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Watjer RM, Heckmans KM, Eekhof JA, Gummi L, Quint KD, Numans ME, Bonten TN. Association between onychomycosis and ulcerative complications in patients with diabetes: a longitudinal cohort study in Dutch general practice. BMJ Open 2024; 14:e076441. [PMID: 38658014 PMCID: PMC11043773 DOI: 10.1136/bmjopen-2023-076441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 04/08/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Diabetic foot ulcers are feared complications of diabetes mellitus (DM), requiring extensive treatment and hospital admissions, ultimately leading to amputation and increased mortality. Different factors contribute to the development of foot ulcers and related complications. Onychomycosis, being more prevalent in patients with diabetes, could be an important risk factor for developing ulcers and related infections. However, the association between onychomycosis and diabetic complications has not been well studied in primary care. RESEARCH DESIGN AND METHODS To determine the impact of onychomycosis on ulcer development and related complications in patients with diabetes in primary care, a longitudinal cohort study was carried out using routine care data from the Extramural Leiden University Medical Center Academic Network. Survival analyses were performed through Cox proportional hazards models with time-dependent covariates. RESULTS Data from 48 212 patients with a mean age of 58 at diagnosis of DM, predominantly type 2 (87.8%), were analysed over a median follow-up of 10.3 years. 5.7% of patients developed an ulcer. Onychomycosis significantly increased the risk of ulcer development (HR 1.37, 95% CI 1.13 to 1.66), not affected by antimycotic treatment, nor after adjusting for confounders (HR 1.23, 95% CI 1.01 to 1.49). The same was found for surgical interventions (HR 1.54, 95% CI 1.35 to 1.75) and skin infections (HR 1.48, CI 95% 1.28 to 1.72), again not affected by treatment and significant after adjusting for confounders (HR 1.32, 95% CI 1.16 to 1.51 and HR 1.27, 95% CI 1.10 to 1.48, respectively). CONCLUSIONS Onychomycosis significantly increased the risk of ulcer development in patients with DM in primary care, independently of other risk factors. In addition, onychomycosis increased the risk of surgeries and infectious complications. These results underscore the importance of giving sufficient attention to onychomycosis in primary care and corresponding guidelines. Early identification of onychomycosis during screening and routine care provides a good opportunity for timely recognition of increased ulcer risk.
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Affiliation(s)
- Roeland M Watjer
- Public Health and Primary Care, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | - Kim Ml Heckmans
- Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | - Just Ah Eekhof
- Public Health and Primary Care, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | - Luise Gummi
- Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | - Koen D Quint
- Dermatology, Leiden Universitair Medisch Centrum, Leiden, Zuid-Holland, Netherlands
| | - Mattijs E Numans
- Public Health and Primary Care, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | - Tobias N Bonten
- Public Health and Primary Care, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
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Wang S, Chen W, Liu F, Li R. Comparison of dermoscopic characteristics on toenail onychomycosis in psoriatic and non-psoriatic patients: A prospective study. Mycoses 2024; 67:e13721. [PMID: 38570912 DOI: 10.1111/myc.13721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/29/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Psoriatic patients may experience the coexistence of onychomycosis (OM). However, the evaluation of OM in psoriatics has been hindered by potential clinical differences from OM in non-psoriatics. OBJECTIVE To assess and compare dermoscopic features between toenail OM in psoriatic and in non-psoriatic patients. PATIENTS AND METHODS Between September 2020 and September 2023, dermoscopy was conducted on 183 affected toenails by OM in psoriatics and 232 affected toenails by OM in non-psoriatics in two centres. The dermoscopic characteristics were compared using the Chi-squared test. RESULTS Among toenail OM cases in psoriatic subjects, the most prevalent dermoscopic features included pitting (147/183, 80.33%) and subungual hyperkeratosis (118/183, 64.48%). Conversely, toenail OM in non-psoriatics was characterized by subungual hyperkeratosis (175/232, 75.43%) and nail spikes (139/232, 59.91%). Comparative analysis revealed a significantly higher occurrence of pitting (80.33% vs. 15.96%, p < .001), periungual telangiectasis (22.40% vs. 4.74%, p < .001), oil patches (12.57% vs. 0.43%,p < .001) and transverse grooves (43.72% vs. 28.45%,p < .01) in toenail OM in psoriatics. Furthermore, toenail OM in psoriatics exhibited a significantly lower frequency of yellow structureless area (13.11% vs. 42.67%, p < .001), nail spikes (43.17% vs. 59.91%, p < .01), ruin appearance of sulphur nugget (8.20% vs. 31.03%, p < .001), dotted/blocky haemorrhage (6.01% vs. 20.69%,p < .001) and partial onycholysis (32.79% vs. 46.98%, p < .01). CONCLUSIONS Dermoscopic features of toenail OM in psoriatic and non-psoriatic patients exhibit notable differences. OM in psoriatics shows a higher frequency of pitting and periungual telangiectasis, while a lower frequency of yellow structureless areas and nail spikes under dermoscopy.
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Affiliation(s)
- Shiqi Wang
- Department of Dermatology, Venereology and Cosmetology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wei Chen
- Department of Dermatology, Peking University First Hospital, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Beijing, China
- NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
| | - Fang Liu
- Department of Dermatology, Venereology and Cosmetology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ruoyu Li
- Department of Dermatology, Peking University First Hospital, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Beijing, China
- NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
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Alrauosh H, Ababneh A, Bakri FG, Abujbara M, Kanaan H, Younes NA. Prevalence and Associated Factors of Toenail Onychomycosis Among Patients with Diabetes in Jordan. Curr Diabetes Rev 2024; 20:e030423215425. [PMID: 37016517 DOI: 10.2174/1573399819666230403132241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Toenail onychomycosis is common in patients with diabetes and it can increase the risk of secondary infections and foot complications. Despite several studies investigating the prevalence and associated factors of toenail onychomycosis from different parts of the world, there are no data from Jordan. OBJECTIVE To determine the prevalence and the associated factors of toenail onychomycosis among patients with diabetes in Jordan. METHODS A cross-sectional study was conducted on 375 patients with diabetes at the National Centre for Diabetes, Endocrinology, and Genetics in Amman, Jordan. Several socio-demographic and health-independent variables including foot self-care practices were collected. Toenail onychomycosis was assessed by a specimen culture and microscopic examinations. Descriptive and inferential statistics were used for data analysis. RESULTS The prevalence of toenail onychomycosis was 57.6% (n=216). Multiple logistic regression revealed four significant associated factors; the presence of neuropathy (β=1.87, p=0.02), being an ex-smoker (β=2.69, p=0.01), being treated by both insulin and oral hypoglycemics drugs (β=1.32, p=0.03), and using antibiotics in the last year (β=1.78, p=0.02). CONCLUSION The prevalence of toenail onychomycosis among patients with diabetes in Jordan is high. Regular foot screening and podiatric care are recommended especially among patients with diabetic neuropathy, current treatment by insulin and oral hypoglycemics drugs, previous history of smoking, and previous use of antibiotics.
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Affiliation(s)
- Hesham Alrauosh
- Prince Hamzah Hospital, Amman, Jordan
- The National Centre for Diabetes, Endocrinology, and Genetics, Amman, Jordan
| | - Anas Ababneh
- Faculty of Nursing, Applied Science Private University, Amman, Jordan
| | - Faris G Bakri
- The National Centre for Diabetes, Endocrinology, and Genetics, Amman, Jordan
- Department of Medicine, Division of Infectious Diseases, Jordan University Hospital, Amman, Jordan
- Infectious Diseases and Vaccine Center, University of Jordan, Amman, Jordan
- Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Mousa Abujbara
- The National Centre for Diabetes, Endocrinology, and Genetics, Amman, Jordan
| | - Hashem Kanaan
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nidal A Younes
- The National Centre for Diabetes, Endocrinology, and Genetics, Amman, Jordan
- Faculty of Medicine, University of Jordan, Amman, Jordan
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Mervak JE. Hair and Nail Conditions: Nail Conditions. FP Essent 2022; 517:27-34. [PMID: 35679470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A thorough understanding of nail anatomy can help physicians identify the causes of nail conditions. Observation of changes to the nail can help establish a diagnosis. Patient evaluation should include a physical examination, dermoscopy, and, in some cases, nail biopsy. Onychomycosis is the most common nail condition worldwide, and should be distinguished from other nail conditions with similar manifestations. Empiric onychomycosis treatment without confirmatory tests has been proposed, but studies have shown the cost-effectiveness of testing to prevent inappropriate therapy. Systemic drugs for management include terbinafine and itraconazole. Longitudinal melanonychia is a brown band through the length of the nail. Nail melanoma should be suspected if the band is dark brown-black, is located on a single digit, and occupies 40% or more of the nail plate width. Biopsy with local anesthesia should be performed in patients with suspected nail melanoma or other neoplastic nail conditions. Identification of warning signs of nail melanoma can result in earlier diagnosis and limit potential morbidity and mortality. Nail psoriasis often is overlooked but can affect up to 50% of patients with psoriasis. Nail lichen planus can cause permanent scarring with loss of normal nail anatomy. Other common nail conditions include acute and chronic paronychia, onychocryptosis, onycholysis, Pseudomonas infection (ie, green nails), onychogryphosis, subungual hematoma, and onychomadesis.
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Affiliation(s)
- Julie E Mervak
- Department of Dermatology - University of Michigan School of Medicine, 1910 Taubman Center 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5314
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van Zijverden LM, Marees CH. [Persistently crumbling nails in a patient with limited Dutch proficiency]. Ned Tijdschr Geneeskd 2022; 166:D6461. [PMID: 35499542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Nail psoriasis, also called psoriasis unguium, is a variant of psoriasis in which nail changes appear due to inflammation of nail bed or nail matrix. 15% to 50% of patients with cutaneous psoriasis have nail psoriasis, the condition also occurs without or before the appearance of skin lesions. CASE DESCRIPTION A 54-year-old male visits his general practitioner because of crumbling of his fingernails. Upon clinical examination, this was interpreted as onychomycosis and treated with oral antimycotics. Due to the lack of improvement and a negative PCR-test on dermatophytes, the condition was later diagnosed as nail psoriasis. CONCLUSION Nail psoriasis is often diagnosed as fungal infection of the nails. To make the right diagnosis, a complete medical history should be obtained, and physical examination of skin and joints need to be conducted. Furthermore, we advise to rule out onychomycosis in patients with known skin psoriasis to prevent overtreatment with antimycotics.
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Affiliation(s)
- L M van Zijverden
- Amsterdam UMC, locatie VUmc, afd. Huisartsgeneeskunde, Amsterdam
- Contact: L. M. van Zijverden
| | - C H Marees
- Amsterdam UMC, locatie VUmc, afd. Huisartsgeneeskunde, Amsterdam
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Suprun K, Kutasevych Y, Oliinyk I, Bilozorov O, Mashtakova I, Stuliy O. PECULIARITIES OF TREATMENT OF PATIENTS WITH ONYCHOMYCOSIS WITH CONTRAINDICATIONS TO SYSTEMIC ANTIMYCOTICS. Wiad Lek 2021; 74:2070-2075. [PMID: 34725278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim: To increase the effectiveness of treatment of patients with onychomycosis with contraindications to administration of systemic antifungal therapy. PATIENTS AND METHODS Materials and methods: The study involved 63 patients with onychomycosis of the toes aged 18 to 72 years under supervision at the clinic of the Institute of Dermatology and Venereology of the National Academy of Medical Sciences of Ukraine, who were divided into groups: Group I (30 patients) received naftifine hydrochloride solution and cream; Group II (33 patients) additionally used nail kit mycosan and cytoflavin 2 tablets 2 times a day for 1-1.5 months. The study implied microscopic and molecular genetic examination of nail plates before treatment and starting from the 4th week every 2 weeks. The study included patients with onychomycosis with positive results of both microscopic and PCR studies. Mycological recovery was noted in case of coincidence of results of these studies. RESULTS Results: Mycological recovery in patients of Group II began in the sixth week in 6.3% and occurred in 100% of cases at the 24th week of treatment, depending on the severity and clinical form. The overall effectiveness of therapy at the 48th week reached 56.7% in Group I and 72.7% in Group II. CONCLUSION Conclusions: The developed method of treatment, which includes the use of naftifine hydrochloride solution and cream, nail kit micozan and cytoflavin, allows to achieve clinical and mycological recovery in 72.7% of patients and is a priority in the treatment of patients with onychomycosis with comorbid conditions.
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Affiliation(s)
- Kseniia Suprun
- SE «INSTITUTE OF DERMATOLOGY AND VENEREOLOGY OF NAMS OF UKRAINE», KHARKIV, UKRAINE
| | - Yanina Kutasevych
- SE «INSTITUTE OF DERMATOLOGY AND VENEREOLOGY OF NAMS OF UKRAINE», KHARKIV, UKRAINE
| | - Iryna Oliinyk
- SE «INSTITUTE OF DERMATOLOGY AND VENEREOLOGY OF NAMS OF UKRAINE», KHARKIV, UKRAINE
| | - Oleksii Bilozorov
- SE «INSTITUTE OF DERMATOLOGY AND VENEREOLOGY OF NAMS OF UKRAINE», KHARKIV, UKRAINE
| | - Iryna Mashtakova
- SE «INSTITUTE OF DERMATOLOGY AND VENEREOLOGY OF NAMS OF UKRAINE», KHARKIV, UKRAINE
| | - Olga Stuliy
- SE «INSTITUTE OF DERMATOLOGY AND VENEREOLOGY OF NAMS OF UKRAINE», KHARKIV, UKRAINE
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Fabrizi V, Zacconi I, Principato M, Pesca C, Cruciani D, Crotti S, Papini M. Toenail onychomycosis by Trichophyton rubrum and concurrent infestation with Tyrophagus putrescentiae. Infez Med 2017; 25:377-380. [PMID: 29286021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A remarkable case of onychomycosis by Trichophyton (T.) rubrum combined with nail infestation by Tyrophagus (T.) putrescentiae in an elderly diabetic farmer is described and discussed. Large numbers of eggs and mites in all development stages were present in nail debris, reflecting active reproduction on site. Treatment with ivermectin 0.1% cream and environmental decontamination cleared the mite infestation, while onychomycosis responded well to oral terbinafine and ciclopirox 8% nail lacquer. Such a combination of onychomycosis and mite infestation of the same nail is an exceptional finding reported only twice in the literature.
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Affiliation(s)
- Valentina Fabrizi
- Dipartimento di Scienze Chirurgiche e Biomediche, Clinica Dermatologica di Terni, Università degli Studi di Perugia, Terni, Italy
| | - Ivana Zacconi
- Dipartimento di Scienze Chirurgiche e Biomediche, Clinica Dermatologica di Terni, Università degli Studi di Perugia, Terni, Italy
| | - Mario Principato
- Dipartimento di Medicina Veterinaria, Sezione di Parassitologia, Università degli Studi di Perugia, Perugia, Italy
| | - Cristina Pesca
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
| | - Deborah Cruciani
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
| | - Silvia Crotti
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
| | - Manuela Papini
- Dipartimento di Scienze Chirurgiche e Biomediche, Clinica Dermatologica di Terni, Università degli Studi di Perugia, Terni, Italy
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Eichenfield LF, Friedlander SF. Pediatric Onychomycosis: The Emerging Role of Topical Therapy. J Drugs Dermatol 2017; 16:105-109. [PMID: 28300851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Fungal infection of the nails is an increasingly recognized disease in infants and children. However, it can be difficult to distinguish clinically from other nail dystrophies. In addition, many mistakenly believe that onychomycosis does not occur in childhood. Under-recognition of this infectious disorder therefore occurs. Although many consider "nail fungus" a trivial cosmetic concern, it can lead to discomfort, risk of secondary infection, and a more significant health threat in immunocompromised or diabetic individuals. It should always be considered in the differential diagnosis of nail plate disorders in children as it is one of the more common causes.</p> <p>Here we review the latest data on prevalence of the disease, reasons for its relatively low incidence compared with adults, and important predisposing factors. It is important to confirm the clinical diagnosis of onychomycosis in children, and affected individuals should be examined for concomitant tinea pedis. As familial disease often occurs, it is important to check parents and siblings as well for onychomycosis and tinea pedis.</p> <p>Treatment of onychomycosis is challenging, and recurrence appears to be more common in children than in adults. Prolonged systemic antifungal therapy is commonly required. However, pediatric practitioners and parents alike hesitate when asked to treat young children with a systemic drug that requires laboratory monitoring and can have systemic toxicities. Due to their thinner, faster-growing nails, children are theoretically more likely to respond to topical monotherapy than adults, and therefore good candidates for topical antifungal therapy.</p> <p>The clinical data on the use of topical antifungals in pediatric onychomycosis is scarce. We review data that exist from case reports and small clinical trials. New topical antifungals are now available that afford better nail penetration and additional delivery routes to the site of infection. Pediatric trials are now on-going, and should clarify the usefulness of these agents in children.
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Walker LG, Arechavala A, Messina F, Negroni R, Santiso G. [Clinical problems in medical mycology: Problem number 50]. Rev Iberoam Micol 2016; 34:53-55. [PMID: 27450641 DOI: 10.1016/j.riam.2016.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 01/25/2016] [Indexed: 11/19/2022] Open
Abstract
We present the case of a 34 year-old man, HIV-positive, who had suffered a disseminated histoplasmosis treated with amphotericin B one year before his admission. He was admitted at the Infectious Diseases Muñiz Hospital with a non-lithiasic chlolecystitis. During the clinical examination perigenital skin lesions compatible with tinea cruris, as well as proximal subungual onychomycoses of toenails, were observed. Microsporum gypseum was isolated from both types of lesions. Oral terbinafine led to a good clinical response. Treatment prescription was a big challenge in this patient because he was receiving HAART and itraconazole, and there was scarce experience in the treatment of nail infections due to M. gypseum.
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Affiliation(s)
- Laura Guadalupe Walker
- Unidad Micología, Hospital de Infecciosas Francisco Javier Muñiz, Buenos Aires, Argentina
| | - Alicia Arechavala
- Unidad Micología, Hospital de Infecciosas Francisco Javier Muñiz, Buenos Aires, Argentina
| | - Fernando Messina
- Unidad Micología, Hospital de Infecciosas Francisco Javier Muñiz, Buenos Aires, Argentina
| | - Ricardo Negroni
- Unidad Micología, Hospital de Infecciosas Francisco Javier Muñiz, Buenos Aires, Argentina
| | - Gabriela Santiso
- Unidad Micología, Hospital de Infecciosas Francisco Javier Muñiz, Buenos Aires, Argentina.
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Assadamongkol R, Lertwattanarak R, Wannachalee T, Bunyaratavej S, Leeyaphan C, Matthapan L. Prevalence, Risk Factors, and Type of Organism in Fungal Foot Infection and Toenail Onychomycosis in Thai Diabetic Patients. J Med Assoc Thai 2016; 99:659-664. [PMID: 29900728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is a known and important predisposing factor for toenail onychomycosis and fungal foot infection. DM also increases the risk of patient developing secondary bacterial infection if fungal infection goes unrecognized and untreated. OBJECTIVE To assess the prevalence and risk factors of toenail onychomycosis and fungal foot infection in Thai diabetic patients. MATERIAL AND METHOD This single center cross-sectional observational study recruited type 1 and type 2 diabetic patients older than 18 years who attended Siriraj Hospital between October 1, 2012 and November 30, 2013. Patient demographic data, clinical data, and medical history were collected by questionnaire and assessed. Diagnosis of fungal infection was confirmed by potassium hydroxide investigation and fungal culture was performed to identify the type of organism. RESULTS One hundred forty four diabetes outpatients were enrolled and 38.9% were men. The mean (±SD) age was 59.6±12.7 years. Fungal infection was diagnosed 46 cases (31.9%). There were 28 cases (61%) with only toenail onychomycosis, two cases (4%) with only fungal foot infection, and 16 cases (35%) with co-infection (fungal foot infection and toenail onychomychosis). The organisms identified as causing fungal foot infection and toenail onychomycosis were dermatophytes (44.4% and 34.1%, respectively), non-dermatophytes (44.5% and 47.7%, respectively), and Candida species (5.6% and 4.5%, respectively). Risk factors found to be significantly correlated with toenail onychomycosis and fungal foot infection were male gender (p = 0.001), age older than 60 years (p = 0.006), agriculture-related activities (p = 0.006), family history of dermatophytosis (p = 0.034), and co-morbidity coronary heart disease (p = 0.044). No significant association was found for BMI, duration of DM, HbA1c, and diabetes related complications. CONCLUSION Prevalence of fungal foot and toenail infection in Thai diabetes patient was 31.9%. We found higher prevalence of non-dermatophyte organisms as the cause of dermatomycosis and toenail onychomycosis. Accordingly, clinical diagnosis without proper culture identification may result in treatment failure.
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Lucchina S, Maggiulli F. IS NON-TRAUMATIC NAIL DYSTRPOPHY ONLY DUE TO CHRONIC ONYCHOMYCOSIS? THE ONYCHOMATRICOMA. CASE REPORT. Acta Chir Plast 2016; 58:43-45. [PMID: 27873532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Onychomatricoma is a rare benign fibroepithelial tumour that originates from the nail matrix and can affect the nail bed of fingers and toes. Onychomatricoma may represent a premalignant lesion and although the etiology is still not fully understood, a previous finger trauma is considered the main predisposing factor. Unlike previous scientific articles we report a case of a "non traumatic" onychomatricoma in a 60 years old woman underlining the clinical and histological features to distinguish this uncommon lesion from other lesions originating from the nail apparatus.
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Shelburne SA, Ajami NJ, Chibucos MC, Beird HC, Tarrand J, Galloway-Peña J, Albert N, Chemaly RF, Ghantoji SS, Marsh L, Pemmaraju N, Andreeff M, Shpall EJ, Wargo JA, Rezvani K, Alousi A, Bruno VM, Futreal PA, Petrosino JF, Kontoyiannis DP. Implementation of a Pan-Genomic Approach to Investigate Holobiont-Infecting Microbe Interaction: A Case Report of a Leukemic Patient with Invasive Mucormycosis. PLoS One 2015; 10:e0139851. [PMID: 26556047 PMCID: PMC4640583 DOI: 10.1371/journal.pone.0139851] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 09/17/2015] [Indexed: 12/19/2022] Open
Abstract
Disease can be conceptualized as the result of interactions between infecting microbe and holobiont, the combination of a host and its microbial communities. It is likely that genomic variation in the host, infecting microbe, and commensal microbiota are key determinants of infectious disease clinical outcomes. However, until recently, simultaneous, multiomic investigation of infecting microbe and holobiont components has rarely been explored. Herein, we characterized the infecting microbe, host, micro- and mycobiomes leading up to infection onset in a leukemia patient that developed invasive mucormycosis. We discovered that the patient was infected with a strain of the recently described Mucor velutinosus species which we determined was hypervirulent in a Drosophila challenge model and has a predisposition for skin dissemination. After completing the infecting M. velutinosus genome and genomes from four other Mucor species, comparative pathogenomics was performed and assisted in identifying 66 M. velutinosus-specific putatively secreted proteins, including multiple novel secreted aspartyl proteinases which may contribute to the unique clinical presentation of skin dissemination. Whole exome sequencing of the patient revealed multiple non-synonymous polymorphisms in genes critical to control of fungal proliferation, such as TLR6 and PTX3. Moreover, the patient had a non-synonymous polymorphism in the NOD2 gene and a missense mutation in FUT2, which have been linked to microbial dysbiosis and microbiome diversity maintenance during physiologic stress, respectively. In concert with host genetic polymorphism data, the micro- and mycobiome analyses revealed that the infection developed amid a dysbiotic microbiome with low α-diversity, dominated by staphylococci. Additionally, longitudinal mycobiome data showed that M. velutinosus DNA was detectable in oral samples preceding disease onset. Our genome-level study of the host-infecting microbe-commensal triad extends the concept of personalized genomic medicine to the holobiont-infecting microbe interface thereby offering novel opportunities for using synergistic genetic methods to increase understanding of infectious diseases pathogenesis and clinical outcomes.
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Affiliation(s)
- Samuel A. Shelburne
- Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Nadim J. Ajami
- The Alkek Center for Metagenomics and Microbiome Research and the Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Marcus C. Chibucos
- Department of Microbiology & Immunology and Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Hannah C. Beird
- Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Jeffrey Tarrand
- Department of Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Jessica Galloway-Peña
- Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Nathan Albert
- Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Roy F. Chemaly
- Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Shashank S. Ghantoji
- Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Lisa Marsh
- Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Naveen Pemmaraju
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Michael Andreeff
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Elizabeth J. Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Jennifer A. Wargo
- Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Amin Alousi
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Vincent M. Bruno
- The Alkek Center for Metagenomics and Microbiome Research and the Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Phillip A. Futreal
- Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Joseph F. Petrosino
- The Alkek Center for Metagenomics and Microbiome Research and the Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Dimitrios P. Kontoyiannis
- Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- * E-mail:
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Mermel LA, McKay M, Dempsey J, Parenteau S. PseudomonasSurgical-Site Infections Linked to a Healthcare Worker With Onychomycosis. Infect Control Hosp Epidemiol 2015; 24:749-52. [PMID: 14587936 DOI: 10.1086/502125] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To determine the etiology ofPseudomonas aeruginosasurgical-site infections following cardiac surgery.Setting:University teaching hospital.Patients:Those with wound cultures that grewP. aeruginosaafter cardiac surgery performed from 1999 to 2001.Methods:Medical records and operating room (OR) records of patients withP. aeruginosacardiac surgical-site infections from 1999 to 2001 were reviewed. Healthcare workers involved with two or more cases were interviewed and examined. Specimens for environmental cultures were obtained from the ORs and cardiac surgical equipment. Cardiac surgery cases were observed and postoperative care and the cleaning of surgical instruments were investigated. OR air handling system records during the epidemic period were reviewed. Molecular fingerprinting of availableP. aeruginosaisolates from infected patients and a healthcare worker was done.Results:There were fiveP. aeruginosacardiac surgical-site infections from January to August 2001, compared with no such infections from 1999 to 2000. All were adult patients. One cardiac surgeon with onychomycosis operated on all five cases. He did not routinely double glove. The involved fingernail grewP. aeruginosa.ThreeP. aeruginosapatient isolates were available for pulsed-field gel electrophoresis; two were identical to the isolate from the involved surgeon's onychomycotic nail. No environmental OR cultures grewP. aeruginosa.The surgeon's culture-positive nail was completely removed. There have been noP. aeruginosasurgical-site infections among cardiac surgery patients since this intervention.Conclusion:At least two cases of a cluster ofP. aeruginosasurgical-site infections resulted from colonization of a cardiac surgeon's onychomycotic nail.
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Affiliation(s)
- Leonard A Mermel
- Department of Epidemiology and Infection Control, Rhode Island Hospital, Providence, Rhode Island 02903, USA
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15
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Fukunaga A, Washio K, Ogura K, Taguchi K, Chiyomaru K, Ohno Y, Masaki T, Nagai H, Nagano T, Oka M, Nishigori C. Onychomycosis as a warning sign for peripheral arterial disease. Acta Derm Venereol 2013; 93:747-8. [PMID: 23529206 DOI: 10.2340/00015555-1576] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Atsushi Fukunaga
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
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16
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Alvarez-Falconí PP, Moncada-Vilela Z, Montero-Navarrete S, Hernandez-García JA. [Report of a case of strongyloidiasis with a coinfection by HTLV-1 and onychomycosis]. Rev Gastroenterol Peru 2013; 33:348-351. [PMID: 24419034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The infection caused by the human T-cell lymphotropic virus type 1 (HTLV-1) (HTLV-I) has a worldwide distribution. This condition has a worldwide distribution and now it is spreading towards non-endemic areas and it is becoming a public health problem. It is not unusual to see patients with HTLV-1 coinfected with Strongyloides stercoralis and presenting with digestive manifestations, but it is less frequent to find the additional occurrence of other pathogens leading to bacterial infections and multiple onychomycosis. We present the case of a 34-year old man with all those coinfections with peripheral vascular involvement. Some aspects of HTLV-1 pathogenesis are discussed, emphasizing the presence of this virus and the other associated pathogens, and we suggest that tests for determining the presence of HTLV-1 infection may be requested in such cases.
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Affiliation(s)
- Pedro P Alvarez-Falconí
- Sección de Post Grado, Facultad de Medicina Humana, Universidad de San Martín de Porres. Lima, Perú
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17
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[When the nail is the polished one]. MMW Fortschr Med 2012; 154:24. [PMID: 22803235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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18
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Chularojanamontri L, Wimoolchart S, Tuchinda P, Kulthanan K, Kiewjoy N. Role of omalizumab in a patient with hyper-IgE syndrome and review dermatologic manifestations. Asian Pac J Allergy Immunol 2009; 27:233-236. [PMID: 20232578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Hyper-IgE syndrome (HIES) is a rare idiopathic primary immunodeficiency. It is characterized by a triad of findings, including high levels of serum IgE, recurrent skin abscesses and pneumonia and leads to pneumatocele formation. The diagnosis of HIES is complicated by a diversity of clinical and immunological spectrums and a heterogeneous set of genetic defects. The National Institute of Health (NIH) developed a scoring system for HIES in which a score greater than 14 indicates a probable diagnosis. Our patient presented with recurrent multiple abscesses on her scalp, recalcitrant eczema, candida onychomycosis, alopecia universalis, and highly elevated levels of serum IgE. Using the NIH scoring system, a 30 total-point score in this patient indicated the likelihood of carrying the HIES genotype. To our knowledge, there are no specific treatments of HIES. The humanized recombinant monoclonal antibody against IgE, subcutaneous omalizumab, was successfully used in this patient.
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Affiliation(s)
- Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
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19
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Shinjo T. [Treatment of fungus infection with diabetic foot--importance of the foot care]. Nihon Rinsho 2008; 66:2294-2297. [PMID: 19069095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Fungus infection is high frequently complicated of the diabetic foot. Especially onychomycosis make a injury neighbor toe skin or paronychia. This tiny lesion make a bacterial infection, and progress to foot gangrene unfortunately if patient delayed treatment. So it is important to do daily check of the foot and regularly foot care included nail care. Toenail onychomycosis need medicational treatment just after microscopically diagnosis. It is important to check the interaction between the antifungal medicine and other medicine, and side effect after started treatment.
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Park MK. Onychomycosis is more than a cosmetic concern. J Fam Pract 2007; 56:984. [PMID: 18053437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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22
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Brenner MA, Harkless LB, Mendicino RW, Page JC. Ciclopirox 8% nail lacquer topical solution for the treatment of onychomycosis in patients with diabetes: a multicenter, open-label study. J Am Podiatr Med Assoc 2007; 97:195-202. [PMID: 17507527 DOI: 10.7547/0970195] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND An open-label, noncomparative study was conducted to assess the safety and efficacy of ciclopirox 8% nail lacquer topical solution in patients with type 2 diabetes mellitus. METHODS Forty-nine diabetic patients with distal subungual onychomycosis were treated once daily for 48 weeks with ciclopirox 8% nail lacquer, a topical nail solution approved for the treatment of patients with mild-to-moderate onychomycosis. RESULTS Treatment resulted in clinical improvement in 63.4% of patients. Most patients (85.7%) had a mycologic outcome of improvement or cure, with 54.3% attaining mycologic cure. Consideration of mycologic and clinical outcomes generated a treatment outcome of improvement, success, or cure in 84.4% of patients. Moreover, patients experienced improvement in the diseased area of the nail (63.4%), nail surface (56.1%), nail color (48.8%), and nail thickness (65.9%). Ciclopirox 8% nail lacquer was safe, with treatment-related adverse events limited to infection in one patient, which resolved in 15 days; the patient completed the study. No treatment-related serious adverse events were observed. CONCLUSION Ciclopirox 8% nail lacquer is a safe and effective treatment for distal subungual onychomycosis in patients with type 2 diabetes mellitus receiving insulin or oral hypoglycemic therapy.
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Affiliation(s)
- Marc A Brenner
- Institute for Diabetic Foot Research, Glendale, NY 11385, USA
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23
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Kuvandik G, Çetin M, Genctoy G, Horoz M, Duru M, Akcali C, Satar S, Kiykim AA, Kaya H. The prevalance, epidemiology and risk factors for onychomycosis in hemodialysis patients. BMC Infect Dis 2007; 7:102. [PMID: 17760994 PMCID: PMC2206043 DOI: 10.1186/1471-2334-7-102] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Accepted: 08/30/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Onychomycosis has a high prevalance among immunocompromised patients such as diabetics and hemodialysis patients. In the present study, we aimed to investigate the prevalence of onychomycosis among hemodialysis patients with and without diabetes mellitus, and to find out the factors likely to be associated with the development of onychomycosis among hemodialysis patients. METHODS One hundred and nine hemodialysis patients were enrolled. Fifty-seven of hemodialysis patients had the diagnosis of diabetes mellitus. Nail scrapings were obtained from 76 patients who had dystrophic nail changes. Samples were examined with 20% potassium hydroxide solution and all of the samples were inoculated on Saboraud's dextrose agar, potateus dextrose agar and mycobiotic agar. Diagnosis of onychomycosis was based on the presence of both positive clinical signs and positive potassium hydroxide test. RESULTS Onychomycosis was diagnosed in 26.6% of hemodialysis patients. Diabetes mellitus was present in 68.9% of patients with onychomycosis. Toenail scraping cultures were reported to be positive in 19.7% of patients with dystrophic nail changes. Logistic regression analysis revealed that the presence of diabetes mellitus and the mean duration of hemodialysis were the significant predictors associated with the development of onychomycosis. CONCLUSION The prevalence of dystrophic nail changes and onychomycosis is increased among hemodialysis patients. The dialysis duration and the presence of diabetes mellitus are the independent risk factors associated with the development of onychomycosis in uraemic patients.
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Affiliation(s)
- Güven Kuvandik
- Mustafa Kemal University, Faculty of Medicine, Department of Emergency Medicine, Hatay, Turkey
| | - Meryem Çetin
- Mustafa Kemal University, Faculty of Medicine, Department of Microbyology and Clinical Microbyology, Hatay, Turkey
| | - Gultekin Genctoy
- Mersin University, Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Mersin, Turkey
| | - Mehmet Horoz
- Mersin University, Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Mersin, Turkey
| | - Mehmet Duru
- Mustafa Kemal University, Faculty of Medicine, Department of Emergency Medicine, Hatay, Turkey
| | - Cenk Akcali
- Mustafa Kemal University, Faculty of Medicine, Department of Dermatology, Hatay, Turkey
| | - Salim Satar
- Cukurova University, Faculty of Medicine, Department of Emergency, Adana, Turkey
| | - Ahmet A Kiykim
- Mersin University, Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Mersin, Turkey
| | - Hasan Kaya
- Mustafa Kemal University, Faculty of Medicine, Department of Internal Medicine, Hatay, Turkey
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Szepietowski JC, Reich A, Pacan P, Garlowska E, Baran E. Evaluation of quality of life in patients with toenail onychomycosis by Polish version of an international onychomycosis-specific questionnaire. J Eur Acad Dermatol Venereol 2007; 21:491-6. [PMID: 17373976 DOI: 10.1111/j.1468-3083.2006.02004.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Onychomycosis is the most frequent nail disease, which could impair the patient's quality of life. OBJECTIVE The present study was undertaken to evaluate the impact of toenail onychomycosis on quality of life among Polish population. PATIENTS AND METHODS Three thousand nine-hundred and four (3904: 2269 females and 1635 males) individuals fulfilled an international onychomycosis-specific quality-of-life questionnaire consisting of statements regarding social, emotional and symptoms problems. All patients had toenail onychomycosis confirmed by the positive direct microscopic examination and/or by the positive mycologic culture. Seven hundred and sixty-seven patients simultaneously had fingernail onychomycosis. All patients were divided into subgroups according to sex, age, education level, place of living, type of onychomycosis, number of involved toenails, fingernails involvement, duration of illness and previously used antimycotic therapy. RESULTS Most of the patients demonstrated significantly reduced quality of life. The degree of life impairment varied between analysed subgroups. Patients with more advanced toenail onychomycosis and with fingernail involvement were more seriously affected. Both social and emotional impairments were more pronounced in female than in male patients, although there were no differences according to symptoms. Moreover, patients with better educational level and people living in towns or cities were more emotionally and socially affected by onychomycosis, although people living in the country or with poorer education level presented with significantly more severe symptoms. CONCLUSIONS Toenail onychomycosis is still a serious medical problem, which can significantly reduce the patient's quality of life.
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Affiliation(s)
- J C Szepietowski
- Department of Dermatology, Venereology and Allergology, University of Medicine, Wroclaw, Poland.
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Tunc SE, Ertam I, Pirildar T, Turk T, Ozturk M, Doganavsargil E. Nail changes in connective tissue diseases: do nail changes provide clues for the diagnosis? J Eur Acad Dermatol Venereol 2007; 21:497-503. [PMID: 17373977 DOI: 10.1111/j.1468-3083.2006.02012.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the frequency and the specificity of nail changes associated with connective tissue diseases (CTD). METHODS In a case-control study, 190 patients including those with systemic lupus erythematosus (SLE; 56), rheumatoid arthritis (RA, 47), primary Sjögren's syndrome (pSS; 35), systemic sclerosis (SSc; 39), and dermatomyositis/polymyositis (DM/PM; 13) were enrolled in the study. Patients with SLE and other CTDs were compared with two different control groups. Twenty nails were examined. Nail features were noted and classified. Nail samples were collected for mycological cultures. RESULTS In patients with SLE, erythema of proximal nailfold (P<0.01), splinter haemorrhages in fingernails (P<0.01), capillary loops in proximal nailfold (P<0.05), periungual erythema (P<0.05), and thin nail plates (P<0.05) were more common than those in controls. Only splinter haemorrhages were associated with the disease activity. In patients with SSc and DM/PM, splinter haemorrhages (P<0.05) and capillary loops in proximal nailfold (P<0.01) in fingernails were common as well. Increase in longitudinal curvature (P<0.001), transverse curvature (P<0.01), and white dull colour in fingernails were other frequent findings in patients with SSc. Increase in transverse curvature was associated with the disease activity in SSc. In patients with RA, splinter haemorrhages (P<0.05), red lunula (P<0.05), and white dull colour (P<0.05) in fingernails were frequent. The sensitivity values of all these changes were very low. However, their specificity values were found to be relatively high. CONCLUSION Proximal nailfold is the most important site of affection in CTDs. These nail changes can be used in combination with highly sensitive diagnostic modalities to establish an accurate diagnosis.
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Affiliation(s)
- S E Tunc
- Department of Internal Medicine, Division of Rheumatology, Suleyman Demirel University, Isparta, and Internal Medicine Clinic, Section of Rheumatology, State Hospital, Denizli, Turkey.
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Sumikawa M, Egawa T, Honda I, Yamamoto Y, Sumikawa Y, Kubota M. Effects of foot care intervention including nail drilling combined with topical antifungal application in diabetic patients with onychomycosis. J Dermatol 2007; 34:456-64. [PMID: 17584323 DOI: 10.1111/j.1346-8138.2007.00310.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We performed periodical foot care intervention including nail drilling combined with topical antifungal application for 6 months or more in 24 diabetic patients with onychomycosis who were not receiving oral antifungals, and evaluated its effects. The type of onychomycosis was superficial white onychomycosis (SWO) in eight patients, and distal-lateral subungual onychomycosis (DLSO) in 16. The state of onychomycosis was evaluated according to the Scoring Clinical Index for Onychomycosis (SCIO). Of the eight patients with SWO, none showed aggravation of the onychomycosis state, and two were cured 6 months after the initiation of intervention and two after 1 year (total of four patients, 50%). In the patients with DLSO, the SCIO score was 18.1 +/- 6.5 before intervention but significantly decreased to 14.6 +/- 6.6 6 months after intervention. In 12 patients who we were able to consecutively follow up for 1 year, the SCIO score also significantly decreased compared with the score before intervention. Thus, foot care intervention including nail drilling combined with topical antifungal application had effects on onychomycosis and achieved cure in some patients with SWO. In addition, intervention increased patients' awareness of foot care, showing educational effects. Therefore, foot care intervention including nail drilling may be useful.
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Affiliation(s)
- Masuko Sumikawa
- Department of Nursing, School of Health Science, Faculty of Medicine, Kyoto University, Kyoto, Japan.
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Abstract
Itraconazole is widely used to treat onychomycosis because of its significant therapeutic effects. An otherwise healthy 30-year-old man treated with itraconazole developed frequent premature ventricular contractions (PVC). He presented with a dry cough and palpitation. The results of 12-lead electrocardiography (ECG) were essentially normal, but Holter ECG revealed 17,484 (18%) uniform PVC, including 4 short runs among 96,930 beats/day. Another Holter ECG after withdrawing itraconazole revealed 1,032 premature atrial contractions but no PVC. The corrected QT interval was 0.39 s without itraconazole, 0.41 s with itraconazole, and 0.43 s when multiple PVC were documented. Itraconazole inhibits the fungal cytochrome P450 that is involved in fungal cell membrane formation, interrupts human cytochrome P450A4 in the liver and causes adverse interactions with various drugs such as antiarrythmics, but its cardiac side-effects are obscure. Both patients and physicians should be aware that itraconazole can cause PVC as a side-effect.
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Affiliation(s)
- Junko Okamoto
- Department of Cardiovascular Surgery, Kinki University School of Medicine, Osaka-Sayama, Japan.
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29
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Abstract
Onychomatricoma is an uncommon benign tumor of the nail matrix, with peculiar clinical and histologic features and electron microscopic findings. The main clinical signs are longitudinal ridging, yellow coloration along the entire length of the nail plate with splinter hemorrhages in its proximal portion, and a tendency towards transverse overcurvature of the affected nails. We report onychomatricoma associated with onychomycosis in the same nail in a 4-year-old girl.
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Affiliation(s)
- Bianca Maria Piraccini
- Department of Dermatology, University of Bologna, St. Orsola-Malpighi Hospital, Via Massarenti 1, 40138 Bologna, Italy.
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Yamamoto T, Yokoyama A. Superficial white onychomycosis of the fingernails in a 1-year-old child with hypoxemia. Pediatr Dermatol 2007; 24:95-6. [PMID: 17300664 DOI: 10.1111/j.1525-1470.2007.00348.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- Paul L Bollyky
- Department of Laboratory Medicine, University of Washington Medical Center, Seattle, WA 98195, USA
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Gupta AK, Gover MD, Lynde CW. Pulse itraconazole vs. continuous terbinafine for the treatment of dermatophyte toenail onychomycosis in patients with diabetes mellitus. J Eur Acad Dermatol Venereol 2006; 20:1188-93. [PMID: 17062029 DOI: 10.1111/j.1468-3083.2006.01698.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Oral terbinafine and oral itraconazole are two of the most common agents used for the treatment of toenail dermatophyte onychomycosis. Despite the fact that diabetic patients are more likely to have onychomycosis than normal individuals are, there is little research into the efficacy of standard oral regimens of terbinafine and itraconazole for onychomycosis in the diabetic population. STUDY DESIGN We present a prospective, randomized, single-blind, parallel group, comparator-controlled, multi-centre study designed to assess the efficacy of the pulse itraconazole (200 mg twice daily, 1 week on, 3 weeks off, for 12 weeks) vs. continuous terbinafine (250 mg once daily for 12 weeks) oral therapies in the treatment of dermatophyte toenail distal and lateral subungual onychomycosis (DLSO) in the diabetic population. EFFICACY PARAMETERS: Primary efficacy measures included mycological cure rate (negative KOH and culture) and effective cure (mycological cure plus nail plate involvement of 10% or less) at Week 48. RESULTS At Week 48, mycological cure was attained by 88.2% (30 of 34) and 79.3% (23 of 29) of patients in the itraconazole and terbinafine groups, respectively (P not significant). Effective cure (mycological cure with <or=10% of nail plate involvement) was attained by 52.9% (18 of 34) of the itraconazole group and 51.7% (15 of 29) of the terbinafine group (P not significant). Three itraconazole patients experienced side effects in the form of gastrointestinal problems. There were no serious adverse events and no interactions with concomitant medications recorded. DISCUSSION Both continuous terbinafine and itraconazole pulse therapy are effective and safe in the management of dermatophyte toenail onychomycosis in people with diabetes.
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Affiliation(s)
- A K Gupta
- Division of Dermatology, Department of Medicine, Sunnybrook and Women's College Health Sciences Center (Sunnybrook site), University of Toronto and Toronto General Hospital, Canada.
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Negroni R, Arechavala A, Maiolo E. [Clinical cases in medical mycology. Case no. 20]. Rev Iberoam Micol 2006; 23:116-8. [PMID: 16854192 DOI: 10.1016/s1130-1406(06)70028-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ricardo Negroni
- Unidad de Micología, Hospital de Infecciosas Francisco Javier Muñiz, Uspallata 2272 1282, Buenos Aires, Argentina.
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Abstract
A 39-year-old female patient with systemic lupus erythematosus was treated with terbinafine for onychomycosis. After only 7 days of treatment with 250 mg terbinafine, a widespread severe erythematous eruption developed. The results of clinical, histological and immunofluorescent examinations confirmed the diagnosis of coexisting subacute and systemic lupus erythematosus. The patient was treated with drug withdrawal and administration of cyclosporine and methylprednisolone. One year later, mycophenolate mofetil was successfully used. Exacerbation or induction of lupus erythematosus is an extremely rare cutaneous side-effect of terbinafine. Patients with lupus erythematosus should be advised about the risk of some drugs that might exacerbate their disease.
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Affiliation(s)
- Petra Cetkovská
- Department of Dermatology, Charles University Hospital, Pilsen, The Czech Republic.
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Enshaieh SH, Darougheh A, Asilian A, Iraji F, Shahmoradi Z, Yoosephi A, Davami M, Siadat AH, Vaez A. Disseminated subcutaneous nodules caused by Pseudallescheria boydii in an atopic patient. Int J Dermatol 2006; 45:289-91. [PMID: 16533231 DOI: 10.1111/j.1365-4632.2004.02546.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present a 40-year-old woman with atopic dermatitis and multiple purulent subcutaneous nodules of 20 years' evolution. The biopsy material was cultured and revealed Pseudallescheria boydii. The patient was treated with oral itraconazole for 4 months and incision and drainage of the lesions. Afterwards the patient remained asymptomatic and no new lesions were detected.
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Affiliation(s)
- S H Enshaieh
- Department of Dermatology, St-Zahra Hospital, Isfahan University School Of Medicine, Isfahan, Iran
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36
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Pavlović MD, Bulajić N. Great toenail onychomycosis caused by Syncephalastrum racemosum. Dermatol Online J 2006; 12:7. [PMID: 16638375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
Nondermatophyte molds are fungi found in soil and decaying plant debris and are generally considered to be uncommon or secondary pathogens of diseased nails. Prevalence rates of onychomycoses caused by nondermatophyte molds range between 1.45 percent and 17.60 percent. The most common nondermatophyte molds associated with nail disease are Scopulariopsis, Scytalidium, Fusarium, Aspergillus and Onychocola canadensis. Syncephalastrum racemosum, a nondermatophyte mold, belongs to the class Zygomycetae. Only one well-documented case of human disease attributed to this organism has been described. We describe a 45-year-old man with culture proven toenail onychomycosis due to Syncephalstrum racemosum.
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Affiliation(s)
- Milos D Pavlović
- Department of Dermatology, Military Medical Academy, Belgrade, Serbia and Montenegro.
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37
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Abstract
Laryngo-onycho-cutaneous syndrome is a very rare entity found in Punjabi families. It affects the skin, nails, and larynx. Laryngeal involvement may cause lethal airway obstruction, and has in the past proved very difficult to treat. Mitomycin C is an antibiotic that acts as an alkylating agent, inhibiting DNA synthesis. It reduces fibroblast proliferation, and has previously been used to treat choanal atresia and laryngeal stenosis. We report an 18-year-old man with complete transglottic laryngeal stenosis secondary to laryngo-onycho-cutaneous syndrome. An airway was established by dissection with a bougie and sickle knife, and was initially maintained by the upper limb of a Montgomery T-tube. Laryngeal granulation tissue present on removal of the T-tube was treated with topical mitomycin C (2 mg/mL) applied for 4 minutes on two occasions with an interval of 1 month. A year later, the airway remained patent, with no granulation tissue.
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Affiliation(s)
- P Seamus Phillips
- Department of Pediatric ENT, Great Ormond Street Hospital for Children, London, United Kingdom.
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38
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Rufke C, Nieber K. [Long QT interval. Interaction of terfenadine and itraconazole]. Med Monatsschr Pharm 2006; 29:22-4. [PMID: 16463550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Cornelia Rufke
- Institut für Pharmazie - Lehrstuhl Pharmakologie für Naturwissenschaftler, Universität Leipzig, Talstr. 33, 04103 Leipzig
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39
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Abstract
This is a retrospective study of the agents, clinical aspects, sources of infection and therapy of onychomycosis in children. In the period 1989-2000, we observed 46 consecutive children, until 16 years of age with onychomycosis (29 boys, 17 girls, mean age 10.8 years). Dermatophytes were isolated in 30 cases (Trichophyton rubrum in 22 cases, Trichophyton mentagrophytes in five, Epidermophyton floccosum in two and Trichophyton violaceum in one) and Candida spp. in 16, associated with Trichophyton rubrum in two. Moulds were isolated in three children (Fusarium oxysporum in one, Scopulariopsis brevicaulis in another and Aspergillus fumigatus associated with Trichophyton rubrum in a third). The commonest features were distal and distolateral subungual hyperkeratosis in dermatophyte infections (93%) and onychodystrophy and paronychia in Candida infections (56% and 50% respectively). Forty patients achieved clinical and mycological recovery. It is appropriate to suspect onychomycosis in children, perform microbiological diagnosis and undertake early treatment. An approach of this kind may help to prevent nail dystrophy and the spread of infection.
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Affiliation(s)
- C Romano
- Department of Dermatology, University of Siena, Italy.
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40
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Kulac M, Acar M, Karaca S, Cetinkaya Z, Albayrak R, Haktanir A, Demirel R. Venous insufficiency in patients with toenail onychomycosis. J Ultrasound Med 2005; 24:1085-9. [PMID: 16040823 DOI: 10.7863/jum.2005.24.8.1085] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Onychomycosis is a common fungal infection of the toenails and can originate secondary to vascular abnormalities. The aim of this study was to evaluate the relationship between onychomycosis and venous insufficiency. METHODS Forty-two patients with onychomycosis and 39 healthy control subjects who had normal toenails were enrolled in the study. Doppler examinations were performed with a commercially available scanner and a 7.5-MHz linear probe. Major superficial and deep veins of the lower limb, including long and short saphenous, femoral, and popliteal veins, were examined. Venous insufficiency was assessed with the Valsalva test. With the Doppler examination, retrograde flow of more than 1 second was accepted as venous insufficiency. RESULTS Venous insufficiency was detected more frequently in patients with onychomycosis than in the control group (15 [35.7%] of 42 and 6 [15.4%] of 39, respectively; P = .037). Reflux was bilateral in 4 (26.7%) of 15 patients with onychomycosis, and in those 4 patients the onychomycosis was also bilateral. In 7 (46.7%) of 15 patients, onychomycosis and venous insufficiency were detected ipsilaterally, whereas there were no onychopathic features contralaterally. Although unilateral insufficiency was present in 4 (26.7%) of 15 patients, these patients had bilateral onychomycosis. CONCLUSIONS We found a significant relationship between onychomycosis and venous insufficiency; therefore, we recommend a routine venous Doppler examination for patients with onychomycosis to diagnose or rule out venous insufficiency.
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Affiliation(s)
- Mustafa Kulac
- Department of Dermatology, Afyon Kocatepe University, Faculty of Medicine, Kirmizi Hastane, Turkey
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Boszczowski I, Nicoletti C, Puccini DMT, Pinheiro M, Soares RE, Van der Heijden IM, Costa SF, Barone AA, Levin AS. Outbreak of extended spectrum beta-lactamase-producing Klebsiella pneumoniae infection in a neonatal intensive care unit related to onychomycosis in a health care worker. Pediatr Infect Dis J 2005; 24:648-50. [PMID: 15999012 DOI: 10.1097/01.inf.0000168844.55898.8f] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Four cases of infection by extended spectrum beta-lactamase-producing Klebsiella pneumoniae occurred in the neonatal intensive care unit. Isolation, empiric therapy change and education produced no effect. Newborn weekly colonization rates were 0-18.7%. One health care worker with onychomycosis was positive for extended spectrum beta-lactamase-producing K. pneumoniae. Isolates were identical by molecular typing. Outbreak was controlled when the health care worker was excluded from the neonatal intensive care unit.
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Gupta AK, Ryder JE, Lynch LE, Tavakkol A. The use of terbinafine in the treatment of onychomycosis in adults and special populations: a review of the evidence. J Drugs Dermatol 2005; 4:302-8. [PMID: 15898285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Terbinafine is an allylamine with fungicidal activity, first approved for the treatment of onychomycosis in the United Kingdom in the early 1990s, and in the US in 1996. Terbinafine is the most frequently prescribed oral antifungal agent in the US and Canada for onychomycosis. Its efficacy and safety in dermatophyte toenail onychomycosis in adults has been established in many studies. In fact, 18 randomized controlled trials have shown terbinafine to be highly effective, with a meta-average for mycological cure of 76% +/- 3% (mean +/- standard error). In large surveillance studies, terbinafine exhibited excellent safety profiles consistent with results obtained in pivotal studies. Additionally, terbinafine has been reported to be superior to both itraconazole and fluconazole in comparative studies in the treatment of dermatophyte toenail onychomycosis. Recent studies have reported terbinafine to be more cost effective than griseofulvin, fluconazole, or itraconazole. Terbinafine has also been used to treat onychomycosis effectively and safely in special patient populations, such as children, the elderly, immunocompromised patients, diabetics, and those with Down syndrome. Terbinafine should therefore be considered for the management of onychomycosis in adults based on its effectiveness, broad spectrum, fungicidal nature, established safety profile, and very low occurrence of drug interactions. Furthermore, the data support the use of terbinafine to treat dermatophyte onychomycosis in children and the elderly.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, Sunnybrook and Women's College Health Sciences Center (Sunnybrook site), University of Toronto, Toronto, Canada.
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Abstract
We report an unusual case of nail infestation by Liposcelis bostrychophila Badonnel in a 70-year-old woman with onychomycosis. Liposcelis spp., also known as booklouse, are tiny insects that feed on fungi, lichen and decaying materials. In this case, the loosened hyperkeratotic nail provided a favourable environment for these insects. This is the second report of human infestation by Liposcelis spp.
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Affiliation(s)
- Y-C Lin
- Chi-Mei Medical Centre, Department of Dermatology, Tainan County, Taiwan.
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Abstract
This article provides a focused look at the need to treat onychomycosis from a podiatric perspective, new classifications of the disorder, definitive diagnostic methods, predictability of host responsiveness, and current strategies for treatment.
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Affiliation(s)
- Frances J Lagana
- Winchester Hospital, 41 Highland Avenue, Winchester, MA 01890, USA.
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Negroni R, Robles AM, Arechavala A. [Clinical problems in medical mycology: problem no.11. Generalized dermatophytosis with subcutaneous nodules]. Rev Iberoam Micol 2004; 21:155-6. [PMID: 15709793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Affiliation(s)
- Ricardo Negroni
- Unidad de Micología, Hospital de Infecciones Francisco Javier Muñiz, Buenos Aires, Argentina.
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46
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Rao R, Shenoi SD. Acrokeratosis paraneoplastica (Bazex syndrome): an atypical presentation. Dermatol Online J 2004; 10:21. [PMID: 15347503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
A 62-year-old male presented with a 2-year history of hyperkeratotic lesions of the hands and feet. Previous treatment with topical steroids was unsuccessful. A complete physical examination revealed the presence of blood in the stool, and sigmoidoscopy showed an ulcerative growth at the rectosigmoid junction. The histopathology showed adenocarcinoma.
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Affiliation(s)
- Raghavendra Rao
- Department of Dermatology, Kasturba Medical College, Manipal, Karnataka India.
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Abstract
BACKGROUND Dermatophyte infections have been considered rare in psoriasis. However, there are data indicating that tinea unguium is as common or even more common in psoriasis compared with healthy controls. Tinea unguium is generally a secondary event to tinea pedis infection. OBJECTIVES To study the prevalence of tinea pedis and tinea unguium in psoriasis compared with a control group. METHODS Consecutive psoriasis outpatients aged 18-64 years attending a department of dermatology were examined. Samples for direct microscopy and culture were taken from the interdigital spaces, soles and toenails. Consecutive patients without signs of psoriasis or atopic dermatitis seeking examination of moles constituted the control group. RESULTS In total, 239 patients with psoriasis and 245 control patients were studied. The prevalence of tinea pedis was 8.8%[95% confidence interval (CI) +/- 3.6%] in the psoriasis group and 7.8% (95% CI +/- 3.4%) in the control group. The corresponding figures for prevalence of tinea unguium were 4.6% (95% CI +/- 2.7%) and 2.4% (95% CI +/- 1.9%), respectively. The differences found in the psoriasis vs. the control groups were not statistically significant. CONCLUSIONS This study does not support the hypothesis that the prevalence of tinea pedis and tinea unguium in patients with psoriasis differs from that in a normal population.
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Affiliation(s)
- N Hamnerius
- Department of Dermatology, Blekinge Hospital, S-371 85 Karlskrona, Sweden.
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Fletcher CL, Hay RJ, Smeeton NC. Onychomycosis: the development of a clinical diagnostic aid for toenail disease. Part I. Establishing discriminating historical and clinical features. Br J Dermatol 2004; 150:701-5. [PMID: 15099366 DOI: 10.1111/j.0007-0963.2004.05871.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The ideal method for diagnosing onychomycosis is unclear. Mycological investigation is currently the method of choice, although there is a false-negative culture rate of at least 30%. OBJECTIVES To establish a clinical diagnostic aid which may be used alongside laboratory-based mycological tests and in epidemiological studies. METHODS Patients with nail disease (n = 209) were enrolled in the study. The examining clinician completed a questionnaire containing four historical questions and 21 questions related to the clinical findings. All patients had samples taken for mycological analysis. The gold standard for the diagnosis of onychomycosis was a positive result on both direct microscopy and culture of nail samples. Following exclusions, questionnaire responses from 169 patients were analysed using Stata. Multiple logistic regression with forward stepwise selection of variables was performed. RESULTS Both microscopy and culture results were positive in 32% of cases and negative in 42%. Dermatophytes formed the majority of isolates. Four parameters were found to be significantly related to positive mycology results: a history of tinea pedis in the last year, scaling on one or both soles, white crumbly patches on the nail surface, and an abnormal colour of the nail plate. CONCLUSIONS Our results have shown one historical feature and three clinical features to be strongly associated with onychomycosis. The questionnaire has been revised to include only these stems and is being tested further with the aim of achieving a binary definition.
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Affiliation(s)
- C L Fletcher
- St John's Institute of Dermatology, St Thomas' Hospital, London SE1 7EH.
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49
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[Especially in patients with diabetes, onychomycosis is not a harmless illness]. MMW Fortschr Med 2004; 146:45. [PMID: 15347086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Carducci M, Latini A, Acierno F, Amantea A, Capitanio B, Santucci B. Erythema multiforme during cytomegalovirus infection and oral therapy with terbinafine: a virus-drug interaction. J Eur Acad Dermatol Venereol 2004; 18:201-3. [PMID: 15009306 DOI: 10.1111/j.1468-3083.2004.00806.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The authors report a case of erythema multiforme in a 32-year-old woman who was also taking oral terbinafine for an onychomycosis. The patient data analysis showed serological positivity for cytomegalovirus (IgM and IgG) and hepatitis C virus and serological titre of antinuclear antibody was elevated. After a brief review of the literature the authors propose the possibility of virus-drug interaction as a model of adverse drug reactions.
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Affiliation(s)
- M Carducci
- Department of Inflammatory, Istituto San Gallicano, Via Elio Chianesi, 53, 00144 Rome, Italy.
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