Onychomycosis – a small step for quality of care

Onychomycosis is a fungal infection of the nail unit, representing the most common nail disorder and accounting for 50% all nail diseases. Unfortunately, many patients are mismanaged, as physicians routinely treat onychomycosis empirically, falsely believing that they can make the diagnosis based on history and clinical inspection alone. We propose and provide evidence for why the diagnosis of onychomycosis should be confirmed by objective methods in each patient before initiating treatment.     

Chronic interdigital dermatophytic infection: a common lesion associated with potentially severe consequences

Interdigital intertrigo and onychomycosis has the potential cause of severe bacterial infectious complications with pain, mobility problems, abscess, erysipelas, cellulitis, fasciitis and osteomyelitis. In another hand, diabetic neuropathy, which affects 60-70% of those with diabetes mellitus, is one of the most troubling complications for persons with diabetes. These people are high suspecting to be infected by dermatophytic infections in interdigital spaces or onychomycosis witch are frequently induce damage to the stratum corneum, leading to bacterial proliferation and secondary infection.A patient presented with an asymptomatic warm, painless, erythematous swelling of the second left toe, which had been present for a few weeks. Clinically, the lesion was categorized as erysipelas upon an insidious abscess formation. Further investigation was undertaken to confirm the presence of diabetes.Leg erysipelas is a common affection which, according to various studies, has both local concomitants (interdigital intertrigo, lymphoedema, surgical antecedents) and/or general causes (immune suppression, diabetes, alcoholism, etc). Interdigital intertrigo, tinea pedis, and onychomycosis present as public health problems that could trigger serious deterioration in patient quality of life, due to complications induced by secondary bacterial infections.     

光学治疗在甲真菌病中的应用

甲真菌病是甲板和甲床被皮肤癣菌或其他真菌感染所引起的病变,常用的治疗方法包括局部外用或口服抗真菌药物治疗及拔甲治疗,但这些方法均存在一定的缺陷.近年来,光学治疗被应用于甲真菌病的治疗中,目前用于甲真菌病的光学治疗包括光动力治疗和激光治疗,它们分别通过光化学反应及选择性光热作用原理治疗甲真菌病.多项临床研究均表明,光动力疗法和激光可以有效治疗甲真菌病,且不良反应小.概述光学治疗甲真菌病的机制,疗效及安全性.     

两种培养基在甲真菌病诊断中的对比研究

目的采用含放线菌酮和氯霉素的沙氏培养基（SCCA）、皮肤癣菌培养基（DTM）检测甲真菌病临床标本,将结果作比较,选出较好培养基用于诊断甲真菌病。方法收集临床拟诊为甲真菌病的标本,分别接种于SCCA、DTM;记录菌株的开始生长时间、培养基开始变色时间及开始变色时菌落的直径,将结果进行对比研究。结果①SCCA、DTM的培养阳性率、菌种的生长速度及形态差异无统计学意义（P〉0.05）。②所有分离的皮肤癣菌,均能使DTM培养基变色;非皮肤癣菌生长时49.5%能使DTM培养基变色。而SCCA都不变色。③皮肤癣菌与非皮肤癣菌在DTM上生长情况的比较：其开始变色时间差异无统计学意义（P〉0.05）,开始变色时菌落直径两组比较差异有统计学意义（P〈0.05）。皮肤癣菌开始变色时菌落直径≤5mm。结论 DTM不仅能用于诊断甲真菌病,而且能简便、快速、准确地分离鉴定皮肤癣菌,在甲真菌病诊断中有着良好的应用前景。     

Clinical and mycological features of onychomycosis in central Tunisia: a 22 years retrospective study (1986–2007)

Onychomycosis is the most frequently encountered nail disease and may be difficult to diagnose and treat. The objective of this study was to determine the prevalence, the clinical and mycological characteristics of onychomycosis in central Tunisia. It is a retrospective study performed over a 22‐year period (1986–2007). It included 7151 patients (4709 women and 2442 men) with suspected fingernails and/or toenails onychomycosis. The patients were referred to the Mycology‐Parasitology Laboratory of Farhat Hached hospital in Sousse for mycological examination. Both direct microscopy and culture of the nail material were performed to diagnose and identify the causative fungal species. Onychomycosis was confirmed in 78.6% of investigated patients (5624/7151). The positivity rate was higher in women as compared with men. In both men and women, fingernails were most frequently involved than toenails. No significant relation was found between gender and toenails onychomycosis, whereas fingernails were frequently involved in women. As far as aetiological agents are considered, dermatophytes, yeast and moulds were responsible for 49.9%, 47.4% and 2.7% of onyxis cases respectively. In fingernail infections, yeast were the most frequent fungi (83.6%), Candida albicans being the leading species (51.6%). In contrast, in toenail infections, dermatophytes were more frequent (74.1%). Trichophyton rubrum was by far the dominant species (88.1%). Yeast were observed more frequently in women whereas dermatophytes were more common in men. Moulds were involved in 4.2% of cases. The most frequent species were Aspergillus sp. and Chrysosporium sp. Onychomycosis is a frequent disease in central Tunisia. T. rubrum is the predominant agent in toenails infection and yeast, mainly C. albicans, in fingernails onychomycosis.     

长脉宽Nd:YAG激光治疗甲真菌病疗效观察

目的 探讨长脉宽Nd:YAG激光治疗甲真菌病的疗效及安全性。 方法 对35例甲真菌病患者使用长脉宽Nd:YAG激光进行治疗,治疗参数：波长1064 nm,能量30 ～ 40 J/cm2,脉宽35 ms,光斑4 mm。观察疗效及不良反应,并根据不同感染菌种、临床类型、病甲位置对病例进行分组,采用SPSS17.0统计软件进行卡方检验比较不同分组间疗效、复发情况的差异。结果 共治疗79甲,随访至初次治疗后9个月,临床有效率为67.1%,真菌学有效率为73.4%,复发或再感染率为19.0%。红色毛癣菌组的临床疗效（χ2 = 10.913,P < 0.05）及真菌学疗效（χ2 = 13.532,P < 0.05）均优于其他真菌组,复发或再感染率低于其他真菌组（χ2 = 10.980,P < 0.05）,但与白念珠菌组比较这三方面的差异均无统计学意义。白色浅表甲真菌病（WSO）组的临床疗效优于远侧甲下真菌病（DLSO）组（χ2 = 11.935,P < 0.05）,而DLSO组的临床疗效又优于近端甲下真菌病（PSO）及全甲营养不良甲真菌病（TDO）组（χ2 = 17.515,P < 0.05）。根据病甲位置不同分类,第2 ～ 5指甲组的临床疗效优于拇指甲/第2 ～ 5趾甲组（χ2 = 13.437,P < 0.05）及拇趾甲组（χ2 = 10.595,P < 0.05）,而拇指甲/第2 ～ 5趾甲组与拇趾甲组相比临床疗效差异无统计学意义（χ2 = 3.030,P > 0.05）,它们的真菌学疗效及治疗后的复发或再感染率差异无统计学意义。治疗过程中除疼痛外未发生其他不良反应。结论 长脉宽Nd:YAG激光是治疗甲真菌病的一种安全有效的方法,其疗效受到感染菌种、临床类型、病甲位置的影响。     

Epidemiological and mycological data of onychomycosis in Goiania, Brazil

Onychomycosis defined as fungal infection of the nail represents more than 50% of all onychopathies. Epidemiological studies have shown that this mycosis is worldwide in occurrence, but with geographical variation in distribution. The direct microscopy and culture of the nail samples were performed to identify the causative agent. Out of 2273 patients with nail infection examined between January 2000 and December 2004 in Goiania, state of Goias, Brazil, diagnosis of onychomycosis was confirmed in 1282 cases, with dermatophytes and Candida species being the most common aetiological agents isolated. Dermatophyte onychomycosis was more common in toenails than in fingernails, while onychomycosis caused by yeast had a similar frequency in both toenails and fingernails. Among the species identified, Candida albicans was responsible for 492 cases (38.4%) of onychomycosis, Trichophyton rubrum was found in 327 cases (25.6%) and Trichophyton mentagrophytes in 258 cases (20.1%). Other fungi isolated from nail infections included Aspergillus sp., Trichosporon sp., Geotrichum sp. and Fusarium sp. In our study, yeast of the genus Candida were the dominant cause of onychomycosis in women and dermatophytes were the principal cause of this condition in men.     

Onychomycosis in patients with chronic leg ulcer and toenail abnormalities

Nails have a limited number of reactive patterns to disease. Accordingly, toenail changes of different etiologies may mimic onychomycosis.

OBJECTIVE

To determine the prevalence of toenail onychomycosis among patients with leg ulcer and toenail abnormalities attending a dermatology clinic.

METHODS

A cross-sectional study was conducted through the analysis of clinical records and results of mycological examination.

RESULTS

A total of 81 patients were included, with a median age of 76.0 years. Most ulcers were of venous etiology, followed by those of mixed and arterial pathogenesis. The mycological evaluation confirmed the diagnosis of onychomycosis in 27.2% of the patients. The etiologic agent was a dermatophyte in 59.1% of isolates in nail samples, while Trichophyton interdigitale was the most frequent fungal species (40.9%).

CONCLUSIONS

Most toenail abnormalities in patients with chronic leg ulcer were not onychomycosis. This study highlights the importance of systematic mycological examination in these patients, in order to avoid overtreatment with systemic antifungals, unnecessary costs and side effects.     

浙北地区334例甲真菌病真菌培养结果分析

目的：明确浙北地区甲真菌病的致病菌菌种分布特点。方法：对2016年真菌镜检阳性的1007例标本进行致病菌的分离培养和菌种鉴定。结果： 334例标本培养阳性,阳性率33.17%。皮肤癣菌148例,其中红色毛癣菌最多（136例）;酵母菌108例,其中白色念珠菌最多（35例）;霉菌78例,其中曲霉属最多（49例）。<55岁患者以皮肤癣菌感染为主,>55岁患者以酵母菌感染为主;52.34%指甲致病菌培养酵母菌阳性,58.74%趾甲致病菌培养皮肤癣菌阳性。结论：本研究中甲真菌病患者病原菌主要为皮肤癣菌和酵母菌,菌种分布与年龄和部位可能有关。