Onychomycosis due to opportunistic molds

BACKGROUND:

Onychomycosis are caused by dermatophytes and Candida, but rarely by non- dermatophyte molds. These opportunistic agents are filamentous fungi found as soil and plant pathogens.

OBJECTIVES:

To determine the frequency of opportunistic molds in onychomycosis.

METHODS:

A retrospective analysis of 4,220 cases with onychomycosis, diagnosed in a 39-month period at the Institute of Dermatology and Skin surgery "Prof. Dr. Fernando A. Cordero C." in Guatemala City, and confirmed with a positive KOH test and culture.

RESULTS:

32 cases (0.76%) of onychomycosis caused by opportunistic molds were confirmed. The most affected age group ranged from 41 to 65 years (15 patients, 46.9%) and females were more commonly affected (21 cases, 65.6%) than males. Lateral and distal subungual onychomycosis (OSD-L) was detected in 20 cases (62.5%). The microscopic examination with KOH showed filaments in 19 cases (59.4%), dermatophytoma in 9 cases (28.1%), spores in 2 cases (6.25%), and filaments and spores in 2 cases (6.25%). Etiologic agents: Aspergillus sp., 11 cases (34.4%); Scopulariopsis brevicaulis, 8 cases (25.0%); Cladosporium sp., 3 cases (9.4%); Acremonium sp., 2 cases (6.25%); Paecilomyces sp., 2 cases (6.25%); Tritirachium oryzae, 2 cases (6.25%); Fusarium sp., Phialophora sp., Rhizopus sp. and Alternaria alternate, 1 case (3.1%) each.

CONCLUSIONS:

We found onychomycosis by opportunistic molds in 0.76% of the cases and DLSO was present in 62.5%. The most frequent isolated etiological agents were: Aspergillus sp. and Scopulariopsis brevicaulis.     

涎沫念珠菌引起的甲真菌病2例

报道2例涎沫念珠菌引起的甲真菌病,均为女性（31岁和39岁）,临床表现类似,均为手指甲的远侧甲下甲真菌病伴甲分离,真菌直接镜检见芽孢和菌丝。     

甲真菌病分离菌株体外角蛋白酶活性的测定

目的对甲真菌病常见分离菌株进行体外降解角蛋白能力的比较,以初步探讨该病的临床表现与角蛋白酶的相关性。方法角蛋白酶的诱导培养基为含甲培养基,测定的底物为keratin-azure,以A595nm值衡量角蛋白酶的活性。结果①皮肤癣菌与非皮肤癣菌的角蛋白酶活性无显著性差异(P=0.12);②红色毛癣菌角蛋白酶活性显著高于其他受试真菌(P<0.001);③不同SCIO积分段的甲真菌病红色毛癣菌临床分离株角蛋白酶活性的差异无显著性(P=0.68)。结论甲真菌病的发病与角蛋白酶有一定相关性,但仅用角蛋白酶尚不能完全解释该病的发病机制。     

Onychomycosis in Children: An Experience of 59 Cases

Background

Although tinea unguium in children has been studied in the past, no specific etiological agents of onychomycosis in children has been reported in Korea.

Objective

The purpose of this study was to investigate onychomycosis in Korean children.

Methods

We reviewed fifty nine patients with onychomycosis in children (0~18 years of age) who presented during the ten-year period between 1999 and 2009. Etiological agents were identified by cultures on Sabouraud''s dextrose agar with and without cycloheximide. An isolated colony of yeasts was considered as pathogens if the same fungal element was identified at initial direct microscopy and in specimen-yielding cultures at a follow-up visit.

Results

Onychomycosis in children represented 2.3% of all onychomycosis. Of the 59 pediatric patients with onychomycosis, 66.1% had toenail onychomycosis with the rest (33.9%) having fingernail onychomycosis. The male-to-female ratio was 1.95:1. Fourteen (23.7%) children had concomitant tinea pedis infection, and tinea pedis or onychomycosis was also found in eight of the parents (13.6%). Distal and lateral subungual onychomycosis was the most common (62.7%) clinical type. In toenails, Trichophyton rubrum was the most common etiological agent (51.3%), followed by Candida albicans (10.2%), C. parapsilosis (5.1%), C. tropicalis (2.6%), and C. guilliermondii (2.6%). In fingernails, C. albicans was the most common isolated pathogen (50.0%), followed by T. rubrum (10.0%), C. parapsilosis (10.0%), and C. glabrata (5.0%).

Conclusion

Because of the increase in pediatric onychomycosis, we suggest the need for a careful mycological examination of children who are diagnosed with onychomycosis.     

Fingernail Onychomycosis Due to Aspergillus 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 {"type":"entrez-nucleotide","attrs":{"text":"AY373852","term_id":"34809332","term_text":"AY373852"}}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.     

Onychomycosis: strategies to improve efficacy and reduce recurrence

Fungal infections may be difficult to treat for several reasons. It is important to obtain the correct diagnosis, and select the appropriate antifungal agent and route. General considerations that may be associated with recurrent infections are, a genetic predisposition and suboptimal bioavailability of drug, resulting in insufficient concentration at the target site. The aetiologic organism, the severity of disease, other coexisting diseases, concomitant drug intake, and the presence of fungal infection at other sites are some factors that determine the choice of antifungal therapy and its route of administration, oral vs. topical lacquer. Local factors such as the thickness of the nail, presence of lateral onychomycosis, longitudinal spike, dermatophytoma and severe onycholysis are some factors that may determine the choice of secondary measures such as mechanical or topical treatment. Booster or supplemental therapy may be of benefit when the response to initial treatment is poorer than expected and unlikely to result in complete response. Steps should be taken to reduce the possibility of recurrence once cure has been achieved.     

甲真菌病患者生活质量调查研究

目的 调查甲真菌病对患者生活质量的影响.方法 采用国际通用的半定势调查问卷,由皮肤科医师对确诊为甲真菌病的患者逐项询问.在全国421家医院进行.结果 共调查55602例甲真菌病患者,其中有效病例47638例,男22616例(47.5%),女25022例(52.5%).指甲真菌病为55.4%,趾甲真菌病为70.6%,指、趾甲共患率26%.甲真菌病对生活质量有显著的负面影响,85.3%的患者主观感到存在健康问题,83.1%的患者具有情感受影响,79.5%出现思维受影响,而社交障碍达到73.3%.甲真菌病对14～30岁年龄组、病程在6个月至1年之间患者的生活质量影响最显著,对女性患者生活质量(主观感受、情感受影响、思维受影响和社交障碍)的影响显著大于男性(P<0.001).感染指/趾甲数目越多,患者生活质量的影响越大.结论 甲真菌病不仅是一个病理和美容问题,还导致患者的生活质量降低,表现为患者对自身健康状况评价降低,影响患者情感、思维并出现社交障碍.     

甲真菌病甲板真菌镜检方法的探讨

目的探索一种操作简便、结果可靠的甲真菌病检验方法。方法对341例拟诊甲真菌病的患者分别采用KOH直接镜检法和浸软法进行病损指、趾甲的真菌镜检。取病损指、趾甲末端标本少许放入标本小碗中,加入10%的KOH后加盖浸泡至病甲标本完全浸透软化呈蛋白胨状,取标本放在载玻片上并将标本压平、压薄呈云雾状或毛玻璃状,在普通光学显微镜下检查真菌成分。结果KOH直接镜检法和浸软法的真菌检出率分别为34.90%和100.00%。结论浸软法真菌镜检是一种适合临床的、检出率较高的甲真菌病诊断方法。     

穿高跟鞋对女性趾甲真菌病的影响

目的 观察穿高跟鞋对女性趾甲真菌病的影响。方法 依据 条件选择138例有穿高跟鞋经历的女性趾甲真菌病患者,分别观察其发病时间、病甲损害程度与穿高跟鞋的关系。结果 ①年穿高跟鞋时间与甲真菌病发病呈正相关关系。②年穿高跟鞋时间延长,病甲数量赵多,病甲受损越严重。③趾甲真菌病以远端甲下型多见。结论 穿高跟鞋对女性趾甲真菌病发病有一定影响。     

广州地区甲真菌病病原菌流行病学的多中心研究

目的：了解近年来广州地区甲真菌病病原菌的种类和构成情况,获取流行病学的资料。方法：我们于1997年11月-1998年11月采取多中心研究的方式组织了广州地区不同区域的6家主要医院对有典型临床表现且真菌镜检阳性的1045例甲真菌病患者进行了真菌分离培养。结果：共培养出致病真菌915株,构成比为皮肤癣菌占64.81%（593/915）,其中红色毛癣菌占51.48%（471/915）,须癣毛癣菌占10.49%(96/915);酵母菌占28.09%(257/915),其中以白念珠菌最常见为13.01%(119/915）;霉菌占7.1%(96/915）,主要是曲霉和青霉。混合感染指趾甲占6.73%(57/847）。结论：近年来广州地区的甲真菌病的病原菌为皮肤癣菌、酵母菌和霉菌,其中以红色毛癣菌和白念珠菌最常见。     

甲真菌病危险因素的病例对照研究

目的探讨甲真菌病发病可能的危险因素。方法对175例甲真菌病患者进行1∶1配比的病例对照研究,采用单因素和多因素的条件Logistic回归分析。结果甲真菌病发病与下列9个因素密切相关:足癣(OR=10.502),手癣(OR=9.991),长期用广谱抗生素、皮质类固醇、免疫抑制剂治疗(OR=7.180),潮湿的生活或工作环境(OR=5.167),家族史(OR=2.687),甲外伤(OR=2.668),公用拖鞋、擦脚布、脚盆(OR=2.081),手足多汗(OR=1.955)、勤换鞋袜(OR=0.324)。结论足癣,手癣,长期用广谱抗生素、皮质类固醇、免疫抑制剂治疗,潮湿的生活或工作环境,家族史,甲外伤,公用拖鞋、擦脚布、脚盆,手足多汗是甲真菌病发病的危险因素,勤换鞋袜为甲真菌病的保护因素。     

多点培养法分离培养150例甲真菌病病原菌

目的 比较多点培养法和常规培养法在甲真菌病病原菌分离中的差别;获取甲真菌病病原菌流行病学资料.方法 150例病甲标本同时采用多点培养法和常规培养法分离菌种并作菌种鉴定.结果 多点培养法与常规培养法的培养阳性率和菌种构成差异有统计学意义(P<0.05).女性、手指甲、近端甲下型和低临床指数评分者病原菌以酵母菌为主;男性、足趾甲、远端侧位甲下型和高临床指数评分者病原菌中皮肤癣菌占优势.结论 多点培养法阳性率高,能发现更多酵母菌.     

Onychomycosis Caused by Chaetomium globosum

Onychomycosis is usually caused by dermatophytes, but some nondermatophytic molds and yeasts are also associated with invasion of nails. The genus Chaetomium is a dematiaceous nondermatophytic mold found in soil and plant debris as a saprophytic fungus. We report the first Korean case of onychomycosis caused by Chaetomium globosum in a 35-year-old male. The patient showed brownish-yellow discoloration and subungual hyperkeratosis on the right toenails (1st and 5th) and left toenails (1st and 4th). Direct microscopic examination of scraping on the potassium hydroxide preparation revealed septate hyphae and repeated cultures on Sabouraud''s dextrose agar (SDA) without cycloheximide slants showed the same fast-growing colonies, which were initially velvety white then turned to dark gray to brown. However, there was no growth of colony on SDA with cycloheximide slants. Brown-colored septated hyphae, perithecia and ascospores were shown in the slide culture. The DNA sequence of internal transcribed spacer region of the clinical sample was a 100% match to that of C. globosum strain ATCC 6205 (GenBank accession number {"type":"entrez-nucleotide","attrs":{"text":"EF524036.1","term_id":"146706231","term_text":"EF524036.1"}}EF524036.1). We confirmed C. globosum by KOH mount, colony, and light microscopic morphology and DNA sequence analysis. The patient was treated with 250 mg oral terbinafine daily and topical amorolfine 5% nail lacquer for 3 months.     

广州市185株甲真菌病病原菌构成分析

目的：了解广州市甲真菌病病原菌的构成分布情况。方法：对2008年3月至2009年10月我科实验室185例甲屑培养阳性的病例及其病原菌构成比例进行回顾性分析。结果：185株菌中酵母菌占61.5%,其中光滑念珠菌最多见（19.0%）,次为近平滑念珠菌（15.1%）;皮肤癣菌占35.2%,主要以红色毛癣菌为主（17.8%）,须癣毛癣菌次之（16.2%）;非皮肤癣菌霉菌占4.8%,以黑曲霉为主（3.3%）。结论：本研究显示广州市甲真菌病病原菌中主要致病菌为酵母菌,其次为皮肤癣菌。     

甲真菌病病甲形态学特征与致病真菌种类关系的研究

目的 研究甲真菌病病甲的形态学特征与致病真菌类型或菌种之间的关系。为临床快速推断致病真菌建立依据。方法 ３６０例门诊甲真菌病患者,观察临床分型和特征,牙钻机取材,镜检和培养确定致病真菌。结果 经培养确定致病真菌感染者１６５例,其中皮肤癣菌占８０．０％,酵母菌１３．９％,霉菌２．４％,混合感染３．６％。结论 根据甲真菌病病甲的形态学特征,可以大致推断致病菌的种类。     

青岛地区甲真菌病流行病学分析

目的了解青岛地区甲真菌病病原菌的种类和构成情况,分析其流行病学特点。方法于2007年4月～2008年4月对青岛市立医院、青岛市中心医院、青岛大学医学院附属医院和海慈医院皮肤科就诊的直接镜检阳性的甲真菌病患者613例的临床资料进行分析,并进行真菌分离培养、鉴定菌种。结果613例患者中男228例,女385例;且以26～50岁者居多,占72.59%;职业以工人居多(141例),其次为家务劳动者(98例)、退休职工(75例)等。分型:远端侧位甲下型甲真菌病(DLSO)329(53.67%)例,全甲损毁型甲真菌病(TDO)152(24.80%)例,近端侧位甲下型甲真菌病(PSO)87(14.19%)例,白色浅表型甲真菌病(SWO)45(7.34%)例。真菌培养阳性470例,阳性率76.67%,共分离出481株真菌,其中皮肤癣菌386(80.25%)株,酵母菌75(15.59%)株,霉菌20(4.16%)株。结论青岛地区甲真菌病病原菌以皮肤癣菌为主,其次为酵母菌和霉菌,红色毛癣菌是最常见的皮肤癣菌,临床以DLSO型居多,其他依次是TDO、PSO和SWO。以26～50岁年龄段最多见,女性居多。     

深圳地区甲真菌病病原菌流行病学的多中心研究

目的 了解深圳地区最近4年甲真菌病病原菌的种类和构成,发现流行病学特点。方法 以多中心研究方式选取深圳地区6家不同区域的主要医院,选取临床表现典型、真菌镜检阳性的1162例甲真菌病患者进行真菌分离培养。结果共培养出致病真菌553株。皮肤癣菌占68.53％,以红色毛癣菌为主占52.26％,其次是须癣毛癣菌占11.21％;酵母菌占25.68％,其中以白念珠菌最多占9.22％;霉菌占5.79％,主要是曲霉属和青霉属;混合感染占4.30％。结论深圳地区最近4年甲真菌病病原菌为皮肤癣菌、酵母菌和霉菌。红色毛癣菌和白念珠菌所占比例最高。     

复方甲癣净治疗甲癣临床观察

目的 评价甲癣净治疗甲癣的疗效及安全性。方法 将90例甲癣患者分为3组,治疗1组和治疗2组分别甲癣净外用,对照组予硝酸舍他康唑乳膏外用,疗程均为12周,疗程结束后评价临床疗效及安全性。结果 治疗1组有效率83.33%,治疗2组90.00%,对照组66.67%,治疗组疗效明显优于对照组(P<0.05),且无不良反应。结论 甲癣净治疗甲癣疗效好,且比较安全。     

甲真菌病临床评分指数指导特比萘芬连续疗法治疗甲真菌病

目的 制定甲真菌病临床评分指数(SCIO),并观察其指导特比萘芬连续疗法治疗甲真菌病的疗效及安全性。方法 根据影响甲真菌病疗效的主要因素;甲真菌病的病情和甲的生长速度,制定SCIO。计算99例甲真菌病患者靶甲的SCIO积分,并予相应疗程的特比萘芬口服治疗。结果 94例患者,停药时(近期)临床痊愈率15.96％,有效率51.06％,真菌学治愈率72.34％;停药后3个月(中期)临床痊愈率79.79％,有效率91.49％,真菌学治愈率89.36％。不良反应发生率为16.16％。结论 SCIO具有一定的科学性和实用性,指导特比萘芬连续疗法治疗甲真菌病疗效良好。     

临床疑诊甲真菌病1036例真菌学分析

目的　了解近 5年本院甲真菌病病原菌的种类和构成 ,观察流行病学特点。方法　对近 5年临床疑诊的10 3 6例甲真菌病患者的真菌学实验室检查情况进行系统分析、总结。结果　共培养出真菌 63 1株 ,其中酵母菌占49.60 % ,以克柔念珠菌、红酵母、近平滑念珠菌为主 ;皮肤癣菌占 2 1.71% ,主要菌种为须癣毛癣菌和红色毛癣菌 ;其他丝状真菌占 19.81% ,主要菌种为曲霉和青霉 ;污染真菌占 8.87%。结论　本院近 5年甲真菌病患者病原菌依次为酵母菌、皮肤癣菌、其他丝状真菌 ,排前 5位的真菌分别是须癣毛癣菌 (11.2 5 % ) ,克柔念珠菌 (10 .14 % ) ,红酵母 (9.98% ) ,红色毛癣菌 (9.5 1% ) ,曲霉 (8.87% )。