Clinical Suspicion Of Onychomycosis Research Articles

Epidemiologic, Clinical and Mycological Profile of Onychomycosis in the Hospital Setting in Benin.

Introduction: Onychomycosis accounts for 50% of nail disorders and remains one of the most frequent reasons for consultation in dermatology. Several factors favour the development of onychomycosis, such as age, morphological abnormalities of the nails, immunodeficiency and certain underlying pathologies. The aim was to study the epidemiological and diagnostic profile of onychomycosis in patients treated in the dermatology and venerology department of the Benin referral hospital. Patients and Methods: This was a retrospective study conducted from 2003 to 2022, covering patients treated for onychomycosis in the Dermatology-Venerology University Clinic at the National University Hospital Center Hubert Koutoukou Maga (NUHC-HKM) in Cotonou. Results: During the study period, 389 new patients were seen for onychopathy, 301 of whom had a clinical suspicion of onychomycosis. Of these, 128 were confirmed by mycological examination, giving a hospital frequency of onychomycosis of 32.90% compared with onychopathy. The mean age was 44.93 ± 12.50 years; the patients were predominantly female, with a sex ratio (M/F) of 0.41. Aesthetic complaints (76.47%) were the most frequent reason for consultation, and the nail of the hand was the most common lesion location. Melanonychia was the most frequent morphological anomaly, and distolateral subungual onychomycosis was the most frequent clinical form. Yeasts (86.92%) were the most isolated group of fungi, followed, respectively, by moulds (08.44%) and dermatophytes (04.64%). Candida albicans (21.52%) was the most common species. Conclusion: Onychomycosis is relatively uncommon in hospitals in Benin. This is underestimated because most patients with a clinical suspicion of onychomycosis do not undergo a mycological examination before being put on antifungal treatment.

Identification of Dermatophyte and Non-Dermatophyte Agents in Onychomycosis by PCR and DNA Sequencing-A Retrospective Comparison of Diagnostic Tools.

Rapid and reliable fungal identification is crucial to delineate infectious diseases, and to establish appropriate treatment for onychomycosis. Compared to conventional diagnostic methods, molecular techniques are faster and feature higher accuracy in fungal identification. However, in current clinical practice, molecular mycology is not widely available, and its practical applicability is still under discussion. This study summarizes the results of 16,094 consecutive nail specimens with clinical suspicion of onychomycosis. We performed PCR/sequencing on all primary nail specimens for which conventional mycological diagnostics remained inconclusive. In specimens with a positive direct microscopy but negative or contaminated culture, molecular mycology proved superior and specified a fungal agent in 65% (587/898). In 75% (443/587), the identified pathogen was a dermatophyte. Positive cultures for dermatophytes, yeasts and non-dermatophyte molds (NDMs) were concordant with primary-specimen-DNA PCR/sequencing in 83% (10/12), 34% (22/65) and 45% (76/169), respectively. Among NDMs, agreement was high for Fusarium spp. (32/40; 80%), but low for Penicillium spp. (5/25; 20%) and Alternaria spp. (1/20; 5%). This study underlines the improvement in diagnostic yield by fungal primary-specimen-DNA PCR/sequencing in the event of a negative or contaminated culture, as well as its significance for the diagnosis of dermatophyte and non-dermatophyte onychomycosis. Molecular mycology methods like PCR and DNA sequencing should complement conventional diagnostics in cases of equivocal findings, suspected NDM onychomycosis or treatment-resistant nail pathologies.

Use of real time multiplex PCR for the diagnosis of dermatophytes onychomycosis in patients with empirical antifungal treatments

BackgroundOnychomycosis is a nail fungal infection mainly caused by dermatophytes. Diagnostic confirmation is conventionally made by direct microscopy and culture, which suffer from low or moderate sensitivity. Several molecular methods have been used for dermatophytes detection and identification directly from nail samples. The aim of this study was the evaluation of the DermaGenius®(DG) multiplex kit in detecting and identifying dermatophytes from nail samples of untreated and treated patients with a clinical suspicion of onychomycosis. MethodsAll the patients underwent a nail scarification, performed with a sterile scalpel to collect small nail fragments from the suspected site of infection. All nail clippings were first analysed by microscopic and culture methods to define a diagnostic confirmation. DG PCR assays were retrospectively applied to the same samples. ResultsA total of 109 toenails were collected for the microscopic, culture and DG PCR assays. The sensitivity, specificity, positive and negative predictive values of DG in the onychomycosis diagnosis in all 109 patients were respectively 78.5%, 100%, 100%, and 75.9%. Only for cultural exams the rate of positive results was significantly different in the two groups of patients with a percentage of 73.7% in untreated patients versus a 40.7% value in treated patients (P < 0.05). ConclusionsOur results suggest that the use of DG kit could be useful to confirm the diagnosis of onychomycosis, implementing sensitivity especially in patients who underwent antifungal treatments without any clinical improvement.

Efficacy of periodic acid–Schiff stain in the diagnosis of onychomycosis – A cross-sectional study

Background: Onychomycosis is the fungal infection of the nail which needs to be differentiated from other causes of dystrophic nails due to its long-term treatment. Direct microscopic examination with potassium hydroxide (KOH) mount along with fungal culture shows inconsistent sensitivity. Thus, there is a need of more accurate and efficient method to detect onychomycosis. Aims and Objectives: This study aims to compare periodic acid–Schiff (PAS) stain with KOH and nail fungal culture in the diagnosis of onychomycosis. Materials and Methods: This was a cross-sectional study conducted in the dermatology outpatient department of a tertiary care center in South India from July 2019 to July 2021. A total of 93 patients with clinical suspicion of onychomycosis were included in the study and evaluated for the following three methods: KOH mount, nail fungal culture, and PAS stain. Results: Of the 93 patients, PAS was positive in 82 (88%) cases, KOH mount was positive in 32 (34%) cases, and nail fungal culture showed positive results in 49 (53.2%) patients. The percentage of positivity of combined PAS and culture was 89 (95.7%) and combined KOH and culture was 63 (65.7%). The culture yielded growth in 49 patients showing dermatophytes in 2, yeasts in 35, and nondermatophyte molds (NDMs) in 12 specimens The most common isolated species was Candida tropicalis found in 11 (22.4%) followed by Candida species in 8 (16.3%), Candida albicans in 7 (14.2%), and Trichosporon species in 6 (12.2%) specimens. Among the NDMs, Fusarium oxysporum was the most isolated found in 5 (10.2%). Conclusion: The importance of this study is to highlight the utility of PAS stain in the diagnosis of onychomycosis which otherwise may be missed with KOH and culture. PAS can be performed as an additional test to KOH mount and nail fungal culture to close the diagnostic gap.

Fungal bioaerosol as an occupational hazard in the podiatrist’s workplace

ABSTRACT Previous studies have reported the potential emission of nail dust to the indoor air of the podiatrist’s workplace during nail drilling procedures. The main objective of this study was to analyse the fungal bioaerosol present in the indoor air of podiatry rooms, including during the nail drilling procedure. Seventeen private clinics were sampled in Madrid during spring and summer. The most prevalent filamentous fungi detected were Cladosporium spp. and Penicillium spp. in both seasons. The presence of Trichophyton rubrum and Trichophyton interdigitale was reported in samples during the drilling procedures, establishing a positive association with the clinical suspicion of onychomycosis (p = 0.002) and the utilization of aspiration systems (p=0.04). The present study concludes that airborne fungal concentrations in podiatrist’s clinics are consistent with national and international guidance. Occupational exposure to dermatophytes may briefly occur during definite periods across the daily activity despite the use of dust aspiration systems.

Patrones dermatoscópicos en pacientes con diagnóstico clínico de onicomicosis y examen micológico directo positivo

IntroductionOnychomycosis is one of the most common nail disorders, representing almost 50% of them. The sensitivity and specificity of direct examination and mycological culture for diagnosis can be as low as 15%. The objective of this study was to describe dermatoscopic patterns in cases of onychomycosis confirmed by direct examination and to correlate them with the type of causal fungal agent and the clinical subtype of onychomycosis. Material and methodA prospective observational and descriptive cross-sectional study of 45 patients with clinical suspicion of onychomycosis was conducted. All patients underwent clinical examination, dermatoscopy with HEINE mini 3000 dermatoscopy, direct mycological examination with KOH and culture analysis. The most frequent dermatoscopic patterns were identified and their correlation with the type of causal fungal agent and the clinical subtype of onychomycosis were analyzed. Results40 patients with clinical suspicion of onychomycosis and positive direct mycological examination were included. 22 (55%) patients had lateral distal subungual onychomycosis, 12 (30%) total dystrophic onychomycosis, and 6 (15%) superficial white onychomycosis. The dermatoscopic patterns of onychomycosis found were: focal macular in 6 (15%) cases, longitudinal striations in 12 (30%), jagged edge with spikes in 11 (27.5%) and distal irregular termination in 11 (27.5%) patients. Focal macular pattern was associated with lateral distal subungual onychomycosis (p = 0.002) and dermatophyte non mycelial fungus (p = 0.0001), the presence of longitudinal striations was associated with lateral distal subungual onychomycosis (p = 0.005) and dermatophyte fungus (p = 0.0001), jagged edge with spikes was associated with lateral distal subungual onychomycosis (p = 0.005) and dermatophyte fungus (p = 0.0001), finally distal irregular termination pattern was associated with total dystrophic onychomycosis (p = 0.0001), dermatophyte fungi (p = 0.0001) and yeasts (p = 0.004). ConclusionDermoscopy is a simple and fast technique that can provide immediate information to guide the diagnosis of onychomycosis.

A descriptive study of onychoscopic features in various subtypes of onychomycosis

BackgroundThe diagnosis of onychomycosis is usually clinical and is confirmed by 40% KOH examination. A diagnostic dilemma occurs when KOH examination is negative despite strong clinical suspicion. Dermoscopic evaluation of the nail is referred to as onychoscopy. We attempted to assess the dermoscopic findings in Onychomycosis positive with KOH examination. MethodsA cross sectional study was conducted in a tertiary care center including 122 patients with clinical suspicion of onychomycosis with KOH positivity. After assessment of risk factors and gross nail examination, onychoscopic examination was done to identify the presence of the specific features. ResultsPrimary findings of onychoscopic examination were 'spiked pattern' in 80.3% subjects, of which 95 were distal lateral subungual onychomycosis (DLSO), 8 of total dystrophic onychomycosis (TDO). True leukonychia was seen in the single patient of proximal subungual onychomycosis (PSO) and pseudoleukonychia in the single patient of white superficial onychomycosis (WSO). Distal irregular termination was observed in 23% of subjects – 8 from DLSO and in all 20 patients of TDO. 'Ruin appearance' was observed in all 20 patients of TDO, 56 patients with DLSO and not seen in other types of onychomycosis (OM). Presence of spiked pattern, Longitudinal striae, Distal irregular termination and Ruin appearance were found to be statistically significant (p < 0.001). ConclusionIn suspected onychomycosis, specific onychoscopic findings such as Spiked pattern, Longitudinal striae, Ruin appearance and Distal irregular termination can be used as supporting evidence for diagnosing onychomycosis clinically and initiating antifungal therapy if mycological testing is unavailable or negative.

Clinical, Dermoscopic, and Mycological Association in Onychomycosis in a Tertiary Care Hospital

Background: Onychomycosis (OM) refers to fungal infection of the nail unit. It is one of the most common nail disorders, accounting for 50% of all nail disorders and about 30% of all cutaneous fungal infections. OM is mostly diagnosed clinically, but Dermoscopic (DS) examination aids in diagnosis. Objectives: The purpose of the study is to study the association between clinical, dermoscopic, and mycological patterns of OM. Materials and Methods: A total of 200 patients with clinical suspicion of OM were included in the study. All patients underwent clinical examination, dermoscopic examination with a handheld dermoscope Dermlite II pro (3 Gen, San Juan, Capistrano, CA, USA) with a ×10 magnification, KOH assessment, and culture analysis. The most frequent dermoscopic patterns were identified and their associations with the clinical subtype of OM were analyzed. Results: Out of the 200 cases, 65 cases were male and 135 cases were female. The most common findings seen on clinical examination of nails were discoloration of nail plates (178) and onycholysis (109). Distal irregular termination (91) was the most common dermoscopic finding seen followed by spike pattern (76). A significant association was seen between dermoscopic patterns such as superficial transverse striation, spike pattern, and different types of OM (P &lt; 0.05). Eighty-two cases were positive for fungal elements by direct microscopy, 68 were positive by culture, and 18 patients showed positive result for both. The most common causative organism found on culture examination was Candida albicans (24). Conclusion: Dermoscopy is an easy-to-perform, noninvasive, and cost-effective method which aids in early diagnosis of OM.

Candidal Onychomycosis: Clinicoepidemiological Profile, Prevailing Strains, and Antifungal Susceptibility Pattern-A Study from a Tertiary Care Hospital.

Background:Despite an increasing trend of onychomycosis caused by Candida species in recent years, there is a scarcity of published data.Objective:To determine the epidemiological and clinical characteristics of Candida onychomycosis, to identify the prevalent, and perform in-vitro antifungal susceptibility testing (AFST) of the isolates.Methodology:A total of 506 consecutive patients with a clinical suspicion of onychomycosis were included in a cross-sectional clinical study. Nail scrapings and clippings were subjected to KOH examination and culture. Species identification and antifungal drug sensitivity testing were done for Candida isolates using Vitek 2YST Compact system using Vitek 2 cards.Results:Out of 384 (75.88%) culture-positive cases, dermatophytes were isolated in 58.08%, yeast in 26.30%, and NDM in 12.24%. Of the yeast, Candida albicans was isolated in 59.4% and non-albicans species in 40.59%. AFST showed that most of Candida species exhibited 100% susceptibility to most of the antifungal drugs tested, while intermediate resistance to fluconazole and flucytosine was seen in some non-albicans species (C. krusei, C. glabrata, and C. guilliermondii). Time taken for species identification was 14–18 h (average 15.5 h), while determination of minimum inhibitory concentration took 9–27 h (average 13 h).Conclusions:Our study showcases the present scenario of Candida distribution and the resistance patterns of various species afflicting the nail unit. Furthermore, our findings clearly indicate that the carriage of this pathogenic yeast is seen in both healthy individuals as well as with immunosuppression.

Antifungal Susceptibility Pattern of Non - Dermatophytic Fungi Causing Onychomycosis

Introduction: Non-dermatophytic molds (NDM) are filamentous fungi or yeast, commonly found in nature as saprophytes and plant pathogens. The incidence of onychomycosis due to NDM is 1.45 – 16.6%. NDMs are usually resistant to conventional antifungal treatment.&#x0D; Objective: To know the anti-fungal susceptibility pattern of non-dermatophyte fungi causing onychomycosis. &#x0D; Materials and Methods: A prospective hospital based cross-sectional study was done on non - dermatophytic isolates from patients with clinical suspicion of onychomycosis. All non – dermatophytic isolates were subjected to anti-fungal susceptibility against terbinafine, itraconazole, fluconazole and griseofulvin by micro broth dilution method. &#x0D; Results: NDM were isolated in 20.2% cases of clinically suspected onychomycosis, among which Fusarium species was the most common followed by Aspergillus species and Candida species. MIC50 (Mean Inhibitory Concentration) for overall non - dermatophytic isolates for terbinafine, itraconazole, fluconazole and griseofulvin was 0.25μg/mL, 0.5μg/mL, 32μg/mL and 2μg/mL respectively and the order of sensitivity was Itraconazole (74.7%) &gt; terbinafine (68%) &gt; Fluconazole (60%) &gt; Griseofulvin (51.6%) of the study samples. For Fusarium species, the sensitivity for terbinafine was (73.5%) &gt; itraconazole (67.6%) &gt; fluconazole (64.7%) and griseofulvin (64.7%). For Aspergillus species, the sensitivity for itraconazole was 79.1% &gt; fluconazole (58.3%) &gt; terbinafine (54.1%) &gt; griseofulvin (50%). For Candida species, the sensitivity was fluconazole (83.3%) &gt; itraconazole (75%) &gt; terbinafine (41.6%), while no candida species was found sensitive to griseofulvin. &#x0D; Conclusion: Non-dermatophytes play a significant role in onychomycosis. On in vitro estimation, Itraconazole was the most sensitive drug, followed by terbinafine, fluconazole and griseofulvin.

Onychoscopy: an observational study in 237 patients from the Kashmir Valley of North India.

BackgroundNail disorders comprise approximately 10% of all dermatological conditions. Because diagnosis is not always possible by clinical means alone, additional diagnostic procedures may be required at times. Dermoscopy of nails (onychoscopy) has shown promising results in diagnosing various nail disorders and also avoids time-consuming investigations such as culture and biopsy.ObjectiveTo study the dermoscopic features of various nail disorders to determine the correlation between KOH examination and onychoscopic patterns in patients with the clinical suspicion of onychomycosis, and to differentiate benign pigmented lesions from malignant ones.MethodsAn open, observational and cross-sectional study of 237 patients was conducted. All patients underwent clinical examination and the affected nails were examined with a dermatoscope. The onychoscopic patterns were identified and recorded.ResultsThe study included 237 patients with the following diagnoses: 81 onychomycosis, 63 psoriasis, 27 lichen planus, 30 longitudinal melanonychia, 24 connective tissue disorders, 5 onychophagia and nail tics, 3 subungual verrucae, 2 glomus tumor, 1 Darier disease, and 1 enchondroma. The most common onychoscopic findings were spiked pattern in cases of onychomycosis, dilated and tortuous capillaries in cases of psoriasis, longitudinal streaks and nail fragmentation in cases of lichen planus, and enlarged capillaries in cases of connective tissue diseases.LimitationsThe study was only observational and did not compare the results to biopsy and culture.ConclusionsOnychoscopy may be used as an important diagnostic tool when evaluating nail disorders. It should be used to aid in the diagnosis of various nail disorders and to avoid unnecessary and time-consuming investigations.

Onychoscopy: an observational study in 237 patients from the Kashmir Valley of North India

Background: Nail disorders comprise approximately 10% of all dermatological conditions. Because diagnosis is not always possible by clinical means alone, additional diagnostic procedures may be required at times. Dermoscopy of nails (onychoscopy) has shown promising results in diagnosing various nail disorders and also avoids time-consuming investigations such as culture and biopsy. Objective: To study the dermoscopic features of various nail disorders to determine the correlation between KOH examination and onychoscopic patterns in patients with the clinical suspicion of onychomycosis, and to differentiate benign pigmented lesions from malignant ones. Methods: An open, observational and cross-sectional study of 237 patients was conducted. All patients underwent clinical examination and the affected nails were examined with a dermatoscope. The onychoscopic patterns were identified and recorded. Results: The study included 237 patients with the following diagnoses: 81 onychomycosis, 63 psoriasis, 27 lichen planus, 30 longitudinal melanonychia, 24 connective tissue disorders, 5 onychophagia and nail tics, 3 subungual verrucae, 2 glomus tumor, 1 Darier disease, and 1 enchondroma. The most common onychoscopic findings were spiked pattern in cases of onychomycosis, dilated and tortuous capillaries in cases of psoriasis, longitudinal streaks and nail fragmentation in cases of lichen planus, and enlarged capillaries in cases of connective tissue diseases. Limitations: The study was only observational and did not compare the results to biopsy and culture. Conclusions: Onychoscopy may be used as an important diagnostic tool when evaluating nail disorders.

Onicomicosis: comparación de tres métodos diagnósticos en pacientes del Archipiélago Juan Fernández

BackgroundOnychomycosis is a prevalent disease in the general population. There are currently 2 methods recommended for its clinical and laboratory diagnosis, direct microscopy (with potassium hydroxide KOH) and mycology culture. However, both test have notable deficiencies that call into question its clinical efficacy. Direct microscopy has a low sensitivity and is operator dependent, while the mycology culture is very sensitive and requires an incubation period of 35 days. Consequently, numerous techniques have been employed to overcome the diagnostic difficulties in onychomycosis. These include the histological study of the nail plate with PAS staining. This has shown good diagnostic indices, with reports of positivity of 33 to 92%, with a mean of 48%. ObjectiveTo determine and compare the sensitivity and negative predictive value of three diagnostic methods for onychomycosis: Direct mycological with potassium hydroxide, mycological culture, and biopsy of nail plate with PAS staining in patients with clinical suspicion of onychomycosis in residents of the Juan Fernández Archipelago. Materials and methodsA cross-sectional study was conducted with a sample size of 55 patients living in the Juan Fernandez Archipelago. Specimens of nail tissue were taken for the direct mycological study, mycological culture, and histological study with PAS staining. Calculation and comparison of sensitivity and NPV for the three diagnostic methods was performed. ResultsA total of 39 (70.9%) patients showed positive in at least one of the three practiced methods used, which was considered positive for onychomycosis (gold standard). By comparing each test in isolation, the best sensitivity was direct microscopy with 83%, followed by PAS (80.9%), and finally culture (46.8%). The highest sensitivity (97.9%) was detected in the combination of direct microscopy with potassium hydroxide and with histology PAS staining. The negative predictive value was 50% for direct microscopy, 47.1% for PAS, and 24.2% for the culture. ConclusionsThe high sensitivity demonstrated and high negative predictive value shown in the histopathological PAS technique can be considered a simple and rapid alternative method for the diagnosis of onychomycosis.

Epidemiology of onychomycosis in Crete, Greece: a 12-year study.

Onychomycosis is a chronic fungal nail infection caused by dermatophytes, yeasts or non-dermatophyte moulds (NDMs). It occurs worldwide and accounts for about 50% of all nail disorders. The incidence of the disease and the prevalence of pathogens involved vary in different geographical areas and change with time. This study was undertaken to determine the epidemiology of onychomycosis in Crete, Greece during a 12-year period. Mycologic nail investigation (direct microscopy and cultures) was performed in samples taken from 3317 patients with clinical suspicion of onychomycosis. Demographic characteristics, comorbidities and concurrent superficial fungal infections at other body sites were also recorded. Onychomycosis was mycologically confirmed in 547 (16.5%) patients. Fingernail onychomycosis was found in 274 (50.1%) patients, toenail onychomycosis in 271 (49.5%), and both toenail and fingernail onychomycosis in two (0.4%). Yeasts were the major causative agents, followed by dermatophytes and NDMs. Candida albicans was the most commonly isolated yeast species and Trichophyton rubrum the most common dermatophyte. Concomitant fungal skin infections were noted in 53 (19.6%) patients with toenail onychomycosis. Factors predisposing to onychomycosis were trauma, diabetes, psoriasis, peripheral circulatory insufficiency and immunosuppression. Mycological investigations are necessary to confirm clinical diagnosis and identify the pathogen, in order to select the most appropriate treatment.

Clinico-mycological study of onychomycosis in children from a tertiary care center

Introduction: Onychomycosis is rare in children as compared to adults and hence the presence of any nail changes in children needs careful examination and carrying out proper diagnostic tests to cure this treatable cause of dystrophic nails. Aim: The study was undertaken to study in detail the clinico-mycological aspects of onychomycosis in children. Materials and Methods: A prospective hospital-based cross-sectional study was done on ninety children with a strong clinical suspicion of onychomycosis during a period of 2 years. All the children were subjected to three diagnostic tests, namely direct microscopy, fungal culture, and histopathological examination using periodic acid Schiff staining (HPE-PAS). Results: Distal and lateral subungual onychomycosis is the most common type (82%), and toe nails (57.78%) are more commonly involved than fingernails. Direct microscopy yielded results in 62%, culture in 64%, and HPE-PAS in 71.1%. Dermatophytes were the most common group of organisms isolated (58%) with Trichophytonmentagrophytes as the most common isolate (31%). However, nondermatophytic molds and Candida species also accounted for 25% and 17% of the culture positive cases in children. Conclusion: As children <18 years constitute one-third of our population, we suggest the need for careful evaluation of onychomycosis in this subgroup.

Dermoscopic patterns in patients with a clinical diagnosis of onychomycosis-results of a prospective study including data of potassium hydroxide (KOH) and culture examination.

Background:Onychomycosis is the most common nail disease, representing 50% of cases affecting the nail apparatus. The diagnosis is made by clinical examination along with the KOH exam of the nail and culture of the sample. However, not all dermatologists have access to a mycology lab.Objective:To determine the correlation between KOH examination and dermoscopic patterns in patients with clinical diagnosis of onychomycosis.Patients/Methods:A descriptive, open, observational, prospective, cross-sectional study of 178 patients with clinical suspicion of onychomycosis was conducted. All patients underwent clinical examination, dermoscopy with a DermLite PHOTO dermatoscope (3Gen, San Juan Capistrano, CA, USA), KOH assessment and culture analysis. The most frequent dermoscopic patterns were identified and their correlation with the clinical subtype of onychomycosis was analyzed.Results:The study included 178 patients with clinical suspicion of onychomycosis. Of these, 155 (87.1%) had positive direct KOH examination for onychomycosis. Eighty-seven patients (56.13%) presented with clinical onychomycosis pattern of total dystrophic onychomycosis (TDO), 67 (43.23%) with distal lateral subungual onychomycosis (DLSO), 1 (0.65%) with trachyonychia). Dermoscopic patterns of onychomycosis showed the following frequencies: the spiked pattern was present in 22 patients (14.19%), longitudinal striae pattern in 51 patients (32.9%) and linear edge pattern in 21 patients (13.55%). We identified a pattern described as “distal irregular termination” in 41 patients with TDO and 26 with DLSO.Conclusions:This is the fist study conducted in a Mexican population that uses dermoscopy as a diagnostic tool along with the KOH examination for the diagnosis of onychomycosis. Dermoscopy may be used as an important diagnostic tool when evaluating nail disease. However, it should not be used as the only diagnostic criteria for onychomycosis.

Onychomycosis in qassim region of saudi arabia: a clinicoaetiologic correlation.

Onychomycosis is mainly caused by dermatophytes, but yeasts and nondermatophyte molds have also been implicated, giving rise to diverse clinical presentations. The aetiological agents of the disease may show geographic variation. The aim of the present study was to isolate the causative pathogens and to correlate the various clinical patterns of onychomycosis with causative pathogens. The study population comprised 170 patients with clinical suspicion of onychomycosis. Nail samples were collected for direct microscopic examination and culture. Clinical patterns were noted and correlated with causative pathogens. Out of total 170 cases included in the study, 140 (82.4%) were positive by microscopy and 77 (45.3%) showed positive mycological findings by both microscopy and culture. The male: female ratio was 1:2.5 and the mean age was 35.29 ± 16.47 years. Fingernails were involved in 51.9%, toenails in 28.6% and both fingernails and toenails in 19.5% of the 77 patients. The clinical types noted were distal lateral subungual onychomycosis (71.4%), proximal subungual onychomycosis (10.4%), total dystrophic onychomycosis (10.4%), superficial white onychomycosis (3.9%) and mixed pattern onychomycosis (3.9%). Yeasts were the most common pathogens isolated, being found in 36 patients (46.8%) followed by nondermatophyte molds which were isolated from 28 patients (36.4%) followed by dermatophytes which were isolated from 13 patients (16.9%). Distal lateral subungual onychomycosis was the most common clinical presentation. Candida albicans, Aspergillus species and Tricophyton rubrum were the major pathogens. A single pathogen can give rise to more than one clinical type.

Identification of fungi species in the onychomycosis of institutionalized elderly

BACKGROUND Superficial fungal infections are caused by dermatophytes, yeasts or filamentous fungi. They are correlated to the etiologic agent, the level of integrity of the host immune response, the site of the lesion and also the injured tissue. OBJECTIVE The purpose of this study is to isolate and to identify onychomycosis agents in institutionalized elderly (60 years old +). METHODS The identification of the fungi relied upon the combined results of mycological examination, culture isolation and micro cultures observation under light microscopy from nail and interdigital scales, which were collected from 35 elderly with a clinical suspicion of onychomycosis and a control group (9 elderly with healthy interdigital space and nails). Both groups were institutionalized in two nursing homes in Sao Bernardo do Campo, SP, Brazil. RESULTS The nail scrapings showed 51.40% positivity. Of these, dermatophytes were found in 44.40% isolates, 27.78% identified as Trichophyton rubrum and 5.56% each as Trichophyton tonsurans, Trichophyton mentagrophytes and Microsporum gypseum. The second more conspicuous group showed 38.89% yeasts: 16.67% Candida guilliermondii, 11.11% Candida parapsilosis, 5.56% Candida glabrata, and 5.56% Trichosporon asahii. A third group displayed 16.70% filamentous fungi, like Fusarium sp, Aspergillus sp and Neoscytalidium sp (5.56% each). The interdigital scrapings presented a positivity rate of 14.29%. The agents were coincident with the fungi that caused the onychomycosis. In the control group, Candida guilliermondii was found at interdigital space in one person. CONCLUSION Employing a combination of those identification methods, we found no difference between the etiology of the institutionalized elderly onychomycosis from that reported in the literature for the general population.

Avaliação dos métodos diagnósticos para onicomicose

FUNDAMENTOS: As onicomicoses são infecções fúngicas responsáveis por 15 a 40% das doenças ungueais. Apesar do pleno conhecimento de seus agentes etiológicos e do surgimento de inúmeros medicamentos antifúngicos, mantêm-se as dificuldades para se estabelecer diagnóstico correto. OBJETIVOS: Comparar o exame micológico direto, o histopatológico e a cultura dos pacientes com suspeita de onicomicose e verificar a sensibilidade e especificidade de cada método. MÉTODO: Foram selecionados 40 pacientes com suspeita clínica de onicomicose e avaliados os três métodos diagnósticos. Calculou-se para cada exame: sensibilidade, especificidade e valores preditivos, positivo e negativo. RESULTADOS: O exame micológico direto foi positivo em 29 pacientes (72,5%), o histopatológico em 14 (35%), a cultura em 22 (55%). As especificidades foram: exame micológico direto 78,6%, histopatológico 92,9% e cultura 100%. As especificidades não apresentaram diferença significativa (p &gt; 0,05). Na análise dos valores preditivos positivo e negativo, a cultura e o exame micológico direto obtiveram maior eficácia, respectivamente. CONCLUSÕES: O exame micológico direto foi o mais confiável para seu resultado negativo. A cultura mostrou-se específica quando positiva. Quanto à biópsia, não se mostrou sensível e apresentou especificidade equivalente à dos outros exames.

Onicomicoses por fungos emergentes: análise clínica, diagnóstico laboratorial e revisão

FUNDAMENTOS: As dermatomicoses causadas por fungos emergentes são entidades clínicas raras, à exceção das onicomicoses. Como certos fungos e leveduras podem residir na pele, a positividade em culturas de escamas ungueais deve ser interpretada obrigatoriamente em concordância com os respectivos dados clínicos, exames diretos das amostras, quantificação das colônias isoladas em relação aos pontos de inoculação e, principalmente, deve a positividade ser mantida após a repetição dos cultivos. A invasão da unha por fungos não dermatofíticos (nondermatophytic molds, NDM) em diferentes estudos varia de 1,45% a 17,6%. OBJETIVOS: Os objetivos do trabalho são mostrar a ocorrência e realçar a importância dos fungos emergentes como causadores de onicomicose. MÉTODOS: As unhas dos pacientes atendidos nos consultórios dos dermatologistas foram examinadas, e, caso houvesse suspeita clínica de onicomicose, coletavam-se amostras que eram enviadas para exame micológico no laboratório. RESULTADOS: Neste estudo, foram avaliados 2.271 pacientes e diagnosticada onicomicose em 400 deles, sendo 264 com acometimento das unhas do pé, e 136 das unhas da mão. O agente etiológico foi confirmado pelo exame micológico direto e crescimento em cultura. A onicomicose por fungos emergentes representou 4,5% de todas as infecções de unha. Foram detectadas as leveduras do gênero Candida (49%) como agentes etiológicos mais freqüentes de onicomicoses nas unhas das mãos e em mulheres. Em contraste, os dermatófitos foram os mais freqüentes de todas as onicomicoses dos pés, no total de 186 (46,5%). CONCLUSÃO: Ao contrário da rotina diagnóstica hoje utilizada, concluiu-se que o diagnóstico correto do agente etiológico da onicomicose não dermatofítica deve obedecer a determinados critérios, dos quais se destaca o conjunto formado pela positividade no exame direto, na cultura, com comprovação na repetição do exame.