1
|
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.
Collapse
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
| |
Collapse
|
2
|
Maskan Bermudez N, Rodríguez-Tamez G, Perez S, Tosti A. Onychomycosis: Old and New. J Fungi (Basel) 2023; 9:jof9050559. [PMID: 37233270 DOI: 10.3390/jof9050559] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
Onychomycosis is a common chronic fungal infection of the nail that causes discoloration and/or thickening of the nail plate. Oral agents are generally preferred, except in the case of mild toenail infection limited to the distal nail plate. Terbinafine and itraconazole are the only approved oral therapies, and fluconazole is commonly utilized off-label. Cure rates with these therapies are limited, and resistance to terbinafine is starting to develop worldwide. In this review, we aim to review current oral treatment options for onychomycosis, as well as novel oral drugs that may have promising results in the treatment of onychomycosis.
Collapse
Affiliation(s)
- Narges Maskan Bermudez
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33125, USA
| | - Giselle Rodríguez-Tamez
- Dermatology Department, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
| | - Sofia Perez
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33125, USA
| | - Antonella Tosti
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33125, USA
| |
Collapse
|
3
|
Song G, Zhang M, Liu W, Liang G. Children onychomycosis, a neglected dermatophytosis: A retrospective study of epidemiology and treatment. Mycoses 2023; 66:448-454. [PMID: 36707404 DOI: 10.1111/myc.13571] [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: 01/15/2023] [Accepted: 01/22/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Onychomycosis was an ignored disease in children, and the prevalence was still unknown worldwide. OBJECTIVES This study was conducted to investigate the prevalence and treatment regimens of onychomycosis in children younger than 18 years old. METHODS We systemically reviewed all publications by searching the key terms to reveal the onychomycosis in children from 1990 to 2022. RESULTS A total of 44 articles including 2,382 children with onychomycosis were enrolled in this study. The male to female ratio was 1.29:1. The youngest child was 35 days old and the average age was 9.8 years old. The duration of disease usually ranged from 7 days to 4 years. Onychomycosis in children was more prevalent in toenails compared to fingernails (77.6% vs. 18.4%), and 4% patients had both. A total of 527 children (22.12%) had concomitant tinea pedis infection, and in 267 patients (11.21%), their family members had onychomycosis or tinea pedis. The most common clinical type of onychomycosis was DLSO (67.74%) and the predominant isolates were T. rubrum (66.13%), followed by C. albicans (9.08%) and T. mentagrophytes complex (5.34%). There were 419 children (74.03%) receiving systematic treatment only, 74 patients (13.07%) receiving topical treatment only, and 73 patients (12.90%) receiving both systematic and topical treatment. Twelve patients (2.12%) had mild drug-related side effects. During the follow-up, 71.25% children were cured, 17.50% symptoms improved and 4.17% failed. CONCLUSIONS Onychomycosis was underestimated in children and the diagnosis of onychomycosis should be properly considered in children with nail disorders. For mild patients, topical treatment can be a good choice, and oral antifungal drugs could be added to severe individuals under monitoring.
Collapse
Affiliation(s)
- Ge Song
- Department of Dermatology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China
| | - Meijie Zhang
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China.,Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weida Liu
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, China.,Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Guanzhao Liang
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China.,CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, China.,Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Rosalie S, Lize C, Laurence S, Rajae D, Caroline A, Katrien L, Marie-Pierre H. Epidemiology of Dermatophytes in Belgium: A 5 Years' Survey. Mycopathologia 2021; 186:399-409. [PMID: 33900539 DOI: 10.1007/s11046-021-00542-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 03/15/2021] [Indexed: 01/01/2023]
Abstract
Dermatophytes are among the most common fungal agents causing superficial skin infections worldwide. Epidemiology of these infections is evolving and variable in every country. This report presents the Belgian epidemiological data regarding the distribution of dermatophytes species isolated by the two national reference centers for mycosis during a period of 5 years (2012-2016). Trichophyton rubrum was the most frequently isolated species, considering all sampling sites (60.3% on average between 2012 and 2016). More precisely, this dermatophyte was the major agent of Tinea unguium and Tinea corporis during this period, followed by species of the Trichophyton mentagrophytes complex. Moreover, Microsporum audouinii was the main etiological agent of Tinea capitis (TC) with a frequency of 52.5% on average between 2012 and 2016. Other African dermatophytes species such as Trichophyton soudanense and Trichophyton violaceum were also agents of TC with a respective prevalence of 11.6% and 11.5% on average. This study highlights a different dermatophyte distribution in Belgium in comparison with other European countries.
Collapse
Affiliation(s)
- Sacheli Rosalie
- Department of Clinical Microbiology, Belgian National Reference Center, University Hospital of Liege, Liège, Belgium.
| | - Cuypers Lize
- Laboratory of Clinical Bacteriology and Mycology, Belgian National Reference Center, University Hospital of Leuven, Leuven, Belgium
| | - Seidel Laurence
- Department of Biostatistics, University Hospital of Liege, Liege, Belgium
| | - Darfouf Rajae
- Department of Clinical Microbiology, Belgian National Reference Center, University Hospital of Liege, Liège, Belgium
| | - Adjetey Caroline
- Department of Clinical Microbiology, Belgian National Reference Center, University Hospital of Liege, Liège, Belgium
| | - Lagrou Katrien
- Laboratory of Clinical Bacteriology and Mycology, Belgian National Reference Center, University Hospital of Leuven, Leuven, Belgium
| | - Hayette Marie-Pierre
- Department of Clinical Microbiology, Belgian National Reference Center, University Hospital of Liege, Liège, Belgium
| |
Collapse
|
6
|
Skin Fungal Infections in Children: Diagnostic Challenges. CURRENT FUNGAL INFECTION REPORTS 2020. [DOI: 10.1007/s12281-020-00407-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
7
|
Gupta AK, Venkataraman M, Shear NH, Piguet V. Onychomycosis in children - review on treatment and management strategies. J DERMATOL TREAT 2020; 33:1213-1224. [PMID: 32799713 DOI: 10.1080/09546634.2020.1810607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Onychomycosis is an uncommon condition in children with increasing global prevalence. Health practitioners should confirm the diagnosis through mycology examination and examine family members of affected individuals for onychomycosis and tinea pedis. OBJECTIVE To comprehensively summarize the treatment and management strategies for pediatric onychomycosis. METHODS We performed a comprehensive literature search in the PubMed database to identify clinical studies on treatment for mycologically-confirmed dermatophyte onychomycosis in children <18 years. The exclusion criteria were combination therapy, case reports, reviews, systematic reviews and duplicate studies. RESULTS Per-weight dosing regimens of systemic antifungal agents such as terbinafine, itraconazole, and fluconazole are found to be safe in children and are used off-label for the treatment of pediatric onychomycosis with high efficacy. Topical antifungal agents such as ciclopirox, efinaconazole, and tavaborole have established safety and efficacy in children. Children respond better than adults to topical therapy due to their thinner, faster growing nails. There is no data on the efficacy of medical devices for onychomycosis in children. CONCLUSION Efinaconazole topical solution 10% and tavaborole topical solution 5% are FDA approved for the treatment of onychomycosis in children ≥6 years; ciclopirox topical solution 8% nail lacquer is approved in children ≥12 years.
Collapse
Affiliation(s)
- Aditya K Gupta
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, ON, Canada.,Mediprobe Research Inc., London, ON, Canada
| | | | - Neil H Shear
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Vincent Piguet
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
| |
Collapse
|
8
|
|
9
|
Hejazi R, Hasosah M. Tuberculosis, onychomycosis and immune deficiency in complicated Crohn's disease. BMJ Case Rep 2019; 12:12/8/e228986. [PMID: 31383674 DOI: 10.1136/bcr-2018-228986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The immune system is composed of innate humoral defence and adaptive immunity. One of the key mechanisms of the innate humoral defence is through complement activation. Mutations of certain enzyme may affect the complement activation and result in decreased defence against microorganisms. Mannan-binding lectin serine protease 2 (MASP-2) mutation was associated with recurrent infections and autoimmune diseases. Tuberculosis (TB) has been linked with mannose-binding lectin and MASP-2 gene polymorphism. We report a case of a paediatric patient with MASP-2 deficiency with classical and atypical features associated with Crohn's, onychomycosis and severe cutaneous infections including TB. We also report the presence of a new mutation variant in MASP-2 reported in whole exome sequencing of our patient.
Collapse
Affiliation(s)
- Rayan Hejazi
- Department of Pediatrics, National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Mohammed Hasosah
- Department of Pediatrics, National Guard Health Affairs, Jeddah, Saudi Arabia.,Department of Pediatric Gastroenterology, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (KAIMRC), National Guard Health Affairs, Jeddah, Saudi Arabia
| |
Collapse
|
10
|
Abstract
BACKGROUND Onychomycosis is one of the most common nail diseases with an increasing number of cases. There is always a need for therapy because fungal nail infection never shows a tendency to spontaneous self-healing. Thus, the disease belongs to core competency of dermatologists. CONCLUSION Successful treatment requires a correct diagnosis based on meticulous anamnesis, the clinical findings as well as the identification of the pathogen fungus. Dermatoscopy and histological examination play an important role in this context. The algorithm as presented gives a concise overview of treatment.
Collapse
Affiliation(s)
- E G Hasche
- Hautklinik, Klinikum Darmstadt, Heidelberger Landstr. 379, 64297, Darmstadt, Deutschland.
| | - M Podda
- Hautklinik, Klinikum Darmstadt, Heidelberger Landstr. 379, 64297, Darmstadt, Deutschland
| |
Collapse
|
11
|
Gupta AK, Mays RR, Versteeg SG, Piraccini BM, Takwale A, Shemer A, Babaev M, Grover C, Di Chiacchio NG, Taborda PRO, Taborda VBA, Shear NH, Piguet V, Tosti A. Global perspectives for the management of onychomycosis. Int J Dermatol 2018; 58:1118-1129. [PMID: 30585300 DOI: 10.1111/ijd.14346] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/24/2018] [Accepted: 11/24/2018] [Indexed: 12/18/2022]
Abstract
Onychomycosis is a fungal nail infection caused by dermatophytes, nondermatophyte molds, and yeasts. This difficult-to-treat chronic infection has a tendency to relapse despite treatment. This paper aims to offer a global perspective on onychomycosis management from expert physicians from around the world. Overall, the majority of experts surveyed used systemic, topical, and combination treatments approved in their countries and monitored patients based on the product insert or government recommendations. Although the basics of treating onychomycosis were similar between countries, slight differences in onychomycosis management between countries were found. These differences were mainly due to different approaches to adjunctive therapy, rating the severity of disease and use of prophylaxis treatment. A global perspective on the treatment of onychomycosis provides a framework of success for the committed clinician with appreciation of how onychomycosis is managed worldwide.
Collapse
Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Incorporated, London, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
| | | | | | - Bianca Maria Piraccini
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Anita Takwale
- Gloucestershire Royal Hospital, Gloucester, United Kingdom
| | - Avner Shemer
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Meir Babaev
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Chander Grover
- Division of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Nilton G Di Chiacchio
- Dermatology Clinic, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | - Paulo R O Taborda
- Division of Dermatology, Faculdade de Medicina do ABC, Santo André, Brazil
| | | | - Neil H Shear
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada.,Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada.,Division of Dermatology, Women's College Hospital, Toronto, Canada.,Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Antonella Tosti
- Fredric Brandt Endowed Professor of Dermatology, University of Miami, Miami, FL, USA
| |
Collapse
|
12
|
Gupta AK, Mays RR, Versteeg SG, Shear NH, Friedlander SF. Onychomycosis in children: Safety and efficacy of antifungal agents. Pediatr Dermatol 2018; 35:552-559. [PMID: 29943838 DOI: 10.1111/pde.13561] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Onychomycosis is an uncommon condition in childhood, but prevalence in children is increasing worldwide.The objective was to review the efficacy and safety of systemic and topical antifungal agents to treat onychomycosis in children. Databases (Pubmed, OVID, Scopus, clinicaltrials.gov, Cochrane Library) were searched. Seven studies were selected for inclusion. Only one was a randomized controlled trial. In total, 208 children were administered antifungal agents for the treatment of onychomycosis. Four reports of mild adverse events were documented (1.9% of treated children), one of which discontinued treatment (0.5%). Limitations of this review are the lack of randomized controlled trials available in pediatric onychomycosis. These findings suggest that antifungal therapies used to treat onychomycosis in children are associated with a low incidence of adverse events. Current dosing regimens for antifungal drugs are effective and appear safe to use in children, notwithstanding that the Food and Drug Administration has not approved any of these agents for the treatment of onychomycosis in children. To our knowledge, this review is the most up-to-date, comprehensive summary of pediatric onychomycosis treatment.
Collapse
Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc., London, ON, Canada.,Division of Dermatology, Department of Medicine, School of Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | - Neil H Shear
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | |
Collapse
|
13
|
Alvarado Z, Pereira C. Fungal diseases in children and adolescents in a referral centre in Bogota, Colombia. Mycoses 2018; 61:543-548. [DOI: 10.1111/myc.12774] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 02/21/2018] [Accepted: 03/21/2018] [Indexed: 01/12/2023]
Affiliation(s)
- Zulma Alvarado
- Mycology Unit; Centro Dermatológico Federico Lleras Acosta, E.S.E.; Bogotá Colombia
| | - Claudia Pereira
- Dermatology Resident; Fundación Universitaria Sanitas; Centro Dermatológico Federico Lleras Acosta, E.S.E.; Bogotá Colombia
| |
Collapse
|
14
|
Bongomin F, Batac CR, Richardson MD, Denning DW. A Review of Onychomycosis Due to Aspergillus Species. Mycopathologia 2018; 183:485-493. [PMID: 29147866 PMCID: PMC5958150 DOI: 10.1007/s11046-017-0222-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/02/2017] [Indexed: 01/22/2023]
Abstract
Aspergillus spp. are emerging causative agents of non-dermatophyte mould onychomycosis (NDMO). New Aspergillus spp. have recently been described to cause nail infections. The following criteria are required to diagnose onychomycosis due to Aspergillus spp.: (1) positive direct microscopy and (2) repeated culture or molecular detection of Aspergillus spp., provided no dermatophyte was isolated. A review of 42 epidemiological studies showed that onychomycosis due to Aspergillus spp. varies between < 1 and 35% of all cases of onychomycosis in the general population and higher among diabetic populations accounting for up to 71% and the elderly; it is very uncommon among children and adolescence. Aspergillus spp. constitutes 7.7-100% of the proportion of NDMO. The toenails are involved 25 times more frequently than fingernails. A. flavus, A. terreus and A. niger are the most common aetiologic species; other rare and emerging species described include A. tubingensis, A. sydowii, A. alliaceus, A. candidus, A. versicolor, A. unguis, A. persii, A. sclerotiorum, A. uvarum, A. melleus, A. tamarii and A. nomius. The clinical presentation of onychomycosis due to Aspergillus spp. is non-specific but commonly distal-lateral pattern of onychomycosis. A negative culture with a positive KOH may point to a NDM including Aspergillus spp., as the causative agent of onychomycosis. Treatment consists of systemic therapy with terbinafine or itraconazole.
Collapse
Affiliation(s)
- Felix Bongomin
- The National Aspergillosis Centre, Education and Research Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - C R Batac
- Skin Study Group, Institute of Herbal Medicine, National Institutes of Health, University of the Philippines - Manila, Manila, Philippines
| | - Malcolm D Richardson
- The National Aspergillosis Centre, Education and Research Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
- NHS Mycology Reference Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
| | - David W Denning
- The National Aspergillosis Centre, Education and Research Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK.
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| |
Collapse
|
15
|
The Efficacy and Safety of Systemic Antifungals in Children’s Onychomycosis. CURRENT FUNGAL INFECTION REPORTS 2017. [DOI: 10.1007/s12281-017-0280-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
16
|
Abstract
Because of high exposure (e. g. swimmers and athletes competing on mats) and disposition (e. g. microtraumata of the skin in runners) athletes are prone to a higher risk for mycotic infections by dermatophytes. In disciplines with close contact during competition-especially wrestlers and judoists-infections by the anthropophilic Trichophyton (T.) tonsurans are most important (tinea gladiatorum). These infections are highly contagious and often cause small epidemics especially if the primary source of infection is not promptly recognized. The environment of the athletes (e. g. mats) and asymptomatic carriers may be sources of further spread. Tinea pedis with its clinical manifestations seems to be often underdiagnosed and insufficiently treated. Environmental contamination by fungal spores may be responsible for the significantly higher level of mycotic infections of the feet in children and adolescents active in sports. There is a higher risk for spread of the infection to the toe nails (onychomycosis) and for consecutive infections by bacteria (e. g. erysipelas). More rarely infections by zoophilic or geophilic dermatophytes are seen in athletes (e.g. equestrians). Education and more intensive measures of prevention and environmental decontamination are essential for all dermatophytoses associated with sports.
Collapse
Affiliation(s)
- P Mayser
- , Hofmannstr. 11, 35444, Biebertal, Deutschland.
| | - W Handrick
- Institut für Medizinische Diagnostik Oderland, Frankfurt (Oder), Deutschland
| | - P Nenoff
- Labor für medizinische Mikrobiologie, Mölbis, Deutschland
| |
Collapse
|
17
|
Totri CR, Feldstein S, Admani S, Friedlander SF, Eichenfield LF. Epidemiologic Analysis of Onychomycosis in the San Diego Pediatric Population. Pediatr Dermatol 2017; 34:46-49. [PMID: 27699839 DOI: 10.1111/pde.12986] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Onychomycosis (OM) is thought to be a rare disease in children, although there are few epidemiologic studies. METHODS This 3-year retrospective case series of nearly 400 children seen at Rady Children's Hospital-San Diego (RCHSD) describes the characteristics of OM found in this pediatric population. RESULTS From 2011 to 2013, the Pediatric and Adolescent Dermatology Clinic at RCHSD saw a total of 36,634 unique patients, of whom 433 were unique patients with OM. Thirty-four patients met exclusion criteria, leaving 399 (1.1%) with a diagnosis of OM by a pediatric dermatologist. Nail cultures were obtained in 242 cases (60.7%), 116 (48.0%) of which were positive. Trichophyton rubrum was the most commonly isolated pathogen, responsible for 106 cases (91.3%) of positive cultures in the cohort. CONCLUSIONS Our study provides important regional information regarding epidemiologic data in pediatric onychomycosis, highlighting the diagnostic methods most commonly used and the pathogens most frequently encountered in our practice.
Collapse
Affiliation(s)
- Christine R Totri
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Stephanie Feldstein
- Department of Dermatology, University of California, Davis, Davis, California
| | - Shehla Admani
- Department of Dermatology, University of California, San Diego, La Jolla, California
| | - Sheila F Friedlander
- Department of Dermatology, University of California, San Diego, La Jolla, California.,Pediatric and Adolescent Dermatology, Rady Children's Hospital, University of California, San Diego, La Jolla, California
| | - Lawrence F Eichenfield
- Department of Dermatology, University of California, San Diego, La Jolla, California.,Pediatric and Adolescent Dermatology, Rady Children's Hospital, University of California, San Diego, La Jolla, California
| |
Collapse
|
18
|
Wlodek C, Trickey A, de Berker D, Johnson E. Trends in Pediatric Laboratory-Diagnosed Onychomycosis Between 2006 and 2014 in the Southwest of England. Pediatr Dermatol 2016; 33:e358-e359. [PMID: 27654021 DOI: 10.1111/pde.12989] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This is the largest study of laboratory-diagnosed onychomycosis in England for children younger than 17 years. The most common (91.5%) cultured organism in this population was Trichophyton rubrum. Candida species were isolated only from fingernails, and the majority were from children younger than 5 years. Continued analysis of fungal pathogens is vital to identify changing trends.
Collapse
Affiliation(s)
| | - Adam Trickey
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | | |
Collapse
|
19
|
Solís-Arias MP, García-Romero MT. Onychomycosis in children. A review. Int J Dermatol 2016; 56:123-130. [DOI: 10.1111/ijd.13392] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 04/04/2016] [Accepted: 05/11/2016] [Indexed: 11/30/2022]
|
20
|
Barber K, Claveau J, Thomas R. Review of Treatment for Onychomycosis: Consideration for Special Populations. J Cutan Med Surg 2016. [DOI: 10.2310/7750.2006.00054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article provides a brief discussion of onychomycosis treatment in special populations such as children, the elderly, and patients with diabetes, human immunodeficiency virus (HIV), or Down syndrome. These subjects are generally not included in clinical trials, and few data on antifungal therapy are available in the literature. Issues with onychomycosis infection and treatment affecting each group are discussed, and where treatment reports exist, efficacy and safety data are presented. The discussion is restricted to agents approved for use in onychomycosis in Canada: oral terbinafine, oral itraconazole, and ciclopirox 8% nail lacquer. Although sparse, the literature demonstrates that onychomycosis therapies can be used safely and effectively in these special populations, although it is likely that the appropriateness of such treatment would have to be assessed on a case-by-case basis. Typically, oral medications are used reluctantly in these groups as the potential for adverse liver or kidney effects and medication interactions may be significant. Ciclopirox nail lacquer has recently become available for use and may offer an alternative to oral therapy in the future for mild to moderate cases of onychomycosis; however, the efficacy in these patients has not typically been reported. It remains to be seen what impact this medication will have for special populations. More knowledge of treatment in special populations must be accumulated in the literature before more formal treatment guidelines may be formulated.
Collapse
Affiliation(s)
- Kirk Barber
- From The Dermatology Centre, Calgary, AB; Dermatology Division, Laval University, Quebec City, PQ; Centre Hospitalier Universitaire de Quebec, Hotel Dieu de Quebec, Quebec City, PQ; and Department of Dermatology, University of British Columbia, Vancouver, BC
| | - Joël Claveau
- From The Dermatology Centre, Calgary, AB; Dermatology Division, Laval University, Quebec City, PQ; Centre Hospitalier Universitaire de Quebec, Hotel Dieu de Quebec, Quebec City, PQ; and Department of Dermatology, University of British Columbia, Vancouver, BC
| | - Richard Thomas
- From The Dermatology Centre, Calgary, AB; Dermatology Division, Laval University, Quebec City, PQ; Centre Hospitalier Universitaire de Quebec, Hotel Dieu de Quebec, Quebec City, PQ; and Department of Dermatology, University of British Columbia, Vancouver, BC
| |
Collapse
|
21
|
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.
Collapse
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, ,
| | | | | |
Collapse
|
22
|
Mayser PA, Gries A, Hamrouni N. [Trichophyton rubrum onychomycosis with secondary Aspergillus versicolor infection in a 12-year-old girl: successful topical therapy with terbinafine-urea ointment]. Hautarzt 2015; 65:628-32. [PMID: 24817253 DOI: 10.1007/s00105-014-2798-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CASE REPORT A 12-year-old with a functional circulatory disturbance had toe nail onychomycosis caused by Trichophyton rubrum. There were no other underlying diseases. THERAPY AND OUTCOME Oral therapy with terbinafine 125 mg once weekly in addition to ciclopirox nail lacquer was ineffective. Two years later the disease worsened and A. versicolor was found in pure culture. A preparation of 10% terbinafine HCl in a 20% urea ointment (Onychomal®) applied daily for 4 weeks, then once weekly resulted in complete cure after 7 months.
Collapse
Affiliation(s)
- P A Mayser
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gaffkystr. 14, 35385, Gießen, Deutschland,
| | | | | |
Collapse
|
23
|
Carvalho VO, Vicente VA, Werner B, Gomes RR, Fornari G, Herkert PF, Rodrigues CO, Abagge KT, Robl R, Camiña RH. Onychomycosis by Fusarium oxysporum probably acquired in utero. Med Mycol Case Rep 2014; 6:58-61. [PMID: 25383318 PMCID: PMC4223825 DOI: 10.1016/j.mmcr.2014.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/16/2014] [Accepted: 09/26/2014] [Indexed: 11/24/2022] Open
Abstract
Fusarium oxysporum has been described as a pathogen causing onychomycosis, its incidence has been increasing in immunocompetent and disseminated infection can occur in immunosuppressed individuals. We describe the first case of congenital onychomycosis in a child caused by Fusarium oxysporum. The infection being acquired in utero was proven by molecular methods with the identification of the fungus both in the nail and placenta, most probably as an ascending contamination/infection in a HIV-positive, immunosuppressed mother.
Collapse
Affiliation(s)
- Vania O. Carvalho
- Department of Pediatric Dermatology, Federal University of Paraná, Hospital de Clínicas, General Carneiro, 181, CEP 80060-900, Curitiba, Parana, Brazil
| | - Vania A. Vicente
- Postgraduate Program in Microbiology, Parasitology and Pathology, Biological Sciences, Department of Basic Pathology; LabMicro – Laboratory of Microbiology and Molecular Biology, Federal University of Parana, Curitiba, Parana, Brazil
- Fellowship from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brasilia, Brazil
| | - Betina Werner
- Medical Pathology Department, Federal University of Paraná, Hospital de Clínicas, General Carneiro, 181, CEP 80060-900, Curitiba, Parana, Brazil
| | - Renata R. Gomes
- Postgraduate Program in Microbiology, Parasitology and Pathology, Biological Sciences, Department of Basic Pathology; LabMicro – Laboratory of Microbiology and Molecular Biology, Federal University of Parana, Curitiba, Parana, Brazil
- Fellowship from Coordination for the Improvement of Higher Education Personnel (CAPES), Brasilia, Brazil
| | - Gheniffer Fornari
- Postgraduate Program in Microbiology, Parasitology and Pathology, Biological Sciences, Department of Basic Pathology; LabMicro – Laboratory of Microbiology and Molecular Biology, Federal University of Parana, Curitiba, Parana, Brazil
| | - Patricia F. Herkert
- Postgraduate Program in Microbiology, Parasitology and Pathology, Biological Sciences, Department of Basic Pathology; LabMicro – Laboratory of Microbiology and Molecular Biology, Federal University of Parana, Curitiba, Parana, Brazil
| | - Cristina O. Rodrigues
- Department of Pediatric Infectology, Federal University of Paraná, Hospital de Clínicas, General Carneiro, 181, CEP 80060-900, Curitiba, Parana, Brazil
| | - Kerstin T. Abagge
- Department of Pediatric Dermatology, Federal University of Paraná, Hospital de Clínicas, General Carneiro, 181, CEP 80060-900, Curitiba, Parana, Brazil
| | - Renata Robl
- Department of Pediatric Dermatology, Federal University of Paraná, Hospital de Clínicas, General Carneiro, 181, CEP 80060-900, Curitiba, Parana, Brazil
| | - Ricardo H Camiña
- Medical Pathology Department, Federal University of Paraná, Hospital de Clínicas, General Carneiro, 181, CEP 80060-900, Curitiba, Parana, Brazil
| |
Collapse
|
24
|
García-Romero MT, Lopez-Aguilar E, Arenas R. Onychomycosis in immunosuppressed children receiving chemotherapy. Pediatr Dermatol 2014; 31:618-20. [PMID: 23106131 DOI: 10.1111/pde.12030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Onychomycosis in children has a low incidence worldwide; certain conditions such as immunosuppression have been described as risk factors for it. We studied 72 children receiving chemotherapy for different neoplasms to determine the frequency of onychomycosis. Only one patient had white superficial onychomycosis from Trichophyton rubrum, a frequency of 1.3%, not different from that reported in healthy patients.
Collapse
|
25
|
Konate A, Yavo W, Kassi KF, Djohan V, Angora KE, Bosson-Vanga H, Barro-Kiki P, E I H Menan. [Onychomycosis mycological profile in Abidjan (Cote d'Ivoire)]. J Mycol Med 2014; 24:205-10. [PMID: 24751943 DOI: 10.1016/j.mycmed.2014.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 02/18/2014] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
Abstract
AIM OF THE STUDY The epidemiological profile of onychomycosis is poorly determined in Cote d'Ivoire. This study aimed to determine the fungal aetiologies of these onychomycosis in Abidjan. PATIENTS AND METHODS This cross-sectional study was conducted from February to August 2011 at the Department of Dermatology of the University Hospital of Treichville. All patients who consulted for onycholysis were interviewed. All samples were analyzed by direct examination and Sabouraud-chloramphenicol and Sabouraud-chloramphenicol-actidione culture was performed. Species identification was based on microscopic characteristics of the fungus observed. RESULTS A total of 53 patients were included. The prevalence of onychomycosis was estimated at 66%. The unilateral lesions were statistically different from bilateral lesions (P=0.010). Women were more affected at the hands than men (P=0.010). Five species of yeasts and two dermatophytes species were identified. Yeasts species were essentially Candida tropicalis (36.4%) and Candida albicans (30.3%). Trichophyton rubrum and Trichophyton soudanense were the only dermatophytes isolated. No contributing factors were statistically related to the occurrence of onychomycosis in our series. CONCLUSION The observed onychomycosis in Côte d'Ivoire are mainly caused by yeasts. Although in our series the risk factors have not been identified, hygiene of the nails should provide effective prevention.
Collapse
Affiliation(s)
- A Konate
- Laboratoire de parasitologie-mycologie, centre hospitalier universitaire de Yopougon, 21, BP 632 Abidjan 21, Abidjan, Côte d'Ivoire; Laboratoire de parasitologie-mycologie, CHU de Yopougon, 21 BP 632 , Abidjan, Côte d'Ivoire.
| | - W Yavo
- Laboratoire de parasitologie-mycologie, centre hospitalier universitaire de Yopougon, 21, BP 632 Abidjan 21, Abidjan, Côte d'Ivoire
| | - K F Kassi
- Laboratoire de parasitologie-mycologie, centre hospitalier universitaire de Yopougon, 21, BP 632 Abidjan 21, Abidjan, Côte d'Ivoire; Laboratoire de parasitologie-mycologie, Centre de diagnostic et de recherche sur le sida et les maladies opportunistes, 01 BPV 13, Abidjan, Côte d'Ivoire
| | - V Djohan
- Laboratoire de parasitologie-mycologie, centre hospitalier universitaire de Yopougon, 21, BP 632 Abidjan 21, Abidjan, Côte d'Ivoire
| | - K E Angora
- Laboratoire de parasitologie-mycologie, centre hospitalier universitaire de Yopougon, 21, BP 632 Abidjan 21, Abidjan, Côte d'Ivoire
| | - H Bosson-Vanga
- Laboratoire de parasitologie-mycologie, centre hospitalier universitaire de Yopougon, 21, BP 632 Abidjan 21, Abidjan, Côte d'Ivoire
| | - P Barro-Kiki
- Laboratoire de parasitologie-mycologie, centre hospitalier universitaire de Yopougon, 21, BP 632 Abidjan 21, Abidjan, Côte d'Ivoire
| | - E I H Menan
- Laboratoire de parasitologie-mycologie, centre hospitalier universitaire de Yopougon, 21, BP 632 Abidjan 21, Abidjan, Côte d'Ivoire; Laboratoire de parasitologie-mycologie, Centre de diagnostic et de recherche sur le sida et les maladies opportunistes, 01 BPV 13, Abidjan, Côte d'Ivoire
| |
Collapse
|
26
|
Khebizi S, Mansouri R. [Extensive inflammatory and childhood dermatophytosis caused by Trichophyton rubrum]. J Mycol Med 2014; 24:e131-6. [PMID: 24746729 DOI: 10.1016/j.mycmed.2014.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 02/03/2014] [Accepted: 02/03/2014] [Indexed: 11/27/2022]
Abstract
We report an observation of extensive and atypical dermatophytosis to Trichophyton rubrum coexisting with fingernails and tinea manuum candidiasis in a 13-year-old girl presenting inflammatory cutaneous lesions, involvement of scalp, as well as total dystrophic onychomycosis of feet associated with a perionyxis of hands. The results of the mycological examination of specimen showed fungal elements of septate hyphae and pilar parasitism. The fungal culture allowed the diagnosis of certainty of the dermatophytosis to T. rubrum. The therapeutic success of this infection was obtained thanks to the administration of antifungals by oral route.
Collapse
Affiliation(s)
- S Khebizi
- Service de parasitologie-mycologie médicale, CHU Ibn Sina, 23000 Annaba, Algérie.
| | - R Mansouri
- Service de parasitologie-mycologie médicale, CHU Ibn Sina, 23000 Annaba, Algérie
| |
Collapse
|
27
|
Abstract
The authors herein describe several nail conditions, which the general pediatrician is likely to encounter in the course of routine practice. Because pediatric nail disorders represent a limited component of a general pediatric practice, it can be challenging for practitioners to establish expertise in the diagnosis and treatment of these conditions and to recognize when reassurance is appropriate or when referral to a specialist is necessary. This article summarizes the anatomy of the normal nail unit, as well as the evaluation and management of onychomycosis, melanonychia, trachyonychia, onychomadesis, and nail pitting.
Collapse
|
28
|
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.
Collapse
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
| |
Collapse
|
29
|
Young LS, Arbuckle HA, Morelli JG. Onychomycosis in the Denver pediatrics population, a retrospective study. Pediatr Dermatol 2014; 31:106-8. [PMID: 22612465 DOI: 10.1111/j.1525-1470.2012.01769.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Onychomycosis (OM) is a common nail disorder in adults but has been rare in children. Recent international studies have demonstrated a rise in the prevalence of OM in children and adolescents, with Trichophyton rubrum being the most common pathogen. This 5-year retrospective chart review of children (aged <18) found that 66 of 141 patients (46.8%) presenting to Children's Hospital Colorado or Denver Health Medical Center Dermatology clinics with nail complaints had OM, with the highest prevalence in those aged 6 to 10 and a slight male predominance. Toenails were more commonly affected, and Trichophyton rubrum was the most common pathogen.
Collapse
Affiliation(s)
- Lindsay S Young
- Department of Pediatrics, School of Medicine University of Colorado, Denver, ColoradoDepartment of Dermatology, Kaiser Permanente Colorado, Denver, ColoradoDepartment of Dermatology, School of Medicine University of Colorado, Denver, ColoradoDepartment of Pediatric Dermatology, Children's Hospital Colorado, Aurora, Colorado
| | | | | |
Collapse
|
30
|
Kim DM, Suh MK, Ha GY. Onychomycosis in children: an experience of 59 cases. Ann Dermatol 2013; 25:327-34. [PMID: 24003276 PMCID: PMC3756198 DOI: 10.5021/ad.2013.25.3.327] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 07/27/2012] [Accepted: 08/06/2012] [Indexed: 11/29/2022] Open
Abstract
Background Although tinea unguium in children has been studied in the past, no specific etiological agents of onychomycosis in children has been reported in Korea. Objective The purpose of this study was to investigate onychomycosis in Korean children. Methods We reviewed fifty nine patients with onychomycosis in children (0~18 years of age) who presented during the ten-year period between 1999 and 2009. Etiological agents were identified by cultures on Sabouraud's dextrose agar with and without cycloheximide. An isolated colony of yeasts was considered as pathogens if the same fungal element was identified at initial direct microscopy and in specimen-yielding cultures at a follow-up visit. Results Onychomycosis in children represented 2.3% of all onychomycosis. Of the 59 pediatric patients with onychomycosis, 66.1% had toenail onychomycosis with the rest (33.9%) having fingernail onychomycosis. The male-to-female ratio was 1.95:1. Fourteen (23.7%) children had concomitant tinea pedis infection, and tinea pedis or onychomycosis was also found in eight of the parents (13.6%). Distal and lateral subungual onychomycosis was the most common (62.7%) clinical type. In toenails, Trichophyton rubrum was the most common etiological agent (51.3%), followed by Candida albicans (10.2%), C. parapsilosis (5.1%), C. tropicalis (2.6%), and C. guilliermondii (2.6%). In fingernails, C. albicans was the most common isolated pathogen (50.0%), followed by T. rubrum (10.0%), C. parapsilosis (10.0%), and C. glabrata (5.0%). Conclusion Because of the increase in pediatric onychomycosis, we suggest the need for a careful mycological examination of children who are diagnosed with onychomycosis.
Collapse
Affiliation(s)
- Dong Min Kim
- Department of Dermatology, Dongguk University College of Medicine, Gyeongju, Korea
| | | | | |
Collapse
|
31
|
Friedlander SF, Chan YC, Chan YH, Eichenfield LF. Onychomycosis does not always require systemic treatment for cure: a trial using topical therapy. Pediatr Dermatol 2013; 30:316-22. [PMID: 23278851 DOI: 10.1111/pde.12064] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Standard teaching dictates that systemic therapy is required for treatment of onychomycosis. It is unknown whether topical antifungal therapy is effective for pediatric nail infections. This prospective, randomized, double-blind, vehicle-controlled study was conducted in the Pediatric Dermatology Research Unit at Rady Children's Hospital to determine whether topical antifungal therapy is efficacious for pediatric onychomycosis. Forty patients ages 2 to 16 years with nonmatrix onychomycosis were randomized 1:3 to ciclopirox lacquer or vehicle lacquer. Ciclopirox lacquer or vehicle was applied daily for 32 weeks, with weekly removal of the lacquer and mechanical trimming. Those with poor response were crossed over to active drug at week 12. Thirty-seven patients completed the 32-week study, and follow-up data were collected 1 year after completion of the study from 24 patients. Mycologic cure, effective treatment, and complete cure were assessed, as well as adverse events and effect on quality of life. Mycologic cure was 70% in the treated group and 20% in the vehicle arm (p = 0.03) at week 12. At end of the study (week 32), 77% of treated patients achieved mycologic cure and 71% effective treatment, compared with 22% of the control group. Ninety-two percent of those who were cured and followed for 1 year remained clear. Topical antifungal lacquer (ciclopirox) can be an effective option for children with nonmatrix onychomycosis. Pediatric onychomycosis does not always require systemic therapy and responds better to topical therapy than does adult disease.
Collapse
Affiliation(s)
- Shiela Fallon Friedlander
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital-San Diego and University of California at San Diego School of Medicine, San Diego, CA 92123, USA.
| | | | | | | |
Collapse
|
32
|
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]
|
33
|
Aghamirian MR, Ghiasian SA. Onychomycosis in Iran: epidemiology, causative agents and clinical features. ACTA ACUST UNITED AC 2010; 51:23-9. [PMID: 20185868 DOI: 10.3314/jjmm.51.23] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Onychomycosis represents the most frequently encountered nail disease, which is difficult to eradicate with drug treatment. AIM This study was undertaken to document the clinico-mycological pattern of onychomycosis in Iran. Results of mycological tests of nail scrapings collected over a 4-year period were analyzed. METHODS Both direct microscopy and cultures of the nail material were performed to identify the causative agents. RESULTS The microscopic and/or cultural detection of fungi was positive in 40.2% of samples. The most common clinical type noted was distolateral subungual onychomycosis in 48.4% of cases. Etiological fungal agents were 50% dermatophytes, 46.8% yeasts, and 3.2% saprophytic moulds. The most frequently detected dermatophyte species were Trichophyton rubrum (48.4%) and T. mentagrophytes (41.9%). Among yeasts, Candida albicans (58.6) was most common, followed by C. parapsilosis (17.2%), C. glabrata (10.3%), C. krusei and C. tropicalis (each 6.9%). Aspergillus niger and A. flavus were the most frequent saprophytic moulds. Females were affected more frequently than males, and in both sexes those most infected were between 40-49 years of age. Fingernails were affected more frequently than toenails. CONCLUSIONS The clinico-epidemiological data collected can serve as reference for future research and may be useful in the development of preventive and educational strategies.
Collapse
Affiliation(s)
- Mohammad Reza Aghamirian
- Medical Parasitology and Mycology Department, Qazvin University of Medical Sciences and Health Services, Qazvin, Iran
| | | |
Collapse
|
34
|
Rodríguez-Pazos L, Pereiro-Ferreirós M, Pereiro M, Toribio J. Onychomycosis observed in children over a 20-year period. Mycoses 2010; 54:450-3. [DOI: 10.1111/j.1439-0507.2010.01878.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
35
|
|
36
|
Pföhler C, Hollemeyer K, Heinzle E, Altmeyer W, Graeber S, Müller CSL, Stark A, Jager SU, Tilgen W. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry: a new tool in diagnostic investigation of nail disorders? Exp Dermatol 2009; 18:880-2. [DOI: 10.1111/j.1600-0625.2008.00838.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
37
|
Mayser P, Freund V, Budihardja D. Toenail onychomycosis in diabetic patients: issues and management. Am J Clin Dermatol 2009; 10:211-20. [PMID: 19489654 DOI: 10.2165/00128071-200910040-00001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Diabetes mellitus may be associated with serious sequelae, such as renal disease, retinopathy, and diabetic foot. A recent large prospective study has shown that onychomycosis is among the most significant predictors of foot ulcer. As the severity of onychomycosis may be associated with the length of time the individual has had the infection, early intervention is advisable owing to the progressive nature of the fungal infection. If left untreated, toenails can become thick, causing pressure and irritation, and thus act as a trigger for more severe complications. In the treatment of onychomycosis, compliance and drug interactions are important considerations, as diabetic patients frequently take concomitant medications. Terbinafine and itraconazole have been investigated for the treatment of onychomycosis in diabetic patients and have been shown to have efficacy and safety profiles comparable to those in the nondiabetic population. Data from clinical trials and postmarketing surveillance suggest that drug interactions resulting in hypoglycemia may not be an important issue when itraconazole and terbinafine are used to treat diabetic patients receiving concomitant hypoglycemic medications. Patient advice and education in improved foot care are an integral part of onychomycosis management, and help achieve long-term cure and reduce the complications of diabetic foot.
Collapse
Affiliation(s)
- Peter Mayser
- Center of Dermatology and Andrology, Justus Liebig University, Giessen, Germany.
| | | | | |
Collapse
|
38
|
Al Sheikh H. Epidemiology of Dermatophytes in the Eastern Province of Saudi Arabia. ACTA ACUST UNITED AC 2009. [DOI: 10.3923/jm.2009.229.234] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
39
|
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.
Collapse
|
40
|
Leibovici V, Evron R, Dunchin M, Westerman M, Ingber A. A Population-based study of Toenail onychomycosis in Israeli children. Pediatr Dermatol 2009; 26:95-7. [PMID: 19250420 DOI: 10.1111/j.1525-1470.2008.00832.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Onychomycosis is widespread in the adult population, but considered to be rare in children. A number of studies in recent years show a rise in the prevalence of toenail onychomycosis in children. Of these, only a few were population-based. Here, we present a comprehensive cross-sectional population-based survey of toenail onychomycosis in primary school children in Israel. The survey included 1148 children, 598 boys, and 550 girls aged 5 to 14 from primary schools in the Jerusalem vicinity. Each child underwent a physical examination and completed a personal questionnaire, which provided background information of predisposing factors. The survey shows a prevalence of 0.87% of toenail onychomycosis. Although this figure is too small for statistical analysis, some important conclusions could be drawn: prevalence increased with age: boy/girl ratio was 2.2; the dominant etiologic agent was Trichophyton rubrum followed by Trichophyton mentagrophytes and Candida albicans. Infections were probably transferred from adults via the environment to children. Infected children came from different socio-economic backgrounds. This condition should be considered in the differential diagnosis of nail diseases in children.
Collapse
Affiliation(s)
- Vera Leibovici
- Department of Dermatology, Hadassah University Hospital, Jerusalem, Israel.
| | | | | | | | | |
Collapse
|
41
|
Makni F, Cheikhrouhou F, Amri H, Sellami A, Sellami H, Néji S, Marrekchi S, Turki H, Ayadi A. Les onychomycoses chez les enfants à Sfax (Tunisie). J Mycol Med 2008. [DOI: 10.1016/j.mycmed.2008.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
42
|
Ginter-Hanselmayer G, Weger W, Smolle J. Onychomycosis: a new emerging infectious disease in childhood population and adolescents. Report on treatment experience with terbinafine and itraconazole in 36 patients. J Eur Acad Dermatol Venereol 2008; 22:470-5. [DOI: 10.1111/j.1468-3083.2007.02498.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
43
|
Abanmi A, Bakheshwain S, El Khizzi N, Zouman AR, Hantirah S, Al Harthi F, Al Jamal M, Rizvi SS, Ahmad M, Tariq M. Characteristics of superficial fungal infections in the Riyadh region of Saudi Arabia. Int J Dermatol 2008; 47:229-35. [PMID: 18289321 DOI: 10.1111/j.1365-4632.2008.03563.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prevalence and characteristics of superficial fungal infections (SFIs) vary with climatic conditions, lifestyle, and population migration patterns. This study was undertaken to determine the characteristics of SFIs amongst patients visiting the dermatology clinic of Riyadh Military Hospital, Riyadh, Saudi Arabia, during the period 2003-2005. METHODS One hundred and nineteen patients with confirmed SFI (37 males and 82 females), aged between 5 months and 67 years, were included in this study. The diagnosis of SFI was based on clinical presentation confirmed by laboratory analysis. The type of mycotic pathogen and the site of infection were recorded as a function of age and sex. RESULTS Onychomycosis (40.3%) was the most frequent infection, followed by tinea capitis (21.9%), tinea pedis (16%), tinea cruris (15.1%), and tinea corporis (6.7%). Tinea capitis was most prevalent (15.1%) in children (male to female ratio, 1 : 1.57), whereas tinea pedis was most common (11.8%) in adults (male to female ratio, 1 : 2.5). Trichophyton mentagrophytes and Microsporum canis were the most common dermatophytes responsible for tinea infections, and T. mentagrophytes, Candida spp., and Aspergillus spp. were mainly responsible for onychomycosis. CONCLUSION The prevalence of SFI was twofold greater in females than males. Children were most commonly affected by tinea capitis, whereas adults generally suffered from tinea pedis. The frequency of onychomycosis was nearly three times higher in adults. This study clearly shows that SFIs are of concern in both genders and in all age groups.
Collapse
Affiliation(s)
- Abdullah Abanmi
- Department of Dermatology, Research Center, Riyadh Military Hospital, Riyadh, Saudi Arabia
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Martinez Roig A, Torres Rodriguez JM. Twelve cases of tinea unguium in a pediatric clinic in 9 years. Eur J Pediatr 2007; 166:975-7. [PMID: 17123110 DOI: 10.1007/s00431-006-0332-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2006] [Accepted: 10/03/2006] [Indexed: 11/30/2022]
Abstract
Tinea of the nails is not an exclusively adult pathology. The pediatrician should include this entity in the differential diagnosis.
Collapse
Affiliation(s)
- A Martinez Roig
- Servei de Pediatria, Hospital del Mar, Universitat Autonoma de Barcelona, Passeig Maritim 25-29, Barcelona, Catalonia, Spain.
| | | |
Collapse
|
45
|
Popoola TOS, Ojo DA, Alabi RO. Prevalence of dermatophytosis in junior secondary schoolchildren in Ogun State, Nigeria. Mycoses 2006; 49:499-503. [PMID: 17022768 DOI: 10.1111/j.1439-0507.2006.01279.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A total of 2772 randomly selected junior secondary school pupils (aged 8-14) from 60 schools were examined for dermatophytic infections by direct microscopy and culture-based laboratory diagnostic methods. Of these, 641 (23.21%) had dermatophytosis. Out of these, 376 (13.56%) were male while 265 (9.56%) were female. Aetiological agents identified with infection were Microsporum canis (30.19%), Microsporum audouinii (32.92%), Trichophyton interdigitale (14.37%), Trichophyton soudanense (9.73%) and Trichophyton tonsurans (12.05%). Most of the dermatophytes encountered were anthropophilic species. Microsporum canis was the only zoophilic dermatophyte. Differences were not observed in infection pattern for all the different geo-political zones that make up the state. The head and the skin of the students were more frequently infected than the nails and toes. Infection frequency increased steadily up to age 11 after which it drastically decreased.
Collapse
Affiliation(s)
- T O S Popoola
- Department of Microbiology, University of Agriculture, Abeokuta, Nigeria.
| | | | | |
Collapse
|