Nondermatophyte Molds Research Articles

STUDY ON THE CUTANEOUS FUNGAL PATHOGENS OF ATTENDING PATIENTS IN HUE UNIVERSITY HOSPITAL

Objectives: We surveyed the cutaneous fungal pathogens and the causative fungi species by clinical types from 181 patients in Hue Medicine and Pharmacy of hospital. Materials and methods: A crossectional survey for describe on 181 patients with positive direct examination from samples, including skin, hair and nail scrapings. These specimens were cultured on Sabouraud agar – Chloramphenicol medium or Sabouraud agar – Chloramphenicol – Cycloheximide medium or two kinds of media. Dermatophytes and nondermatophyte moulds were identified by the microscopic morphology. Identification of Candida species and other yeast pathogens based on the Dalmau technique and colorimetric sugar utilisation test. Results: The results were as follows: - The cutaneous fungal pathogens: + Dermatophytes was 90.64%, in which Trichophyton species was 82.91% T.rubrum 58.01%, T. mentagrophytes 14.36%, T.tonsurans 3.33%, T.violaceum 2.76%, T. erinacei 1.66%, T.schoenleini 1.10%, T.soudanense 0.55%, T.verrucosum 1.10%), Microsporum species was 7.18% M.gypseum 4.42%, M.canis 2.21%, M.persicolor 0.55%), and Epidermophyton floccosum was 0.55%. + Yeasts was 7.71%, in which C. albicans was 3.86%, C. parapsilopsis was 1.10%, C. tropicalis was 0.55%, C.famata was 0.55%, C.guilliermondii 0.55% and Trichosporon cutaneum was 1.10%. + Nondermatophytes moulds were 1.65%, in which Fusarium solani was 0.55%, Fusarium onysix was 0.55% and Scopulariopsis was 0.55%. - The causative fungi species by clinical types: Tinea capitis: T.rubrum (33.33%), T.mentagrophytes (33.33%), M.canis (33.33%). Tinea unguium: T.rubrum (66.66%), T.schoenleini (16.67%), Fusarium solani (16.67%). Tinea manuum and intertrigo: T.rubrum (16.67%), T.mentagrophytes (16.67%), M.gypseum (16.66%), Candida albicans (50.00%). Tinea pedis: T.rubrum (63.64%), T.mentagrophytes (9.09%), T.violaceum (9.09%), T.soudanense (9.09%), M.persicolor (9.09%). Tinea corporis: T.rubrum (57.70%), T.mentagrophytes (17.31%), T.violaceum (1.92%), T.tonsurans (1.92%),T. Erinacei (5.77%), T.verrucosum (1.92%), M.gypseum (9.62%), M.canis (1.92%), Fusarium onysix (1.92%). Tinea cruris: T.rubrum (60.32%), T.mentagrophytes (17.46%), T.violaceum (3.17%), T.tonsurans (7.94%), T.schoenleini (1.59%), T.verrucosum (1.59%), M.gypseum (3.17%), M.canis (3.17%), Epidermophyton floccosum (1.59%). Mutiple clinical type: T.rubrum (85.71%), T. mentagrophytes (10.71%), T.violaceum (3.58%). Paronychia - onychomychosis : Candida albicans (36.37%), Candida parapsilopsis (18.18%), Candida tropicalis (9,09%), Candida famata (9.09%), Candida guilliermondii (9.09%) và Trichosporon cutaneum (18.18%). Conclusion: Dermatophytes was the most prevalent cutaneous fungal infection (90.61%), followed by yeasts (7.74%) and then nondermatophytes moulds (1.65%). As the causative dermatophytes species, Trichophyton rubrum was the most frequently isolated pathogen (58.01%). T.rubrum and T.mentagrophytes were isolated from all the dermatophytosis clinical types. Candida sp and Trichosporon cutaneum were etiological agent of paronychia - onychomycosis.

Onychomycosis: modern diagnostic and treatment approaches

The medical term onychomycosis should be understood as chronic infection of the nails caused by a fungus. The most common causative agents are the dermatophytes and Candida species. The less common are certain types of moulds (nondermatophyte moulds or NDMs). In approximately 60-80 % of the cases, onychomycosis is due to dermatophytes. Among dermatophytes, the most often isolated causative pathogen is Trichophyton (T.) rubrum. Other common species are T. interdigitale (formerly T. mentagrophytes), Epidermophyton floccosum, and T. tonsurans. The most significant yeasts causing onychomycosis are Candida albicans and Candida parapsilosis. Predisposing factors for onychomycosis include mainly diseases such as diabetes mellitus, peripheral vascular arterial disease, chronic venous insufficiency, polyneuropathies of diverse etiologies, and immunosuppression, e.g., myeloproliferative diseases (such as lymphoma and paraproteinemia), HIV/AIDS, etc. Other factors facilitating the fungal infection are frequent trauma in professional sportsmen, often accompanied by excessive perspiration. The diagnostic methods that are often applied in different dermatologic departments and ambulatory units are also different. This precludes the creation of a unified diagnostic algorithm that could be used everywhere as a possible standard. In most of the cases, the method of choice depends on the specialist's individual experience. The therapeutic approach depends mostly on the fungal organism identified by the dermatologist or mycologist. This review hereby includes the conventional as well as the newest and most reliable and modern methods used for the identification of the pathogens causing onychomycosis. Moreover, detailed information is suggested, about the choice of therapeutic scheme in case whether dermatophytes, moulds, or yeasts have been identified as causative agents. A thorough discussion of the schemes and duration of the antifungal therapy in certain groups of patients have been included.

Molecular determination of mixed infections of dermatophytes and nondermatophyte molds in onychomycosis patients undergoing therapy

Molecular determination of mixed infections of dermatophytes and nondermatophyte molds in onychomycosis patients undergoing therapy

Isolation Rates and Carrier State of Dermatophytes, Nondermatophyte Molds,Malassezia Species, and Candida Species in Indoor Dogs and Cats in Daegu

Isolation Rates and Carrier State of Dermatophytes, Nondermatophyte Molds,Malassezia Species, and Candida Species in Indoor Dogs and Cats in Daegu

Antifungal Activities of Some Nigerian Medicinal Plants against Non-dermatophyte Molds Isolated from Cases of Onychomycosis among Rice Farmers in Anambra State, Nigeria

Aims: To investigate in vitro antifungal activities of methanol, hexane and cold water extracts of Cassia alata, Mitracarpus villosus and Lawsonia inermis against nondermatophyte molds isolated from rice farmers with onychomycosis in Anambra State, Nigeria. Study Design: Examination of antifungal activity of medicinal plants among cross-section of farmers.

Onychomycosis Due to Nondermatophytic Molds

BackgroundAlthough there have been many studies about onychomycosis due to nondermatophytic molds (NDM), few studies about etiologic agents including NDM in onychomycosis have been reported in Korea. Objective: This study investigated onychomycosis due to NDM in the Gyeongju area of Korea.ObjectiveThis study investigated onychomycosis due to NDM in the Gyeongju area of Korea.MethodsIn the 10-year period from 1999~2009, we reviewed 59 patients with onychomycosis due to NDM. The etiologic agents were identified by cultures on Sabouraud's Dextrose agar with and without cycloheximide. In some cases, internal transcribed spacer sequence analysis was done. NDM isolated considered pathogens when the presence of fungal elements was identified by direct microscopy observation and in follow-up cultures yielding the same fungi.ResultsOnychomycosis due to NDM comprised 2.3% of all onychomycosis. Of the 59 patients with onychomycosis due to NDM, 84.7% were toenail onychomycosis and 15.3% were fingernail onychomycosis. The incidence rate was highest in the fifth decade (27.1%). The ratio of male to female patients was 1:1.6. The frequency of associated diseases, in descending order, was hypertension, diabetes mellitus, and cerebral hematoma. Distal and lateral subungual onychomycosis (86.4%) was the most common clinical type of onychomycosis. Aspergillus spp. was the most frequently isolated etiologic agent of onychomycosis due to NDM (83.0%). Other causative agents were Scopulariopsis brevicaulis (10.2%), Acremonium spp. (3.4%), Fusarium solani (1.7%), and Chaetomium globosum (1.7%).ConclusionBecause of the increase in onychomycosis due to NDM, we suggest the need of a careful mycological examination in patients with onychomycosis.

Onychomycosis Caused byScopulariopsis brevicaulis: Report of Two Cases

Onychomycosis is usually caused by dermatophytes, but some nondermatophytic molds and yeasts are also associated with invasion of nails. Scopulariopsis brevicaulis is a nondermatophytic mold found in soil as a saprophyte. We report two cases of onychomycosis caused by S. brevicaulis in a 48-year-old male and a 79-year-old female. The two patients presented with a typical distal and lateral subungual onychomycosis. Direct microscopic examination of the potassium hydroxide preparation revealed fungal elements. From toenail lesions of the patients, brown colonies with powdery surface, which are a characteristic of S. brevicaulis, were cultured on two Sabouraud's dextrose agar plates. Three cultures taken from nail plates within a 2-week interval yielded similar findings. Numerous branched conidiophores with chains of rough walled, lemon-shaped conidia were observed in slide culture by light microscopy and scanning electron microscopy. The nucleotide sequences of the internal transcribed spacer for the two clinical isolates were identical to that of S. brevicaulis strain WM 04.498. To date, a total of 13 cases of S. brevicaulis onychomycosis including the two present cases have been reported in Korea. Mean age of the patients was 46.1 years, with a higher prevalence in males (69.2%). Toenail involvement was observed in all cases including a case involving both fingernail and toenail. The most frequent clinical presentation was distal and lateral subungual onychomycosis in 12 cases, while one case was proximal subungual onychomycosis.

Fingernail Onychomycosis Due toAspergillus niger

Onychomycosis is usually caused by dermatophytes, but some species of nondermatophytic molds and yeasts are also associated with nail invasion. Aspergillus niger is a nondermatophytic mold which exists as an opportunistic filamentous fungus in all environments. Here, we report a case of onychomycosis caused by A. niger in a 66-year-old female. The patient presented with a black discoloration and a milky white base and onycholysis on the proximal portion of the right thumb nail. Direct microscopic examination of scrapings after potassium hydroxide (KOH) preparation revealed dichotomous septate hyphae. Repeated cultures on Sabouraud's dextrose agar (SDA) without cycloheximide produced the same black velvety colonies. No colony growth occurred on SDA with cycloheximide slants. Biseriate phialides covering the entire vesicle with radiate conidial heads were observed on the slide culture. The DNA sequence of the internal transcribed spacer region of the clinical sample was a 100% match to that of A. niger strain ATCC 16888 (GenBank accession number AY373852). A. niger was confirmed by KOH mount, colony identification, light microscopic morphology, and DNA sequence analysis. The patient was treated orally with 250 mg terbinafine daily and topical amorolfine 5% nail lacquer for 3 months. As a result, the patient was completely cured clinically and mycologically.

A case report of a mixed Chaetomium globosum/Trichophyton mentagrophytes onychomycosis

Recently, an increasing prevalence of nondermatophyte mold onychomycosis was observed, in which Chaetomium globosum was rarely involved as primary pathogenic agent. Besides this, reports of mixed infection associating a dermatophyte and a nondermatophyte mold have become more frequent. Here, we present a clinical case of a mixed onychomycosis infection of a toenail caused by Chaetomium globosum and Trichophyton mentagrophytes. To our knowledge, this specific association is reported for the first time in Canada.

Fusarium solani : A causative agent of skin and nail infections

Fusarium spp are non-dermatophytic hyaline moulds found as saprophytes and plant pathogens. Human infections are probably a result of various precipitating predisposing factors of impaired immune status. Immunocompetent individuals of late are also vulnerable to various unassuming saprophytic and plant pathogens. To stress the need to identify correctly and institute appropriate antifungal therapy in newly emerging human fungal infectious agents. Repeated mycological sampling of the skin and nails of the suspected fungal infection were processed as per the standard format including direct microscopy and fungal culture on Sabouraud's dextrose agar. The fungus was isolated as Fusarium solani. Fusarium is an important plant pathogen and soil saprophyte. Infection is acquired by direct inoculation or inhalation of spores. It is associated with a variety of diseases like keratitis, onychomycosis, eumycetoma, skin lesions and disseminated diseases.

Onicomicosis: estudio multicéntrico clínico, epidemiológico y micológico

BackgroundOnychomycosis accounts for up to 50% of all nail disorders. They can be caused by: yeasts, dermatophytes and non-dermatophyte moulds. Objectives and methodsA multicentre study designed to determine the prevalence, mycological test results, aetiological agents, and clinical presentation of onychomycosis was carried out. All fingernail and toenail samples taken during a one year period at 9 diagnostic centres were included. ResultsA total of 5,961 samples were analysed, of which 82.3% were from toenails and 17.7% from fingernails. The mean age of the patients was 49.7 years, and 66% were females. Direct microscopic examination was positive in 61% of the samples. In adults, 61.2% of toenails were positive using potassium hydroxide (KOH), and 43.7% were positive in cultures. The prevailing aetiological agents belong to the dermatophyte group (82.8%), and distal subungual was the most common clinical form. In fingernails, direct examination showed 59.8% positive samples, and cultures were positive in 52.9%. The prevailing agents were yeasts belonging to Candida species, and onycholysis was the most common lesion. ConclusionsDirect mycological examinations were positive in 61%, a higher value than that found in other series. Dermatophytes were prevalent in toenails of both sexes, and in finger nails yeast were prevalent in females, and dermatophytes in males. Non-dermatophyte moulds corresponded to 4.8% of toenail and 2.05% of fingernails isolates.

A randomized, placebo- and active-controlled, parallel-group, multicentre, investigator-blinded study of four treatment regimens of posaconazole in adults with toenail onychomycosis

Onychomycosis accounts for up to 50% of all onychopathies. To evaluate the efficacy of four posaconazole regimens compared with placebo in the treatment of toenail onychomycosis, to assess the safety and tolerability of posaconazole, and to estimate the relative efficacy of posaconazole against terbinafine. A phase 2B, randomized, placebo- and active-controlled, parallel-group, multicentre, investigator-blinded (double blind for placebo) study (ClinicalTrials.gov identifier: NCT00491764). Onychomycosis patients aged 18-75years (n=218) were randomized equally to one of six treatment regimens: posaconazole (oral suspension) 100, 200 or 400mg once daily (24weeks); posaconazole 400 mg once daily (12weeks); terbinafine (tablets) 250mg once daily (12weeks); or placebo (24weeks). The primary efficacy variable was complete cure (negative mycology and 0% nail involvement) at week 48. All posaconazole treatment arms had a significantly (P≤0·012) greater proportion of patients with complete cure at week 48 compared with placebo. The proportions of patients with complete cure were numerically higher for posaconazole 200mg/24weeks (54·1%) and 400mg/24weeks (45·5%), but lower for 400mg/12weeks (20%) compared with terbinafine (37%; differences were not statistically significant). Posaconazole was well tolerated. Seven patients receiving posaconazole withdrew because of asymptomatic liver enzyme increases, as mandated by protocol discontinuation criteria. The efficacy and favourable safety profile of posaconazole suggest a potential new treatment for onychomycosis. The availability of low-cost generic terbinafine may limit posaconazole use to second-line treatment of infections refractory to, or patients intolerant of, terbinafine, or nondermatophyte mould infections.

Onychomykose – ein Update

Trichophyton (T.) rubrum is the most frequently isolated dermatophyte in onychomycosis, both in Germany and worldwide. T. interdigitale (formerly T. mentagrophytes var. interdigitale) follows in second place. A further however rarely isolated dermatophyte in onychomycosis is Epidermophyton floccosum. Candida parapsilosis, Candida guilliermondii, and Candida albicans, followed by Trichosporon spp. are the most important yeasts which are found in onychomycosis. The molds most often responsible include Scopulariopsis brevicaulis, and several Aspergillus species, e.g. Aspergillus versicolor, and Fusarium spp. These so called non-dermatophyte molds (NDM) are increasingly isolated as emerging pathogens in onychomycosis. The diagnosis of onychomycosis should be verified in the mycology laboratory. Conventional diagnostic methods include the direct examination, ideally using fluorescence staining with Calcofluor® or Blancophor®, and culture. However, new molecular biological methods primarily employing the polymerase chain reaction (PCR) for direct detection of dermatophyte DNA in skin scrapings and nail samples have been introduced into routine mycological diagnostics. The diagnostic sensitivity is higher when both conventional and molecular procedures are combined.

Non-dermatophyte moulds as pathogens of onychomycosis.

To determine the role and pattern of non-dermatophyte moulds as causative agents of onychomycosis. Case series. Department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from November 2009 to July 2010. Nail clippings and nail scrapings were obtained from abnormal looking nails with treatment and detection failure for onychomycosis. Microscopic (40% potassium hydroxide mounts) examination and culture on Sabouraud's dextrose agar (SDA), SDA containing chloramphenicol, and SDA containing actidione and chloramphenicol were used for species identification. Non-dermatophyte moulds were isolated from 32 out of the total 47 culture positive cases (68%). Alternaria alternata was the commonest species (46%). Dermatophytes were isolated from only 7 patients (15%) belonging to genus Trichophyton. Yeasts were isolated in 8 (17%). There was no fungal growth in 53% of cases. The non-dermatophytes should be considered important in evaluating the culture negative cases for dermatophytes as well as those cases ending up in treatment failure after empirical treatment for dermatophyte infections.

Treatment of refractory fingernail onychomycosis caused by nondermatophyte molds with methylaminolevulinate photodynamic therapy

Treatment of refractory fingernail onychomycosis caused by nondermatophyte molds with methylaminolevulinate photodynamic therapy

Fusarium solani onychomycosis of the thumbnail coinfected with Pseudomonas aeruginosa: report of two cases

Fusarium species are non-dermatophytic moulds, which are commonly known soil saprophytes and important plant pathogens, and have been frequently reported to be aetiological agents of opportunistic infections in humans. The prevalence of onychomycosis caused by Fusarium species varies in the literature because of geographical differences in mould distribution and diagnostic methods. Onychomycosis caused by Fusarium species is considered rare in Korea, and only four cases have been described to date. Pseudomonas aeruginosa also can infect nails and cause green nail syndrome, and recent research has shown that fungal infection may potentiate the colonisation or growth of P. aeruginosa within a nail. Furthermore, such coinfection with P. aeruginosa can prevent the isolation of the fungus because of bacterial overgrowth in culture. The authors report the cases of two immunocompetent patients with F. solani onychomycosis coinfected with P. aeruginosa. Both presented with a greenish/yellowish discolouration and thickening of a thumbnail, and were treated with systemic ciprofloxacin in combination with itraconazole or terbinafine.

Onychomycosis caused by Phaeoacremonium parasiticum: first case report

A variety of non-dermatophyte moulds can cause human onychomycosis. We report an unusual case of onychomycosis caused by Phaeoacremonium parasiticum, which has not been mentioned in the literature before. The diagnosis was made by a clinical-mycological correlation. The pathogen was identified by morphological characteristics and further confirmed by sequencing of the β-tubulin gene.

Epidemiology of superficial fungal diseases in French Guiana: a three-year retrospective analysis

A three-year retrospective analysis of fungi isolated from specimens of patients with superficial fungal infections in French Guiana is presented. Clinical samples from 726 patients with presumptive diagnoses of onychomycosis (28.2% of the patients), tinea capitis (27.8%), superficial cutaneous mycoses of the feet (22.0%), and of other areas of the body (21.9%), were assessed by microscopic examination and culture. Dermatophytes accounted for 59.2% of the isolates, followed by yeasts (27.5%) and non-dermatophytic molds (13.1%). Trichophyton rubrum was the most common dermatophyte recovered from cases of onychomycosis (67.4%), tinea pedis (70.6%) and tinea corporis (52.4%). In contrast, Trichophyton tonsurans was the predominant species associated with tinea capitis (73.9%). Yeasts were identified as the principal etiologic agents of onychomycosis of the fingernails (74.2%), whereas molds were found mainly in cases of onychomycosis of the toenails. In such instances, Neoscytalidium dimidiatum (70.8%) was the most common mold recovered in culture. In conclusion, the prevalence of T. rubrum and the occurrence of onychomycosis and fungal infections of the feet in French Guiana are similar to results reported from Europe, whereas the frequency of tinea capitis and the importance of T. tonsurans in such infections are similar to the situation in the Americas.

Onychomycosis: Diagnosis and management

Onychomycosis is a common nail ailment associated with significant physical and psychological morbidity. Increased prevalence in the recent years is attributed to enhanced longevity, comorbid conditions such as diabetes, avid sports participation, and emergence of HIV. Dermatophytes are the most commonly implicated etiologic agents, particularly Trichophyton rubrum and Trichophyton mentagrophytes var. interdigitale, followed by Candida species and non dermatophytic molds (NDMs). Several clinical variants have been recognized. Candida onychomycosis affects fingernails more often and is accompanied by paronychia. NDM molds should be suspected in patients with history of trauma and associated periungual inflammation. Diagnosis is primarily based upon KOH examination, culture and histopathological examinations of nail clippings and nail biopsy. Adequate and appropriate sample collection is vital to pinpoint the exact etiological fungus. Various improvisations have been adopted to improve the fungal isolation. Culture is the gold standard, while histopathology is often performed to diagnose and differentiate onychomycosis from other nail disorders such as psoriasis and lichen planus. Though rarely used, DNA-based methods are effective for identifying mixed infections and quantification of fungal load. Various treatment modalities including topical, systemic and surgical have been used.Topically, drugs (ciclopirox and amorolfine nail lacquers) are delivered through specialized transungual drug delivery systems ensuring high concentration and prolonged contact. Commonly used oral therapeutic agents include terbinafine, fluconazole, and itraconazole. Terbinafine and itraconazole are given as continuous as well as intermittent regimes. Continuous terbinafine appears to be the most effective regime for dermatophyte onychomycosis. Despite good therapeutic response to newer modalities, long-term outcome is unsatisfactory due to therapeutic failure, relapse, and reinfection. To combat the poor response, newer strategies such as combination, sequential, and supplementary therapies have been suggested. In the end, treatment of special populations such as diabetic, elderly, and children is outlined.

Tinea Unguium

Although onychomycoses are caused by dermatophytes, yeasts or non-dermatophyte molds, tinea unguium describes chronic fungal infections by dermatophytes only. Tinea unguium is a common fungal infection of the nail plate or nail bed with increasing prevalence worldwide. It is not self-limited and shows a higher frequency among the elderly population. In Japan, approximately 10% of the entire population is estimated to have tinea unguium. During the period when only griseofulvin was available for treatment, it was a very difficult disease to treat. Since in the 1990's, however, the introduction of new oral antifungals, itraconazole and terbinafine, initiated a new era in the treatment of tinea unguium. Many excellent textbooks, review articles, and original articles have already been published. This paper considers the circumstances in Japan, epidemiology, causative agents including non-dermatophyte molds, differential diagnosis, diagnostic techniques, the quality of life of the patients with tinea unguium, and then the treatment options are reviewed again.