.40%). Conclusion Non-dermatophytic molds are increasingly incriminated as the causative organisms for OM in DM and must be considered as potential pathogens in the present scenario, thus necessitating the change in the treatment options accordingly.
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Affiliation(s)
- Sonia Agrawal
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Chander Grover
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Shukla Das
- Department of Microbiology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - S V Madhu
- Department of Endocrinology, University College of Medical Sciences and GTB Hospital, Delhi, India
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Benedict K, Lipner SR, Lockhart SR, Gold JA. Low positivity rate and high percentage of nondermatophyte molds in an analysis of 35,257 fungal nail culture results from a United States national commercial laboratory, 2019-2022. JAAD Int 2023; 12:43-45. [PMID: 37274390 PMCID: PMC10236190 DOI: 10.1016/j.jdin.2023.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Affiliation(s)
- Kaitlin Benedict
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shari R. Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Shawn R. Lockhart
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeremy A.W. Gold
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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Aljehani FH, Alluhaibi R, Alhothali OS, Fageeh SM, Al Ahmadi GA, Malyani RZ. An Unusual Presentation of Candidal Onychomycosis: A Case Report. Cureus 2023; 15:e43222. [PMID: 37692660 PMCID: PMC10491008 DOI: 10.7759/cureus.43222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Onychomycosis can present with various manifestations such as subungual hyperkeratosis, onycholysis, and nail plate destruction. Here we present a case of a 61-year-old African male with a known case of type 2 diabetes mellitus on insulin. He worked as a mechanic and presented with nail changes that started four months prior to presentation and worsened over time, mainly affecting the fingernails of bilateral hands. On examination, there was yellowish to greenish discoloration with very extensive hyperkeratosis of skin around the fingers and nails that caused avulsion of nails. Swab and culture showed Candida albicans +3. Nail and skin biopsy showed bacterial colony with fungal hypha. The patient showed marked improvement after receiving oral fluconazole 300 mg weekly for three months.
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Affiliation(s)
| | | | | | - Sarah M Fageeh
- Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | | | - Rana Z Malyani
- Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
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da Rosa Pinheiro T, Dantas GA, da Silva JLG, Leal DBR, da Silva RB, de Lima Burgo TA, Santos RCV, Iglesias BA. The First Report of In Vitro Antifungal and Antibiofilm Photodynamic Activity of Tetra-Cationic Porphyrins Containing Pt(II) Complexes against Candida albicans for Onychomycosis Treatment. Pharmaceutics 2023; 15:pharmaceutics15051511. [PMID: 37242753 DOI: 10.3390/pharmaceutics15051511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/25/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
Onychomycosis is a prevalent nail fungal infection, and Candida albicans is one of the most common microorganisms associated with it. One alternative therapy to the conventional treatment of onychomycosis is antimicrobial photoinactivation. This study aimed to evaluate for the first time the in vitro activity of cationic porphyrins with platinum(II) complexes 4PtTPyP and 3PtTPyP against C. albicans. The minimum inhibitory concentration of porphyrins and reactive oxygen species was evaluated by broth microdilution. The yeast eradication time was evaluated using a time-kill assay, and a checkerboard assay assessed the synergism in combination with commercial treatments. In vitro biofilm formation and destruction were observed using the crystal violet technique. The morphology of the samples was evaluated by atomic force microscopy, and the MTT technique was used to evaluate the cytotoxicity of the studied porphyrins in keratinocyte and fibroblast cell lines. The porphyrin 3PtTPyP showed excellent in vitro antifungal activity against the tested C. albicans strains. After white-light irradiation, 3PtTPyP eradicated fungal growth in 30 and 60 min. The possible mechanism of action was mixed by ROS generation, and the combined treatment with commercial drugs was indifferent. The 3PtTPyP significantly reduced the preformed biofilm in vitro. Lastly, the atomic force microscopy showed cellular damage in the tested samples, and 3PtTPyP did not show cytotoxicity against the tested cell lines. We conclude that 3PtTPyP is an excellent photosensitizer with promising in vitro results against C. albicans strains.
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Affiliation(s)
- Ticiane da Rosa Pinheiro
- Graduate Program in Pharmaceutical Sciences, Center for Health Sciences, Department of Microbiology and Parasitology, Federal University of Santa Maria, Santa Maria 97105-900, Brazil
| | - Gabrielle Aguiar Dantas
- Graduate Program in Pharmaceutical Sciences, Center for Health Sciences, Department of Microbiology and Parasitology, Federal University of Santa Maria, Santa Maria 97105-900, Brazil
| | | | - Daniela Bitencourt Rosa Leal
- Laboratory of Experimental and Applied Immunology, Federal University of Santa Maria, Santa Maria 97105-900, Brazil
| | | | - Thiago Augusto de Lima Burgo
- Bioinorganic and Porphyrin Materials Laboratory, Department of Chemistry, Federal University of Santa Maria, Santa Maria 97105-900, Brazil
| | - Roberto Christ Vianna Santos
- Graduate Program in Pharmaceutical Sciences, Center for Health Sciences, Department of Microbiology and Parasitology, Federal University of Santa Maria, Santa Maria 97105-900, Brazil
| | - Bernardo Almeida Iglesias
- Department of Chemistry and Environmental Sciences, Ibilce, São Paulo State University (Unesp), São Jose do Rio Preto 15054-000, Brazil
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Barros ILE, Veiga FF, de Castro-Hoshino LV, Souza M, Malacrida AM, Diniz BV, dos Santos RS, Bruschi ML, Baesso ML, Negri M, Svidzinski TIE. Performance of Two Extracts Derived from Propolis on Mature Biofilm Produced by Candida albicans. Antibiotics (Basel) 2022; 12:antibiotics12010072. [PMID: 36671272 PMCID: PMC9854723 DOI: 10.3390/antibiotics12010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
Species of the Candida genus represent the third most common cause of onychomycosis, the most frequent and difficult to treat nail infection. Onychomycosis has been attributed to fungi organized in biofilm and some natural products have proved promising for its treatment. This study aimed to evaluate the antibiofilm activity of propolis extract (PE) and its by-product (WPE) on 7-day preformed biofilms produced by Candida albicans in polystyrene microplates, as well as in an ex vivo model on human nail fragments. The cytotoxicity and permeation capacity were also assessed. Firstly, multiple parameters were evaluated over 7 days to elucidate the dynamics of biofilm formation by C. albicans. The cell viability and total biomass did not vary much from the beginning; however, days 3 and 4 were crucial in terms of metabolic activity, which was significantly increased, and the levels of extracellular matrix components, wherein proteins and nucleic acids experienced an increase, but polysaccharide levels dropped. Architecturally, one-day biofilm showed a monolayer of organized cells (blastoconidia, hyphae, and pseudohyphae), while in the seven-day biofilm there was a three-dimensional well-structured and complex biofilm. This yeast was also able to form a biofilm on both surfaces of the nail, without an additional nutritional source. Both extracts showed excellent antibiofilm activity against the 7-day preformed biofilm and were not toxic to Vero cells at concentrations compatible with the antifungal and antibiofilm activities. Both extracts permeated the experimentally infected nail, with WPE being more efficient. The results of this study, taken together, reinforce the potential of these natural products, containing propolis, as a safe option for the topical treatment of onychomycosis.
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Affiliation(s)
- Isabella Letícia Esteves Barros
- Postgraduate Program in Health Sciences, State University of Maringá, Colombo Avenue, 5790, Maringá 87020-900, PR, Brazil
- Medical Mycology Laboratory, Department of Clinical Analysis and Biomedicine, State University of Maringá, Colombo Avenue, 5790, Maringá 87020-900, PR, Brazil
| | - Flávia Franco Veiga
- Postgraduate Program in Health Sciences, State University of Maringá, Colombo Avenue, 5790, Maringá 87020-900, PR, Brazil
- Medical Mycology Laboratory, Department of Clinical Analysis and Biomedicine, State University of Maringá, Colombo Avenue, 5790, Maringá 87020-900, PR, Brazil
| | | | - Monique Souza
- Department of Physics, State University of Maringá, Colombo Avenue, 5790, Maringá 87020-900, PR, Brazil
| | - Amanda Milene Malacrida
- Postgraduate Program in Health Sciences, State University of Maringá, Colombo Avenue, 5790, Maringá 87020-900, PR, Brazil
- Medical Mycology Laboratory, Department of Clinical Analysis and Biomedicine, State University of Maringá, Colombo Avenue, 5790, Maringá 87020-900, PR, Brazil
| | - Beatriz Vesco Diniz
- Postgraduate Program in Health Sciences, State University of Maringá, Colombo Avenue, 5790, Maringá 87020-900, PR, Brazil
- Medical Mycology Laboratory, Department of Clinical Analysis and Biomedicine, State University of Maringá, Colombo Avenue, 5790, Maringá 87020-900, PR, Brazil
| | - Rafaela Said dos Santos
- Laboratory of Research and Development of Drug Delivery Systems, Department of Pharmacy, State Unversity of Maringá, Colombo Avenue, 5790, Maringá 87020-900, PR, Brazil
| | - Marcos Luciano Bruschi
- Laboratory of Research and Development of Drug Delivery Systems, Department of Pharmacy, State Unversity of Maringá, Colombo Avenue, 5790, Maringá 87020-900, PR, Brazil
| | - Mauro Luciano Baesso
- Department of Physics, State University of Maringá, Colombo Avenue, 5790, Maringá 87020-900, PR, Brazil
| | - Melyssa Negri
- Postgraduate Program in Health Sciences, State University of Maringá, Colombo Avenue, 5790, Maringá 87020-900, PR, Brazil
- Medical Mycology Laboratory, Department of Clinical Analysis and Biomedicine, State University of Maringá, Colombo Avenue, 5790, Maringá 87020-900, PR, Brazil
| | - Terezinha Inez Estivalet Svidzinski
- Postgraduate Program in Health Sciences, State University of Maringá, Colombo Avenue, 5790, Maringá 87020-900, PR, Brazil
- Medical Mycology Laboratory, Department of Clinical Analysis and Biomedicine, State University of Maringá, Colombo Avenue, 5790, Maringá 87020-900, PR, Brazil
- Correspondence:
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9
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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: 19] [Impact Index Per Article: 9.5] [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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10
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Prevalence of Onychomycosis in Diabetic Patients: A Case-Control Study Performed at University Hospital Policlinico in Catania. J Fungi (Basel) 2022; 8:jof8090922. [PMID: 36135647 PMCID: PMC9500927 DOI: 10.3390/jof8090922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/12/2022] [Accepted: 08/29/2022] [Indexed: 11/25/2022] Open
Abstract
Diabetes is characterized by an increased rate of serum glucose due to defects in insulin secretion, insulin action or both conditions. Glucose excesses can lead to extended cellular damage, with the consequence of several infectious and non-infectious skin disorders. The aim of the present study was to evaluate the toenail onychomycosis incidence in diabetic patients and healthy ones. The non-interventional, retrospective study was performed at the mycology laboratory of the University hospital “Policlinico-San Marco” in Catania, Italy, for over one year. Nail clippings were collected to perform microscopic and cultural exams, which allowed for the identification of fungal aetiological agents. A total of 715 patients (47 diabetic and 668 non-diabetic patients) were enrolled. In diabetic patients, dermatophytes were the most common cultural isolates (50%), followed by yeasts and moulds in 30.8% and 19.2%, respectively. In non-diabetic patients, the distribution of dermatophytes, yeasts and non-dermatophytic moulds was 67.4%, 5.3% and 27.3%, respectively. According to our results, diabetic patients are more predisposed to nail fungal infection. Our data suggest that dermatological follow-ups should always be performed for diabetic patients. All skin and nail disorders should be carefully monitored to perform a diagnostic confirmation and correct management of diabetic patients.
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11
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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.
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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.
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12
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Cerqueira P, Cunha A, Almeida-Aguiar C. Potential of propolis antifungal activity for clinical applications. J Appl Microbiol 2022; 133:1207-1228. [PMID: 35592938 DOI: 10.1111/jam.15628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/24/2022] [Accepted: 05/12/2022] [Indexed: 11/29/2022]
Abstract
The high incidence of skin diseases of microbial origin along with the widespread increase of microbial resistance demand for therapeutic alternatives. Research on natural compounds has been opening new perspectives for the development of new therapies with health positive impacts. Propolis, a resinous mixture produced by honeybees from plant exudates, is widely used as a natural medicine since ancient times, mainly due to its antimicrobial properties. More recently, antioxidant, anti-tumor, anti-inflammatory, hepatoprotective and immunomodulatory activities were also reported for this natural product, highlighting its high potential pharmacological interest. In the present work, an extensive review of the main fungi causing skin diseases as well as the effects of natural compounds, particularly propolis, against such disease-causing microorganisms was organized and compiled in concise handy tables. This information allows to conclude that propolis is a highly effective antimicrobial agent suggesting that it could be used as an alternative skin treatment against pathogenic microorganisms and also as a cosmeceutic component or as a source of bioactive ingredients.
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Affiliation(s)
- Patrícia Cerqueira
- Department of Biology, School of Sciences, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Ana Cunha
- Department of Biology, School of Sciences, University of Minho, Campus de Gualtar, Braga, Portugal.,CBMA - Centre of Molecular and Environmental Biology, University of Minho, Braga, Portugal.,CITAB, Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Minho, Braga, Portugal
| | - Cristina Almeida-Aguiar
- Department of Biology, School of Sciences, University of Minho, Campus de Gualtar, Braga, Portugal.,CBMA - Centre of Molecular and Environmental Biology, University of Minho, Braga, Portugal.,CITAB, Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Minho, Braga, Portugal
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13
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Alqahtani A, Raut B, Khan S, Mohamed JMM, Fatease AA, Alqahtani T, Alamri A, Ahmad F, Krishnaraju V. The Unique Carboxymethyl Fenugreek Gum Gel Loaded Itraconazole Self-Emulsifying Nanovesicles for Topical Onychomycosis Treatment. Polymers (Basel) 2022; 14:polym14020325. [PMID: 35054731 PMCID: PMC8779379 DOI: 10.3390/polym14020325] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 12/12/2022] Open
Abstract
The novel itraconazole (ITZ) nail penetration enhancing self-emulsifying nanovesicles (ITZ-nPEVs) loaded in carboxymethyl fenugreek gum (CMFG) gel circumvent the systemic onychomycosis treatment. The ITZ-nPEVs were prepared by the thin film hydration technique, and the particle size (PS), zeta potential (ZP), drug content (DC), entrapment efficiency (% EE), deformity index (DI), viscosity, morphology, and physical stability of the ITZ-nPEVs were measured. In terms of nail hydration, transungual drug absorption, and antifungal efficacy against Candida albicans, the chosen ITZ-nPEVs, nPEV-loaded CMFG (CMFG-ITZ-nPEVs) gel, and the commercialized Itrostred gel were compared. The ITZ-nPEVs showed spherical structure with high DC, % EE, low PS and PDI and positive ZP of ITZ ranging from 95.36 to 93.89 mg/5 mL and 95.36–96.94%, 196.55–252.5 nm, 0.092–0.49, and +11.1 to +22.5 mV, respectively. Compared to the Itrostred gel, the novel ITZ-nPEVs exhibited hydration enhancement factor for 24 h (HE24) of 1.53 and 1.39 drug uptake enhancement factor into nail clippings. Moreover, zone of inhibitions for ITZ-nPEVs (27.0 ± 0.25 mm) and CMFG-ITZ-nPEVs (33.2 ± 0.09 mm) against Candida albicans were significantly greater than that of Itrostred gel (22.9 ± 0.44 mm). For clinical investigation on onychomycotic patients, a nail penetration enhancer containing ITZ-nPEV-loaded CMFG gel presents a highly promising approach.
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Affiliation(s)
- Ali Alqahtani
- Department of Pharmacology, College of Pharmacy, King Khalid University, Guraiger, Abha 62529, Saudi Arabia; (A.A.); (T.A.); (V.K.)
| | - Bhavana Raut
- Institute of Pharmaceutical Education and Research, Borgaon (Meghe) Wardha, Wardha 442001, India;
| | - Shagufta Khan
- Institute of Pharmaceutical Education and Research, Borgaon (Meghe) Wardha, Wardha 442001, India;
- Correspondence: ; Tel.: +91-75591-78862
| | | | - Adel Al Fatease
- Department of Pharmaceutics, College of Pharmacy, King Khalid University, Guraiger, Abha 62529, Saudi Arabia; (A.A.F.); (A.A.)
| | - Taha Alqahtani
- Department of Pharmacology, College of Pharmacy, King Khalid University, Guraiger, Abha 62529, Saudi Arabia; (A.A.); (T.A.); (V.K.)
| | - Ali Alamri
- Department of Pharmaceutics, College of Pharmacy, King Khalid University, Guraiger, Abha 62529, Saudi Arabia; (A.A.F.); (A.A.)
| | - Fazil Ahmad
- Department of Anesthesia Technology, College of Applied Medical Sciences in Jubail, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia;
| | - Venkatesan Krishnaraju
- Department of Pharmacology, College of Pharmacy, King Khalid University, Guraiger, Abha 62529, Saudi Arabia; (A.A.); (T.A.); (V.K.)
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Halvaee S, Daie-Ghazvini R, Hashemi SJ, Khodavaisy S, Rahimi-Foroushani A, Bakhshi H, Rafat Z, Ardi P, Abastabar M, Zareei M, Borjian-Boroujeni Z, Kamali Sarvestani H. A Mycological and Molecular Epidemiologic Study on Onychomycosis and Determination In Vitro Susceptibilities of Isolated Fungal Strains to Conventional and New Antifungals. Front Cell Infect Microbiol 2021; 11:693522. [PMID: 34336717 PMCID: PMC8319826 DOI: 10.3389/fcimb.2021.693522] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/29/2021] [Indexed: 11/19/2022] Open
Abstract
Background Onychomycosis is one of the most common and recurrent dermatological diseases worldwide. The antimycotic activity of prescribed medications varies according to the causative agents, and treatment failure rates exceeding 30%. This study aimed to assess the epidemiological profile of onychomycosis in Iran. Also, the susceptibilities to conventional and new antifungals were investigated. Methods In this descriptive cross-sectional study, during the period of 18 months starting from September 2019 until March 2020, 594 nail specimens were obtained from patients who presented nail changes compatible with a clinical diagnosis of onychomycosis. The patients were referred from different cities, including Tehran, Kermanshah, Arak, Kashan, Rasht, Qom, Urmia, Zahedan, Hamadan, Zanjan, Borujerd, Bushehr, and Yazd. All the samples were subjected to microscopic examination and fungal culture. Fungi identified were confirmed through the PCR-sequencing method. The susceptibility to itraconazole, fluconazole, terbinafine, griseofulvin, posaconazole, ravuconazole, efinaconazole, luliconazole, and tavaborole was evaluated according to the Clinical and Laboratory Standards Institute (CLSI) guidelines, document M38-A2 for filamentous fungi, and document M27-A3 for yeasts. Results 594 patients were included. Of these, in 179 cases (30.1%) (95% CI:0.3 ± 0.037) onychomycosis was confirmed. The majority of patients were ≥ 60 years of age (n=58, 32.6%) and female (n=113, 63.1%). Saprophytic fungi accounted for the vast majority of the nail isolates (n=92, 51.4%) (95% CI:0.051 ± 0.0.073), followed by dermatophytes (n=45, 25.1%) (95% CI:0.25 ± 0.063), and yeasts (n=42, 23.5%) (95% CI:0.23 ± 0.061). Diabetes mellitus (77.3%), hypothyroidism (18.2%), and solid tumors (4.5%) were documented as the most prevalent underlying conditions. Antifungal susceptibility testing was performed against 60 fungal isolates (20 each of Candida species, saprophytic fungi, and dermatophytes). Efinaconazole, ravuconazole, and luliconazole were the most active agents against Candida species. Also, luliconazole, posaconazole, and efinaconazole were most potent against dermatophytes. Luliconazole had the greatest antifungal activity against saprophytic fungi. Conclusions The prevalence of onychomycosis in Iranian patients was relatively high. LUL exhibited potent antifungal activity against the three groups of fungi tested, determining its broad-spectrum antimycotic activity and its probable use as the first-line therapy for onychomycosis.
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Affiliation(s)
- Samaneh Halvaee
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Roshanak Daie-Ghazvini
- 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.,Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadegh Khodavaisy
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Rahimi-Foroushani
- Department of Statistics and Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Heidar Bakhshi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Rafat
- Department. of Medical Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Pegah Ardi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Abastabar
- Invasive Fungi Research Center, Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahdi Zareei
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Borjian-Boroujeni
- Department of Medical Parasitology and Mycology, 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
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15
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Grynszpan R, Barreiros G, do Nascimento Paixão M, Frasnelli Fernandes M, Aguinaga F, Camargo C, Ramos-E-Silva M, Carneiro S. Coexistence of onychomycosis and nail psoriasis and its correlation with systemic treatment. Mycoses 2021; 64:1092-1097. [PMID: 34061419 DOI: 10.1111/myc.13331] [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: 02/02/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Epidemiological studies indicate that onychomycosis may affect up to 79% of psoriatic patients. Onychomycosis in psoriatic patients is more commonly caused by yeasts comparing with non-psoriatic. OBJECTIVES Evaluate the prevalence of fungi in nail psoriasis. Evaluate the association between direct mycological examination (DME) and mycological culture, Nail Psoriasis Severity Index (NAPSI) and systemic treatment for psoriasis. METHODS Of 133 nails from 20 patients with nail psoriasis were evaluated as follows: 9 patients were using topical treatment and 11 were on systemic treatment. The assessment of psoriasis severity using NAPSI was performed in all psoriatic nails. The presence of fungi was confirmed in DME and culture. RESULTS DME showed the presence of fungal elements in 45 nails (33.83%) with a predominance of blastoconidia (95.5%) No septate hyphae were seen. Mycological culture was positive in 36 (27.06%) samples. Among them, Candida grew in 31 (86.1%): Candida parapsilosis in 15 (48.38%), Candida spp in 14 (45.16%). No growth of dermatophytes was observed. Patients with systemic treatment showed a higher frequency of positive test (DME and culture) for fungi when compared to topic treatment (p:.006). There was a positive correlation between NAPSI, mycological culture and systemic treatment (p:.0063); the risk was four times higher (OR:4.0). LIMITATION OF THE STUDY Sample size. CONCLUSION These results are consistent with some previous reports, Candida was the fungus with higher frequency on the psoriatic nails, however, the role of these fungi is controversial (contamination x colonisation x infection). The fact that the immunosuppressive treatment increases the chance of fungal infection leads us to a greater attention to this patient profile, to prevent the intensification of nail psoriasis (Köbner phenomenon).
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Affiliation(s)
- Rachel Grynszpan
- Sector of Dermatology, Medical Clinics Post-Graduation Program, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gloria Barreiros
- Sector of Dermatology, Medical Clinics Post-Graduation Program, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marilene do Nascimento Paixão
- Sector of Dermatology, Medical Clinics Post-Graduation Program, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mariana Frasnelli Fernandes
- Sector of Dermatology, Medical Clinics Post-Graduation Program, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Felipe Aguinaga
- Sector of Dermatology, Medical Clinics Post-Graduation Program, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cláudia Camargo
- Sector of Dermatology, Medical Clinics Post-Graduation Program, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia Ramos-E-Silva
- Sector of Dermatology, Medical Clinics Post-Graduation Program, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sueli Carneiro
- Sector of Dermatology, Medical Clinics Post-Graduation Program, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Medical Specialties Department, Post Graduation Course, Sector of Dermatology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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16
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Reker D, Rybakova Y, Kirtane AR, Cao R, Yang JW, Navamajiti N, Gardner A, Zhang RM, Esfandiary T, L'Heureux J, von Erlach T, Smekalova EM, Leboeuf D, Hess K, Lopes A, Rogner J, Collins J, Tamang SM, Ishida K, Chamberlain P, Yun D, Lytton-Jean A, Soule CK, Cheah JH, Hayward AM, Langer R, Traverso G. Computationally guided high-throughput design of self-assembling drug nanoparticles. NATURE NANOTECHNOLOGY 2021; 16:725-733. [PMID: 33767382 PMCID: PMC8197729 DOI: 10.1038/s41565-021-00870-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 01/28/2021] [Indexed: 05/22/2023]
Abstract
Nanoformulations of therapeutic drugs are transforming our ability to effectively deliver and treat a myriad of conditions. Often, however, they are complex to produce and exhibit low drug loading, except for nanoparticles formed via co-assembly of drugs and small molecular dyes, which display drug-loading capacities of up to 95%. There is currently no understanding of which of the millions of small-molecule combinations can result in the formation of these nanoparticles. Here we report the integration of machine learning with high-throughput experimentation to enable the rapid and large-scale identification of such nanoformulations. We identified 100 self-assembling drug nanoparticles from 2.1 million pairings, each including one of 788 candidate drugs and one of 2,686 approved excipients. We further characterized two nanoparticles, sorafenib-glycyrrhizin and terbinafine-taurocholic acid both ex vivo and in vivo. We anticipate that our platform can accelerate the development of safer and more efficacious nanoformulations with high drug-loading capacities for a wide range of therapeutics.
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Affiliation(s)
- Daniel Reker
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Yulia Rybakova
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ameya R Kirtane
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ruonan Cao
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Engineering Science, University of Toronto, Toronto, Ontario, Canada
| | - Jee Won Yang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Robert Frederick Smith School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, NY, USA
| | - Natsuda Navamajiti
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Biomedical Engineering Program, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Apolonia Gardner
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Rosanna M Zhang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Tina Esfandiary
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Johanna L'Heureux
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Thomas von Erlach
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Elena M Smekalova
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Kaitlyn Hess
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Aaron Lopes
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jaimie Rogner
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Joy Collins
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Siddartha M Tamang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Keiko Ishida
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Paul Chamberlain
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - DongSoo Yun
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Abigail Lytton-Jean
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Christian K Soule
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jaime H Cheah
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Alison M Hayward
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert Langer
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Giovanni Traverso
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
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17
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Kenechukwu FC, Dias ML, Ricci-Júnior E. Biodegradable nanoparticles from prosopisylated cellulose as a platform for enhanced oral bioavailability of poorly water-soluble drugs. Carbohydr Polym 2021; 256:117492. [PMID: 33483021 DOI: 10.1016/j.carbpol.2020.117492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 11/18/2022]
Abstract
Bio-inspired nanotechnology-based strategies are potential platforms for enhanced dissolution and oral biovailability of poorly water-soluble drugs. In this study, a recently patented green biopolymer (Prosopis africana gum, PG) was compatibilized with microcrystalline cellulose (MCC), a conventional polysaccharide, via thermo-regulated coacervation to obtain PG-MCC (1:0, 1:1, 1:2, 2:1, and 0:1) rational blends and the nanoparticles developed with optimized (1:1) biocomposites (termed "prosopisylated cellulose") by combined homogenization-nanoprecipitation technique was engineered as a high circulating system for improved oral bioavailability of griseofulvin (GF), a model Biopharmaceutics Classification System (BCS) Class-II drug. The effects of biopolymer interaction on morphological and microstructural properties of drug-free biocomposites obtained were investigated by Fourier transform infra-red spectroscopy, scanning electron microscopy and x-ray diffractometry, while the physicochemical properties and in-vivo pharmacokinetics of GF-loaded nanoparticles were also ascertained. Optimized biocomposites revealed inter-molecular and intra-molecular hydrogen bonding between the hydroxyl group of MCC and polar components of PG, as well as reduction in crystallinity of MCC. Griseofulvin-loaded nanoparticles were stable, displayed particles with relatively smooth surfaces and average size of 26.18 ± 0.94 . nm, with zeta potential and polydispersity index of 32.1 ± 0.57 mV and 0.173 ± 0.06, respectively. Additionally, the nanoparticles showed good entrapment efficiency (86.51 ± 0.93 %), and marked improvement in griseofulvin dissolution when compared to free drug, with significantly (p < 0.05) higher GF release in basic than acidic PEG-reinforced simulated bio-microenvironments. Besides, x-ray diffractogram of GF-loaded nanoparticles showed amorphization with few characteristic peaks of GF while infra-red spectrum indicated broader principal peaks of GF and components compatibility. Furthermore, GF-loaded nanoparticles showed low plasma clearance with three-fold increase in systemic bioavailability of griseofulvin compared with free drug. These results showed that prosopisylated cellulose nanoparticles would be a facile approach to improve oral bioavailability of BCS class-II drugs and can be pursued as a new versatile drug delivery platform.
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Affiliation(s)
- Franklin Chimaobi Kenechukwu
- Drug Delivery and Nanomedicines Research Group, Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, Enugu State, 410001, Nigeria; Instituto de Macromoléculas Professora Eloisa Mano (IMA), Programa de Ciencia e Tecnologia de Polimeros, Centro de Tecnologia, Universidade Federal do Rio de Janeiro (UFRJ), Brazil.
| | - Marcos Lopes Dias
- Instituto de Macromoléculas Professora Eloisa Mano (IMA), Programa de Ciencia e Tecnologia de Polimeros, Centro de Tecnologia, Universidade Federal do Rio de Janeiro (UFRJ), Brazil
| | - Eduardo Ricci-Júnior
- Nanomedicines Unit, Facultade de Pharmacia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro-RJ, Brazil
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18
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Lotfali E, Fattahi M, Ghasemi R, Zakermashhadi F, Shafiei M, Borzouie M, Rabiei MM. Enhancement of the Anti-biofilm Activity of Gold Nanoparticles- Itraconazole Conjugates in Resistant Candida glabrata. RECENT ADVANCES IN ANTI-INFECTIVE DRUG DISCOVERY 2021; 16:137-147. [PMID: 34961432 DOI: 10.2174/2772434416666210607144543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/26/2021] [Accepted: 04/15/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Onychomycosis, also called tinea unguium, is a common fungal infection affecting the nails. After dermatophytes, Candida species are recognized as second-line pathogens responsible for this infection. The treatment of onychomycosis requires a long time and is associated with high rates of recurrence. Antifungal medicines conjugated with gold (Au-NP) nanoparticle are the possible platforms for the reduction of drug resistance. METHODS In the present study, we reported the in-vitro antifungal activity of itraconazole (ITZ) - Au conjugates, time-kill studies, and biofilm-producing ability of six ITZ-resistant C. glabrata. RESULTS 3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium bromide (MTT) quantitative results revealed that four out of six resistant isolates studied able to form biofilms in vitro. ITZ-Au conjugates were more effective than ITZ or Au nanoparticle alone, and the time-kill tests pointed to the suitable effect of ITZ-Au conjugate. CONCLUSION The present study concluded that ITZ-Au conjugates have an inhibitory effect on the biofilm of resistant C. glabrata isolates. Further studies are needed to compare the ex-vivo onychomycosis model.
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Affiliation(s)
- Ensieh Lotfali
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Fattahi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Ghasemi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzan Zakermashhadi
- Student Research Committee, Gifted and Talented Dental Students Division, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Shafiei
- Department of Medicinal Chemistry, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojgan Borzouie
- Medical Laboratory Scientist, Hospital RomGerMed, Bucharest, Romania
| | - Mohammad Mahdi Rabiei
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Rather S, Keen A, Shah FY, Yaseen A, Farooq S, Bakhshi A. Candidal Onychomycosis: Clinicoepidemiological Profile, Prevailing Strains, and Antifungal Susceptibility Pattern-A Study from a Tertiary Care Hospital. Indian J Dermatol 2021; 66:132-137. [PMID: 34188267 PMCID: PMC8208255 DOI: 10.4103/ijd.ijd_395_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Despite an increasing trend of onychomycosis caused by Candida species in recent years, there is a scarcity of published data. Objective: To determine the epidemiological and clinical characteristics of Candida onychomycosis, to identify the prevalent, and perform in-vitro antifungal susceptibility testing (AFST) of the isolates. Methodology: A total of 506 consecutive patients with a clinical suspicion of onychomycosis were included in a cross-sectional clinical study. Nail scrapings and clippings were subjected to KOH examination and culture. Species identification and antifungal drug sensitivity testing were done for Candida isolates using Vitek 2YST Compact system using Vitek 2 cards. Results: Out of 384 (75.88%) culture-positive cases, dermatophytes were isolated in 58.08%, yeast in 26.30%, and NDM in 12.24%. Of the yeast, Candida albicans was isolated in 59.4% and non-albicans species in 40.59%. AFST showed that most of Candida species exhibited 100% susceptibility to most of the antifungal drugs tested, while intermediate resistance to fluconazole and flucytosine was seen in some non-albicans species (C. krusei, C. glabrata, and C. guilliermondii). Time taken for species identification was 14–18 h (average 15.5 h), while determination of minimum inhibitory concentration took 9–27 h (average 13 h). Conclusions: Our study showcases the present scenario of Candida distribution and the resistance patterns of various species afflicting the nail unit. Furthermore, our findings clearly indicate that the carriage of this pathogenic yeast is seen in both healthy individuals as well as with immunosuppression.
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Affiliation(s)
- Shagufta Rather
- Department of Dermatology, Government Medical College and Hospital, Srinagar, Jammu & Kashmir, India
| | - Abid Keen
- Department of Dermatology, Government Medical College and Hospital, Srinagar, Jammu & Kashmir, India
| | - Faizan Younus Shah
- Department of Dermatology, Government Medical College and Hospital, Srinagar, Jammu & Kashmir, India
| | - Atiya Yaseen
- Department of Dermatology, Government Medical College and Hospital, Srinagar, Jammu & Kashmir, India
| | - Shaiqa Farooq
- Department of Microbilogy, Government Medical College and Hospital, Srinagar, Jammu & Kashmir, India
| | - Asifa Bakhshi
- Department of Microbilogy, Government Medical College and Hospital, Srinagar, Jammu & Kashmir, India
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Virulence Factors and Antifungal Susceptibility in Candida Species Isolated from Dermatomycosis Patients. Mycopathologia 2020; 186:71-80. [PMID: 33216273 DOI: 10.1007/s11046-020-00509-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/05/2020] [Indexed: 10/20/2022]
Abstract
Dermatomycoses caused by Candida spp. are increasingly common, however there are few reports in the literature regarding their epidemiology, pathogenesis and antifungal susceptibility of these fungal pathogens. This study aimed to identify, characterize virulence and determine the antifungal susceptibility of Candida species isolated from patients with dermatomycoses. We studied a total of 45 yeast samples isolated from dermal scrapings from patients treated at a public hospital, Bauru, São Paulo, Brazil. After identification, the samples were analyzed for protease activity, phospholipase, biofilm formation and antifungal susceptibility. The most common species was Candida albicans (40%), followed by C. krusei (22.22%), C. parapsilosis complex (22.22%) and C. famata (6.67%). Regarding virulence mechanisms, 57.78% and 28.89% of the samples showed enzymatic activity for protease and phospholipase, respectively. A total of 13.33% of the samples showed secretion of both enzymes. All isolates were biofilm producers, and a higher production was observed in C. tropicalis isolates. Regarding the antifungal susceptibility test, 97.78% of the samples had the highest levels of the minimal inhibitory concentration (MIC) for terbinafine, and one C. krusei sample showed intermediate susceptibility to fluconazole. The correct identification of dermatomycosis-related microorganisms, as well as a better knowledge of their pathogenicity and susceptibility against the antifungals used in the clinic, is extremely important for an efficient preventive and therapeutic action.
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Harada K, Maeda T. Case of onychomycosis due to
Candida tropicalis
successfully treated using fosravuconazole. J Dermatol 2020; 47:e348-e349. [DOI: 10.1111/1346-8138.15505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Tatsuo Maeda
- Department of Dermatology Tokyo Medical University Tokyo Japan
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Shemer A, Daniel R, Lyakhovitsky A, Aghion-Svirsky V, Kassem R, Rigopoulos D, Farhi R, Galili E. Clinical significance of Candida isolation from dystrophic fingernails. Mycoses 2020; 63:964-969. [PMID: 32563206 DOI: 10.1111/myc.13133] [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: 05/05/2020] [Revised: 06/06/2020] [Accepted: 06/12/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Candida onychomycosis mostly involves fingernails. Yet, in contrast to dermatophytes, Candida isolation from dystrophic fingernails does not prove casualty, as sample contamination and non-pathogenic Candida growth occur. Characterising treatment outcome of Candida-positive dystrophic nails is crucial to avoid unnecessary treatment. OBJECTIVE To investigate predicators associated with treatment outcome among Candida-positive dystrophic fingernails. PATIENTS AND METHODS A retrospective cohort study was carried out among 108 adults with Candida-positive dystrophic fingernails not cured with adequate systemic anti-fungal course. Diagnosis was based on a single mycological culture. Patients with treatment failure (n = 85; 78.7% of the cases) were compared to patients with partial response (mild to almost cure; n = 23; 21.3% of the cases) at 9 to 12 months following treatment initiation. RESULTS Treatment failure was significantly associated with primary onycholysis (odds ratio [OR] 2.8; 95% confidence interval [CI] 1.1-7.4) and prolonged dystrophy (12.8 vs. 3.7 years in average), compared to partial treatment response. Non-responders had lower odds to present with distal lateral subungual onychomycosis, compared to partial responders (OR 0.3; 95% CI 0.1-0.7). Demographic and mycological characteristics, as well as number of nails affected, co-presence of paronychia, and treatment regime were not found to be associated with treatment response. CONCLUSION Candida-positive primary onycholysis was shown to be non-responsive to systemic anti-fungal treatment, suggesting that anti-fungal treatment is not indicated. For other clinical scenarios, high proportions of treatment non-response suggest that determining causality of Candida should not be based on a single positive mycological culture.
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Affiliation(s)
- Avner Shemer
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ralph Daniel
- University of Mississippi Medical Center, Jackson, MS, USA.,University of Alabama, Birmingham, AL, USA
| | - Anna Lyakhovitsky
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vered Aghion-Svirsky
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Riad Kassem
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dimitris Rigopoulos
- National and Kapodistrian University of Athens, Medical School, 'A.Sygros' Hospital, Athens, Greece
| | - Renata Farhi
- Hospital Nossa Senhora da Saude, University Fundação Tecnico Educacional Souza Marques, Rio De Janeiro, Brazil
| | - Eran Galili
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Widaty S, Miranda E, Bramono K, Menaldi SL, Marissa M, Oktarina C, Surya D, Kusumawardhani HT. Prognostic factors influencing the treatment outcome of onychomycosis Candida. Mycoses 2019; 63:71-77. [DOI: 10.1111/myc.13018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/30/2019] [Accepted: 10/04/2019] [Indexed: 01/25/2023]
Affiliation(s)
- Sandra Widaty
- Department of Dermatology and Venereology Faculty of Medicine Dr. Cipto Mangunkusumo National General HospitalUniversitas Indonesia Jakarta Indonesia
| | - Eliza Miranda
- Department of Dermatology and Venereology Faculty of Medicine Dr. Cipto Mangunkusumo National General HospitalUniversitas Indonesia Jakarta Indonesia
| | - Kusmarinah Bramono
- Department of Dermatology and Venereology Faculty of Medicine Dr. Cipto Mangunkusumo National General HospitalUniversitas Indonesia Jakarta Indonesia
| | - Sri Linuwih Menaldi
- Department of Dermatology and Venereology Faculty of Medicine Dr. Cipto Mangunkusumo National General HospitalUniversitas Indonesia Jakarta Indonesia
| | - Melani Marissa
- Department of Dermatology and Venereology Faculty of Medicine Dr. Cipto Mangunkusumo National General HospitalUniversitas Indonesia Jakarta Indonesia
| | - Caroline Oktarina
- Department of Dermatology and Venereology Faculty of Medicine Dr. Cipto Mangunkusumo National General HospitalUniversitas Indonesia Jakarta Indonesia
| | - Danny Surya
- Department of Dermatology and Venereology Faculty of Medicine Dr. Cipto Mangunkusumo National General HospitalUniversitas Indonesia Jakarta Indonesia
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Gallo L, Cinelli E, Fabbrocini G, Vastarella M. A 15‐year retrospective study on the prevalence of onychomycosis in psoriatic vs non‐psoriatic patients: A new European shift from dermatophytes towards yeast. Mycoses 2019; 62:659-664. [DOI: 10.1111/myc.12925] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/27/2019] [Accepted: 04/23/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Lucia Gallo
- Department of Dermatology University of Naples Federico II Naples Italy
| | - Eleonora Cinelli
- Department of Dermatology University of Naples Federico II Naples Italy
| | | | - Maria Vastarella
- Department of Dermatology University of Naples Federico II Naples Italy
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Ferreira EO, Mendes INVF, Monteiro SG, Crosara KTB, Siqueira WL, de Maria Pedroso Silva de Azevedo C, Moffa EB, de Andrade Monteiro C. Virulence properties and sensitivity profile of Candida parapsilosis complex species and Kodamaea ohmeri isolates from onychomycosis of HIV/AIDS patients. Microb Pathog 2019; 132:282-292. [PMID: 31082527 DOI: 10.1016/j.micpath.2019.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/04/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Abstract
Cutaneous fungal infections include onychomycosis, an infection of the nail that affects both healthy and immunocompromised patients. This study investigated the in vitro hydrolytic enzymes production, adhesion and biofilm formation capacity of Candida parapsilosis complex species and Kodamaea ohmeri isolates from onychomycoses of HIV/AIDS patients and also established the antifungal sensitivity profiles of these isolates. Onychomycosis in HIV/AIDS patients showed a high prevalence of emerging yeasts, among which C. parapsilosis complex species and K. ohmeri were the most frequent. Three C. parapsilosis sensu stricto and two C. orthopsilosis isolates were resistant to amphotericin B and 83% of isolates were resistant to terbinafine. All three different species evaluated were proteinase and hemolysin producers. All isolates adhered to stainless steel and siliconized latex surfaces, and carbohydrates intensified adhesion of all isolates. Isolates adhered to keratinous nail and 50% formed biofilms with strong intensity. In multispecies or polymicrobial biofilms, C. albicans and Staphylococcus aureus regulated the biofilm formation of the analyzed species, decreasing the number of their cells in biofilms. The isolation of emerging yeast species from onychomycosis which are great producers of hydrolytic enzymes and with high adhesion and biofilm formation capacity is a result that should be considered relevant in clinical practice. In addition, half of the isolates was resistant to at least one of the tested antifungals. Taken together these data corroborate the infectious capacity and viability of these isolates under favorable conditions.
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Affiliation(s)
- Erika Oliveira Ferreira
- Laboratório de Microbiologia Aplicada, Programa de Mestrado em Biologia Parasitária, Universidade Ceuma, São Luís, MA, Brazil
| | | | - Sílvio Gomes Monteiro
- Laboratório de Microbiologia Aplicada, Programa de Mestrado em Biologia Parasitária, Universidade Ceuma, São Luís, MA, Brazil
| | - Karla Tonelli Bicalho Crosara
- School of Dentistry and Department of Biochemistry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
| | - Walter Luiz Siqueira
- School of Dentistry and Department of Biochemistry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
| | | | - Eduardo Buozi Moffa
- Laboratório de Microbiologia Aplicada, Programa de Mestrado em Biologia Parasitária, Universidade Ceuma, São Luís, MA, Brazil; School of Dentistry and Department of Biochemistry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
| | - Cristina de Andrade Monteiro
- Laboratório de Microbiologia Aplicada, Programa de Mestrado em Biologia Parasitária, Universidade Ceuma, São Luís, MA, Brazil; Departamento de Biologia, Instituto Federal de Educação Tecnológica do Maranhão, São Luís, MA, Brazil.
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Modiri M, Khodavaisy S, Barac A, Akbari Dana M, Nazemi L, Aala F, Salehi M, Rezaie S. Comparison of biofilm-producing ability of clinical isolates of Candida parapsilosis species complex. J Mycol Med 2019; 29:140-146. [PMID: 30871787 DOI: 10.1016/j.mycmed.2019.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/28/2019] [Accepted: 02/14/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Candida parapsilosis is one of the main emerging non-Candida albicans species leading to superficial and systemic fungal infections in humans. Candida has the ability to produce biofilms associated with pathogenesis. The aim of the study was to estimate biofilm-producing ability of clinical isolates of C. parapsilosis sp. complex. METHODS Clinical samples of C. parapsilosis complex have been analyzed. Crystal violet (CV) staining and tetrazolium reduction assay (MTT) have been used to analyze the clinical isolates ability to produce biofilms. The biofilm's structural characteristics have been assessed by using scanning electron microscopy. RESULTS All 65 isolates were able to form biofilm. In addition, no significant difference was found between biofilm quantification based on two assays at different time intervals (24h, 48h, 72h, 96h) (P>0.05), with the exception of Candida orthopsilosis, which exhibited higher metabolic activity at 24h time point (P<0.05). Moreover, metabolic activity and production of biofilm biomass demonstrated statistically significant correlation (r=0.685, P<0.01). According to microscopic observations, the investigated clinical strains formed the similar surface topography with the slight differences in morphology; in addition, there was no statistically significant difference between efficiency of two assays to quantify biofilm. CONCLUSION It was shown that, similar to C. parapsilosissensu stricto, two cryptic identified species (C. orthopsilosis and Candida metapsilosis) obtained from different clinical samples, were biofilm producers, while C. parapsilosissensu stricto exhibited the highest biofilm production.
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Affiliation(s)
- M Modiri
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - S Khodavaisy
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Zoonoses Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - A Barac
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - M Akbari Dana
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - L Nazemi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - F Aala
- Department of Medical Mycology and Parasitology, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - M Salehi
- Department of Infectious Diseases, School of Medicine, Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Iran
| | - S Rezaie
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Abd El-Aal EB, Abdo HM, Ibrahim SM, Eldestawy MT. Fractional carbon dioxide laser assisted delivery of topical tazarotene versus topical tioconazole in the treatment of onychomycosis. J DERMATOL TREAT 2018; 30:277-282. [DOI: 10.1080/09546634.2018.1509046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Álvarez-Mosquera I, Hernáez S, Sánchez J, Suárez MD, Cisterna R. Diagnosis of Superficial Mycoses by a Rapid and Effective PCR Method from Samples of Scales, Nails and Hair. Mycopathologia 2018; 183:777-783. [PMID: 30094709 DOI: 10.1007/s11046-018-0290-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 07/28/2018] [Indexed: 11/26/2022]
Abstract
Superficial mycoses are the most frequently diagnosed affections of the stratum corneum of the skin, nails and hair. It is generally caused by the presence of yeasts and dermatophytes. Onychomycosis is the most common infection with an incidence of 80-90% in Europe generally produced by Trichophyton rubrum. The aim of this study is to compare the traditional diagnostic techniques of superficial mycoses with a homemade and wide-spectrum fungal polymerase chain reaction (PCR) technique that amplifies a specific region of the 18S ribosomal RNA (rRNA) directly from samples of scales, nails and hair. A total of 626 clinical samples (obtained in the Basurto University Hospital, Bilbao, Spain) were analysed by traditional culture, microscopy and PCR. DNA extraction was carried out by using an extraction buffer and bovine serum, and amplification of samples and performance of the PCR were checked by conventional agarose gel electrophoresis with subsequent sequencing of amplified samples. A total of 211 samples (34%) resulted in positive diagnosis with at least one of the two applied methods: culture (21%) and PCR (22%). Despite the low percentage of identification achieved by the sequencing technique (40%), the value contributed by the amplification of the 18S region of the rRNA was considered important in the identification as it showed a high predictive values for both positive and negative diagnoses (90.9% and 94.6%, respectively). The proposed PCR method has been confirmed as a complementary, rapid, and effective method in the diagnosis of superficial mycoses. Additionally, it reduces the time to obtain satisfactory results from 4 weeks to 7 h.
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Affiliation(s)
- Irene Álvarez-Mosquera
- Immunology, Microbiology and Parasitology Department, School of Medicine, University of Basque Country (UPV/EHU), Barrio Sarriena s/n, 48940, Leioa, Bizkaia, Spain.
| | - Silvia Hernáez
- Clinical Microbiology and Infection Control Department, Basurto University Hospital, Avda.Montevideo 18, 48013, Bilbao, Bizkaia, Spain
| | - Juan Sánchez
- Clinical Microbiology and Infection Control Department, Basurto University Hospital, Avda.Montevideo 18, 48013, Bilbao, Bizkaia, Spain
| | - Maria Dolores Suárez
- Clinical Microbiology and Infection Control Department, Basurto University Hospital, Avda.Montevideo 18, 48013, Bilbao, Bizkaia, Spain
| | - Ramón Cisterna
- Clinical Microbiology and Infection Control Department, Basurto University Hospital, Avda.Montevideo 18, 48013, Bilbao, Bizkaia, Spain
- Immunology, Microbiology and Parasitology Department, School of Medicine, University of Basque Country (UPV/EHU), Barrio Sarriena s/n, 48940, Leioa, Bizkaia, Spain
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Arce M, Gutiérrez-Mendoza D. Fungal Paronychia. Clinical, Diagnosis and Treatment Aspects. CURRENT FUNGAL INFECTION REPORTS 2017. [DOI: 10.1007/s12281-017-0286-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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An innovative polysaccharide nanobased nail formulation for improvement of onychomycosis treatment. Eur J Pharm Sci 2017; 100:56-63. [PMID: 28063967 DOI: 10.1016/j.ejps.2016.12.043] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/21/2016] [Accepted: 12/30/2016] [Indexed: 11/20/2022]
Abstract
Tioconazole-loaded nanocapsule suspensions and its coating with a cationic polymer were developed for nail drug delivery. The colloidal systems presented a nanometric size around 155nm for uncoated nanoparticles and 162nm for those with the cationic coating, with negative and positive zeta potential values, respectively. Both nanosuspensions showed drug content close to theoretical values (1mgmL-1), association efficiency close to 100% (HPLC) and were able to control tioconazol release. The developed formulations showed in vitro antifungal activity (agar diffusion method) against C. albicans. The cationic nanocapsules were considered bioadhesive, showed higher viscosity and were chosen to be incorporated into an ungueal formulation. Pullulan nanobased nail formulation showed adequate viscosity for nail application and drug content close to the theoretical values. It was equivalent to the commercial formulation Trosid® in preventing nail infection by T. rubrum in an in vitro onychomycosis model. The nanocapsule suspensions and Pullulan nanobased nail formulation showed lower irritant potential than the commercial formulation and than free drug in an in vitro evaluation. Pullulan nanobased nail formulation is promising for the treatment of onychomycosis.
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Heidrich D, Stopiglia CDO, Magagnin CM, Daboit TC, Vettorato G, Amaro TG, Scroferneker ML. SIXTEEN YEARS OF DERMATOMYCOSIS CAUSED BY Candida spp. IN THE METROPOLITAN AREA OF PORTO ALEGRE, SOUTHERN BRAZIL. Rev Inst Med Trop Sao Paulo 2016; 58:14. [PMID: 27007557 PMCID: PMC4804551 DOI: 10.1590/s1678-9946201658014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 08/27/2015] [Indexed: 01/19/2023] Open
Abstract
The yeasts of the genus Candida infect skin, nails, and mucous membranes of the gastrointestinal and the genitourinary tract. The aim of this study was to determine the prevalence of dermatomycoses caused by Candida spp., and their etiological aspects in the metropolitan area of Porto Alegre, Brazil. A retrospective study with data obtained from tertiary hospital patients, from 1996 to 2011, was performed. The analyzed parameters were date, age, gender, ethnicity, anatomical region of lesions, and the direct examination results. For all the statistical analyses, a = 0.05 was considered. Among positive results in the direct mycological examination, 12.5% of the total of 4,815 cases were positive for Candida spp. The angular coefficient (B) was -0.7%/ year, showing a decrease over the years. The genus Candida was more prevalent in women (15.9% of women versus 5.84% of men), and in addition, women were older than men (54 versus 47 years old, respectively). There was no difference between ethnic groups. The nails were more affected than the skin, with 80.37% of the infections in the nails (72.9% in fingernails and 7.47% in toenails). Our study corroborates the literature regarding the preference for gender, age, and place of injury. Moreover, we found a decrease in infection over the studied period.
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Affiliation(s)
- Daiane Heidrich
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil, , , ,
| | | | | | | | - Gerson Vettorato
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil, ,
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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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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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Machado Vila TV, Sousa Quintanilha N, Rozental S. Miltefosine is effective against Candida albicans and Fusarium oxysporum nail biofilms in vitro. J Med Microbiol 2015; 64:1436-1449. [DOI: 10.1099/jmm.0.000175] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Taissa Vieira Machado Vila
- Laboratório de Biologia Celular de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Natália Sousa Quintanilha
- Laboratório de Biologia Celular de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Sonia Rozental
- Laboratório de Biologia Celular de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Superficial Fungal Infections in a French Teaching Hospital in Grenoble Area: Retrospective Study on 5470 Samples from 2001 to 2011. Mycopathologia 2015; 181:59-66. [DOI: 10.1007/s11046-015-9953-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/29/2015] [Indexed: 12/26/2022]
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Feng X, Ling B, Yang X, Liao W, Pan W, Yao Z. Molecular Identification of Candida Species Isolated from Onychomycosis in Shanghai, China. Mycopathologia 2015; 180:365-71. [DOI: 10.1007/s11046-015-9927-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 05/02/2015] [Indexed: 10/23/2022]
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Onicomicosis por levaduras: agentes y estudio de sensibilidad en la región de Valparaíso, Chile. Rev Iberoam Micol 2015; 32:132-3. [DOI: 10.1016/j.riam.2014.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 02/28/2014] [Accepted: 03/24/2014] [Indexed: 11/20/2022] Open
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Abstract
Onychomycosis is the most common nail infective disorder. It is caused mainly by anthropophilic dermatophytes, in particular by Trichophyton rubrum and T. mentagrophytes var. interdigitale. Yeasts, like Candida albicans and C. parapsilosis, and molds, like Aspergillus spp., represent the second cause of onychomycosis. The clinical suspect of onychomycosis should be confirmed my mycology. Onychoscopy is a new method that can help the physician, as in onychomycosis, it shows a typical fringed proximal margin. Treatment is chosen depending on the modality of nail invasion, fungus species and the number of affected nails. Oral treatments are often limited by drug interactions, while topical antifungal lacquers have less efficacy. A combination of both oral and systemic treatment is often the best choice.
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El-Tatawy RA, Abd El-Naby NM, El-Hawary EE, Talaat RAZ. A comparative clinical and mycological study of Nd-YAG laser versus topical terbinafine in the treatment of onychomycosis. J DERMATOL TREAT 2015; 26:461-4. [DOI: 10.3109/09546634.2014.998607] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vila TVM, Rozental S, de Sá Guimarães CMD. A new model of in vitro fungal biofilms formed on human nail fragments allows reliable testing of laser and light therapies against onychomycosis. Lasers Med Sci 2014; 30:1031-9. [DOI: 10.1007/s10103-014-1689-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 11/05/2014] [Indexed: 10/24/2022]
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Ramos LDS, Barbedo LS, Braga-Silva LA, dos Santos ALS, Pinto MR, Sgarbi DBDG. Protease and phospholipase activities of Candida spp. isolated from cutaneous candidiasis. Rev Iberoam Micol 2014; 32:122-5. [PMID: 24853474 DOI: 10.1016/j.riam.2014.01.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 12/13/2013] [Accepted: 01/21/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Cases of superficial and invasive mycoses caused by emerging species of Candida have been increasingly reported over the last thirty years. The production of hydrolytic enzymes plays a central role in the fungal infective process. In Candida infections the secretion of both proteases and phospholipases are well-known virulence attributes. AIMS To determine the protease and phospholipase production from 58 human clinical isolates of Candida obtained from individuals with cutaneous candidiasis seen in the Human and Veterinary Diagnostic Mycology Sector from Universidade Federal Fluminense (UFF), Brazil, from November 2008 to August 2009. METHODS Fungal identification was performed using biochemical tests. Proteolytic activity was detected on agar plates containing bovine serum albumin, and phospholipase production was determined on egg-yolk plates. RESULTS The Candida species isolated were Candida parapsilosis (27.59%), Candida famata (18.96%), Candida albicans (15.52%), Candida haemulonii (12.06%), Candida ciferri (8.62%), Candida guilliermondii (6.90%), Candida tropicalis (5.17%) and Candida lipolytica (5.17%). All isolates of C. albicans produced both protease and phospholipase. As regards the isolates of non-C. albicans Candida species, 53.06% and 4.08% were able to produce protease and phospholipase, respectively. For example, the majority of isolates of C. parapsilosis (15/16) produced protease, while 40% of C. ciferri isolates (2/5) were phospholipase producers. This study shows, for the first time, that C. ciferri and C. haemulonii strains were able to produce protease. CONCLUSIONS Collectively, our results showed that different species of Candida isolated from cutaneous lesions were able to produce proteases and/or phospholipases, which are multifunctional molecules directly involved in the infectious process of these fungi.
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Affiliation(s)
- Lívia de Souza Ramos
- Instituto Biomédico, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil; Instituto de Microbiologia Paulo de Góes and Programa de Pós-Graduação em Bioquímica - Instituto de Química, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo Silva Barbedo
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Lys Adriana Braga-Silva
- Instituto de Microbiologia Paulo de Góes and Programa de Pós-Graduação em Bioquímica - Instituto de Química, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - André Luis Souza dos Santos
- Instituto de Microbiologia Paulo de Góes and Programa de Pós-Graduação em Bioquímica - Instituto de Química, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia Ribeiro Pinto
- Instituto Biomédico, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
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Novickij V, Grainys A, Švedienė J, Markovskaja S, Paškevičius A, Novickij J. Microsecond pulsed magnetic field improves efficacy of antifungal agents on pathogenic microorganisms. Bioelectromagnetics 2014; 35:347-53. [DOI: 10.1002/bem.21848] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 01/28/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Vitalij Novickij
- High Magnetic Field Laboratory; Vilnius Gediminas Technical University; Vilnius Lithuania
| | - Audrius Grainys
- High Magnetic Field Laboratory; Vilnius Gediminas Technical University; Vilnius Lithuania
| | - Jurgita Švedienė
- Laboratory of Biodeterioration Research; Institute of Botany of Nature Research Centre; Vilnius Lithuania
| | - Svetlana Markovskaja
- Laboratory of Mycology; Institute of Botany of Nature Research Centre; Vilnius Lithuania
| | - Algimantas Paškevičius
- Laboratory of Biodeterioration Research; Institute of Botany of Nature Research Centre; Vilnius Lithuania
| | - Jurij Novickij
- High Magnetic Field Laboratory; Vilnius Gediminas Technical University; Vilnius Lithuania
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Fich F, Abarzúa-Araya A, Pérez M, Nauhm Y, León E. Candida parapsilosis and Candida guillermondii: emerging pathogens in nail candidiasis. Indian J Dermatol 2014; 59:24-9. [PMID: 24470656 PMCID: PMC3884923 DOI: 10.4103/0019-5154.123485] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Onychomycosis of the fingernails and toenails is generally caused by dermatophytes and yeasts. Toenail mycoses involve mainly dermatophytes but when Candida is also involved, the strain most commonly isolated worldwide is C. albicans. Aims: To determine Candida strains prevailing in onychomycosis. Materials and Methods: A retrospective, observational and descriptive study of fungal cultures retrieved from the registry of the microbiology laboratory of the Pontificia Universidad Católica was performed. Specimens obtained from patients attending the healthcare network between December 2007 and December 2010 was analyzed. Statistical Analysis: A descriptive statistical analysis was performed. Results: Candida was retrieved from 467 of 8443 specimens (52% fingernails and 48% toenails). Cultures were negative in 5320 specimens (63.6%). Among Candida-positive cultures, parapsilosis was the most commonly isolated strain with 202 cases (43.3%). While isolates of Candida guillermondii were 113 (24.2%), those of Candida albicans were 110 (23.6%), those of spp. were 20 (4.3%) and there were 22 cases of other isolates (4.71%). Among the 467 patients with positive cultures for Candida, 136 (29,1%) were men and 331 (70,9%) were women. All patients were older than 18 years old. Clinical files were available for only 169 of the 467 patients with positive cultures for Candida. For those, age, gender, underlying illnesses and use of immunossupresive agents during the trial was reviewed. Conclusions: The present study shows that both C. parapsilosis as well as C. guillermondii appear as emerging pathogens that would be in fact taking the place of C. albicans as the most commonly isolated pathogen in patients with Candida onychomycosis. The relative percentage of C parapsilosis increases every year. Identification of Candida strains as etiological agents of nail candidiasis becomes relevant to the management both nail as well as systemic candidiasis, in view of the resistance to conventional treatments readily reported in the literature.
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Affiliation(s)
- Felix Fich
- Departament of Dermatology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alvaro Abarzúa-Araya
- Departament of Dermatology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mario Pérez
- Departament of Dermatology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yalile Nauhm
- Departament of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eugenia León
- Departament of Clinical Laboratory of Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Zhou J, Chen M, Chen H, Pan W, Liao W. Rhodotorula minutaas onychomycosis agent in a Chinese patient: first report and literature review. Mycoses 2013; 57:191-5. [PMID: 24118107 DOI: 10.1111/myc.12143] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 08/10/2013] [Accepted: 09/03/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Jie Zhou
- Shanghai Key Laboratory of Medical Molecular Mycology & PLA Key Laboratory of Fungal Disease, ChangZheng Hospital; Second Military Medical University; Shanghai China
| | - Min Chen
- Shanghai Key Laboratory of Medical Molecular Mycology & PLA Key Laboratory of Fungal Disease, ChangZheng Hospital; Second Military Medical University; Shanghai China
| | - Hongduo Chen
- Department of Dermatology; No.1 Hospital of China Medical University; Shenyang China
| | - Weihua Pan
- Shanghai Key Laboratory of Medical Molecular Mycology & PLA Key Laboratory of Fungal Disease, ChangZheng Hospital; Second Military Medical University; Shanghai China
| | - Wanqing Liao
- Shanghai Key Laboratory of Medical Molecular Mycology & PLA Key Laboratory of Fungal Disease, ChangZheng Hospital; Second Military Medical University; Shanghai China
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Fernández MS, Rojas FD, Cattana ME, Sosa MDLÁ, Mangiaterra ML, Giusiano GE. Aspergillus terreus complex: an emergent opportunistic agent of Onychomycosis. Mycoses 2013; 56:477-81. [PMID: 23448599 DOI: 10.1111/myc.12061] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 01/09/2013] [Accepted: 01/18/2013] [Indexed: 11/29/2022]
Abstract
The incidence of onychomycosis due to non-dermatophyte moulds (NDM) is increasing. Aspergillus terreus is relatively undocumented as an agent of this fungal infection. The aim of this work is to show the prevalence of onychomycosis caused by A. terreus and to describe its clinical features. Nail samples were collected for microscopic examination and culturing in selective media. All cases of onychomycosis due to NDM were confirmed by a second sample. Aspergillus terreus isolates were identified through their morphological characteristics and using molecular methods. A total of 2485 samples were obtained. Positive cultures were obtained in 1639 samples. From 124 NDM confirmed cultures, 23 were identified as A. terreus (18.5%). Superficial white onychomycosis was the most frequent clinical pattern. A high percentage was found in fingernails. The prevalence of A. terreus in this study considerably exceeded the percentages reported by other authors. Onychomycosis due to A. terreus presents similar clinical patterns to those caused by dermatophytes, but is difficult to eradicate and is associated with less predictable treatment outcomes. Better knowledge of the aetiology of A. terreus may be important for accomplishing more accurate and effective treatment.
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Affiliation(s)
- Mariana S Fernández
- Departamento de Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, Resistencia, Argentina
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Rapid real-time diagnostic PCR for Trichophyton rubrum and Trichophyton mentagrophytes in patients with tinea unguium and tinea pedis using specific fluorescent probes. J Dermatol Sci 2013; 69:229-35. [DOI: 10.1016/j.jdermsci.2012.11.589] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 11/24/2012] [Accepted: 11/27/2012] [Indexed: 11/16/2022]
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49
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Prevalence of Dermatomycosis in a Brazilian Tertiary Care Hospital. Mycopathologia 2012; 174:489-97. [DOI: 10.1007/s11046-012-9576-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 08/14/2012] [Indexed: 10/28/2022]
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50
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Relloso S, Arechavala A, Guelfand L, Maldonado I, Walker L, Agorio I, Reyes S, Giusiano G, Rojas F, Flores V, Capece P, Posse G, Nicola F, Tutzer S, Bianchi M. [Onychomycosis: multicentre epidemiological, clinical and mycological study]. Rev Iberoam Micol 2011; 29:157-63. [PMID: 22198612 DOI: 10.1016/j.riam.2011.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 11/30/2011] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Onychomycosis accounts for up to 50% of all nail disorders. They can be caused by: yeasts, dermatophytes and non-dermatophyte moulds. OBJECTIVES AND METHODS A multicentre study designed to determine the prevalence, mycological test results, aetiological agents, and clinical presentation of onychomycosis was carried out. All fingernail and toenail samples taken during a one year period at 9 diagnostic centres were included. RESULTS A total of 5,961 samples were analysed, of which 82.3% were from toenails and 17.7% from fingernails. The mean age of the patients was 49.7 years, and 66% were females. Direct microscopic examination was positive in 61% of the samples. In adults, 61.2% of toenails were positive using potassium hydroxide (KOH), and 43.7% were positive in cultures. The prevailing aetiological agents belong to the dermatophyte group (82.8%), and distal subungual was the most common clinical form. In fingernails, direct examination showed 59.8% positive samples, and cultures were positive in 52.9%. The prevailing agents were yeasts belonging to Candida species, and onycholysis was the most common lesion. CONCLUSIONS Direct mycological examinations were positive in 61%, a higher value than that found in other series. Dermatophytes were prevalent in toenails of both sexes, and in finger nails yeast were prevalent in females, and dermatophytes in males. Non-dermatophyte moulds corresponded to 4.8% of toenail and 2.05% of fingernails isolates.
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Affiliation(s)
- Silvia Relloso
- Laboratorio de Microbiología, CEMIC. Caba, Ciudad de Buenos Aires, Argentina.
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