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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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Nair SS, Abhishek, Saini S, M S C, Sharun K, V A, Thomas P, Kumar B, Chaturvedi VK. Dermatophytosis caused by Nannizzia nana (Microsporum nanum): a comprehensive review on a novel pathogen. Braz J Microbiol 2023; 54:509-521. [PMID: 36437438 PMCID: PMC9943922 DOI: 10.1007/s42770-022-00880-5] [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: 04/30/2022] [Accepted: 11/19/2022] [Indexed: 11/29/2022] Open
Abstract
Keratinophilic fungi are mostly soil-inhabiting organisms with occasional infections in humans and animals. Even though most dermatophytes are host-adapted, cross-species infections are common by zoophilic and geophilic dermatophytes. N. nana is considered an etiological agent of ringworm in pigs but has also been isolated from other animals, including humans. However, it also possesses many characteristics of geophilic dermatophytes including the ability to grow in soil. N. nana produces characteristic pear-shaped macroconidia and usually exhibits an ectothrix pattern of hair infection. It has been isolated from dermatitis lesions as well as from soil. N. nana infections in pigs are not of much concern as far as economy or health is concerned. But it has been associated with onychomycosis and gonathritis in humans, which are significant in human medicine. The shift in the predominance of dermatophytes in humans and the ability to evolve into a potential tinea pathogen necessitates more understanding of the physiology and genetics of N. nana. In this review, we have attempted a detailed analysis of the studies about N. nana, emphasizing growth and cultural characters, physiology, isolation, infection in humans and animals, molecular characterization and antifungal susceptibility.
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Affiliation(s)
- Sonu S Nair
- Division of Bacteriology and Mycology, ICAR-Indian Veterinary Research Institute, Uttar Pradesh, Izatnagar, Bareilly, India.
| | - Abhishek
- Division of Bacteriology and Mycology, ICAR-Indian Veterinary Research Institute, Uttar Pradesh, Izatnagar, Bareilly, India.
| | - Shubham Saini
- Division of Veterinary Public Health and Epidemiology, ICAR-Indian Veterinary Research Institute, Uttar Pradesh, Izatnagar, Bareilly, India
| | - Chandana M S
- Division of Bacteriology and Mycology, ICAR-Indian Veterinary Research Institute, Uttar Pradesh, Izatnagar, Bareilly, India
| | - Khan Sharun
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Uttar Pradesh, Izatnagar, Bareilly, India
| | - Athira V
- Division of Bacteriology and Mycology, ICAR-Indian Veterinary Research Institute, Uttar Pradesh, Izatnagar, Bareilly, India
| | - Prasad Thomas
- Division of Bacteriology and Mycology, ICAR-Indian Veterinary Research Institute, Uttar Pradesh, Izatnagar, Bareilly, India
| | - Bablu Kumar
- Division of Biological Products, ICAR-Indian Veterinary Research Institute, Uttar Pradesh, Izatnagar, Bareilly, India
| | - V K Chaturvedi
- Division of Bacteriology and Mycology, ICAR-Indian Veterinary Research Institute, Uttar Pradesh, Izatnagar, Bareilly, India
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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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Abdallah M, Abu-Ghali MM, El-Sayed MT, Soltan MY. Fractional CO 2-assisted photodynamic therapy improves the clinical outcome and patient's satisfaction in toenail onychomycosis treatment: an intra-patient comparative single-center study. J DERMATOL TREAT 2020; 33:542-549. [PMID: 32419540 DOI: 10.1080/09546634.2020.1771252] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Device-based therapies have been used for onychomycosis patients with intolerance to systemic treatments. Photodynamic therapy (PDT) improves onychomycosis, while fractional carbon dioxide (FrCO2) augments the topical drug delivery. Comparative studies between PDT alone and laser-assisted one are lacking.Objective: We aimed to evaluate the efficacy of PDT alone versus FrCO2-assisted PDT for treatment of onychomycosis.Methods: Twenty-one patients with bilateral onychomycosis of toenails with nearly the same degree of affection were enrolled in this prospective intra-patient-controlled study. The right affected toenail was treated via PDT alone. The left toenail was treated via a FrCO2 followed immediately by PDT. The sessions were bimonthly for a total of six sessions. Direct microscopy, fungal cultures, clinical evaluation, onychomycosis severity index scoring, and patient's satisfaction were assessed before and 12 weeks after the last session.Results: Both treatments reduced significantly the onychomycosis severity index (p < .05) without significant difference between them. The improvement in nail appearance and patient's satisfaction were higher in laser-assisted PDT than PDT alone (p < .05).Conclusion: Both treatments effectively reduced the severity of onychomycosis with a high degree of safety and tolerability. Fractional CO2-assisted PDT enhanced the clinical outcome via improving the nail appearance and patient's satisfaction.Key messagePhotodynamic therapy has a good success rate in clearing onychomycosis. Addition of fractional CO2 to photodynamic therapy improves the nail appearance and induces better satisfaction to treatment.
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Affiliation(s)
- Marwa Abdallah
- Department of Dermatology and Venereology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mustafa M Abu-Ghali
- Department of Dermatology and Venereology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Taha El-Sayed
- Department of Microbiology and Immunology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Marwa Y Soltan
- Department of Dermatology and Venereology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Najafzadeh MJ, Dolatabadi S, de Hoog S, Esfahani MK, Haghani I, Aghili SR, Ghazvini RD, Rezaei-Matehkolaei A, Abastabar M, Al-Hatmi AMS. Phylogenetic Analysis of Clinically Relevant Fusarium Species in Iran. Mycopathologia 2020; 185:515-525. [PMID: 32506392 DOI: 10.1007/s11046-020-00460-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 05/22/2020] [Indexed: 10/20/2022]
Abstract
Fungi of the genus Fusarium are well known as major plant pathogens but also cause a broad spectrum of human infections. Sixty-three clinical isolates, collected during 2014-2017, were identified using a part of the TEF1 gene as barcoding marker. Fusarium fujikuroi species complex (FFSC, n = 41, 65%) showed to be the dominant etiological agent, followed by F. solani species complex (FSSC, n = 14, 22%) and F. oxysporum species complex (FOSC, n = 7, 11%). There was one strain belonging to F. lateritium species complex (FLSC, n = 1, 1.5%). For final identification, a phylogenetic tree was constructed including the type strains of each species complex. Most cases of fusariosis were due to nail infection (n = 38, 60.3%), followed by keratitis (n = 22, 34%). Fusarium infections are difficult to be treated due to their intrinsic resistance to different azoles; however, accurate and fast identification of etiological agents may enhance management of the infection. We present the first phylogenetic study on clinical Fusarium spp. from Iran.
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Affiliation(s)
- Mohammad Javad Najafzadeh
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Cancer Molecular Pathology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Somayeh Dolatabadi
- Faculty of Engineering, Sabzevar University of New Technology, Sabzevar, Iran
| | - Sybren de Hoog
- Center of Expertise in Mycology of Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Foundation Atlas of Clinical Fungi, Hilversum, The Netherlands
| | - Mahmoud Karimizadeh Esfahani
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Iman Haghani
- Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Reza Aghili
- Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roshanak Daei Ghazvini
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Rezaei-Matehkolaei
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahdi Abastabar
- Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Abdullah M S Al-Hatmi
- Center of Expertise in Mycology of Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands. .,Foundation Atlas of Clinical Fungi, Hilversum, The Netherlands. .,Ministry of Health, Directorate General of Health Services, Ibri, Oman.
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Real-time PCR: A rapid and sensitive method for diagnosis of dermatophyte induced onychomycosis, a comparative study. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2015.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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8
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Candida sp. Infections in Patients with Diabetes Mellitus. J Clin Med 2019; 8:jcm8010076. [PMID: 30634716 PMCID: PMC6352194 DOI: 10.3390/jcm8010076] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 12/27/2018] [Accepted: 01/03/2019] [Indexed: 02/07/2023] Open
Abstract
Candidiasis has increased substantially worldwide over recent decades and is a significant cause of morbidity and mortality, especially among critically ill patients. Diabetes mellitus (DM) is a metabolic disorder that predisposes individuals to fungal infections, including those related to Candida sp., due to a immunosuppressive effect on the patient. This review aims to discuss the latest studies regarding the occurrence of candidiasis on DM patients and the pathophysiology and etiology associated with these co-morbidities. A comprehensive review of the literature was undertaken. PubMed, Scopus, Elsevier’s ScienceDirect, and Springer’s SpringerLink databases were searched using well-defined search terms. Predefined inclusion and exclusion criteria were applied to classify relevant manuscripts. Results of the review show that DM patients have an increased susceptibility to Candida sp. infections which aggravates in the cases of uncontrolled hyperglycemia. The conclusion is that, for these patients, the hospitalization periods have increased and are commonly associated with the prolonged use of indwelling medical devices, which also increase the costs associated with disease management.
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Khattab A, Shalaby S. Optimized Ciclopirox-Based Eudragit RLPO Nail Lacquer: Effect of Endopeptidase Enzyme as Permeation Enhancer on Transungual Drug Delivery and Efficiency Against Onychomycosis. AAPS PharmSciTech 2018; 19:1048-1060. [PMID: 29138987 DOI: 10.1208/s12249-017-0917-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 10/29/2017] [Indexed: 12/16/2022] Open
Abstract
The aims of our investigation were to develop and optimize ciclopirox (CPX) nail lacquer using nonbiodegradable Eudragit RLPO (E-RLPO) as a film former and to assess its penetration efficiency across the human nail plate. Preliminary trials such as hydration enhancement factor (HEF), a retained drug in the nail plate, and SEM were studied to select the optimized permeation enhancer to be incorporated in the optimized lacquer formulation. A 33 full factorial design was built up to study the effect of three different factors, concentration of E-RLPO (10, 20, and 30%), Tween 80 (0.25, 0.5, and 1%), and triacetin (0, 10, and 30% of polymer weight). The studied responses were the drying time, water resistance, viscosity, and drug release up to 4 h. An ex vivo permeation study for the optimized formulations was carried out. The preliminary study aided the selection of 5% papain (endopeptidase enzyme) as a penetration enhancer; it showed the highest HEF of 15.27%, the highest amount of drug retained in the nail plate (886.2 μg/g). An ex vivo permeation study guided the selection of F4B (flux value of 3.79 μg/cm2/h) as optimized formulation. The optimized lacquer formula showed threefold increases in the permeation than the marketed CPX lacquer (Batrafen®). Confocal laser scanning microscopy revealed the higher intensity of the Rhodamine B dye across the nail plate in the case of the formula containing papain than the marketed formula without papain. Conclusively, an efficient and stable nail lacquer was developed for potential transungual delivery of CPX to target the drug to the nail bed and ensure efficiency against onychomycosis.
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Fatahinia M, Jafarpour S, Rafiei A, Taghipour S, Makimura K, Rezaei-Matehkolaei A. Mycological aspects of onychomycosis in Khuzestan Province, Iran: A shift from dermatophytes towards yeasts. Curr Med Mycol 2017; 3:26-31. [PMID: 29707676 PMCID: PMC5917098 DOI: 10.29252/cmm.3.4.26] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose: Onychomycosis is fungal infection of the nails with an overall increasing incidence, worldwide. The epidemiological aspects of onychomycosis in Khuzestan, Iran, have not been established. In this study, we aimed to evaluate the clinical and mycological status of fungal nail infection in Khuzestan Province, Iran. Materials and Methods: The study population included 433 patients (143 males vs. 290 females). Nail samples underwent primary direct microscopy and culture. The isolated yeasts and dermatophytes were then subjected to additional molecular identification by r-DNA ITS-RFLP. Identification of some non-dermatophytic molds (NDMs) and unknown yeasts was accomplished by ITS and beta-tubulin sequencing. Results: Onychomycosis was confirmed in 154 patients (males: 36.4%; n=56 vs. females: 63.6%; n=98), whose age ranged from 2 to 85 years, with the highest prevalence in the age group of 41-50 years. Infection mostly occurred due to yeasts (57.15%), with Candida albicans as the most frequent (29.35%) species, followed by C. parapsilosis (13.8%) and C. tropicalis (4.5%). Dermatophytes were isolated in 38.35% of the cases; the most common isolates were found to be Trichophyton interdigitale (21.1%), Epidermophyton floccosum (10.5%), T. rubrum (5.25%), and Microsporum canis (1.5%). NDMs were isolated from 4.5% of the cases with Aspergillus spp. as the most common agent. Dermatophytes and NDMs were more frequently seen in toenails, whereas yeasts mostly infected fingernails. Fingernail onychomycosis was significantly more prevalent among females than in males (P<0.05). Conclusion: The study highlights that in Khuzestan province, the causative agents of onychomycosis have shifted from dermatophytes to yeasts.
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Affiliation(s)
- Mahnaz Fatahinia
- Department of Medical Mycology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sima Jafarpour
- Department of Medical Mycology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Abdollah Rafiei
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Medical Parasitology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Simin Taghipour
- Department of Medical Mycology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Koichi Makimura
- Laboratory of Space and Environmental Medicine, Graduate School of Medicine, Teikyo University, Tokyo, Japan.,General Medical Education and Research Center, Teikyo University, Tokyo, Japan
| | - Ali Rezaei-Matehkolaei
- Department of Medical Mycology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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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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van Diepeningen AD, Feng P, Ahmed S, Sudhadham M, Bunyaratavej S, de Hoog GS. Spectrum of Fusarium infections in tropical dermatology evidenced by multilocus sequencing typing diagnostics. Mycoses 2015; 58:48-57. [PMID: 25530264 DOI: 10.1111/myc.12273] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 09/17/2014] [Accepted: 10/27/2014] [Indexed: 11/29/2022]
Abstract
Fusarium species are emerging causative agents of superficial, cutaneous and systemic human infections. In a study of the prevalence and genetic diversity of 464 fungal isolates from a dermatological ward in Thailand, 44 strains (9.5%) proved to belong to the genus Fusarium. Species identification was based on sequencing a portion of translation elongation factor 1-alpha (tef1-α), rDNA internal transcribed spacer and RNA-dependent polymerase subunit II (rpb2). Our results revealed that 37 isolates (84%) belonged to the Fusarium solani species complex (FSSC), one strain matched with Fusarium oxysporum (FOSC) complex 33, while six others belonged to the Fusarium incarnatum-equiseti species complex. Within the FSSC two predominant clusters represented Fusarium falciforme and recently described F. keratoplasticum. No gender differences in susceptibility to Fusarium were noted, but infections on the right side of the body prevailed. Eighty-nine per cent of the Fusarium isolates were involved in onychomycosis, while the remaining ones caused paronychia or severe tinea pedis. Comparing literature data, superficial infections by FSSC appear to be prevalent in Asia and Latin America, whereas FOSC is more common in Europe. The available data suggest that Fusarium is a common opportunistic human pathogens in tropical areas and has significant genetic variation worldwide.
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Emergence of fusarioses in a university hospital in Turkey during a 20-year period. Eur J Clin Microbiol Infect Dis 2015; 34:1683-91. [DOI: 10.1007/s10096-015-2405-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 05/05/2015] [Indexed: 12/22/2022]
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Campione E, Paternò EJ, Costanza G, Diluvio L, Carboni I, Marino D, Favalli C, Chimenti S, Bianchi L, Orlandi A. Tazarotene as alternative topical treatment for onychomycosis. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:879-86. [PMID: 25733808 PMCID: PMC4338256 DOI: 10.2147/dddt.s69946] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Distal and lateral onychomycoses are the most frequent forms of onychomycosis, causing subungual hyperkeratosis that usually limits local penetration of antimycotic drugs. Tazarotene exerts anti-inflammatory and immune-modulating activities toward both infective agents and damaged keratinocytes. Given the well-documented efficacy of tazarotene on hyperkeratotic nail psoriasis, we investigated its therapeutic use in onychomycosis. Patients and methods We designed a preliminary open clinical trial in patients affected by distal and lateral subungual onychomycosis of the toenails and verified the fungistatic activity of tazarotene in vitro. Fifteen patients were treated with topical tazarotene 0.1% gel once per day for 12 weeks. Mycological cultures and potassium hydroxide stains of nail samples were performed at the beginning and at the end of the study. Treatment was considered effective when clinical healing and negative mycological culture were obtained. Onycholysis, nail bed discoloration, and subungual hyperkeratosis were measured using standardized methodologies and analyzed by means of Mann–Whitney test and analysis of variance. Fungistatic activity of tazarotene was evaluated by disk diffusion assay. Results Six patients (40%) reached a mycological cure on target nail samples already after 4 weeks of treatment. Complete clinical healing and negative cultures were reached in all patients at week 12, with a significant improvement of all clinical parameters of the infected nails. Disk diffusion assay after 48 hours of incubation with tazarotene solution showed a central area of inhibition in all examined fungal cultures. Conclusion Our results documented a good clinical outcome using topical tazarotene 0.1% gel in distal and lateral subungual onychomycosis and its fungistatic activity of tazarotene in vitro. The majority of patients appeared cured at a 6-month follow-up. The efficacy and safety of tazarotene must be confirmed on a larger number of patients, although already documented in nail psoriasis patients often affected by onychomycosis.
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Affiliation(s)
- Elena Campione
- Department of Dermatology, Policlinic Tor Vergata, Rome, Italy
| | | | - Gaetana Costanza
- Department of Biomedicine and Prevention, Policlinic Tor Vergata, Rome, Italy ; Department of Anatomic Pathology, Policlinic Tor Vergata, Rome, Italy
| | - Laura Diluvio
- Department of Dermatology, Policlinic Tor Vergata, Rome, Italy
| | | | - Daniele Marino
- Department of Microbiology, University of Rome Tor Vergata, Rome, Italy
| | - Cartesio Favalli
- Department of Microbiology, University of Rome Tor Vergata, Rome, Italy
| | - Sergio Chimenti
- Department of Dermatology, Policlinic Tor Vergata, Rome, Italy
| | - Luca Bianchi
- Department of Dermatology, Policlinic Tor Vergata, Rome, Italy
| | - Augusto Orlandi
- Department of Biomedicine and Prevention, Policlinic Tor Vergata, Rome, Italy ; Department of Anatomic Pathology, Policlinic Tor Vergata, Rome, Italy
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Chiang YR, Li A, Leu YL, Fang JY, Lin YK. An in vitro study of the antimicrobial effects of indigo naturalis prepared from Strobilanthes formosanus Moore. Molecules 2013; 18:14381-96. [PMID: 24284490 PMCID: PMC6270593 DOI: 10.3390/molecules181114381] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 10/24/2013] [Accepted: 10/25/2013] [Indexed: 11/16/2022] Open
Abstract
Indigo naturalis is effective in treating nail psoriasis coexisting with microorganism infections. This study examines the antimicrobial effects of indigo naturalis prepared from Strobilanthes formosanus Moore. Eight bacterial and seven fungal strains were assayed using the agar diffusion method to examine the effects of indigo naturalis and its bioactive compounds. The bioactive compounds of indigo naturalis were purified sequentially using GFC, TLC, and HPLC. Their structures were identified using mass spectrometry and NMR spectroscopy. UPLC-MS/MS was applied to compare the metabolome profiles of indigo naturalis ethyl-acetate (EA) extract and its source plant, Strobilanthes formosanus Moore. The results of in vitro antimicrobial assays showed that indigo naturalis EA-extract significantly (≥1 mg/disc) inhibits Gram-positive bacteria (Staphylococcus aureus, S. epidermis and methicillin-resistant S. aureus (MRSA)) and mildly inhibits non-dermatophytic onychomycosis pathogens (Aspergillus fumigates and Candida albicans), but has little effect on dermatophyes. Isatin and tryptanthrin were identified as the bioactive compounds of indigo naturalis using S. aureus and S. epidermis as the bioassay model. Both bioactive ingredients had no effect on all tested fungi. In summary, indigo naturalis prepared from Strobilanthesformosanus Moore exhibits antimicrobial effects on Staphylococcus and non-dermatophytic onychomycosis pathogens. Tryptanthrin and isatin may be its major bioactive ingredients against Staphylococcus and the inhibitory effect on MRSA may be due to other unidentified ingredients.
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Affiliation(s)
- Yin-Ru Chiang
- Biodiversity Research Center, Academia Sinica, Taipei 115, Taiwan; E-Mail:
| | - Ann Li
- Graduate Institute of Natural Products, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; E-Mails: (A.L.); (Y.-L.L.)
| | - Yann-Lii Leu
- Graduate Institute of Natural Products, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; E-Mails: (A.L.); (Y.-L.L.)
| | - Jia-You Fang
- Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan; E-Mail:
| | - Yin-Ku Lin
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung 204, Taiwan
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan 303, Taiwan
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +886-2-2431-3131 (ext. 2777); Fax: +886-2-2546-2083
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Khosravi AR, Shokri H, Nikaein D, Mansouri P, Erfanmanesh A, Chalangari R, Katalin M. Yeasts as Important Agents of Onychomycosis:In VitroActivity of Propolis Against Yeasts Isolated from Patients with Nail Infection. J Altern Complement Med 2013; 19:57-62. [DOI: 10.1089/acm.2011.0722] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ali Reza Khosravi
- Mycology Research Center, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | | | - Donya Nikaein
- Mycology Research Center, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Parvin Mansouri
- Dermatology Clinic, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Erfanmanesh
- Academic Center of Education, Culture and Research (ACECR), Tehran, Iran
| | - Reza Chalangari
- Dermatology Clinic, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Martis Katalin
- Dermatology Clinic, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Gupta AK, Drummond-Main C, Cooper EA, Brintnell W, Piraccini BM, Tosti A. Systematic review of nondermatophyte mold onychomycosis: Diagnosis, clinical types, epidemiology, and treatment. J Am Acad Dermatol 2012; 66:494-502. [DOI: 10.1016/j.jaad.2011.02.038] [Citation(s) in RCA: 175] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 02/03/2011] [Accepted: 02/13/2011] [Indexed: 11/28/2022]
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18
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Ataides FS, Chaul MH, El Essal FE, Costa CR, Souza LKH, Fernandes OFL, Silva MRR. Antifungal susceptibility patterns of yeasts and filamentous fungi isolated from nail infection. J Eur Acad Dermatol Venereol 2011; 26:1479-85. [PMID: 22049990 DOI: 10.1111/j.1468-3083.2011.04315.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Onychomycosis is the nail infection caused by a wide spectrum of fungi species, including yeasts, dermatophytes and filamentous fungi non-dermatophytes (FFND). This fungal infection represents an important medical problem because it involves the patient's life quality. OBJECTIVE The aim was to isolate and identify the fungal agents of onychomycosis, and to determine the in vitro susceptibility to antifungal agents. METHODS During the period of March 2008 to March 2009, 114 patients clinically suspected of having onychomycosis were examined. Demographic data, mainly age and gender were obtained from each patient. The nail samples collected (136) were submitted to direct examination with potassium hydroxide 20% and grown on Sabouraud dextrose agar. The in vitro antifungal susceptibility testing was performed according to the method of broth microdilution, recommended by the Clinical Laboratory Standards Institute (CLSI). RESULTS Onychomycosis was observed in 95 (83.3%) patients, including 16 men (16.8%) and 79 women (83.2%), with mean age of 48.1 years. Candida parapsilosis, Trichophyton rubrum and Fusarium spp were the fungi most frequently isolated. The most of the isolated yeasts showed susceptibility to antifungal agents studied. Among filamentous fungi, high MIC values to itraconazole were found for T. rubrum and T. mentagrophytes, while Fusarium spp showed decreased susceptibility to itraconazole and voriconazole. CONCLUSION C. parapsilosis was the most common fungal species isolated from patients with onychomycosis. The different response obtained by in vitro susceptibility testing to drugs shows the importance of these methods to assist clinicians in choosing the best therapeutic option.
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Affiliation(s)
- F S Ataides
- Institute of Tropical Diseases and Public Health, Federal University of Goiás, Goiânia-Goias, Brazil
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Das NK, Ghosh P, Das S, Bhattacharya S, Dutta RN, Sengupta SR. A study on the etiological agent and clinico-mycological correlation of fingernail onychomycosis in eastern India. Indian J Dermatol 2010; 53:75-9. [PMID: 19881992 PMCID: PMC2763711 DOI: 10.4103/0019-5154.41651] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Onychomycosis manifests itself in various forms, notably onychodystrophy, onycholysis, subungual hyperkeratosis, or nail-plate discoloration. Not necessarily nail changes mentioned here should always be of fungal origin. Objective: The present study is planned to get an idea about etiological agent and clinical correlation in fingernail onychomycosis. Materials and Methods: Nail-clipping and subungual debris of patients with above mentioned nail changes were subjected to KOH preparation. Culture was done on SDA and SDCCA media. Species identification was done by colony character, pigment production, LCB staining, and some special tests like germ tube test, etc. Results: Out of 85 cases, 44 cases showed the growth of fungus, amounting to 51.76% positivity. Among those 44 cases, the infective fungal agents were predominantly dermatophytes (50%), and the rest were due to yeasts (27.27%) and moulds (22.72%). Among the different species, Trichophyton rubrum (29.54%) accounted for the majority of dermatophytes; Candida albicans (11.78%) was the predominant yeast; and Aspergillus niger (18.18%) the commonest mold. No significant association could be established between the different fungal species and various clinical manifestations. Positive results were found more with fungal culture (95.45%) than KOH preparation (63.64%). Conclusion: The results show that nail changes are not always a reliable marker for predicting the causative organism, and relying only on the clinical manifestation (i.e., pattern of nail changes) in the diagnosis of onychomycosis is often misleading. The present study highlights the need for microbiological confirmation in case of onychomycosis.
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Affiliation(s)
- Nilay Kanti Das
- Department of Dermatology, Medical College and Hospital, 88 College Street, Kolkata - 73, India.
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Abstract
Onychomycosis is a common fungal infection affecting nails. The primary cause for onychomycosis is dermatophytes, while Candida species have emerged as second-line pathogens. Onychomycosis due to Candida (candidal onychomycosis) is increasingly found in individuals having defective immunity consequential to aging, diabetes mellitus, vascular diseases, HIV infection and drug therapies such as immunosuppressives and broad-spectrum antibiotics. Breached local immunity at the nail complex due to trauma, chronic exposure to moisture and chemicals including smoke, detergents, soap, etc., also contribute to candidal onychomycosis. Adhesion, filamentation, secretion of extracellular enzymes and the development of antifungal resistance are some of the virulence mechanisms of Candida species associated with onychomycosis. Diagnosis of onychomycosis depends on history and clinical examination, direct microscopic investigation, mycological culture and histopathology. Restoration of immune defenses, elimination of fungi using appropriate drug therapy and improvement of nail hygiene with the removal of predisposing factors are key aspects in the management of candidal onychomycosis.
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22
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Chang SJ, Hsu SC, Tien KJ, Hsiao JY, Lin SR, Chen HC, Hsieh MC. Metabolic syndrome associated with toenail onychomycosis in Taiwanese with diabetes mellitus. Int J Dermatol 2008; 47:467-72. [PMID: 18412863 DOI: 10.1111/j.1365-4632.2008.03606.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Onychomycosis is a complication of diabetes mellitus (DM), which has a deleterious impact on the quality of life. Aim To explore the prevalence of onychomycosis amongst Taiwanese diabetics, and to analyze the factors associated with onychomycosis after adjusting for age and sex. METHODS A total of 1245 Taiwanese diabetics were enrolled, and a nested case-control study was performed by onychomycosis outcome and the exposures were compared. RESULTS The overall prevalence of onychomycosis among DM patients was 30.76% (383/1245), with a significantly higher prevalence in men than in women (P = 0.024). The factors associated with onychomycosis in matched pairs by gender and age were analyzed in 375 pairs. It was found that metabolic syndrome, obesity, triglyceride (TG) levels, and glycosylated hemoglobin (HbA1c) were associated with onychomycosis (P < 0.05). CONCLUSION Higher prevalence rates of onychomycosis were found in men and older DM patients. Metabolic syndrome, obesity, high TG levels, and poor glycemic control were associated with onychomycosis.
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Affiliation(s)
- Shun-Jen Chang
- Department of Public Health, Faculty of Medicine, College of Medicine, Graduate Institute of Medical Genetics, and Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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23
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Buzina W. [Health effects of indoor molds]. Wien Med Wochenschr 2008; 157:462-5. [PMID: 18030548 DOI: 10.1007/s10354-007-0459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Accepted: 07/11/2007] [Indexed: 11/25/2022]
Abstract
Molds are found almost everywhere in the environment. Their airborne propagules (conidia, spores, hyphal fragments) can--under certain circumstances--cause a variety of health problems like mycotic infections, allergies, asthma, irritations or toxic syndromes.
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Affiliation(s)
- Walter Buzina
- Institut für Hygiene, Mikrobiologie und Umweltmedizin, Medizinische Universität Graz, Graz, Osterreich.
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Bagyalakshmi R, Senthilvelan B, Therese KL, Murugusundram S, Madhavan HN. Application of polymerase chain reaction (PCR) and PCR based restriction fragment length polymorphism for detection and identification of dermatophytes from dermatological specimens. Indian J Dermatol 2008; 53:15-20. [PMID: 19967012 PMCID: PMC2784578 DOI: 10.4103/0019-5154.39735] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To develop and optimize polymerase chain reaction-based restriction fragment length polymorphism (PCR-RFLP) targeting 18S rDNA and internal transcribed spacer (ITS) region of fungi for rapid detection and identification of dermatophytes. MATERIALS AND METHODS Two PCR-RFLP methods targeting 18S rDNA and ITS regions of fungi were optimized using standard and laboratory isolates of dermatophytes and other fungi. Sixty-eight dermatological clinical specimens (nail clippings (56), material obtained from blisters (8), hair root (2), scraping from scaly plaque of foot (1) and skin scraping (1) collected by the dermatologist were subjected to both the optimized PCR-RFLP and conventional mycological (smear and culture) methods. RESULTS PCRs targeting 18S rDNA and the ITS region were sensitive to detect 10 picograms and 1 femtogram of T. rubrum DNA, respectively. PCR targeting 18S rDNA was specific for dermatophytes and subsequent RFLP identified them to species level. PCR-RFLP targeting the ITS region differentiated dermatophytes from other fungi with identification to species level. Among the 68 clinical specimens tested, both PCR-RFLP methods revealed the presence of dermatophytes in 27 cases (39.7%), whereas culture revealed the same only in 2 cases (7.40%), increasing the clinical sensitivity by 32.3%. Among 20 smear positive specimens, both PCR-RFLP methods detected dermatophytes in 12 (17.6%). Both the methods detected the presence of dermatophytes in 13 (19.11%) smear and culture negative specimens, increasing the clinical sensitivity by 36.1%. CONCLUSION PCR-RFLP methods targeting 18S rDNA and the ITS regions of fungi were specific and highly sensitive for detection and speciation of dermatophytes.
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Affiliation(s)
- R Bagyalakshmi
- Larsen and Toubro Microbiology Research Centre, Vision Research Foundation, Sankara Nethralaya, No. 18, College Road, Chennai - 600 006, India
| | - B Senthilvelan
- Government Kilpauk Medical College, Kilpauk, Chennai - 600 010, India
| | - K L Therese
- Larsen and Toubro Microbiology Research Centre, Vision Research Foundation, Sankara Nethralaya, No. 18, College Road, Chennai - 600 006, India
| | - S Murugusundram
- Dermatology Clinic (Skin, Hair and Nail Specialist), No. 2c, 2 Floor, No. 853, Thyagaraya Complex, Poonamalle High Road, Chennai, India
| | - H N Madhavan
- Larsen and Toubro Microbiology Research Centre, Vision Research Foundation, Sankara Nethralaya, No. 18, College Road, Chennai - 600 006, India
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Souza EADF, Almeida LMMD, Guilhermetti E, Mota VA, Rossi RM, Svidzinski TIE. Freqüência de onicomicoses por leveduras em Maringá, Paraná, Brasil. An Bras Dermatol 2007. [DOI: 10.1590/s0365-05962007000200006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
FUNDAMENTOS: Onicomicoses são afecções ungueais de origem infecciosa causadas por fungos e estão entre as principais onicopatias em todo o mundo. OBJETIVOS: Determinar a freqüência de leveduras como agentes etiológicos de onicomicoses na cidade de Maringá, PR, Brasil. MATERIAL E MÉTODOS: Realizou-se um estudo retrospectivo do período entre janeiro de 1997 e dezembro de 2004, em que foram avaliados os resultados de 1.295 pacientes com suspeita de onicomicose, recebidos no Laboratório de Ensino e Pesquisa em Análises Clínicas da Universidade Estadual de Maringá, Paraná, Brasil. RESULTADOS: A confirmação micológica de onicomicose ocorreu em 761 (58,76%) desses pacientes. As mulheres foram responsáveis por 71% das onicomicoses, e os homens, por 29%. A prevalência nas unhas das mãos foi de 28,67% e nas unhas dos pés, 71,33%. Em relação aos agentes, as leveduras foram mais freqüentemente isoladas (46,39%), seguidas pelos dermatófitos (40,60%) e pelos fungos filamentosos não dermatófitos (13,01%). CONCLUSÃO: A alta freqüência de fungos leveduriformes em onicomicoses indica aprimoramento nas técnicas diagnósticas de confirmação laboratorial de fungos oportunistas. Esses resultados, associados à abordagem clínica do paciente, possibilitam maior segurança no diagnóstico e tratamento.
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Abstract
PURPOSE OF REVIEW The number of people affected by onychomycosis continues to increase. The prevalence of different pathogens in different areas depends on several factors, such as climate, geography and migration. We reviewed the recent literature to identify new agents responsible for onychomycosis. RECENT FINDINGS Recent studies performed in different countries are not only reporting molds and yeasts as contaminants, but are increasingly reporting them as pathogens. Infection by novel agents is also being reported, although the individual cases do not necessarily indicate that these are emerging agents. SUMMARY Clinicians should bear in mind the increased number of case series reporting the role of molds and yeasts in onychomycosis, and should not treat the disease without first examining the mycology results. The question remains as to whether these agents are truly new fungi responsible for onychomycosis, or whether improvement of diagnostic techniques and increasing reference to such species in the literature has resulted in better identification of such agents.
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Affiliation(s)
- Matilde Iorizzo
- Department of Dermatology, University of Bologna, Bologna, Italy.
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Hsiao YP, Lin HS, Wu TW, Shih HC, Wei SJ, Wang YL, Lin KL, Chiou HL, Yang JH. A comparative study of KOH test, PAS staining and fungal culture in diagnosis of onychomycosis in Taiwan. J Dermatol Sci 2007; 45:138-40. [PMID: 17145169 DOI: 10.1016/j.jdermsci.2006.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Revised: 09/12/2006] [Accepted: 09/20/2006] [Indexed: 11/18/2022]
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Sehgal VN, Aggarwal AK, Srivastava G, Gupta M, Chaudhary A. Onychomycosis: a 3-year clinicomycologic hospital-based study. Skinmed 2007; 6:11-7. [PMID: 17215614 DOI: 10.1111/j.1540-9740x.2007.05645.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Despite onychomycosis being an established entity, only a few studies are available from the Indian subcontinent. The authors investigated the comprehensive pattern of the condition. AIM To investigate the epidemiologic, clinical, and mycologic factors associated with onychomycosis in 50 patients using a prospective study design. METHODS Fifty patients with potassium hydroxide-positive tests were evaluated according to a predetermined protocal recording details of epidemiologic, clinical, and mycologic characteristics. The collected data were analyzed to determine the correlation of various parameters. RESULTS Distal and lateral subungual onychomycosis, total dystrophic onychomycosis, and superficial white onychomycosis variants of onychomycosis were identified, mostly in men 21-30 years of age (mean age, 34.5 years). Epidemiologic characteristics were instrumental to either initiate, perpetuate, or disseminate the disease process. Trichophyton rubrum and Trichophyton mentagrophytes were the main causative dermatophytes; yeasts and molds were less common. CONCLUSIONS Recognition of onychomycosis is less difficult providing the clinician is aware of the entity. Should the etiologic diagnosis be made, its eradication is desirable to surmount its implication in the society at large.
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Affiliation(s)
- Virendra N Sehgal
- Dermato-Venereology (Skin/VD) Centre, Sehgal Nursing Home, Panchwati, Azadpur, Delhi, India.
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Oliveira ACP, Shinobu CS, Longhini R, Franco SL, Svidzinski TIE. Antifungal activity of propolis extract against yeasts isolated from onychomycosis lesions. Mem Inst Oswaldo Cruz 2006; 101:493-7. [PMID: 17072451 DOI: 10.1590/s0074-02762006000500002] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 05/15/2006] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to determine the in vitro activity of propolis extract against 67 yeasts isolated from onychomycosis in patients attending at the Teaching and Research Laboratory of Clinical Analysis of the State University of Maringá. The method used was an adaptation made from the protocol approved by the National Committee for Clinical Laboratory Standards. The yeasts tested were: Candida parapsilosis 35%, C. tropicalis 23%, C. albicans 13%, and other species 29%. The propolis extract showed excellent performance regarding its antifungal activity: the concentration capable of inhibiting the all of the yeasts was 5 x 10(-2) mg/ml of flavonoids and 2 x 10(-2) mg/ml of flavonoids stimulated their cellular death. Trichosporon sp. were the most sensitive species, showing MIC50 and MIC90 of 1.25 x 10(-2) mg/ml of flavonoids, and C. tropicalis was the most resistant, with CFM50 of 5 x 10(-2) mg/ml of flavonoids and MFC90 of 10 x 10(-2) mg/ml. In view of the fact that propolis is a natural, low cost, nontoxic product with proven antifungal activity, it should be considered as another option in the onychomycosis treatment.
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Affiliation(s)
- Ana Carla Pozzi Oliveira
- Laboratório de Micologia, Departamento de Análises Clînicas, Centro de Ciências da Saúde, Universidade Estadual de Maringá, Maringá, PR, Brasil
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