Fungal species isolated from skin and nail lesions of hands and feet of patients suspected of mycotic infection

Epidemiology of onychomycosis in patients with diabetes mellitus in India

BACKGROUND

The number of individuals diagnosed with diabetes mellitus is increasing worldwide. Although onychomycosis is often observed in diabetics, there have been no large studies of its epidemiology in this patient group in India.

METHODS

We studied the prevalence of onychomycosis in diabetics attending the Diabetes Clinic at the Postgraduate Institute of Medical Education and Research, Chandigarh, India, and compared it with that in a nondiabetic control group. A total of 400 diabetic subjects (237 males, 163 females), aged 48.8 +/- 0.5 years (mean +/- SD), were evaluated.

RESULTS

The prevalence of onychomycosis in the diabetic and control groups was 17% and 6.8%, respectively, the difference being statistically significant (P < 0.001). The presence of onychomycosis was found to correlate significantly with increasing age (P < 0.01) and male gender (P < 0.05) in both diabetic and control groups. From diabetics, yeasts were the most common isolate (48.1%), followed by dermatophytes and nondermatophyte molds in 37% and 14.8%, respectively. In the control group, the distribution of yeasts, dermatophytes, and nondermatophyte molds was 25%, 62.5%, and 12.5%, respectively. After controlling for age and sex, a stepwise logistic regression demonstrated that significant predictors for onychomycosis included the duration of diabetes (P < 0.01), absent or feeble peripheral pulses (P < 0.15), peripheral neuropathy (P < 0.05), and retinopathy (P < 0.001).

CONCLUSIONS

Diabetics were found to be 2.5 times more likely to have onychomycosis than the controls. Predisposing factors included increasing age, male gender, duration of diabetes, impaired peripheral circulation, peripheral neuropathy and retinopathy.

The frequency of Candida species in onychomycosis

Mycological investigation of 108 nail specimens taken from a total of 41 patients examined over three years included direct microscopy and repeated cultures. A higher incidence of onychomycosis of the fingernails (75%) was observed in women while afflictions of the toenails (71%) prevailed in men. The highest prevalence of onychomycosis was found in patients between 50 and 70 years of age. Candida albicans was the dominant organism causing onychomycosis (prevalence rate 60.9%), followed by C. parapsilosis (19.6%), C. tropicalis (9.8), C. krusei (4.9), C. guilliermondii and C. zeylanoides (2.4% each).

Disseminated dermatophytosis caused by Microsporum gypseum in two patients with the acquired immunodeficiency syndrome

Microsporum gypseum is not a common agent of human dermatophytosis. To the best of our knowledge, this fungus has not been described in human immunodeficiency virus (HIV)-infected patients. We report a tinea corporis infection with atypical presentation caused by M. gypseum in two patients with the acquired immunodeficiency syndrome (AIDS) studied at the São Paulo Hospital (São Paulo, Brazil).

Treatment of Candida nail infection with terbinafine

BACKGROUND

Terbinafine is a highly potent drug against dermatophytes. Data regarding its effectiveness against Candida species are few and variable.

OBJECTIVE

Our purpose was to evaluate the efficacy and safety of oral terbinafine in patients with Candida nail infection.

METHODS

In an open-label uncontrolled study, 20 patients completed 16 weeks of treatment with terbinafine, 250 mg/day, and an additional 8 weeks with placebo. Efficacy was assessed clinically and mycologically at weeks 0 (baseline), 4, 8, 16, 24, 36, and 48. Routine laboratory studies were performed at baseline and weeks 4, 8, and 16.

RESULTS

At the end of the trial 60% of target nails were cured clinically and mycologically; in 10% there was mycologic cure with residual clinical signs, in 25% a moderate improvement (> 50%), and failure in only 5% (one patient). Most nails were infected by Candida parapsilosis. Two of 28 patients showed mild reversible elevation of liver enzymes 1 month after initiation of terbinafine treatment.

CONCLUSION

The administration of terbinafine for 16 weeks is effective in the treatment of Candida nail infection. Liver enzyme values should be determined during the first month of treatment.

Isolation of fungi from onychomycosis-suspected nails by two methods: clipping and drilling

We examined 101 nails clinically suspected of onychomycosis by taking specimens with two different techniques: clipping and drilling. We then compared the mycological results of these two techniques. The microscopic results were similar, but culture was more successful with the clipping technique. Twenty-seven per cent of specimens obtained by clipping were culture positive for dermatophytes compared with 20% obtained by drilling and a combined positivity rate of 31%.

Present and potential diagnostic techniques in onychomycosis

The problem of onychomycosis has been frequently addressed during recent years. To make the diagnosis of onychomycosis dermatologists have relied on clinical presentation, culture, and microscopy. These approaches are hampered by false-negative and false-positive results that have confused treatment outcomes. Two new diagnostic techniques, immunohistochemistry and flow cytometry, provide an effective means of identifying different dermatophytes, yeasts, and nondermatophytic molds. Immunohistochemistry employs antibodies to certain fungi to enable positive identification in situ, whereas flow cytometry differentiates fungi on the basis of molecular differences. These techniques provide new evidence that nondermatophytic molds and yeasts can actively invade nail tissue and that mixed infections occur. These findings could have important implications for the treatment of onychomycosis.

The prevalence of onychomycosis in Finland

Few studies have been made of the prevalence of onychomycosis among ordinary people. We therefore investigated 800 people aged between 6 and 80 years, in different age groups. We found 162 persons in whom onychomycosis was clinically suspected. However, only the 91, in whom the fungal culture was positive for dermatophytic fungi, were included in the final prevalence numbers. We found a prevalence of 13.0% in men, 4.3% in women, and 8.4% in the entire population including children. Onychomycosis was not found in any of the 200 people aged less than 20 years. The prevalences found in this study are much higher than those reported in the earlier studies made elsewhere in Europe.

[Clinico-mycological study of onychomycosis in elderly patients]

Physical examination of nails was carried out in 210 elderly patients and nail scrapings were obtained from onychomycosis suggested lesions in order to determine their causative agents, incidence and clinical characteristics. Diagnostic was confirmed by the isolation of the agents from 74 patients, mainly from toe-nails (incidence 35.2). Tinea pedis occurred in 25% of the cases and Diabetes mellitus was the most prevalent associated disease and the most frequent clinical characteristics were the thickening, the opacity and the presence of longitudinal strias in the surface of the nails. It was compared the results obtained by microscopic examination and by culture. Trichophyton rubrum was the most common dermatophyte isolated; Candida parapsilosis was dominant among Candida species.

Dermatomycoses and their etiology in the material of the Dermatological Department in Lódź, Poland

In the period of 1982-1988 mycological examinations were carried out on 4,657 patients suspected of having dermatomycoses. In approximately 60% of patients infections were localized on the feet and hands and in approximately 30% other regions of the glabrous skin were involved. Before treatment, 5,725 examinations were made. The diagnosis was confirmed mycologically in 30% of the cases, most often in tinea cruris (51%) and chronic paronychia (60%). In more than half of the cases the isolated fungi were dermatophytes, the most frequent species being Tr. mentagrophytes, followed by Tr. rubrum and E. floccosum. Among the other fungi, more than 50% were C. albicans and other Candida species.