Cases Of Onychomycosis Research Articles

In vitro antifungal susceptibility testing of fungi in patients with onychomycosis.

Onychomycosis is the most common nail disorder. To examine in vitro antifungal susceptibility of fungi among onychomycosis patients. The study included 68 patients with onychomycosis. Nail specimens were cultured on Sabouraud dextrose agar and Dermasel agar base-media. Isolated fungi were subjected to antifungal susceptibility tests against terbinafine, itraconazole, fluconazole, and griseofulvin. Candida species (Candida spp.) were detected in 32.4% of the cases of candidal onychomycosis (n = 37), 23.5% of the cases of distal and lateral subungual onychomycosis (n = 17), and 21.4% of the cases of total dystrophic onychomycosis (n = 14). Candida spp. were sensitive to fluconazole in 73.5%, itraconazole in 58.8%, and terbinafine in 5.9% of the cases. Aspergillus spp. were sensitive to itraconazole in all cases, and terbinafine in 87.5% of cases. Penicillium spp. were sensitive to itraconazole and terbinafine in 88.9% and 77.8% of cases, respectively. Trichophyton spp. were sensitive to terbinafine and resistant to itraconazole. Microsporum spp. were sensitive to itraconazole and resistance to terbinafine. All isolated fungi were resistant to griseofulvin. An increasing proportion of Candida spp. was observed among patients with different clinical varieties of onychomycosis. Candida spp. were highly sensitive to fluconazole and a lesser extent to itraconazole.

Non-dermatophyte Mould Onychomycosis in Japan.

The incidence of non-dermatophyte mould onychomycosis has been increasing worldwide for the past several decades, but it is not well recognized in Japan. Recent molecular techniques and phylogenetic analyses contributed to the identification of uncommon and emerging species. We came across 13 (0.5%) cases of non-dermatophyte onychomycosis among a total of 2,591 onychomycosis cases in 106,703 outpatients during the past 5 years (January 2015-December 2019). The cases included 5 patients with Aspergillus species, 4 patients with Fusarium species, and one patient each with Scopulariopsis brevicaulis and Botryosphaeria dothidea, respectively. Botryosphaeria dothidea is closely related phylogenetically to Neoscytalidium dimidiatum. In Japan, at the time of writing this report, there are 26 reported cases of ungual aspergillosis and 18 cases of hyalohyphomycosis caused by Fusarium species. We summarize these cases and report the symptoms and mycological features.

A rare case of onychomycosis induced by Alternaria alternata

A rare case of onychomycosis induced by Alternaria alternata

The Role of PCR in the Diagnosis of Dermatophytes in Onychomycosis

Background: Onychomycosis is a critical medical problem. This fungal infection of the nails leads to disfigurement, pain and impaired quality of life. Given that it requires long-term expensive therapy; a proper diagnosis of this infection is greatly demanded. Hence, study aimed at investigating the different laboratory methods used in the identification of dermatophytes implicated in onychomycosis including conventional laboratory methods (KOH preparation), Culture and PCR (multiplex). Subjects and Methods: This cross-section study included sixty-one (61) patients [ 82% females and 18% males]. All collected samples were investigated using microscopic examination and cultivation of samples. In addition, DNA extraction and PCR amplification were evaluated. Results: Distal and lateral subungual onychomycosis(DLSO) was the most common clinical types of onychomycosis represented 70 % of total cases. Pain was the most common presenting symptoms. Among the studied group, the most common fungal infections encountered were chronic paronychia, tinea pads and tinea manum (37.7%, 16.4%, and 8.2%) respectively. The 67.2% of the studied group by PCR were +ve, by culture 60.7% were +ve and finally, 73.8% were +ve by direct smear. The sensitivity of PCR in the diagnosis of lesions was 100% specificity was 83.3% and accuracy was 93.4%. Conclusion: The dermatophyte responsible for a majority of cases of onychomycosis. However, the role of NDMs should not be ignored and this may be now a consideration in evaluating and treating onychomycosis. PCR is highly sensitive methods for diagnosis of fungal infection. The application of PCR technology directly to the clinical specimens will allow early and accurate diagnosis of onychomycosis. This will permit prompt and targeted initiation of antifungal therapy. So, it is recommended to be used in the rapid diagnosis of onychomycosis.

A STUDY OF CLINICO-MYCOLOGICAL CORRELATES OF ONYCHOMYCOSIS

Onychomycosis (OM) is one of the most common problems affecting the nails and has shown to have an extreme variability in clinical presentation, risk factors and etiology. The aim of our study was to study the clinico-etiopathological profile of OM in patients at a tertiary care centre in North India. A total of 100 cases of OM attending the Dermatology OPD were enrolled in the study. Their demographic profile, exposure to risk factors and medical history was recorded. Clinical examination was done and the pattern of disease was recognised. Nail and skin scrapings were obtained and subjected to KOH mounting and culture assessment. Data was analysed using SPSS 21.0, Chi-square and ANOVA tests. Age of patients ranged from 13 to 75 years (Mean age 35.53±15.46 years). Majority of the patients were males (64%). Laborers/farmers and housewives comprised the majority of patients (29% +23%). DLSO (63%) was the most common pattern. Co-morbidities were seen in 17% cases. 89% were either KOH or culture positive, 36% were both KOH and culture positive, 1% was only KOH positive and 52% were only culture positive. A total of 11% cases were both culture and KOH negative. Dermatophytes (47%) were the most common species, followed by yeast/yeast-like isolates (28%) and non-dermatophytes (13%). Among dermatophytes, T. rubrum (n=40), C. albicans (n=16) and Aspergillus niger (n=4) were the most common Dermatophytes, Yeast and non-Dermatophyte species respectively. A significant association of clinical pattern was observed with sex and site of involvement. KOH positivity was significantly associated with culture positivity for different isolates. The clinicopathological spectrum of OM was quite diverse. The study emphasised the need for comprehensive diagnostic work-up of these patients in view of diverse etiology and clinical spectrum.

Optical coherence tomography of onychomycosis: proposed terminology and a suggestion of practical usage.

Onychomycosis is the most common cause of nail changes accounting for about half of all nail diseases. It is important to diagnose the fungal pathogen to prescribe adequate treatment, but as genus- and species-specific diagnostic tests can be time consuming and expensive, it is crucial to obtain representative tissue during nail scrapings. Optical coherence tomography (OCT) is a non-invasive imaging tool enabling real-time imaging of skin and tissue. Pilot studies using OCT have described morphological characteristics of onychomycosis, though diagnostic criteria of onychomycosis and other nail diseases are lacking. The aim of this study is to investigate the applicability of OCT to detect and localize fungal elements in nails with clinical signs of onychomycosis. OCT scans and nail scrapings were performed on all participants and only confirmed cases of onychomycosis were included in the data analysis. All scans were analyzed, and a set of morphological criteria based on known literature and deviations from healthy nail morphology were suggested. The suggested morphological features were: hyperreflective lines divided into sharply and diffusely demarcated; hyperreflective dots divided into singular and clustered patterns; irregular surface, divided into mild, moderate and severe degree; dark bands and disturbed architecture. The suggested OCT morphology is a refinement of previous studies, and though OCT cannot replace genus- or species-specific identification, it could be a useful assistance tool to increase diagnostic sensitivity of nail scrapings and laboratory tests as well as for monitoring treatment response.

A comparison of direct microscopy and culture with periodic acid schiff staining in the diagnosis of onychomycosis

Introduction and Objectives: Onychomycosis, or fungal infection of the nail apparatus by dermatophytes or nondermatophytes, is more than just a cosmetic problem. Dermatophytes are known to cause 90% of toenail and atleast 50% of fingernail onychomycosis. Our study offers insight into the unique current epidemiological aspects of onychomycosis in our region, including the less known nondermatophytemolds;. Since histopathology of nail clippings using Periodic Acid Schiff is clearly an invaluable tool in diagnosing onychomycosis, we integrated and comparatively evaluated it with the tests of routine mycology for the same. Materials and Methods: Patients in Rajarajeswari Medical College and Hospital (a tertiary care hospital) presenting with clinically apparent onychomycosis were included in this study. Each specimen of subungual debris and nail clippings was divided into two portions- one for direct microscopy and the other for culture. Nail clippings alone were used for PAS staining. Results: The present study was carried out on 40 clinically suspected cases of onychomycosis in the Department of Microbiology, Rajarajeshwari Medical College and Hospital over a period of one year. Out of 40 samples, 14(35%) samples showed fungal elements in 20% KOH, in 12(30%) samples fungal culture was positive and 19(47.5%) were PAS stain positive. Out of 12 isolates, 5(41.6%) were dermatophytes and 7(58.4%) were nondermatophytes. Keywords: KOH, PAS, Dermatophytes, Nondermatophytes, Nail infection, Onychomycosis.

Onychomycosis Caused by Malassezia pachydermatis in a Dog

Background: Malassezia species are commensal skin organisms of warm-blooded vertebrates that can act as opportunistic pathogens. Malassezia pachydermatis is of importance in both veterinary and human medicine. Recognised initially as causes of infection of the skin, they are now known to be superficial commensals as well as potential causes of infections in domestic animals and more serious human conditions such as fungemia. They have also been implicated in the pathogenesis of allergic and other inflammatory diseases. Onychomycosis is defined as fungal infection of the claw (nail disease) caused by dermatophytes (Microsporum and Trichophyton genus), non-dermatophyte molds (hyaline and dematiaceous) and/or yeasts. The objective of this work was to report a case of canine onychomycosis by Malassezia pachydermatis based on reference standard diagnostics of this pathology.Case: A 9-year-old male West Highland White Terrier presented history of claw abnormality: brown staining and partly brittle. The dog has no apparent history of trauma on the affected claw and no skin disease was reported. Direct examination of claw was performed using the tape strip technique revealed Malassezia organisms. Nail fragments were cultured onto Sabouraud Dextrose Agar with Chloramphenicol and Cycloheximide. After 10 days of incubation (32ºC) nail fragments allowed the isolation of pure colonies of Malassezia pachydermatis. The histopathological evaluation was performed by Sector of Veterinary Clinical Pathology, Faculdade de Veterinária (FAVET/UFRGS) and fungal infection due to Malassezia pachydermatis was confirmed by histopathologic examination (Hematoxylin and eosin and Grocott’s methenamine silver stain) of the nail, that revealed abundant yeasts (blastoconidia).Discussion: Fungal infection of the skin, hair and nails are common and are primary caused by the dermatophyte molds. Non-dermatophyte molds isolated from nails constitute a long list, but only a few species cause onychomycoses. These include Scopulariopsis brevicaulis, Fusarium sp., Acremonium spp., Aspergillus spp., Penicillium spp. Yeasts like Malassezia and Candida spp. are saprophytes and usually represent incidental contaminants associated with a non-sterile specimen at mycological culture, however in some cases they may parasite the nails and become an etiological agent of the disease. M. pachydermatis, normally present on the skin and in the ear canal of dogs and cats, can act as opportunistic pathogenic microbe and frequently causes dermatitis and otitis in mammals. In the case of onychomycosis, there is little evidence that Malassezia yeasts are implicated in nail plate invasion, although this may be a rare occurrence. All species of the genus are obligatory lipid-dependent forms, with the exception of M. pachydermatis, as well as absence of keratinolytic ability. Malassezia organisms were commonly retrieved from the subungual claw fold region of normal healthy dogs (should be considered resident microflora of the normal canine claw fold). Some authors suggests that high numbers of yeast can be detected on cytological evaluation of the skin surface of the canine claw fold from allergic dogs in both the absence and presence of concurrent signs of pruritus and paronychia.

Sensitivity of PAS histopathology stain for the diagnosis of onychomycosis at multicenter teaching hospitals, Pakistan.

The aim of this study was to determine the sensitivity of Periodic acid –Schiff (PAS) staining an early and quick effective diagnostic test of nail clipping with routine tests in the diagnosis of Onychomycosis. Background: The routine gold standard for diagnosis of fungal nail infections has been direct microscopy (KOH mount) and mycological culture which often yield delayed or weak/false negative results. However recent studies have suggested that nail plate biopsy using PAS stain is rapid method of detection that grasped the diagnosis and manage the disease. Study Design: Cross sectional descriptive study. Setting: 320 clinical diagnosed cases of onychomycosis performed at Department of Microbiology, Quaid-e-Azam Medical College Bahawalpur and Department of Histopathology King Edward medical University Lahore. Period: January 2012 to August 2018. Materials and Methods: The parameter looked in the sent investigation were histopathology PAS stain, mycological culture and microscopy. Presences of intensely stained reddish dots or threads like structures in between the cells of nail plate were considered to be positive results on histopathology with periodic acid Schiff (PAS). The microscopic study showed hyphae or spores and growth of organism concluded by morphological colony characteristics on Sabouraud's dextrose agar (SDA) periodically after 4 weeks. Result: out of total 320 cases, 81.25% was positive for histopathology PAS stain. Culture positivity was 60% and KOH mount recovered 52.5% positive. The combination of PAS stain and culture results showed 90.62% while Culture and KOH were 62.5% in nail clipping specimen. Conclusion: Histopathological PAS technique was found to be more effective than other laboratory methods for the diagnosis of Onychomycosis.

Distal and lateral subungual onychomycosis of the finger nail in a neonate: a rare case

BackgroundOnychomycosis is extremely rare in neonates, infrequently reported in children and is considered to be exclusively a disease of adults.Case presentationWe, herein report a case of fingernail onychomycosis in a 28-day-old, healthy, male neonate. The child presented with a history of yellowish discoloration of the fingernail of the left hand for one week. The etiological agent was demonstrated both by microscopic examination and culture of nail clippings. The isolate grown on culture was identified as Candida albicans by phenotypic characteristics and by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Antifungal sensitivity testing was performed by broth dilution method as per the Clinical & Laboratory Standards Institute guidelines. An oral swab culture of the child also yielded C. albicans with the same antibiogram as the nail isolate. The case was diagnosed as distal and lateral subungual candida onychomycosis of severity index score 22 (severe) and was treated with syrup fluconazole 6 mg/kg body weight/week and 5% amorolfine nail lacquer once/week for three months. After three months of therapy, the patient completely recovered with the development of a healthy nail plate.ConclusionsThe case is presented due to its rarity in neonates which, we suppose is the first case report of onychomycosis from Nepal in a 28-day-old neonate. Oral colonization with pathogenic yeasts and finger suckling could be risk factors for neonatal onychomycosis.

Recent Findings in Onychomycosis and Their Application for Appropriate Treatment.

Onychomycosis is mainly caused by two dermatophyte species, Trichophyton rubrum and Trichophyton interdigitale. A study of nail invasion mechanisms revealed that the secreted subtilisin Sub6, which has never been detected under in vitro growth conditions, was the main protease secreted by T. rubrum and T. interdigitale during infection. In contrast, most of the proteases secreted during the digestion of keratin in vitro were not detected in infected nails. The hypothesis that proteases isolated from dermatophytes grown in a keratin medium are virulence factors is no longer supported. Non-dermatophyte fungi can also be infectious agents in nails. It is necessary to identify the infectious fungus in onychomycosis to prescribe adequate treatment, as moulds such as Fusarium spp. and Aspergillus spp. are insensitive to standard treatments with terbinafine or itraconazole, which are usually applied for dermatophytes. In these refractory cases, topical amphotericin B treatment has shown to be effective. Terbinafine treatment failure against dermatophytes is also possible, and is usually due to resistance caused by a missense mutation in the squalene epoxidase enzyme targeted by the drug. Trichophyton resistance to terbinafine treatment is an emerging problem, and a switch to azole-based treatment may be necessary to cure such cases of onychomycosis.

Demonstration of Adventitious Sporulation in Fusarium Petroliphilum Onychomycosis.

Fusarium petroliphilum is a recently described species within the Fusarium solani species complex. Some strains of Fusarium species are capable of forming yeast-like structures in tissue as well as in culture through a process known as "adventitious sporulation." Here, we describe the formation of these yeast-like reproductive structures in infected nail tissue obtained from a case of onychomycosis. These structures were also observed in culture grown on RPMI 1640 agar supplemented with 2% glucose. The isolate was resistant to azoles and echinocandins. To the best of our knowledge, this is the first report describing adventitious sporulation in F. petroliphilum and its etiologic role in onychomycosis.

A rare case of onychomycosis due to Aspergillus species in a neonate

Onychomycosis is a common condition affecting 5.5% of the population worldwide and represents 20%–40% of all onychopathies and about 30% of cutaneous mycotic infections. It is common in elderly, uncommon in children, and rare in neonates. Onychomycosis is caused by dermatophytes, nondermatophytic molds (NDM), and yeasts. Onychomycosis due to NDM is even rarer in neonates. Here, we report a case of a 3-week-old neonate who was diagnosed as a case of onychomycosis due to Aspergillus species. The neonate was started on topical antifungal amorolfine 5% and improved in 8 weeks.

Clinicomycological and Histopathological Profile of Onychomycosis: A Cross-sectional Study from South India.

Background:Onychomycosis (OM) is a fungal infection of the finger or toenails caused by dermatophytes, yeasts, or nondermatophyte molds (NDMs) and can involve any component of the nail unit. OM, apart from being asymptomatic, is a chronic disease and warrants long-term treatment.Aims:The aim was to study the clinicoepidemiological features of OM and to evaluate the mycological and histopathological features among patients attending the dermatology outpatient department.Subjects and Methods:A cross-sectional hospital-based study was performed in 500 patients with symptoms related to the nails and nail folds. OM was confirmed in 284 patients by potassium hydroxide (KOH) mount, fungal culture, or biopsy. Descriptive analysis of the data was undertaken.Results:The study included 284 confirmed cases of OM of which 117 (41.1%) were positive for fungal elements by KOH mount, 168 (59.1%) samples showed positivity in fungal culture, and 62 (21.8%) samples had positive nail biopsy results. Distolateral subungual OM was the most common clinical type (47.6%). Among the fungal isolates, a predominance of dermatophytes was observed followed by yeasts and NDMs. The most common dermatophytic fungal isolate in the culture was Trichophyton rubrum (45%).Conclusion:Our study implies the importance of laboratory diagnosis of OM as it can mimic diverse nail disorders. As the role of NDMs and yeasts is on the rise for etiology of OM, investigations such as KOH examination, culture, or nail biopsy becomes essential for correct diagnosis and management.

Nail clipping in onychomycosis and comparison with normal nails and ungual psoriasis

BackgroundOf all nail disorders seen in dermatology offices, half of them are due to onychomycosis. The main differential diagnosis is nail psoriasis. The objective of this study was to compare the microscopic findings, other than the presence of fungi, in the clipping of onychomycosis versus normal nails and nail psoriasis.MethodsCross-sectional study of onychomycosis cases, analyzed by clipping and compared with data on normal nails and those with nail psoriasis.ResultsSixty-two onychomycosis samples were compared with 30 normal nails and 50 nails with psoriasis. In onychomycosis, measurement of subungual region, serous lakes, neutrophils and number of layers of parakeratosis are more intense than in psoriasis. Onychocariosis is less common in psoriasis, while bacteria are more frequent. The nail transition zone is more commonly blurred and irregular in onychomycosis.ConclusionClipping helps in the differential diagnosis of onychomycosis and nail psoriasis and may be useful even when fungi are not found.

Evaluation of relationships between onychomycosis and vascular diseases using sequential pattern mining

Onychomycosis (OM) is a common nail disease. Although controversial, vascular diseases are considered independent predictors of OM and vice versa. Sequential pattern mining (SPM) has not been previously used for statistical analysis in dermatology, but it is an efficient method for identifying frequent association rules in multiple sequential data sets. The aim of our study was to identify the relationship between OM and vascular diseases in the real world through a population-based study using SPM. We obtained population-based data recorded from 2002 to 2013 by the Health Insurance Research and Assessment Agency. Cases of vascular-related disease and OM were identified using the diagnostic codes of the International Classification of Diseases 10th Revision, version 2010. SPM measures were based on comorbidity and duration values. We estimated 3-year risk for progression from OM to vascular disease and vice versa using logistic regression. Patients with varicose veins and peripheral vascular disease had higher OM comorbidity (comorbidity: 1.26% and 0.69%, respectively) than did those with other vascular diseases. Patients diagnosed with varicose veins and peripheral vascular disease were diagnosed with OM after 25.50 and 55.10 days, respectively, which was a shorter duration than that observed for other diseases. Patients with OM were at higher risk for peripheral vascular disease (adjusted odds ratio (aOR) 1.199 [95% confidence interval (CI) 1.151–1.249]) and varicose veins (aOR 1.150 [95% CI 1.063–1.245]). Patients with peripheral vascular disease (aOR 1.128 [95% CI 1.081–1.177]) were at higher risk for OM, while patients with varicose veins had no significant risk for OM. Careful consideration of varicose veins or peripheral vascular disease is required for proper management of comorbidities in patients with OM.

Epidemiological survey of onychomycosis pathogens in Japan by real-time PCR.

In Japan, an epidemiological survey of onychomycosis pathogens was performed using culture methods; however, the positive culture rate was 40% or less. As part of an epidemiological survey of dermatomycoses in Japan, we overcame this low positive rate by employing a real-time polymerase chain reaction (PCR) assay that allowed rapid and accurate detection and identification. In 2011, nail specimens were collected from patients at nine institutes in various prefectures in Japan and diagnosed as onychomycosis. For the detection and identification of the main pathogens causing onychomycosis, we performed real-time PCR using specific TaqMan® MGB probes and primer sets. Of the 496 onychomycosis samples, real-time PCR detected 382 cases (77.0%) caused by Trichophyton rubrum; 74 cases (15.0%) caused by Trichophyton interdigitale; and eight cases (1.6%) caused by Candida albicans. The real-time PCR positive rate was 96.2%. The most frequent pathogen was T. rubrum throughout life, with the number of patients affected peaking in the range of 60 to 69 years of age and no significant differences in the composition of causative pathogens by sex. We were able to detect and identify pathogens from almost all specimens and succeeded in analyzing the pathogens involved in onychomycosis cases in Japan. These data confirmed that our real-time PCR method was effective for detecting and identifying the main fungal pathogens from onychomycosis specimens.

ONYCHOMYCOSIS FINGER AND TOE NAIL BY CRYPTOCOCCUS LAURENTII.T VERRUCOSSUM AND CANDIDA SP

ONYCHOMYCOSIS FINGER AND TOE NAIL BY Cryptococcus laurentii, Trychophyton verrucosum, and Candida sp Dhelya Widasmara, Diane Tantia SariDepartment of Dermatology and Venereology, Medical Faculty, Brawijaya Universitydr.Saiful Anwar Regional Public Hospital, Malang, IndonesiaEmail: dhelya.widasmara@gmail.com AbstractIntroduction : Onychomycosis is included in most common nail disease and contributes to 50% of onychodystropic events. So far, there are rare cases of onychomycosis due to Cryptoccus laurentii and Trychophyton verrucosum. Case : Woman, 54 y.o, complaining of brittle nails and cracked on the soles of the feet and hands since 6 months ago. Patients have daily habits to go to rice fields without gloves and footwear, and rarely wash their hands and feet after the rice fields. Dermatologic examination of all unguium digiti manus and the right and left hand, obtained discolorization of yellow and white and some blackish, subungual hyperkeratosis, onikolisis, and onikodistrofik. In plantar dekstra et sinistra, obtained erythema plaque, multiple, irregular shape, varied size, with rough skuama, as well as multiple yellow and white hyperkeratotic plaques with fissures. A 20% KOH examination of a hand and foot nail, both of which obtained a long septae hyphae. Periodic Acid-Schiff coloration (PAS) obtained a description of spores. Fungal culture from fingernail obtained growth of Criptococcus laurentii and Trichophyton spp., culture of toenails obtained growth Trichophyton verrucosum and Candida sp. Patients were treated with itraconazole tablet dose of 2x200mg / day dose for a week every month, gentamicin ointment, and 20% urea cream, myologic improvement after 4 weeks of therapy. Discussion : The incidence of onychomycosis due to Cryptoccus laurentii and Trychophyton verrucosum is still rare. The predisposing factor of infection in these patients is due to the patient's habitual contact with the paddy fields. Keywords : onychomycosis, Cryptococcus laurentii, Trychophyton verrucosum

Fungal diseases in children and adolescents in a referral centre in Bogota, Colombia.

A cross-sectional descriptive study was conducted at a dermatology referral centre in Bogotá, to estimate the frequencies and aetiologies of mycoses in the population under 18years of age attending the medical mycology laboratory over a 13-year period (2000-2012). A total of 1337 samples from 1221 patients were evaluated, involving direct examination and culture for 1279 samples, direct examination alone for 50 and culture alone for 8. During the study period, dermatophytosis was diagnosed via culture in 537 cases (40.1%). The most common aetiological agents were Trichophytonrubrum (235 cases), Microsporumcanis (177), Trichophytonmentagrophytes (74) and Microsporumgypseum (22). Pityriasis versicolor was found in 31 cases (5.1%), Candida spp. were found in 17 cases, and non-dermatophyte moulds were confirmed by a second sample in 6 cases (3 cases involving Fusarium spp., 2 Neoscytalidiumdimidiatum and 1 Acremonium spp.). In addition, white piedra was diagnosed in 4 cases (0.7%), and tinea nigra in 2 cases (0.3%). Regarding subcutaneous mycoses, 14 cases of sporotrichosis were identified. The results from this study confirm the predominance of dermatophytosis in the paediatric population. T.rubrum and M.canis were the main aetiological agents. We found a few cases of onychomycosis by non-dermatophyte moulds. Sporotrichosis was the only subcutaneous mycosis diagnosed during the study period.

Onychoscopic evaluation of onychomycosis in a tertiary care teaching hospital: a cross-sectional study from South India.

Onychoscopy is the dermoscopic evaluation of nail and associated structures. It is useful in identifying the various onychoscopic patterns which act as a link between naked eye examination and nail histopathology and may help in avoiding nail biopsy in unnecessary cases. To evaluate the onychoscopic patterns in confirmed cases of onychomycosis. An observational, prospective, cross-sectional study was performed in 500 patients with symptoms related to the nails and nail folds. Onychomycosis was confirmed in 234 patients by KOH mount/fungal culture/biopsy. These patients underwent dermoscopy with a handheld 20× polarized contact dermoscope (Heine's delta 20 T). The dermoscopic patterns were identified, and their correlation with the clinical subtype of onychomycosis was analyzed. The study included 234 confirmed cases of onychomycosis. The common dermoscopic patterns observed were spikes (43.16%), jagged (29.9%), longitudinal striae (49.1%), linear edge (3.4%), and distal irregular termination (34.6%). The statistically significant findings of distal and lateral subungual onychomycosis (DLSO) were longitudinal striae, spikes, and jagged patterns. The new patterns observed in our study are bluish streaks and globules (8.9%) and bluish gray globules (7.6%) in cases of DLSO which were not statistically significant. Onychoscopy, being handy, inexpensive, and noninvasive, has the potential to reduce the invasive procedures. Statistically significant patterns in DLSO and total dystrophic onychomycosis (TDO) are described in our study. Few new patterns have been described whose significance has to be tested by conducting larger sample size studies.