Nondermatophyte Molds Research Articles

Evaluation of mycological profile of onychomycosis in a tertiary care centre in Bareilly

Onychomycosis is a chronic fungal infection of nails which is not associated with significant morbidity and mortality but it can have negative impact on patient's emotional, social and occupational functioning. The affected nail can also serve as a chronic reservoir and can communicate the fungal infection to family members this makes onychomycosis an important public health problem. Treatment regimen and duration depends on the etiological agent. So, for the timely initiation of appropriate and effective treatment knowledge of etiological agents causing onychomycosis is required. This study was conducted to improve the knowledge of demographic and mycological profile of onychomycosis in Bareilly region. 74 nail specimens of suspected onychomycosis were evaluated clinically, KOH examination and fungal culture was done. Onychomycosis was present in 59.46% by culture and /or KOH examination. Fingernails and toenails were infected in 24.32% and 41.89% respectively and remaining 6.75% had both. Principal causative agents were dermatophytes (43.47%) with Trichophyton mentagrophytes being the most common (19.56%). In 15 (32.60%) cases, candida species and in 11 (23.91%) cases non-dermatophyte moulds have been isolated as the sole causative agent. This study demonstrated dermatophytes as the main agents causing onychomycosis in our region, as well as proves the importance of performing direct examination and culture in diagnosis of onychomycosis.

Quality of life and therapeutic regimen management in onychomycosis patients and in vitro study of antiseptic solutions

Onychomycosis or tinea unguium (EE12.1) and Onychomycosis due to non-dermatophyte moulds (1F2D.5) (OM) is a fungal infection of the nail plates with a high prevalence that often affects vulnerable people with co-existing health problems. Gold standard pharmacological treatments for onychomycosis have been associated with low success rates and increasing antifungal resistance, suggesting that treatment outcome is dependent on multiple variables. Here, the prevalence of OM and quality of life were characterized in two vulnerable populations—Hospital patients and Homeless people. Comparing both groups, the most prevalent fungal species were identified in Hospital patients. Then, the in vitro fungicidal properties of the antiseptics povidone-iodine, polyhexamethylene biguanide-betaine, octenidine dihydrochloride, and a super-oxidized solution against two ATCC strains (Candida albicans and Aspergillus niger) and three clinical fungal isolates from Hospital patients (Candida parapsilosis, Trichophyton interdigitale, and Trichophyton rubrum) were tested. OM prevalence was high in both patient groups studied, who also reported a reduction in quality of life and concerns about the state of their feet. In addition, Hospital patients had a non-negligent therapeutic regimen management style. Antiseptics tested in vitro revealed antifungal properties. As antiseptics are low-cost and easy to apply and have few iatrogenic effects, the demonstration of fungicidal properties of these solutions suggests that they may constitute potential supportive therapeutics for OM.

Prevalence of Non-Dermatophytic Molds Associated with Cutaneous Mycoses in Cattle in Abia and Imo States, Nigeria

Aims: To study the prevalence and identification of non-dermatophytic molds associated with cattle in Abia and Imo States, Nigeria.
 Study Design: The systematic random sampling method was adopted.
 Place and Duration of Study: A total of 2255 cattle was encountered, out of which 451 skin samples from both infected and asymptomatic animals were sampled from six cattle markets in Abia and Imo States, Nigeria between January and August, 2018.
 Methodology: The 451 samples were analysed for their colonial and microscopic morphology and molecular analysis. Polymerase chain reaction of the 16SrRNA internal transcriber spacer (ITS) sequence techniques were carried out on the isolates. Pathogenicity of the isolates were determined.
 Results: A total of 16 non-dermatophytic molds were obtained from 451samples analysed at different frequency of occurrences from the cattle skins in both states and these include Aspergillusfumigatus (3.6%), Aspergillus terreus (2.7%), Aspergillus wewitschiae (13.5%), Aspergillus flavus (10.0%), Aspergillus aculeatus (9.0%), Aspergillus sydowii (5.0%), Fusarium solani (3.2%), Fusarium lichenicola (17.9%), Fusarium succisae (12.0%), Fusarium oxysporum (2.0%), Penicillium citrinum (3.0%), Curvularia kusanol (0.6%), Cladosporium tenuissimum (4.9%), Pestalotiopsis microspora (0.1%), Talaromyces kendrickii (0.1%) and Absidia specie (12.9%).
 Conclusion: The study revealed that non-dermatophytic molds were highly prevalent and are possible causative agent of cutaneous mycoses in cattle. Pathogenicity evaluation carried out in this study revealed that Aspergillus welwitschiae, Cladosporium tenuissimum and Absidia sp. were highly virulent.

Pepper and Garlic Extracts as an Alternative Treatment to Onychomycosis: AMyth or Truth?

Onychomycosis is a chronic disease ofa nail infection by the fungi. Based on the mode of nail invasion and morphologic patterns, it can be divided into 5subtypes: distal and lateral subungualonychomycosis, proximal subungualonychomycosis, superficial onychomycosis, total dystrophic onychomycosis, and endonyxsubungualonychomycosis.Common pathogens are dermatophytes, non-dermatophyte molds, and yeasts. In recent years, the development of new antifungal agents, such as allylamines and azoles, has provided good treatment options for onychomycosistherapy. There is a growing interest in the use of plant-derived compounds or alternatives to treat dermatophyte infection. Recently, a Chinese web page describing an alternative method for onychomycosis by using garlic and pepper extractswas very popular [Figure 1] [1]. They described 200 cases of onychomycosis patients treated once daily with a mixture of 100g garlic and 20g pepper extracted with 500ml acetic acid for 30 days. They claimed the cure rate was 94.05% and the effective rate was 99.88%. Although it may seem effective, the detailed exact preparation methods, the culture results, and the subtypes of the onychomycosis were not described. The treatment responses also seemed too good to be true. Martin et al. reviewed 7 controlled clinical trials performed to determine the effectiveness of plant extracts against fungal infection [2]. Among them, tea tree oil was the most thoroughly clinically tested. Solanum species and oil of bitter orange preparations were also reviewed. However, there were no researches on garlic or pepper preparation. Till now, there are still no peer-reviewed, double-blind, placebo-controlledclinical trials of garlic or pepper-based preparations used as an alternative treatment method for onychomycosis.

The role of oxidative stress in onychomycosis: Thiol/disulphide homeostasis.

Onychomycosis is the general term to define fungal nail infections that arise from dermatophytes, non-dermatophytic moulds and yeasts. Thiol/disulphide homeostasis is a new indicator of oxidative stress. In this study, we aimed to investigate the role of thiol/disulphide balance in the pathogenesis of onychomycosis. This cross-sectional study included adult patients with onychomycosis who were admitted to the dermatology department and healthy adult volunteers without any dermatologic or systemic condition. The patients and controls were evaluated in terms of native thiol, total thiol, and disulphide levels, and disulphide/native thiol, disulphide/total thiol and native thiol/total thiol ratios. The possible association between these parameters and clinical subtypes of onychomycosis and demographic characteristics was also investigated. A total of 52 patients with onychomycosis and 50 healthy subjects were enrolled in the study. The patient group showed lower levels of total thiol, native thiol and native thiol/total thiol ratio, and higher ratios of disulphide/native thiol and disulphide/total thiol. No statistically significant relationship was found between the parameters, clinical subtypes of onychomycosis and demographic characteristics (p>.05). Patients with onychomycosis showed a shifted thiol/disulphide homeostasis towards oxidative stress with a reduction in thiols and an increase in disulphide/native thiol, and disulphide/total thiol ratios. These findings may indicate the role of oxidative stress in the pathogenesis of onychomycosis.

Prevalence of superficial-cutaneous fungal infections in Shiraz, Iran: A five-year retrospective study (2015-2019).

BackgroundSuperficial and cutaneous fungal infections are common in tropical areas. The aim of this study was to provide a basic database of superficial and cutaneous mycoses and the most common etiological agents among patients.MethodsBetween 2015 and 2019, a total of 1807 patients suspected of superficial and cutaneous mycosis referring to the mycology laboratory of Shiraz medical school, Fars, Iran were evaluated. Specimens were taken from the patients’ affected area, and clinical samples were examined by direct microscopy and culture. The epidemiological profile of the patients was collected.ResultsA total of 750 patients were confirmed with mycoses. Positive samples totaled 750 cases consisting of the nail (373/49.7%), skin (323/43%), head (47/6.26%), and mucosal membrane (4/0.5%). The yeasts group included 304 Candida spp. (70.3%), 123 Malassezia spp. (28.47%), and 5 Rhodotorula spp. (1.1%). The filamentous fungi were distributed as 34.8% dermatophytes and 7.5% non‐dermatophyte. The clinical types of dermatophytosis were tinea unguium (110/261), tinea capitis (50/261), tinea pedis (48/261), tinea corporis (37/261), and tinea cruris (16/261). Non‐dermatophyte molds included A. flavus 17, A. niger 4, Aspergillus spp. 15, Penicillium. 10, Fusarium 6, Mucor 2, Stemphylium 1, and Alternaria 1.ConclusionThis study provides useful data for the study trends of superficial and cutaneous fungal infections in a specific area. The mycological data confirmed higher incidence of candidiasis (mainly onychomycosis) and dermatophytosis in patients affected by fungal pathogens, which helped to better understand the epidemiological aspects of these mycoses.

Nondermatophyte mould onychomycosis.

Nondermatophyte moulds (NDMs) onychomycosis is often difficult to diagnose as NDMs have been considered contaminants of nails. There are several diagnostic methods used to identify NDMs, however, repeated laboratory isolation is recommended to validate pathogenicity. With NDM and mixed infection (dermatophytes plus NDM) onychomycosis on the rise, accurate clinical diagnosis along with mycological tests is recommended. Systemic antifungal agents such as itraconazole and terbinafine (e.g. pulse regimen: 1 pulse=every day for one week, followed by no treatment for three weeks) have shown efficacy in treating onychomycosis caused by various NDMs such as Aspergillus spp., Fusarium spp., Scopulariopsis brevicaulis, and Onychocola canadensis. Studies investigating topical therapy and devices for NDM onychomycosis are limited. The emergence of antifungal resistance necessitates the incorporation of antifungal susceptibility testing into diagnosis when possible, for the management of recalcitrant infections. Case studies documented in the literature show newer azoles such as posaconazole and voriconazole as sometimes effective in treating resistant NDM onychomycosis. Treatment with broad-spectrum antifungal agents (e.g. itraconazole and efinaconazole) and other combination therapy (oral+oral and/or oral+topical) may be considerations in the management of NDM onychomycosis.

Clinicomycological pattern of dermatomycosis – A two-year retrospective study in a tertiary care hospital of north India

Fungal infections are a growing cause of concern in both hospital and non-hospital settings all over the world. Fungal infections are often characterized by the location of the infection. These may be referred to as superficial, subcutaneous, or systemic, which is also referred to as deep-seated. Dermatomycosis are superficial fungal infections of the skin & or its appendages.This study was undertaken to determine: 1) The predominant dermatophytes and non dermatophytes causing dermatomycosis. 2) The clinicomycological profile of dermatomycosis.641 samples from clinically suspected cases of dermatomycosis including the skin, hair, and nail samples were collected. All the relevant clinical, demographic, and epidemiological details were noted. Samples were then subjected to direct microscopy and fungal culture.Of the total 641 cases, 337 (52.6%) were males and 304 (47.4) were females (Table 1). The most commonly affected age group was 20–39 years (51%). Out of total, 340 (53%) were nail samples, 283 (44.1%) were skin samples, and 18 (2.9%) were hair samples. Onychomycosis was the commonest clinical presentation (48.8%) followed by Scaly skin lesions (13.1%). Moreover, Tinea corporis was seen in 10.3%, Tinea cruris in 5.3% cases. KOH wet mount was performed on all 641 samples with 230 (35.9%) showing positive results. Whereas, 312 (48.7%) were positive by culture. the most common Fungi isolated in our study were Dermatophytes n=154 (49.4%), followed by Non-dermatophyte molds (NDMs) n=93 (29.8%) and Yeasts n=65 (20.8%).A combination of direct microscopy and culture was found to be superior than direct microscopy and culture alone. The recovery of NDMs and yeasts from routine dermatological samples in addition to the usual suspects, dermatophytes, also increases the awareness and suspicion among clinicians and mycologists to look beyond dermatophytes as the lone cause of superficial skin infections. Additionally, given the geographical location of Kashmir valley and its temperate climate with extremely cold winters (November to March) and a relatively milder summer with moderate humidity levels, when compared to the rest of northern Indian states doesn’t make it a suitable environment for fungal infections, more so the superficial mycosis. That said, people at risk are always vulnerable to develop fungal infections.

Superficial mycoses, a matter of concern: Global and Indian scenario-an updated analysis.

Superficial mycoses of skin, nails and hair are among the common fungal infections. They are caused by dermatophytes, non-dermatophyte moulds, yeasts and yeast-like fungi. Such fungal infections are widespread all over the world and are predominant in tropical as well as subtropical regions. Environmental factors, such as warm, humid and pitiable hygienic conditions, are conducive for their growth and proliferation. Although it does not cause mortality, it is known to be associated with excessive morbidity which may be psychological or physical. This affects the quality of life of the infected individuals which leads to a negative impact on their occupational, emotional and social status. Such infections are increasing on a global scale and, therefore, are of serious concern worldwide. This review article covers the global and Indian scenario of superficial mycoses taking into account the historical background, aetiological agents, prevalence, cultural and environmental factors, risk factors, pathogenesis and hygienic practices for the prevention of superficial mycoses.

Identification and in vitro antifungal susceptibility of causative agents of onychomycosis due to Aspergillus species in Mashhad, Iran

Aspergillus species are emerging causative agents of non-dermatophyte mold onychomycosis. In this study, 48 Aspergillus isolates were obtained from patients with onychomycosis in Mashhad, Iran, during 2015–2018. The aim is to identify the Aspergillus isolates to the species level by using partial calmodulin and beta-tubulin gene sequencing and MALDI-TOF MS, and to evaluate their in vitro susceptibility to ten antifungal drugs: terbinafine, itraconazole, voriconazole, posaconazole, ravuconazole, isavuconazole, caspofungin, micafungin, anidulafungin and amphotericin B according to CLSI M38-A3. Our results indicate that A.flavus (n = 38, 79%) is the most common Aspergillus species causing onychomycosis in Mashhad, Iran. Other detected species were A. terreus (n = 3), A. tubingensis (n = 2), A. niger (n = 1), A. welwitschiae (n = 1), A. minisclerotigenes (n = 1), A. citrinoterreus (n = 1) and A. ochraceus (n = 1). Aspergillus flavus, A. terreus and A. niger isolates were correctly identified at the species level by MALDI-TOF MS, while all cryptic species were misidentified. In conclusion, A. flavus is the predominant Aspergillus species causing onychomycosis due to Aspergillus spp. in Mashhad, Iran. MALDI-TOF MS holds promise as a fast and accurate identification tool, particularly for common Aspergillus species. It is important that the current database of reference spectra, representing different Aspergillus species is expanded to increase the precision of the species-level identification. Terbinafine, posaconazole and echinocandins were in vitro most active against the studies Aspergillus isolates and terbinafine could be the first choice for treatment of onychomycosis due to Aspergillus.

Clinico–mycological correlation of onychomycosis: emphasizing the role of non-dermatophytes in a tertiary care hospital from Karnataka, India

Background: Onychomycosis is a widespread problem in the clinical practice of dermatology, caused by dermatophytes, yeasts, and non-dermatophyte molds. In India, relatively little work has been done on this problem. It is a known fact that the geographical distribution of the fungi may change from time to time. Hence, through this study, an attempt was made to identify the clinical patterns and causative agents of onychomycosis. Methods: This study was conducted on 100 clinically suspected onychomycosis patients. The necessary clinical details were noted with their consent. Nail clippings were collected from the most severely affected parts and were subjected to direct microscopy in 40% potassium hydroxide before being inoculated into Sabouraud’s dextrose agar with and without cycloheximide at 25 °C and 37 °C for up to four weeks. Growth was identified following the standard protocols by assessing the rate of growth, colony character, lactophenol cotton blue mount, slide culture, urease test, germ tube test, etc. Results: Among the 100 patients, the mean age was 40.8 years. The male/female ratio was 1.28:1. Fingernail (49%) involvement was more common than toenail involvement (32%). Distal lateral subungual onychomycosis (52%) comprised the predominant clinical pattern. KOH mount was positive in 46%, while the culture was positive in 44% of patients. The causative agents isolated were non-dermatophyte molds (63.6%), dermatophytes (18.2%), and yeasts (18.2%). Conclusion: This work shows the broad spectrum of causative agents of onychomycosis with non-dermatophyte molds as the predominant isolates.

Non-dermatophyte fungi in onychomycosis-Epidemiology and consequences for clinical practice.

Onychomycoses are difficult-to-treat fungal infections with a high recurrence rate that relates to the anatomic and pathophysiological conditions in the nail organ and the required extended duration of treatment. Clinical-epidemiological studies demonstrated that non-dermatophyte molds and yeasts are the primary causative agents in 20%-30% of onychomycoses. Mixed infections with dermatophytes are observed as well. Therefore, the causative agents should be determined by fungal culture and the antifungal treatment regimen should reliably cover non-dermatophytes, if appropriate. Systemic-topical combination therapy involving a broad-spectrum, locally applied antifungal may increase the mycological and clinical cure rates compared to monotherapy with systemic drugs.

Mycological Profile and Prevalence of Superficial Mycoses Agents: A Study from North India

Background: Superficial fungal infections are one of the commonest human infections. Causative agents of such infections may vary from yeasts like Candida species, Trichosporon species to dermatophytes and non-dermatophyte moulds. Fungal culture therefore, holds importance in identification and characterization of a fungal isolate, so that proper diagnosis can be made and correct treatment is instituted. Our objective was to study the etiology of the superficial fungal infections in patients presenting to the dermatology department in a tertiary care hospital in New Delhi. Materials and Methods: A total of 340 skin and hair samples from patients clinically suspected to have superficial fungal infection of skin and hair were microscopically examined and cultured over a period of 2 years. The percentage and frequency distribution of etiological fungal agents was studied. Also the performance of the culture and microscopy as methods of detecting fungal agents was statistically compared using Kappa and proportions of positive and negative agreement as well as McNemar’s Chi-squared value. Corresponding p-values were also calculated for both kappa and Chi-squared values. The analysis has been done using Epitools. Results: Of these, 57.6% were positive for fungal elements by microscopic examination and the overall positivity of fungal infection was 70%. Out of 238 culture positive samples, 72.7% grew dermatophytes and 27.3% grew non-dermatophytes (including 16.8% yeasts and 10.9% non-dermatophyte moulds. Trichophyton mentagrophytes was the commonest (60.7%) dermatophyte isolated, followed by T. rubrum (17.3%), T. violaceum (7.5%), T. tonsurans (7.5%), T. verucosum (2.9%), Microsporum gypseum (1.2%) and M. canis (0.6%). Among the isolated non-dermatophytes, Candida species was the commonest (50.8%) majority of which were C. albicans, other non-dermatophytes included moulds like Fusarium spp. (6.1%), Aspergillus fumigatus (4.6%), A. flavus (3.1%), Alternaria spp. (3.1%), Acremonium spp. (3.1%), A. niger (3.1%) etc. and yeasts like Trichosporon spp. (10.8%). Conclusion: Dermatophytosis still remains the most common type of fungal infection involving skin and its appendages but non-dermatophytes are also slowly emerging as the causative agents for these infections.

Epidemiological and Microbiological Study of Onychomycosis

Introduction: Onychomycosis is a common fungal infection of nail. It may be caused by dermatophytes, non-dermatophytic moulds or yeasts involving nail bed, nail plate or matrix of nail. As the fungi show variable susceptibility to antifungal drugs and treatment requires long duration of antifungal therapy, so it’s prevalence as well as proper laboratory diagnosis and antifungal susceptibility testing is essential for effective therapy. Aim: To find the prevalence of onychomycosis with demography along with various aetiology and the suitable antifungal drugs used for treatment. Materials and Methods: For this prospective study, over a period of two years a total of 300 nail samples were processed in the Department of Microbiology at IMS and SUM Hospital, Bhubaneswar, Odisha, India. The wet mount for microscopic examination was prepared using 20% Potassium Hydroxide (KOH) and examined after overnight incubation. Culture was done in duplicate in Sabouraud’s Dextrose Agar (SDA) tubes; one with actidione and another without it and both were incubated at 25°C in Biological Oxygen Demand (BOD) incubator. Culture tubes growing yeasts were further subjected to speciation by germ tube test, culture on Chromogenic (CHROM) agar and on cornmeal agar. In-vitro antifungal susceptibility testing was performed against Candida species using disc diffusion method on Muller Hinton agar. Chi-square test was used for statistical analysis of the results. Results: Onychomycosis can affect a wide age group though seen commonly at 31-40 years equally in both male and females. Fingernail infection was observed mostly in female cases. It was caused by Candida species (66%), moulds (24%) and dermatophytes (10%) and out of Candida sp. C.albicans was the main culprit. Although all the Candida strains were susceptible to amphotericin B, still some of them showed resistance to the commonly used antifungals like fluconazole and itraconazole. Conclusion:Candida albicans was the most common aetiological agent which contributed for onychomycosis and showed a variable resistance pattern to the commonly used antifungals. Proper laboratory diagnosis and selection of antifungal drug is essential prior to institution of therapy for successful treatment of this disease.

A clinico-mycological spectrum of superficial mycoses of scalp in pediatric population

Objective: A clinico-mycological study was conducted to assess the profile of dermatophytes and non-dermatophytes in patients with superficial mycoses of scalp.
 Methods: This Descriptive cross sectional study was conducted at Department of Microbiology, Basic Medical Sciences Institute, in collaboration with Department of Dermatology, Jinnah Postgraduate Medical Centre, Karachi. The study was carried out from May 2019 to September 2019. A total of 114 children were enrolled in the study having a clinical diagnosis of superficial mycoses of scalp. The hair specimens and scales from the scalp were collected. The specimens were processed for wet mounts (KOH and CFW staining) and mycological culture. .
 Results: The most common clinical presentation was found to be dermatophytoses (28%). Non-dermatophytoses was seen in 16.1% cases, while 55.2% cases were culture negative. The most common isolated dermatophyte was Trichophyton violaceum (35.4%), while among non-dermatophyte molds, Aspergillus spp accounted for 45% of cases.
 Conclusion: The unambiguous diagnosis of scalp mycoses can be made by mycological culture and conventional techniques like KOH mounts and CFW staining.
 Keywords: Calcoflour white stain, Dermatophytes, KOH mount, Tinea capitis

The Growing Problem of Antifungal Resistance in Onychomycosis and Other Superficial Mycoses.

Superficial mycoses are becoming increasingly resistant to current antifungal medications. As alternative therapeutic options are limited, the increasing frequency of reports of antifungal resistance is alarming. This epidemic parallels the rise of antibiotic resistance; however, the significance of this problem has yet to gain global attention. Here, we discuss the reports of antifungal resistance from around the world, present our own experience with treatment-resistant infections, and examine alternative treatment strategies. The majority of reports of recalcitrant infections indicate terbinafine resistance as the causative factor. Single-point mutations in the squalene oxidase gene is the most reported mechanism of resistance to terbinafine. Mixed infections of dermatophytes with non-dermatophyte molds and/or yeasts are becoming more prevalent and contributing to the resistant nature of these infections. The key to selecting an effective antifungal therapy for a recalcitrant infection is identification of the infectious organisms(s) and testing susceptibility of the organism(s) to antifungal drugs. Combination and sequential therapy regimens are options, but both require active monitoring for hepatic and renal function, drug interactions, and other adverse effects. Selected topical antifungals with a wide spectrum of activity may also be considerations in some clinical presentations. Innovative treatment regimens and novel therapeutics are needed to overcome the rising epidemic of antifungal resistance.

Clinico-aetiological profile of onychomycosis at a tertiary care centre in northeast India

Onychomycosis (OM) represents nearly 50 percent of all nail disorders and accounts for about 30 percent of all superficial fungal infections of the skin. Often it becomes a nidus for recurrent superficial skin infections. Aims and Objectives: To study the clinico- aetiological profile of onychomycosis and identify various predisposing factors. Materials and Methods: A hospital-based, cross-sectional prospective study from October 2010 to March 2012 in Department of Dermatology, Venereology and Leprology in collaboration with Department of Microbiology at a tertiary hospital in Imphal, Manipur. Demographic profile, detailed history, risk factors, clinical examinations, investigations which consisted of direct microscopy with 10% potassium hydroxide (KOH), culture in Sebouraud’s dextrose agar (SDA), SDA incorporated with chloramphenicol (0.05mgs/ml) and cyclohexamide (0.5mg/ml) were taken. Results: A total of 122 (54 male and 68 female) patients diagnosed with onychomycosis were included in this study. Maximum number of our patients (56.6%) was between 21 and 40 years of age. Male to female ratio was 1:1.3. Housewives form the predominant group accounting for 41.9%, followed by students (28.7%) and farmer (13.9%). Some of the predisposing factors associated were smoking (25.4%), trauma (31.2%), concomitant fungal infection (59%) and family history of superficial mycosis (16.4%). DLSO (82%) was the commonest morphological pattern of OM, followed by TDO (9.8%). Trichophyton sp (44.3%) forms the commonest aetiological agent of OM. NDMs constituted 36.9% of the total nail cases in our study. Aspergillus sp (73.3%) was the most common isolate among the nondermatophyte molds (NDM), followed by Mucor sp (11.1%). Dermatophytes (45%) were the commonest cause of DLSO, Candida sp were responsible for all the cases of PSO. Conclusion: Dermatophytes are still the commonest cause of onychomycosis but NDMs and yeast can no longer be ignored as one of the causative organisms of OM.

AMPHOTERICIN B TOPICAL EXTEMPORANEOUS PREPARATIONS FOR THE TREATMENT OF NON-DERMATOPHYTIC ONYCHOMYCOSIS

Objective: At present, the nail preparation to cure onychomycosis, caused by non-dermatophyte molds, is not commercially available in Thailand. The physical and chemical stability of amphotericin B (AmB) extemporaneous preparations in the presence of 30% dimethyl sulfoxide (DMSO) and their in vitro nail permeation was evaluated.
 Methods: AmB extemporaneous preparations in the presence of 30% DMSO were prepared from a commercial sterile injection product, and cream or hydrophilic ointment. Physical stability was tested at 30°C for 2 months, or using 6 heating-cooling cycles. The chemical stability and in vitro nail permeation of AmB content were analyzed using high-performance liquid chromatography (HPLC). In vitro nail permeation was performed by applying 3.5 mg/mm2 of the tested formulation on nail clippings for 5 consecutive days.
 Results: The AmB cream and ointment extemporaneous preparations containing 30% DMSO, a permeation enhancer, were homogeneous and pale yellow to yellow cream or ointment. The AmB ointment was stable for up to 60 days. The ointment preparation allows in vitro penetration through nails up to 14.17 μg/cm2. The ointment preparation allows significantly better penetration through than the cream preparation due to the presence of DMSO, sodium lauryl sulfate (SLS), and water in the ointment preparation.
 Conclusion: The AmB extemporaneous ointment was successfully compounded from a commercial sterile injection product with a beyond-use date of 60 days. The ointment preparation is currently under further investigation for in vivo efficacy.

16050 Global mixed infections in onychomycosis

Background: Onychomycosis is estimated at a global prevalence of 10% usually due to Trichophyton rubrum. Traditional culture identification risks overestimating dermatophytes by inhibiting the growth of potential nondermatophyte mould (NDM) environmental contaminants which could also be causative agents.

The change of causative pathogens in toenail onychomycosis.

Toenail dystrophies are among the most common diseases in adulthood. Onychomycosis is one of the most frequently observed infectious diseases of the nail. The aim of this study was to determine the prevalence of fungal agents in the etiology of nail dystrophies such as discoloration, thickening, subungual hyperkeratosis, and onycholysis in toenails and to emphasize the importance of diagnosis by other laboratory confirmation tests since various nail diseases may mimic onychomycosis. Nail samples taken from 53 patients who were admitted to the dermatology clinic with the complaint of toenail disorders were examined by using potassium hydroxide mount, fungal culture, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry methods. Each nail was photographed, and descriptive analysis of the data was performed. Of 53 patients included in the study, 39 were female (73.6%) and 14 were male (26.4%). The ages of the patients ranged from 14 to 70years, and the mean age was 37.8years. No fungi could be isolated in 17 (32%) patients with nail dystrophy, while fungal pathogens were observed in 36 (68%) patients on potassium hydroxide mount, culture, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry examinations. Among nondermatophyte molds, Aspergillus species (52.7%) were identified as the most common fungal pathogen causing onychomycosis. Although fungal pathogenic agents are mostly detected among the diseases causing color changes and deformities in the nails, it should be kept in mind that nail findings of systemic or other skin diseases may mimic onychomycosis and the diagnosis should be confirmed by laboratory tests in addition to clinical manifestations for accurate treatment. Other systemic diseases causing nail dystrophy were not questioned in the study.