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Gupta AK, Cooper EA, Wang T, Polla Ravi S, Lincoln SA, Piguet V, McCarthy LR, Bakotic WL. Detection of Squalene Epoxidase Mutations in United States Patients with Onychomycosis: Implications for Management. J Invest Dermatol 2023; 143:2476-2483.e7. [PMID: 37236595 DOI: 10.1016/j.jid.2023.04.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/11/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023]
Abstract
Resistance to oral terbinafine, the most commonly used antifungal to treat dermatophytosis and onychomycosis worldwide, is being increasingly reported. In this study, we aimed to investigate the species distribution and prevalence of squalene epoxidase mutations among toenail dermatophyte isolates. Samples from 15,683 patients suspected of onychomycosis visiting the offices of dermatologists and podiatrists in the United States were analyzed. Clinical information was reviewed, and dermatophyte species with or without squalene epoxidase mutations were detected using multiplex real-time PCRs. The frequency of dermatophytes was 37.6%; of isolates belonging to the Trichophyton genus, 88.3% were the T. rubrum complex, and 11.2% were the T. mentagrophytes complex. Individuals aged >70 years exhibited higher infection rates for the T. mentagrophytes complex. The overall mutation rate among Trichophyton spp. was 3.7%, with a higher mutation rate detected in the T. mentagrophytes complex (4.3 vs. 3.6%). Commonly detected mutations were T1189C/Phe397Leu (34.5%), T1306C/Phe415Ser (16.0%), and C1191A/Phe397Leu (11.0%). Squalene epoxidase gene mutations associated with decreased terbinafine susceptibility have been identified in United States patients with toenail onychomycosis. Physicians should be aware of the risk factors for resistance development and engage in antifungal stewardship practices such as directed diagnosis and treatment of dermatophytosis and onychomycosis.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Mediprobe Research, London, Ontario, Canada.
| | | | - Tong Wang
- Mediprobe Research, London, Ontario, Canada
| | | | | | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada
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Agrawal S, Singal A, Grover C, Das S, Madhu SV. Clinico-Mycological Study of Onychomycosis in Indian Diabetic Patients. Indian Dermatol Online J 2023; 14:807-813. [PMID: 38099045 PMCID: PMC10718108 DOI: 10.4103/idoj.idoj_642_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 12/17/2023] Open
Abstract
Background Onychomycosis (OM) is the most common nail disorder accounting for 40-50% of all onychopathies. Onychomycosis is caused by dermatophytes in majority, mostly Trichophyton (T.) rubrum followed by T. mentragrophytes var. interdigitale. However, there is a variation in the etiological profile with the subset of population, time, and geographical location. In immunocompromised hosts, non-dermatophytic molds (NDMs) and yeasts like Candida albicans and Candida parapsilosis are the main causative agents. Diabetes mellitus (DM) is a well-established risk factor for OM. Aim and Objectives This study was conducted to determine the clinical and mycological characteristics of OM in diabetic patients and to evaluate the clinico-etiological correlation, if any. Materials and Methods Three hundred consecutive diabetic patients were screened, of whom 102 (34%) patients were diagnosed with OM based on clinical, mycological, dermoscopic, and histological criteria. Results Distal lateral subungual onychomycosis was the most common clinical variant seen in 80 (78.43%) patients. Fungal culture was positive in 57 (55.88%) of which NDMs constituted approximately half (47.61%) of the isolates, followed by Candida species (30.15%) and dermatophytes (22.22%). The clinico-mycological correlation was performed to look for the association of various fungi with the clinical type of OM. Distal lateral subungual onychomycosis was majorly caused by NDMs (51.02%), followed by Candida species (28.57%), and dermatophytes (20.40%). Conclusion Non-dermatophytic molds are increasingly incriminated as the causative organisms for OM in DM and must be considered as potential pathogens in the present scenario, thus necessitating the change in the treatment options accordingly.
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Affiliation(s)
- Sonia Agrawal
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Chander Grover
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Shukla Das
- Department of Microbiology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - S V Madhu
- Department of Endocrinology, University College of Medical Sciences and GTB Hospital, Delhi, India
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Agrawal S, Singal A, Grover C, Das S, Arora VK, Madhu SV. Prevalence of onychomycosis in patients with diabetes mellitus: A cross-sectional study from a tertiary care hospital in North India. Indian J Dermatol Venereol Leprol 2023; 89:710-717. [PMID: 37067104 DOI: 10.25259/ijdvl_360_2022] [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: 04/07/2022] [Accepted: 12/11/2022] [Indexed: 04/05/2023]
Abstract
Background Though diabetes mellitus (DM) is a well-recognised risk factor for onychomycosis (OM), the epidemiology of OM in diabetic patients remains largely unexplored, especially from the Indian subcontinent. Aims and objectives To estimate the prevalence of OM in diabetic patients, to identify and analyse risk factors, and correlate the severity of nail changes with glycemic control (HBA1c). Methods This cross-sectional, analytical study involved 300 diabetic patients. Patients with the clinical diagnosis of OM, supplanted by at least two of the four tests (KOH, culture, onychoscopy and nail histopathology) were considered cases of OM. Demographic and haematological profile was analysed using chi-square test/ Fischer's exact test. Logistic regression was applied to assess the independent risk factors. Results The prevalence of OM in DM patients was 34% (102/300) and significant risk factors included; age >60 years, male gender, closed shoes, disease duration >5 years, high BMI (>25) and lack of awareness about nail changes. Distal and lateral subungual OM (78%) was the commonest presentation followed by proximal subungual OM, superficial OM and total dystrophic OM. Correlation between HbA1c and the number of nails involved was found to be significant. Limitation As cases were recruited from a hospital setting, there could be chances of Berksonian bias. Conclusion The prevalence of OM in diabetic patients is high and the severity of nail changes correlates with HbA1C levels. It is important to diagnose OM early in order to treat and prevent complications.
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Affiliation(s)
- Sonia Agrawal
- Department of Dermatology & STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Archana Singal
- Department of Dermatology & STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Chander Grover
- Department of Dermatology & STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Shukla Das
- Department of Microbiology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - V K Arora
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - S V Madhu
- Department of Endocrinology, University College of Medical Sciences and GTB Hospital, Delhi, India
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Kumar P, Ramachandran S, Das S, Bhattacharya SN, Taneja B. Insights into Changing Dermatophyte Spectrum in India Through Analysis of Cumulative 161,245 Cases Between 1939 and 2021. Mycopathologia 2023:10.1007/s11046-023-00720-6. [PMID: 36976442 DOI: 10.1007/s11046-023-00720-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/12/2023] [Indexed: 03/29/2023]
Abstract
Dermatophytosis is one of the most common superficial infections of the skin affecting nearly one-fifth of the world population at any given time. With nearly 30% of worldwide terbinafine-resistance cases in Trichophyton mentagrophytes/Trichophyton interdigitale and Trichophyton rubrum reported from India in recent years, there is a significant burden of the emerging drug resistance epidemic on India. Here, we carry out a comprehensive retrospective analysis of dermatophytosis in India using 1038 research articles pertaining to 161,245 cases reported from 1939 to 2021. We find that dermatophytosis is prevalent in all parts of the country despite variable climatic conditions in different regions. Our results show T. rubrum as the most prevalent until 2015, with a sudden change in dermatophyte spectrum towards T. mentagrophytes/T. interdigitale complex since then. We also carried out an 18S rRNA-based phylogenetics and an average nucleotide identity-and single nucleotide polymorphism-based analysis of available whole genomes and find very high relatedness among the prevalent dermatophytes, suggesting geographic specificity. The comprehensive epidemiological and phylogenomics analysis of dermatophytosis in India over the last 80 years, presented here, would help in region-specific prevention, control and treatment of dermatophyte infections, especially considering the large number of emerging resistance cases.
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Affiliation(s)
- Pawan Kumar
- CSIR-Institute of Genomics and Integrative Biology(CSIR-IGIB), New Delhi, 110025, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - S Ramachandran
- CSIR-Institute of Genomics and Integrative Biology(CSIR-IGIB), New Delhi, 110025, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Shukla Das
- UCMS-GTB, Hospital, Dilshad Garden, Delhi, 110095, India
| | - S N Bhattacharya
- Dr. Babasaheb Ambedkar Medical College and Hospital, Delhi, 110085, India
| | - Bhupesh Taneja
- CSIR-Institute of Genomics and Integrative Biology(CSIR-IGIB), New Delhi, 110025, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
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Devi Sangeetha A, Gopalakrishnan K, Ramachandran R, Narasimhan M, Ramraj B. A descriptive study of onychoscopic features in various subtypes of onychomycosis. Med J Armed Forces India 2022; 78:S219-S225. [PMID: 36147430 PMCID: PMC9485850 DOI: 10.1016/j.mjafi.2021.03.019] [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: 09/15/2020] [Accepted: 03/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background The diagnosis of onychomycosis is usually clinical and is confirmed by 40% KOH examination. A diagnostic dilemma occurs when KOH examination is negative despite strong clinical suspicion. Dermoscopic evaluation of the nail is referred to as onychoscopy. We attempted to assess the dermoscopic findings in Onychomycosis positive with KOH examination. Methods A cross sectional study was conducted in a tertiary care center including 122 patients with clinical suspicion of onychomycosis with KOH positivity. After assessment of risk factors and gross nail examination, onychoscopic examination was done to identify the presence of the specific features. Results Primary findings of onychoscopic examination were 'spiked pattern' in 80.3% subjects, of which 95 were distal lateral subungual onychomycosis (DLSO), 8 of total dystrophic onychomycosis (TDO). True leukonychia was seen in the single patient of proximal subungual onychomycosis (PSO) and pseudoleukonychia in the single patient of white superficial onychomycosis (WSO). Distal irregular termination was observed in 23% of subjects - 8 from DLSO and in all 20 patients of TDO. 'Ruin appearance' was observed in all 20 patients of TDO, 56 patients with DLSO and not seen in other types of onychomycosis (OM). Presence of spiked pattern, Longitudinal striae, Distal irregular termination and Ruin appearance were found to be statistically significant (p < 0.001). Conclusion In suspected onychomycosis, specific onychoscopic findings such as Spiked pattern, Longitudinal striae, Ruin appearance and Distal irregular termination can be used as supporting evidence for diagnosing onychomycosis clinically and initiating antifungal therapy if mycological testing is unavailable or negative.
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Affiliation(s)
- A. Devi Sangeetha
- Junior Resident (Dermatology), SRM Medical College & Research Centre, SRM Nagar, Tamil Nadu, India
| | - K. Gopalakrishnan
- Associate Professor (Dermatology), SRM Medical College & Research Centre, SRM Nagar, Tamil Nadu, India
| | - R. Ramachandran
- Associate Professor (Dermatology), SRM Medical College & Research Centre, SRM Nagar, Tamil Nadu, India
| | - Murali Narasimhan
- Professor & Head (Dermatology), SRM Medical College & Research Centre, SRM Nagar, Tamil Nadu, India
| | - Balaji Ramraj
- Associate Professor (Community Medicine), SRM Medical College & Research Centre, SRM Nagar, Tamil Nadu, India
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Prevalence of Onychomycosis in Diabetic Patients: A Case-Control Study Performed at University Hospital Policlinico in Catania. J Fungi (Basel) 2022; 8:jof8090922. [PMID: 36135647 PMCID: PMC9500927 DOI: 10.3390/jof8090922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/12/2022] [Accepted: 08/29/2022] [Indexed: 11/25/2022] Open
Abstract
Diabetes is characterized by an increased rate of serum glucose due to defects in insulin secretion, insulin action or both conditions. Glucose excesses can lead to extended cellular damage, with the consequence of several infectious and non-infectious skin disorders. The aim of the present study was to evaluate the toenail onychomycosis incidence in diabetic patients and healthy ones. The non-interventional, retrospective study was performed at the mycology laboratory of the University hospital “Policlinico-San Marco” in Catania, Italy, for over one year. Nail clippings were collected to perform microscopic and cultural exams, which allowed for the identification of fungal aetiological agents. A total of 715 patients (47 diabetic and 668 non-diabetic patients) were enrolled. In diabetic patients, dermatophytes were the most common cultural isolates (50%), followed by yeasts and moulds in 30.8% and 19.2%, respectively. In non-diabetic patients, the distribution of dermatophytes, yeasts and non-dermatophytic moulds was 67.4%, 5.3% and 27.3%, respectively. According to our results, diabetic patients are more predisposed to nail fungal infection. Our data suggest that dermatological follow-ups should always be performed for diabetic patients. All skin and nail disorders should be carefully monitored to perform a diagnostic confirmation and correct management of diabetic patients.
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Laroche L, Bourgeois N, Lachaud L, Rispail P. Epidemiological analysis of nail aspergillosis and non-dermatophyte moulds. Criteria for the involvement of Aspergillus in 102 cases of onychomycosis at Montpellier University Hospital, France (1991-2019). Mycoses 2021; 64:1546-1553. [PMID: 34467565 DOI: 10.1111/myc.13366] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Moulds are often wrongly considered contaminants, not very sensitive to conventional antifungal treatments, but they may cause ungual hyphomycosis, particularly Aspergillus. Due to the lack of precise diagnostic criteria, their real impact is underestimated. OBJECTIVES Retrospective descriptive analysis of all ungual hyphomycosis cases diagnosed at Montpellier Hospital from 1991 to 2019 to: (i) determine the incidence of onychomycosis by pseudo-dermatophytes and moulds; (ii) perform an epidemiological analysis of nail aspergillosis; and (iii) provide simple criteria for mould involvement in onychopathy. PATIENTS/METHODS Data concerning 4053 patients were collected: age, sex, onychomycosis location, direct examination results, species(s) identified and fungal co-infections. Moreover, clinical data of patients with nail aspergillosis were analysed to identify potential contributing factors, and the classical criteria for mould involvement in onychopathy were critically reviewed. RESULTS A pseudo-dermatophyte or a mould was involved in nail colonisation in 17.25% of patients (men/women ratio: 0.70; mean age: 53.1 years). The identified hyphomycetes belonged mainly to the genera Fusarium (45.68%), Scopulariopsis (30.23%) and Aspergillus (16.94%). Analysis of the clinical reports of 102 patients with ungual aspergillosis (men/women ratio: 0.67; mean age: 56.3 years) identified cardiovascular (43.9%), endocrine (25.8%), cancer (19.7%) and skin (18.2%) diseases as contributing factors. CONCLUSIONS The adoption of simple and reliable criteria (ie, characteristic filaments on direct microscopic examination after periodic acid-Schiff staining, growth at seeding points in culture) allows determining the formal involvement of a mould in chronic onychopathies and avoiding possible side effects and costs of empirical or inappropriate and repetitive treatments.
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Affiliation(s)
- Laëtitia Laroche
- "MiVEGEC" and Department of Mycology and Parasitology, CNRS, IRD, University Hospital Center of Montpellier, University Montpellier, Montpellier, France
| | - Nathalie Bourgeois
- "MiVEGEC" and Department of Mycology and Parasitology, CNRS, IRD, University Hospital Center of Montpellier, University Montpellier, Montpellier, France
| | - Laurence Lachaud
- "MiVEGEC" and Department of Mycology and Parasitology, CNRS, IRD, University Hospital Center of Montpellier, University Montpellier, Montpellier, France
| | - Philippe Rispail
- "MiVEGEC" and Department of Mycology and Parasitology, CNRS, IRD, University Hospital Center of Montpellier, University Montpellier, Montpellier, France
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Kayarkatte MN, Singal A, Pandhi D, Das S. Clinico‐mycological study of onychomycosis in a tertiary care hospital—A cross‐sectional study. Mycoses 2019; 63:113-118. [DOI: 10.1111/myc.13025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/16/2019] [Accepted: 10/18/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Manasa N. Kayarkatte
- Department of Dermatology & STD University College of Medical GTB Hospital (University of Delhi) Delhi India
| | - Archana Singal
- Department of Microbiology University College of Medical Sciences GTB Hospital (University of Delhi) Delhi India
| | - Deepika Pandhi
- Department of Microbiology University College of Medical Sciences GTB Hospital (University of Delhi) Delhi India
| | - Shukla Das
- Department of Microbiology University College of Medical Sciences GTB Hospital (University of Delhi) Delhi India
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Dogra S, Shaw D, Rudramurthy SM. Antifungal Drug Susceptibility Testing of Dermatophytes: Laboratory Findings to Clinical Implications. Indian Dermatol Online J 2019; 10:225-233. [PMID: 31149563 PMCID: PMC6536077 DOI: 10.4103/idoj.idoj_146_19] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Sunil Dogra
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipika Shaw
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India E-mail:
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India E-mail:
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Veiga FF, Gadelha MC, da Silva MRT, Costa MI, Kischkel B, de Castro-Hoshino LV, Sato F, Baesso ML, Voidaleski MF, Vasconcellos-Pontello V, Vicente VA, Bruschi ML, Negri M, Svidzinski TIE. Propolis Extract for Onychomycosis Topical Treatment: From Bench to Clinic. Front Microbiol 2018; 9:779. [PMID: 29922236 PMCID: PMC5996904 DOI: 10.3389/fmicb.2018.00779] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/05/2018] [Indexed: 12/28/2022] Open
Abstract
Onychomycosis is a chronic fungal infection of nails, commonly caused by dermatophyte fungi, primarily species of Trichophyton. Because of the limited drug arsenal available to treat general fungal infections and the frequent failure of onychomycosis treatment, the search for new therapeutic sources is essential, and topical treatment with natural products for onychomycosis has been encouraged. Propolis, an adhesive resinous compound produced by honeybees (Apis mellifera), has shown multiple biological properties including significant antifungal and anti-biofilm activities in vitro. In spite of promising in vitro results, in vivo results have not been reported so far. This study assessed an ethanol propolis extract (PE) as a topical therapeutic option for onychomycosis, including its characterization in vitro and its applicability as a treatment for onychomycosis (from bench to clinic). The in vitro evaluation included analysis of the cytotoxicity and the antifungal activity against the planktonic cells and biofilm formed by Trichophyton spp. We also evaluated the capacity of PE to penetrate human nails. Patients with onychomycosis received topical PE treatments, with a 6-month follow-up period. The results of the in vitro assays showed that PE was non-toxic to the cell lines tested, and efficient against both the planktonic cells and the biofilm formed by Trichophyton spp. The results also showed that PE is able to penetrate the human nail. The results for PE applied topically to treat onychomycosis were promising, with complete mycological and clinical cure of onychomycosis in 56.25% of the patients. PE is an inexpensive commercially available option, easy to obtain and monitor. Our results indicated that PE is a promising natural compound for onychomycosis treatment, due to its ability to penetrate the nail without cytotoxicity, and its good antifungal performance against species such as Trichophyton spp. that are resistant to conventional antifungals, both in vitro and in patients.
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Affiliation(s)
- Flavia F. Veiga
- Laboratório de Micologia Médica, Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, Brazil
| | - Marina C. Gadelha
- Laboratório de Micologia Médica, Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, Brazil
| | - Marielen R. T. da Silva
- Laboratório de Micologia Médica, Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, Brazil
| | - Maiara I. Costa
- Laboratório de Micologia Médica, Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, Brazil
| | - Brenda Kischkel
- Laboratório de Micologia Médica, Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, Brazil
| | | | - Francielle Sato
- Programa de Pós-Graduação em Física, Departamento de Física, Universidade Estadual de Maringá, Maringá, Brazil
| | - Mauro L. Baesso
- Programa de Pós-Graduação em Física, Departamento de Física, Universidade Estadual de Maringá, Maringá, Brazil
| | - Morgana F. Voidaleski
- Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Vanessa Vasconcellos-Pontello
- Laboratório de Micologia Médica, Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, Brazil
| | - Vânia A. Vicente
- Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Marcos L. Bruschi
- Laboratory of Research and Development of Drug Delivery Systems, Department of Pharmacy, Universidade Estadual de Maringá, Maringá, Brazil
| | - Melyssa Negri
- Laboratório de Micologia Médica, Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, Brazil
| | - Terezinha I. E. Svidzinski
- Laboratório de Micologia Médica, Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, Brazil
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Banik A, Durairaj E, Lyngdoh WV, Khyriem AB, Sabhapandit D. Clinico-aetiologic profile of Onychomycoses in a tertiary care centre in northeast India. Trop Doct 2017; 48:136-142. [PMID: 29078738 DOI: 10.1177/0049475517735979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Onychomycosis refers to fungal nail infection. Despite a clearly diseased appearance, it is often deemed a merely cosmetic problem of relatively minor importance. However, it may result in much psychological or occupational turmoil, diminished self-esteem and resulting reluctance for public interaction. A wide number of factors determine the treatment outcome and its prevalence varies greatly. Our study was conducted between January 2011 and December 2014 in northeast India. Of 243 patients presenting with nail abnormalities, 158 (65%) were positively diagnosed by either direct microscopy or culture or both. A distal lateral subungual infection was the most predominant clinical pattern observed, and the most frequent aetiological agents were dermatophytes, of which Trichophyton rubrum was predominant.
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Affiliation(s)
- Amit Banik
- 1 Assistant Professor (Microbiology), 471318 ANIIMS , Port Blair. (Ex Senior Resident, NEIGRIHMS), Shillong, India
| | | | - W V Lyngdoh
- 3 Associate Professor (Microbiology), 56918 NEIGRIHMS , Shillong, India
| | - Annie B Khyriem
- 4 Associate Professor (Microbiology), 56918 NEIGRIHMS , Shillong, India
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Parekh M, Ramaiah G, Pashilkar P, Ramanujam R, Johnston P, Ilag LL. A pilot single centre, double blind, placebo controlled, randomized, parallel study of Calmagen® dermaceutical cream and lotion for the topical treatment of tinea and onychomycosis. Altern Ther Health Med 2017; 17:464. [PMID: 28923039 PMCID: PMC5604504 DOI: 10.1186/s12906-017-1970-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/11/2017] [Indexed: 12/02/2022]
Abstract
Background Most of the current anti-fungal treatments are chemical-based, fungistatic, have low efficacy in the treatment of tinea and toxicity concerns, while onychomycosis remains recalcitrant to most antifungal therapies. The study aimed to establish the fungicidal, efficacy and safety profile of Calmagen® dermaceutical cream and lotion containing AMYCOT® as a topical treatment in patients with severe to very severe presentations of fungal skin (tinea) and nail infections (onychomycosis). Methods A randomized, placebo-controlled, double blind, parallel, single centre study was conducted on 28 subjects with severe to very severe tinea or onychomycosis. All patients were randomized in a ratio of 1:1 for treatment or placebo group. Subjects in the treatment arm received Calmagen® cream or lotion, while subjects in the placebo arm received a similar inert topical preparation. Tinea subjects were treated with cream for four weeks, while onychomycosis subjects were treated with lotion for 12 weeks. Mycological cure, the primary endpoint, was assessed by three parameters: KOH (potassium hydroxide) smear, fungal culture and live spore count. Clinical cure was defined as Investigator Global Assessment (IGA) response of ‘cleared’ or ‘excellent’. Results All three parameters constituting mycological cure were confirmed in 92.8% (13/14) of subjects in the treatment arm, while all 14 subjects in the placebo arm remained positive for KOH smear. Calmagen® cream and lotion treatment showed a significant improvement in all three parameters: KOH smear, (95% CI (Calmagen): 79.4, 100.0; 95% CI (placebo): 0.0, 0.0; p < 0.0001); fungal culture (95% CI (Calmagen); 100.0, 100.0; 95% CI (Placebo): 17.0, 100.0; p < 0.0019); and live spore count (95% CI (Calmagen): 100.0, 100.0; 95% CI (Placebo): 17.0, 100.0; p < 0.0019). Clinical cure was achieved in all subjects in the treatment arm while none in the placebo arm were clinically cured. No treatment-related adverse effects were observed in either group. Conclusions The Calmagen® cream and lotion containing AMYCOT® represent a potentially safe and efficacious natural alternative in the treatment of Tinea and onychomycosis. Trial registration This trial has been registered with the clinical trial registry-India (CTRI; registration number: CTRI/2012/03/002522).
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Molecular Identification and Antifungal Susceptibility Patterns of Clinical Dermatophytes Following CLSI and EUCAST Guidelines. J Fungi (Basel) 2017; 3:jof3020017. [PMID: 29371535 PMCID: PMC5715923 DOI: 10.3390/jof3020017] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/20/2017] [Accepted: 03/20/2017] [Indexed: 11/16/2022] Open
Abstract
Dermatophytes are associated with superficial infections in humans worldwide. The aim of the present study was to determine the species distribution and susceptibility patterns of clinical dermatophytes. Samples received for routine mycological processing from 124 suspected cases attending a dermatologic clinic in a tertiary care hospital were included in the study. On direct microscopy, 74.1% (92/124) were positive and 53.2% (66/124) grew on culture. The isolates were comprised of Trichophytoninterdigitale (56%) followed by Trichophytontonsurans (25.7%), Trichophytonrubrum (7.5%), Trichophytonviolaceum (4.5%), Microsporumgypseum (4.5%), and Trichophytonverrucosum (1.5%). Conventional mycological identification was concordant with ITS sequencing except for T.mentagrophytes. High minimum inhibitory concentration (MIC) values (geometric mean, >1 µg/mL) were observed for T.tonsurans and T.rubrum to terbinafine and griseofulvin. This study highlights the shift in epidemiology from T.rubrum to T.interdigitale. It also raises a concern of high MICs of terbinafine and griseofulvin among our isolates. Surveillance of antifungal susceptibility patterns can provide clinicians with local MIC data that can further aid in guiding better management in relapse cases of dermatomycosis.
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Rigopoulos D, Papanagiotou V, Daniel R, Piraccini BM. Onychomycosis in patients with nail psoriasis: a point to point discussion. Mycoses 2016; 60:6-10. [DOI: 10.1111/myc.12542] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/08/2016] [Accepted: 07/11/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Dimitrios Rigopoulos
- 2nd Department of Dermatology and Venereology; National and Kapodistrian University of Athens, Medical School; Attikon University Hospital; Athens Greece
| | - Vasilios Papanagiotou
- 2nd Department of Dermatology and Venereology; National and Kapodistrian University of Athens, Medical School; Attikon University Hospital; Athens Greece
| | - Ralph Daniel
- University of Mississippi Medical Center and University of Alabama; Birmingham AL USA
| | - Bianca Maria Piraccini
- Department of Specialized, Diagnostic and Experimental Medicine; Division of Dermatology; University of Bologna; Bologna Italy
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