Onychomycosis Research Articles

Whole-genome resequencing of Trichophyton rubrum provides insights into population differentiation and drug resistance.

Trichophyton rubrum (T. rubrum) is anthropophilic fungus and thus a very common cause of dermatophyte infections around the world. Infection of T. rubrum could result in conditions such as tinea capitis, tinea corporis, tinea inguinalis, tinea manus, tinea unguium, or tinea pedis. Because of this, the resistance of T. rubrum to antifungal therapies has drawn extensive research interest. However, the pathogenic characteristics of T. rubrum, such as site of infections, geographic location and host groups, have yet to be explored. In this study, the whole genome of 48 strains from different regions is resequenced and the population structure and association of single nucleotide polymorphism with resistance to six widely used antifungal drugs are analyzed. A total of 23,394 genomic variations are detected, which cover 2165 genes with only 15.14% of the variations located in exons. The population structure of T. rubrum is monomorphic, and genetic diversity is very low. Population structure analysis shows that the 48 sampled strains can be divided into two sub-populations. The gene TERG_08771 harboring the highest SNPs density is found to be associated with resistance to voriconazole. Although many proteins have yet to be identified and explored, association studies could still be useful to identify drug resistance or drug-susceptible loci, which would warrant further insightful investigations.

Internal environment of footwear is a risk factor for tinea pedis.

The relation between tinea pedis and the internal environment of footwear has not been scientifically proven. This study aimed to determine whether the internal environment of footwear affects the incidence of tinea pedis and tinea unguium. This cross‐sectional, observatory study involved 420 outpatients who were categorized into non‐tinea, tinea pedis or tinea unguium groups based on mycological analysis. External climatic conditions, and temperature, humidity and dew points inside the patients’ footwear were recorded. Univariate and multivariate analyses were used to determine independent risk factors for tinea pedis and tinea unguium. A significant correlation was found between high temperature/high humidity and dew point of the internal environment of the footwear and the season. Furthermore, those who wore footwear with internal environments characterized by high temperature, high humidity, high‐temperature/high‐humidity and high dew point values had a significantly higher incidence of tinea pedis. The internal dew point correlated with the incidence of tinea pedis, whereas the external temperature correlated with the incidence of tinea unguium. The internal humidity and dew point of footwear as well as the frequency with which footwear with a high‐temperature/high‐humidity internal environment were worn was significantly higher in men than in women. In conclusion, the internal environment of footwear is a risk factor for tinea pedis, and this environment is affected by the season. Moreover, the frequency of tinea pedis among men is related to the internal environment of footwear. The dew point is an appropriate index for evaluating temperature and humidity in relation to tinea pedis.

Onychomycosis in athletes

Onychomycosis in athletes

Safety and Efficacy of Next Science Gel on Toenail Fungus

Safety and Efficacy of Next Science Gel on Toenail Fungus

Superficial candidosis by Candida duobushaemulonii: An emerging microorganism

The Candida haemulonii species complex and other phylogenetically related species, such as Candida auris, are emerging pathogens. The C. haemulonii complex comprises C. haemulonii, C. haemulonii var. vulnera, and Candida duobushaemulonii species. The correct identification of this fungal complex is clinically and epidemiologically relevant; however, conventional identification methods are currently inadequate. In this study, we report the molecular reidentification of two clinical isolates: isolate 553 that was recovered from a patient with total dystrophic onychomycosis and isolate 77–18 from a patient with mucocutaneous candidiasis. Both patients had diabetes mellitus as baseline disease. These isolates were initially identified as C. haemulonii by the VITEK® 2 system but were later determined to be C. duobushaemulonii based on the amplification and sequencing of a 115-bp fragment of the region of 26S rDNA. The isolates were resistant to fluconazole, and only isolate 553 was resistant to amphotericin B. Patients showed clinical and mycological cure after treatment with itraconazole. The clinical and microbiological data of these two cases of superficial candidiasis caused by C. duobushaemulonii, along with previous reports about infections with the C. haemulonii complex species, suggest that patients with diabetes mellitus are highly susceptible to infection with these fungi. Therefore, for diagnosing candidiasis in patients with diabetes mellitus, yeasts must be identified at the species level, and antifungal susceptibility testing must be carried out for adequate treatment.

Epidemiology of dermatophytosis in northeastern Iran; A subtropical region.

Background and Purpose:Dermatophytes as the causative agents of dermatophytosis (ringworm) are widely spread around the world. Accurate identification of dermatophytes in one area can be particularly important for epidemiological studies. Regarding this, the aim of the present study was to describe the species spectrum of dermatophytes, isolated from patients in Mashhad city, Iran, using the molecular-based method.Materials and Methods:This study was conducted on 79 dermatophyte isolates obtained from the human skin, hair, and nail specimens. Species identification was performed by the polymerase chain reaction-restriction fragment length polymorphism analysis of ribosomal DNA internal transcribed spacer regions using MvaI restriction enzyme.Results:The identified species included Trichophyton mentagrophytes/T. interdigitale species complex (n=37, 46.8%), Epidermophyton floccosum (n=12, 15.2%), T. rubrum (n=8, 10.1%), Microsporum canis (n=8, 10.1%), T. violaceum (n=5, 6.3%), T. tonsurans (n=4, 5.1%), Nannizzia gypsea (n=3, 3.8%), T. benhamiae (n=1, 1.3%), and T. verrucosum (n=1, 1.3%). The clinical forms of infection were tinea corporis (n=26, 32.8%), tinea cruris (n=22, 27.8%), tinea capitis (n=10, 12.6%), tinea unguium (n=7, 9%), tinea manuum (n=6, 8%), tinea pedis (n=5, 6.3%), and tinea faciei (n=3, 3.5%).Conclusion:As the findings indicated, T. mentagrophytes/T. interdigitale species complex had the highest prevalence, and T. benhamiae appeared to be a new emerging agent of dermatophytosis in Mashhad, northeastern Iran.

Onychomycosis: modern possibilities of topical therapy

Onychomycosis (OM) is an infectious fungal lesion of the nail plate, nail bed, matrix. It is characterized by extreme prevalence, long, recurrent course, torpidity to existing methods of treatment.Objectave — to increase the effectiveness of treatment of patients with onychomycosis by using the topical complex drug Onychocid® Emtrix as monotherapy.Materials and methods. There were 27 patients with OM under our observation. The age of the patients ranged from 27 to 77 years, there were 11 men (40.7 %) and 16 women (59.3 %), the period of the disease varied from 1 to 35 years. Treatment of patients with OM was administered as a monotherapy with Onychocid® Emtrix topical complex agent. The drug was applied on the nail plates and under the tips of the affected nails 1 time per day in the evening before bedtime. The duration of treatment depended on the prevalence and severity of the clinical course of OM and ranged from 3 to 6 months.Results and discussion. The patients showed different clinical forms of onychomycosis: distal-­lateral, white surface and total­-dystrophic. Clinical effect of complete or partial restoration of the nail plate was observed in 83.3 % of patients with distally-­lateral and white surface and in 60 % of patients with total­-dystrophic type of defeat of nail plates. Negative results of the mycological study at the end of the course of treatment were fixed in 85.2 % of patients. No adverse reactions were observed during treatment.Conclusions. Treatment of patients with OM using the modern topical complex drug Onychocid® Emtrix is an effective and safe method of therapy. Onychocid® Emtrix is effective in treatment of superficial white and distal-­lateral forms of OM. The use of Onychocid® Emtrix can be recommended as a monotherapy for patients with OM with concomitant pathology, for whom antifungal therapy is contraindicated.

Epidemiology of dermatophytic infections between 2008 and 2017 in Barcelona, Spain

ObjectiveThe aim of this study was to evaluate the epidemiological profile of dermatophytoses from 2008 to 2017 in the area of “Barcelonès Nord”, located in north-eastern Spain. MethodsFrom 2008 to 2017, 13,419 specimens obtained from patients with suspected superficial mycosis were subjected to direct microscopy and culture. Clinical and sociodemographic data were recorded. Proportions were compared using Chi-square and Fisher's exact tests. A logistic regression model was used for multivariate analysis. ResultsTrichophyton rubrum was the most frequently isolated fungus (76.1%), followed by Trichophyton mentagrophytes/Trichophyton interdigitale (11.9%) and Microsporum canis (2.9%). Among the population over 15 years of age, tinea unguium pedum (40.4%) and tinea corporis (29.1%) were the predominant dermatophyte infections. Tinea capitis was mostly prevalent (53.6%) among patients up to 15 years of age, followed by tinea corporis (21.4%). We observed an increase in non-endemic anthropophilic dermatophytes (Trichophyton soudanense, Microsporum audouinii and Trichophyton violaceum) in the last few years. These species were associated with the population up to 15 years of age (p<0.001), having tinea capitis (p=0.0017) and being of African/Hindustani origin (p<0.001). ConclusionsWe confirmed the spread of T. rubrum as the predominant dermatophyte in our area and reported an increase in non-endemic anthropophilic dermatophytes in the last few years, especially in the African and Hindustani population up to 15 years of age.

Onicomicosis en pacientes con infección por el VIH y su relación con la cifra de linfocitos CD4

ObjectiveTo determine the clinical, aetiological and epidemiological features of onychomycosis in human immunodeficiency virus infected patients, and its relationship with the CD4 lymphocyte count. Materials and methodsDescriptive and prospective study in human immunodeficiency virus infected patients who attended the Hospital Regional Docente de Trujillo, a regional referral centre of the north of Peru. Pearson chi-squared and likelihood ratios were used to correlate clinical features, severity, the aetiological agent and CD4 count. ResultsThe study included a total of 51 patients, the large majority (86.3%) of them male, and with a mean age of 35 years-old. The predominant job (25.5%) was manual worker. About 74.4% stated they were non-drug users, and the most frequent sexual behaviour was heterosexual (60.8%). The onset of illness ranged from 1 to 120 months. The most common clinical presentation (60.8%) was total dystrophic onychomycosis. The most frequent (74.5%) location was the feet and 62.7% were severely compromised. The onset of human immunodeficiency virus diagnosis ranged from 1 to 96 months. Trichophyton sp. was the most found aetiological agent (52.9%). Two-thirds (66.7%) were not on antiretroviral treatment at the time of diagnosis. Viral load ranged from 80 to 1,322,930. CD4+ cell count varied between 2 and 566. A statistically significant relationship was found between clinical presentation and CD4 cell count. ConclusionThe large majority of patients were young adults, male, manual workers, non-drug users, and heterosexual. The most frequent clinical presentation was total dystrophic onychomycosis. The most commonly isolated aetiological agent was Trichophyton sp. A relationship was found between total dystrophic onychomycosis and a CD4 cell count less to 200 cell/ml.

Nail Involvement in Psoriatic Patients and Association with Onychomycosis: Results from a Cross-Sectional Study Performed in a Military Hospital in Tunisia

Nail psoriasis has variable prevalence and heterogeneous aspects. Many of them could mimic onychomycosis (OM). It has been suggested that patients with nail psoriasis are at high risk of OM. The aim of our study was to determine the epidemiological and clinical characteristics of nail psoriasis and to estimate the frequency and the factors associated with OM in psoriatic patients. The studied group included 163 patients with psoriasis aged 18 years or older. Epidemiological and clinical data, as well as the severity of skin and nails disease by evaluating the Psoriasis Area Severity Index (PASI) and Nail Area Psoriasis Severity Index (NAPSI) scores were specified. Mycological testing was performed for patients with nail alterations. Nail involvement was found in 71.2% of patients. The most common nail alterations were subungual hyperkeratosis and onycholysis. The mean NAPSI score was 11.6. Mycological testing was performed in 104 patients with onychodystrophy. OM was diagnosed in 53% of the cases. Dermatophytes were the most isolated pathogens. OM was associated with male gender, but not with age, NAPSI, or PASI score. Psoriasis is one of the dermatoses that most commonly affect the nail. Available data about the association between nail psoriasis and OM are controversial. However, mycological testing should be routinely performed on psoriatic nails.

New Remedy to Control Human Skin Fungal Infections by Silver Nanoparticles Biosynthesized by Two Marine Macro Algae.

FROM Dermatology Department of Tanta University Hospitals during 2016, it was observed that cutaneous fungal infections were more common in patients dealing with indoor closed pipe networks as a water source (recorded in 73 cases), sewage disposal by outdoor conservancy (68 cases), of 2-20 years old (38 cases) and house wives (23 cases). The most common fungal isolates among the studied cutaneous infections were Microsporum canis (21 cases), Malassezia furfur (16 cases), Trichophyton rubrum (11 cases), Candida albicans (9 cases), Epidermophyton floccosum (8 cases) and Candida tropicalis (7 cases); that caused Tinea capitis (29 cases), Tinea unguium (23 cases), Tinea versicolor (16 cases) and Tinea corporis (13 cases). The present study reported an eco-friendly biosynthesis of stable silver nano-particles (AgNPs) by two selected marine algal extracts; which gave a great antifungal activity against the most commonly isolated fungi; that was confirmed by their low MIC values, namely MIC for AgNPs of Corallina mediterranea was 0.25mg/ml against Epidermophyton floccosum, while MIC for AgNPs of C. officinalis was 0.5mg/ml against Candida tropicalis and further elucidated by their destructive effects, as observable thinning of cell wall (as low as 89.1nm in C. tropicalis and 54.9nm in E. floccosum), agglutination of cellular proteins, rupture of cell membrane and leakage of intracellular components, revealed through TEM examinations.

Contemplate of Nail Fungus Infection Among Different Scholars of University

Muhammad Imran Qadir and Ayesha Munir* Author Affiliations Institute of Molecular Biology and Biotechnology, Pakistan Received: January 31, 2019 | Published: March 06, 2019 Corresponding author: Ayesha Munir, Institute of Molecular Biology and Biotechnology, Pakistan DOI: 10.26717/BJSTR.2019.15.002723

Uptake and diffusion of plasma-generated reactive nitrogen species through keratinized membrane

We propose a mathematical model for uptake and diffusion of air plasma-generated reactive nitrogen species (RNS) in a model keratinized membrane, such as a thin slice of bovine hoof or human nail material. An experimental system consisting of a surface microdischarge (SMD) in air was designed for the purpose of developing and validating a reaction-diffusion model to describe this system. Key variables such as membrane effective diffusivity, surface reaction rate coefficients, and other parameters are determined through comparison between the model predictions and experimental measurements. The model results yield spatial and temporal concentration profiles of RNS inside the keratinized membrane, leading to an improved understanding of transport and reaction of plasma generated RNS through the membrane. This work offers insights into possible mechanisms underlying plasma treatment of toenail fungus.

Differences Between Patient-Reported Versus Clinician-Observed Nonulcerative Signs and Symptoms of the Foot in Patients With Diabetes Mellitus.

The primary aim of this study was to compare patient reported versus clinician-observed nonulcerative foot conditions in patients attending a diabetic foot clinic and deemed at risk for diabetic foot ulcers. Retrospective review of medical records. The medical records of 126 patients with diabetes mellitus and deemed at risk for developing diabetic foot ulcers were reviewed. All patients received care from a diabetic foot outpatient clinic in a university-based hospital in Tokyo, Japan, between November 2008 and October 2009. We compared patients' self-identified foot complaints with clinically observable conditions affecting the feet of these individuals with diabetes mellitus. Patients' medical records were retrieved, and patient complaints and identified preulcerative signs of the foot were documented. All clinical observations were made by nurse specialists with knowledge of diabetic foot conditions. Nonulcerative diabetic foot conditions we observed included calluses, corns, abnormal nails, fissures, tinea pedis, and tinea unguium. Patient sensitivity to correctly identify these signs was calculated using the following formula: patient-reported foot signs divided by clinically identified preulcerative signs. Patient sensitivity for identifying nonulcerative signs varied based on the foot condition was 51.4% for calluses, 47.8% for pincer nails, 44.4% for corns, 33.3% for fissures, 19.4% for nail abnormalities, 3.9% for scales/maceration between the toes, 2.6% for interdigital tinea pedis, and 18.2% for tinea unguium. These findings suggest that persons with diabetes vary in their awareness of conditions affecting their feet and enhancing their risk for the development of diabetic foot ulcers. We recommend additional education on foot-related self-care including how often to observe their feet and how to recognize symptoms that may elevate their risk for diabetic foot ulcers.

Dermoscopic features of onychomycosis and nail psoriasis

Objective To investigate dermoscopic features of onychomycosis and nail psoriasis. Methods From March 2017 to March 2018, 128 patients with onychomycosis and 128 with nail psoriasis were enrolled from Department of Dermatology, Xiangyang Central Hospital. Dermoscopic images of the lesional nails were compared. Enumeration data were analyzed by chi-square test and Fisher′s exact test. Results There were 7 kinds of dermoscopic patterns in onychomycosis, including jagged edge (69/128, 53.91%) , longitudinal striae (72/128, 56.25%) , cone-shaped keratosis (30/128, 23.44%) , nail plate thickening (21/128, 16.41%) , black dots (5/128, 3.91%) , onycholysis (26/128, 20.31%) , and nail discoloration (23/128, 17.97%) . The jagged edge and longitudinal striae occurred more frequently in distal/lateral subungual onychomycosis (DLSO) than in the other 3 clinical subtypes of onychomycosis (all P 0.05) . There were 7 kinds of dermoscopic patterns in nail psoriasis, including pitting corrosion (61/128, 47.66%) , oil drop sign (41/128, 32.03%) , splinter hemorrhage (41/128, 32.03%) , dilated hyponychial capillaries (23/128, 17.97%) , nail plate thickening (20/128, 15.63%) , onycholysis (20/128, 15.63%) , and nail discoloration (13/128, 10.16%) . The oil drop sign occurred more frequently in psoriasis vulgaris and psoriasis arthropathica than in the other 2 clinical subtypes of psoriasis (P = 0.019) . The dilated hyponychial capillaries occurred more frequently in pustular psoriasis than in the other 3 clinical subtypes of psoriasis (P = 0.047) . There were no significant differences in the prevalance of pitting corrosion, splinter haemorrhage, nail plate thickening and nail discoloration among the 4 clinical subtypes of psoriasis (all P > 0.05) . Conclusions The dermoscopic features of onychomycosis include jagged edge, longitudinal striae, cone-shaped keratosis and black dots, and the dermoscopic features of nail psoriasis include pitting corrosion, oil drop sign, splinter haemorrhage and dilated hyponychial capillaries. Their common dermoscopic features include nail plate thickening, onycholysis and nail discoloration. Key words: Onychomycosis; Psoriasis; Nails; Dermoscopy

Terbinafine-resistant strain of Trichophyton interdigitale strain isolated from a tinea pedis patient.

Trichophyton interdigitale is an anthropophilic species that is frequently isolated from tinea unguium and tinea pedis throughout the world. In the present study, antifungal susceptibility testing was performed on T. interdigitale isolates from Japanese patients (isolated in 2017-2018; 24 strains) to assess itraconazole (ITZ) and terbinafine (TRF) susceptibility of these strains. E-test determinations revealed that the mean ITZ minimum inhibitory concentration (MIC) of the 24 strains was 0.023 mg/L (range, 0.064-1). Clinical Laboratory Standards Institute M38-A2 determinations revealed that the mean TRF MIC of 23 of the 24 strains was less than 0.03125 mg/L. Among these strains, one (NUBS18016) had a TRF MIC of 2 mg/L, confirming its resistance to TRF. The predicted amino acid sequences of the squalene epoxidase (SQLE) gene from the TRF-resistant strain (NUBS18016) was 100% identical to the SQLE gene sequence of the reference strain T. interdigitale, indicating that no gene mutations were present in NUBS18016. Therefore, the TRF-resistance mechanism of our TRF-resistant strain NUBS18016 has not been defined. Dermatologists should be cautious about the prevalence of foot dermatophytosis due to antifungal drug-resistant strains.

Contemplate of Nail Fungus Infection among Different Scholars of University

The basic objective of this research was too well informing the people about nail fungus infection. This is the contemplate (survey) of nail fungal infection among different scholars of university. Nail fungal taints are the utmost communal illnesses of the nails, making half of our nail uncharacteristic. This infection is most common in adults. So, for this project we took the feedback about the awareness of this infectious disease from different scholars of Bahauddin Zakariya University Multan, Pakistan. They all gave various types of information about this infection. Then I concluded from this feedback that knowledge on nail fungus infection was higher in females than in male, some were suffering from this infection, someone’s relatives, friends, and neighbors were agonizing. Even there were some who were not aware of this fungal disease.

Onychomycosis medications: huge cost gap generic vs branded in US

Onychomycosis medications: huge cost gap generic vs branded in US

How to Manage Onychomycosis

Not available.

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.