Onychomycosis in Adana, Turkey: a 5-year study

BACKGROUND: Onychomycosis results from invasion of the nail plate by dermatophytes, yeasts or mould species of fungi. This report documents the etiological agents of onychomycosis in Adana, Turkey. METHODS: Results of mycological tests of nail clippings or subungal scrapings collected in the period between 1998 and 2002 were analyzed. Both the direct microscopy and the cultures of the nail material were performed to identify the causative agent. RESULTS: Out of a total of 388 cases examined, finger (12.4%) and toenail (87.6%) involvement, 155 (39.9%), were mycologically proven cases of onychomycosis (15 finger, 140 toenail). Among the 98 specimens from positive fungal cultures, dermatophytes were isolated in 74 (75.5%), and yeasts in 24 (24.5%). Trichophyton rubrum was the most common causative agent (48.0%), followed by T. mentagophytes var. interdigitale (26.6%), Candida tropicalis (11.2%), C. albicans (9.2%), C. glabrata (2.0%), C. krusei (2.0%) and Epidermophyton floccosum (1.0%). CONCLUSIONS: Dermatophyte fungi, especially T. rubrum and T. mentagrophytes var. interdigitale, were responsible for most of the infections.     

Fungal flora in mycoses among the population of the south-eastern Poland 1978-1988

In the years 1978-1988 a group of 2257 subjects was examined for the presence of fungal infection. In 785 cases positive results of cultures were obtained yielding 468 dermatophytes (60.1%) and 317 yeast-like fungi (39.9%). The most frequently isolated fungi were: Candida albicans (27.3%), Trichophyton mentagrophytes v. interdigitale (27.0%) and Trichophyton rubrum (20.6%). In the subgroup of dermatophytes anthropophilic fungi accounted for 87.5%.     

试管法检测氟康唑和特比萘芬对常见致病性真菌的敏感性观察

目的(1)检测氟康唑和特比萘芬对临床常见真菌的敏感性;(2)探讨并建立皮肤癣菌的标准药敏试验方法.方法以NCCLS M27-A方案试管法为基础,检测氟康唑和特比萘芬对24株念珠菌和20株皮肤癣菌的敏感性.结果氟康唑对大部分念珠菌的敏感性较好,对皮肤癣菌的敏感性较差,而特比萘芬对皮肤癣菌高度敏感.结论NCCLS M27-A方案具有重复性好、一致性高的特点,可应用于酵母菌和皮肤癣菌的体外药敏实验.     

Antifungal susceptibility patterns of yeasts and filamentous fungi isolated from nail infection

Background Onychomycosis is the nail infection caused by a wide spectrum of fungi species, including yeasts, dermatophytes and filamentous fungi non‐dermatophytes (FFND). This fungal infection represents an important medical problem because it involves the patient′s life quality. Objective The aim was to isolate and identify the fungal agents of onychomycosis, and to determine the in vitro susceptibility to antifungal agents. Methods During the period of March 2008 to March 2009, 114 patients clinically suspected of having onychomycosis were examined. Demographic data, mainly age and gender were obtained from each patient. The nail samples collected (136) were submitted to direct examination with potassium hydroxide 20% and grown on Sabouraud dextrose agar. The in vitro antifungal susceptibility testing was performed according to the method of broth microdilution, recommended by the Clinical Laboratory Standards Institute (CLSI). Results Onychomycosis was observed in 95 (83.3%) patients, including 16 men (16.8%) and 79 women (83.2%), with mean age of 48.1 years. Candida parapsilosis, Trichophyton rubrum and Fusarium spp were the fungi most frequently isolated. The most of the isolated yeasts showed susceptibility to antifungal agents studied. Among filamentous fungi, high MIC values to itraconazole were found for T. rubrum and T. mentagrophytes, while Fusarium spp showed decreased susceptibility to itraconazole and voriconazole. Conclusion C. parapsilosis was the most common fungal species isolated from patients with onychomycosis. The different response obtained by in vitro susceptibility testing to drugs shows the importance of these methods to assist clinicians in choosing the best therapeutic option.     

中国致病皮肤真菌流行病学研究——1986、1996、2006年

目的:对中国8大区1986、1996及2006年作全年临床所培养阳性的致病真菌作动态流行病学调查。方法:对全国8个大区2,5个省市3,4个单位所收集的1986年、1996年及2006年全年按统一方法培养出的致病真菌进行分析。结果:1986年共分离9 096株,其中皮癣菌有7 834株;1996年共收集19 009株,其中皮癣菌有9 570株;2006年共33 022株,其中皮癣菌有12 221株,共29 725株。在这每隔10年的调查分析显示:1986年1、996年度均以红色毛癣菌为首位菌,2006年则以念珠菌尤以白念珠菌为首位。总的趋势是皮癣菌逐渐减少而念珠菌和霉菌逐渐增多,1986年共分离计27个属、种;1996年共分出108个,而2006年则分离到117个属种病原真菌。结论:通过1986年1、996年、2006年前后21年每十年度调查全年结果,提示我国致病真菌时有变动。致病真菌均以红色毛癣菌居首,但其与念珠菌和霉菌的比率正逐渐降低,且在全国东、南、西、北、中八个大区之间亦互有变动,应引起足够重视。     

Species distribution and frequency of isolation of yeasts and dermatophytes from toe webs of diabetic patients

The paper identifies fungal species, looking at the incidence of fungal isolation and risk factors influencing the development of fungal infection and colonization of interdigital spaces of the feet in 509 diabetic outpatients. Using standard mycologic diagnostic methods, fungi were detected in toe webs of 122 (24%) diabetic patients. The finding of fungi was twice as common in interdigital spaces of one (85/16.7% of the patients) than both feet (37/7.3% of the patients). Yeasts were the most common isolates (95/18.7% of the patients), followed by dermatophytic moulds (24/4.7% of the patients), whereas coexistence of yeasts and dermatophytes was the most infrequent finding (3/0.6% of the patients). From toe webs, 24 fungal species, 21 yeast species belonging to nine genera (Candida, Rhodotorula, Cryptococcus, Trichosporon, Saccharomyces, Blastoschizomyces, Geotrichum, Debaryomyces, and Ustilago) as well as three species of dermatophytes of the genera Trichophyton and Epidermophyton were isolated. The most frequently isolated fungi were Candida parapsilosis (59/11.6% of the patients) and Trichophyton mentagrophytes (16/3.1% of the patients). Although there was no correlation between the incidence of toe web space colonization with yeasts and dermatophytosis with the criteria of patient sex and age, and duration of diabetes, the difference in the incidence according to type of diabetes was statistically significant. In non insulin dependent diabetes mellitus patients, the incidence of fungal isolation from toe webs was statistically significantly higher (30.1%) than in insulin dependent diabetes mellitus patients (19.8%).     

武汉地区甲真菌病的致病菌及菌种变迁分析

目的了解1999年1月~2005年12月武汉地区甲真菌病的致病菌种分布及变迁情况。方法对1999年1月~2005年12月甲真菌病患者的真菌培养资料1237例进行系统分析总结。结果真菌培养阳性895例,阳性率72.4%。致病菌中,皮肤癣菌559株(61.1%),酵母菌287株(31.4%),霉菌69株(7.5%)。皮肤癣菌中红色毛癣菌占95.0%(531/559),酵母菌中念珠菌属占71.8%(206/287),霉菌中曲霉属占53.6%(37/69);混合感染20例占2.2%。结论武汉地区甲真菌病的致病菌中以皮肤癣菌为主,其中红色毛癣菌为优势菌种,但是占致病菌的比例下降;酵母菌属和念珠菌属的比例上升;霉菌中以曲霉属和镰刀菌属为主。甲真菌病混合感染的比例上升。     

Incidence and enzymatic properties of yeast-like fungi. Examination of workers of various departments of the District Meat-Processing Industry in Bia?ystok

In a group of 111 workers of the District Meat Processing Plant clinical examination of the skin and cultures for Candida organisms were performed. The proteolytic and lipolytic properties of these fungi were analysed. From the interdigital spaces of hands 42 strains were isolated, with the species Candida albicans accounting for 13.5% of the strains (15). Case history and the character of skin lesions on the hands and forearms suggested that they were caused by skin contact with meat and internal organs producing the so called "gut eczema" while Candida was secondary agent causing exacerbation of skin changes.     

Yeasts of the genus Candida are the dominant cause of onychomycosis in Libyan women but not men: results of a 2-year surveillance study

BACKGROUND: The reported frequency of recovery of fungi from infected nails varies according to the geographical area. OBJECTIVES: To establish the nature of the causal agents in a sample of the Libyan population presenting with suspected onychomycosis. METHODS: Samples were taken from the infected fingernails of 648 patients attending the Tripoli Medical Centre. RESULTS: Samples from 500 patients proved positive for fungi following culturing, while 476 were potassium hydroxide and culture positive. Of the culture-positive samples, yeasts of the genus Candida (C. albicans, C. parapsilosis, C. glabrata, C. guillermondii and C. tropicalis) were the dominant cause of this condition in women (417 of 434, 96%) but were responsible for only a minority of cases in men (three of 66, 5%). In contrast, dermatophytes (Trichophyton violaceum, T. rubrum, T. mentagrophytes and Microsporum canis) were responsible for this condition in the majority of cases in men (53 of 66, 80%) but only 3% (15 of 434) of cases in women. The mould Aspergillus nidulans was isolated from the nails of 10 (15%) men and two (0.5%) women. CONCLUSIONS: The data obtained in this study reveal an almost total separation of the aetiological agents responsible for onychomycosis based on gender.     

Geschichte des Lehrbuches

Onychomycosis describes a chronic fungal infection of the nails most frequently caused by dermatophytes, primarily Trichophyton rubrum. In addition, yeasts (e. g. Candida parapsilosis), more rarely molds (Scopulariopsis brevicaulis), play a role as causative agents of onychomycosis. However, in every case it has to be decided if these yeasts and molds are contaminants, or if they are growing secondarily on pathological altered nails. The point prevalence of onychomycosis in Germany is 12.4%, as demonstrated within the "Foot-Check-Study", which was a part of the European Achilles project. Although, onychomycosis is rarely diagnosed in children and teens, now an increase of fungal nail infections has been observed in childhood. More and more, diabetes mellitus becomes important as significant disposing factor both for tinea pedis and onychomycosis. By implication, the onychomycosis represents an independent and important predictor for development of diabetic foot syndrome and foot ulcer. When considering onychomycosis, a number of infectious and non-infectious nail changes must be excluded. While psoriasis of the nails does not represent a specific risk factor for onychomycosis, yeasts and molds are increasing isolated from patients with psoriatic nail involvement. In most cases this represents secondary growth of fungi on psoriatic nails. Recently, stigmatization and impairment of quality of life due to the onychomycosis has been proven.     

Characteristics of superficial mycoses in Malta

BACKGROUND: A study was conducted to determine the chief agents of superficial mycoses in Malta. Data were collected over a 5-year period from mycologic investigations carried out on all dermatologic specimens sent to the Mycology Laboratory at St. Luke's Hospital in Malta. METHODS: In the period between January 1995 and December 1999, a total of 1271 specimens from skin, nails, or hair were collected from 1200 clinically suspected cases of dermatomycoses. RESULTS: The fungi cultivated included dermatophytes (n = 371), yeasts (n = 33), and nondermatophyte filamentous fungi (n = 12). Trichophyton rubrum (n = 121) was the most prevalent, followed by Microsporum canis (n = 109), T. mentagrophytes (n = 80), M. gypseum (n = 27), Epidermophyton floccosum (n = 17), T. soudanense (n = 10), T. tonsurans (n = 2), T. verrucosum (n = 2), M. persicolor (n = 1), and T. violaceum (n = 1). Candida species were also cultivated, with C. parapsilosis (n = 14) being the most common, followed by C. albicans (n = 12) and C. tropicalis (n = 6). Nondermatophyte filamentous fungi were isolated from nail specimens only. CONCLUSIONS: In this study, superficial fungal infections were reported more commonly in female (n = 207) than in male (n = 182) patients. M. canis was the chief agent of tinea capitis and tinea corporis, whilst T. rubrum was the main causative agent of tinea pedis, tinea manuum, and tinea unguium. Onychomycosis due to Candida species was more common in female than in male patients.     

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。     

儿童、青少年甲真菌病临床特点及致病菌分析

目的:确定儿童、青少年甲真菌病的主要临床特征和致病菌的种类。方法:回顾性分析220例(年龄18岁)甲真菌病患者的临床特征和致病菌种类。结果:220例患者中男110例,女100例,年龄3个月~17岁,儿童、青少年甲真菌病最常见的感染类型是远端侧缘甲下型(50.45%)和白色浅表型(42.27%)。趾甲较指甲感染常见,共分离出病原菌228株(混合感染8例),其中皮肤癣菌199株(87.28%)、念珠菌属27株(11.84%)、曲霉菌属2株(0.88%)。在199株皮肤癣菌属中红色毛癣菌192株(96.48%),趾甲真菌病多为红色毛癣菌,指甲多为念珠菌属。结论:儿童、青少年甲真菌病中最常见的病原菌为红色毛癣菌,其次为念珠菌属。     

Ringworm in the South-West of England, 1960–1970, with special reference to onychomycosis

The numbers of dermatophytes isolated from specimens sent to a mycological diagnostic service in the West of England from i960 to 1970 are reported. An increasing rate of failure to culture from microscopically positive specimens is noted. One reason for this was the large number of nail clippings sent in unaccompanied by scrapings from skin lesions. The cultural failure rate from nail clippings makes the diagnosis of the causal fungi in onychomycosis very unsatisfactory. For treatment purposes, means of deducing the nature of these uncultured fungi by combining clinical and laboratory observations are proposed. It is suggested that two features of mycological diagnostic services—(a) failure to culture from a proportion of microscopically positive specimens, and (b) the fact that only the more severe, widespread and recalcitrant lesions are usually seen by dermatologists—result in a very misleading picture if these figures are used to assess the incidence of the various dermatophyte species in the general population.     

Skin fungal biocontamination and the skin hydrogel pad test

Previous observations have revealed that environmental nondermatophyte molds (NDM) can grow inside specific hydrogel pads (LaserAid). Some of these NDM might be responsible for superficial and invasive mycoses as well as for allergic respiratory and cutaneous disorders. The load of NDM propagules in the environment is considered to be an important risk factor for all these diseases. It is postulated that the quantification of the responsible fungi deposited at the skin surface may be an indicator of a recent exposure to environmental fungi. The aim of the present study was to assess using the LaserAid hydrogel pads, the density of living NDM adhering to the skin surface of healthy subjects. Sterile hydrogel pads were applied in a repeat procedure onto the normal-looking skin of the palms and face of 35 healthcare workers who were active in low exposure areas. Similar samplings were performed after washing the skin with a regular skin cleanser, or after applying an alcohol solution or a povidone iodine solution. As controls, 20 sterile pads were exposed for a few minutes to ambient air of the laboratory without any contact with the skin. Each of these samples was stored for 2 weeks at room temperature in a clean protected environment. After that period, visual inspection of the pads was followed by microscopic examination of PAS-stained 6 microm-thick sections. In addition, mycological cultures were performed from pieces of the pads deposited onto Sabouraud agar plates. While 19/20 air-exposed samples were not contaminated by environmental air-borne fungi, 61/70 of the initial skin samplings and 6/70 of the repeat skin samplings showed foci of fungal colonization confirmed by microscopic examination. No specific differences were disclosed between the face and palm samplings. Cultures revealed the presence of NDM in the majority (64/67) of the colonized pads, and a few Candida albicans contaminations (3/67) were also disclosed. The cleansing with a non-antimicrobial product as well as disinfecting procedures performed before sampling markedly decreased the mycoflora without, however, clearing the skin of NDM and yeasts. In conclusion, the hydrogel pad procedure brings information about potential environmental skin contamination by NDM and commensal yeasts. The regular cleansing and disinfecting procedures do not eradicate these fungi from the skin surface.     

湖南郴州地区某医院甲真菌病305例临床病原菌分析

目的了解湖南省郴州地区甲真菌病的临床分类、菌种构成,探讨其防治对策。方法对305例镜检阳性的甲真菌病患者病甲进行真菌培养、鉴定和临床分析。结果 305例患者中真菌培养阳性257例,阳性率84.26%,共分离出267株真菌,其中皮肤癣菌143株(53.56%),酵母菌106株(39.70%),霉菌18株(6.74%)。143株皮肤癣菌中,亲人和亲动物性小孢子菌35株(24.48%)。305例患者中临床类型以远端侧位甲下型甲真菌病(DLSO)最为常见。结论湖南省郴州地区甲真菌病种类以DLSO型居多。病原菌以皮肤癣菌为主,酵母菌次之,霉菌最少。亲人和亲动物性小孢子菌分离率较高,应引起重视。     

APPLICATION OF POLYMERASE CHAIN REACTION (PCR) AND PCR BASED RESTRICTION FRAGMENT LENGTH POLYMORPHISM FOR DETECTION AND IDENTIFICATION OF DERMATOPHYTES FROM DERMATOLOGICAL SPECIMENS

Objective:

To develop and optimize polymerase chain reaction-based restriction fragment length polymorphism (PCR-RFLP) targeting 18S rDNA and internal transcribed spacer (ITS) region of fungi for rapid detection and identification of dermatophytes.

Materials and Methods:

Two PCR-RFLP methods targeting 18S rDNA and ITS regions of fungi were optimized using standard and laboratory isolates of dermatophytes and other fungi. Sixty-eight dermatological clinical specimens (nail clippings (56), material obtained from blisters (8), hair root (2), scraping from scaly plaque of foot (1) and skin scraping (1) collected by the dermatologist were subjected to both the optimized PCR-RFLP and conventional mycological (smear and culture) methods.

Results:

PCRs targeting 18S rDNA and the ITS region were sensitive to detect 10 picograms and 1 femtogram of T. rubrum DNA, respectively. PCR targeting 18S rDNA was specific for dermatophytes and subsequent RFLP identified them to species level. PCR-RFLP targeting the ITS region differentiated dermatophytes from other fungi with identification to species level. Among the 68 clinical specimens tested, both PCR-RFLP methods revealed the presence of dermatophytes in 27 cases (39.7%), whereas culture revealed the same only in 2 cases (7.40%), increasing the clinical sensitivity by 32.3%. Among 20 smear positive specimens, both PCR-RFLP methods detected dermatophytes in 12 (17.6%). Both the methods detected the presence of dermatophytes in 13 (19.11%) smear and culture negative specimens, increasing the clinical sensitivity by 36.1%.

Conclusion:

PCR-RFLP methods targeting 18S rDNA and the ITS regions of fungi were specific and highly sensitive for detection and speciation of dermatophytes.     

1229例甲真菌病致病菌分离培养结果分析

目的了解近5年来我科就诊患者甲真菌病病原菌的构成分布情况。方法对2006年5月-2010年12月来我科门诊就诊的有典型,临床表现且真菌镜检阳性的患者进行了致病菌的分离培养。结果1229例中,591例培养阳性,阳性率48．09％。其中皮肤癣茵311株（52．62％）,以红色毛癣菌为主,占50．08％,须癣毛癣菌与紫色毛癣菌合计占2．54％;酵母茵188株（31-81％）,克柔念珠茵为主,占16．92％,其次为光滑念珠菌5．58％,热带念珠菌和白念珠菌分别为3．89％和2．37％;霉菌92株（15．57％）,以曲霉为主,占10．15％,其次为青霉,占5．08％。结论在我科就诊患者的甲真菌病病原茵中,主要致病菌以皮肤癣茵为主,其次为酵母菌。本研究结果与该地区1980-1994年期间甲真菌病病原菌的构成存在差异,皮肤癣菌的比例有所下降,酵母菌和霉茵所占比例上升。     

Amorolfine spray in the treatment of foot mycoses (a dose-finding study)

Summary A total of 382 patients with foot mycosis were entered into a dose-finding study. Patients were randomly treated with amorolfine spray 0.5% or 2% (double-blind) or cream 0.5% (open; used as a reference agent). The spray or cream was applied once daily for 4 weeks on average. At screening, in 348 patients evaluable for efficacy, a total of 381 fungi were isolated: Trichopyton rubrum (196), T. mentagrophytes (73), other dermatophytes (17), Candida albicans (65), other yeasts (23), and moulds (7). In 33 patients the fungal infection was mixed. Two weeks after the end of treatment, the culture was negative in 94.1% and 97.4% of patients treated with 0.5% or 2% amorolfine spray, respectively. The difference was not statistically significant. In the 0.5% cream group the culture was negative in 86.6% of patients. Nine out of 380 patients evaluable for safety had local adverse events: four (3.2%) in each of the spray groups, and one (0.8%) in the cream group. The most common local adverse events in the patients treated with spray were a burning sensation and dryness of the skin. In conclusion, both spray concentrations were highly efficacious and well tolerated. Further studies should show if more widely spaced treatment with amorolfine spray is as effective as daily administration.     

Causative agents of onychomycosis — a retrospective study

Background: Dermatophytes, yeasts and moulds all are potential causative agents of onychomycosis.The aim of this study was to determine the percentage of cases of onychomycoses caused by each group. In addition, the responsible genus and species was identified for each nail infection. Patients and Methods: In a retrospective study performed at the Department of Dermatology of the Leipzig University, 5 077 nail samples from 4 177 patients – 2 240 women and 1 937 men – with a variety of nail changes – not just onychomycosis – were investigated. 75% were toenails, 23% fingernails, and 2% from both sites. Results: Both microscopic and/or cultural detection of fungi (dermatophytes, yeasts and moulds) were successful in 54% of samples.Causative fungal agents were: 68% dermatophytes, 29% yeast, and 3% moulds. The most frequently detected dermatophyte species were T. rubrum (91%), and T. mentagrophytes (7.7%).Among yeasts, C. parapsilosis (42%) was most common,followed by C. guilliermondii (20.1%), C. albicans (14.2%), and Trichosporon spp. (10%).Scopulariopsis brevicaularis (43%) was the most frequent mould. The percentage of mixed fungal infections was 22%. Conclusions: Dermatophytes, in particular T.rubrum, but also T. mentagrophytes, are the most frequently isolated causative agents in onychomycosis. In addition, yeasts may be isolated relatively frequently, while moulds are uncommon.