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Miller RC, Lipner SR. Distinct patient characteristics and pathogenesis of fingernail only vs. fingernail and toenail onychomycosis in a retrospective single-centre academic study. J Eur Acad Dermatol Venereol 2023; 37:e116-e118. [PMID: 35986705 DOI: 10.1111/jdv.18552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/12/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Rhiannon C Miller
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
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Alfageme-García P, Jiménez-Cano VM, Ramírez-Durán MDV, Gómez-Luque A, Hidalgo-Ruiz S, Basilio-Fernández B. Onychomycosis in Two Populations with Different Socioeconomic Resources in an Urban Nucleus: A Cross-Sectional Study. J Fungi (Basel) 2022; 8:jof8101003. [PMID: 36294568 PMCID: PMC9604941 DOI: 10.3390/jof8101003] [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: 09/05/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 11/22/2022] Open
Abstract
Onychomycosis is one of the most common foot conditions. Mixed onychomycosis and onychomycosis caused by non-dermatophyte moulds are increasing in incidence, especially in vulnerable populations, hence the importance of this study, which presents the prevalence of onychomycosis in a population of homeless people, comparing the findings with a sample of a well-resourced population. The total sample consisted of 70 participants, divided into two separate groups, a homeless population and a second group in which we included people attending a private clinic. The average age of the sample is [49.19 ± 28.81] with an age range of 18 to 78 years. In the homeless group, the most prevalent infectious agents were non-dermatophyte fungi, with a total of 48%, compared to 28% in the group housed. The most common site of infection in both groups was the nail of the first finger. We, therefore, conclude that there is a difference in the infecting agent in the homeless population and the population with homes.
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Costa PDS, Prado A, Bagon NP, Negri M, Svidzinski TIE. Mixed Fungal Biofilms: From Mycobiota to Devices, a New Challenge on Clinical Practice. Microorganisms 2022; 10:microorganisms10091721. [PMID: 36144323 PMCID: PMC9506030 DOI: 10.3390/microorganisms10091721] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022] Open
Abstract
Most current protocols for the diagnosis of fungal infections are based on culture-dependent methods that allow the evaluation of fungal morphology and the identification of the etiologic agent of mycosis. Most current protocols for the diagnosis of fungal infections are based on culture-dependent methods that enable the examination of the fungi for further identification of the etiological agent of the mycosis. The isolation of fungi from pure cultures is typically recommended, as when more than one species is identified, the second agent is considered a contaminant. Fungi mostly survive in highly organized communities that provoke changes in phenotypic profile, increase resistance to antifungals and environmental stresses, and facilitate evasion from the immune system. Mixed fungal biofilms (MFB) harbor more than one fungal species, wherein exchange can occur that potentialize the effects of these virulence factors. However, little is known about MFB and their role in infectious processes, particularly in terms of how each species may synergistically contribute to the pathogenesis. Here, we review fungi present in MFB that are commensals of the human body, forming the mycobiota, and how their participation in MFB affects the maintenance of homeostasis. In addition, we discuss how MFB are formed on both biotic and abiotic surfaces, thus being a significant reservoir of microorganisms that have already been associated in infectious processes of high morbidity and mortality.
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Bitew A, Osman F, Yassin S. Non-Dermatophyte Mold Dominated Onychomycosis in Patients Attending a Rank Higher Specialized Dermatology Clinic in Addis Ababa, Ethiopia. Clin Cosmet Investig Dermatol 2022; 15:507-518. [PMID: 35356385 PMCID: PMC8958195 DOI: 10.2147/ccid.s357738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/12/2022] [Indexed: 01/19/2023]
Abstract
Background Onychomycosis is a common refractory fungal infection associated with significant morbidity. The objective of this study was to determine the prevalence of onychomycosis, and the diversity and species composition of fungal etiological agents. Materials and Methods A clinic-based, prospective, non-randomized cross-sectional study was carried out between October 2018 and June 2019 at Rank Higher Specialized Dermatology Clinic, Addis Ababa, Ethiopia. Nail scrapings were collected aseptically from 200 patients clinically identified with nail disorders of fungal origin by dermatologists. Fungal etiological agents were identified microscopically and by culture method following standard procedures. Results Among 200 nail scrapings, 161 (80.5%) samples were found out to be culture positive. Of these, 135 (83.9%) samples yielded single colonies while 26 (16.1%) mixed colonies gave a total of 190 isolates. Among the isolates, 25.8% were dermatophytes while 61.1% were non- dermatophytes molds, and 13.1% were yeasts. Females were more likely to present dystrophic nails than men. Patients in the middle age group were more affected. Trichophyton interdigitale, Aspergillus spp, and Candida albicans were the dominant species. Conclusion The prevalence rate of onychomycosis in the present study was high. The isolation rate of non-dermatophyte molds was higher than dermatophytes and yeasts. Trichophyton interdigitale, Aspergillus spp, and Candida albicans were the dominant etiological agents. Females and patients in the middle age group were more affected. An increase in the prevalence of non-dermatophyte molds in nail infections dictates further investigation demonstrating how this group of fungi causes onychomycosis.
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Affiliation(s)
- Adane Bitew
- Department of Medical Laboratory Science, College Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Feruza Osman
- Saint Peter's Specialized Tuberculosis Referral Hospital, Addis Ababa, Addis Ababa Administrative Region, Ethiopia
| | - Seid Yassin
- International Care and Treatment for HIV/AIDS Program, Emergency Operation Center, Addis Ababa, Ethiopia
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Correlation of clinical characteristics, by calculation of SCIO index, with the laboratory diagnosis of onychomycosis. Braz J Microbiol 2022; 53:221-229. [PMID: 35000126 PMCID: PMC8882508 DOI: 10.1007/s42770-021-00676-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 12/24/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Onychomycosis is a chronic fungal infection with increasing incidence and the global prevalence is estimated to be 5.5%. The aim of our study was to perceive objectively severity of onychomycosis by calculating Scoring Clinical Index for Onychomycosis and to correlate this index with accurate laboratory diagnosis in our patients. MATERIALS AND METHODS The study population comprised of 417 patients with laboratory confirmed onychomycosis. For each patient, we recorded basic demographic information, site of infection, the most affected nail with onychomycosis, clinical presentation, and type of onychomycosis. The evaluation of the disease severity was based on Scoring Clinical Index for Onychomycosis which was calculated for every patient separately. Mycological identification was done by microscopy and fungal culture. RESULTS The majority of patients had distal and lateral subungual onychomycosis (95.44%) that was localized on big toe (62.59%), with female to male ratio 1.24:1. Male patients had significantly more nails affected with onychomycosis compared with female patients (p = 0.011), while female had significantly more often onychomycosis on fingernails 2-5 (p < 0.05), and they reported significantly more often pain (p < 0.05) and esthetic problems (p < 0.05). Mean Scoring Clinical Index for Onychomycosis was 16.76. Dermatophytes were most frequently isolated (91.85%). In patients with onychomycosis caused by dermatophytes, Scoring Clinical Index for Onychomycosis had significantly higher values (p = 0.032). CONCLUSION Comprehensive understanding of disease characteristics will allow introduction of individualized treatment plan for each patient, based on proper fungal identification and standardized method of evaluating disease severity, which could help the patient achieve a complete cure.
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Marcos-Tejedor F, Mota M, Iglesias-Sánchez MJ, Mayordomo R, Gonçalves T. Identification of Fungi Involved in Onychomycosis in Patients of a Spanish Rural Area. J Fungi (Basel) 2021; 7:jof7080623. [PMID: 34436162 PMCID: PMC8398180 DOI: 10.3390/jof7080623] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022] Open
Abstract
Onychomycosis is one of the most frequent reasons for visiting podiatrist clinics. Complementary tests and the accurate identification of the infectious agents are key issues for a successful treatment of onychomycosis. This is particularly important when lifestyle, age and immunodepressed patients increase the prevalence of non-dermatophyte fungal infection. In this paper, we describe issues related to onychomycosis prevalence in a population of patients, mostly with rural lifestyles, visiting a podiatry clinic in a rural area of Spain. A total of 51 cases were studied with an average age of 65.96 ± 21.28 years (the youngest being 16 years and the oldest being 95 years). Fungal agents were isolated using conventional sampling and microbiological culture techniques. The results obtained with these techniques were compared with the results obtained with a direct methodology using molecular biology, by PCR and nucleotide sequencing of the ITS-5.8S rDNA fragment. The classical culture methodology confirmed the infection in 76.5% of the samples (n = 39), while the PCR confirmed the infection in 84.3% (n = 51) of the nails, although the difference between these results did not show statistical significance (p = 0.388). We found a high variability in agents, with more yeasts than dermatophytes as etiological agents of onychomycosis. However, only among individuals older than 65 years, was the difference between yeasts (82%) and dermatophytes (18%) was statistically significant (p = 0.004). Among the agents of non-dermatophyte onychomycosis, we found predominantly fungi (yeasts) of the Candida genus, interestingly with no isolates of Candida albicans, and moulds of the Aspergillus genus.
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Affiliation(s)
- Felix Marcos-Tejedor
- Department of Medical Sciences, Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain
- Correspondence:
| | - Marta Mota
- Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal; (M.M.); (T.G.)
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
| | - María José Iglesias-Sánchez
- Department of Medical and Surgical Therapy, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain;
| | - Raquel Mayordomo
- Department of Anatomy and Human Embryology, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain;
| | - Teresa Gonçalves
- Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal; (M.M.); (T.G.)
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
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Asifa N, Farhath K. Current mycological profile of onychomycosis in Kashmir valley: A hospital-based study. J Lab Physicians 2020; 9:190-194. [PMID: 28706389 PMCID: PMC5496297 DOI: 10.4103/jlp.jlp_131_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Onychomycosis is a common nail ailment associated with significant physical and psychological morbidity. It is caused by dermatophytes, nondermatophytic molds, and yeasts. Increased prevalence in the recent years is attributed to enhanced longevity, comorbid conditions such as diabetes, avid sports participation, and emergence of HIV. AIMS AND OBJECTIVES This study was undertaken to identify the mycological profile and etiological agents associated with this infection. MATERIALS AND METHODS One hundred and twenty-nine cases of clinically suspected onychomycosis were included in this study. Clinical patterns were noted, and samples collected from most severely affected nail. They were subjected to direct microscopy and culture. RESULTS The microscopic and/or culture examination was positive in 64.34% of cases. The most common clinical type was distal lateral subungual onychomycosis in 42 (50.60%) Candida sp. was the most common fungal agent among yeasts, followed by Trichophyton sp among dermatophytes and Aspergillus among nondermatophytic molds. Females were affected more than males and fingernails were affected more frequently than toenails. CONCLUSION Onychomycosis is a significant and important disease which can cause many physical, physiological, and occupational problems, considerably impairing patient quality of life. Hence, fungal cultures are of paramount importance in all suspected cases of onychomycosis because the antifungal agent with an appropriate spectrum of activity can only be used if the underlying fungal pathogen is identified correctly.
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Affiliation(s)
- Nazir Asifa
- Department of Microbiology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Kanth Farhath
- Department of Microbiology, Government Medical College, Srinagar, Jammu and Kashmir, India
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Bitew A, Wolde S. Prevalence, Risk Factors, and Spectrum of Fungi in Patients with Onychomycosis in Addis Ababa, Ethiopia: A Prospective Study. J Trop Med 2019; 2019:3652634. [PMID: 31275400 PMCID: PMC6582801 DOI: 10.1155/2019/3652634] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/03/2019] [Accepted: 05/23/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Onychomycosis is a common refractory infection deleteriously affecting quality of life via social stigma and upsetting day-to-day activities. OBJECTIVE To study the prevalence of onychomycosis, spectrum of fungal etiological agents, and associated risk factors. METHODS A prospective nonrandomized study on the prevalence of onychomycosis was carried out from September 2017 to April 2018 at a dermatology center in Addis Ababa. Nail scrapings were collected from 303 patients clinically identified with nail disorders of fungal origin by dermatologists. Fungal etiological agents were identified microscopically and by culture method following standard procedures. RESULTS The prevalence of onychomycosis was 60.4%. Fungi neither were detected nor showed visible fungal growth in 39.6% of the cases. Females were more likely to present dystrophic nails than men. Patients in the middle age group were more affected. The isolation rates of dermatophytes, yeasts, and nondermatophyte molds were 44.7%, 33.3%, and 32.3%, respectively. Trichophyton rubrum, Scytalidium dimidiatum, and Candida albicans were the dominant species of dermatophytes, nondermatophyte molds, and yeasts, respectively. There was no statistically significant association between onychomycosis and risk factors. CONCLUSIONS The prevalence rate of onychomycosis in the present study was high. The isolation rate of nondermatophyte molds was comparable with that of dermatophytes. Further studies on the prevalence of onychomycosis, fungal etiological agents, and changes in species distribution of the etiological agents of nail infection in Ethiopia are important.
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Affiliation(s)
- Adane Bitew
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sinknesh Wolde
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Lubis NZ, Muis K, Nasution LH. Polymerase Chain Reaction-Restriction Fragment Length Polymorphism as a Confirmatory Test for Onychomycosis. Open Access Maced J Med Sci 2018; 6:280-283. [PMID: 29531588 PMCID: PMC5839432 DOI: 10.3889/oamjms.2018.098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 01/16/2018] [Accepted: 01/20/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Onychomycosis is a fungal infection of one or more units of the nail caused by dermatophytes, or mould and nondermatophytes yeast. Investigations are needed to establish the diagnosis of onychomycosis before starting treatment. Several investigations methods for diagnosing onychomycosis are microscopic examination with 20% KOH, fungal culture, histopathology examination with PAS staining (Periodic acid Schiff) and PCR (Polymerase Chain Reaction). Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) is a method after PCR amplification allowing more specific results. AIM To determine the diagnostic value of PCR - RFLP in the diagnosis of onychomycosis using fungal culture as the gold standard and to find out the majority fungal species that cause onychomycosis. METHODS This study is a diagnostic test for the diagnosis of onychomycosis by using culture as the gold standard. SUBJECTS Thirty - five patients suspected of having onychomycosis from history and dermatological examination. RESULTS PCR - RFLP in the diagnosis of onychomycosis has a sensitivity of 85.71%, specificity of 28.57%, positive predictive value (PPV) of 82.76% and negative predictive value (NPV) of 33.33%. The positive and negative likelihood ratios are 1.20 and 0.5 with an accuracy of 74.29%. CONCLUSIONS PCR - RFLP may be considered for a faster and more accurate alternative examination in the diagnosis of onychomycosis.
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Affiliation(s)
- Nova Zairina Lubis
- Universitas Sumatera Utara, Dermatology and Venereology, Medan, North Sumatera, Indonesia
| | - Kamaliah Muis
- Universitas Sumatera Utara, Dermatology and Venereology, Medan, North Sumatera, Indonesia
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Chanana M, Kumar A, Tyagi SP, Singla AK, Sharma A, Farooq UB. End-threaded intramedullary positive profile screw ended self-tapping pin (Admit pin) - A cost-effective novel implant for fixing canine long bone fractures. Vet World 2018; 11:181-185. [PMID: 29657401 PMCID: PMC5891872 DOI: 10.14202/vetworld.2018.181-185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/05/2018] [Indexed: 11/16/2022] Open
Abstract
Aim The current study was undertaken to evaluate the clinical efficacy of end-threaded intramedullary pinning for management of various long bone fractures in canines. Materials and Methods This study was conducted in two phases, managing 25 client-owned dogs presented with different fractures. The technique of application of end-threaded intramedullary pinning in long bone fractures was initially standardized in 6 clinical patients presented with long bone fractures. In this phase, end-threaded pins of different profiles, i.e., positive and negative, were used as the internal fixation technique. On the basis of results obtained from standardization phase, 19 client-owned dogs clinically presented with different fractures were implanted with end-threaded intramedullary positive profile screw ended self-tapping pin in the clinical application phase. Results The patients, allocated randomly in two groups, when evaluated postoperatively revealed slight pin migration in Group-I (negative profile), which resulted in disruption of callus site causing delayed union in one case and large callus formation in other two cases whereas no pin migration was observed in Group-II (positive profile). Other observations in Group-I was reduced muscle girth and delayed healing time as compared to Group-II. In clinical application, phase 21st and 42nd day post-operative radiographic follow-up revealed no pin migration in any of the cases, and there was no bone shortening or fragment collapse in end-threaded intramedullary positive profile screw ended self-tapping pin. Conclusion The end-threaded intramedullary positive profile screw ended self-tapping pin used for fixation of long bone fractures in canines can resist pin migration, pin breakage, and all loads acting on the bone, i.e., compression, tension, bending, rotation, and shearing to an extent with no post-operative complications.
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Affiliation(s)
- Mitin Chanana
- Department of Veterinary Surgery and Radiology, College of Veterinary and Animal Sciences, Chaudhary Sarwan Kumar Himachal Pradesh Krishi Vishvavidyalaya, Palampur - 176 061, Himachal Pradesh, India
| | - Adarsh Kumar
- Department of Veterinary Surgery and Radiology, College of Veterinary and Animal Sciences, Chaudhary Sarwan Kumar Himachal Pradesh Krishi Vishvavidyalaya, Palampur - 176 061, Himachal Pradesh, India
| | - Som Prakash Tyagi
- Department of Veterinary Surgery and Radiology, College of Veterinary and Animal Sciences, Chaudhary Sarwan Kumar Himachal Pradesh Krishi Vishvavidyalaya, Palampur - 176 061, Himachal Pradesh, India
| | - Amit Kumar Singla
- Department of Veterinary Surgery and Radiology, College of Veterinary and Animal Sciences, Chaudhary Sarwan Kumar Himachal Pradesh Krishi Vishvavidyalaya, Palampur - 176 061, Himachal Pradesh, India
| | - Arvind Sharma
- Department of Veterinary Surgery and Radiology, College of Veterinary and Animal Sciences, Chaudhary Sarwan Kumar Himachal Pradesh Krishi Vishvavidyalaya, Palampur - 176 061, Himachal Pradesh, India
| | - Uiase Bin Farooq
- Department of Veterinary Surgery and Radiology, College of Veterinary and Animal Sciences, Chaudhary Sarwan Kumar Himachal Pradesh Krishi Vishvavidyalaya, Palampur - 176 061, Himachal Pradesh, India
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EPIDEMIOLOGIC, CLINICO - MYCOLOGICAL ASPECTS OF FUNGAL INFECTIONS OF SKIN AND ITS APPENDAGES. ACTA ACUST UNITED AC 2014. [DOI: 10.14260/jemds/2014/2420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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