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Sample records for onychomycosis

  1. Onychomycosis. A Mexican survey.

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    Arenas, Roberto; Bonifaz, Alexandro; Padilla, Ma Carmen; Arce, Martín; Atoche, Carlos; Barba, José; Campos, Pablo; Fernández, Ramón; Mayorga, Jorge; Nazar, Dulce; Ocampo, Jorge

    2010-01-01

    Onychomycosis is a nail infection caused by dermatophytes, Candida and molds. We aimed to obtain an estimated frequency of onychomycosis in out-patients in private practice through a survey in ten representative cities of Mexico. 12,637 ambulatory patients voluntarily agreed to participate in this National Survey, answering 17 questions on onychomycosis, regardless if they had or did not have any clinical suspicion of onychomycosis. 53% of them were seen for the first time and their main complaint was not onychomycosis. The study was performed in the private offices of 300 physicians in different cities. 48% were clinically diagnosed with onychomycosis. Toenails were affected in 88%, fingernails in 5% and both in 7%. Onychomycosis was diagnosed more frequently in the nails of the first toes and of the thumbs. The main complaint was nail thickening and aesthetic changes. Other associated diseases were diabetes (22%) and arterial hypertension (21%). This survey showed the high frequency of onychomycosis. An intentional search with mycological confirmation is needed in out-patients attending general practice with other complaints, to detect undiagnosed cases.

  2. Nail clipping in onychomycosis*

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    Bertanha, Laura; Chiacchio, Nilton Di

    2016-01-01

    Onychomycosis is the most prevalent onychopathy and it requires a correct early diagnosis. Currently, the diagnostic gold standard is the association of direct mycological test with culture; however, it shows variable sensitivity. The histopathological examination of the distal nail plate, called clipping, has shown to be an adjuvant in diagnosing onychomycosis. This is an easy-to-perform, relatively cheap examination that is little dependent of the examiner, rapidly provides results, has high sensitivity, and for patients it is painless and harmless. PMID:27828655

  3. Onychomycosis due to opportunistic molds*

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    Martínez-Herrera, Erick Obed; Arroyo-Camarena,Stefanie; Tejada-García, Diana Luz; Porras-López, Carlos Francisco; Arenas, Roberto

    2015-01-01

    Abstract 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 w...

  4. Onychomycosis: Diagnosis and management

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    Archana Singal

    2011-01-01

    Full Text Available 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

  5. Plasma treatment of onychomycosis

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    Xiong, Zilan; Roe, Jeff; Grammer, Tim; Him, Yeon-Ho; Graves, David B.

    2015-09-01

    Onychomycosis or fungal infection of the toenail or fingernail is a common affliction. Approximately 10% of the world's adult population is estimated to suffer from onychomycosis. Current treatment options such as topical creams, oral drugs, or laser treatments are generally limited by a variety of problems. We present results for an alternative onychomycosis treatment scheme using atmospheric pressure cold air plasmas. Using thinned cow hoof as a model nail material, we tested the ability of various plasma sources to act through the model nail to eradicate either bacteria or fungus deposited on the opposite side. Following 20 minute exposure to a surface microdischarge (SMD) device operating in room air, we observed a ~ 2 log reduction of E. coli. A similar result was obtained against T. rubrum after 45 min plasma treatment. NOx species concentration penetrating through the model nail as well as uptake into the nail were measured as a function of nail thickness. We propose that these plasma-generated species, or perhaps their reaction products, are responsible for at least part of the observed anti-microbial effect. We also explore the use of ultraviolet light acting in synergy with plasma-generated chemical species.

  6. Onychomycosis due to opportunistic molds*

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    Martínez-Herrera, Erick Obed; Arroyo-Camarena, Stefanie; Tejada-García, Diana Luz; Porras-López, Carlos Francisco; Arenas, Roberto

    2015-01-01

    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. PMID:26131862

  7. Onychomycosis: A significant medical problem

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    Jesudanam T

    2002-11-01

    Full Text Available The importance of onychomycosis is often underestimated. Far more than being a simple cosmetic problem, infected nails serve as a chronic reservoir of infection which can give rise to repeated mycotic infections of the skin. 448 patients with nail abnormalities attending Skin O. P. D of King George Hospital, Visakhapatnam during a 1(one year period between November′98 - October′99, were subjected to detailed clinical, epidemiological study. Diagnosis was confirmed in 204 cases by direct microscopy or culture or by both. Females (51. 96% were slightly more than the males (48. 04%. Majority of the cases were between 21-40 years age group. Housewives (33. 33% were most frequently affected. Trauma was a predisposing factor in 11. 27% of the cases. The duration of lesions varied from 3 months to 15 years. In the majority (38. 23% it was less than one year. Candidal onychomycosis was the most prevalent clinical type (58. 82% followed by distal subungual onychomycosis (38. 72%. Disease was limited only to finger nails in 57. 35% and toe nails in 32. 35%. Ptedominant isolates obtained were condida spp. (56. 7%, followed by dermatophytes (38. 2% and non-dermatophyte molds (3. 37%. 26. 96% of the patients had experienced physical, psychosocial and occupational problems.

  8. CLINICO - MYCOLOGICAL STUDY OF ONYCHOMYCOSIS

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    Sharath Kumar

    2013-10-01

    Full Text Available ABSTRACT : Onychomycosis is defined as the fungal infection of the nail by any fungus including non - dermatophy tes and yeasts . Tinea unguium is clinically defined as a dermatophytic infection of the nail plate. OBJECTIVES : To assess the prevalence of fungal infections in nail disorders and to find out incidence of dermatophytes , candida and other non - dermatophytic moulds. METHODOLOGY : History of patient was noted. The material was collected from lesions which were inoculated to the media. Slants were incubated and examined. If there was growth of dermatophytes , they were subjected to lactophenol cotton blue staining . RESULTS : Incidence was 100 ( out of 260 nail cases. Male: female ratio was 1.3:1.69% presented with subungual hyperkeratosis. Distal subungual onychomycosis was most common ( 51% , proximal ( 46% and superficial white ( 3%. Predisposing factor - occupation associated with wet work ( 48% . Commonly isolated species were dermatophytes ( 31% in which more common was trichophyton rubrum ( 27% , Non dermatophytes ( 48% , Aspergillus species ( 41% , and candida albicans ( 4% . INTERPRETATION AND CONCLUSION : Finger nai ls were commonly affected . A ssociated diseases were Tinea pedis , Tinea manum , diabetes mellitus and anemia. It is a significant and important disease which can generate physical , psychological and occupational problems.

  9. Scanning electron microscopy of superficial white onychomycosis*

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    de Almeida Jr., Hiram Larangeira; Boabaid, Roberta Oliveira; Timm, Vitor; Silva, Ricardo Marques e; de Castro, Luis Antonio Suita

    2015-01-01

    Superficial white onychomycosis is characterized by opaque, friable, whitish superficial spots on the nail plate. We examined an affected halux nail of a 20-year-old male patient with scanning electron microscopy. The mycological examination isolated Trichophyton mentagrophytes. Abundant hyphae with the formation of arthrospores were found on the nail's surface, forming small fungal colonies. These findings showed the great capacity for dissemination of this form of onychomycosis. PMID:26560225

  10. Toenail onychomycosis in a Portuguese geriatric population

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    Dias, Nicolina; Portela, M.; Santos,C.; Lima,Nelson

    2011-01-01

    Onychomycosis is a common fungal infection of the nail but few data of mycological features in geriatric Portuguese population are yet available. The aim of this study was to perform a mycological examination and characterization of fungal nail pattern of a geriatric population from the north of Portugal clinically suspected of onychomycosis. A total of 108 patients attending the Podology Service in the Centro Hospitalar do Alto Ave (Portugal) from October 2007 to J...

  11. Toenail onychomycosis in a Portuguese geriatric population.

    Science.gov (United States)

    Dias, N; Santos, C; Portela, M; Lima, N

    2011-07-01

    Onychomycosis is a common fungal infection of the nail but few data of mycological features in geriatric Portuguese population are yet available. The aim of this study was to perform a mycological examination and characterization of fungal nail pattern of a geriatric population from the north of Portugal clinically suspected of onychomycosis. A total of 108 patients attending the Podology Service in the Centro Hospitalar do Alto Ave (Portugal) from October 2007 to January 2009 were enrolled. All were suspected of having onychomycosis by the abnormal appearance of their nails. From these, 59.3% were diabetic. Distal and lateral subungual onychomycosis was the more common clinical pattern followed by total dystrophic onychomycosis. In 21.3% cases, every nail in both feet had an abnormal appearance. In 86%, the hallux was involved in at least one foot. Fifty samples were culture positive, and fifty-four isolates were reported regardless of the questionable pathogenicity of the infectious agent. In three cases, clinical feature of the nail, direct microscopy, and culture were consistent with Scopulariopsis infection. Fusarium spp. were identified in three cases; however, only one isolate was preceded by the observation of branching septate filaments by direct microscopy. No mixed infections with dermatophytes were reported. Trichophyton rubrum was the dermatophyte most frequently isolated (83.3%) followed by Trichophyton interdigitale. In Portugal, onychomycosis is still viewed by general population as a cosmetic condition. Health risk is enhanced in geriatrics that only perceived the severity of their condition when experiencing further foot complications that include bacterial infection and pain.

  12. Onychomycosis caused by Trichosporon mucoides

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    Gaetano Rizzitelli

    2016-01-01

    Full Text Available A case of onychomycosis caused by Trichosporon mucoides in a man with diabetes is presented. The infection was characterized by a brown–black pigmentation of the nail plates and subungual hyperkeratosis of the first three toes of both feet. Onychogryphosis was also visible on the third left toe. Direct microscopic examinations revealed wide and septate hyphae and spores. Three cultures on Sabouraud–gentamicin–chloramphenicol 2 agar and chromID Candida agar produced white, creamy, and smooth colonies that were judged to be morphologically typical of T. mucoides. Microscopic examinations of the colonies showed arthroconidia and blastoconidia. The urease test was positive. A sugar assimilation test on yeast nitrogen base agar showed assimilation of galactitol, sorbitol, and arabinitol. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF confirmed the diagnosis of T. mucoides infection. The patient was treated with topical urea and oral itraconazole. Three months later, a mild improvement was observed. The patient was subsequently lost to follow-up.

  13. Onychomycosis in close quarter living review of the literature.

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    Gazes, Michael I; Zeichner, Joshua

    2013-11-01

    Onychomycosis is defined as a fungal infection of the nail bed and/or nail plate. The prevalence of onychomycosis has increased dramatically as a worldwide condition in the twentieth century due to occlusive footwear, global wars and natural migration. Risk factors generally leading to onychomycosis development include bodily spread of dermatophyte and non-dermatophyte tinea pedis, peripheral vascular disease, damaged nails via sports and trauma, older age, genetics, immunodeficiency and diabetes. Many publications discuss prevalence, symptoms and treatment of the disease in individual cases, hospitals or specific locations, but few strongly link the cause of onychomycosis to living environments. This is a review of the current literature on the prevalence of onychomycosis and its relationship to surrounding living environments of those infected. A Pubmed search was performed with 'onychomycosis'. Articles were selected based on the relevance to close quarter living environments. All ages can be affected with onychomycosis, ranging from children in boarding schools to elderly in nursing homes. Although not directly linking living environments to transmission and infection in all articles reviewed, onychomycosis was very prevalent in many different close quarter living settings, including within families, boarding schools, military quarters and nursing homes. This review demonstrates that various close quarter living environments are highly associated with increased transmission and infection with onychomycosis.

  14. Onychomycosis Associated with Exophiala oligosperma in Taiwan.

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    Wen, Yu-Min; Rajendran, Ranjith Kumar; Lin, Ying-Fang; Kirschner, Roland; Hu, Sindy

    2016-02-01

    A fungus was isolated from a nail of a 54-year-old female patient with onychomycosis in Taiwan. Based on ITS rDNA as well as beta tubulin gene sequences and microscopic analyses, this fungus was identified as Exophiala oligosperma. This is the first record of E. oligosperma in Taiwan. Negative keratin azure test indicates that keratin degradation is not involved in cases of E. oligosperma associated with skin and nail diseases.

  15. Evaluation of clinicomycological aspects of onychomycosis

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    Kaur Ravinder

    2008-01-01

    Full Text Available Background: Incidence of onychomycosis has increased tremendously in recent times. Relatively little work has been done on this problem in our country. Research in past has been concentrated mainly on superficial mycoses of the skin. Aim: It is a well-established fact that geographical distribution of the fungi may change from time to time; hence, this study was planned to analyze clinical, epidemiological, and mycological features of onychomycosis. Materials and Methods: Sixty patients clinically suspected and microscopically proven to have onychomycosis were taken up for the study. Nail samples, collected by scraping in 30 patients and by using a dental drill in the rest, were examined microscopically and cultured for fungus. Results and Conclusions: Forty-five fungal isolates were obtained from 60 patients. Trichophyton rubrum was the commonest fungus isolated (46.67%. Trichophyton mentagrophytes and Candida albicans accounted for 20% and 15.56% isolates, respectively. Two cases showed mixed growth of Trichophyton rubrum and Aspergillus niger in one and Trichophyton rubrum and Aspergillus fumigatus in the other. Isolation rate was higher by drilling compared to scraping, the rates being 83.33% and 66.67%, respectively. Superficial mycotic infections were present in 27 patients (45%.

  16. Onychomycosis by molds. Report of 78 cases.

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    Bonifaz, Alexandro; Cruz-Aguilar, Pamela; Ponce, Rosa María

    2007-01-01

    A retrospective study of onychomycohosis by molds was carried out during a 14-year period (1992-2005). All cases were clinically and mycologically proven (repetitive KOH and culture) and then each of the molds was identified. A total of 5,221 cases of onychomycosis were evaluated, 78 of which were molds (1.49%). Mean patient age was 44.1 years. 75/78 cases occurred in toenails. Associated factors were detected in 39/78 (50.0%) cases, with the major ones being: peripheral vascular disease, contact with soil, and trauma. The most frequent clinical presentation was distal and lateral subungual onychomycosis (DLSO), in 54/78 cases (69%). The most frequent causative agents were: Scopulariopsis brevicaulis in 34/78 cases and Aspergillus niger in 13/78 cases. Onychomycoses by molds are infrequent; in this study they accounted for 1.49% of cases. The clinical features are virtually similar to those caused by dermatophytes, which makes the clinicomycological tests necessary.

  17. Network Meta-Analysis of Onychomycosis Treatments

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    Gupta, Aditya K.; Daigle, Deanne; Foley, Kelly A.

    2015-01-01

    Background Many onychomycosis treatments have not been directly compared in head-to-head clinical trials. Objective: To determine the relative efficacy of onychomycosis treatments using network meta-analysis (NMA). Methods We conducted a systematic review and NMA of mycological cure rates. Results Nineteen trials were included in the network. Terbinafine 250 mg was significantly superior to all treatments except itraconazole 400 mg pulse therapy. The itraconazole 400 mg pulse regimen was significantly superior to all topicals except efinaconazole 10% nail solution. Itraconazole 200 mg was significantly superior to all topical treatments, while fluconazole 150-450 mg, efinaconazole 10% nail solution, tavaborole 5% nail solution, ciclopirox nail lacquer 8%, terbinafine nail solution, and amorolfine 5% nail lacquer were significantly superior to placebo. Conclusions Newly developed topicals have improved the odds ratios (ORs) of mycological cure, yet these ORs were not significantly greater than preexisting topical treatments. Further experience with these agents will reveal their clinical significance, and head-to-head trials are warranted. © 2015 S. Karger AG, Basel PMID:27170937

  18. Onychomycosis by Fusarium oxysporum probably acquired in utero

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    Vania O. Carvalho

    2014-10-01

    Full Text Available Fusarium oxysporum has been described as a pathogen causing onychomycosis, its incidence has been increasing in immunocompetent and disseminated infection can occur in immunosuppressed individuals. We describe the first case of congenital onychomycosis in a child caused by Fusarium oxysporum. The infection being acquired in utero was proven by molecular methods with the identification of the fungus both in the nail and placenta, most probably as an ascending contamination/infection in a HIV-positive, immunosuppressed mother.

  19. Essential Oils for Treatment for Onychomycosis: A Mini-Review.

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    Flores, Fernanda C; Beck, Ruy C R; da Silva, Cristiane de B

    2016-02-01

    Onychomycosis are fungal infections affecting finger and toenails mainly caused by dermatophyte fungi and some Candida species. Low cure rates and frequent recurrence, development of a fungal resistance front to various antimicrobial agents topical and systemic, and an ineffective topical treatment make onychomycosis difficult to treat. Essential oils are excellent candidates for the topical treatment for onychomycosis because the development of resistance by fungi is rare, and the presence of side effects is low. They are composed of a complex variety of compounds, mainly terpenes, with low molecular weight, which may easily penetrate into the nail plate, finding the fungi elements. The complex mixture confers a broad antifungal spectrum of action, through interaction with biological membranes, interference in radical and enzymatic reaction of fungi cells. Essential oils may become the source of new therapeutic molecules, and the use of an essential oil incorporated into a topical formulation is an interesting, safe, and effective alternative for the treatment for onychomycosis. However, studies are needed to evaluate the efficacy of essential oils in the treatment for onychomycosis in vivo. This mini-review aims to present the potential use of essential oils for the treatment for onychomycosis, focusing on the last decade.

  20. Epidemiological and mycological data of onychomycosis in Goiania, Brazil.

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    Souza, L K H; Fernandes, O F L; Passos, X S; Costa, C R; Lemos, J A; Silva, M R R

    2010-01-01

    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.

  1. Species isolated as the cause of onychomycosis in patients with pemphigus vulgaris

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    J. Vélez-Ponce

    2016-01-01

    Conclusions: The presence of onychomycosis in patients with PV was not associated with the use of glucocorticoids; no greater prevalence of onychomycosis was observed in patients without PV and without steroid therapy.

  2. Refractory onychomycosis due to Trichophyton rubrum: combination therapy with itraconazole and terbinafine

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    Bonifaz Alexandro; Vázquez-González Denisse; Saúl Amado; Fierro-Arias Leonel; Ponce-Olivera M. Rosa

    2011-01-01

    Objectives: Evaluate the efficacy and tolerability of itraconazole plus terbinafine for refractory onychomycosis. This is a prospective clinical trial. Patients with proven Trychophyton rubrum onychomycosis of toenails were enrolled; the treatment consisted of weekly administration: itraconazole 200mg/day and terbinafine 250mg/day, for four months. Results: Thirty-two patients with onychomycosis were studied. Twenty-eight cases had distal subungual onychomycosis and 4 total dystrophic onychom...

  3. Evaluation of the Drug Treatment and Persistence of Onychomycosis

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    Andrew W. Campbell

    2004-01-01

    Full Text Available Onychomycosis is a common nail disease responsible for approximately 50% of diseases of the nail. It occurs more in the elderly, though several cases have been reported among children. Several factors influence, such as climate, geography, and migration. The two dermatophytes most commonly implicated in onychomycosis are Trichophyton rubrum and T. mentagrophytes, accounting for more than 90% of onychomycoses. Nonetheless, several other toxigenic molds have been implicated. For convenience, onychomycosis is divided into four major clinical presentations: distal subungal, which is the most common form of the disease; proximal subungal, which is the most common form found in patients with human immunodeficiency virus infection; superficial; and total dystrophic onychomycosis. Epidemiology of onychomycosis in adults and children is evaluated and the most common clinical symptoms addressed. Although the risk factors are discussed, the multifactorial nature of onychomycosis makes this inexhaustible. The diagnosis and treatments are difficult and the choice of appropriate antifungal drugs complex and require the knowledge of the chemical structures of the metabolites of the molds that cause onychomycosis and their interaction with the antifungal drugs. This is true because most of the antifungal drugs are derived from mold/fungal metabolism. Treatment with griseofulvin and amphotericin is displaced by the use of newer drugs from azole compounds, pyrimidines, and allylamines derivatives. Amorolfine, itraconazole, and ciclopirox nail lacquer solution 8 have gained support globally, but the side effects, drug resistance, and persistence of the disease are still a serious concern to the patients, just as economics and quality of life. Hence, the search for safer and more efficacious drug treatments are continuing.

  4. Onychomycosis: Sampling, diagnosing as efficiant part of hospital pharmacology

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    Ignjatović Vesna A.

    2014-01-01

    Full Text Available Introduction Onychomycosis is a fungal infection of one or more nails. Causes of onychomycosis are dermatophytes, yeasts and non-dermatophyte molds, but the most common cause is Trichophytonrubrum (T. Rubrum from the group of dermatophyte fungi. The aims Using sampling determination of the most common clinical type of onychomycosis, lokalization and involvement of the nail plate, and monitoring the efficacy of methods/tests in the diagnosis of nail onychomycosis. Material and methods This paper is a part of academic IV phase study. The study included 30 patients with onychomycosis. Each sample was seeded on Sabouraud Dextrose Agar (SDA and Diluted SDA (D-SDA at 28°C and 37°C, as well as the Dermatophyte Test Medium (DTM at 28°C. Identification of isolated fungi to the level of genus/species has been based on macroscopic and microscopic characteristics by KOH and Blancophor fluorescent dye. PCR were performed to detect T. Rubrum-specific and pan-dermatophyte multiplex PCR product. Informed consent was obtained from all patients. Results The most common clinical form was subungual lateral distal onychomycosis (DLSOof the hands and feet pollex fingernails, while the size of the involvement of the nail plate was 1/2 - 1/3 in the majority of patients. Cultivation gave a positive result in 50% of cases and the most commonly isolated microorganism was the T. Rubrum. For negative cultures (50% the PCR was carried out which demonstrated high sensitivity and T. Rubrum remained the most frequently detected. Conclusions Using the methods of cultivation and PCR, onychomycosis was confirmed in 28 (93.3% patients. Cultivation gave a negative result in 50% of cases, while the PCR was positive in 86.6%. Our research shows the highest incidence of T. Rubrum (60%. In continuation of this study will be analyzed the choice and effectiveness of therapy.

  5. Spotlight on tavaborole for the treatment of onychomycosis

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    Jinna S

    2015-11-01

    Full Text Available Sphoorthi Jinna, Justin Finch Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT, USA Abstract: Onychomycosis is a fungal nail plate infection that has been increasing in prevalence. A variety of oral and topical anti-fungal agents are currently available but their use is limited by their adverse effect profile, drug–drug interactions, and limited efficacy. Therefore, there is a great need for newer anti-fungal agents. Tavaborole is one of these newer agents and was approved by the US Food and Drug Administration in July 2014 for the topical treatment of mild to moderate toenail onychomycosis. Tavaborole is a novel, boron-based anti-fungal agent with greater nail plate penetration than its predecessors, due to its smaller molecular weight. It has proven through several Phase II and III trials that it can be a safe and effective topical agent for the treatment of mild to moderate toenail onychomycosis without the need for debridement. In this paper, we review the landscape of topical and systemic treatment of onychomycosis, with particular attention to the pharmacokinetics, safety, and efficacy of topical tavaborole. Keywords: tavaborole, boron-based antifungals, oxaboroles, onychomycosis

  6. Aspergillus species: An emerging pathogen in onychomycosis among diabetics

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    T M Wijesuriya

    2015-01-01

    Full Text Available Introduction: Approximately, 33% patients with diabetes are afflicted with onychomycosis. In the past, nondermatophyte molds have been regarded as opportunistic pathogens; recently, Aspergillus species are considered as emerging pathogens of toenail infections. In Sri Lanka, the prevalence of Aspergillus species in onychomycosis among diabetics is not well documented. Objective: To determine the proportion of Aspergillus onychomycosis, risk factors and knowledge among diabetics. Materials and Methods: This was descriptive cross-sectional study. Three hundred diabetic patients were included. Clinical examinations of patients' toenails were performed by a clinical microbiologist. Laboratory identification was done, and pathogens were identified to the species level by morpho-physiological methods. All inferential statistics were tested at P age group. In men, Aspergillus onycomycosis was seen in 82%. Among patients who had Aspergillus nail infection, 114 (63% had diabetes for a period of > years. Among patients who were engaged in agricultural activities, 77% were confirmed to have infected nails due to Aspergillus species. Conclusion: Aspergillus niger was the most common pathogen isolated from toenail infection. Aspergillus species should be considered as an important pathogen in toenail onychomycosis in diabetic patients. Risk factors associated with Aspergillus onychomycosis were age, gender, duration of diabetes, length of exposure to fungi, and occupation.

  7. Subclinical onychomycosis in patients with type II diabetes

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    Amira Elbendary

    2015-12-01

    Full Text Available Fungal organisms could be present in the nail without any clinical manifestations. As onychomycosis in diabetics has more serious complications, early detection of such infection could be helpful to prevent them. We aim in this study to assess the possibility of detecting subclinical onychomycosis in type II diabetic patients and addressing possible associated neuropathy. A cross sectional, observational study included patients with type II diabetes with normal big toe nail. All were subjected to nail clipping of the big toe nail, followed by staining with Hematoxylin and Eosin and Periodic-Acid-Schiff (PAS stains and examined microscopically. A total of 106 patients were included, fungal infection was identified in eight specimens, all were uncontrolled diabetes, and six had neuropathy. Using the nail clipping and microscopic examination with PAS stain to detect such subclinical infection could be an applicable screening test for diabetic patients, for early detection and management of onychomycosis.

  8. Tavaborole topical solution, 5% for the treatment of toenail onychomycosis.

    Science.gov (United States)

    Zane, L T; Plattner, J; Chanda, S; Coronado, D; Merchant, T; Alley, M R K; Gupta, A K

    2015-10-01

    Tavaborole topical solution, 5% (tavaborole) is a novel, boron-based, antifungal pharmaceutical agent indicated for treatment of toenail onychomycosis due to the dermatophytes Trichophyton rubrum or Trichophyton mentagrophytes. In preclinical studies, tavaborole effectively penetrated through full-thickness, non-diseased cadaver fingernails, including those with up to four layers of nail polish. Limited systemic absorption was observed following topical application of tavaborole. In phase III clinical trials involving patients with distal subungual onychomycosis affecting 20-60% of a target great toenail, significantly more patients treated with tavaborole versus vehicle achieved completely clear nail with negative mycology following daily application for 48 weeks. Treatment-emergent adverse events reported by at least 1% of patients treated with tavaborole and at a greater frequency versus vehicle included ingrown toenail, exfoliation, erythema and dermatitis. Treatment discontinuations were uncommon. Results from preclinical studies and phase III clinical trials establish tavaborole as a safe and efficacious treatment for toenail onychomycosis.

  9. Nondermatophytic onychomycosis by Fusarium oxysporum in an immunocompetent host.

    Science.gov (United States)

    Shah, S R; Dalal, B D; Modak, M S

    2016-03-01

    Fusarium onychomycosis is not uncommon in tropical countries but is worth reporting. We report a case of nondermatophytic onychomycosis by Fusarium oxysporum in an immunocompetent woman from Buldhana district of Maharashtra (India). Bilateral involvement of great toe nail, chronic duration and acquisition of infection due to peculiar practice of daily pasting floors with mud and dung, is interesting. The case was successfully treated with topical and oral terbinafine with a dose of 250 mg daily for 3 weeks. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  10. A clinical and mycological study of onychomycosis in HIV infection

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    Surjushe Amar

    2007-01-01

    Full Text Available Background: Onychomycosis is one of the early manifestations of HIV infection with a prevalence of 15-40%. Multiple nail involvement, isolation of both common and rare species, and resistance to treatment are the characteristics of onychomycosis in HIV. Aim: To study the epidemiology, clinical manifestations of onychomycosis in HIV-infected individuals and to identify the various causative fungi microbiologically. Methods: A total of 250 HIV infected patients, diagnosed by ELISA, were screened for nail involvement; of which 60 patients i.e., 40 males and 20 females, who had clinically suspected untreated fungal infection were included in this study. Results: Of the 60 respondents, 34 (56.66% were from the 31-40 years age group. Amongst the 40 males, there were 20 manual laborers and 14 farmers; while 18 of 20 females were housewives. Toenail involvement was seen in 38 patients (63.33%, fingernail in 12 patients (20% while 10 (16.66% patients had involvement of both. Twenty eight (46.66% patients gave history of some trauma, 6 (10% had diabetes mellitus, and only 1 patient (1.66% had history of peripheral vascular disease. Nineteen (31.66% patients had associated tinea pedis, 5 (8.33% had tinea manuum, 10 (16.66% had tinea corporis and 7 (11.66% had tinea cruris. Twenty one (35% respondents had distal and lateral superficial onychomycosis (DLSO, 5 (8.33% had proximal subungual onychomycosis (PSO, 1 (1.66% had superficial white onychomycosis (SWO, while 33 (55% had total dystrophic onychomycosis (TDO. Fungal elements were demonstrated by KOH mount in 49 patients (81.66% and growth was seen in 32 (53.33% cultures. Dermatophytes were isolated in 13 (21.66% and nondermatophytic molds (NDM in 19 (31.66%. Out of the 13 positive dermatophyte cultures, Trichophyton rubrum was isolated on 11 and Trichophyton mentagrophytes on 2 cultures. Of the 19 non-dermatophytic cultures, Aspergillus niger was isolated on 3 and Candida spp. on 12 while Cladosporium spp

  11. Modified PAS stain: A new diagnostic method for onychomycosis.

    Science.gov (United States)

    Hajar, Tamar; Fernández-Martínez, Ramon; Moreno-Coutiño, Gabriela; Vásquez Del Mercado, Elsa; Arenas, Roberto

    2016-01-01

    Onychomycosis is the most common nail disease and represents around 50% of nail disorders. Accurate diagnosis with adequate evidence is ideal before starting any treatment. Current diagnostic methods offer low specificity and sensitivity. To create a new method for the diagnosis of onychomycosis, and to compare its sensitivity and specificity with the existing methods. One hundred and ninety-two samples with clinical suspicion of onychomycosis were included and underwent modified PAS stain (M-PAS), KOH/chlorazol black (KOH/CB) and culture testing. Sensitivity, specificity, positive and negative predictive values were calculated. In 152 out of 192 samples (79.2%) fungi structures were found in at least one of the three tests performed, and the patients were diagnosed with onychomycosis; 40 samples out of 192 (20.8%) were negative. Using M-PAS, filaments and/or spores were seen in 143 samples from the 152 positive (94%); 39 of them were negative to KOH/CB and positive to M-PAS (25.6%). With KOH/CB, filaments and/or spores were seen in 113 cases from the 152 positive samples (73.8% of the onychomycosis cases). Thirty-five cultures were positive, of which 77% were identified as Trichophyton rubrum; 117 onychomycosis cases were diagnosed despite the negative culture (76.9%). M-PAS showed 92.5% sensitivity and 55.55% specificity, a 67.5% positive predictive value and a 81.6% negative productive value. This procedure, a combination of the existing methods to diagnose onychomycosis, KOH/CB together with a nail clipping biopsy, proved to have high sensitivity, as well as being rapid, easy, inexpensive and readily available in most hospital settings. M-PAS allowed us to diagnose 39 cases (25.6% of the cases of onychomycosis) that were false negative using only KOH/CB and culture. Copyright © 2014 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.

  12. Study of onychomycosis: Prevailing fungi and pattern of infection

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    Veer P

    2007-01-01

    Full Text Available A mycological study of onychomycosis was undertaken in 88 patients. The nails were judged to be infected by their clinical appearance. Direct microscopy of the nail clips in 20% KOH solution was positive in 72 (81.8% and culture was positive in 43 (48.8% cases. Out of the samples cultured, dermatophytes were grown in 26 cases (29.5%, non dermatophyte moulds in 12 (13.6% and Candida spp. in 5 (5.6% while 45 (51.1% samples yielded no growth. Amongst dermatophytes, T. rubrum was found to be commonest etiological agent (57.6% followed by T. mentagrophyte . Amongst the non-dermatophyte mould (NDM, Aspergillus spp. was the most prevalent species followed by Alternaria spp, Curvularia spp. and Fusarium spp. Commonest age group affected was above 31 years. Males were predominantly affected (65%, male to female ratio being 1.8:1. Fingernails were affected more frequently than toe nails with the ratio of 3:1. Distal and lateral subungual onychomycosis (DLSO was more common (50% than other clinical pattern followed by proximal subungual onychomycosis (PSO (20.4%, white superficial onychomycosis (SWO (2%, total dystrophic onychomysosis (TDO (14% and paronychia (10.2%.

  13. Onychomycosis: Potential of Nail Lacquers in Transungual Delivery of Antifungals

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    Nida Akhtar

    2016-01-01

    Full Text Available Onychomycosis constitutes the most common fungal infection of the nail (skin beneath the nail bed that affects the finger as well as toe nails. It is an infection that is initiated by yeasts, dermatophytes, and nondermatophyte molds. Nail lacquers are topical solutions intended only for use on fingernails as well as toenails and have been found to be useful in the treatment of onychomycosis. Thus, in the present review an attempt has been made to focus on the treatment aspects of onychomycosis and the ungual delivery of antifungals via nail lacquer. Several patents issued on nail lacquer till date have also been discussed. Penetration efficiency was assessed by several researchers across the human nail plate to investigate the potentiality of nail lacquer based formulations. Various clinical trials have also been conducted in order to evaluate the safety and efficacy of nail lacquers in delivering antifungal agents. Thus, it can be concluded that nail lacquer based preparations are efficacious and stable formulations. These possess tremendous potential for clinical topical application to the nail bed in the treatment of onychomycosis.

  14. Comparative study of nail sampling techniques in onychomycosis.

    Science.gov (United States)

    Shemer, Avner; Davidovici, Batya; Grunwald, Marcelo H; Trau, Henri; Amichai, Boaz

    2009-07-01

    Onychomycosis is a common problem. Obtaining accurate laboratory test results before treatment is important in clinical practice. The purpose of this study was to compare results of curettage and drilling techniques of nail sampling in the diagnosis of onychomycosis, and to establish the best technique and location of sampling. We evaluated 60 patients suffering from distal and lateral subungual onychomycosis and lateral subungual onychomycosis using curettage and vertical and horizontal drilling sampling techniques from three different sites of the infected nail. KOH examination and fungal culture were used for detection and identification of fungal infection. At each sample site, the horizontal drilling technique has a better culture sensitivity than curettage. Trichophyton rubrum was by far the most common pathogen detected by both techniques from all sampling sites. The drilling technique was found to be statistically better than curettage at each site of sampling, furthermore vertical drilling from the proximal part of the affected nail was found to be the best procedure for nail sampling. With each technique we found that the culture sensitivity improved as the location of the sample was more proximal. More types of pathogens were detected in samples taken by both methods from proximal parts of the affected nails.

  15. An update on photodynamic therapies in the treatment of onychomycosis.

    Science.gov (United States)

    Simmons, B J; Griffith, R D; Falto-Aizpurua, L A; Nouri, K

    2015-07-01

    Onychomycosis is a common fungal infection of the nails that is increasing in prevalence in the old, diabetics and immunocompromised. Onychomycosis presents a therapeutic challenge that can lead to significant reductions in quality of life leading to both physical and psychological consequences. Current treatment modalities are difficult to implement due to the poor penetration of topical treatments to the nail bed, the slow growing nature of nails and the need for prolonged use of topical and/or oral medications. Standard of care medications have cure rates of 63-76% that leads to a high propensity of treatment failures and recurrences. Photodynamic therapy (PDT) offers an alternative treatment for onychomycosis. Methylene blue dye, methyl-aminolevulinate (MAL) and aminolevulinic acid (ALA) have been used as photosensitizers with approximately 630 nm light. These modalities are combined with pre-treatment of urea and/or microabrasion for better penetration. PDT treatments are well tolerated with only mild transient pain, burning and erythema. In addition, significant cure rates for patients who have contraindications to oral medications or failed standard medications can be obtained. With further enhancements in photosensitizer permeability, decreased pre-treatment and photosensitizer incubation times, PDT can be a more efficient and cost-effective in office based treatment for onychomycosis. However, more large-scale randomized control clinical trials are needed to access the efficacy of PDT treatments.

  16. BLOOD LEUKOCYTES PHENOTYPING BY HEMATOFLOW METHOD IN PATIENTS WITH ONYCHOMYCOSIS

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    A. A. Savchenko

    2015-01-01

    Full Text Available The aim of the investigation was to evaluate the information content of Hematoflow method in the pathogenetic significance in determining the violations of the cellular responses of innate and adaptive immunity, as well as the decision on the appointment of immunotropic treatment of patients with onychomycosis. The study involved 42 patients with onychomycosis feet and hands/feet at the age of 20–45 years before the appointment of a systemic antifungal therapy. The diagnosis of mycosis, onychomycosis was confirmed by microscopic examination of the fragments of the damaged nail plate. The growth of the fungus culture on special media was observed in 64% of patients. 24 healthy persons were examined as controls. A study of the phenotype of white blood cells was performed on a dual-platform technology hematology analyzer and flow cytometry using a set of antibodies Cytodiff: CD36-FITC, CD2-PE, CD294(CRTH2-PE, CD19-ECD, CD16-PC5 и CD45-PC7. The phenotypic composition evaluation of the white blood cells by the Hematoflow method allowed to establish in patients with onychomycosis the violation cellular innate and adaptive immunity. Minor changes were detected in the population composition of granule cells in the peripheral blood of patients manifested to an increase in the content of the young and segmented granulocytes. When monotsitopeniya patients with onychomycosis increases the content of the «classic» monocytes and decreases the level of «non-classical» monocytes. Changes in the composition of blood monocytes subpopulation identified in patients with the infection lasting up to 3 years and stored in the course of the disease. The most pronounced changes were found in patients with onychomycosis by the performance of adaptive immunity. Lymphopenia in these patients is realized by reducing the number of immature and mature B-cell, but by increasing the content of T-lymphocytes. Moreover, if the content of immature B-cells have decreased in

  17. A STUDY ON THE MYCOLOGICAL PROFILE OF ONYCHOMYCOSIS

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    Saroj

    2012-12-01

    Full Text Available ABSTRACT: BACKGROUND: Onychomycosis refers to fungal infection of nails w ith various etiological agents, involving dermatophytes, yeasts and moulds. It constitutes an important health problem because of its rising prevalence and u nder-diagnosis especially in developing countries. AIMS: To analyse the mycological and cultural characteri stics of onychomycosis with respect to the various etiological agents. SETTINGS AND DESIGN: Nail samples collected from patients attending the dermatology clinic of Dr B.R Ambedkar medical college were processed in the microbiology department of Dr B.R Ambedkar medic al college. MATERIALS AND METHODS: Nail clippings and subungual scrapings of patients wi th onychomycosis were subjected to KOH preparation. Culture was done on Sab ouraud’s dextrose agar medium and Sabouraud’s dextrose agar with 5% chloramphenicol an d cycloheximide. Species identification was done by colony characteristics, pigment productio n, slide culture and LPCB stain. RESULTS: Out of 98 cases, 73 showed the growth of fungus, a mounting to 74.50% positivity. Among those 73 cases, the infective fungal agents pr edominantly were dermatophytes (54.80%, and the rest were due to yeasts (23.30% and moulds(22% . Among the different species, Trichophyton rubrum (43.84% accounted for the majority of dermatophytes; candida albicans (16.44% was the predominant yeast; and as pergillus niger (16.44% the commonest mould. The age group most commonly affected was 16-3 0yrs and males were commonly affected in our study. CONCLUSION: The present study highlights the need for microbiol ogical confirmation in case of onychomycosis for appropriate management of onychomycosis cases and further epidemiological study

  18. Self-controlled Study of Onychomycosis Treated with Long-pulsed Nd:YAG 1064-nm Laser Combined with Itraconazole

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    Yan Li

    2016-01-01

    Conclusions: For patients with mild or moderate onychomycosis, we recommended a pure medication treatment or combination treatment with medication and laser. For those patients with severe onychomycosis, we recommended a combination of medication and laser therapy.

  19. Growing Incidence of Non-Dermatophyte Onychomycosis in Tehran, Iran

    Science.gov (United States)

    Motamedi, Marjan; Ghasemi, Zeinab; Shidfar, Mohammad Reza; Hosseinpour, Leila; Khodadadi, Hossein; Zomorodian, Kamiar; Mirhendi, Hossein

    2016-01-01

    Background Non-dermatophyte onychomycosis (NDO) is caused by a wide range of mold fungi other than dermatophytes, and has been reported at various rates in different countries worldwide. Studies on the incidence of NDO in the community are essential for understanding its epidemiology and control, as well as for the appropriate treatment of these infections. Objectives In this study, the incidence of NDO in Tehran, Iran, was compared to the incidence of onychomycoses due to dermatophytes and yeasts. Methods From 2014 through 2015, samples from a total of 1,069 patients with suspected fungal nail diseases, who were referred to three medical mycology laboratories in Tehran, were collected and subjected to direct examination (all samples) and culture (788 samples). Differentiation of the causative agents of onychomycosis was based on microscopic observation of characteristic fungal elements in the nail samples and growth of a significant number of identical colonies on the culture plate. Results Based on only direct microscopy, onychomycosis was diagnosed in 424 (39.6%) cases, among which 35.8% were caused by dermatophytes, 32.7% by yeasts, and 29.3% by non-dermatophyte molds (NDMs), while 2.2% were mixed infections. Direct exam was significantly more sensitive than culture for the diagnosis. The most commonly isolated NDMs were Aspergillus spp. (69.3%, n = 52), followed by Fusarium spp. (n = 7). The other isolated species were Paecilomyces spp., Scopulariopsis spp., Acremonium spp., Cladosporium spp., and Chrysosporium spp., with only one case of each. Conclusions An increasing frequency of NDO compared to onychomycosis due to other causative agents has been noticeable over the past few years in Iran. This epidemiological data may be useful in the development of preventive and educational strategies. PMID:27800138

  20. Clinico-etiologic correlates of onychomycosis in Sikkim

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    Adhikari Luna

    2009-04-01

    Full Text Available Aims and objectives: The etiological spectrum of any superficial mycosis is largely dependent on the flora in the immediate environment of the individual. It is influenced by the geographic, climatic and occupational factors. The study is basically to formulate baseline data for the species prevalence of various dermatophytes in patients with onychomycosis attending the Central Referral Hospital, Gangtok, Sikkim. Materials and Methods: Thirty-four clinically suspected cases of onychomycosis were subjected to mycological studies. Results: Thirty-two (94.12% cases were positive for fungal elements by direct microscopy and 28 (82.35% by culture. Young adults in the age group of 21-30 years were mainly affected. The male:female ratio was 1.125:1. Dermatophytes were isolated in 18 cases (64.29%. Trichophyton tonsurans (44.44% was the most common isolate followed by T. mentagrophytes (22.22%, T. rubrum (11.11%, T. verrucosum (11.11% and Microsporum audouinii (11.11%. Apart from dermatophytes, Aspergillus niger (21.43% and Penicillium marneffei (14.28% were also isolated. Conclusion: Dermatophytes, mainly T. tonsurans, as well as moulds other than dermatophytes were isolated from onychomycosis patients in Gangtok, Sikkim.

  1. Proximal subungual onychomycosis caused by Fusarium falciforme successfully cured with posaconazole

    NARCIS (Netherlands)

    Al-Hatmi, A M S; Bonifaz, A; Calderón, L; Curfs-Breuker, I; Meis, J F; van Diepeningen, A D; de Hoog, G S

    2015-01-01

    Proximal subungual onychomycosis (PSO) is a fungal infection on the inner layer of the nail plate which starts from the eponychium and nail matrix.(1) Onychomycosis can be caused by a variety of dermatophytes, yeasts and non-dermatophyte molds (NDMs) including species of Aspergillus, Acremonium, Sco

  2. Proximal subungual onychomycosis caused by Fusarium falciforme successfully cured with posaconazole

    NARCIS (Netherlands)

    Al-Hatmi, A M S; Bonifaz, A; Calderón, L; Curfs-Breuker, I; Meis, J F; van Diepeningen, A D; de Hoog, G S

    2015-01-01

    Proximal subungual onychomycosis (PSO) is a fungal infection on the inner layer of the nail plate which starts from the eponychium and nail matrix.(1) Onychomycosis can be caused by a variety of dermatophytes, yeasts and non-dermatophyte molds (NDMs) including species of Aspergillus, Acremonium, Sco

  3. Onychomycosis is rare in young children, and treatment is a task for dermatological specialists.

    DEFF Research Database (Denmark)

    Haugaard, Line Klingen; Skov, Lone; Arendrup, Maiken Cavling

    2013-01-01

    Onychomycosis was diagnosed in a two-year-old girl. The infection was caused by Trichophyton rubrum, which is the most frequent cause of toenail onychomycosis. The diagnosis was confirmed by polymerase chain reaction, microscopy and culture. She was treated with orally given terbinafine and topic...

  4. Refractory onychomycosis due to Trichophyton rubrum: combination therapy with itraconazole and terbinafine

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    Bonifaz Alexandro

    2011-07-01

    Full Text Available Objectives: Evaluate the efficacy and tolerability of itraconazole plus terbinafine for refractory onychomycosis. This is a prospective clinical trial. Patients with proven Trychophyton rubrum onychomycosis of toenails were enrolled; the treatment consisted of weekly administration: itraconazole 200mg/day and terbinafine 250mg/day, for four months. Results: Thirty-two patients with onychomycosis were studied. Twenty-eight cases had distal subungual onychomycosis and 4 total dystrophic onychomycosis. At the end of the follow-up 17/32 patients had clinical and mycologic cure (53.12%, 5 had clinical improvement only (15.6%, and 10 (31.2% failed. Conclusion: Weekly alternate therapy with itraconazole + terbinafine represents a safe rescue treatment.

  5. Epidemiology of superficial mycosis (tinea pedis, onychomycosis) in elementary school children in Istanbul, Turkey.

    Science.gov (United States)

    Hapcioglu, Bilge; Yegenoglu, Yildiz; Disci, Rian; Erturan, Zayre; Kaymakcalan, Hande

    2006-03-01

    The purpose of this study is to determine the prevalence of tinea pedis and onychomycosis in children of elementary school age and to examine the socio-demographic attributes that may be effective in correlation of both mycoses. 3,390 female and 3,768 male children between ages 6-14 have been examined in seven schools. Skin scrapings and nail samples were taken from 13 students who were suspected to have tinea pedis and from 49 students who were suspected to have onychomycosis. According to direct microscopy (10-15% KOH+calcofluor white) and culturel examination (Sabouraud dextrose agar and dermatophyte test medium) 11 students were diagnosed as tinea pedis and 24 were diagnosed as onychomycosis. Trichophyton rubrum was isolated in 3 students with tinea pedis whose culture was positive and five Candida albicans, five Candida glabrata and one Candida tropicalis cases were isolated from 11 samples with onychomycosis. Tinea pedis prevalence has been found to be 3.3%0. Differences between onychomycosis prevalence based on age have been found to be significant (p < 0.001). In conclusion, it has been determined that the prevalence of tinea pedis and onychomycosis among children is low. Candida spp. was isolated from all of the 14 samples diagnosed as onychomycosis. Our study shows similar results with previous studies done in Turkey and that Trichophyton rubrum continues to be the most isolated agent.

  6. Successive mycological nail tests for onychomycosis: a strategy to improve diagnosis efficiency

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    Tereza Elizabeth Fernandes Meireles

    2008-08-01

    Full Text Available Onychomycosis is a fungal infection of nails caused by dermatophytes, yeasts and moulds, accounting for about 50% of onychopathies. A high frequency of onychomycosis caused by Candida species has been reported during the last few years in northeast Brazil, as well as in other regions of the world. A clinical diagnosis of onychomycosis needs to be confirmed through laboratory exams. We evaluated the importance of serial repetition of direct microscopic exams and fungal culture for the diagnosis of onychomycosis in the city of Fortaleza, Ceará, in northeast Brazil. We first made a retrospective study of 127 patients with onychomycosis, identifying the fungi that had been isolated from fingernails and toenails. We then made a prospective study of 120 patients, who were submitted to three successive mycological examinations. Ungual residues were scraped off and directly examined with a microscope and fungal cultures were made. In the retrospective study, in which only one sample was analyzed, the incidence of onychomycosis was 25.0%. In our prospective study, in which we had data from successive mycological examinations, 37.8% had onychomycosis. The most commonly isolated fungi in both studies were yeasts from the genera Candida, especially C albicans, C. parapsilosis and C. tropicalis. We found a high proportion of onychomycosis caused by Candida species. We also concluded that serial repetition of direct microscopic examination and fungal culture, with intervals of 2-5 days improved the diagnosis of onychomycosis. We suggest that this laboratorial strategy is necessary for accurate diagnosis of this type of mycosis, especially when the standard procedures fail to diagnose fungal infection, despite strong clinical suspicion.

  7. Successive mycological nail tests for onychomycosis: a strategy to improve diagnosis efficiency

    Directory of Open Access Journals (Sweden)

    Tereza Elizabeth Fernandes Meireles

    Full Text Available Onychomycosis is a fungal infection of nails caused by dermatophytes, yeasts and moulds, accounting for about 50% of onychopathies. A high frequency of onychomycosis caused by Candida species has been reported during the last few years in northeast Brazil, as well as in other regions of the world. A clinical diagnosis of onychomycosis needs to be confirmed through laboratory exams. We evaluated the importance of serial repetition of direct microscopic exams and fungal culture for the diagnosis of onychomycosis in the city of Fortaleza, Ceará, in northeast Brazil. We first made a retrospective study of 127 patients with onychomycosis, identifying the fungi that had been isolated from fingernails and toenails. We then made a prospective study of 120 patients, who were submitted to three successive mycological examinations. Ungual residues were scraped off and directly examined with a microscope and fungal cultures were made. In the retrospective study, in which only one sample was analyzed, the incidence of onychomycosis was 25.0%. In our prospective study, in which we had data from successive mycological examinations, 37.8% had onychomycosis. The most commonly isolated fungi in both studies were yeasts from the genera Candida, especially C albicans, C. parapsilosis and C. tropicalis. We found a high proportion of onychomycosis caused by Candida species. We also concluded that serial repetition of direct microscopic examination and fungal culture, with intervals of 2-5 days improved the diagnosis of onychomycosis. We suggest that this laboratorial strategy is necessary for accurate diagnosis of this type of mycosis, especially when the standard procedures fail to diagnose fungal infection, despite strong clinical suspicion.

  8. [Interdigital and foot fungal infection in patients with onychomycosis].

    Science.gov (United States)

    Chanussot, Caroline; Arenas, Roberto

    2007-06-01

    In patients with onychomycosis (OM) 71.5% of them have been reported with plantar fungal infection. The aim of this study was to study the frequency and distribution of plantar and interdigital affection in diabetic patients and in a control group without diabetes, all of them with OM. Diabetic patients with OM were more frequently diagnosed with plantar (61.2%) than interdigital (46.7%) infection. In the control group similar results were obtained; patients with OM in 76.5% had plantar mycotic infection and 67.1% interdigital involvement.

  9. A Case of Onychomycosis Caused by Rhodotorula glutinis

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    Hatice Uludag Altun

    2014-01-01

    Full Text Available Rhodotorula spp. have emerged as opportunistic pathogens, particularly in immunocompromised patients. The current study reports a case of onychomycosis caused by Rhodotorula glutinis in a 74-year-old immunocompetent female. The causative agent was identified as R. glutinis based on the pinkish-orange color; mucoid-appearing yeast colonies on Sabouraud Dextrose Agar at 25°C; morphological evaluation in the Corn Meal-Tween 80 agar; observed oval/round budding yeast at 25°C for 72 hours; no observed pseudohyphae; positive urease activity at 25°C for 4 days; and assimilation features detected by API ID 32C kit and automated Vitek Yeast Biochemical Card 2 system. Antifungal susceptibility test results were as follows: amphotericin B (MIC = 0.5 µg/mL, fluconazole (MIC = 128 µg/mL, itraconazole (MIC = 0.125 µg/mL, voriconazole (MIC = 1 µg/mL, posaconazole (MIC = 0.5 µg/mL, anidulafungin (MIC = 0.5 µg/mL, and caspofungin (MIC = 16 µg/mL. Antifungal therapy was initiated with oral itraconazole at a dose of 400 mg/day; seven-day pulse therapy was planned at intervals of three weeks. Clinical recovery was observed in the clinical evaluation of the patient before the start of the third cure. Although R. glutinis has rarely been reported as the causative agent of onychomycosis, it should be considered.

  10. Epidemiologic Analysis of Onychomycosis in the San Diego Pediatric Population.

    Science.gov (United States)

    Totri, Christine R; Feldstein, Stephanie; Admani, Shehla; Friedlander, Sheila F; Eichenfield, Lawrence F

    2017-01-01

    Onychomycosis (OM) is thought to be a rare disease in children, although there are few epidemiologic studies. This 3-year retrospective case series of nearly 400 children seen at Rady Children's Hospital-San Diego (RCHSD) describes the characteristics of OM found in this pediatric population. From 2011 to 2013, the Pediatric and Adolescent Dermatology Clinic at RCHSD saw a total of 36,634 unique patients, of whom 433 were unique patients with OM. Thirty-four patients met exclusion criteria, leaving 399 (1.1%) with a diagnosis of OM by a pediatric dermatologist. Nail cultures were obtained in 242 cases (60.7%), 116 (48.0%) of which were positive. Trichophyton rubrum was the most commonly isolated pathogen, responsible for 106 cases (91.3%) of positive cultures in the cohort. Our study provides important regional information regarding epidemiologic data in pediatric onychomycosis, highlighting the diagnostic methods most commonly used and the pathogens most frequently encountered in our practice. © 2016 Wiley Periodicals, Inc.

  11. A review of the mechanism of action of lasers and photodynamic therapy for onychomycosis.

    Science.gov (United States)

    Bhatta, Anil Kumar; Keyal, Uma; Wang, Xiuli; Gellén, Emese

    2017-02-01

    Onychomycosis is one of the most common diseases in the field of dermatology. It refers to the fungal infection of the nail plate or nail bed with high incidence in the general population. The available treatment options for onychomycosis have limited use due to side effects, drug interactions, and contraindications, which necessitates the application of an alternative treatment for onychomycosis. In the recent years, lasers and photodynamic therapy (PDT) have been recognized as alternative treatment options. Most of the previous studies have found them to be safe and effective treatment modalities in this indication; however, the results varied greatly and the in vitro and in vivo outcomes are contradictory. In the present review, studies related to the mechanism of action of lasers and PDT for the treatment of onychomycosis will be discussed, with a focus on to find explanation to the contradictory results.

  12. A meta-analysis comparing efficacy of continuous terbinafine with intermittent itraconazole for toenail onychomycosis

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    Trivedi N

    2010-01-01

    Full Text Available Background: Toenail onychomycosis is a challenge for clinicians to treat. While both Itraconazole and terbinafine have proven to be effective against onychomycosis, very little is known about their comparative efficacy in achieving mycological and clinical cure. Aim: The purpose of this meta-analysis is to compare the efficacy of continuous terbinafine with intermittent itraconazole in the treatment of toenail onychomycosis. Material and Methods: all RCTs comparing continuous terbinafine with intermittent itraconazole were identified from PUBMED and BIDS electronic database. Results: analysis of total eight trials including 1181 patients state that treatment with continuous terbinafine is more likely to produce mycological and clinical cure compared to intermittent itraconazole with odds ratio 2.3(95% CI, 1.7 to 3.0 P< 0.0001 Conclusion: though both itraconazole and terbinafine are well tolerated and highly effective drugs, continuous terbinafine is more effective than intermittent itraconazole at achieving mycological cure of toenail onychomycosis

  13. The prevalence of culture-confirmed toenail onychomycosis in at-risk patient populations.

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    Gupta, A K; Daigle, D; Foley, K A

    2015-06-01

    Onychomycosis is a fungal infection of the nail and is the most common nail affliction in the general population. Certain patient populations are at greater risk of infection and the prevalence of onychomycosis reported in the literature has yet to be summarized across these at-risk groups. We performed a systematic review of the literature and calculated pooled prevalence estimates of onychomycosis in at-risk patient populations. The prevalence of dermatophyte toenail onychomycosis was as follows: general population 3.22% (3.07, 3.38), children 0.14% (0.11, 0.18), the elderly 10.28% (8.63, 12.18), diabetic patients 8.75% (7.48, 10.21), psoriatic patients 10.22% (8.61, 12.09), HIV positive patients 10.40% (8.02, 13.38), dialysis patients 11.93% (7.11, 19.35) and renal transplant patients 5.17% (1.77, 14.14). Dialysis patients had the highest prevalence of onychomycosis caused by dermatophytes, elderly individuals had the highest prevalence of onychomycosis caused by yeasts (6.07%; 95% CI = 3.58, 10.11) and psoriatic patients had the highest prevalence of onychomycosis caused by non-dermatophyte moulds (2.49%; 95% CI = 1.74, 3.55). An increased prevalence of onychomycosis in certain patient populations may be attributed to impaired immunity, reduced peripheral circulation and alterations to the nail plate which render these patients more susceptible to infection.

  14. Analysis of the Factors Influencing the Therapeutic Effects of Onychomycosis

    Institute of Scientific and Technical Information of China (English)

    ZHENG; Yuechen; WU; Yanqing; CHEN; Hui; ZHU; Zhaoru; LIU; Ling; ZENG; Jingsi

    2001-01-01

    In order to improve the curative effect of onychomycosis, the factors influencing the therapeutic effects were investigated. 545 cases including 245 males and 300 females, who were diagnosed both clinically and mycologically, were treated by Intraconazole with intermittent pulse therapy. The therapeutic effects were judged by the following observations regularly and analyzed from the factors as follows: age; growing speed of nails; accompanied diseases; family history; trauma of nails; infection ways of the pathogens; manifestation of the injury; pathogens; duration of the treatment. The results showed that the recovery rate was higher in younger patients (P<0.01) with a quicker recovery rate (P<0. 001), and a lower recurrent rate (P<0. 01), as well as in those with quicker growing speed of new-born nail. Also the patients with WSO and DLSO manifestation had a higher recovery rate. The patients with onychomycosis caused by T. rubrum had a higher recovery rate (P<0. 01 to 0. 001) no matter whether to prolong the treatment duration. The patients with diabetes mellitus or hyperhidrosis, as well as with positive family history or basic nail diseases such as trauma and paronychia, had a lower recovery rate and the curative effects were not satisfactory. It was concluded that although the single and some DLSO-manifestation nail injury could be cured by internal and external treatments with the help of removing the sick nail and the duration of the treatment could be shortened. The treatment duration should be prolonged in order to increase the curative effects and decrease the recurrence under such conditions as following: old patients above 60 years; patients with low-growing-speed new-borne nails; patients with thumb and big toel injury and ingrowing nail; patients with diabetes mellitus, hyperhidrosis or Renauld's phenomenon; patients with nail trauma before or during the treatment ; patients with PSO or TDO manifestation ; patients with onychomycosis caused

  15. Long-pulse Nd:YAG 1064-nm laser treatment for onychomycosis

    Institute of Scientific and Technical Information of China (English)

    ZHANG Rui-na; WANG Dong-kun; ZHUO Feng-lin; DUAN Xiao-han; ZHANG Xiao-yan; ZHAO Jun-ying

    2012-01-01

    Background Recent research shows that lasers can inhibit fungal growth and that Nd:YAG 1064-nm lasers can penetrate as deep as the lower nail plate.The aim of this study was to observe the effect of a long-pulse Nd:YAG 1064-nm laser on 154 nails of 33 patients with clinically and mycologically proven onychomycosis.Methods Thirty-three patients with 154 nails affected by onychomycosis were randomly assigned to two groups,with the 154 nails divided into three sub-groups (Ⅱ degree,Ⅲ degree,and Ⅳ degree) according to the Scoring Clinical Index of Onychomycosis.The 15 patients (78 nails) in group 1 were given eight sessions with a one-week interval,and the 18patients (76 nails) in group 2 were given four sessions with a one-week interval.Results In group 1,the effective rates at 8 weeks,16 weeks,and 24 weeks were 63%,62%,and 51%,respectively,and the effective rates in group 2 were 68%,67%,and 53% respectively.The treatment effect was not significantly different between any sub-group pair (P >0.05).Conclusions Long pulse Nd:YAG 1064-nm laser was effective for onychomycosis.It is a simple and effective method without significant complications or side effects and is expected to become an alternative or replacement therapy for onychomycosis.

  16. Onicomicosis por hongos fuliginosos Onychomycosis Caused by Demateaceous Fungi

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    Ingrid Salas-Campos

    2009-12-01

    Full Text Available Justificación y objetivo: Las infecciones de las uñas producidas por hongos son un problema de frecuente consulta dermatológica. Los dermatofitos son la mayor causa de estas infecciones, siendo Trichophyton rubrum el agente etiológico más importante. Sin embargo, los hongos no dermatofitos, tanto hialinos como fuliginosos, pueden ser también responsables de estos cuadros clínicos. Debido a que estos hongos tienden a ser resistentes a los antimicóticos comúnmente usados para tratar las onicomicosis, es que se hace indispensable que el clínico se asegure por medio de un examen de laboratorio de la etiología de la infección. Métodos: Se estudiaron tres casos de pacientes con lesiones en uñas, que acudieron al laboratorio de Micología Médica, Facultad de Microbiología, Universidad de Costa Rica. Se realizaron los análisis de rutina para aislamiento e identificación de hongos patógenos. Resultados: En los tres casos estudiados se observó al examen directo micelio fuliginoso. En uno de los casos se aisló e identificó Scytalidium dimidiatum, hongo que presenta resistencia a los antifúngicos utilizados para tratar onicomicosis. Conclusión. El reporte de hongos diferentes a los dermatofitos como agentes etiológicos de onicomicosis es importante para que el médico pueda elegir el tratamiento más recomendado para este tipo de infección.Background and aim: Onychomycosis is one of the commonest dermatological conditions. Dermatophytes, especially Trichophyton rubrum, are responsible for the majority of infections. However, hyaline non-dermathophyte and demataceous fungi may also cause nail infections. The antifungal agents commonly use to treat non-dermatophyte nail infections are of low efficacy. Thus, the medical doctor must be provided with a laboratory diagnosis of the etiological agent before treating the patient. Methods: Three clinical cases of nail infections were studied in the laboratory of Medical Mycology, School of

  17. A rare case of onychomycosis in all 10 fingers of an immunocompetent patient

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    Asima Banu

    2013-01-01

    Full Text Available Onychomycosis, traditionally referred as a non-dermatophytic infection of the nail, is now used as a general term to denote any fungal nail infection. It is an important public health problem due to its increasing incidence and has significant clinical consequences in addition to serving as a reservoir of infection. We report a case of Onychomycosis in all 10 fingers of an immunocompetent male with no co-morbid conditions caused by a non-dermatophytic fungus, Aspergillus niger. To the best of our knowledge, this is the first case of its kind to be reported.

  18. Factors influencing coexistence of toenail onychomycosis with tinea pedis and other dermatomycoses: a survey of 2761 patients.

    Science.gov (United States)

    Szepietowski, Jacek C; Reich, Adam; Garlowska, Emilia; Kulig, Marzena; Baran, Eugeniusz

    2006-10-01

    To evaluate the prevalence and factors influencing the presence of concomitant dermatomycoses in patients with toenail onychomycosis. Prospective study based on a specially designed questionnaire completed by dermatologists. A total of 2761 patients with toenail onychomycosis. The diagnosis of fungal skin infections was confirmed by direct microscopic examination or by culture. In 1181 patients (42.8%) with toenail onychomycosis, concomitant fungal skin infections were noted. Tinea pedis was the most common and was found in 933 patients (33.8%). Other concomitant fungal skin infections were fingernail onychomycosis (7.4%), tinea cruris (4.2%), tinea corporis (2.1%), tinea manuum (1.6%), and tinea capitis (0.5%). The presence of concomitant fungal skin infections depended on number of involved toenails; duration of onychomycosis; sex, age, and education level; area of residence; and type of isolated fungus. The coexistence of toenail onychomycosis with other types of fungal skin infections is a frequent phenomenon. It could be hypothesized that infected toenails may be a site from which the fungal infections could spread to other body areas. Effective therapy for onychomycosis might therefore be essential not only to treat the lesional toenails but also to prevent spreading the infection to other sites of the skin.

  19. Rapid response of Trichophyton tonsurans-induced onychomycosis after treatment with terbinafine.

    Science.gov (United States)

    Aly, Raza; Hafeez, Zeba Hasan; Rodwell, Carmen; Frieden, Ilona J; Abrams, Beatrice

    2002-06-01

    We describe an 8-year-old Hispanic female who presented with distal subungual onychomycosis and tinea capitis. Both foci of infection yielded Trichophyton tonsurans upon culture, and were clinically and mycologically cured with terbinafine 125 mg, once daily for 1 week [DOSAGE ERROR CORRECTED]. This aspect of treatment with terbinafine has not previously been reported.

  20. Role of HLA-DR Alleles to Increase Genetic Susceptibility to Onychomycosis in Nail Psoriasis

    Science.gov (United States)

    Carrillo-Meléndrez, Hilda; Ortega-Hernández, Esteban; Granados, Julio; Arroyo, Sara; Barquera, Rodrigo; Arenas, Roberto

    2016-01-01

    Background Patients with nail psoriasis have an increased risk of onychomycosis. Previous studies suggest it may be due to structural changes of the nails. However, a genetic predisposition seems to be also at play. Objective To determine a genetic susceptibility for onychomycosis in nails with changes of psoriasis. Methods This is a prospective case-control study of patients with suggestive changes of nail psoriasis with onychomycosis (cases) and without onychomycosis (controls) confirmed by mycological tests. HLA typing was performed in all of them by sequence-specific primers. Results Twenty-five patients and 20 controls with a mean age of 50 years (range 37-72 years) were studied. HLA-DRB1*08 was found in 12 cases (48%) and only 3 controls (15%) [p < 0.033, odds ratio (OR) = 3.8, 95% confidence interval (CI): 0.9-19]. HLA-DR1 was found in 9 cases (36%) and only 1 control (5%) (p < 0.023, OR = 8.5, 95% CI: 1-188). Conclusion HLA-DR*08 and HLA-DR*01 probably increase the susceptibility to fungal infection in psoriasis-affected nails, but larger studies are required to confirm this observation. PMID:27843918

  1. Prevalence of toenail onychomycosis among diabetics at a primary care facility in Malaysia.

    Science.gov (United States)

    Leelavathi, M; Azimah, M N; Kharuddin, N F; Tzar, M N

    2013-05-01

    Onychomycosis increases the risk of developing secondary bacterial infection and cellulitis if left untreated. The aim of this study was to determine the prevalence of onychomycosis among diabetics and its associated factors. A cross sectional study using universal sampling of all type 1 and 2 diabetic patients attending a primary care facility of the Universiti Kebangsaan Malaysia (UKM) from January to March 2011 was conducted. Samples were taken from clinically abnormal nails and from the first right toenail in the absence of nail abnormalities and cultured for fungal elements. A total of 151 diabetics participated in the study. The mean patient age was 60.7 +/- 9.1 years. A total of 123 nail samples (81.5%) were culture positive for fungal elements. A positive correlation was found between onychomycosis and increasing age (p = 0.011) and clinically abnormal nails (p < 0.05). There were no significant correlations with gender, ethnic group, duration of diabetes, types of diabetes or glycemic control. The prevalence of onychomycosis among diabetics in our study was high.

  2. A prospective epidemiological study on tinea pedis and onychomycosis in Hong Kong

    Institute of Scientific and Technical Information of China (English)

    鄭秀儀; 莊禮賢

    2002-01-01

    Objective To study the epidemiology of foot diseases, including tinea pedis and onychomycosis in clinic attendees in Hong Kong.Methods Two groups were included: the institutional group consisted of clinical evaluation and mycological investigations by dermatologists; and the private group consisted of clinical evaluation only by the private physicians. Patients who had a regular visit to the clinics were randomly invited to have a clinical examination of their feet.Results A total of 1014 patients were studied. The prevalence rate of foot disease, fungal infections, tinea pedis and toe nail onychomycosis were respectively 50.7%, 26.9%, 20.4% and 16.6%. More male and elderly patients were affected except that the sex prevalence in toe nail onychomycosis was not shown to be significant. Vascular disease, diabetes mellitus and obesity were the three most prevalent predisposing factors in foot disease, fungal disease and fungal nail disease. Dermatophytes, in particular Trichophyton rubrum, were shown to be the most common pathogen in both skin and nail infections.Conclusions Foot diseases, especially tinea pedis and toe nail onychomycosis, are common in patients attending local clinics in Hong Kong. Both physicians and patients should be more aware of foot problems and have more active approaches and management strategies.

  3. Onychomycosis in the elderly. A 2-year retrospective study of 138 cases

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    J. Araiza-Santibáñez

    2016-01-01

    Conclusions: Approximately 9 out of 10 nail disorders in the elderly were onychomycosis; many of these patients may present with comorbidities such as hypertension or diabetes mellitus, which often complicate treatment outcomes, affecting quality of life. Elderly patients should receive adequate health education and monitoring. This will improve their quality of life.

  4. Procedure to diagnose onychomycosis through changes in emissivity on infrared images.

    Science.gov (United States)

    Villaseñor-Mora, Carlos; Vega, Arturo Gonzalez; Garay-Sevilla, Maria Eugenia; Padilla-Medina, José Alfredo; Arteaga-Murillo, Lauro Ivan

    2013-11-01

    A noninvasive, quick, reliable, and relatively cheap procedure for the diagnosis of onychomycosis is put forward. It is known that a nail may show an abnormal appearance, although only 50% of all the nails having such an appearance may owe it to the presence of onychomycosis; hence, adequate diagnosis of nail disease is needed for appropriate prescription of medication and treatment of the nail. In order to contribute to the process of improvement in the diagnosis, a procedure based on the analysis of medium-range infrared images is presented in which it is possible to observe energy changes mostly due to the changes in emissivity of the nail. As a nail is more affected by onychomycosis, such changes become more intense. Also, it was found that a nail without onychomycosis has a lower temperature than toe skin, but has a higher emission of energy. Fifty percent of the ailments that may a cause a fingernail or toenail to have an abnormal appearance are not considered in the present work.

  5. A study of onychomycosis in Krishna district of Andhra Pradesh, India

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    Dusi Ratna Harika

    2015-09-01

    Full Text Available Introduction: Onychomycosis is a chronic infection of nails caused by fungi such as dermatophytes, yeasts or nondermatophyte moulds. It is the most prevalent of all the nail ailments and affects 3- 5% of the population worldwide and represents 20-40% of onychopathies and about 30% of mycotic cutaneous infections. Aims: 1To isolate and identify the etiological fungi and to assess the prevalence of onychomycosis. 2To analyse the epidemiological and mycological features of onychomychosis. Methods: 109 nail samples were collected from 102 clinically suspected cases of onychomycosis and further analysed. Results: Of 102 cases, the commonest age group was 41-50 years 38 (37.25%; males were 63 (61.76% and females 39 (38.24%; involvement of toe nails in 73 (71.57%, finger nails 25 (24.51% and both 4 (3.92%; 56 (54.90% belonged to low socio-economic status, middle 31 (30.39% and high 15 (14.71%. Labourers were 14 (13.73%, farmers and office personnel 10 (9.80%. Of 109 samples, direct microscopy by KOH mount was positive in 82 (75.23% and fungal culture in 52 (47.71% of which 29 (26.61% yielded dermatophytes, NDM’s 11(21.15%, Candida spp. 8 (15.38% and mixed growth 4 (7.68%. Dermatophytes 25(48.08% were the predominant group isolated from toe nails and Candida spp. 6 (11.54% from the finger nails respectively. Among the 56 isolates, dermatophytes were the predominant group 31 (55.36% followed by NDM’s 15 (26.78% and Candida spp.10 (17.86%. Conclusion: Onychomycosis is a frequent cause of nail infection. The mycological study and the identification of etiological agents of onychomycosis are needed to confirm the clinical diagnosis and for the choice of therapy

  6. Onychomycosis does not always require systemic treatment for cure: a trial using topical therapy.

    Science.gov (United States)

    Friedlander, Shiela Fallon; Chan, Yuin C; Chan, Yiong H; Eichenfield, Lawrence F

    2013-01-01

    Standard teaching dictates that systemic therapy is required for treatment of onychomycosis. It is unknown whether topical antifungal therapy is effective for pediatric nail infections. This prospective, randomized, double-blind, vehicle-controlled study was conducted in the Pediatric Dermatology Research Unit at Rady Children's Hospital to determine whether topical antifungal therapy is efficacious for pediatric onychomycosis. Forty patients ages 2 to 16 years with nonmatrix onychomycosis were randomized 1:3 to ciclopirox lacquer or vehicle lacquer. Ciclopirox lacquer or vehicle was applied daily for 32 weeks, with weekly removal of the lacquer and mechanical trimming. Those with poor response were crossed over to active drug at week 12. Thirty-seven patients completed the 32-week study, and follow-up data were collected 1 year after completion of the study from 24 patients. Mycologic cure, effective treatment, and complete cure were assessed, as well as adverse events and effect on quality of life. Mycologic cure was 70% in the treated group and 20% in the vehicle arm (p = 0.03) at week 12. At end of the study (week 32), 77% of treated patients achieved mycologic cure and 71% effective treatment, compared with 22% of the control group. Ninety-two percent of those who were cured and followed for 1 year remained clear. Topical antifungal lacquer (ciclopirox) can be an effective option for children with nonmatrix onychomycosis. Pediatric onychomycosis does not always require systemic therapy and responds better to topical therapy than does adult disease.

  7. The OnyCOE-t™ questionnaire: responsiveness and clinical meaningfulness of a patient-reported outcomes questionnaire for toenail onychomycosis

    OpenAIRE

    Kianifard Farid; Raut Monika; Mathias Susan D; Potter Lori P; Tavakkol Amir

    2006-01-01

    Abstract Background This research was conducted to confirm the validity and reliability and to assess the responsiveness and clinical meaningfulness of the OnyCOE-t™, a questionnaire specifically designed to measure patient-reported outcomes (PRO) associated with toenail onychomycosis. Methods 504 patients with toenail onychomycosis randomized to receive 12 weeks of terbinafine 250 mg/day with or without target toenail debridement in the IRON-CLAD® trial completed the OnyCOE-t™ at baseline, w...

  8. Onicomicosis por Acremonium Kiliense Onychomycosis by Acremonium Kiliense

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    M C Albrecht

    2007-03-01

    Full Text Available El rol de los hongos filamentosos hilalinos no dermatofitos, como agentes causales de onicomicosis, ha sido documentado en las últimas tres décadas por diferentes autores y son considerados oportunistas emergentes. El objetivo de este trabajo es presentar un caso de onicomicosis producido por Acremonium kiliense, cuya evolución fue estudiada. Se presentó al laboratorio de micología un paciente de 18 años de edad de sexo femenino con traumatismo en la uña del primer dedo del pie derecho. Se tomaron muestras seriadas de la lesión para la observación microscópica directa con OHK 40% p/v y para cultivos en Agar Sabouraud, Agar Lactrimel y DTM (medio selectivo para dermatofitos y con las colonias recuperadas se efectuaron microcultivos. Se implementó tratamiento con ciclopirox laca al 8% combinado al principio con Itraconazol vía oral (100 mg/día, con buena evolución. Es importante tener en cuenta a estos hongos oportunistas como agentes etiológicos potenciales de micosis ungueales, en especial en pacientes inmunodeprimidos, ya que la afección ungueal puede ser la puerta de entrada para la diseminación de la infección.The role of non-dermatophytic hyaline filamentous fungi as agents of onychomycosis has been documented in the last three decades by different authors, who have considered these fungi emerging opportunists. A 18-year-old female patient with trauma to the first toenail of the right foot came to the mycology laboratory. Serial samples of the lesion were collected for direct microscopic observation using 40% (w/v potassium hydroxide (KOH and for culture in Sabouraud agar, Lactrimel agar and DTM (dermatophyte selective medium. Microcultures were grown from the colonies recovered. Treatment with 8% ciclopirox nail lacquer, combined at the beginning with oral administration of itraconazole (100 mg a day, was implemented with good evolution. It is important to consider these opportunist fungi as potential etiological agents

  9. Safety and efficacy of tinea pedis and onychomycosis treatment in people with diabetes: a systematic review

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    Matricciani Lisa

    2011-12-01

    Full Text Available Abstract Background Effective treatment of tinea pedis and onychomycosis is crucial for patients with diabetes as these infections may lead to foot ulcers and secondary bacterial infections resulting in eventual lower limb amputation. Although numerous studies have assessed the effectiveness of antifungal drug and treatment regimens, most exclude patients with diabetes and examine otherwise healthy individuals. While these studies are useful, results cannot necessarily be extrapolated to patients with diabetes. The purpose of this study was to therefore identify the best evidence-based treatment interventions for tinea pedis or onychomycosis in people with diabetes. Methods The question for this systemic review was: 'what evidence is there for the safety and/or efficacy of all treatment interventions for adults with tinea pedis and/or onychomycosis in people with diabetes'? A systematic literature search of four electronic databases (Scopus, EbscoHost, Ovid, Web of Science was undertaken (6/1/11. The primary outcome measure for safety was self-reported adverse events likely to be drug-related, while the primary outcome measures assessed for 'efficacy' were mycological, clinical and complete cure. Results The systematic review identified six studies that examined the safety and/or efficacy of treatment interventions for onychomycosis in people with diabetes. No studies were identified that examined treatment for tinea pedis. Of the studies identified, two were randomised controlled trials (RCTs and four were case series. Based on the best available evidence identified, it can be suggested that oral terbinafine is as safe and effective as oral itraconazole therapy for the treatment of onychomycosis in people with diabetes. However, efficacy results were found to be poor. Conclusions This review indicates that there is good evidence (Level II to suggest oral terbinafine is as safe and effective as itraconazole therapy for the treatment of

  10. Onychomycosis due to Candida parapsilosis in a Child with Ventricular Septal Defect: An Unusual Predisposition

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    Supram Hosuru Subramanya

    2016-01-01

    Full Text Available Candida parapsilosis is emerging as a potential pathogen for onychomycosis. A 4-year-old male child with perimembranous ventricular septal defect (VSD was admitted with features of cystitis and was treated with broad spectrum antibiotics. Two weeks later, he developed yellowish discoloration of nails of both hands. The sloughed out nail, on microscopy, showed numerous yeast forms that were identified as Candida parapsilosis by both phenotypic and genotypic methods. Antifungal sensitivity testing of the isolate was performed by microbroth dilution method in accordance with CLSI guidelines. Patient was successfully treated with topical amphotericin B and oral fluconazole. Thus, one should have a high index of suspicion of C. parapsilosis onychomycosis, especially when the patient is in the paediatric age group, presenting with unusual predisposing condition like congenital heart disease, and is on broad spectrum antibiotics.

  11. Evaluation of topical antifungal products in an in vitro onychomycosis model.

    Science.gov (United States)

    Sleven, Reindert; Lanckacker, Ellen; Delputte, Peter; Maes, Louis; Cos, Paul

    2016-05-01

    Many topical commercial products are currently available for the treatment of onychomycosis. However, limited data are available concerning their antifungal activity. Using an in vitro onychomycosis model, the daily application of seven nail formulations was compared to the antifungal reference drug amorolfine (Loceryl(®) ) and evaluated for inhibitory activity against Trichophyton mentagrophytes using an agar diffusion test. Of all commercial nail formulations, only Excilor(®) and Nailner(®) demonstrated inhibitory activity, which was much lower compared to the daily application of Loceryl(®) . However, Excilor(®) showed similar efficacy compared to the conventional weekly application of Loceryl(®) . These results suggest a role for organic acids in the antifungal effect of Excilor(®) (acetic acid, ethyl lactate) and Nailner(®) (lactic acid, citric acid, ethyl lactate) as all tested formulations without organic acids were inactive.

  12. Effective Single Photodynamic Treatment of ex Vivo Onychomycosis Using a Multifunctional Porphyrin Photosensitizer and Green Light

    OpenAIRE

    Hollander, Chelsea; Visser, Jasper; Haas, Ellen; Incrocci, Luca; Smijs, Threes

    2015-01-01

    Onychomycosis is predominantly caused by the dermatophytes Trichophyton rubrum, Trichophyton mentagrophytes and Trichophyton tonsurans. The main treatment obstacle concerns low nail-plate drug permeability. In vitro antifungal photodynamic treatment (PDT) and nail penetration enhancing effectiveness have been proven for multifunctional photosensitizer 5,10,15-tris(4-N-methylpyridinium)-20-(4-(butyramido-methylcysteinyl)-hydroxyphenyl)-[21H,23H]-porphine trichloride (PORTHE). This study invest...

  13. Effective Single Photodynamic Treatment of ex Vivo Onychomycosis Using a Multifunctional Porphyrin Photosensitizer and Green Light

    OpenAIRE

    Hollander, Chelsea; Visser, Jasper; Haas, Ellen; Incrocci, Luca; Smijs, Threes

    2015-01-01

    Onychomycosis is predominantly caused by the dermatophytes Trichophyton rubrum, Trichophyton mentagrophytes and Trichophyton tonsurans. The main treatment obstacle concerns low nail-plate drug permeability. In vitro antifungal photodynamic treatment (PDT) and nail penetration enhancing effectiveness have been proven for multifunctional photosensitizer 5,10,15-tris(4-N-methylpyridinium)-20-(4-(butyramido-methylcysteinyl)-hydroxyphenyl)-[21H,23H]-porphine trichloride (PORTHE). This study invest...

  14. Treatment of Onychomycosis with Efinaconazole 10% Topical Solution and Quality of Life

    OpenAIRE

    Tosti, Antonella; Elewski, Bom E.

    2014-01-01

    Objective: To evaluate the benefits of efinaconazole topical solution, 10% on quality of life in onychomycosis patients. Methods: An analysis of 1,655 patients, aged 18 to 70 years, randomized to receive efinaconazole topical solution, 10%, or vehicle from two identical multicenter, double-blind, vehicle-controlled, 48-week studies evaluating safety and efficacy. The primary endpoint was complete cure rate (0% clinical involvement of target toenail, and both negative potassium hydroxide exami...

  15. Fractional carbon-dioxide (CO2) laser-assisted topical therapy for the treatment of onychomycosis.

    Science.gov (United States)

    Bhatta, Anil Kumar; Keyal, Uma; Huang, Xin; Zhao, Jing Jun

    2016-05-01

    Inability of topical medications to penetrate via nail plate brings a great challenge to clinicians in treating onychomycosis. Furthermore, oral medications are not appropriate for all patients because of drug interactions, adverse effects, and contraindications. We sought to evaluate the clinical efficacy of fractional carbon-dioxide laser-assisted topical therapy for onychomycosis. In total, 75 patients with 356 onychomycotic nails confirmed by mycologic examination were included in this study. All the affected nails received 3 sessions of laser therapy at 4-week intervals and once-daily application of terbinafine cream for 3 months. In all, 94.66% and 92% of the treated patients were potassium hydroxide and culture negative, respectively, after 3 months of treatment. However, only 84% and 80% were potassium hydroxide and culture negative, respectively, at 6 months of follow-up. Using Scoring Clinical Index for Onychomycosis electronic calculator, 73.33% of the patients scored higher than 6 and 26.66% of the patients scored 6 or less. Those who scored more than 6 were evaluated clinically and 98.18% of them showed response to treatment at 3 months and 78.18% of them at 6 months of follow-up. Lack of control group and short duration of follow-up are limitations. Fractional carbon-dioxide laser therapy combined with topical antifungal was found to be effective in the treatment of onychomycosis. However, randomized clinical studies are needed before it can be widely used in clinics. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  16. Comparison of direct microscopy, culture and calcofluor white for the diagnosis of onychomycosis.

    Science.gov (United States)

    Bonifaz, Alexandro; Rios-Yuil, José Manuel; Arenas, Roberto; Araiza, Javier; Fernández, Ramón; Mercadillo-Pérez, Patricia; Ponce-Olivera, Rosa María

    2013-01-01

    Mycological diagnosis of onychomycosis can be performed by direct microcopy (KOH), cultures and calcofluor white. To compare the percentage of positivity and the degree of correlation of KOH, cultures and calcofluor white for the diagnosis of onychomycosis. Descriptive, transversal and comparative study. Samples of toenails with onychomycosis were used for KOH, cultures and calcofluor white under fluorescence. The percentage of positivity of the different techniques was calculated and the degree of correlation between them was determined (Epi Info v 3.4.3(©)). KOH was positive in 66.67% of the cases, cultures in 33.33% and calcofluor white in 57.58%. KOH and calcofluor white had a higher percentage of positivity than culture (p<0.01 and p<0.05 respectively). The degree of correlation between KOH and calcofluor white was excellent (κ=0.8085; p<0.0001); however, the degree of correlation between KOH and culture and between calcofluor white and culture was poor. The use of calcofluor white is not recommended in routine laboratories because it does not seem to bring any additional benefits when comparing with KOH. This is especially important when funding is a great problem. Copyright © 2012 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.

  17. Scanning electron microscopy of the nail plate in onychomycosis patients with negative fungal culture.

    Science.gov (United States)

    Yue, Xueping; Li, Qing; Wang, Hongwei; Sun, Yilin; Wang, Aiping; Zhang, Qi; Zhang, Cuiping

    2016-01-01

    Onychomycosis is a common dermatological problem and can be identified by direct microscopic examination and fungal culture. However, the positive rate of fungal culture is low. This study investigated the application of scanning electron microscopy in the diagnosis of onychomycosis in 20 patients with negative fungal culture. In this study, a routine glutaraldehyde fixation method was used to prepare specimens for electron microscope examination. Results showed that under the scanning electron microscope, significant structural damage was observed in the nail plate in all patients. Hyphaes were seen in 70% of cases. A mixture of scattered hyphaes, pseudohyphaes, and spores was observed in 30% of cases. A mixture of spores and bacteria was observed in 10% of cases. A mixture of hyphaes and bacteria was observed in 20% of cases. The typical hyphae pierced a thin layer or single layer of corneocytes. Hyphaes could be smooth, sleek, and straight with visible separation, or dry, bent, and folded with a smooth surface. The diameter of hyphaes was 1-2 µm. The scattered spores were the main form of spore growth, and the growth of budding spores can be seen attached to the surface of layered armor. Most of the bacteria were gathered in clumps on the ventral surface, especially in grooves. In conclusion, scanning electron microscopy can be used to preliminarily identify the pathogen involved and the degree of damage in cases where onychomycosis is clinically diagnosed, but fungal culture is negative.

  18. Natural coniferous resin lacquer in treatment of toenail onychomycosis: an observational study.

    Science.gov (United States)

    Sipponen, Pentti; Sipponen, Arno; Lohi, Jouni; Soini, Marjo; Tapanainen, Riikka; Jokinen, Janne J

    2013-05-01

    In in vitro tests, natural coniferous resin from the Norway spruce (Picea abies) is strongly antifungal. In this observational study, we tested the clinical effectiveness of a lacquer composed of spruce resin for topical treatment of onychomycosis. Thirty-seven patients with clinical diagnosis of onychomycosis were enrolled into the study. All patients used topical resin lacquer treatment daily for 9 months. A mycological culture and potassium hydroxide (KOH) stain were done from nail samples in the beginning and in the end of the study. Treatment was considered effective, if a mycological culture was negative and there was an apparent clinical cure. At study entry, 20 patients (20/37; 54%; 95% CI: 38-70) had a positive mycological culture and/or positive KOH stain for dermatophytes. At study end, the result of 13 patients was negative (13/19; 68%; 95% CI: 48-89). In one case (1/14; 7%; 95% CI: 0-21) the mycological culture was initially negative, but it turned positive during the study period. By 14 compliant patients (14/32; 44%; 95% CI: 27-61), resin lacquer treatment was considered clinically effective: complete healing took place in three cases (9%) and partial healing in 11 cases (85%). The results indicate some evidence of clinical efficacy of the natural coniferous resin used for topical treatment of onychomycosis. © 2012 Blackwell Verlag GmbH.

  19. Laser therapy for onychomycosis in patients with diabetes at risk for foot complications : study protocol for a randomized, double-blind, controlled trial (LASER-1)

    NARCIS (Netherlands)

    Nijenhuis-Rosien, Leonie; Kleefstra, Nanne; Wolfhagen, Maurice J.; Groenier, Klaas H.; Bilo, Henk J. G.; Landman, Gijs W. D.

    2015-01-01

    Background: In a sham-controlled double-blind trial, we aim to establish the efficacy and safety of the local application of laser therapy in patients with diabetes, onychomycosis and risk factors for diabetes-related foot complications. Onychomycosis leads to thickened and distorted nails, which in

  20. Prevalence and risk factors of onychomycosis in primary school children living in rural and urban areas in Central Anatolia of Turkey

    Directory of Open Access Journals (Sweden)

    Mustafa Gulgun

    2013-01-01

    Full Text Available Background: Onychomycosis is a world-wide public health concern in children, requiring epidemiological data for different regions for control and prevention. Aim: The aim of this study was to evaluate the predominant pathogens and risk factors for onychomycosis in school children living in Kayseri, Turkey. Methods: This study included 8122 school children, aged 5-16 years, living in the rural and urban areas around Kayseri. Onychomycosis was clinically classified as distal and lateral subungual (DLSO, proximal subungual, superficial white, endonyx and totally dystrophic onychomycosis. Nail samples from children with clinically diagnosed onychomycosis were collected, examined by direct microscopy and inoculated for culture study. The demographic features and possible risk factors were recorded and assessed by logistic regression models. Results: We clinically diagnosed onychomycosis in 152 out of 8,122 (0.18% school children. DLSO was the most frequent clinical diagnosis (120/152, 78.9%. Culture-positive onychomycosis was detected in 27/152 (17.7% children. The prevalence of culture-positive onychomycosis was determined as 0.33%. All culture-positive samples were only from toenails. The onychomycosis causative agents were dermatophytes in 17/27 cases (62.9%, including Trichophyton rubrum 12 (44.4%, Trichophyton mentagrophytes 1 (3.7%, Trichophyton tonsurans 1 (3.7% and Trichophyton spp. 3 (11.1% and yeasts in 10/27 cases (37.1%, including Candida glabrata 4 (14.8%, Candida parapsilosis 1 (3.7%, Trichosporon 2 (7.4% and Rhodotorula 3 (11.1%. Age, father′s occupation, number of siblings and rooms were statistically associated with the frequency of onychomycosis. Conclusions: Although to be prevalence of onychomycosis in school children in central Anatolia of Turkey seems very low degree, pediatric onychomycosis is a growing public health concern all over the world. Children having more siblings or unemployed fathers and children living in small

  1. Evaluation of improvement of onychomycosis in HIV-infected patients after initiation of combined antiretroviral therapy without antifungal treatment.

    Science.gov (United States)

    Ruíz-López, Patricia; Moreno-Coutiño, Gabriela; Fernández-Martínez, Ramón; Espinoza-Hernández, Jessica; Rodríguez-Zulueta, Patricia; Reyes-Terán, Gustavo

    2015-09-01

    Onychomycosis in HIV-infected patients has a prevalence of 20-44% and is more frequently seen with CD4(+) T cell counts ≤450 cel μl(-1). There are case reports of improvement in onychomycosis after initiation of combined antiretroviral therapy (cART), but there are no prospective studies that prove the existence and frequency of this phenomenon. The aim of this study was to evaluate if HIV-infected patients with onychomycosis who begin cART improve and/or cure without antifungal treatment. We included HIV-infected patients with onychomycosis who had not started cART and nor received antifungal therapy during 6 months prior to the study. We evaluated affected the nails with the Onychomycosis Severity Index (OSI); nail scrapings were collected and direct microscopy with potassium hydroxide (KOH) as well as mycological culture were performed. We repeated these procedures at 3 and 6 months to assess changes. CD4 T cell counts and HIV viral load were obtained. A total of 16 patients were included, with male gender predominance (68.7%); distal and lateral subungual onychomycosis (DLSO) was the most common form (31.3%). Trichophyton rubrum was the most frequently isolated microorganism. OSI decreased 21.5% at 3 months and 40% at 6 months after initiation of antiretrovirals (P = 0.05). We found a non-significant tendency towards improvement with higher CD4(+) T cell counts and with viral loads <100 000 copies ml(-1). This could be due to the increase in CD4(+) T cells, decreased percentage of Treg (CD4(+)CD25(+)) among CD4(+) Tcells and/or a decreased viral load; further studies are necessary to prove these hypothesis.

  2. Photodynamic and Nail Penetration Enhancing Effects of Novel Multifunctional Photosensitizers Designed for The Treatment of Onychomycosis.

    Science.gov (United States)

    Smijs, Threes; Dame, Zoë; de Haas, Ellen; Aans, Jan-Bonne; Pavel, Stan; Sterenborg, Henricus

    2014-01-01

    Novel multifunctional photosensitizers (MFPSs), 5,10,15-tris(4-N-methylpyridinium)-20-(4-phenylthio)-[21H,23H]-porphine trichloride (PORTH) and 5,10,15-tris(4-N-methylpyridinium)-20-(4-(butyramido-methylcysteinyl)-hydroxyphenyl)-[21H,23H]-porphine trichloride (PORTHE), derived from 5,10,15-Tris(4-methylpyridinium)-20-phenyl-[21H,23H]-porphine trichloride (Sylsens B) and designed for treatment of onychomycosis were characterized and their functionality evaluated. MFPSs should function as nail penetration enhancer and as photosensitizer for photodynamic treatment (PDT) of onychomycosis. Spectrophotometry was used to characterize MFPSs with and without 532 nm continuous-wave 5 mW cm(-2) laser light (± argon/mannitol/NaN3 ). Nail penetration enhancement was screened (pH 5, pH 8) using water uptake in nails and fluorescence microscopy. PDT efficacy was tested (pH 5, ± argon/mannitol/NaN3 ) in vitro with Trichophyton mentagrophytus microconida (532 nm, 5 mW cm(-2) ). A light-dependent absorbance decrease and fluorescence increase were found, PORTH being less photostable. Argon and mannitol increased PORTH and PORTHE photostability; NaN3 had no effect. PDT (0.6 J cm(-2) , 2 μm) showed 4.6 log kill for PORTH, 4.4 for Sylsens B and 3.2 for PORTHE (4.1 for 10 μm). Argon increased PORTHE, but decreased PORTH PDT efficacy; NaN3 increased PDT effect of both MFPSs whereas mannitol increased PDT effect of PORTHE only. Similar penetration enhancement effects were observed for PORTH (pH 5 and 8) and PORTHE (pH 8). PORTHE is more photostable, effective under low oxygen conditions and thus realistic candidate for onychomycosis PDT.

  3. Terbinafine hydrochloride loaded liposome film formulation for treatment of onychomycosis: in vitro and in vivo evaluation.

    Science.gov (United States)

    Tanrıverdi, Sakine Tuncay; Hilmioğlu Polat, Süleyha; Yeşim Metin, Dilek; Kandiloğlu, Gülşen; Özer, Özgen

    2016-01-01

    Onychomycosis is a fungal infection of nail unit that is caused by dermatophytes. Oral Terbinafine hydrochloride (TBF-HCl) is being used for the treatment of onychomycosis since 24 years. The side effects caused by the systemic application and limitations of topical administration of this drug regarding the diffusion through nail lead to the development of a new formulation based on, TBF-HCl-loaded liposome. The newly obtained film formulations were prepared and characterized via several parameters, such as physical appearance, drug content, thickness, bioadhesive properties and tensile strength. In vitro and ex vivo permeation studies were performed to select an optimum film formulation for antifungal activity to show the efficiency of formulations regarding the treatment of onychomycosis. The in vitro release percentages of drug were found 71.6 ± 3.28, 54.4 ± 4.26, 56.1 ± 7.48 and 46.0 ± 2.43 for liposome loaded pullulan films (LI-P, LII-P) and liposome loaded Eudragit films (LI-E, LII-E), respectively. The accumulated drug in the nail plates were found 31.16 ± 4.22, 24.81 ± 5.35, 8.17 ± 1.81 and 8.92 ± 3.37 for LI-P, LII-P, LI-E and LII-E, respectively, which within therapeutic range for all film formulations. The accumulated drug in the nail plate was found within therapeutic range for all film formulations. The efficacy of the selected TBF-HCl-loaded liposome film formulation was compared with TBF-HCl-loaded liposome, ethosome, liposome poloxamer gel and ethosome chitosan gel formulations. It was found that TBF-HCl-loaded liposome film formulation had better antifungal activity on fungal nails which make this liposome film formulation promising for ungual therapy of fungal nail infection.

  4. Descriptive analysis of mycological examination of patients with onychomycosis treated in private practice*

    Science.gov (United States)

    Veasey, John Verrinder; Nappi, Flávio; Zaitz, Clarisse; Muramatu, Laura Hitomi

    2017-01-01

    This is a retrospective study of 160 patients treated in private practice in São Paulo from March 2003 to March 2015. We analyzed 171 results of direct mycological examinations and fungal cultures from nail scrapings. The agreement between direct mycological examination results and fungal culture was satisfactory, consistent with the literature (kappa 0.603). The main agent identified was Trichophyton rubrum (51%). We observed an isolation rate of non-dermatophyte filamentous fungi superior to the literature (34%). Determining the agent is key to defining the appropriate onychomycosis treatment, and knowing the epidemiology of patients treated in private practice helps the dermatologist who works in this context. PMID:28225975

  5. The low keratin affinity of efinaconazole contributes to its nail penetration and fungicidal activity in topical onychomycosis treatment.

    Science.gov (United States)

    Sugiura, Keita; Sugimoto, Noriaki; Hosaka, Shinya; Katafuchi-Nagashima, Maria; Arakawa, Yoshio; Tatsumi, Yoshiyuki; Jo Siu, William; Pillai, Radhakrishnan

    2014-07-01

    Onychomycosis is a common fungal nail disease that is difficult to treat topically due to the deep location of the infection under the densely keratinized nail plate. Keratin affinity of topical drugs is an important physicochemical property impacting therapeutic efficacy. To be effective, topical drugs must penetrate the nail bed and retain their antifungal activity within the nail matrix, both of which are adversely affected by keratin binding. We investigated these properties for efinaconazole, a new topical antifungal for onychomycosis, compared with those of the existing topical drugs ciclopirox and amorolfine. The efinaconazole free-drug concentration in keratin suspensions was 14.3%, significantly higher than the concentrations of ciclopirox and amorolfine, which were 0.7% and 1.9%, respectively (P nails into the receptor phase and also inhibited the growth of Trichophyton rubrum under the nail. In the presence of keratin, efinaconazole exhibited fungicidal activity against Trichophyton mentagrophytes comparable to that of amorolfine and superior to that of ciclopirox. In a guinea pig onychomycosis model with T. mentagrophytes infection, an efinaconazole solution significantly decreased nail fungal burden compared to that of ciclopirox and amorolfine lacquers (P nail permeability of efinaconazole and its potent fungicidal activity in the presence of keratin are related to its low keratin affinity, which may contribute to its efficacy in onychomycosis. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

  6. Efinaconazole topical solution, 10%: formulation development program of a new topical treatment of toenail onychomycosis.

    Science.gov (United States)

    Bhatt, V; Pillai, R

    2015-07-01

    Transungual drug delivery of antifungals is considered highly desirable to treat common nail disorders such as onychomycosis, due to localized effects, and improved adherence resulting from minimal systemic adverse events. However, the development of effective topical therapies has been hampered by poor nail penetration. An effective topical antifungal must permeate through, and under the dense keratinized nail plate to the site of infection in the nail bed and nail matrix. We present here the formulation development program to provide effective transungual and subungual delivery of efinaconazole, the first topical broad spectrum triazole specifically developed for onychomycosis treatment. We discuss the important aspects encompassing the formulation development program for efinaconazole topical solution, 10%, focusing on its solubility in a number of solvents, in vitro penetration through the nail, and in vivo efficacy. Efinaconazole topical solution, 10% is a stable, non-lacquer, antifungal with a unique combination of ingredients added to an alcohol-based formulation to provide low surface tension and good wetting properties. This low surface tension is believed to affect effective transungual delivery of efinaconazole and believed to provide a dual mode of delivery by accessing the nail bed by wicking into the space between the nail and nail plate. © 2015 Wiley Periodicals, Inc. and the American Pharmacists Association.

  7. Influence of human nail etching for the assessment of topical onychomycosis therapies.

    Science.gov (United States)

    Repka, Michael A; Mididoddi, Praveen K; Stodghill, Steven P

    2004-09-10

    The purpose of this investigation was to study the physico-chemical properties of hot-melt extruded films containing ketoconazole and to determine the influence of 'nail etching' on film bioadhesion and drug permeability for the assessment of topical onychomycosis therapies. Hot-melt extrusion (HME) was used to prepare films containing 20% w/w ketoconazole. Ketoconazole 0.125% gel was also prepared using Carbopol 974P NF. Films were processed at a temperature range of 115-120 degrees C utilizing a Killion extruder (KLB-100), and were evaluated for post-extrusion drug content, content uniformity, bioadhesion, thermal behavior and nail drug permeation. The extruded films demonstrated excellent content uniformity and post-processing drug content. Tensile and peel tests were recorded to determine the bioadhesive profiles. In this study, work of adhesion and peak adhesive force determinations using the peel tests provided more sensitive results for evaluating the bioadhesivity of the HME films than the tensile tests. The in vitro permeability profiles have demonstrated, that nail samples treated with an 'etchant' demonstrated a significant increase in drug permeability compared to control. Differential scanning calorimetry (DSC) thermograms indicated that ketoconazole was in solid solution within the HME films. These findings are encouraging for the future design and formulation of novel drug delivery systems for the topical treatment of onychomycosis.

  8. Antifungal activity of propolis extract against yeasts isolated from onychomycosis lesions

    Directory of Open Access Journals (Sweden)

    Ana Carla Pozzi Oliveira

    2006-08-01

    Full Text Available The aim of this study was to determine the in vitro activity of propolis extract against 67 yeasts isolated from onychomycosis in patients attending at the Teaching and Research Laboratory of Clinical Analysis of the State University of Maringá. The method used was an adaptation made from the protocol approved by the National Committee for Clinical Laboratory Standards. The yeasts tested were: Candida parapsilosis 35%, C. tropicalis 23%, C. albicans 13%, and other species 29%. The propolis extract showed excellent performance regarding its antifungal activity: the concentration capable of inhibiting the all of the yeasts was 5 × 10-2 mg/ml of flavonoids and 2 × 10-2 mg/ml of flavonoids stimulated their cellular death. Trichosporon sp. were the most sensitive species, showing MIC50 and MIC90 of 1.25 × 10-2 mg/ml of flavonoids, and C. tropicalis was the most resistant, with CFM50 of 5 × 10-2 mg/ml of flavonoids and MFC90 of 10 × 10-2 mg/ml. In view of the fact that propolis is a natural, low cost, non-toxic product with proven antifungal activity, it should be considered as another option in the onychomycosis treatment.

  9. [Tinea pedis and Onychomycosis in Children of the Mazahua Indian Community in Mexico].

    Science.gov (United States)

    Ruiz-Esmenjaud, Julieta; Arenas, Roberto; Rodríguez-Alvarez, Mauricio; Monroy, Elena; Felipe Fernández, Ramón

    2003-01-01

    Tinea pedis and onychomycosis in childhood are unusual, The previous reported prevalence range from 4.2 to 8.2%. In a mestizo population, in the South of Mexico a 3.4% has been found. To determine the frequency of dermatophytosis of feet and toenails in scholars in an Indian Mazahua community. A total of 456 children were studied. The age range from 5 to 15 years of age (average 11.4). Only 71 children with suggestive lesions of dermatophytosis were studied (15.57%). Mycological samples (66/71) and a KOH and Chlorazol black, and cultures on Mycocel agar were performed. 71 children (15.57%) presented suggestive lesions of dermatophytosis of the feet and toenails. A fungal infection was demonstrated in 13 cases (18%), 8 males and 5 females (mean age 12.3 years), but pathogenic fungi were isolated only in 7 (10%). All of them with tinea pedis and three also had toenail involvement (4.2%) and also Trichosporon sp was isolated in two cases and Candida albicans in one. We found a low frequency of tinea pedis and onychomycosis in children from this Mazahua community. The environmental factors such as humidity, and the frequently use of rubber and leather shoes instead of the traditional "huarache" (sandals), make them prone to maceration and can be cofactors in the development of mycotic infections and in the high incidence of pitted keratolysis (29.5%).

  10. Photodynamic Therapy treatment of onychomycosis with Aluminium-Phthalocyanine Chloride nanoemulsions: A proof of concept clinical trial.

    Science.gov (United States)

    Morgado, Luciano Ferreira; Trávolo, Ana Regina Franchi; Muehlmann, Luís Alexandre; Narcizo, Paulo Souza; Nunes, Rodrigo Barbosa; Pereira, Pedro Alencar Gomes; Py-Daniel, Karen Rapp; Jiang, Cheng-Shi; Gu, Jinsong; Azevedo, Ricardo Bentes; Longo, João Paulo Figueiró

    2017-08-01

    The conventional treatment of onychomycosis, a common fungal infection, consists in the use of local and systemic drugs for 4-6 months. This long protocol is often ineffective due to patient compliance, and usually promotes important collateral effects such as liver and kidney failure. As the alternative, Photodynamic Therapy (PDT) has been used as a noninvasive alternative local treatment for onychomycosis due to the reduction of systemic side effects, fact indicates their use for patients undergoing other systemic treatments. In the present article, we evaluated the effectiveness, as well as the safety of PDT mediated by Aluminium-Phthalocyanine Chloride, entrapped in nanoemulsions, as a drug carrier, to treat onychomycosis in a proof of concept clinical trial. To the date, this is the first published clinical trial that uses PDT mediated by nanomedicines to treat onychomycosis. As main results, we can highlight the safety of the clinical protocol and the antifungal effectiveness similar to the conventional treatments. We observed the (1) clinical cure of 60% of treated lesions; (2) the absence of local and systemic adverse effects; (3) from these clinically healed lesions, 40% were negative for fungal infection in laboratorial exams; and (4) nails that presented negative fungal culture were kept without fungal infection for at least four weeks. The innovation of this approach is the absence of collateral effects, due to the local therapeutically treatment, and the possibility to repeat the treatment without inducing fungal resistance, a fact that indicates this approach as a possible alternative protocol for onychomycosis management. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Efficacy Coefficients Determined Using Nail Permeability and Antifungal Activity in Keratin-Containing Media Are Useful for Predicting Clinical Efficacies of Topical Drugs for Onychomycosis

    OpenAIRE

    Yoshiki Matsuda; Keita Sugiura; Takashi Hashimoto; Akane Ueda; Yoshihiro Konno; Yoshiyuki Tatsumi

    2016-01-01

    Onychomycosis is difficult to treat topically due to the deep location of the infection under the densely keratinized nail plate. In order to obtain an in vitro index that is relevant to the clinical efficacy of topical anti-onychomycosis drugs, we profiled five topical drugs: amorolfine, ciclopirox, efinaconazole, luliconazole, and terbinafine, for their nail permeabilities, keratin affinities, and anti-dermatophytic activities in the presence of keratin. Efinaconazole and ciclopirox permeat...

  12. Efficacy Coefficients Determined Using Nail Permeability and Antifungal Activity in Keratin-Containing Media Are Useful for Predicting Clinical Efficacies of Topical Drugs for Onychomycosis

    OpenAIRE

    Yoshiki Matsuda; Keita Sugiura; Takashi Hashimoto; Akane Ueda; Yoshihiro Konno; Yoshiyuki Tatsumi

    2016-01-01

    Onychomycosis is difficult to treat topically due to the deep location of the infection under the densely keratinized nail plate. In order to obtain an in vitro index that is relevant to the clinical efficacy of topical anti-onychomycosis drugs, we profiled five topical drugs: amorolfine, ciclopirox, efinaconazole, luliconazole, and terbinafine, for their nail permeabilities, keratin affinities, and anti-dermatophytic activities in the presence of keratin. Efinaconazole and ciclopirox permeat...

  13. Use of restriction fragment length polymorphism to identify Candida species, related to onychomycosis

    Science.gov (United States)

    Mohammadi, Rasoul; Badiee, Parisa; Badali, Hamid; Abastabar, Mahdi; Safa, Ahmad Hosseini; Hadipour, Mahboubeh; Yazdani, Hajar; Heshmat, Farnaz

    2015-01-01

    Background: Onychomycosis is one of the most common clinical forms of fungal infections due to both filamentous fungi and yeasts. The genus of Candida is one of the most prominent causes of onychomycosis in all around the world. Although Candida albicans is still the most frequent cause of nail infections, use of broad-spectrum antifungal agents has led to a shift in the etiology of C. albicans to non-albicans species. The aim of the present study is rapid and precise identification of candida species isolated from nail infection by using of PCR-RFLP technique. Materials and Methods: A total of 360 clinical yeast strains were collected from nail infections in Iran. Genomic DNA was extracted using FTA; cards. ITS1-5.8SrDNA-ITS2 region was amplified using universal primers and subsequently products were digested with the restriction enzyme MspI. For identification of newly described species (C. parapsilosis complex), the SADH gene was amplified, followed by digestion with Nla III restriction enzyme. Results: Candida albicans was the most commonly isolated species (41.1%), followed by C. parapsilosis (21.4%), C. tropicalis (12.8%), C. kefyr (9.4%), C. krusei (5.5%), C. orthopsilosis (4.1%), C. glabrata (2.8%), C. guilliermondii (1.4%), C. rugosa (0.8%), and C. lusitaniae (0.5%). Patients in the age groups of 51-60 and 81-90 years had the highest and lowest distribution of positive specimens, respectively. Conclusion: Rapid and precise identification of Candida species from clinical specimens lead to appropriate therapeutic plans. PMID:26015921

  14. Characterization of Antifungal Activity and Nail Penetration of ME1111, a New Antifungal Agent for Topical Treatment of Onychomycosis

    OpenAIRE

    Tabata, Yuji; Takei-Masuda, Naomi; Kubota, Natsuki; Takahata, Sho; Ohyama, Makoto; Kaneda, Kaori; Iida, Maiko; Maebashi, Kazunori

    2016-01-01

    Fungal nail infection (onychomycosis) is a prevalent disease in many areas of the world, with a high incidence approaching 23%. Available antifungals to treat the disease suffer from a number of disadvantages, necessitating the discovery of new efficacious and safe antifungals. Here, we evaluate the in vitro antifungal activity and nail penetration ability of ME1111, a novel antifungal agent, along with comparator drugs, including ciclopirox, amorolfine, terbinafine, and itraconazole. ME1111 ...

  15. The Low Keratin Affinity of Efinaconazole Contributes to Its Nail Penetration and Fungicidal Activity in Topical Onychomycosis Treatment

    OpenAIRE

    Sugiura, Keita; Sugimoto, Noriaki; HOSAKA, Shinya; Katafuchi-Nagashima, Maria; Arakawa, Yoshio; TATSUMI, Yoshiyuki; Jo Siu, William; Pillai, Radhakrishnan

    2014-01-01

    Onychomycosis is a common fungal nail disease that is difficult to treat topically due to the deep location of the infection under the densely keratinized nail plate. Keratin affinity of topical drugs is an important physicochemical property impacting therapeutic efficacy. To be effective, topical drugs must penetrate the nail bed and retain their antifungal activity within the nail matrix, both of which are adversely affected by keratin binding. We investigated these properties for efinacona...

  16. Characterization of Antifungal Activity and Nail Penetration of ME1111, a New Antifungal Agent for Topical Treatment of Onychomycosis

    OpenAIRE

    Tabata, Yuji; Takei-Masuda, Naomi; Kubota, Natsuki; Takahata, Sho; Ohyama, Makoto; Kaneda, Kaori; Iida, Maiko; Maebashi, Kazunori

    2016-01-01

    Fungal nail infection (onychomycosis) is a prevalent disease in many areas of the world, with a high incidence approaching 23%. Available antifungals to treat the disease suffer from a number of disadvantages, necessitating the discovery of new efficacious and safe antifungals. Here, we evaluate the in vitro antifungal activity and nail penetration ability of ME1111, a novel antifungal agent, along with comparator drugs, including ciclopirox, amorolfine, terbinafine, and itraconazole. ME1111 ...

  17. The Low Keratin Affinity of Efinaconazole Contributes to Its Nail Penetration and Fungicidal Activity in Topical Onychomycosis Treatment

    OpenAIRE

    Sugiura, Keita; Sugimoto, Noriaki; Hosaka, Shinya; Katafuchi-Nagashima, Maria; Arakawa, Yoshio; TATSUMI, Yoshiyuki; Jo Siu, William; Pillai, Radhakrishnan

    2014-01-01

    Onychomycosis is a common fungal nail disease that is difficult to treat topically due to the deep location of the infection under the densely keratinized nail plate. Keratin affinity of topical drugs is an important physicochemical property impacting therapeutic efficacy. To be effective, topical drugs must penetrate the nail bed and retain their antifungal activity within the nail matrix, both of which are adversely affected by keratin binding. We investigated these properties for efinacona...

  18. A study on the etiological agent and clinico-mycological correlation of fingernail onychomycosis in eastern India

    Directory of Open Access Journals (Sweden)

    Das Nilay

    2008-01-01

    Full Text Available Background: Onychomycosis manifests itself in various forms, notably onychodystrophy, onycholysis, subungual hyperkeratosis, or nail-plate discoloration. Not necessarily nail changes mentioned here should always be of fungal origin. Objective: The present study is planned to get an idea about etiological agent and clinical correlation in fingernail onychomycosis. Materials and Methods: Nail-clipping and subungual debris of patients with above mentioned nail changes were subjected to KOH preparation. Culture was done on SDA and SDCCA media. Species identification was done by colony character, pigment production, LCB staining, and some special tests like germ tube test, etc. Results: Out of 85 cases, 44 cases showed the growth of fungus, amounting to 51.76% positivity. Among those 44 cases, the infective fungal agents were predominantly dermatophytes (50%, and the rest were due to yeasts (27.27% and moulds (22.72%. Among the different species, Trichophyton rubrum (29.54% accounted for the majority of dermatophytes; Candida albicans (11.78% was the predominant yeast; and Aspergillus niger (18.18% the commonest mold. No significant association could be established between the different fungal species and various clinical manifestations. Positive results were found more with fungal culture (95.45% than KOH preparation (63.64%. Conclusion: The results show that nail changes are not always a reliable marker for predicting the causative organism, and relying only on the clinical manifestation (i.e., pattern of nail changes in the diagnosis of onychomycosis is often misleading. The present study highlights the need for microbiological confirmation in case of onychomycosis.

  19. Tinea pedis and onychomycosis frequency in diabetes mellitus patients and diabetic foot ulcers. A cross sectional – observational study

    OpenAIRE

    Akkus, Gamze; Evran, Mehtap; Gungor, Dilek; Karakas, Mehmet; Sert, Murat; Tetiker, Tamer

    2016-01-01

    Objective: Impaired cellular immunity and reduced phagocytic function of polymorphonuclear leukocytes facilitate the development of skin fungal and bacterial infections due to uncontrolled hyperglycemia in diabetic patients. In our study, we aimed to assess onychomycosis and/or tinea pedis frequency in diabetic patients, and effects on the development of chronic complications, particularly foot ulcer. Methods: We included 227 diabetic patients in the study. Forty-three patients had diabetic f...

  20. Genetic diversity of Aspergillus species isolated from onychomycosis and Aspergillus hongkongensis sp. nov., with implications to antifungal susceptibility testing.

    Science.gov (United States)

    Tsang, Chi-Ching; Hui, Teresa W S; Lee, Kim-Chung; Chen, Jonathan H K; Ngan, Antonio H Y; Tam, Emily W T; Chan, Jasper F W; Wu, Andrea L; Cheung, Mei; Tse, Brian P H; Wu, Alan K L; Lai, Christopher K C; Tsang, Dominic N C; Que, Tak-Lun; Lam, Ching-Wan; Yuen, Kwok-Yung; Lau, Susanna K P; Woo, Patrick C Y

    2016-02-01

    Thirteen Aspergillus isolates recovered from nails of 13 patients (fingernails, n=2; toenails, n=11) with onychomycosis were characterized. Twelve strains were identified by multilocus sequencing as Aspergillus spp. (Aspergillus sydowii [n=4], Aspergillus welwitschiae [n=3], Aspergillus terreus [n=2], Aspergillus flavus [n=1], Aspergillus tubingensis [n=1], and Aspergillus unguis [n=1]). Isolates of A. terreus, A. flavus, and A. unguis were also identifiable by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The 13th isolate (HKU49(T)) possessed unique morphological characteristics different from other Aspergillus spp. Molecular characterization also unambiguously showed that HKU49(T) was distinct from other Aspergillus spp. We propose the novel species Aspergillus hongkongensis to describe this previously unknown fungus. Antifungal susceptibility testing showed most Aspergillus isolates had low MICs against itraconazole and voriconazole, but all Aspergillus isolates had high MICs against fluconazole. A diverse spectrum of Aspergillus species is associated with onychomycosis. Itraconazole and voriconazole are probably better drug options for Aspergillus onychomycosis.

  1. 1,064-nm diode laser therapy of onychomycosis: results of a prospective open treatment of 82 toenails.

    Science.gov (United States)

    Renner, Regina; Grüsser, Kathrin; Sticherling, Michael

    2015-01-01

    Onychomycosis is one of the most prevalent nail disorders in adults, where conventional topical therapy is often protracted and in most cases ineffective. On the other hand, systemic/oral therapy is not suitable for all patients and might be associated with relevant side effects. Therefore, laser therapy can be used as an alternative to or extension of existing treatment protocols. We used diode laser treatment for onychomycosis to evaluate the efficacy of this treatment as single therapy as well as in combination with an ongoing antimycotic treatment. We used a 1,064-nm diode laser (FOX Laser, ARC Laser GmbH, Germany) in pulse mode with a spot size of 4 mm. The laser's settings were: 8 W, with a pulse duration of 80 ms and a repetition rate of 5.6 Hz; the energy fluence/pulse was 5.1 J/cm(2), and a total energy of 250-500 J for large and/or thickened nails (digit I), 120-200 J for medium nails (digits II-IV) and 60-120 J for small and/or very thin nail plates (digit V) was counted in the laser display. Two to three passes where applied continuously over the entire area of the nail (nail plate, nail folds and eponychium) in a grid pattern. Eighty-two affected toenails were treated at least twice every 8 weeks; all nails treated were clinically diagnosed as onychomycosis. The evaluation of the treated nails was conducted by two dermatologists, initially by semiquantitative visual examination, followed by evaluation with the Onychomycosis Severity Index (OSI). In addition, the patients were asked to state their satisfaction with the treatment and its results in a written questionnaire. All nails showed an improvement ranging between 14 and 56% including the analytical evaluation scale (OSI). Two dermatologists evaluated 34 nails. Both reported significant improvement and/or good clinical improvement, which corresponds to about 41% for both evaluations. The mean OSI of all patients was 18.9/19.9 before treatment which changed to 14.3/14.8 after treatment. This

  2. Treatment of onychomycosis caused by dermatophytes--an opinion proposed by Committee for Standardization of the Japanese Society for Medical Mycology 2007.

    Science.gov (United States)

    Mohri, Shinobu; Watanabe, Shinichi; Toshio, Kusunoki; Shibuya, Kazutoshi; Nishiyama, Yayoi; Abe, Michiko; Uno, Jun; Oguri, Toyoko; Maeasaki, Shigefumi; Ikeda, Reiko; Abe, Shigeru

    2008-01-01

    After the rapid progress in therapeutic pharmaceutics against onychomycosis caused by dermatophytes in the 1990s, an optimal therapeutic strategy for individual patients with the onychomycosis has become possible for clinical dermatologists. In this review, we discuss on clinical problems concerning this disease and propose recommendable treatments for each patient with topical and/or systemic use of antifungal agents. Finally, with consideration of already published therapeutic guidelines, we stress the necessity of "order-made" therapy for each patient with his/her medical status and wishes taking into account.

  3. Characterization of Antifungal Activity and Nail Penetration of ME1111, a New Antifungal Agent for Topical Treatment of Onychomycosis.

    Science.gov (United States)

    Tabata, Yuji; Takei-Masuda, Naomi; Kubota, Natsuki; Takahata, Sho; Ohyama, Makoto; Kaneda, Kaori; Iida, Maiko; Maebashi, Kazunori

    2016-02-01

    Fungal nail infection (onychomycosis) is a prevalent disease in many areas of the world, with a high incidence approaching 23%. Available antifungals to treat the disease suffer from a number of disadvantages, necessitating the discovery of new efficacious and safe antifungals. Here, we evaluate the in vitro antifungal activity and nail penetration ability of ME1111, a novel antifungal agent, along with comparator drugs, including ciclopirox, amorolfine, terbinafine, and itraconazole. ME1111 showed potent antifungal activity against Trichophyton rubrum and Trichophyton mentagrophytes (the major etiologic agents of onychomycosis) strains isolated in Japan and reference fungal strains with an MIC range of 0.12 to 0.5 mg/liter and an MIC50 and MIC90 of 0.5 mg/liter for both. Importantly, none of the tested isolates showed an elevated ME1111 MIC. Moreover, the antifungal activity of ME1111 was minimally affected by 5% wool keratin powder in comparison to the other antifungals tested. The ME1111 solution was able to penetrate human nails and inhibit fungal growth in a dose-dependent manner according to the TurChub assay. In contrast, 8% ciclopirox and 5% amorolfine nail lacquers showed no activity under the same conditions. ME1111 demonstrated approximately 60-fold-greater selectivity in inhibition of Trichophyton spp. than of human cell lines. Our findings demonstrate that ME1111 possesses potent antidermatophyte activity, maintains this activity in the presence of keratin, and possesses excellent human nail permeability. These results suggest that ME1111 is a promising topical medication for the treatment of onychomycosis and therefore warrants further clinical evaluation. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

  4. The OnyCOE-t™ questionnaire: responsiveness and clinical meaningfulness of a patient-reported outcomes questionnaire for toenail onychomycosis

    Science.gov (United States)

    Potter, Lori P; Mathias, Susan D; Raut, Monika; Kianifard, Farid; Tavakkol, Amir

    2006-01-01

    Background This research was conducted to confirm the validity and reliability and to assess the responsiveness and clinical meaningfulness of the OnyCOE-t™, a questionnaire specifically designed to measure patient-reported outcomes (PRO) associated with toenail onychomycosis. Methods 504 patients with toenail onychomycosis randomized to receive 12 weeks of terbinafine 250 mg/day with or without target toenail debridement in the IRON-CLAD® trial completed the OnyCOE-t™ at baseline, weeks 6, 12, 24, and 48. The OnyCOE-t™ is composed of 6 multi-item scales and 1 single-item scale. These include a 7-item Toenail Symptom assessment, which comprises both Symptom Frequency and Symptom Bothersomeness scales; an 8-item Appearance Problems scale; a 7-item Physical Activities Problems scale; a 1-item Overall Problem scale; a 7-item Stigma scale; and a 3-item Treatment Satisfaction scale. In total, 33 toenail onychomycosis-specific items are included in the OnyCOE-t™. Clinical data, in particular the percent clearing of mycotic involvement in the target toenail, and OnyCOE-t™ responses were used to evaluate the questionnaire's reliability, validity, responsiveness, and the minimally clinical important difference (MCID). Results The OnyCOE-t™ was shown to be reliable and valid. Construct validity and known groups validity were acceptable. Internal consistency reliability of multi-item scales was demonstrated by Cronbach's alpha > .84. Responsiveness was good, with the Treatment Satisfaction, Symptom Frequency, Overall Problem, and Appearance Problem scales demonstrating the most responsiveness (Guyatt's statistic of 1.72, 1.31, 1.13, and 1.11, respectively). MCID was evaluated for three different clinical measures, and indicated that approximately an 8.5-point change (on a 0 to 100 scale) was clinically meaningful based on a 25% improvement in target nail clearing. Conclusion The OnyCOE-t™ questionnaire is a unique, toenail-specific PRO questionnaire that can be

  5. The OnyCOE-t™ questionnaire: responsiveness and clinical meaningfulness of a patient-reported outcomes questionnaire for toenail onychomycosis

    Directory of Open Access Journals (Sweden)

    Kianifard Farid

    2006-08-01

    Full Text Available Abstract Background This research was conducted to confirm the validity and reliability and to assess the responsiveness and clinical meaningfulness of the OnyCOE-t™, a questionnaire specifically designed to measure patient-reported outcomes (PRO associated with toenail onychomycosis. Methods 504 patients with toenail onychomycosis randomized to receive 12 weeks of terbinafine 250 mg/day with or without target toenail debridement in the IRON-CLAD® trial completed the OnyCOE-t™ at baseline, weeks 6, 12, 24, and 48. The OnyCOE-t™ is composed of 6 multi-item scales and 1 single-item scale. These include a 7-item Toenail Symptom assessment, which comprises both Symptom Frequency and Symptom Bothersomeness scales; an 8-item Appearance Problems scale; a 7-item Physical Activities Problems scale; a 1-item Overall Problem scale; a 7-item Stigma scale; and a 3-item Treatment Satisfaction scale. In total, 33 toenail onychomycosis-specific items are included in the OnyCOE-t™. Clinical data, in particular the percent clearing of mycotic involvement in the target toenail, and OnyCOE-t™ responses were used to evaluate the questionnaire's reliability, validity, responsiveness, and the minimally clinical important difference (MCID. Results The OnyCOE-t™ was shown to be reliable and valid. Construct validity and known groups validity were acceptable. Internal consistency reliability of multi-item scales was demonstrated by Cronbach's alpha > .84. Responsiveness was good, with the Treatment Satisfaction, Symptom Frequency, Overall Problem, and Appearance Problem scales demonstrating the most responsiveness (Guyatt's statistic of 1.72, 1.31, 1.13, and 1.11, respectively. MCID was evaluated for three different clinical measures, and indicated that approximately an 8.5-point change (on a 0 to 100 scale was clinically meaningful based on a 25% improvement in target nail clearing. Conclusion The OnyCOE-t™ questionnaire is a unique, toenail-specific PRO

  6. Estudio clinico micologico de onimicosis en ancianos Clinico-mycological study of onychomycosis in elderly patients

    Directory of Open Access Journals (Sweden)

    Mayda Elena Rodriguez-Soto

    1993-06-01

    Full Text Available Se realizó examen físico de las uñas a 210 ancianos y a aquellos que presentaron lesiones sugestivas de onicomicosis se les realizó toma de muestra con el objetivo de conocer los principales agentes causales, las características e incidencia de las lesiones. Se confirmó el diagnóstico mediante el aislamiento del agente causal en 74 de los casos procedentes principalmente de las uñas de los pies, para una incidencia de 35,2. La tinea pedis se presentó en el 25,7% de los casos, mientras que la enfermedad asociada más frecuente fue la Diabetes mellitus; entre las características clínicas de las uñas predominaron el engrosamiento, la pérdida del brillo y la aparición de estrías longitudinales. Existió una correspondencia significativa entre el examen microscópico directo y el cultivo. La especie de dermatofito predominate fue Trichophyton rubrum, mientras que Candida parapsilosis fue la más aislada entre las especies de Candida.Physical examination of nails was carried out in 210 elderly patients and nail scrapings were obtained from onychomycosis suggested lesions in order to determine their causative agents, incidence and clinical characteristics. Diagnostic was confirmed by the isolation of the agents from 74 patients, mainly from toe-nails (incidence 35,2. Tinea pedis occurred in 25% of the cases and Diabetes mellitus was the most prevalent associated disease and the most frequent clinical characteristics were the thickening, the opacity and the presence of longitudinal strias in the surface of the nails. It was compared the results obtained by microscopic examination and by culture. Trichophyton ru-brum was the most common dermatophyte isolated; Candida parapsilosis was dominant among Candida species.

  7. Characterization of hot-melt extruded drug delivery systems for onychomycosis.

    Science.gov (United States)

    Mididoddi, Praveen K; Repka, Michael A

    2007-04-01

    The objectives of this investigation were to study the physico-chemical properties of hot-melt extruded (HME) films for onychomycosis and to determine the stability of the model antifungal drug incorporated within these films. The influence of etching and instrument variables on the bioadhesion of these drug delivery systems for the human nail was also studied. Six 250 g batches (F1-F6) of hydroxypropyl cellulose (HPC) and/or poly(ethylene oxide) films containing ketoconazole (20%) were extruded using a Killion extruder (Model KLB-100). The thermal properties of HME films were investigated using differential scanning calorimetry (DSC). Scanning electron microscopy (SEM) was used to examine the surface morphology of the films and X-ray diffraction (XRD) was used to investigate the crystalline properties of the drugs, physical mixtures as well as the HME films. Stability studies were performed on the films stored at 25 degrees C/60%RH. The bioadhesive properties of these films were investigated on the human nail (ex vivo) using a Texture Analyzer. The nail samples tested were either non-treated (control) or treated with an etching gel. The parameters measured were peak adhesion force (PAF) and area under the curve (AUC). The Hansen solubility parameter was calculated using a combination of Hoy and Hoftyzer/Van Krevelen methods to estimate the likelihood of drug-polymer miscibility. SEM provided direct physical evidence of the physical state of the drug within the films. The theoretical post-extrusion content of ketoconazole remaining in the six film batches ranged from 90.3% (+/-2.2) to 102.4% (+/-9.0) for up to 6 months and from 83.9% (+/-3.6) to 91.6% (+/-3.0) for up to 12 months. Bioadhesion studies of HPC film tested on 'etched' nails recorded significantly higher PAF and AUC than that of the non-treated 'control' nails. Ketoconazole was found to be relatively stable during the extrusion process. Melting points corresponding to the crystalline drugs were not

  8. Identification of fungi species in the onychomycosis of institutionalized elderly Identificação de espécies fúngicas nas onicomicoses do idoso institucionalizado

    OpenAIRE

    Cidia Vasconcellos; Carolina de Queiroz Moreira Pereira; Marta Cristina Souza; Andrea Pelegrini; Roseli Santos Freitas; Juliana Possato Takahashi

    2013-01-01

    BACKGROUND: Superficial fungal infections are caused by dermatophytes, yeasts or filamentous fungi. They are correlated to the etiologic agent, the level of integrity of the host immune response, the site of the lesion and also the injured tissue. OBJECTIVE: The purpose of this study is to isolate and to identify onychomycosis agents in institutionalized elderly (60 years old +). METHODS: The identification of the fungi relied upon the combined results of mycological examination, cultu...

  9. Treatment of distal subungual onychomycosis with a topical preparation of urea, propylene glycol and lactic acid: results of a 24-week, double-blind, placebo-controlled study.

    Science.gov (United States)

    Emtestam, L; Kaaman, T; Rensfeldt, K

    2012-11-01

    Onychomycosis is difficult to cure as this requires eradication of the primary infection and protection of new areas of growth from reinfection. A new topical treatment (K101) has been developed. The aim of this study was to assess the efficacy, safety and tolerability of K101 treatment of distal subungual onychomycosis. This was a 24-week (plus 2-week washout), multicentre, randomised, double-blind, placebo-controlled study in 493 patients with distal subungual onychomycosis (K101, n = 346; placebo, n = 147), stratified according to degree of nail involvement. More patients with ≤50% nail involvement achieved the primary endpoint (mycological cure after 26 weeks) in the K101 group (27.2%) than placebo (10.4%; P = 0.0012). Proportions for patients with 51-75% involvement were 19.1% for K101 and 7.0% for placebo (not significant). More patients applying K101 than placebo judged that their condition had improved from week 2 (P = 0.0148) to week 24 (P = 0.0004). No safety issues were identified. K101 provides early visible improvements in nail appearance and a clinically meaningful antifungal activity.

  10. A comparison of results from two mycology laboratories for the diagnosis of onychomycosis: a study of 85 cases in a geriatric population.

    Science.gov (United States)

    Scherer, William P; Scherer, Michael D

    2004-01-01

    An investigative study was performed to compare the results from two mycology laboratories for the diagnosis of onychomycosis in a geriatric population and to determine the possible pharmacologic treatments based on the two laboratories' results. In this study, 85 cases of suspected onychomycosis involving men and women 65 years and older from a nursing home setting in South Florida were used. Samples were taken from the hallux toenail and sent to two different mycology laboratories for fluorescent potassium hydroxide preparation and microscopic examination of a fungal culture. Of the 85 cases studied, the two mycology laboratories reported similar potassium hydroxide preparation results for 58.8% of the patients and similar fungal culture results for genus and species identification for 37.6% of the patients. When the potassium hydroxide preparation and fungal culture results were combined, the two mycology laboratories reported similar results for only 27.1% of the patients. As a result of the two mycology laboratories' findings, the possible US Food and Drug Administration-approved pharmacologic treatments may differ for 43.5% of the patients studied. The discrepancy between the two independent laboratories leaves physicians to question the reproducibility of fluorescent potassium hydroxide preparation and fungal culture analysis in a geriatric patient population for the diagnosis of onychomycosis.

  11. Routes of drug delivery into the nail apparatus: Implications for the efficacy of topical nail solutions in onychomycosis.

    Science.gov (United States)

    Gupta, Aditya K; Simpson, Fiona C

    2016-01-01

    The route of antifungal drug entry into the nail plate and the underlying nail bed plays an important role in determining the efficacy of therapy. Oral antifungal agents reach the nail bed and nail plate by being ingested and achieving antifungal levels in the blood stream that are well in excess of the minimum inhibitory concentration. The reticular circulation at the distal end of the digit enables the drug to reach the nail bed, the proximal matrix and the lateral nail folds. The drug then diffuses into the proximal, ventral and lateral nail plate. The primary route of drug delivery for topical lacquers is transungual, with drug applied to the dorsal aspect of the nail plate and penetrating to the underlying nail bed. The new topical agents approved in the US for the treatment of onychomycosis are solutions with lower viscosity and increased nail penetration characteristics; therefore, these agents penetrate through the transungual route, but also through the space between the nail plate and the nail bed. This subungual route is an important method of drug delivery and is able to in part circumvent the thickness of the nail plate.

  12. Tinea pedis and onychomycosis frequency in diabetes mellitus patients and diabetic foot ulcers. A cross sectional - observational study.

    Science.gov (United States)

    Akkus, Gamze; Evran, Mehtap; Gungor, Dilek; Karakas, Mehmet; Sert, Murat; Tetiker, Tamer

    2016-01-01

    Impaired cellular immunity and reduced phagocytic function of polymorphonuclear leukocytes facilitate the development of skin fungal and bacterial infections due to uncontrolled hyperglycemia in diabetic patients. In our study, we aimed to assess onychomycosis and/or tinea pedis frequency in diabetic patients, and effects on the development of chronic complications, particularly foot ulcer. We included 227 diabetic patients in the study. Forty-three patients had diabetic foot ulcer. We screened and recorded demographic characteristics, HbA1c levels of patients, and presence of complications We examined patients dermatologically, and collected samples by scalpel from skin between toes, and from sole, toe nail, and area surrounding nails from suspected to have fungal infection. Native positivity between toes was higher in men compared to women (pFungal infection between toes, at sole and toe nail significantly increased in patients with diabetic foot ulcer compared to patients without diabetic foot ulcer (pdiabetic foot ulcer correlated with presence of fungal infection examination findings (pFungal infections were more frequently observed in the presence of poor glycemic control and peripheral vascular disease in diabetic patients in compliance with the literature, and the presence of fungal infection may also responsible for the development of foot ulcers.

  13. Tinea pedis and onychomycosis frequency in diabetes mellitus patients and diabetic foot ulcers. A cross sectional – observational study

    Science.gov (United States)

    Akkus, Gamze; Evran, Mehtap; Gungor, Dilek; Karakas, Mehmet; Sert, Murat; Tetiker, Tamer

    2016-01-01

    Objective: Impaired cellular immunity and reduced phagocytic function of polymorphonuclear leukocytes facilitate the development of skin fungal and bacterial infections due to uncontrolled hyperglycemia in diabetic patients. In our study, we aimed to assess onychomycosis and/or tinea pedis frequency in diabetic patients, and effects on the development of chronic complications, particularly foot ulcer. Methods: We included 227 diabetic patients in the study. Forty-three patients had diabetic foot ulcer. We screened and recorded demographic characteristics, HbA1c levels of patients, and presence of complications We examined patients dermatologically, and collected samples by scalpel from skin between toes, and from sole, toe nail, and area surrounding nails from suspected to have fungal infection. Results: Native positivity between toes was higher in men compared to women (pFungal infection between toes, at sole and toe nail significantly increased in patients with diabetic foot ulcer compared to patients without diabetic foot ulcer (pdiabetic foot ulcer correlated with presence of fungal infection examination findings (pFungal infections were more frequently observed in the presence of poor glycemic control and peripheral vascular disease in diabetic patients in compliance with the literature, and the presence of fungal infection may also responsible for the development of foot ulcers. PMID:27648034

  14. 甲真菌病400例致病真菌分析%Analysis of pathogenic fungal strains in 400 patients of onychomycosis

    Institute of Scientific and Technical Information of China (English)

    马越娥; 李秀丽; 顾俊瑛; 刘至昱; 高飞; 王茠茠

    2014-01-01

    目的:确定上海地区甲真菌病的致病菌种。方法:对本院皮肤科门诊就诊的直接镜检阳性的400例甲真菌病患者的甲标本做真菌分离培养和分析。结果:分离出致病真菌233株,其中皮肤癣菌120株(红色毛癣菌104株,须癣毛癣菌10株,犬小孢子菌3株,絮状表皮癣菌3株),酵母菌68株,非皮肤癣菌11株(曲霉6株,青霉5株),其余为丝状真菌。结论:上海地区甲真菌病的致病真菌以皮肤癣菌为主,酵母菌中非白念珠菌占有一定比例。%Objective:To determine the pathogenic fungal strains isolated from onychomycosis in Shanghai. Methods:Fungal culture was performed on 400 patients of onychomycosis with positive results by direct mi-croscopic examination. Results:A total of 233 strains of fungi was isolated,of which 120 strains were derma-tophytes ( Trichophyton rubrum in 104 isolates, Trichophyton mentagrophytes in 10, Microsporum canis in 3 and Epidermophyton floccosum in 3), 68 were Saccharomycetes, 11 were non-dermatophytes ( Aspergillus 6 and Mould 5) and the rest were filamentous fungi. Conclusion:In Shanghai,the dominated pathogenic fungus of onychomycosis is Trichophyton rubrum, and the non-Candida albicans accounts for a proportion of the yeast.

  15. 沿海地区甲真菌病原菌构成分析%The analysis of causative pathogens of onychomycosis in coastal area

    Institute of Scientific and Technical Information of China (English)

    顾丽娟; 朱雪飞; 喻长法; 王成军

    2012-01-01

    Objective:To get the message of causative pathogens and constitution of onychomycosis in coastal are-a. Methods: A retrospective analysis was conducted on the fungal culture results of 382 cases of onychomycosis patients in nearly 3 years. Results: 382 strains of pathogenic fungi were isolated,the most frequently isolated fungus was dermatophytes (267 cases 69.9% ) , Trichophyton rubrum 186 cases (48.7% )ranked first,followed by Tricho-phyton mentagrophytes 39 cases ( 10. 2%). There were 91 yeast cases (23. 8%), Candida albicans 43 cases (11.3%) ranked first, followed by Candida glabrata 20 cases ( 5. 2 % ). There were 24 mould cases (6.3%), distal and lateral subungual onychomycosis( DLSO, 58. 9% ) were the most frequently clinical types, followed by TDO ( 23.0% ) , PSO (11.3%) and SWO (6.8%). Conclusion: The most frequently pathogenic fungus of onychomycosis were dermatophytes, yeasts and mould,the most frequently clinical types of onychomycosis were DLSO,TDO,PSO and SWO.%目的:了解沿海地区甲真菌病病原菌的种类和构成情况.方法:对近3年来我院皮肤科医治的382例甲屑培养阳性病例病原菌进行回顾性统计分析.结果:382株甲真菌病病原菌中皮肤癣菌267株,占69.9%,其中前二位分别为红色毛癣菌186株(48.7%)和须癣毛癣菌39株(1O.2%);酵母菌91株,占23.8%,其中前二位分别为白色假丝酵母菌43株(11.3%)和光滑假丝酵母菌20株(5.2%);霉菌24株,占6.3%.临床分型:远端甲下型(DLSO)占58.9%,全甲营养不良型(TDO)占23.0%,近端甲下型(PSO)占11.3%,浅表白色型(SWO)占6.8%.发病年龄以15岁~45岁居多,占74.9%.结论:甲真菌病病原菌以皮肤癣菌为主,其次为酵母菌和霉菌,临床分型以DLSO型为主,依次为TDO、PSO和SWO,发病年龄以15岁~ 45岁居多.

  16. Application of Nail Polish During Topical Management of Onychomycosis: Are Data Available to Guide the Clinician About What to Tell Their Patients?

    Science.gov (United States)

    Del Rosso, James Q

    2016-08-01

    Topical antifungal management of toenail onychomycosis has been fraught with several therapeutic challenges including difficulty gaining access to the site of infection and the need for prolonged durations of therapy. In addition, there has been a marked lack of information on the impact of toenail polish application on drug penetration after application. This article reviews available data from studies evaluating the effect of nail polish on antifungal drag penetration using ex vivo laboratory models with cadaver fingernail plates with both tavaborole 5% solution and efinaconazole 10% solution. In addition, changes in nail polish appearance and color transfer to applicators are also discussed, with changes noted with topical efinaconazole. Importantly, there are no data on whether or not nail polish application alters the efficacy of these topical agents.

  17. Identification of fungi species in the onychomycosis of institutionalized elderly Identificação de espécies fúngicas nas onicomicoses do idoso institucionalizado

    Directory of Open Access Journals (Sweden)

    Cidia Vasconcellos

    2013-06-01

    Full Text Available BACKGROUND: Superficial fungal infections are caused by dermatophytes, yeasts or filamentous fungi. They are correlated to the etiologic agent, the level of integrity of the host immune response, the site of the lesion and also the injured tissue. OBJECTIVE: The purpose of this study is to isolate and to identify onychomycosis agents in institutionalized elderly (60 years old +. METHODS: The identification of the fungi relied upon the combined results of mycological examination, culture isolation and micro cultures observation under light microscopy from nail and interdigital scales, which were collected from 35 elderly with a clinical suspicion of onychomycosis and a control group (9 elderly with healthy interdigital space and nails. Both groups were institutionalized in two nursing homes in Sao Bernardo do Campo, SP, Brazil. RESULTS: The nail scrapings showed 51.40% positivity. Of these, dermatophytes were found in 44.40% isolates, 27.78% identified as Trichophyton rubrum and 5.56% each as Trichophyton tonsurans, Trichophyton mentagrophytes and Microsporum gypseum. The second more conspicuous group showed 38.89% yeasts: 16.67% Candida guilliermondii, 11.11% Candida parapsilosis, 5.56% Candida glabrata, and 5.56% Trichosporon asahii. A third group displayed 16.70% filamentous fungi, like Fusarium sp, Aspergillus sp and Neoscytalidium sp (5.56% each. The interdigital scrapings presented a positivity rate of 14.29%. The agents were coincident with the fungi that caused the onychomycosis. In the control group, Candida guilliermondii was found at interdigital space in one person. CONCLUSION: Employing a combination of those identification methods, we found no difference between the etiology of the institutionalized elderly onychomycosis from that reported in the literature for the general population. FUNDAMENTOS: As infecções fúngicas superficiais se correlacionam com o agente etiológico, a resposta imune do hospedeiro, o local da lesão e o

  18. Efficacy Coefficients Determined Using Nail Permeability and Antifungal Activity in Keratin-Containing Media Are Useful for Predicting Clinical Efficacies of Topical Drugs for Onychomycosis.

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    Yoshiki Matsuda

    Full Text Available Onychomycosis is difficult to treat topically due to the deep location of the infection under the densely keratinized nail plate. In order to obtain an in vitro index that is relevant to the clinical efficacy of topical anti-onychomycosis drugs, we profiled five topical drugs: amorolfine, ciclopirox, efinaconazole, luliconazole, and terbinafine, for their nail permeabilities, keratin affinities, and anti-dermatophytic activities in the presence of keratin. Efinaconazole and ciclopirox permeated full-thickness human nails more deeply than luliconazole. Amorolfine and terbinafine did not show any detectable permeation. The free-drug concentration of efinaconazole in a 5% human nail keratin suspension was 24.9%, which was significantly higher than those of the other drugs (1.1-3.9%. Additionally, efinaconazole was released from human nail keratin at a greater proportion than the other drugs. The MICs of the five drugs for Trichophyton rubrum were determined at various concentrations of keratin (0-20% in RPMI 1640 medium. The MICs of ciclopirox were not affected by keratin, whereas those of efinaconazole were slightly increased and those of luliconazole and terbinafine were markedly increased in the presence of 20% keratin. Efficacy coefficients were calculated using the nail permeation flux and MIC in media without or with keratin. Efinaconazole showed the highest efficacy coefficient, which was determined using MIC in media with keratin. The order of efficacy coefficients determined using MIC in keratin-containing media rather than keratin-free media was consistent with that of complete cure rates in previously reported clinical trials. The present study revealed that efficacy coefficients determined using MIC in keratin-containing media are useful for predicting the clinical efficacies of topical drugs. In order to be more effective, topical drugs have to possess higher efficacy coefficients.

  19. Efficacy Coefficients Determined Using Nail Permeability and Antifungal Activity in Keratin-Containing Media Are Useful for Predicting Clinical Efficacies of Topical Drugs for Onychomycosis.

    Science.gov (United States)

    Matsuda, Yoshiki; Sugiura, Keita; Hashimoto, Takashi; Ueda, Akane; Konno, Yoshihiro; Tatsumi, Yoshiyuki

    2016-01-01

    Onychomycosis is difficult to treat topically due to the deep location of the infection under the densely keratinized nail plate. In order to obtain an in vitro index that is relevant to the clinical efficacy of topical anti-onychomycosis drugs, we profiled five topical drugs: amorolfine, ciclopirox, efinaconazole, luliconazole, and terbinafine, for their nail permeabilities, keratin affinities, and anti-dermatophytic activities in the presence of keratin. Efinaconazole and ciclopirox permeated full-thickness human nails more deeply than luliconazole. Amorolfine and terbinafine did not show any detectable permeation. The free-drug concentration of efinaconazole in a 5% human nail keratin suspension was 24.9%, which was significantly higher than those of the other drugs (1.1-3.9%). Additionally, efinaconazole was released from human nail keratin at a greater proportion than the other drugs. The MICs of the five drugs for Trichophyton rubrum were determined at various concentrations of keratin (0-20%) in RPMI 1640 medium. The MICs of ciclopirox were not affected by keratin, whereas those of efinaconazole were slightly increased and those of luliconazole and terbinafine were markedly increased in the presence of 20% keratin. Efficacy coefficients were calculated using the nail permeation flux and MIC in media without or with keratin. Efinaconazole showed the highest efficacy coefficient, which was determined using MIC in media with keratin. The order of efficacy coefficients determined using MIC in keratin-containing media rather than keratin-free media was consistent with that of complete cure rates in previously reported clinical trials. The present study revealed that efficacy coefficients determined using MIC in keratin-containing media are useful for predicting the clinical efficacies of topical drugs. In order to be more effective, topical drugs have to possess higher efficacy coefficients.

  20. Efinaconazole 10% and Tavaborole 5% Penetrate Across Poly-ureaurethane 16%: Results of In Vitro Release Testing and Clinical Implications of Onychodystrophy in Onychomycosis.

    Science.gov (United States)

    Adigun, Chris G; Vlahovic, Tracey C; McClellan, Michael B; Thakker, Kailas D; Klein, Ryan R; Elstrom, Tuan A; Ward, Daniel B

    2016-09-01

    Poly-ureaurethane has been previously described for the management of dry, brittle, and in general, dystrophic nails. The polymer yields a waterproof, breathable barrier to protect the nail plate and prevent further damage to the nail, while regulating transonychial water loss (TOWL). Because nail dystrophy and dessication are contributing factors to onychomycosis, a barrier that protects the nail but also allows a topical antifungal to permeate its shield is potentially an advantageous combination. Oral antifungals such as terbinafine, itraconazole, and fluconazole, as well as the newer topical antifungals efinaconazole and tavaborole (although formulated to penetrate the nail unit and work with the porosity and inherent electrical charge of the nail plate), do not take into account nail damage that has been created from years of harboring a dermatophyte infection. Up to 50% of cases presumed to be onychomycosis are in fact onychodystrophy without fungal infection, and laboratory testing for fungus should be obtained prior to initiating antifungal treatment. Whether a nail has onychomycosis, or onychodystrophy due to other causes, barrier function and structural integrity are compromised in diseased nails, and should be addressed. A poly-ureaurethane barrier that protects against wetting/drying, fungal reservoirs, and microtrauma, followed by the addition of oral or topical antifungals after laboratory fungal confirmation may optimize outcomes in the treatment of onychomycosis. The purpose of this work was to determine through in vitro release testing (IVRT) whether poly-ureaurethane 16% allows for penetration of efinaconazole 10% or tavaborole 5%. Results could spur subsequent clinical studies which would have implications for the addition of an antifungal based on fungal confirmation, after addresssing the underlying nail dystrophy primarily. A vertical diffusion cell system was used to evaluate the ability of efinaconazole 10% and tavaborole 5% to penetrate

  1. Clinical data analysis of onychomycosis in 207 inpatients with diabetes%糖尿病住院患者207例甲真菌病临床调查研究

    Institute of Scientific and Technical Information of China (English)

    范娟; 卜晓琳; 胡晓莉; 蒋建华; 张际晨

    2016-01-01

    目的:调查研究糖尿病住院患者合并甲真菌病的患病率、临床分型及菌种构成。方法以2014年6-12月207例我院糖尿病住院患者为研究对象,调查分析糖尿病住院患者甲真菌病的患病率、临床分型及菌种构成等。结果207例糖尿病住院患者甲真菌病的临床分型为远端侧位甲下型(42.9%)、全甲毁损型(38.1%)、近端甲下型(14.3%)、浅表白色型(4.8%);糖尿病住院患甲真菌病的患病率为10.1%;致病菌主要为皮肤癣菌和酵母菌。结论糖尿病患者甲真菌病的发病率高于普通人群的平均发病率,临床分型以远端侧位甲下型为主,病原菌主要是皮肤癣菌和酵母菌。%Objective To investigate and analyze the incidence of onychomycosis coupled with diabetes in the inpatients, the clinical classification of the disease and species composition.Methods Two hundred and seven patients with diabetes admitted into our hospital from June 2014 to December 2014, were used as the research objects.The incidence of onychomycosis, the clinical classifica-tion of the disease and species composition were investigated and analyzed in the inpatients coupled with diabetes.Results The clinical classifications of onychomycosis in 207 inpatients coupled with diabetes were DLSO (accounting for 42.9%), TDO (accounting for 38.1%), PSO (accounting for 14.3%) and SWO (accounting for 4.8%).The incidence of onychomycosis in diabetic inpatients was 10.1%, with the main pathogens of the disease being dermatophyte and yeast.Conclusion The incidence of onychomycosis in diabetic inpatients was higher than that of the general population.Clinical classification of the disease was chiefly DLSO, with pathogens being dermatophyte and yeast.

  2. Clinical Characteristics and Pathogenic Bacteria Profile of Onychomycosis%甲真菌病临床特点及致病菌谱的研究

    Institute of Scientific and Technical Information of China (English)

    刘芳; 孔庆涛; 王雪连; 王高峰; 冯姣; 桑红

    2012-01-01

    Objective To assess the epidemiologic features of nails such as age of onset, clinical morphologic patterns, predisposing factors and pathogenic bacterium profile. Methods Photographs of 328 nail samples collected (luring December 2010 and December 2011 in our hospital were taken and fungal examinations were preformed (direct microscopic examination and fungal cultivation). Clinical morphologic patterns were noted for all positive patients in fungal examinations. 113 patients completed the questionnaires to investigate the predisposing factors. Results In 328 onychomycosis nail samples, incidence rate of male patients was higher than that of female patients (a ratio of 1.45: 1). The most frequently infected patients were in 20 -29 year-old-age group (35.7%). In 370 ungual clinical morphologic patterns, distal and lateral subungual onychomycosis was the most common clinical pattern (51.4% ) , followed by total dystrophic onychomycosis (24. 3% ), superficial white onychomycosis (18. 6% ) and proximal subungual onychomycosis (5.7% ). Positive results in 196 nail samples cultivation indicated that the most common fungal isolates was dermatophytes (82.7% ) , followed by Candida spp (11.2% ) and nondermatophyte molds (6. 1% ) such as Aspergillus spp, Penicillium spp and Fusarium spp, etc. In dermatophytes, Trichophyton rubrum was the most common isolate, followed by Tricho-phyton mentagrophytes. In Candida spp, Candida albicans was the most common. The predisposing factors in 113 cases included familial infection (11.5%), chronic nephrosis (4.4% ), kidney transplantation (0.9% ), nail trauma (1.8% ), diabetes mellitus (1.8% ), leukemia (0.9% ) and idiopathic thrombocytopenic purpura (0.9% ). Conclusion The recognition of the epidemiologic features and clini-comycologic profile of onyehomycosis can help to guide therapeutic approach and preventative measures.%目的 探讨甲真菌病流行病学特点如发病年龄、临床形态学分型、易感因素,以

  3. Toenail Fungus (Onychomycosis)

    Science.gov (United States)

    ... Tips for Healthy Feet Footwear & Products Products by Company Products by Type Foot Health Awareness Diabetes Awareness ... Your podiatrist can detect a fungal infection early, culture the nail, determine the cause, and form a ...

  4. The Effect of Q-Switched Nd:YAG 1064 nm/532 nm Laser in the Treatment of Onychomycosis In Vivo

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    Kostas Kalokasidis

    2013-01-01

    Full Text Available In this prospective clinical study, the Q-Switched Nd:YAG 1064 nm/532 nm laser (Light Age, Inc., Somerset, NJ, USA was used on 131 onychomycosis subjects (94 females, 37 males; ages 18 to 68 years. Mycotic cultures were taken and fungus types were detected. The laser protocol included two sessions with a one-month interval. Treatment duration was approximately 15 minutes per session and patients were observed over a 3-month time period. Laser fluencies of 14 J/cm2 were applied at 9 billionths of a second pulse duration and at 5 Hz frequency. Follow-up was performed at 3 months with mycological cultures. Before and after digital photographs were taken. Adverse effects were recorded and all participants completed “self-evaluation questionnaires” rating their level of satisfaction. All subjects were well satisfied with the treatments, there were no noticeable side effects, and no significant differences were found treating men versus women. At the 3-month follow-up 95.42% of the patients were laboratory mycologically cured of fungal infection. This clinical study demonstrates that fungal nail infections can be effectively and safely treated with Q-Switched Nd:YAG 1064 nm/532 nm laser. It can also be combined with systemic oral antifungals providing more limited treatment time.

  5. Application of cosmetic nail varnish does not affect the antifungal efficacy of amorolfine 5% nail lacquer in the treatment of distal subungual toenail onychomycosis: results of a randomised active-controlled study and in vitro assays.

    Science.gov (United States)

    Sigurgeirsson, B; Ghannoum, M A; Osman-Ponchet, H; Kerrouche, N; Sidou, F

    2016-05-01

    As onychomycosis is unsightly, this study clinically evaluated whether the antifungal efficacy of amorolfine 5% nail lacquer (NL) was affected by a masking, natural-coloured, cosmetic nail varnish applied 24 h later; in vitro investigations were also performed. Subjects with mild-to-moderate distal subungual toenail onychomycosis were randomised to receive amorolfine 5% NL once weekly with or without cosmetic nail varnish applied 24 h later. After 12-week treatment, antifungal activity of affected toenail clippings was assessed by measurement of zones of inhibition (ZOIs) on Trichophyton mentagrophytes seeded agar plates. Mean diameters were 53.5 mm for the amorolfine 5% NL-alone group (n = 23) and 53.6 mm for amorolfine 5% NL plus cosmetic nail varnish group (n = 25). Also, mycological cultures of subungual debris at week 12 were negative for all subjects in both groups. Most subjects (88%) reported that cosmetic nail varnish masked their infected toenails. Additionally, cadaver human nails coated in vitro with or without cosmetic nail varnish 10 min or 24 h post amorolfine NL application all gave ZOIs on Trichophyton rubrum agar plates representing potent antifungal activity. In conclusion, cosmetic nail varnish applied post amorolfine had no effect on the subungual antifungal activity of amorolfine 5% NL or its penetration through toenails.

  6. 2型糖尿病患者甲真菌病临床资料分析%Clinical data analysis of onychomycosis in patients with type 2 diabetes

    Institute of Scientific and Technical Information of China (English)

    刘昕; 岑雯; 晓冬; 张谨宇; 刘越素; 冯文莉; 马彦

    2015-01-01

    Objective To analyze the clinical classification, pathogenic fungal profile and predisposing factors of onychomycosis in patients with type 2 diabetes. Methods The analysis was performed basing on the clinical data of hospital patients with type 2 diabetes in department of endocrinology from January 2013 to August 2014. Assessed clinical classification and identifying fungi strains of the patients with onychomycosis. Analyzed the possible factors leading to incurrence of fungal infection in patients with type 2 diabetes and all these factors were statistics by Logistic regression analysis. Results A total of 1 125 cases of patients with type 2 diabetes were investigated and 153 patients had a fungal infection and the incidence rate of onychomycosis was 13.6%;DLSO were the most clinical classification (58.39%), followed by TDO (43 cases, 26.71%), SWO (18 cases, 11.18%) and PSO (6 cases, 3.72%); Dermatophytes were still the main pathogen and there were 77 patients infected by dermatophytes. Yeast (23.68%) and aspergillus (3.51%) were less than dermatophytes. Multi-factor analysis showed that age, male gender, duration of diabetes, peripheral circulatory disturbance, peripheral neuropathy, retinopathy were the predisposing factors of onychomycosis in patients with type 2 diabetes (P<0.05). Conclusion The predisposing factors of onychomycosis in patients with type 2 diabetes include age, male gender, and duration of diabetes, peripheral circulatory disturbance, peripheral neuropathy and retinopathy.%目的:了解糖尿病患者甲真菌病的临床分型、菌种构成及易感因素。方法分析2013年1月至2014年8月山西医科大学第二医院内分泌科2型糖尿病住院患者的临床资料,对合并甲真菌病者进行临床分型、菌种鉴定,对可能导致糖尿病患者甲真菌感染的因素进行Logistic回归分析。结果1125例2型糖尿病患者中合并有甲真菌病者153例,患病率为13.6%;临床

  7. Onicomicose na infância: uma perspectiva atual com ênfase na revisão do tratamento Onychomycosis in childhood: a current perspective with emphasis on the review of treatment

    Directory of Open Access Journals (Sweden)

    Roberto Arenas

    2004-04-01

    Full Text Available A prevalência da onicomicose na infância, principalmente quando provocada por dermatófitos e Candida sp, tem aumentado. Tais infecções em crianças parecem infreqüentes em países desenvolvidos, mas não são excepcionais na América Latina. O objetivo principal deste trabalho foi analisar a literatura médica atual. Foi observada a onicomicose por dermatófitos em crianças com idade a partir de dois anos. A faixa entre 12-16 anos é a mais afetada (66,4%, provavelmente devido aos fatores de risco aumentado, como a prática de esportes e os hormônios da puberdade. Os pais foram a fonte de infecção em 46,2% dos casos, e 65% dos parentes de pacientes apresentavam onicomicose ou tinea pedis. As unhas dos dedos dos pés são afetadas por dermatófitos, sendo mais freqüente a onicomicose distal subungueal (88,5%; contudo, também se observam as formas superficial branca e branca subungueal proximal. A suspeita de diagnóstico é obtida com o exame clínico, mas a confirmação micológica é necessária. Os principais agentes dermatófitos são: T. rubrum (69%-92,7%, T. tonsurans (8,8%, T. mentagrophytes var interdigitale (5,4% e M. canis (2,9%. A griseofulvina constitui o tratamento de primeira linha, mas itraconazol, fluconazol e terbinafina também são recomendados para o tratamento sistêmico. O tratamento tópico com ciclopirox a 8%, amorolfina a 5% e uréia a 40% associada a bifonazol a 1% pode ser considerado alternativa terapêutica. Dada a escassez de relatos de onicomicose em crianças, não foi possível uma conclusão sobre a melhor abordagem terapêutica. Mais dados clínicos são necessários para estabelecer o perfil de segurança dos novos agentes antimicóticos a fim de determinar a conduta ideal na onicomicose infantil.The prevalence of onychomycosis in childhood has been increasing, mainly caused by dermatophytes and also by Candida sp. These infections in children seem to be infrequent in the developed countries, while

  8. Ocorrência de onicomicose em Maringá, Estado do Paraná, Brasil = Occurrence of the onychomycosis in Maringá, Paraná State, Brazil

    Directory of Open Access Journals (Sweden)

    Isabel Cristina Martelozo

    2005-07-01

    Full Text Available Onicomicoses são infecções fúngicas que atingem as unhas e acometem cerca de 30% da população. Recentemente tem sido relatado aumento dessas infecções e também alterações em sua etiologia. O objetivo deste estudo foi avaliar a freqüência das onicomicoses e perfil dos pacientes acometidos em Maringá, Estado do Paraná, Brasil. Entre janeiro de 1999 a junho de 2003 foram analisadas, no Laboratório de Micologia do Lepac (Laboratório de Ensino e Pesquisa em Análises Clínicas da Universidade Estadual de Maringá, um total de 435 amostras de pacientes com suspeita clínica de onicomicose. Destas amostras 74,25% (N=323 foram positivas, sendo 15,48% confirmadas por exame direto (N=50, 20,43% exclusivamente por cultura (N=66 e 64,09% por exame direto e cultura (N=207. As mulheres foram mais afetadas que os homens (72,67% e 27,33%, respectivamente, e a maior prevalência foi em indivíduos com mais de 40 anos. As unhas dos pés foram mais acometidas que as unhas das mãos (65,90% e 34,10%, respectivamente. Os agentes etiológicos mais freqüentes foram as leveduras (52,17% isoladas especialmente das unhas das mãos. Os fungos filamentosos foram prevalentes nas unhas dos pés, destacando-se os dermatófitos responsáveis por 33,85% das onicomicoses e os não dermatófitos (FFND por 13,97%.Onychomycosis are fungal infections that reach the nails and affect about 30% of the population. Recently has been observed increase of these infections and also alterations in its etiology. The objective of this study was to evaluate the frequency of these mycosis and profile of the patients attacked in Maringá, Paraná State, Brazil. Between January 1999 to June 2003 were analyzed at the Mycological Laboratory from the Teaching and Research Laboratory in Clinical Analyses (Lepac a total of 435 samples of patients with clinical symptoms of onychomycoses. Of those samples 74,25% (N=323, were positive, being 15,48% confirmed by direct examination (N=50

  9. Efficacy observation of Itraconazole and nail bed dressing surgery in the treatment of severe onychomycosis%伊曲康唑联合甲床修整术治疗重症甲真菌病的疗效观察

    Institute of Scientific and Technical Information of China (English)

    宋维芳; 于宇; 刘作谨

    2012-01-01

    Objective To observe the clinical efficacy of combined therapy of oral itraconazole and nail bed dressing surgery H in the treatment of severe onychomycosis. Methods Totally 140 patients with onychomycosis were randomly divided intotreatment and control groups. The 68 patients in treatment group accepted the therapy of combined therapy of oral itraconazole and nail bed dress-ing surgery, while the 72 patients in control group were treated with itraconazole alone. Results The cure rate and total effective rate of treatment group were 70. 6% and 88. 2% , while of the contrast group were 45. 6% and 65. 2% . The differences of cure rate and total effective rate between the two groups showed statistical significance (P < 0. 01). Conclusion Combined therapy of oral Itraconazole and nail bed dressing surgery significantly is effective and can improve the growth rate and appearance of the new nail.%目的 观察口服伊曲康唑联合甲床修整术治疗重症甲真菌病的临床疗效.方法 将140例甲真菌病患者随机分为两组,治疗组68例采用甲床修整术联合口服伊曲康唑治疗;对照组72例单纯口服伊曲康唑治疗.结果 治疗组痊愈率及总有效率分别为70.6%及88.2%,对照组分别为45.8%及65.2%,两组患者痊愈率及总有效率差异均有显著统计学意义(P<0.01).结论 伊曲康唑口服联合甲床修整术治疗重症甲真菌病疗效高,能显著改善新甲的生长速度及外观.

  10. 中国甲真菌病研究文献计量学分析%Bibliometric analysis of literatures on onychomycosis in China

    Institute of Scientific and Technical Information of China (English)

    吴凡; 冯姣; 孔庆涛; 刘芳; 桑红

    2013-01-01

    目的 反映国内甲真菌病研究现状,为进一步研究提供思路和依据.方法 运用文献计量学方法,以中国期刊全文数据库和万方数据库为数据来源,采用高级检索方式,对1981~ 2011年国内甲真菌病研究文献进行定量分析.结果 共检出有效文献826篇;年文献量变化呈早期较少随后出现高峰,继而进入稳定期的发展趋势;主要的产文省市为北京、江苏、广东、上海和山东,共发表文章398篇,占总文献量的48.18%;发文最多的机构为中国医学科学院皮肤病研究所和北京大学第一医院,共发文46篇,占全部文献的5.57%;发文3篇及以上的第一作者共37人,共计发表论文154篇,占第一作者总人数的4.48%;《临床皮肤科杂志》《中华皮肤科杂志》《中国皮肤性病学杂志》和《中国麻风皮肤病杂志》是甲真菌病研究的核心期刊;文献合作度为3.01,文献合著率为73.24%;主要研究内容为甲真菌病治疗疗效观察,相关文献共423篇,占总文献量的51.21%;署名为基金论文的文献45篇,占所有文献的5.45%.结论 我国甲真菌病研究已进入相对稳定的发展时期,但地区间科研实力存在较大差异,基础研究较薄弱,研究者间的合作尚需加强,基金资助力度有待提高.%Objective To reflect current situation of studies on onychomycosis (OM),so as to provide thinking and evidence for further studies.Methods Quantitative analysis on OM is carried out with bibliometric method,using CNKI and Wanfang Data as resource.Results Altogether 826 literatures are effective,annual literature of OM was increased slowly at the beginning,then achieved peak and now at a stationary phase.Most of them,amounting for 48.18% of total literatures,were from Beijing,Jiangsu,Guangdong,Shanghai and Shandong.The articles,which were published by Chinese Academy of Medical Sciences Institute of Skin Diseases and Peking University First Hospital,added up to 5.57

  11. 系统性红斑狼疮患者合并甲真菌病、口腔念珠菌病的临床资料分析%Clinical Analysis of Onychomycosis and Oral Candidiasis in Systemic Lupus Erythematosus Patients

    Institute of Scientific and Technical Information of China (English)

    黄远忠; 董正蓉; 林伯盛; 马丹晓

    2011-01-01

    目的 探讨分析系统性红斑狼疮(SLE)患者合并甲真菌痛、口腔念珠菌病的情况及特点.方法 观察176例SLE患者的甲真菌病及口腔念珠菌病的危险因素及其致病真菌构成情况.结果 176例SLE患者中,104例合并真菌感染.甲真菌病61例(34.66%),口腔念珠菌病69例(39.20%),其中二者同时发生26例(14.77%).甲真菌病的主要病原体为红色毛癣菌,临床类型主要为远端侧位甲下型(52.46%).口腔念殊菌病主要病原体为白念珠菌.甲真菌病的患病率随着SLE病程延长而增加.口腔念珠菌病的患病率受泼尼松每日用量、接受甲强龙冲击治疗、使用广谱抗生素的影响.使用免疫抑制剂及病情严重程度对二者的发生均有影响.结论 SLE易发生甲真菌病和口腔念珠菌病,要早期检查并关注存在危险因素患者的甲及口腔黏膜变化.%Objective To investigate the prevalence of onychomycosis and oral candidiasis in systemic lupus erythematosus (SLE) patients. Methods Incidence of onychomycosis and oral candidasis were observed in 176 SLE patients. Constituent ratio of the pathogenic fungi and the risk factors of the two mycoses were also included. Results One hundred and four SLE patients had concomitant mycoses. Sixty-one were onychomycosis ( 34.66% ), 69 oral candidiasis ( 39.20% ), 26 with both mycoses. Trichophyton rubrum and Candida albicans were the major pathogens of onychomycosis and oral candidiasis, respectively. Onychomycosis was correlated with the duration of SLE, immunosuppressive drug use, and severity of SLE. While oral candidiasis was correlated with prednisone dose, methylprednisolone pulse therapy, and broad-spectrum antibiotics. Nail and oral changes should be noted early in those SLE patients with risk factors, immunosuppressive drug use, and severity of SLE. Conclusion SLE patient is susceptible to onychomycosis and oral candidiasis. Nail and oral changes should be noted early in those SLE

  12. Preparation and determination method for content in paint for onychomycosis%甲癣涂剂的制备及主要成分含量测定方法的研究

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    刘园; 张华峰; 宋青; 戴博

    2015-01-01

    目的:根据稳定性研究,修改处方工艺;修订 H +总量、碘和碘化钾的含量测定方法。方法建立甲癣涂剂的新的制备方法。滴定法测定 H +总量、碘和碘化钾的含量,并且考察了该方法的重现性、精密度和回收率。将修订前与修订后的测定结果进行了比较。结果甲癣涂剂短期内稳定性良好,可继续考察长期稳定性;H +总量的回收率分别为99.1%、100.2%、99.7%,碘的回收率为99.8%、99.8%、99.9%,碘化钾的回收率为100.1%、100.1%、100.3%。它们的精密度、重现性、稳定性也均符合要求。结论去掉原处方中溶解水杨酸的乙醇和丙酮,利用二甲基亚砜溶解水杨酸,以保证制剂的稳定性;修订后的滴定法测定 H +总量、碘和碘化钾的含量,滴定终点灵敏,易于观察,有利于更好的控制甲癣涂剂的质量。%Objective To improve formula technology based on the findings of stability research,and to revise the method for content determination of volume dose of H +,iodine and potassium iodide.Methods A new preparation method of paint for onychomycosis was adopted.The content of volume dose of H +,iodine and potassium iodide were determined by titrimetric method,and the recovery rate, precision,reproducibility were inspected.The determination results prior to the revision were compared with the revised one.Results Paint for onychomycosis was stabile within a short period and its long-term stability could be investigated.The recovery rates of H + were 99.1%,100.2%,99.7%.The recovery rates of iodine were 99.8%,99.8%,99.9%.The recovery rates of potassium iodide were 100.1%,100.1%,100.3%.The precision,reproducibility and stability of the volume dose of H +,iodine and potassium iodide were consistent with the request.Conclusions It is proposed to remove the alocohol and acetone from pro-prescription,and guarantee the stability of this preparation

  13. Uso de ondas de alta frequência no tratamento de onicomicose: comunicação preliminar de três casos The use of high frequency waves to treat onychomycosis: preliminary communication of three cases

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    Juliana Leal Monteiro da Silva

    2011-06-01

    Full Text Available A pesquisa avaliou a eficácia de ondas de alta frequência, no tratamento de onicomicose em 3 pacientes, durante 12 meses, através do exame clínico das unhas e exame micológico. O agente causal da micose nos três pacientes foi o dermatófito Trichophyton rubrum, e, após a aplicação da alta frequência, foi possível observar uma grande melhora no aspecto das unhas e uma inibição do crescimento em cultura, apesar do micológico direto se manter positivo. O estudo preliminar dos três casos demonstrou a atividade fungistática das ondas de alta frequência sendo um método promissor para ser utilizado, em associação com fármacos convencionaisThe research evaluated the efficacy of high frequency waves in the treatment of onychomycosis in three patients during twelve months through the clinical examination of nails and also through mycological examination. The causative agent of the mycosis, in the three patients, was the dermatophyte Trichophyton rubrum and after application of high frequency, it was possible to notice a great improvement in the appearance of nails and also growth inhibition in culture despite the fact that the mycological examination remained positive. The preliminary study of the three cases demonstrated that the fungistatic activity of high frequency waves is a promising method to be used in combination with conventional drugs

  14. Relationship between HLA-DRB alleles and onychomycosis in Chinese Han population in Jiangsu and Anhui provinces%HLA-DRB等位基因与苏皖籍汉族人群甲真菌病的相关性初步研究

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    冯姣; 桑红; 周国华; 邹秉杰; 吴凡; 张敏; 邓德权; 刘芳; 孔庆涛

    2013-01-01

    Objective To analyze the association of HLA-DRB alleles with onychomycosis in Chinease Han population in Jiangsu and Auhui provinces.Methods Polymerase chain reaction with sequence-specific primers (PCR-SSP) was conducted to analyze the type of HLA-DRB alleles in 50 patients with Trichophyton rubruminduced onychomycosis,14 patients with Trichophyton mentagrophytes-induced onychomycosis and 52 healthy human controls of Chinese Han nationality.Data were processed with the SPSS 13.0 software for Windows.The frequency of HLA-DRB alleles was compared between these groups using chi-square test.Results No significant differences were observed in the frequency of HLA-DRB alleles between the patients with Trichophyton rubruminduced onychomycosis and healthy controls.The patients with Trichophyton mentagrophytes-induced onychomycosis showed significantly higher frequency of HLA-DRB1*14 allele (17.86% vs.3.85%,P < 0.01,OR =5.435,95% CI:1.353-21.835),lower frequency of HLA-DRB1*15 allele (0 vs.16.3%,P < 0.05,OR =0.837,95% CI:0.768-0.911)compared with the healthy controls.Conclusions In Chinese Han population in Jiangsu and Anhui provinces,HLA-DRB alleles appear to be unassociated with Trichophyton rubrum-induced onychomycosis,whereas HLA-DRB1*14 allele seems to be a susceptible allele,and HLA-DRB1*15 be a protective allele,for Trichophyton mentagrophytes-induced onychomycosis.Genetic backgrounds may be different for onychomycosis caused by different Trichophyton species in Chinese Han population.%目的 探讨HLA-DRB等位基因与苏皖籍汉族人群甲真菌病的相关性.方法 采用聚合酶链反应-序列特异性引物方法对50例红色毛癣菌甲真菌病患者、14例须毛癣菌甲真菌病患者和52例健康对照进行HLA-DRB等位基因分型.应用SPSS for windows 13.0软件包,采用X2检验比较甲真菌病患者组与对照组的HLA-DRB等位基因频率.结果 红色毛癣菌甲真菌病患者HLA-DRB各等位基因频率与健康对照

  15. Efficacy of long-pulse Nd:YAG 1064 nm laser combined with occlusive dressing with salicylic acid in the treatment of onychomycosis%长脉宽Nd:YAG 1064 nm激光联合水杨酸封包治疗甲真菌病的疗效评价

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    陈梅; 张敬东; 董正邦

    2015-01-01

    Objective:To assess the efficacy of long-pulse Nd:YAG 1064 nm laser combined with occlu-sive dressing with salicylic acid in the treatment of onychomycosis. Methods: Sixty six patients with onycho-mycosis were randomly divided into the treatment group ( 34 patients, 68 disease nails) and control group ( 32 patients, 72 disease nails) . The disease nails in each group were divided into the SCIO≤9 group and the 90.05) . The effective rates of disease nails with a score of 90.05);对于9

  16. Enteroparasitoses e onicomicoses em manipuladores de alimentos do município de Ribeirão Preto, SP, Brasil Enteroparasitosis and onychomycosis in food handlers in the city of Ribeirão Preto, SP, Brasil

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    Jaqueline Otero Silva

    2005-12-01

    Full Text Available A maioria das doenças veiculadas por alimentos de origem microbiana deve-se à manipulação inadequada dos mesmos. A identificação de manipuladores de alimentos portadores de agentes patogênicos que podem ser propagados para os alimentos é uma ferramenta útil na prevenção da contaminação dos mesmos. OBJETIVOS: Identificar a presença de enteroparasitoses e onicomicoses em manipuladores de alimentos de Ribeirão Preto, contribuindo assim com as ações de vigilância sanitária. MÉTODOS: Foram analisadas entre julho e novembro de 2000, 69 amostras de fezes e 23 de unhas de 23 manipuladores de alimentos de Ribeirão Preto. As fezes foram submetidas aos métodos de KATO e da sedimentação espontânea. Na análise micológica, cada amostra de raspado de unha foi submetida à clarificação com KOH 30% por 30 minutos para estudo microscópico (exame direto e cultura em ágar Sabouraud acrescido de 100 mg/L de cloranfenicol e posterior incubação a 28(0 - 30(0C por até 30 dias, verificando-se o crescimento semanalmente. RESULTADOS: Dos trabalhadores avaliados, 04 (17,4% apresentaram parasitismo intestinal, 08 (34,8% micoses e em 01 (4,3% foi constatada infecção concomitante por enteroparasitas e micose. CONCLUSÕES: Para evitar as doenças transmitidas por alimentos é necessária a implementação conjunta de várias ações, incluindo a identificação dos portadores de agentes patogênicos que possam ser propagados para os alimentos através da manipulação.Most microbial food-borne illnesses are due to inappropriate food handling. The identification of food handlers contaminated with pathogenic organisms that can be transferred to food is a useful tool in the prevention of food contamination. OBJECTIVE: This study aimed to identify the presence of enteroparasitosis and onychomycosis in food handlers in Ribeirão Preto, in order to contribute to sanitary surveillance actions. METHODS: From July to November 2000, 69 fecal and 23

  17. Agentes etiológicos de onicomicosis diagnosticadas en el laboratorio de micología médica de la Universidad de Costa Rica Etiological agents of onychomycosis diagnosed in the medical mycology laboratory of the University of Costa Rica

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    Ingrid Salas-Campos

    2012-06-01

    , levaduras y hongos filamentosos no dermatofitos, lo que es importante tener en cuenta por las implicaciones en la elección del tratamiento.Background and aim: Among the onychodistrophies, onychomycosis are the most frequently encountered. This infection not only constitutes an esthetic problem for the patients, but can also affect their daily activities. For dermatologists, it is crucial to make a differential diagnosis; thus, the medical mycology laboratory plays an important role to achieve this purpose. The fungal agents most frequently encountered are the dermatophytes, however, other filamentous non-dermatophyte fungi have been isolated and are known to be less susceptible to antifungals. In the present work, the frequency of onychomycosis among patients attending the medical mycology laboratory, UCR, was studied during four years, according to the age and sex of the patients, as well as the isolated etiological agents identified. Methods: The study included all patients that requested the community service provided by the Department of Medical Mycology, School of Microbiology, UCR, between January 2007 and December 2010 and that showed nail alterations suspicious for onychomycosis. The age and sex of each patient were registered and samples were processed for direct microscopy and culture. Results: A total of 431 nail samples were collected, of which 85.4% were toenails and 14.6% fingernails. The mean age of the patients was 49 years, of which 64% were females and 36% males. Onychomycosis was diagnosed, either by direct microscopy and culture, or only with positive direct microscopy, in 73.4% of the sample population, of which 89.4% were toenails and 10.6% fingernails. Trichophyton rubrum was the etiological agent most frequently isolated from toenails, followed by Fusarium spp. C albicans was the most frequent fungal agent observed in fingernails. Conclusion: The diagnosis of onychomycosis relies upon both the clinical and laboratory diagnosis. Dermatophytes, yeasts

  18. Effect observation of Amor Luo Fenjia liniment in combined with oral itraconazole and Amor Luo Fenjia lini-ment combined with oral terbinafine in the treatment of onychomycosis%阿莫罗芬甲搽剂联合口服伊曲康唑与联合口服特比萘芬治疗甲真菌病的疗效观察

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    陈健发

    2015-01-01

    目的:探讨甲真菌病采用阿莫罗芬甲搽剂与伊曲康唑口服联合治疗和与特比萘芬口服联合治疗效果展开对比。方法:选取甲真菌病100例,随机分组,分别为阿莫罗芬甲搽剂与伊曲康唑联用组(A 组,n =50)和特比萘芬口服联用组(B 组,n =50),研究两组效果对比。结果:A 组近期痊愈率为26%,远期痊愈率为86%;B 组近期痊愈率为24%,远期痊愈率为60%,远期痊愈率比较,差异有统计学意义(P ﹤0.05);A 组真菌清除率为86%,B 组为70%。两组均无严重不良事件发生。结论:甲真菌病采用阿莫罗芬甲搽剂与伊曲康唑口服联用,可获得理想的临床效果,真菌清除率较高,具有非常重要的应用价值,可显著改善患者生存质量。%Objective To study the onychomycosis by amor Luo Fenjia liniment and combination treatment with oral itraconazole and associated with oral terbinafine treatment effect comparison. Method The 100 cases of onychomycosis were selected and randomly divided into amor Luo Fenjia liniment and itraconazole together group(group A,n = 50)and amor Luo Fenjia liniment and oral terbinafine combi-nation group(group B,n = 50). The effect of the two groups were compared. Results The recent recovery rate of group A was 26% ,the long - term cure rate was 86% ;the recent recovery rate of group B was 24% ,long - term recovery rate was 60% ,the long - term recovery rate of the two groups was statistically significant(P ﹤ 0. 05);The fungal clearance rate of group A was 86% ,B group was 70% . Two groups had no serious adverse events. Conclusion Onychomycosis by amor Luo Fenjia liniment and oral itraconazole together,which can ob-tain ideal clinical effect,fungal clearance rate is higher,it has very important application value,can significantly improve the patients quality of life.

  19. Onychomycosis caused by Scytalidium dimidiatum. Report of two cases. Review of the taxonomy of the synanamorph and anamorph forms of this coelomycete Onicomicose por Scytalidium dimidiatum. Registro de dois casos. Revisão da taxonomia das formas sinanamorfas e anaforma deste celomiceto

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    Carlos da Silva LACAZ

    1999-09-01

    Full Text Available The authors report two cases of onychomycosis in the dystrophic form, one of them involving an HIV-positive patient, provoked by Scytalidium dimidiatum, previously called Scytalidium lignicola. The subject is reviewed from the taxonomic viewpoint, considering the anamorph Hendersonula toruloidea as a synonym of Nattrassia mangiferae, and having Scytalidium dimidiatum as the major synanamorph. According to many mycologists, Scytalidium hyalinum may be a separate species or a hyaline mutant of Scytalidium dimidiatum. Scytalidium lignicola Pesante 1957 was considered to be the type-species of the genus by ELLIS (197113 and later to be a "conidial state" of Hendersonula toruloidea by the same author, today known as Nattrassia mangiferae. The microorganism lives only on the roots of certain plants (mainly Platanus and Pinus. It produces pycnidia and is not considered to be a pathogen, although it is considered as a possible emerging agent capable of provoking opportunistic fungal lesions. The importance of this topic as one of the most outstanding in fungal taxonomy, so likely to be modified over time, as well as its interest in the field of dermatologic mycology, are emphasized.Os Autores registraram dois casos de onicomicose sob forma distrófica, sendo um em paciente HIV-positivo, provocados pelo Scytalidium dimidiatum, no passado considerado como Scytalidium lignicola. Fazem uma revisão da matéria sob o ponto de vista taxonômico, considerado o anamorfo Hendersonula toruloidea como sinônimo de Nattrassia mangiferae, tendo como sinanamorfo principal o Scytalidium dimidiatum. Scytalidium hyalinum seria para muitos micologistas espécie à parte ou mutante hialina do Scytalidium dimidiatum. Scytalidium lignicola Pesante 1957, foi considerada por ELLIS (197113 como espécie-tipo do gênero e mais tarde (197614, pelo mesmo Autor como "estado conidiano" de Hendersonula toruloidea, atualmente Nattrassia mangiferae. Vive somente em raízes de

  20. The Clinical Effect of XTR Combined with Terbinafine in 46 Patients with Toenail Onychomycosis%百癣夏塔热胶囊联合特比萘芬治疗趾甲真菌病46例的临床疗效

    Institute of Scientific and Technical Information of China (English)

    牟萍; 丁敏; 安徐生; 李晶冰; 王艳

    2012-01-01

    Objective: To evaluate the clinical effect of XTR combined with Terbinafine on toenail onychomycosis. Methods: 92 patients who were diagnosed toenail onychomycosis in Xuzhou Central Hosputal were enrolled in the sudy. They were randomly divided into the trial group and the control group, the trail group: patients were receiving oral Terbinafine (250mg qd) and XTR (2 capsules tid); the control group: patients were receiving oral Terbinafine (250 mg qd). One month for a period of treatment. Related indexs were tested three months later and recurrence rate was followed up twelve months later. The agreement also stipulated that patients return visit every two weeks, keep a record of safety. And no drug or treatment should be used during the observation periods. Results: The trail group: Among the 46 cases, 34 patients were clinically cured, 8 markedly improved, 6 effective. The cure rate was 73.91%; 5 patients relapsed after 12months; the recurrence rate is 10.87%. The control group: Among the 46 cases, 29 patients were clinically cured, 8 markedly improved, 9 effective. The cure rate was 63.04%; 15 patients relapsed after 12months; the recurrence rate is 32.60%. Adverse reaction: Gastrointestinal tract reaction or diarrhea turned up in the trail group but only gastrointestinal tract reaction in the control group, all these adverse reactions were temporary, tended to resolve when the drugs were stopped. Conclusion: The cure rate and recurrence rate in treatment group was obviously better than those in control group (P< 0.05), showing the guiding function in instructing the clinical application.%目的:分析百癣夏塔热胶囊联合特比萘芬治疗趾甲真菌病的临床疗效.方法:选择我院门诊就诊的趾甲真菌病患者92例.随机分为治疗组和对照组,治疗组:口服特比萘芬,250mg/次,1次/d,同时加服百癣夏塔热胶囊,2粒/次,3次/d;对照组:按治疗组相同方法服用特比萘芬.2组均以1个月为1个疗程,3

  1. Ocorrência de onicomicose em Maringá, Estado do Paraná, Brasil - DOI: 10.4025/actascihealthsci.v27i2.1425 Occurrence of the onychomycosis in Maringá, Paraná State, Brazil - DOI: 10.4025/actascihealthsci.v27i2.1425

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    Terezinha Inez Estivalet Svidzinski

    2005-03-01

    Full Text Available Onicomicoses são infecções fúngicas que atingem as unhas e acometem cerca de 30% da população. Recentemente tem sido relatado aumento dessas infecções e também alterações em sua etiologia. O objetivo deste estudo foi avaliar a freqüência das onicomicoses e perfil dos pacientes acometidos em Maringá, Estado do Paraná, Brasil. Entre janeiro de 1999 a junho de 2003 foram analisadas, no Laboratório de Micologia do Lepac (Laboratório de Ensino e Pesquisa em Análises Clínicas da Universidade Estadual de Maringá, um total de 435 amostras de pacientes com suspeita clínica de onicomicose. Destas amostras 74,25% (N = 323 foram positivas, sendo 15,48% confirmadas por exame direto (N=50, 20,43% exclusivamente por cultura (N=66 e 64,09% por exame direto e cultura (N=207. As mulheres foram mais afetadas que os homens (72,67% e 27,33%, respectivamente, e a maior prevalência foi em indivíduos com mais de 40 anos. As unhas dos pés foram mais acometidas que as unhas das mãos (65,90% e 34,10%, respectivamente. Os agentes etiológicos mais freqüentes foram as leveduras (52,17% isoladas especialmente das unhas das mãos. Os fungos filamentosos foram prevalentes nas unhas dos pés, destacando-se os dermatófitos responsáveis por 33,85% das onicomicoses e os não dermatófitos (FFND por 13,97%Onychomycosis are fungal infections that reach the nails and affect about 30% of the population. Recently has been observed increase of these infections and also alterations in its etiology. The objective of this study was to evaluate the frequency of these mycosis and profile of the patients attacked in Maringá, Paraná State, Brazil. Between January 1999 to June 2003 were analyzed at the Mycological Laboratory from the Teaching and Research Laboratory in Clinical Analyses (Lepac a total of 435 samples of patients with clinical symptoms of onychomycoses. Of those samples 74,25% (N=323, were positive, being 15,48% confirmed by direct examination (N=50

  2. [Onychomycosis frequency in psoriatic patients in a tertiary care hospital].

    Science.gov (United States)

    Méndez-Tovar, Luis Javier; Arévalo-López, Alfredo; Domínguez-Aguilar, Sofía; Manzano-Gayosso, Patricia; Hernández-Hernández, Francisca; López Martínez, Rubén; Silva González, Israel

    2015-01-01

    Introducción: los cambios ungueales en los pacientes con psoriasis pueden ser muy parecidos a la onicomicosis y, por lo tanto, las infecciones fúngicas pueden ser subdiagnosticadas. Se investigó la frecuencia de onicomicosis en manos y pies de 150 pacientes con psoriasis de un servicio de dermatología. Métodos: se obtuvieron los datos clínicos de la psoriasis. Se cultivaron escamas de las uñas en agar dextrosa Sabouraud con y sin antibióticos y se hizo un examen directo con KOH. Resultados: de los 150 pacientes, 67 (45 %) presentaron uñas sanas; 42 (28 %) tuvieron onicomicosis, y 41 (27 %) onicopatía sin infección. Las alteraciones ungueales en las manos estuvieron más asociadas con onicopatía psoriásica (82.5 %); los cambios de las uñas de los pies se asociaron más frecuentemente a infección fúngica (26.4 frente a 9.45 % en psoriasis). De 20 cultivos positivos, se aislaron 22 agentes: 11 Candida spp. (50 %). Como factor de riesgo para desarrollar onicomicosis, el tiempo de evolución de la psoriasis mostró una diferencia significativa (p = 0.03). Conclusión: en los pacientes con psoriasis, las alteraciones ungueales de manos se deben principalmente a psoriasis, mientras que los cambios ungueales en los pies se asocian a onicomicosis. Esta fue causada principalmente por Candida sp. El único factor de riesgo asociado para onicomicosis fue la larga evolución de la psoriasis.

  3. Onychomycosis by Paecilomyces lilacinus in a patient with leukonychia

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    Patrizia Innocenti

    2010-03-01

    Full Text Available Paecilomyces lilacinus, a filamentous fungus living saprophytic in the environment, very rarely causes infection in immunocompetent humans, mostly ocular or cutaneous and sub-cutaneous infections.The fungal isolates usually show low susceptibility to conventional antifungal drugs in vitro and variable susceptibility to novel triazoles. During a period of 2 years, 4 cultures of nail fragments were grown from a 41 years old female on modified Sabouraud/Dextrose agar (S.D.A. (CAF bioMérieux, CAF+CEX Biolife. Cultures were continued in suspension and the hyphae stained with lactophenole blue analysed microscopically. 2 samples were tested with molecular methods, i.e. DNA extraction, amplification of internal transcribed spacer (ITS region 1 and 2 and automated sequencing. The sequence results were evaluated using a validated reference database for humanpathogenic fungi. Additionally the BLAST algorithm on NIH database GenBank was used. A growth of a filamentous hyaline fungus with white colonies and lila shade was observed in all samples. The presence of Penicillium like conidiophores with divergent long terminal phialides was seen with little elliptical conidia. DNA sequencing determined the species as Paecilomyces lilacinus with 99% homology with GenBank isolate AY213667. The infection of the right hallux did not improve by systemic (Lamisil/terbinafine and local treatment (Locetar/amorolfin nail lacquer.Also change to Sporanox/itraconazol only led to deterioriation, so finally the extraction of the nail had to be performed given the known difficulties with treatment described in the literature. This case highlights the usefulness of molecular techniques, especially use of the highly discriminative ITS region for fungal typing.

  4. Human nail plate modifications induced by onychomycosis: implications for topical therapy.

    Science.gov (United States)

    Baraldi, A; Jones, S A; Guesné, S; Traynor, M J; McAuley, W J; Brown, M B; Murdan, S

    2015-05-01

    Through the characterisation of the human onchomycotic nail plate this study aimed to inform the design of new topical ungual formulations. The mechanical properties of the human nail were characterised using a Lloyd tensile strength tester. The nail's density was determined via pycnometry and the nail's ultrastructure by electron microscopy. Raman spectroscopy analysed the keratin disulphide bonds within the nail and its permeability properties were assessed by quantifying water and rhodamine uptake. Chronic in vivo nail plate infection increased human nailplate thickness (healthy 0.49 ± 0.15 mm; diseased 1.20 ± 0.67 mm), but reduced its tensile strength (healthy 63.7 ± 13.4 MPa; diseased 41.7 ± 5.0 MPa) and density (healthy 1.34 ± 0.01 g/cm(3); diseased 1.29 ± 0.00 g/cm(3)). Onchomycosis caused cell-cell separation, without disrupting the nail disulfide bonds or desmosomes. The diseased and healthy nails showed equivalent water uptake profiles, but the rhodamine penetration was 4-fold higher in the diseased nails using a PBS vehicle and 3 -fold higher in an ethanol/PBS vehicle. Onchomycotic nails presented a thicker but more porous barrier, and its eroded intracellular matrix rendered the tissue more permeable to topically applied chemicals when an aqueous vehicle was used.

  5. Human nail plate modifications induced by onychomycosis: implications for topical therapy.

    OpenAIRE

    Baraldi, A.; S. A. Jones; Guesné, S.; Traynor, M.J.; McAuley, W.J.; Brown, M B; Murdan, S.

    2015-01-01

    Purpose Through the characterisation of the human onchomycotic nail plate this study aimed to inform the design of new topical ungual formulations. Methods The mechanical properties of the human nail were characterised using a Lloyd tensile strength tester. The nail’s density was determined via pycnometry and the nail’s ultrastructure by electron microscopy. Raman spectroscopy analysed the keratin disulphide bonds within the nail and its permeability properties were assessed by quantifying wa...

  6. Human Nail Plate Modifications Induced by Onychomycosis: Implications for Topical Therapy

    OpenAIRE

    Baraldi, A.; Jones, S.A.; Guesné, S.; Traynor, M. J.; McAuley, W J; Brown, M.B.; Murdan, S.

    2014-01-01

    Purpose Through the characterisation of the human onchomycotic nail plate this study aimed to inform the design of new topical ungual formulations. Methods The mechanical properties of the human nail were characterised using a Lloyd tensile strength tester. The nail’s density was determined via pycnometry and the nail’s ultrastructure by electron microscopy. Raman spectroscopy analysed the keratin disulphide bonds within the nail and its permeability properties were assessed by quantifying wa...

  7. Subungual Squamous Cell Carcinoma Associated with Long Standing Onychomycosis: Aggressive Surgical Approach with a Favourable Outcome

    Directory of Open Access Journals (Sweden)

    Yavor Grigorov

    2017-07-01

    CONCLUSION: Although there are no available data in the literature to confirm or reject the contribution of the chronic nail infection to the malignant process, we emphasise the importance of this co-existence regarding the possible disguising of the malignant process. An early biopsy of a chronic persistent nail lesion may be preventive and beneficial regarding avoiding more aggressive treatments and achieving a favourable prognosis.

  8. Verrucous Onychomycosis Caused by Curvularia in a Patient with Congenital Pterygium.

    Science.gov (United States)

    Vineetha, Mary; Palakkal, Seena; Sobhanakumari, K; Celine, M I; Letha, V

    2016-01-01

    A 57 year healthy farmer with congenital nail pterygium presented with a verrucous growth on nail bed since 8 months. He was not diabetic and HIV rapid card test negative. Our clinical diagnosis was chromoblastomycosis but culture showed growth of curvularia species on two occasions and histopathology showed hyphal and yeast forms of the pigmented fungus. After excision biopsy patient was started on oral itraconazole. This case is reported due to rarity of verrucous cutaneous lesions caused by curvularia in immunocompetent individuals.

  9. Mechanical Properties of Healthy and ex vivo Onychomycosis Nails and the Influence of a Porphyrin-propylene Glycol Antifungal Formulation

    NARCIS (Netherlands)

    A. Hosseinzoi (Amu); F. Galli (Federica); L. Incrocci (Luca); T. Smijs (Threes)

    2016-01-01

    textabstractAims: To investigate nail penetration enhancing effectiveness of a novel drug formulation and ingredients, 40% propylene glycol (PG) and 40 μM multifunctional photosensitizer (MFPS). Proposed formulation was proven effective in photodynamic treatment (PDT) of ex vivo fungal infections of

  10. Mechanical Properties of Healthy and ex vivo Onychomycosis Nails and the Influence of a Porphyrin-propylene Glycol Antifungal Formulation

    NARCIS (Netherlands)

    A. Hosseinzoi (Amu); F. Galli (Federica); L. Incrocci (Luca); T. Smijs (Threes)

    2016-01-01

    textabstractAims: To investigate nail penetration enhancing effectiveness of a novel drug formulation and ingredients, 40% propylene glycol (PG) and 40 μM multifunctional photosensitizer (MFPS). Proposed formulation was proven effective in photodynamic treatment (PDT) of ex vivo fungal infections of

  11. The first case of onychomycosis in a koala (Phascolarctos cinereus due to atypical isolates of Microsporum gypseum, a diagnostic challenge

    Directory of Open Access Journals (Sweden)

    Hossein Mirhendi

    2016-06-01

    Conclusion: To the best of our knowledge, the present report is the first confirmed case of dermatophytosis in a koala. The genetics underlying a variety of phenotypic traits in most classical dermatophyte species are unknown, and further studies are needed to understand this phenomenon. 

  12. The first case of onychomycosis in a koala (Phascolarctos cinereus) due to atypical isolates of Microsporum gypseum, a diagnostic challenge

    OpenAIRE

    Hossein Mirhendi; Yayoi Nishiyama; Ali Rezaei-Matehkolaei; Kazuo Satoh; Koichi Makimura

    2016-01-01

    Background and Purpose: Superficial mycotic infections have been only poorly described in koalas and there are no reliable mycologically confirmed data regarding clinical isolation of dermatophytes in this animal. We report an 11-yearold female koala, kept in a zoo in Tokyo, Japan, and presenting with hyperkeratotic lesions and scaly plaques on forepaw claws and pads reminiscent of fungal infection. Case Report: Direct microscopy of the scrapings was indicative of ...

  13. Tinea pedis and onychomycosis frequency in diabetes mellitus patients and diabetic foot ulcers. A cross sectional - observational study

    National Research Council Canada - National Science Library

    Akkus, Gamze; Evran, Mehtap; Gungor, Dilek; Karakas, Mehmet; Sert, Murat; Tetiker, Tamer

    2016-01-01

    Impaired cellular immunity and reduced phagocytic function of polymorphonuclear leukocytes facilitate the development of skin fungal and bacterial infections due to uncontrolled hyperglycemia in diabetic patients...

  14. Dermatomicosis y onicomicosis en estudiantes de una Escuela de Polícia Dermatomycosis and onychomycosis in trainees of a police academy

    Directory of Open Access Journals (Sweden)

    Gabriel Ceballos

    1989-01-01

    Full Text Available

    Con el fin de conocer la prevalencia de las dermatomicosis y de las micosis ungueales se evaluaron clínica y micológicamente en dos oportunidades 213 hombres jóvenes que estaban recibiendo entrenamiento en una Escuela de Policía. El estudio inicial se hizo al Ingreso a la Escuela en abril de 1988 y en él se encontró que 126 individuos (59.2%, tenían algún tipo de micosis superficial y que las dermatofitosis constituían el 65.5% de las 200 lesiones diagnosticadas. Los agentes más frecuentes de dermatofitosis fueron: 7: mentagrophytes (30.5% y E. ffoccosum (18.3%. También se encontraron: candidiasis, trichosporiasis, pitiriasis, infecciones mixtas e Infecciones por hongos ambientales. Se prescribió tratamiento tópico convencional a todos los Individuos afectados.

    Cuatro meses después de la encuesta Inicial, Inmediatamente antes del egreso, se llevó a cabo un segundo estudio de características similares; en esa oportunidad se Incluyeron los 145 individuos que aún permanecían en la Escuela; en 105 de ellos (72.4% se comprobó algún tipo de micosis superficial, con un total de 185 lesiones; se hallaron las mismas entidades que en el primer estudio y, nuevamente, predominaron las dermatofitosis (63,8%, cuya causa más frecuente fue el E. ffoccosum (27.1 % seguido por el 7: mentagrophytes (14.4%. Se obtuvieron muestras de diferentes áreas húmedas de uso común, como baños, vestier y piscina; de ellas se aislaron 7: rubrum y 7: mentagrophytes. Además de la alta prevalencia Inicial de dermatofitosis y micosis ungueales, reveladora de la importancia de estas enfermedades en las comunidades de origen, los resultados del estudio permiten postular que las condiciones ligadas al entrenamiento de este personal (ejercicio físico Intenso y prolongado, sudoración, secado insuficiente, uso de botas favorecen la

    persistencia y la aparición de dermatomicosis y micosis ungueales.

    In order to determine the prevalence of dermatomycosis and ungueal mycosis, we studied 213 young men who were enrolled at a police academy. They received both clinical and mycological evaluation on two separate occasions, the first one at the time of admission In apr1l1988; at this point we found that 126 of them (59.2% had some type of superficial mycosis and that dermatophytosis represented 65.5% of the 200 lesions observed. The most frequent causative agents were: T. mentagrophytes (30.5% y E. floccosum (18.3%. Candidiasis, trichosporiasis, pitiriasis, mixed infections and infections caused by environmental fungi were also found. AII received conventionaliocal therapy. Four months later, just before the end of their training, the 145 that were still at the academy were evaluated for the second time. In 105 of them (72.4%, some type of superficial mycosis was diagnosed, for a total of 185 lesions. Findings were similar to those of the first evaluation with dermatophytosis predominating (63.8%. E. floccosum was found in 27.1 % and T. mentagrophytes in 14.4%. Samples were also obtained from public areas specially moist ones like showers, vestiers and swimming pool and from them T. rubrum and T. mentagrophytes were isolated. Besides the high initial prevalence of dermatomycosis and ungueal mycosis which reveal their importance in the environment of people evaluated, our study allows us to postulate that special conditions tied to policemen training (Intense physical exercise, sweating, insufficient drying after shower, boot wear, favor occurrence and persistence of these mycosis.

  15. Discovery of a sexual stage in Trichophyton onychocola, a presumed geophilic dermatophyte isolated from toenails of patients with a history of T. rubrum onychomycosis

    DEFF Research Database (Denmark)

    Hubka, Vit; Nissen, Christoffer V; Jensen, Rasmus Hare;

    2015-01-01

    -old man. The patient had a history of great toenail infection caused by T. rubrum in 2004 and presented with suspected relapse in 2011 and 2013. Trichophyton onychocola was the only microbial agent isolated at the second visit in 2013 and the identification was confirmed by DNA sequencing. Direct...

  16. Ingrown toenail removal – discharge

    Science.gov (United States)

    Onychocryptosis surgery; Onychomycosis; Unguis incarnates surgery; Ingrown toenail removal; Toenail ... PA: Elsevier Saunders; 2014:chap 51. Pollock M. Ingrown toenails. In: Pfenninger JL, Fowler GC, eds. Pfenninger and ...

  17. Fungal nail infection

    Science.gov (United States)

    Nails - fungal infection; Onychomycosis; Infection - fungal - nails; Tinea unguium ... hair, nails, and outer skin layers. Common fungal infections include: Athlete's foot Jock itch Ringworm on the ...

  18. Psoronychomycosis: A New Term for an Old Problem.

    Science.gov (United States)

    Vender, Reid; Vender, Ronald

    2016-05-01

    Occasionally, psoriatic nail changes are seen in psoriatic patients. The prevalence of psoriasis of the nails has been reported to range from 15% to 79%. Even with effective systemic treatment for psoriasis, the nails may not improve, and these nails are considered nonresponsive psoriatic nails. Psoriatic nails are rarely investigated, and it is assumed that the nail changes are simply attributed to psoriasis because of their clinical similarity. Even patients with nails unresponsive to systemic treatment, or psoriasis treated topically or with phototherapy, onychomycosis is often forgotten, and patients may be left with both onychomycosis and psoriasis or onychomycosis alone. A retrospective chart review of 361 patients was carried out. The investigators report the prevalence of psoriasis and onychomycosis as less than 1%. A new term, "psoronychomycosis," is suggested to denote the rare combination of psoriasis and onychomycosis.

  19. Onicomicose na infância: uma perspectiva atual com ênfase na revisão do tratamento Onychomycosis in childhood: a current perspective with emphasis on the review of treatment

    OpenAIRE

    Roberto Arenas; Julieta Ruiz-Esmenjaud

    2004-01-01

    A prevalência da onicomicose na infância, principalmente quando provocada por dermatófitos e Candida sp, tem aumentado. Tais infecções em crianças parecem infreqüentes em países desenvolvidos, mas não são excepcionais na América Latina. O objetivo principal deste trabalho foi analisar a literatura médica atual. Foi observada a onicomicose por dermatófitos em crianças com idade a partir de dois anos. A faixa entre 12-16 anos é a mais afetada (66,4%), provavelmente devido aos fatores de risco a...

  20. 巢式PCR诊断甲真菌病中红色毛癣菌和须癣毛癣菌%Nested PCR in the diagnosis of Trichophyton rubrum and Trichophyton mentagrophytes infections in onychomycosis

    Institute of Scientific and Technical Information of China (English)

    杨静; 童中胜; 万喆; 陈伟; 胡志敏; 李若瑜

    2014-01-01

    目的:评价巢式PCR诊断甲真菌病中红色毛癣菌和须癣毛癣菌的敏感性和特异性.方法:液氮冷冻甲标本,微量法提取DNA,应用特异性引物,巢式PCR方法扩增DNA.结果:36例直接镜检和培养均为阳性的甲标本,培养显示24例为红色毛癣菌,12例为须癣毛癣菌.巢式PCR中First PCR 34例阳性,34例标本均产生了650 bp目的片段;Nest PCR 32例阳性,32例中有22例标本产生了137 bp的片段,为红色毛癣菌;10例标本产生了102 bp的片段,为须癣毛癣菌.PCR敏感性为88.9%,特异性为100%.结论:巢式PCR是一种快速、特异和敏感的诊断甲真菌病中红色毛癣菌和须癣毛癣菌的方法.

  1. Onchomycosis – a clinical and mycological study of 75 cases

    Directory of Open Access Journals (Sweden)

    Neerja Puri

    2012-07-01

    Full Text Available Onychomycosis or fungal infection of the nails is a common disease, especially in older persons. A mycological study of onchomycosis was undertaken in 75 patients. The nails were judged to be infected by their clinical appearance. There were a total of 75 suspected cases of onychomycosis. Of these 75 cases 22.6% were positive by direct microscopy and 33.3% were culture positive. Of these 75 cases, 18 were males (24% and 57 (76 % were females, male to female ratio being. The commonest age group was 31-40 years followed by 21-30 years. The finger nails were more frequently involved. i.e. 45 (60 %, followed by toe nails 30 (40 % and both in 18 (24% cases. Ratio of finger nail to toe nail infection was 1.5:1. Distal and lateral subungual onychomycosis (DLSO was the commonest clinical pattern (76% followed by total dystrophic onychomycosis (18.66% and then superficial white onychomycosis (4% and proximal subungual onychomycosis (1.33%. The most common fungal isolates were dermatophytes of which 44% were Trytophyton rubrum, 4% were Trytophyton mentagrophytes. Non dermatophyte moulds constituted 16% of the fungus isolates. Onychomycosis was found to be the commonest in housewives (52%, followed by serviceman / businessman (32% followed by farmers (8% and labourer and student 4% each.

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

    Science.gov (United States)

    Simonnet, Christine; Berger, Franck; Gantier, Jean-Charles

    2011-08-01

    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.

  3. A study of nail changes in various dermatosis in Punjab, India

    Directory of Open Access Journals (Sweden)

    Neerja Puri

    2012-07-01

    Full Text Available Nails act as a window to diagnosis of skin diseases. Various dermatosis affect the nails and the severity of the skin disorder is reflected in the nails. Nail changes are seen in various dermatosis like psoriasis, lichen planus, onychomycosis, collagen vascular disorders, vescicobullous disorders and other papulosquamous disorders. We will discuss in detail regarding nail changes in various dermatosis.

  4. Candida ciferrii and Candida chiropterorum isolated from clinical specimens.

    Science.gov (United States)

    Furman, R M; Ahearn, D G

    1983-11-01

    Ten clinical yeast isolates submitted to the Centers for Disease Control from diverse geographic areas were identified as Candida ciferrii and Candida chiropterorum. The association of C. ciferrii with clinical specimens, particularly its repeated isolation from a case of onychomycosis, suggests that this species may be an etiological agent of superficial yeast infections.

  5. Candida ciferrii and Candida chiropterorum Isolated from Clinical Specimens

    OpenAIRE

    1984-01-01

    Ten clinical yeast isolates submitted to the Centers for Disease Control from diverse geographic areas were identified as Candida ciferrii and Candida chiropterorum. The association of C. ciferrii with clinical specimens, particularly its repeated isolation from a case of onychomycosis, suggests that this species may be an etiological agent of superficial yeast infections.

  6. Diagnosis of Fusarium Infections

    NARCIS (Netherlands)

    Diepeningen, van A.D.; Brankovics, Balázs; Iltes, Jearidienne; Lee, van der T.A.J.; Waalwijk, Cees

    2015-01-01

    Infections caused by the genus Fusarium have emerged over the past decades and range from onychomycosis and keratitis in healthy individuals to deep and disseminated infections with high mortality rates in immune-compromised patients. As antifungal susceptibility can differ between the different

  7. Diagnosis of Fusarium Infections : Approaches to Identification by the Clinical Mycology Laboratory

    NARCIS (Netherlands)

    van Diepeningen, Anne D; Brankovics, Balázs; Iltes, Jearidienne; van der Lee, Theo A J; Waalwijk, Cees

    2015-01-01

    Infections caused by the genus Fusarium have emerged over the past decades and range from onychomycosis and keratitis in healthy individuals to deep and disseminated infections with high mortality rates in immune-compromised patients. As antifungal susceptibility can differ between the different Fus

  8. The isolation of Botryodiplodia theobromae from a nail lesion.

    Science.gov (United States)

    Restrepo, A; Arango, M; Velez, H; Uribe, L

    1976-03-01

    Botryodiplodia theobromae not known to produce onychomycosis was repeatedly recovered from a healthy woman with evident lesions in a toe nail. Mycelial fragments were observed in the scales and the fungus was isolated in cycloheximide-free culture media. The report indicates that many fungi, hitherto considered non-pathogens, may still be able to colonize a vaiety of human tissues.

  9. Acute levercelnecrose bij gebruik van ketoconazol tijdens de behandeling van onychomycose

    NARCIS (Netherlands)

    Van Puijenbroek, E P; Metselaar, H J; Berghuis, P H; Zondervan, P E; Stricker, B H

    1998-01-01

    The imidazole derivative ketoconazole is approved in the Netherlands for treatment of local and systemic fungal infections. Despite the risk of major hepatic damage, this antimycotic drug is still being used in daily practice for the oral treatment of patients with onychomycosis. Since April 1986, 1

  10. Fusarium spp. is able to grow and invade healthy human nails as a single source of nutrients.

    Science.gov (United States)

    Galletti, J; Negri, M; Grassi, F L; Kioshima-Cotica, É S; Svidzinski, T I E

    2015-09-01

    Onychomycosis caused by Fusarium spp. is emerging, but some factors associated with its development remain unclear, such as whether this genus is keratinolytic. The main aim of the present study was to evaluate the ability of Fusarium to use the human nail as a single source of nutrients. We also performed an epidemiological study and antifungal susceptibility testing of Fusarium spp. that were isolated from patients with onychomycosis. The epidemiological study showed that Fusarium species accounted for 12.4 % of onychomycosis cases, and it was the most common among nondermatophyte molds. The most frequent species identified were F. oxysporum (36.5 %), F. solani (31.8 %), and F. subglutinans (8.3 %). Fluconazole was not active against Fusarium spp., and the response to terbinafine varied according to species. Fusarium was able to grow in vitro without the addition of nutrients and invade healthy nails. Thus, we found that Fusarium uses keratin as a single source of nutrients, and the model proposed herein may be useful for future studies on the pathogenesis of onychomycosis.

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

    Science.gov (United States)

    Ataides, F S; Chaul, M H; El Essal, F E; Costa, C R; Souza, L K H; Fernandes, O F L; Silva, M R R

    2012-12-01

    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. The aim was to isolate and identify the fungal agents of onychomycosis, and to determine the in vitro susceptibility to antifungal agents. 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). 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. 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. © 2011 The Authors. Journal of the European Academy of Dermatology and Venereology © 2011 European Academy of Dermatology and Venereology.

  12. 2014年英国甲真菌病管理指南解读

    Institute of Scientific and Technical Information of China (English)

    仇萌; 邹先彪

    2015-01-01

    British association of dermatologists' guidelines for the management of onychomycosis 2014 states epidemiology,aeti⁃ology,classification,treatment,and special individuals’ administration of onychomycosis in detail.Above all,Candida and mould nail infection is interpreted more in⁃depth. The guideline plays an important role to clinical work. The paper summarized the essence of guideline.%2014年英国甲真菌病管理指南详细地阐述了甲真菌病的流行病学、病因、分类、治疗及特殊人群的管理等方面的进展,尤其对甲念珠菌感染和霉菌感染进行更为深入的诠释,对临床工作有重要的指导意义,该文简要解读了指南精髓。

  13. Systematic investigation of different formulations for drug delivery through the human nail plate "in vitro"

    OpenAIRE

    Vejnoviċ, Ivana

    2010-01-01

    Human nails do not have only protective and decorative role, but can also be considered as an alternative pathway for drug delivery, especially in nail diseases such as onychomycosis or psoriasis. These nail diseases are widely spread in the population, particularly among elderly and immunocompromised patients. Oral therapies are accompanied by systemic side effects and drug interactions, while topical therapies are limited by the low permeation rate through the nail plate. For the successful...

  14. NAIL AS A PROMISING DRUG DELIVERY SYSTEM FOR CONTROLLED RELEASE

    OpenAIRE

    G. Sai Krishna*, P. Prem Kumar, K. Bala Murugan

    2013-01-01

    ABSTRACT: The effectiveness of topical therapies is limited by minimal drug permeability through the nail plate. Nail permeability is however quite low and limits topical therapy to early/mild disease states such as onychomycosis (fungal infections of the nail). Current research on nail permeation that focuses on altering the nail plate barrier by means of chemical treatments, penetration enhancers as well as physical and mechanical methods is reviewed also the recent research into ungual dru...

  15. Tinea imbricata: autosomal dominant pattern of susceptibility in a polygamous indigenous family of the Nahuatl zone in Mexico.

    Science.gov (United States)

    Bonifaz, A; Araiza, J; Koffman-Alfaro, Susana; Paredes-Solis, Vanessa; Cuevas-Covarrubias, S; Rivera, M R

    2004-08-01

    We report on 9 confirmed cases of tinea imbricata (Tokelau, infection due to Trichophyton concentricum) out of 16 family members. They had a common mother with three different fathers. The genetic analysis of the family suggests an autosomal dominant pattern of susceptibility. Most cases (8/9) were presented as concentric and lamellar forms. One patient also had onychomycosis due to T. concentricum. Only two out of nine cases had a positive response to trichophytin.

  16. Hyperkeratotic warty skin lesion of foot caused by Fusarium oxysporum

    Directory of Open Access Journals (Sweden)

    Ravinder Kaur

    2013-01-01

    Full Text Available Fusarium species are common soil-inhabiting organisms and plant pathogens. Human infections are usually precipitated by local or systemic predisposing factors, and disseminated infection is associated with impaired immune responses. Skin infections caused by Fusarium spp. include keratitis, onychomycosis, mycetoma, painful discrete erythematous nodules. Hyperkeratotic skin lesions caused by Fusarium spp. are, however, rarely reported. We report a case of hyperkeratotic verrucous warty skin lesion in the foot of a 50-year-old immunocompetent male, farmer by occupation.

  17. Candida ciferrii: clinical and microbiological features of an emerging pathogen.

    Science.gov (United States)

    de Gentile, L; Bouchara, J P; Cimon, B; Chabasse, D

    1991-01-01

    The authors report six cases of toenail onyxis due to an unusual yeast species, Candida ciferrii. For half of these cases, direct microscopical examination showed the presence of blastospores and pseudo-to-true mycelium, demonstrating the parasitic transition of the fungus. In light of the literature and of their own experience, the authors suggest that C. ciferrii could be an etiological agent of onychomycosis, particularly for elderly patients with extensive trophic disorders.

  18. Systematic investigation of different formulations for drug delivery through the human nail plate "in vitro"

    OpenAIRE

    Vejnoviċ, Ivana

    2010-01-01

    Human nails do not have only protective and decorative role, but can also be considered as an alternative pathway for drug delivery, especially in nail diseases such as onychomycosis or psoriasis. These nail diseases are widely spread in the population, particularly among elderly and immunocompromised patients. Oral therapies are accompanied by systemic side effects and drug interactions, while topical therapies are limited by the low permeation rate through the nail plate. For the successful...

  19. NAIL AS A PROMISING DRUG DELIVERY SYSTEM FOR CONTROLLED RELEASE

    OpenAIRE

    G. Sai Krishna*, P. Prem Kumar, K. Bala Murugan

    2013-01-01

    ABSTRACT: The effectiveness of topical therapies is limited by minimal drug permeability through the nail plate. Nail permeability is however quite low and limits topical therapy to early/mild disease states such as onychomycosis (fungal infections of the nail). Current research on nail permeation that focuses on altering the nail plate barrier by means of chemical treatments, penetration enhancers as well as physical and mechanical methods is reviewed also the recent research into ungual dru...

  20. Evaluation of Obesity-Associated Dermatoses in Obese and Overweight Individuals

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    Nurhan Döner

    2011-09-01

    Full Text Available Background and Design: Although the effects of obesity on the skin are known, there are no adequate studies on this subject. To evaluate obesity-related dermatoses in obese and overweight people and to compare the obtained results with those of individuals with body mass index (BMI lower than 25 kg/m2.Material and methods: A total of 500 (mean age: 43.6±12.8; 318 female, 182 male volunteer patients aged 18 years and older, who were treated in inpatient clinics except dermatology, and their relatives were included in the study. The subjects were grouped according to BMI: less than 25 kg/m2 (controls, n = 120, 25-29.9 kg/m2 (overweights, n=130, and greater than 30 kg/m2 (obeses, n=250. The participants were examined dermatologically and all known skin diseases associated with obesity were noted. Results: The total number of dermatoses was statistically higher in obeses and overweights than in controls, as well as in obeses than in overweights. The five most frequently seen dermatoses in all groups were: varicose vein, tinea pedis, striae distensae, acrochordon and onychomycosis, respectively. There were statistically significant differences: between obeses and controls with regard to varicose vein, tinea pedis, striae distensae, acrochordon, onychomycosis, acanthosis nigricans and intertrigo; between overweights and controls with respect to varicose vein, tinea pedis, striae distensae, acrochordon and onychomycosis; between obeses and overweights with regard to striae distensae, acanthosis nigricans and onychomycosis. A positive correlation was detected between BMI and degree of plantar hyperkeratosis in all participants; between BMI and hirsutism score, severity of androgenetic alopecia (AGA and cellulite in women. Conclusion: While acanthosis nigricans and AGA in females were associated with obesity, the other dermatoses were related with not only with obesity but also with increasing weight gain.

  1. Trichophyton tonsurans induced recurrent onychomadesis in a very young infant.

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    Khanna, Deepshikha; Goel, Alka; Kedar, Ashwini; Manchanda, Vikas; Agarwal, Swastika

    2013-01-01

    Onychomadesis, or nail shedding, is rarely seen in children and can be due to stress, systemic illnesses, trauma, and drug therapy or may be idiopathic. Fungal infection of the nail is only rarely reported as a cause of onychomadesis. We present here a case of Trichophyton tonsurans-induced onychomycosis and resultant onychomadesis in a 9-month-old boy with onset of lesions at 2 weeks of life.

  2. Challenges in Fusarium, a Trans-Kingdom Pathogen.

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    van Diepeningen, Anne D; de Hoog, G Sybren

    2016-04-01

    Fusarium species are emerging human pathogens, next to being plant pathogens. Problems with Fusarium are in their diagnostics and in their difficult treatment, but also in what are actual Fusarium species or rather Fusarium-like species. In this issue Guevara-Suarez et al. (Mycopathologia. doi: 10.1007/s11046-016-9983-9 , 2016) characterized 89 isolates of Fusarium from Colombia showing especially lineages within the Fusarium solani and oxysporum species complexes to be responsible for onychomycosis.

  3. Directory of Open Access Journals (Sweden)

    Nilton Di Chiacchio

    2013-02-01

    Full Text Available BACKGROUND: Onychomycosis is a type of fungal infection that accounts for over 50% of all onycopathies. Some authors consider superficial mycosis the most difficult to be treated. Very few studies have been carried out in order to assess the epidemiology of onychomycosis in Brazil.OBJECTIVE: To describe the epidemiological profile of onychomycosis in Brazilian dermatology offices and to assess the etiology of the disease, how often mycosis exams are requested, and the treatment adopted.METHODS: A descriptive, observational study was carried out between May and July, 2010. Thirty-eight dermatologists from different Brazilian regions participated in the study, and 7,852 patients with any skin diseases who had all of their nails examined were included in the study.RESULTS: Of the 7,852 patients, 28.3% were clinically diagnosed as having onychomycosis. Women over 45 years old who practiced exercises or with a personal history of the disease showed greater likelihood of having onychomycosis. The disease was most seen in the feet, and the majority of cases involved the hallux. On the hands, the index finger was the most affected. Mycosis exams were not requested for all clinically suspected cases. When exams were done, results showed that the most common fungus was Trichophyton rubrum. The most common clinical lesion was distal-lateral. The most prescribed topical treatments were amorolfine and ciclopirox olamine, while systemic treatments included fluconazole and terbinafine.CONCLUSION: This study was important to describe the epidemiological behavior of onychomycosis in Brazilian dermatology offices and to determine important risk factors, such as gender, age, practice of exercises, personal history of the disease, and comorbidities.BACKGROUND: Fundamentos: As onicomicoses são infecções fúngicas que representam mais de 50% de todas onicopatias e são consideradas por alguns autores a micose superficial de mais difícil tratamento. Poucos estudos

  4. Miltefosine is effective against Candida albicans and Fusarium oxysporum nail biofilms in vitro.

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    Machado Vila, Taissa Vieira; Sousa Quintanilha, Natália; Rozental, Sonia

    2015-11-01

    Onychomycosis is a fungal nail infection that represents ∼50 % of all nail disease cases worldwide. Clinical treatment with standard antifungals frequently requires long-term systemic therapy to avoid chronic disease. Onychomycosis caused by non-dermatophyte moulds, such as Fusarium spp., and yeasts, such as Candida spp., is particularly difficult to treat, possibly due to the formation of drug-resistant fungal biofilms on affected areas. Here, we show that the alkylphospholipid miltefosine, used clinically against leishmaniasis and cutaneous breast metastases, has potent activity against biofilms of Fusarium oxysporum and Candida albicans formed on human nail fragments in vitro. Miltefosine activity was compared with that of commercially available antifungals in the treatment of biofilms at two distinct developmental phases: formation and maturation (pre-formed biofilms). Drug activity towards biofilms formed on nail fragments and on microplate surfaces (microdilution assays) was evaluated using XTT [2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide] assays, and drug effects on fingernail biofilms were analysed by scanning electron microscopy (SEM). For F. oxysporum, miltefosine at 8 μg ml- 1 inhibited biofilm formation by 93%, whilst 256 μg ml- 1 reduced the metabolic activity of pre-formed nail biofilms by 93%. Treatment with miltefosine at 1000 μg ml- 1 inhibited biofilm formation by 89% and reduced the metabolic activity of pre-formed C. albicans biofilms by 99%. SEM analyses of biofilms formed on fingernail fragments showed a clear reduction in biofilm biomass after miltefosine treatment, in agreement with XTT results. Our results show that miltefosine has potential as a therapeutic agent against onychomycosis and should be considered for in vivo efficacy studies, especially in topical formulations for refractory disease treatment.

  5. Luliconazole for the treatment of fungal infections: an evidence-based review

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    Khanna D

    2014-09-01

    Full Text Available Deepshikha Khanna, Subhash Bharti Department of Dermatology, Chacha Nehru Bal Chikitsalaya (Childrens Hospital, Delhi, India Abstract: Luliconazole is an imidazole antifungal agent with a unique structure, as the imidazole moiety is incorporated into the ketene dithioacetate structure. Luliconazole is the R-enantiomer, and has more potent antifungal activity than lanoconazole, which is a racemic mixture. In this review, we summarize the in vitro data, animal studies, and clinical trial data relating to the use of topical luliconazole. Preclinical studies have demonstrated excellent activity against dermatophytes. Further, in vitro/in vivo studies have also shown favorable activity against Candida albicans, Malassezia spp., and Aspergillus fumigatus. Luliconazole, although belonging to the azole group, has strong fungicidal activity against Trichophyton spp., similar to that of terbinafine. The strong clinical antifungal activity of luliconazole is possibly attributable to a combination of strong in vitro antifungal activity and favorable pharmacokinetic properties in the skin. Clinical trials have demonstrated its superiority over placebo in dermatophytosis, and its antifungal activity to be at par or even better than that of terbinafine. Application of luliconazole 1% cream once daily is effective even in short-term use (one week for tinea corporis/cruris and 2 weeks for tinea pedis. A Phase I/IIa study has shown excellent local tolerability and a lack of systemic side effects with use of topical luliconazole solution for onychomycosis. Further studies to evaluate its efficacy in onychomycosis are underway. Luliconazole 1% cream was approved in Japan in 2005 for the treatment of tinea infections. It has recently been approved by US Food and Drug Administration for the treatment of interdigital tinea pedis, tinea cruris, and tinea corporis. Topical luliconazole has a favorable safety profile, with only mild application site reactions reported

  6. Candida parapsilosis and candida guillermondii: Emerging pathogens in nail candidiasis

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    Felix Fich

    2014-01-01

    Full Text Available Background: Onychomycosis of the fingernails and toenails is generally caused by dermatophytes and yeasts. Toenail mycoses involve mainly dermatophytes but when Candida is also involved, the strain most commonly isolated worldwide is C. albicans. Aims: To determine Candida strains prevailing in onychomycosis. Materials and Methods: A retrospective, observational and descriptive study of fungal cultures retrieved from the registry of the microbiology laboratory of the Pontificia Universidad Católica was performed. Specimens obtained from patients attending the healthcare network between December 2007 and December 2010 was analyzed. Statistical Analysis: A descriptive statistical analysis was performed. Results: Candida was retrieved from 467 of 8443 specimens (52% fingernails and 48% toenails. Cultures were negative in 5320 specimens (63.6%. Among Candida-positive cultures, parapsilosis was the most commonly isolated strain with 202 cases (43.3%. While isolates of Candida guillermondii were 113 (24.2%, those of Candida albicans were 110 (23.6%, those of spp. were 20 (4.3% and there were 22 cases of other isolates (4.71%. Among the 467 patients with positive cultures for Candida, 136 (29,1% were men and 331 (70,9% were women. All patients were older than 18 years old. Clinical files were available for only 169 of the 467 patients with positive cultures for Candida. For those, age, gender, underlying illnesses and use of immunossupresive agents during the trial was reviewed. Conclusions: The present study shows that both C. parapsilosis as well as C. guillermondii appear as emerging pathogens that would be in fact taking the place of C. albicans as the most commonly isolated pathogen in patients with Candida onychomycosis. The relative percentage of C parapsilosis increases every year. Identification of Candida strains as etiological agents of nail candidiasis becomes relevant to the management both nail as well as systemic candidiasis, in view of

  7. Prevalence of Candida ciferrii in elderly patients with trophic disorders of the legs.

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    de Gentile, L; Bouchara, J P; Le Clec'h, C; Cimon, B; Symoens, F; Chabasse, D

    1995-08-01

    In order to define the prevalence of Candida ciferrii in onychomycosis, the fungal biota associated with toe nail onyxis was examined in 50 elderly patients with trophic disorders of the legs and in 220 patients without clinical evidence of trophic disorders. Candida ciferrii was more frequent in the first group of patients since it was recovered from 24% of these patients, whereas its prevalence was only 1.4% in the control group. Moreover, the positivity of the direct examination of toe nail scrapings, the absence of any other associated pathogens, and the repeated isolation of this yeast species for some of the patients confirmed its pathogenicity.

  8. [Dermatophytoses in Mexico].

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    Arenas, Roberto

    2002-06-01

    The dermatophytic infections are superficial mycoses common in Mexico, they have an estimated frequency of 5% in dermatological outpatients. In this review we present a global view of these mycoses as well as their etiological agents in tinea capitis, tinea pedis, tinea corporis, tinea cruris and onychomycosis and also uncommon infections such as tinea imbricata and epidermophytosis of the diaper area. We also analyze these infections in diabetic patients, healthy carriers and dermatophytic infections in pets and laboratory animals. The most important publications about dermatophytosis in Mexico in the dermatological, epidemiological or mycological area are reviewed, specially those published in the last ten years.

  9. The evolution of quality-switched lasers.

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    Saedi, Nazanin; Green, Jeremy B; Dover, Jeffrey S; Arndt, Kenneth A

    2012-11-01

    Quality-switched (QS) lasers and their applications have evolved greatly since the ruby laser's effect on tattoo ink was first reported in the 1960s. The 1983 description of selective photothermolysis explained the efficacy of QS lasers for the treatment of cutaneous pigmented lesions and tattoos and cemented their status as the gold standard for these targets. Within the past decade, the uses for QS lasers have expanded dramatically, including nonablative rejuvenation and the treatment of onychomycosis. Additional applications and refined techniques and technologies promise to maintain the stature of QS lasers as an integral part of the laser surgeon's arsenal.

  10. Hyper-Immunoglobulin E Syndrome

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    Gnanraj Pushpa

    2004-01-01

    Full Text Available A case of hyper-IgE syndrome in a 6 year old boy with bronchial asthma is reported here with the various manifestations of multiple tender abscesses of the scalp, recurrent dermatophyte infections of his face and right thigh, eczematous lesions of his neck, shoulders and antecubital fossae, candidiasis of the tongue, angular cheilitis and total dystrophy of his right bit toe nail. Laboratory investigations revealed staphylococcus aureus infection of the scalp, Trichophyton rubrum infection of the face and the thigh and candidal onychomycosis. Immunological survey revealed markedly elevated serum lgE level.

  11. Terbinafine-induced lichenoid drug eruption.

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    Zheng, Yue; Zhang, Jie; Chen, Haiyan; Lai, Wei; Maibach, Howard I

    2017-03-01

    Drug-induced lichen planus has been induced by antibiotics, anticonvulsants, antidiabetics, antimalarials, antitubercular drugs, antihypertensives, psychiatric drugs, chemotherapeutic agents, diuretic, heavy metals, NSAIDs, etc. Terbinafine, an antifungal agent, is widely used for dermatophyte infections and onychomycosis. Cutaneous adverse effects of terbinafine are rarely reported. Here, we report a case of terbinafine-induced lichenoid drug eruption in a 22-year-old who presented with generalized lichenoid eruption 2 weeks after terbinafine initiation of. The body and lip cleared completely after 8 weeks of drug withdrawal; nail change cleared after 12 weeks.

  12. Ultrasound-mediated nail drug delivery system.

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    Abadi, Danielle; Zderic, Vesna

    2011-12-01

    A novel ultrasound-mediated drug delivery system has been developed for treatment of a nail fungal disorder (onychomycosis) by improving delivery to the nail bed using ultrasound to increase the permeability of the nail. The slip-in device consists of ultrasound transducers and drug delivery compartments above each toenail. The device is connected to a computer, where a software interface allows users to select their preferred course of treatment. In in vitro testing, canine nails were exposed to 3 energy levels (acoustic power of 1.2 W and exposure durations of 30, 60, and 120 seconds). A stereo -microscope was used to determine how much of a drug-mimicking compound was delivered through the nail layers by measuring brightness on the cross section of each nail tested at each condition, where brightness level decreases coincide with increases in permeability. Each of the 3 energy levels tested showed statistical significance when compared to the control (P permeability factor of 1.3 after 30 seconds of exposure, 1.3 after 60 seconds, and 1.5 after 120 seconds, where a permeability factor of 1 shows no increase in permeability. Current treatments for onychomycosis include systemic, topical, and surgical. Even when used all together, these treatments typically take a long time to result in nail healing, thus making this ultrasound-mediated device a promising alternative.

  13. Iontophoretic drug delivery across the nail.

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    Delgado-Charro, Maria Begoña

    2012-01-01

    Topical drug delivery to treat nail diseases such as onychomycosis and psoriasis is receiving increasing attention. Topical nail delivery is challenged by the complicated structure of the nail and the low permeability of most drugs across the nail plate. Considerable effort has been directed at developing methods to promote drug permeation across the nail plate. Iontophoresis efficiently enhances molecular transport across the skin and the eye and is now being tested for its potential in ungual delivery. This review covers the basic mechanisms of transport (electro-osmosis and -migration) and their relative contribution to nail iontophoresis as well as the key factors governing nail permselectivity and ionic transport numbers. Methodological issues concerning research in this area are summarized. The data available in vivo on nail iontophoresis of terbinafine specifically are reviewed in separate sections. Our understanding of nail iontophoresis has improved considerably since 2007; most decisively, the feasibility of nail iontophoresis in vivo has been clearly demonstrated. Future work is required to establish the adequate implementation of the technique so that its clinical efficacy to treat onychomycosis and nail psoriasis can be unequivocally determined.

  14. Drug delivery to the nail following topical application.

    Science.gov (United States)

    Murdan, Sudaxshina

    2002-04-02

    The absorption of drugs into the nail unit, following topical application to the nail plate, is highly desirable to treat nail disorders, such as onychomycosis (fungal infections of the nail). Nail permeability is however quite low and limits topical therapy to early/mild disease states. In this paper, the recent research into ungual drug delivery is reviewed. The nail unit and the two most common diseases affecting the nail--onychomycosis and nail psoriasis--are briefly described to set the scene and to give an overview of the nature and scope of the problem. The factors, which affect drug uptake and permeation through the nail plate such as solute molecular size, hydrophilicity/hydrophobicity, charge, and the nature of the vehicle, are then discussed, followed by ways of enhancing drug transport into and through the nail plate. Finally, drug-containing nail lacquers which, like cosmetic varnish, are brushed onto the nail plates to form a film, and from which drug is released and penetrates into the nail, are reviewed.

  15. A study of the treatment of cutaneous fungal infection in animal model using photoactivated composite of methylene blue and gold nanoparticle.

    Science.gov (United States)

    Tawfik, Abeer Attia; Noaman, Islam; El-Elsayyad, Hasan; El-Mashad, Noha; Soliman, Mona

    2016-09-01

    Onychomycosis is a widespread public health problem, in which T. rubrum and T. mentagrophytes is the commenest causative organisms. Current medical therapy has many drawbacks and side effects. Methylene blue (m.b) photodynamic therapy (pdt) proved efficacy but with lengthy sessions. Optimizing methylene blue photodynamic therapy by combination of methylene blue photosensitizer and gold nanoparticles (aunps) in a composite as gold nanoparticles are efficient delivery systems and efficient enhancers of photosensitizers for antifungal photodynamic therapy. Eighty newzealand rabbit (Oryctolagus cuniculus) were used and categorized in eight equal groups as follows; healthy and infection control, composite photodynamic therapy and five comparative groups. Photodynamic therapy was initiated at day three to five post inoculation, for four sessions forty eight hours apart. Each group divided and light exposure at two fluencies; 80J and 100J. All groups were investigated macroscopically and microscopically (histopathology and scanning electron microscope) also flowcytometry assessment for cell death and X-ray analysis for gold nanoparticles accumulation in brain and liver tissues were determined. Recovery from infection approaching 96% in gold nanoparticles+light group, around 40% in methylene blue photodynamic therapy and 34% in composite photodynamic therapy. The observed findings confirmed by apparent decrease of apoptosis, however small amounts of gold nanoparticles detected in brain and liver. Light stimulated gold nanoparticles is a promising tool in treatment of onychomycosis. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. Clinical Evaluation of Superficial Fungal Infections in Children

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    Ragıp Ertaş

    2015-12-01

    Full Text Available Objective: This retrospective study was referred to evaluate 51 cases of superficial mycoses, referred to our Pediatric Dermatology outpatient clinic in one year. Methods: We reviewed following data for all patients: age, gender, accompanied diseases, clinical types, localization and treatment. Superficial mycotic infections were diagnosed on the basis of clinical picture, direct microscopy and some of them were confirmed by fungal cultures. Results: Our patients comprised 33 boys (64.7% and 18 girls (35.3%, with an average age of 6.2 years (range 4 months to 17 years. Eighteen patients (35.3% had dermatophytes on the scalp. Clinical forms, in the order of frequency, were: tinea capitis profunda in 10 patients (19.6%, tinea capitis superficialis in 8 patients (15.8%, tinea unguium in 8 patients (15.8%. Tinea capitis (35.3% was the most frequent form of dermatomycosis. The most common symptom was the pruritus. Thirty (58% patients were treated with local antimycotics and 21 (42% patients were treated with systemic terbinafine or itraconazole. Conclusion: In this study it was found that, tinea capitis was the most frequent form of dermatomycosis and onychomycosis in children are not uncommon as it is mentioned. The data also suggest that topical antifungal agents may be effective and well-tolerated in the treatment of onychomycosis and tinea capitis in children.

  17. Aspergillus pragensis sp. nov. discovered during molecular reidentification of clinical isolates belonging to Aspergillus section Candidi.

    Science.gov (United States)

    Hubka, Vit; Lyskova, Pavlina; Frisvad, Jens C; Peterson, Stephen W; Skorepova, Magdalena; Kolarik, Miroslav

    2014-08-01

    The identity of nine clinical isolates recovered from Czech patients and presumptively identified as Aspergillus sp. section Candidi based on colony morphology was revised using sequences of β-tubulin, calmodulin gene sequence, and internal transcribed spacer rDNA. Six isolates were from suspected and proven onychomycosis, one from otitis externa, and two associated with probable invasive aspergillosis. The results showed that one Aspergillus candidus isolate was the cause of otitis externa, and both isolates obtained from sputa of patients with probable invasive aspergillosis were reidentified as A. carneus (sect. Terrei) and A. flavus (sect. Flavi). Three isolates from nail scrapings were identified as A. tritici, a verified agent of nondermatophyte onychomycosis. One isolate from toenail was determined to be A. candidus and the two isolates belonged to a hitherto undescribed species, Aspergillus pragensis sp. nov. This species is well supported by phylogenetic analysis based on β-tubulin and calmodulin gene and is distinguishable from other members of sect. Candidi by red-brown reverse on malt extract agar, slow growth on Czapek-Dox agar and inability to grow at 37°C. A secondary metabolite analysis was also provided with comparison of metabolite spectrum to other species. Section Candidi now encompasses five species for which a dichotomous key based on colony characteristics is provided. All clinical isolates were tested for susceptibilities to selected antifungal agents using the Etest and disc diffusion method. Overall sect. Candidi members are highly susceptible to common antifungals.

  18. Clinical spectrum of exophiala infections and a novel Exophiala species, Exophiala hongkongensis.

    Science.gov (United States)

    Woo, Patrick C Y; Ngan, Antonio H Y; Tsang, Chris C C; Ling, Ian W H; Chan, Jasper F W; Leung, Shui-Yee; Yuen, Kwok-Yung; Lau, Susanna K P

    2013-01-01

    We characterized 12 Exophiala strains isolated from patients over a 15-year period to the species level using phenotypic tests and internal transcribed spacer (ITS) and Rpb1 sequencing and described the clinical spectrum of the 12 patients. Eight patients had nail or skin infections, two had invasive infections, and two had colonization of the gastrointestinal tract. ITS and Rpb1 sequencing showed that 11 of the 12 strains were known Exophiala species (E. oligosperma [n = 3], E. jeanselmei [n = 2], E. lecanii-corni [n = 2], E. bergeri [n = 1], E. cancerae [n = 1], E. dermatitidis [n = 1], and E. xenobiotica [n = 1]), which included the first reported cases of onychomycosis caused by E. bergeri and E. oligosperma. The 12th strain (HKU32(T)), isolated from the nail clipping of the right big toe of a 68-year-old female patient with onychomycosis, possessed unique morphological characteristics distinct from other Exophiala species. It grew very slowly and had a velvety colony texture after 28 days, short conidiophores of the same olivaceous color as the supporting hyphae, numerous spores, and no chlamydospore-like cells. ITS, Rpb1, β-tubulin, and β-actin gene sequencing unambiguously showed that HKU32(T) was clustered with but formed branches distinct from other Exophiala species in phylogenetic trees. We propose the new species Exophiala hongkongensis to describe this novel fungus.

  19. Production of Fusaric Acid by Fusarium spp. in Pure Culture and in Solid Medium Co-Cultures

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    Nadine Bohni

    2016-03-01

    Full Text Available The ability of fungi isolated from nails of patients suffering from onychomycosis to induce de novo production of bioactive compounds in co-culture was examined. Comparison between the metabolite profiles produced by Sarocladium strictum, by Fusarium oxysporum, and by these two species in co-culture revealed de novo induction of fusaric acid based on HRMS. Structure confirmation of this toxin, using sensitive microflow NMR, required only three 9-cm Petri dishes of fungal culture. A targeted metabolomics study based on UHPLC-HRMS confirmed that the production of fusaric acid was strain-dependent. Furthermore, the detected toxin levels suggested that onychomycosis-associated fungal strains of the F. oxysporum and F. fujikuroi species complexes are much more frequently producing fusaric acid, and in higher amount, than strains of the F. solani species complex. Fusarium strains producing no significant amounts of this compound in pure culture, were shown to de novo produce that compound when grown in co-culture. The role of fusaric acid in fungal virulence and defense is discussed.

  20. [Dermatophytosis due to Trichophyton rubrum. Ten-year period (1996-2006) data collection in a Dermatology Department in Mexico City].

    Science.gov (United States)

    Hernández-Salazar, Amparo; Carbajal-Pruneda, Patricia; Fernández Martínez, Ramón; Arenas, Roberto

    2007-06-01

    Dermatophytosis is the most common mycosis in the world up to 80% caused by Trichophyton rubrum. The aim of the present study was to describe the clinical characteristics of the dermatophytosis caused by T. rubrum in a dermatological outpatient clinic during a ten years period, from 1996 to 2005. We collected the data from patients with a dermatophytosis from which we have isolated T. rubrum. A total of 776 patients with dermatophytosis caused by T. rubrum were found. A slight predominance of female patients (56.2%) was observed. The most commonly affected age group was those in the third to the fifth decade of life, and house working women (33.5%) were predominant. Onychomycosis was found in 63% of the cases, tinea pedis in 22.7%, tinea corporis in 5.2% and tinea cruris in 2.8%. In onychomycosis, the first toe nail was the most commonly affected (58.9%) and the dystrophic type was seen in 50.7% of them.

  1. [Superficial mycoses: comparative study between type 2 diabetic patients and a non-diabetic control group].

    Science.gov (United States)

    García-Humbría, Leila; Richard-Yegres, Nicole; Pérez-Blanco, Maigualida; Yegres, Francisco; Mendoza, Mireya; Acosta, Arnaldo; Hernández, Rosaura; Zárraga, Eluz

    2005-03-01

    Superficial mycoses are considered to affect more frequently patients with type 2 diabetes mellitus (DM-2), specially onychomycosis and Tinea pedis. The purpose of this study was to compare the dermatophytoses, candidiasis and Pitiriasis versicolor frequency between 40 patients with DM-2 and 40 healthy persons of either sex, 40 years old or more. Clinical, metabolic, mycologic and inmunologic studies against Candida albicans, were carried out. Both diabetics 75% (30/40) and controls 65% (26/40) presented a high frequency of superficial mycoses (no significant difference p = 0.329). Pitiriasis versicolor was not detected in diabetic patients. They presented Tinea unguium, concomitant with Tinea pedis, with a higher frequency. The predominant dermatophyte was Trichophyton rubrum 18/23 (78%) in diabetics and 8/16 (50%) in non diabetics. Candida was isolated as commensal from oral mucous: 23/40 (58%) in diabetics and 21/40 (52%) in non diabetics (serotipo A was the more frequent), and from onychomycosis: 11/40 (28%) in diabetics and 12/40 (30%) in non diabetics. The immunological response was the same in both groups: celular 100%, humoral 20%. No statistical correlation among superficial mycoses, blood glucose level, glycosylated hemoglobin values or the time suffering the disease was observed. The high susceptibility to dermatophytes and Candida sp. infection showed to be associated with age and no with the diabetic type 2 condition in those patients.

  2. An In Vitro Study of the Antimicrobial Effects of Indigo Naturalis Prepared from Strobilanthes formosanus Moore

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    Yin-Ru Chiang

    2013-11-01

    Full Text Available Indigo naturalis is effective in treating nail psoriasis coexisting with microorganism infections. This study examines the antimicrobial effects of indigo naturalis prepared from Strobilanthes formosanus Moore. Eight bacterial and seven fungal strains were assayed using the agar diffusion method to examine the effects of indigo naturalis and its bioactive compounds. The bioactive compounds of indigo naturalis were purified sequentially using GFC, TLC, and HPLC. Their structures were identified using mass spectrometry and NMR spectroscopy. UPLC-MS/MS was applied to compare the metabolome profiles of indigo naturalis ethyl-acetate (EA extract and its source plant, Strobilanthes formosanus Moore. The results of in vitro antimicrobial assays showed that indigo naturalis EA-extract significantly (≥1 mg/disc inhibits Gram-positive bacteria (Staphylococcus aureus, S. epidermis and methicillin-resistant S. aureus (MRSA and mildly inhibits non-dermatophytic onychomycosis pathogens (Aspergillus fumigates and Candida albicans, but has little effect on dermatophyes. Isatin and tryptanthrin were identified as the bioactive compounds of indigo naturalis using S. aureus and S. epidermis as the bioassay model. Both bioactive ingredients had no effect on all tested fungi. In summary, indigo naturalis prepared from Strobilanthes formosanus Moore exhibits antimicrobial effects on Staphylococcus and non-dermatophytic onychomycosis pathogens. Tryptanthrin and isatin may be its major bioactive ingredients against Staphylococcus and the inhibitory effect on MRSA may be due to other unidentified ingredients.

  3. Production of Fusaric Acid by Fusarium spp. in Pure Culture and in Solid Medium Co-Cultures.

    Science.gov (United States)

    Bohni, Nadine; Hofstetter, Valérie; Gindro, Katia; Buyck, Bart; Schumpp, Olivier; Bertrand, Samuel; Monod, Michel; Wolfender, Jean-Luc

    2016-03-18

    The ability of fungi isolated from nails of patients suffering from onychomycosis to induce de novo production of bioactive compounds in co-culture was examined. Comparison between the metabolite profiles produced by Sarocladium strictum, by Fusarium oxysporum, and by these two species in co-culture revealed de novo induction of fusaric acid based on HRMS. Structure confirmation of this toxin, using sensitive microflow NMR, required only three 9-cm Petri dishes of fungal culture. A targeted metabolomics study based on UHPLC-HRMS confirmed that the production of fusaric acid was strain-dependent. Furthermore, the detected toxin levels suggested that onychomycosis-associated fungal strains of the F. oxysporum and F. fujikuroi species complexes are much more frequently producing fusaric acid, and in higher amount, than strains of the F. solani species complex. Fusarium strains producing no significant amounts of this compound in pure culture, were shown to de novo produce that compound when grown in co-culture. The role of fusaric acid in fungal virulence and defense is discussed.

  4. Current antifungal treatment of fusariosis.

    Science.gov (United States)

    Al-Hatmi, Abdullah M S; Bonifaz, Alexandro; Ranque, Stephane; de Hoog, G Sybren; Verweij, Paul E; Meis, Jacques F

    2017-07-10

    Fungi of the genus Fusarium are well known as major plant pathogens and soil inhabitants but also cause a broad spectrum of human infections. Fusariosis is the second most common mould infection after aspergillosis and keratitis is the most encountered implantation infection in immunocompetent individuals. Natamycin is active against Fusarium species both in vitro and in vivo, and it is used along with voriconazole as the mainstay of treatment for Fusarium keratitis. Onychomycosis is treated with terbinafine, voriconazole and sometimes itraconazole. Cure is possible despite high in vitro MICs. Recently disseminated infections have increased dramatically, mainly affecting severely immunocompromised patients. The remarkable intrinsic resistance of Fusarium species to most antifungal agents results in high mortality rates in this patient population. Recovery of neutropenia is essential for patient survival and treatment should include voriconazole or amphotericin B as first line and posaconazole as salvage therapy. Copyright © 2017. Published by Elsevier B.V.

  5. Aspergillus pragensis sp nov discovered during molecular reidentification of clinical isolates belonging to Aspergillus section Candidi

    DEFF Research Database (Denmark)

    Lyskova, Pavlina; Hubka, Vit; Kolarik, Miroslav

    2014-01-01

    The identity of nine clinical isolates recovered from Czech patients and presumptively identified as Aspergillus sp. section Candidi based on colony morphology was revised using sequences of beta-tubulin, calmodulin gene sequence, and internal transcribed spacer rDNA. Six isolates were from...... suspected and proven onychomycosis, one from otitis externa, and two associated with probable invasive aspergillosis. The results showed that one Aspergillus candidus isolate was the cause of otitis externa, and both isolates obtained from sputa of patients with probable invasive aspergillosis were......, Aspergillus pragensis sp. nov. This species is well supported by phylogenetic analysis based on beta-tubulin and calmodulin gene and is distinguishable from other members of sect. Candidi by red-brown reverse on malt extract agar, slow growth on Czapek-Dox agar and inability to grow at 37 degrees C...

  6. General aspects of drug interactions with systemic antifungals in a retrospective study sample Aspectos gerais de interações medicamentosas com antifúngicos sistêmicos em um estudo amostral retrospectivo

    Directory of Open Access Journals (Sweden)

    Juliano Vilaverde Schmitt

    2013-06-01

    Full Text Available A retrospective study evaluating hepatic laboratory alterations and potential drug interactions in patients treated for onychomycosis. We evaluated 202 patients, 82% female. In 273 liver enzyme tests, there were changes in only 6%. Potential drug interactions were identified in 28% of patients for imidazole and 14% for terbinafine. The risk of potential interactions increased with the patient's age and use of multiple drugs.Estudo retrospectivo avaliando alterações laboratoriais hepáticas e potenciais interações medicamentosas em pacientes tratados para onicomicose. Foram avaliados 202 pacientes, sendo 82% do sexo feminino. Em 273 exames de enzimas hepáticas, houve alterações em apenas 6%. Potenciais interações medicamentosas foram identificadas em 28% dos pacientes para imidazólicos e 14% para terbinafina. O risco de interações potenciais aumentou com a idade do paciente e o uso de múltiplas medicações.

  7. Nail avulsion: Indications and methods (surgical nail avulsion

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    Deepika Pandhi

    2012-01-01

    Full Text Available The nail is a subject of global importance for dermatologists, podiatrists and surgeons. Nail avulsion is a frequently undertaken, yet simple, intriguing procedure. It may either be surgical or chemical, using 40% urea. The former is most often undertaken using the distal approach. Nail avulsion may either be useful for diagnostic purposes like exploration of the nail bed, nail matrix and the nail folds and before contemplating a biopsy on the nail bed or for therapeutic purposes like onychocryptosis, warts, onychomycosis, chronic paronychia, nail tumors, matricectomy and retronychia. The procedure is carried out mostly under local anesthesia with or without epinephrine (1:2,00,000 dilution. Besides the above-mentioned indications, the contraindications and complications of nail avulsion are briefly outlined.

  8. Fluconazole-, amphotericin-B-, caspofungin-, and anidulafungin-resistant Candida ciferrii: an unknown cause of systemic mycosis in a child.

    Science.gov (United States)

    Agın, Hasan; Ayhan, Yüce; Devrim, Ilker; Gülfidan, Gamze; Tulumoglu, Sener; Kayserili, Ertan

    2011-09-01

    Candida ciferrii, which is known as an agent of superficial yeast infection and onychomycosis, has rarely been isolated as an agent of candidemia. Limited reports have suggested different patterns of antifungal sensitivity. We report a rare candidemia case caused by c.ciferrii in an 8-year-old child in which isolated candida species were resistant to amphotericin-B (MIC > 1 μg/ml), fluconazole, (MIC ≥ 64 μg/ml), caspofungin (MIC ≥ 32 μg/ml), and anidulafungin (MIC ≥ 32 μg/ml) but sensitive to voriconazole (MIC ≤ 0.12 μg/ml). As far as we aware, this was the first recorded C. ciferrii candidemia case in children.

  9. [Isolation of Sporothrix pallida complex in clinical and environmental samples from Chile].

    Science.gov (United States)

    Cruz Choappa, Rodrigo M; Vieille Oyarzo, Peggy I; Carvajal Silva, Laura C

    2014-01-01

    The isolation of S. pallida complex from medical samples and home garden soil of a patient in Chile is here in reported. Fungi of the Sporothrix schenckii complex can cause various infections. In Chile, the medical and environmental isolates of these this complex are rare. The aim of this study was to identify an unusual agent in a case of onychomycosis and to detect its presence in the patient's home garden. For this purpose, clinical samples were obtained by scraping the patient's subungueal first right toe nail as well as by taking soil samples from different areas of her home garden. Species identification was performed by morphophysiology and one of the strains isolated from the patient's toe nail was sent to CBS for molecular confirmation (14.062). S. pallida complex was identified both from the patient's toe nail and samples taken from her home garden.

  10. Human Dectin-1 Deficiency and Mucocutaneous Fungal Infections

    Science.gov (United States)

    Ferwerda, Bart; Ferwerda, Gerben; Plantinga, Theo S.; Willment, Janet A.; van Spriel, Annemiek B.; Venselaar, Hanka; Elbers, Clara C.; Johnson, Melissa D.; Cambi, Alessandra; Huysamen, Cristal; Jacobs, Liesbeth; Jansen, Trees; Verheijen, Karlijn; Masthoff, Laury; Morré, Servaas A.; Vriend, Gert; Williams, David L.; Perfect, John R.; Joosten, Leo A.B.; Wijmenga, Cisca; van der Meer, Jos W.M.; Adema, Gosse J.; Kullberg, Bart Jan; Brown, Gordon D.; Netea, Mihai G.

    2009-01-01

    SUMMARY Mucocutaneous fungal infections are typically found in patients who have no known immune defects. We describe a family in which four women who were affected by either recurrent vulvovaginal candidiasis or onychomycosis had the early-stop-codon mutation Tyr238X in the β-glucan receptor dectin-1. The mutated form of dectin-1 was poorly expressed, did not mediate β-glucan binding, and led to defective production of cytokines (interleukin-17, tumor necrosis factor, and interleukin-6) after stimulation with β-glucan or Candida albicans. In contrast, fungal phagocytosis and fungal killing were normal in the patients, explaining why dectin-1 deficiency was not associated with invasive fungal infections and highlighting the specific role of dectin-1 in human mucosal antifungal defense. PMID:19864674

  11. Fusarium solani : A causative agent of skin and nail infections

    Directory of Open Access Journals (Sweden)

    Thomas S Kuruvilla

    2012-01-01

    Full Text Available 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.

  12. CLINICO - MYCOLOGICAL STUDY OF SUPERFICIAL FUNGAL INFECTIONS IN COASTAL KARNATAKA, INDIA

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    Sweta R.

    2013-10-01

    Full Text Available ABSTRACT: Cutaneous fungal infections are common in coastal Karnataka owing to its tropical and humid climate. The organisms causing these infections commonly are dermatophytes, non dermatophytes and yeasts. This study aims to determine the p revalence of cutaneous mycosis, with their different clinical types and etiological agents, and correlate the findings. A total of 96 patients were included in our study, all of them attending dermatology OPD at a tertiary hospital in Mangalore with clinic ally suspected tinea corporis, tinea cruris, tinea pedis, tinea capitis, tinea mannum, onychomycosis, candidiasis and pityriasis versicolor. The study revealed male to female ratio being 0.74:1. The leading diagnosis was pityriasis versicolor, the commones t organism isolated was C. albicans; and the commonest site involved is groin and skin flexures. This study emphasizes utility of timely detection of cutaneous fungal infection in preventing transmission and spread of KEYWORDS: Fungal infe ctions; Dermatophytes; Pityriasis versicolor such infections

  13. Aspectos epidemiológicos de pacientes com lesões ungueais e cutâneas causadas por Scytalidium spp Epidemiological aspects of patients with ungual and cutaneous lesions caused by Scytalidium spp

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    Ana Paula Martins Xavier

    2010-12-01

    Full Text Available FUNDAMENTO: As dermatomicoses causadas por fungos filamentosos não dermatófitos são infecções raras, exceto as onicomicoses, cuja prevalência vem crescendo nos últimos anos. Dentre esses agentes etiológicos destacam-se o Scytalidium dimidiatum e o S. hyalinum, fungos emergentes responsáveis por micoses em unhas e pele. OBJETIVO: Investigar as características epidemiológicas das onicomicoses e micoses de outras localizações causadas pelos fungos do gênero Scytalidium, utilizando-se como parâmetros sexo, idade e localizações das lesões. MÉTODOS: Avaliaram-se 81 amostras com cultura positiva para o gênero em estudo, oriundas de 74 pacientes encaminhados ao Laboratório de Investigação em Dermatologia (ID situado na cidade do Rio de Janeiro (RJ, no período de 1997 a 2006. As amostras foram submetidas a confirmação diagnóstica por exame direto e cultura. RESULTADOS: A prevalência de onicomicoses por Scytalidium spp. foi de 0,87%, entre as idades de 41 e 60 anos (48,64%. Em relação à localização das lesões, os pés foram mais acometidos (91,36%, com predomínio do hálux esquerdo. No exame direto, as estruturas mais encontradas foram hifas hialinas; na cultura, a espécie S. dimidiatum foi a mais frequente. CONCLUSÃO: As onicomicoses por Scytalidium spp. são raras e o S. dimidiatum foi a espécie mais isolada neste laboratório no período em estudo.BACKGROUND: Dermatomycoses caused by non-dermatophyte filamentous fungi are rare infections, except for onychomycosis, whose prevalence has increased over the past few years. Among these etiologic agents, we highlight Scytalidium dimidiatum and S. hyalinum, emergent fungi that cause mycoses that affect the nails and skin. OBJECTIVE: To investigate the characteristics of onychomycosis and other mycoses caused by the fungi Scytalidium spp, using sex, age and site of infection as parameters. METHODS: Eighty-one samples were evaluated showing positive culture for Scytalidium

  14. A review of current research in light-based technologies for treatment of podiatric infectious disease states.

    Science.gov (United States)

    Bornstein, Eric

    2009-01-01

    Recently, there has been a resurgence of interest in potential phototherapy technologies for the local treatment of bacterial and fungal infection. Currently, onychomycosis is the principle disease that is the target of these phototherapies in podiatric medicine. Some of these technologies are currently undergoing in vitro and in vivo trials approved by institutional review boards. The three light-based technologies are ultraviolet light therapy, near infrared photo-inactivation therapy, and photothermal ablative antisepsis. Each of these technologies have markedly dissimilar mechanisms of action. In this review, each technology will be discussed from the perspectives of history, photobiology, individual mechanism of action, safety, and potential clinical efficacy, with data presented from published material. This review is intended to give podiatric physicians detailed information on state-of-the-art infectious disease phototherapy.

  15. Cutaneous manifestations of familial amyloidotic polyneuropathy.

    Science.gov (United States)

    Rocha, N; Velho, G; Horta, M; Martins, A; Massa, A

    2005-09-01

    Familial amyloidotic polyneuropathy is an autosomal dominant amyloidosis, characterized by the systemic deposition of amyloid with a particular involvement of the peripheral nerves. The disease generally manifests as a severe sensory, motor and autonomic neuropathy. Cardiomyopathy, nephropathy, vitreous opacities and carpal tunnel syndrome may occur in a variable association with the neuropathy. Trophic dermatological lesions are frequent in the more advanced stages of the disease. We examined the skin of 142 patients. The cutaneous manifestations more frequently observed were: xerosis (81.6%), seborrheic dermatitis (21.8%), traumatic and burn lesions (19.7%), acne (18.3%), neurotrophic ulcers (14%) and onychomycosis (10.5%). Among the hepatic transplanted patients (31%), seborrheic dermatitis and acne were the most frequent diagnoses.

  16. Subungual squamous cell carcinoma*

    Science.gov (United States)

    Padilha, Carolina Barbosa de Sousa; Balassiano, Laila Klotz de Almeida; Pinto, Julyana Calegari; de Souza, Flávia Crespo Schueler; Kac, Bernard Kawa; Treu, Curt Mafra

    2016-01-01

    Although subungual squamous cell carcinoma is rare, it is the most common primary malignant neoplasms in this location. The higher incidence occurs in the fingernails, but involvement of the toenails is also possible. Subungual squamous cell carcinoma often looks like other more common benign lesions, such as fungal infection, onychomycosis, or viral wart. These factors, together with a general lack of awareness of this disease among physicians, often result in delayed diagnosis. Therefore, it is underdiagnosed, with few reports in the literature. The authors present a case of a man with a diagnosis of subungual squamous cell carcinoma in the hallux, without bone involvement, which was submitted to the appropriate surgical treatment. PMID:28099608

  17. Maxillary sinusitis caused by Lasiodiplodia theobromae

    Directory of Open Access Journals (Sweden)

    Kindo A

    2010-01-01

    Full Text Available Lasiodiplodia (monotypic comprises a very small proportion of the fungal biota. It is a common plant pathogen in tropical and subtropical regions. Clinical reports on its association with onychomycosis, corneal ulcer and phaeohyphomycosis are available. However, Lasiodiplodia theobromae causing fungal sinusitis has not been reported. We present here a case of fungal sinusitis in a 30-year-old woman, who came to the ENT OPD (out patient department with complaints of intermittent bleeding and nasal discharge from the left side for a week. The patient complained of headache, predominantly on the left side and heaviness on and off since two months. Diagnosis was based on radiological and mycological evidence; the patient underwent endoscopic surgery and was started on antifungal treatment.

  18. Skin rash during treatment with generic itraconazole

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    Antonio De Vuono

    2014-01-01

    Full Text Available Generic drugs have the same active substance, the same pharmaceutical form, the same therapeutic indications and a similar bioequivalence with the reference medicinal product (branded. Although a similar efficacy is postulated, some cases of clinical inefficacy during treatment with generic formulations have been reported. In this case, we describe a woman with onychomycosis that developed a skin rash during treatment with a generic formulation of itraconazole. Drug administration and its re-challenge confirmed the association between itraconazole and skin rash. Both Naranjo probability scale and World Health Organization causality assessment scale documented a probable association between generic-itraconazole and skin rash. The switch from generic formulation to brand one induced an improvement of symptoms. Since we are unable to evaluate the role of each excipient in the development of skin rash, we cannot rule out their involvement. However, more data are necessary to better define the similarities or differences between branded and generic formulations.

  19. Translational medicine in the field of ablative fractional laser (AFXL)-assisted drug delivery

    DEFF Research Database (Denmark)

    Haedersdal, Merete; Erlendsson, Andrés M; Paasch, Uwe

    2016-01-01

    enhanced topical drug uptake into skin after ablative fractional laser treatment. Clinical evidence encompassed 18 studies, of which 9 were randomized controlled trials and 2 were controlled trials, examining neoplastic lesions, photodamaged skin, scars, onychomycosis, and topical anesthetics. The highest......Ablative fractional lasers enhance uptake of topical therapeutics and the concept of fractional laser-assisted drug delivery has now been taken into clinical practice. Objectives We systematically reviewed preclinical data and clinical evidence for fractional lasers to enhance drug uptake...... laser-assisted drug delivery implies risks of systemic drug absorption, especially when performed over large skin areas. Conclusions Fractional laser-assisted drug delivery is beneficial in enhancing preclinical and clinical outcomes for certain skin conditions....

  20. Causative agents of superficial mycoses in Istanbul, Turkey: retrospective study.

    Science.gov (United States)

    Koksal, Fatma; Er, Emine; Samasti, Mustafa

    2009-09-01

    The aim of the present study was to determine the percentage of agents, which can give rise to superficial fungal infections in Istanbul, Turkey. Between 2000 and 2007, the clinical samples collected from 8,200 patients attending the outpatient Dermatology Clinic at Mihrimahsultan Medical Center were examined by direct microscopy and culture. Pathogen fungi were detected in 5,722 of the patients. Of the isolates were 4,218 (74%) dermatophytes, 1,196 (21%) Candida sp., 170 (3%) Malassezia furfur, and 138 (2%) Trichosporon sp. Among the dermatophytes, Trichophyton sp. was the most common isolate followed by Epidermophyton floccosum (243) and Microsporum sp. Among the Candida species, C. albicans (549) was also frequently found. Onychomycosis was the most prevalent type of infection, followed by tinea pedis, tinea cruris, tinea corporis, and tinea capitis. In conclusion, our study showed that the most common isolated agents from superficial infections were T. rubrum being Candida sp. the second most prevalent.

  1. Permeation studies of novel terbinafine formulations containing hydrophobins through human nails in vitro.

    Science.gov (United States)

    Vejnovic, Ivana; Huonder, Cornelia; Betz, Gabriele

    2010-09-15

    Existing treatments of onychomycosis are not satisfactory. Oral therapies have many side effects and topical formulations are not able to penetrate into the human nail plate and deliver therapeutical concentrations of active agent in situ. The purpose of the present study was to determine the amount of terbinafine, which permeates through the human nail plate, from liquid formulations containing enhancers, namely hydrophobins A-C in the concentration of 0.1% (w/v). The used reference solution contained 10% (w/v) of terbinafine in 60% (v/v) ethanol/water without enhancer. Permeability studies have been performed on cadaver nails using Franz diffusion cells modified to mount nail plates and filled with 60% (v/v) ethanol/water in the acceptor chamber. Terbinafine was quantitatively determined by HPLC. The amount of terbinafine remaining in the nail was extracted by 96% ethanol from pulverized nail material after permeation experiment and presented as percentage of the dry nail weight before the milling test. Permeability coefficient (PC) of terbinafine from reference solution was determined to be 1.52E-10 cm/s. Addition of hydrophobins improved PC in the range of 3E-10 to 2E-9 cm/s. Remaining terbinafine reservoir in the nail from reference solution was 0.83% (n=2). An increase of remaining terbinafine reservoir in the nail was observed in two out of three tested formulations containing hydrophobins compared to the reference. In all cases, known minimum inhibitory concentration of terbinafine for dermatophytes (0.003 microg/ml) has been exceeded in the acceptor chamber of the diffusion cells. All tested proteins (hydrophobins) facilitated terbinafine permeation after 10 days of permeation experiment, however one of them achieved an outstanding enhancement factor of 13.05 compared to the reference. Therefore, hydrophobins can be included in the list of potential enhancers for treatment of onychomycosis. Copyright 2010 Elsevier B.V. All rights reserved.

  2. Opportunistic fungi in lake water and fungal infections in associated human population in Dal Lake, Kashmir.

    Science.gov (United States)

    Bandh, Suhaib A; Kamili, Azra N; Ganai, Bashir A; Lone, Bashir A

    2016-04-01

    Natural habitats of opportunistic fungal pathogens are outside of the host; therefore, it is critically important to understand their ecology and routes of transmission. In this study, we investigated the presence of human pathogenic opportunistic fungi in lake water and incidence of fungal infections in associated population in Kashmir, India. Six hundred forty water samples were taken on seasonal basis from a wide network of sampling stations of the lake for an extended period of two years for screening their occurrence. The samples were inoculated onto rose bengal agar, malt extract agar, potato dextrose agar and other specified culture media supplemented with Chloramphenicol and Streptomycin followed by incubation at 37 °C. All the samples were positive for fungi, which were later identified by sequencing the rDNA internal transcribed spacer region aided by classical morphological culture techniques and physiological profiling. The whole process led to the isolation of sixteen species of opportunistic fungal pathogens belonging to genus Aspergillus, Candida, Penicillium, Cryptococcus, Fusarium, Rhizopus and Mucor in decreasing order of prevalence. Furthermore, 20% population (n = 384) of Dal inhabitants was examined for possible fungal infections and it was observed that only 8.07% individuals were positive for fungal infections with 4.68% skin infection cases, 2.34% onychomycosis cases and 1.04% candidiasis cases. Scrapings from onychomycosis and candidiasis patients showed the presence of Aversicolor and Calbicans respectively, resembling exactly the strains isolated from the lake water. However, the skin infection was because of a dermatophyte not isolated for the lake water. Higher prevalence of infection (6.77%) was seen in people using lake water followed by a positive prevalence of 1.30% using tap water. The results of present study suggest that the lake inhabitants are at a greater risk of getting life threatening fungal diseases which may lead to

  3. Dermatological manifestations in HIV-infected patients at a tertiary care hospital in a tribal (Bastar region of Chhattisgarh, India

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    Singh Harminder

    2009-01-01

    Full Text Available Background: Cutaneous disorders during HIV infection are numerous and skin is often the first and only organ affected during most of the course of HIV disease. Some Cutaneous disorders reflect the progression of HIV disease; though the relation is still controversial. Aims : The objective of this study, conducted at a tertiary care centre in Bastar, Jagdalpur, is to estimate the status of cutaneous manifestation in HIV-infected patients and its relationship with CD4 cell counts. Methods: We enrolled 137 HIV positive subjects. Demographic information such as age, gender, weight, height, socioeconomic status, and educational status were recorded. Laboratory parameter (CD4 counts and treatment regimen were noted. Patients were examined for skin disorders by a dermatologist. Data were analyzed using chi-square test for categorical variables. Results: Majority of the patients were from rural area (65.69% and belonged to a low socioeconomic and educational status. 30.65% of the patients were housewives, 23.35% drivers, and 16.78% labourers. Predominant mode of transmission was heterosexual contact (94.16%. Most common HIV-related dermatological manifestations were seborrheic dermatitis (74.16%, xerosis (52.5%, generalized skin hyperpigmentation 56 (46.67%, onychomycosis 53 (44.16%, pruritic papular eruption 27 (22.5%, oral candidiasis 21 (17.5%, photo dermatitis 21 (17.5%, and scabies 4 (3.33%. Significant correlation with low CD4+ cell counts was found for oral candidiasis (P < 0.0001 and Kaposi′s sarcoma ( P = 0.03, while other disorders such as seborrheic dermatitis ( P = 0.22, xerosis ( P = 0.25, and onychomycosis (P = 0.08 were not statistically significant. Conclusion : This study showed high prevalence of dermatological manifestations in HIV-infected subjects, and they occur more frequently with progression of HIV and decline in immune functions. Therefore, early diagnosis and management of skin disorders can improve the quality of life of

  4. [Trichophyton thuringiense H.A. Koch 1969. A rare geophilic dermatophyte--now isolated for the first time from man].

    Science.gov (United States)

    Nenoff, P; Winter, I; Winter, A; Krüger, C; Herrmann, J; Gräser, Y; Rangno, N; Maier, T; Simon, J C

    2014-03-01

    In 1969, Kolipp and Hoffmann isolated Trichophyton (T.) thuringiense spec. nov. Koch when they performed their thesis dealing with the distribution and epidemiology of dermatophytes and keratinophilic fungi in mice and other small mammals. At that time, T. thuringiense was detected as saprophytic fungus of the skin of different mice species (e.g. Mus musculus) both in rural and urban settings in the area of Thuringia in Germany. There were no further reports on this dermatophyte species until now, neither in animals, nor in man. Currently, we were able to isolate this geophilic fungus for the first time from a human being. A 58 year old patient baker by trade and living in a rural setting (village) suffered from nail changes like hyperkeratosis and thickening of the nail plate of his big toe. From his nail samples grew a dermatophyte with peripheral radiating and flat colonies which were a bit cottony in the centre. On Sabouraud's 4 % dextrose agar the thallus of the fungus was white to purple stained, the reverse side showed a dark red to brown color. In a typical manner, macroconidia were cylindrical to clavate, microconidia obovoidal to short-clavate with broad base. The species identification of T. thuringiense was done and confirmed by sequence analysis of the internal transcribed spacer (ITS) region of the ribosomal DNA. Antifungal treatment has been refused from the patient. In conclusion, this is the second description of the geophilic dermatophyte T. thuringiense, which could be isolated for the first time from a human being, in particular from nail sample of the big toe under the suspicion of onychomycosis. However, it is still uncertain if this fungus should be considered either as secondary colonization of the nail plate, or as causative agent of tinea unguium or onychomycosis.

  5. Epidemiological survey of dermatophytosis in Tehran, Iran, from 2000 to 2005

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    Bassiri-Jahromi Shahindokht

    2009-01-01

    Full Text Available Background: Cutaneous fungal infections are common in Tehran, Iran, and causative organisms include dermatophytes, yeasts and non-dermatophyte molds. The prevalence of superficial mycosis infections has risen to such a level that skin mycoses now affect more than 20-25% of the world′s population, making them the most frequent form of infection. Aims: Our aim was to determine the prevalence of superficial cutaneous fungal infections especially dermatophytosis in our Medical Mycology Laboratory in the Pasteur Institute of Iran, Tehran. Methods: A total of 17,573 specimens were collected from clinically suspected tinea corporis, tinea cruris, tinea capitis, tinea faciei, tinea pedis, tinea manuum and finger and toe onychomycosis from 2000 to 2005. Patients were referred to our laboratory for direct examination, fungal culture and identification. The incidence of each species was thus calculated. Results: Dermatophytes remain the most commonly isolated fungal organisms, except from clinically suspected finger onychomycosis, in which case Candida species comprise> 7% of the isolates. Epidermophyton floccosum remains the most prevalent fungal pathogen and increased incidence of this species was observed in tinea cruris. Trichophyton tonsurans continues to increase in incidence. Conclusion: This study identifies the epidemiologic trends and the predominant organisms causing dermatophytosis in Tehran, Iran. These data can be used to ascertain the past and present trends in incidence, predict the adequacy of our current pharmacologic repertoire and provide insight into future developments. Consideration of the current epidemiologic trends in the incidence of cutaneous fungal pathogens is of key importance to investigational effort, diagnosis and treatment.

  6. Comparison of user-friendliness and treatment cost of Loceryl® vs. Ciclopoli®--a patient's perspective.

    Science.gov (United States)

    Schaller, M; Braunsdorf, C; Mailänder-Sanchez, D; Jäckel, A; Müller, J; Borelli, C

    2015-10-01

    Topical monotherapy is a valid therapeutic approach in onychomycosis. Due to its lengthy course and its non-reimbursed product status, cost and compliance are important issues and non-pharmacological properties such as over-the-counter price and ease of use should be considered when deciding which product to recommend. We investigated surrogate parameters for patient-friendliness and treatment cost in Germany in a questionnaire-based prospective, comparative, intra-individual, open-label trial of the two common topical antifungal nail lacquers Loceryl(®) (amorolfine 5%) and Ciclopoli(®) (ciclopirox 8%) in eight patients with clinically diagnosed onychomycosis. The 2.5 ml bottle of Loceryl(®) covered a treatment period of 308 days, resulting in treatment costs of €0.10 per day in comparison to the 3.3 ml bottle of Ciclopoli(®), covering 127 days at €0.21 per day, given once-daily application for Ciclopoli(®) and once-weekly application for Loceryl(®) in accordance with regulatory approval. Six out of eight patients favoured the Loceryl(®) treatment regimen. Furthermore, four out of eight patients found Loceryl(®) easier to apply, whereas three preferred Ciclopoli(®). In total, seven out of eight stated a clear preference for Loceryl(®) over Ciclopoli(®). Loceryl(®) therapy is less expensive and less time-consuming. The therapeutic period that can be covered is longer and more patients stated a clear preference for Loceryl(®) in comparison to Ciclopoli(®). The differences are statistically significant, underlining probable clinical relevance. © 2015 Blackwell Verlag GmbH.

  7. [Superficial mycoses in patients from Anzoátegui state, Venezuela, period 2002-2012].

    Science.gov (United States)

    Lemus-Espinoza, Druvic; Teresa Maniscalchi, María; Villarroel, Oskarina; Bónoli, Stefano B; Wahab, Fadi; García, Oswaldo

    2014-12-01

    Superficial fungal diseases that affect the skin and its appendages are frequently seen in basic triage and in dermatology services. These diseases are distributed in Venezuela with an incidence of 92.9%. The aim of this study was to determine the genera and species that cause dermatomycoses in residents of Anzoátegui state, Venezuela, during the period 2002-2012. A total of 4257 patients with a presumptive diagnosis of superficial mycoses were studied, with ages from 7 months to 79 years. The overall prevalence was 30.9%. The most frequent were dermatophytosis (44.7%). M. canis produced 148 cases of tinea capitis. Three dermatophytic agents represented 95% of all cases, with a significant predominance of T. mentagrophytes with 50%. Candidosis occurred in 28.4%. C. albicans, and the C. parapsilosis complex, were responsible for 80% of the cases. The other species identified were C. tropicalis (n = 41, 11.0%), C. glabrata (n = 10, 2.7%), C. guilliermondii (n = 6, 1.6%), C. krusei (n = 4, 1.1%). Pityriasis versicolor occurred in 22.4% of the cases studied, and less frequently were present onychomycosis produced by a non dermatophytic mold: Fusarium oxysporum (n = 34, 65.4%), Aspergillus terreus (n=16, 30.8%) and Scytalidium dimidiatum (n=2; 3.8%). Rare cases of Trichosporon onychomycosis (0.5%) and one case of black tinea were also found. Health education in the population is recommended to promote measures to prevent transmission of these fungi and prevent the spread of this silent public health problem.

  8. Micoses superficiais na cidade de Manaus, AM, entre março e novembro/2003 Superficial mycoses in the City of Manaus/AM between March and November/2003

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    José Augusto Almendros de Oliveira

    2006-06-01

    /CPCS-INPA. RESULTS - Three hundred and ninety-four examinations were carried out throughout the period and 256 were positive. The mycoses with higher incidence were onychomycosis (135 and pityriasis versicolor (98. The most often isolated agents were Malassezia spp. (77 and Candida spp. (72. Tinea capitis was more frequent in pre-school children (3 and onychomycosis in adults (94. Mycoses were more prevalent in women (91. All socioeconomic classes were affected, with a predominance in class C (37. CONCLUSION - Onychomycosis and pityriasis versicolor affected mostly adults and Tinea capitis occured mainly in children. Superficial mycoses were more predominant in women. Malassezia spp. and Candida spp. were the most often isolated agents.

  9. Freqüência de onicomicoses por leveduras em Maringá, Paraná, Brasil Frequency of onychomycoses caused by yeasts in Maringa, Parana, Brazil

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    Eliane Alves de Freitas Souza

    2007-04-01

    Full Text Available FUNDAMENTOS: Onicomicoses são afecções ungueais de origem infecciosa causadas por fungos e estão entre as principais onicopatias em todo o mundo. OBJETIVOS: Determinar a freqüência de leveduras como agentes etiológicos de onicomicoses na cidade de Maringá, PR, Brasil. MATERIAL E MÉTODOS: Realizou-se um estudo retrospectivo do período entre janeiro de 1997 e dezembro de 2004, em que foram avaliados os resultados de 1.295 pacientes com suspeita de onicomicose, recebidos no Laboratório de Ensino e Pesquisa em Análises Clínicas da Universidade Estadual de Maringá, Paraná, Brasil. RESULTADOS: A confirmação micológica de onicomicose ocorreu em 761 (58,76% desses pacientes. As mulheres foram responsáveis por 71% das onicomicoses, e os homens, por 29%. A prevalência nas unhas das mãos foi de 28,67% e nas unhas dos pés, 71,33%. Em relação aos agentes, as leveduras foram mais freqüentemente isoladas (46,39%, seguidas pelos dermatófitos (40,60% e pelos fungos filamentosos não dermatófitos (13,01%. CONCLUSÃO: A alta freqüência de fungos leveduriformes em onicomicoses indica aprimoramento nas técnicas diagnósticas de confirmação laboratorial de fungos oportunistas. Esses resultados, associados à abordagem clínica do paciente, possibilitam maior segurança no diagnóstico e tratamento.INTRODUCTION: Onychomycoses are infectious ungueal diseases caused by fungi and represent the major onychopathies all over the world. OBJECTIVES: To determine the frequency of yeasts as etiological agents of onychomycoses in the city of Maringa, Parana, Brazil. METHODS: A retrospective study from January 1997 to December 2004. Results of 1295 patients with suspected onychomycosis were evaluated; tests were performed at the Teaching and Research Pathology Laboratory at the Universidade Estadual de Maringá, Parana, Brazil. RESULTS: Onychomycosis was confirmed by mycological exam in 761 (58.76% patients; 71% females and 29.00% males. The

  10. 宜昌地区浅部真菌病及真菌分析%Prevalence of pathogenic fungi of superficial mycoses in Yichang

    Institute of Scientific and Technical Information of China (English)

    陈春燕; 王鹏

    2011-01-01

    OBJECTIVE To investigate the prevalence and pathogenic fungi species of superficial mycoses in Yichang district. METHODS A total of 1982 specimens of clinically suspected patients in dermatological department with dermatomycoses were examined by Microscopy. The bacterial culture and identification were performed.RESULTS Among 1982 cases, the frequencies of onychomycosis(691 cases), tinea cruris (402 cases) and tinea pedis (374 cases) were 34.9% ,20. 3% and 18.9%, respectively. 1030 strains of pathogenic fungi were isolated,in which the most frequently isolated fungus was Trichophyton rubrum 626 (60. 8%), followed by Trichophyton mentagrophytes (5.5 %), Epidermophyton floccosum (2.8 %), candida and yeast-like fungi (22.2 %) and others (2.4%). CONCLUSION Onychomycosis is the most common, and Trichophyton rubrum is the most predominant pathogen of dermatomycoses. The percentage of candida and yeast-like fungus is increased year by year.%目的 了解宜昌地区浅部真菌病及真菌分布特点.方法 对在医院皮肤科就诊,并拟诊为浅部真菌病感染的1982例患者标本,行显微镜检查、细菌培养及菌种鉴定.结果 1982例浅部真菌病患者中,甲真菌病691例,占34.9%,股癣402例,占20.3%,足癣374例,占18.9%;分离的1030株真菌中,主要为红色毛癣菌626株,占60.8%;其余依次为假丝酵母菌属、须癣毛癣菌、絮状表皮癣菌及犬小孢子菌,分别占22.2%、5.5%、2.8%、2.4%.结论 在浅部真菌病及病原菌中,甲真菌病最为常见,致病菌以红色毛癣菌占主导地位,假丝酵母菌属所占比例较往年有大幅增多.

  11. A Phase 1, randomized, open-label crossover study to evaluate the safety and pharmacokinetics of 400 mg albaconazole administered to healthy participants as a tablet formulation versus a capsule formulation

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    van Rossem K

    2013-01-01

    Full Text Available Koen van Rossem,1 Jenny A Lowe21Stiefel, Research Triangle Park, NC, USA; 2Stiefel, Stockley Park West, Uxbridge, UKBackground: Albaconazole is a novel triazole being developed for the oral treatment of fungal diseases. Once-weekly oral dosing with 400 mg albaconazole for 24 or 36 weeks resulted in high rates of clinical and mycological resolution for distal subungual onychomycosis, as well as a favorable safety and tolerability profile.Purpose: To compare four 100-mg albaconazole capsules to one 400-mg albaconazole tablet for bioavailability, bioequivalence, tolerability, and safety.Patients and methods: Forty participants were enrolled in this Phase I, open-label, two-sequence crossover study. Twenty participants were exposed to a single 400-mg tablet dose of albaconazole before being crossed over to a single dose of four 100-mg albaconazole capsules. The second group of 20 participants received the study products in reverse order. Blood samples were taken over 15 days post-dose to assess the plasma concentrations and pharmacokinetic parameters of albaconazole and its primary metabolite, 6-hydroxyalbaconazole. Safety was assessed throughout the study.Results: The area under the curve (AUC and maximum measured plasma concentration (Cmax of the albaconazole tablet were approximately 10% and 22% lower, respectively, than for the albaconazole capsules. Statistical significance was reached for the Cmax but not for the AUC measurements (AUC0-t and AUC0-inf. Because the 90% confidence intervals based on the differences between the tablet and capsule were outside the 80%–125% range for both the Cmax and AUC, we concluded that the formulations were not bioequivalent with respect to the rate or extent of absorption. Both formulations were safe and well-tolerated in this study. All adverse events (AEs were generally mild and were mainly gastrointestinal- or nervous system-related (eg, dizziness, headache. No electrocardiogram findings were reported as

  12. Skin and nail mycoses in patients with diabetic foot.

    Science.gov (United States)

    Papini, M; Cicoletti, M; Fabrizi, V; Landucci, P

    2013-12-01

    Diabetes mellitus affects all socioeconomic and age groups and its incidence is rapidly increasing worldwide. The diabetic foot complication represents one of the most complex and serious complications in these patients. Fungal infections can also contribute to the severity of the diabetic foot. The aim of the present study was to evaluate the prevalence of foot skin and toenail mycosis in a group of 75 patients with diabetic foot complication and in a matched control group. Diabetic patients showed onychomycosis in 53.3% and foot skin mycosis in 46.7% of the cases, with a prevalence of both fungal infections significantly higher than that observed in the control group. At least one type of these fungal infections was present in 69.3% of diabetic subjects with a highly significant difference compared to control group (Pdiabetic foot complication, and that the problem of fungal infections of the foot in diabetic subjects is still highly underestimated. Consequently, there is an important clinical rationale for careful mycological examination of diabetic foot and an adequate treatment tailored for each individual patient according to the fungal species involved.

  13. Onicomicosis: epidemiología, agentes causales y evaluación de los métodos diagnósticos de laboratorio Onychomycoses: epidemiology, causative agents and assessment of diagnostic laboratory methods

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    Javier R Nazar

    2012-03-01

    Full Text Available Desde marzo de 2007 hasta marzo de 2011 se estudiaron prospectivamente 414 pacientes con onicodistrofias en un laboratorio privado de Esquel. La prevalencia de onicomicosis de pie fue del 78 %; la de mano, del 58 %. Los principales agentes etiológicos fueron Trichophyton rubrum, Candida spp. y Trichophyton mentagrophytes. El desarrollo de dermatofitos prevaleció en las onicopatías de pie y el de Candida spp. en las de uñas de mano (ambos, p Since March 2007 to March 2011, 414 patients with onychopathies were prospectively analyzed. Prevalence of the toenail and fingernail mycoses was 78 % and 58 %, respectively. The major etiological agents were Trichophyton rubrum, Candida spp. and Trichophyton mentagrophytes. Dermatophytes were more frequently cultured from toenails, whereas Candida spp. from fingernails (both, p < 0.05. In candidal onychomycosis, species different from C. albicans were prevalent. A higher prevalence of toenail and fingernail mycoses, a predominance of T. rubrum in toenails (p < 0.05, and greater positivity in the direct examination (DE and in culture (both, p < 0.05 were more frequently observed in men than in women. The correlation between DE and culture was 68 %. DE and culture yields were associated with a greater size lesion. DE was more effective in onycodystrophies with duration of more than 5 years. Culture positivity was independent of nail affection chronicity.

  14. Ungual and transungual drug delivery.

    Science.gov (United States)

    Shivakumar, H N; Juluri, Abhishek; Desai, B G; Murthy, S Narasimha

    2012-08-01

    Topical therapy is desirable in treatment of nail diseases like onychomycosis (fungal infection of nail) and psoriasis. The topical treatment avoids the adverse effects associated with systemic therapy, thereby enhancing the patient compliance and reducing the treatment cost. However the effectiveness of the topical therapies has been limited due to the poor permeability of the nail plate to topically applied therapeutic agents. Research over the past one decade has been focused on improving the transungual permeability by means of chemical treatment, penetration enhancers, mechanical and physical methods. The present review is an attempt to discuss the different physical and chemical methods employed to increase the permeability of the nail plate. Minimally invasive electrically mediated techniques such as iontophoresis have gained success in facilitating the transungual delivery of actives. In addition drug transport across the nail plate has been improved by filing the dorsal surface of the nail plate prior to application of topical formulation. But attempts to improve the trans-nail permeation using transdermal chemical enhancers have failed so far. Attempts are on to search suitable physical enhancement techniques and chemical transungual enhancers in view to maximize the drug delivery across the nail plate.

  15. 1st meeting on topical drug delivery to the nail.

    Science.gov (United States)

    Murdan, Sudaxshina

    2007-07-01

    The first ever symposium dedicated solely to drug delivery to the nail following topical application was held on the 2nd April 2007, in London, UK, organised by Dr Clive Roper (Charles River Laboratories, Scotland) and Dr Sudaxshina Murdan (School of Pharmacy, University of London, UK), under the auspices of Skin Forum. The 1-day meeting was attended by approximately 35 delegates from industry, academia and hospitals, and provided a much-needed forum for the presentation and discussion of research and problems in this emerging field. Topical drug delivery is especially suitable for onychomycosis (fungal infections of the nail plate and/or nail bed) and nail psoriasis, which affect 2 - 13 and 1 - 3% of the general population, respectively, and make up the bulk of nail disorders. Topical therapy would avoid the adverse events and drug interactions of systemic antifungal agents and the pain of injection when antipsoriatic agents are injected into affected nail folds. However, successful topical therapy is extremely challenging due to the very low permeability of the nail plate. Five speakers spoke about various aspects of topical drug delivery to the nail, including review of the nail plate structure, function, diseases, their existing therapies (systemic and topical), limitations and global sales. The need for effective topical drug delivery to the nail to overcome the problems associated with present treatment, and the fact that there are few topical formulations available for the treatment of nail fungal infections and psoriasis, and the even fewer effective formulations, was highlighted.

  16. Size and Charge Dependence of Ion Transport in Human Nail Plate.

    Science.gov (United States)

    Baswan, Sudhir M; Li, S Kevin; LaCount, Terri D; Kasting, Gerald B

    2016-03-01

    The electrical properties of human nail plate are poorly characterized yet are a key determinate of the potential to treat nail diseases, such as onychomycosis, using iontophoresis. To address this deficiency, molar conductivities of 17 electrolytes comprising 12 ionic species were determined in hydrated human nail plate in vitro. Cation transport numbers across the nail for 11 of these electrolytes were determined by the electromotive force method. Effective ionic mobilities and diffusivities at infinite dilution for all ionic species were determined by regression analysis. The ratios of diffusivities in nail to those in solution were found to correlate inversely with the hydrodynamic radii of the ions according to a power law relationship having an exponent of -1.75 ± 0.27, a substantially steeper size dependence than observed for similar experiments in skin. Effective diffusivities of cations in nail were 3-fold higher than those of comparably sized anions. These results reflect the strong size and charge selectivity of the nail plate for ionic conduction and diffusion. The analysis implies that efficient transungual iontophoretic delivery of ionized drugs having radii upward of 5 Å (molecular weight, ca. ≥ 340 Da) will require chemical or mechanical alteration of the nail plate. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  17. Controlled nail delivery of a novel lipophilic antifungal agent using various modern drug carrier systems as well as in vitro and ex vivo model systems.

    Science.gov (United States)

    Naumann, Sandy; Meyer, Jean-Philippe; Kiesow, Andreas; Mrestani, Yahya; Wohlrab, Johannes; Neubert, Reinhard H H

    2014-04-28

    The penetration behavior into human nails and animal hoof membranes of a novel antifungal agent (EV-086K) for the treatment of onychomycosis was investigated in this study. The new drug provides a high lipophilicity which is adverse for penetration into nails. Therefore, four different formulations were developed, with particular focus on a colloidal carrier system (CCS) due to its penetration enhancing properties. On the one hand, ex vivo penetration experiments on human nails were performed. Afterwards the human nail plates were cut by cryomicrotome in order to quantify the drug concentration in the dorsal, intermediate and ventral nail layer using high-performance liquid chromatography (HPLC) with UV detection. On the other hand, equine and bovine hoof membranes were used to determine the in vitro penetration of the drug into the acceptor compartment of an online diffusion cell coupled with Fourier transform infrared attenuated total reflectance (FTIR-ATR) spectroscopy. In combination, both results should exhibit a correlation between the EV-086K penetration behavior in human nail plates and animal hoof membranes. The investigations showed that the developed CCS could increase drug delivery through the human nail most compared to other formulations (nail lacquer, solution and hydrogel). Using animal hooves in the online diffusion cell, we were able to calculate pharmacokinetic data of the penetration process, especially diffusion and permeability coefficients. Finally, a qualitative correlation between the penetration results of human nails and equine hooves was established. Copyright © 2014 Elsevier B.V. All rights reserved.

  18. TranScreen-N: Method for rapid screening of trans-ungual drug delivery enhancers.

    Science.gov (United States)

    Murthy, S Narasimha; Vaka, Siva Ram Kiran; Sammeta, Srinivasa Murthy; Nair, Anroop B

    2009-11-01

    Topical monotherapy of nail diseases such as onychomycosis and nail psoriasis has been less successful due to poor permeability of the human nail plate to topically administered drugs. Chemical enhancers are utilized to improve the drug delivery across the nail plate. Choosing the most effective chemical enhancers for the given drug and formulation is highly critical in determining the efficacy of topical therapy of nail diseases. Screening the large pool of enhancers using currently followed diffusion cell experiments would be tedious and expensive. The main objective of this study is to develop TranScreen-N, a high throughput method of screening trans-ungual drug permeation enhancers. It is a rapid microwell plate based method which involves two different treatment procedures; the simultaneous exposure treatment and the sequential exposure treatment. In the present study, several chemicals were evaluated by TranScreen-N and by diffusion studies in the Franz diffusion cell (FDC). Good agreement of in vitro drug delivery data with TranScreen-N data provided validity to the screening technique. In TranScreen-N technique, the enhancers can be grouped according to whether they need to be applied before or simultaneously with drugs (or by either procedures) to enhance the drug delivery across the nail plate. TranScreen-N technique can significantly reduce the cost and duration required to screen trans-ungual drug delivery enhancers. (c) 2009 Wiley-Liss, Inc. and the American Pharmacists Association

  19. Enhancing the nail permeability of topically applied drugs.

    Science.gov (United States)

    Murdan, Sudaxshina

    2008-11-01

    The topical therapy of nail diseases, especially of onychomycosis, and to a smaller extent, of nail psoriasis, is desirable to avoid the side effects associated with their systemic therapy, to increase patient compliance and reduce the cost of treatment. Systemic therapy is however the mainstay of treatment due to the poor permeability of the nail plate to topically applied drugs. For effective topical therapy, ungual drug permeation must be enhanced. This can be achieved by disrupting the nail plate using physical techniques or chemical agents. Alternatively, drug permeation into the intact nail plate may be encouraged, for example, by iontophoresis or by formulating the drug within a vehicle which enables high drug partition out of the vehicle and into the nail plate. The physical techniques (manual and electrical nail abrasion, acid etching, ablation by lasers, microporation, application of low-frequency ultrasound and electric currents) and chemicals (thiols, sulphites, hydrogen peroxide, urea, water, enzymes) that have shown ungual enhancer activity are discussed in this review. Optimal drug formulation, while crucial to ungual drug delivery, is only briefly reviewed due to the limited literature.

  20. [Nail involvement in leprosy].

    Science.gov (United States)

    Belinchón Romero, I; Ramos Rincón, J M; Reyes Rabell, F

    2012-05-01

    Leprosy, a disease caused by Mycobacterium leprae, primarily affects the skin and nerves, but the nails are also involved in as many as 3 out of 4 patients .The factors that trigger nail changes in leprosy are numerous and include repeated trauma, neuropathy, vascular impairment, infections, lepra reactions, and the drugs used to manage the disease. The changes most often reported include subungual hematomas, onycholysis, onychauxis, onychogryphosis, pterygium unguis, and onychoheterotopia, most of which can be attributed to nerve damage and trauma. Furthermore, the acro-osteolysis that occurs in the advanced stages of the disease may present with brachyonychia, racquet nails, or even anonychia. Infections of the nail bed leading to paronychia and onychomycosis should also be taken into account in leprosy. Other typical changes include longitudinal striae, pitting, macrolunula, Terry nails, leukonychia, hapalonychia, and Beau lines. In this review, we describe the principal nail changes associated with leprosy. These changes, which are highly varied and diverse in origin, are in fact a reflection of the significant morbidity caused by M. leprae infection.

  1. Celulitis por Microascus trigonosporus(anamorfo Scopulariopsis trigonospora

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    DELIA CANLE CORTIÑAS

    2013-06-01

    Full Text Available Resumen: Microascus trigonosporus ( anamorfo Scopulariopsis trigonospora es un hongo filamentoso ubicuo que se encuentra en el suelo , plumas de aves, material vegetal e insectos. Aunque Scopulariopsis spp se consideran comúnmente hongos contaminantes , pueden causar ocasionalmente infecciones en humanos, en especial onicomicosis . Excepcionalmente se han descrito infecciones de piel, abscesos cerebrales, endocarditis ,sinusitis e infecciones diseminadas por Scopulariopsis spp , casi siempre en pacientes inmunodeprimidos . En los últimos años se han publicado un mayor número de casos de infecciones oportunistas por Scopulariopsis spp y otros hialohifomicetos multiresistentes. Todavía no está establecido cuál es el mejor régimen de tratamiento para las infecciones por Scopulariopsis spp. Presentamos un caso excepcional de celulitis por Microascus trigonosporus en un paciente con tratamiento prolongado con corticoides. Abstract: Microascus trigonosporus ( Anamorph Scopulariopsis trigonospora is a cosmopolitan filamentous fungus that inhabits soil, feathers ,plant material and insects. While Scopulariopsis is commonly considered as a contaminat fungus it may cause occasionally infections in humans ,especially onychomycosis .Skin lesions, brain abscess , endocarditis, sinusitis and disseminated infections due to Scopulariopsis species have been rarely reported , usually in immunocompromised patients . Over the last few years opportunistic infections by Scopulariopsis species and others multi-resistant hyalohyphomycetes have been increasingly reported . No clear treatment regimen for Scopulariopsis species infections has been established yet. We present a exceptional case of cellulitis due to Microascus trigonosporus in a patient with prolonged steroid therapy.

  2. Cutaneous Mycoses among Rice Farmers in Anambra State, Nigeria

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    Chito Clare Ekwealor

    2013-01-01

    Full Text Available Rice grain is one of the world's most important food crops, and its cultivation is a major occupation in Anambra State, Nigeria. These rice farmers are exposed to various agents that predispose them to cutaneous mycoses. The aim of this work was to screen rice farmers for lesions suggestive of cutaneous mycoses and to isolate and identify fungal agents associated with the infection. This survey was carried out between November 2009 and June 2011 in Anambra State, Nigeria. Clinical samples collected from 201 farmers with lesions suggestive of cutaneous mycoses were processed and the organisms identified. Questionnaires were used to obtain other necessary data and were statistically analyzed. Of the 2,580 rice farmers screened, 201 (7.79% showed positive lesions. Organisms recovered included Microsporum audouinii, Microsporum ferrugineum, Trichophyton megnini, Trichophyton tonsurans, Trichophyton rubrum, Aspergillus terrus, Aspergillus candidus, Aspergillus scleriotorum, Aspergillus niger, Aspergillus flavus, Scopulariopsis sp., Chrysosporium sp., Eupenicillium javanicum, Fusarium sp., Penicillium aculeatum, and Penicillium pinophilum. At the end of this work, onychomycosis was observed to be the most prevalent with nondermatophyte molds now becoming very important agents of cutaneous mycoses among rice farmer.

  3. Antifungal Activity and Nail Permeation of Nail Lacquer Containing Piper regnellii (Miq. C. CD. var. pallescens (C. DC. Yunck (Piperaceae Leave Extracts and Derivatives

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    Andrea Mayumi Koroishi

    2010-06-01

    Full Text Available The dermatophytes are filamentous fungi that cause cutaneous fungal infections because they use keratin as a nutrient source. For this study the antidermatophyte activity of the extracts and derivates from leaves of Piper regnellii was analyzed. From the dichloromethane extract (EBD neolignans such as eupomatenoid-3 and eupomatenoid-5 were obtained, and it was submitted to fractionation to remove the green residue, designated as the chloroform fraction (FF. Extracts, chloroform fraction and compounds were tested against Trichophyton rubrum ATCC 28189 to determine the minimum inhibitory concentration (MIC. The chloroform fraction was incorporated to nail lacquer that was analyzed by photoacoustic spectroscopy, in vitro assay and scanning electronic microscopy. For antifungal activity in solid medium the dichloromethane extract and chloroform fraction were used. The compounds eupomatenoid-3 and eupomatenoid-5 were less active than the dichloromethane extract against T. rubrum. EBD and FF showed moderate activity in hyphal growth inhibition in solid medium and EBD did not link to ergosterol. Nail lacquer containing the chloroform fraction showed good penetration through the nail as determined by photoacoustic spectroscopy. From in vitro studies it was observed that nail lacquer concentrations above 20 mg/mL prevented the growth of fungi, but concentrations up to 2.5 inhibited the growth. Scanning electronic microscopy was used to confirm the in vitro nail lacquer activity results. The specie P. regnellii showed great antifungal activity against T. rubrum, and nail lacquer containing its chloroform fraction has great potential to treat onychomycosis caused by these microorganisms.

  4. A SURVEY OF NAIL INFECTION AND AWARENESS AMONG NON-DIABETIC PATIENTS IN MAURITIUS

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    Jeewon Rajesh

    2013-07-01

    Full Text Available Introduction: Nail infection like onychomycosis is mainly caused by dermatophytes and account for almost half of all nail disorders. Prevalence of nail infection has been attributed to several factors such as age, gender, socioeconomic status and predisposition to diabetes amongst others. This study aims at determining the prevalence and level of awareness of non-diabetics towards nail infections in Mauritius.Material and Methods: A survey was carried out among 471 participants of the non-diabetic population of Mauritius. Data on socio demographic factors, awareness, level of hygiene, family history and quality of life were obtained via questionnaire based studies. Data was analysed using the SPSS software.Results: Results show almost the same ratio of female to male was affected with nail infection but varies gender wise. Participants within the age group 20-60 with less than US 500 monthly income had a higher incidence of nail infection. No significant relation was obtained between nail infection and education level. A significant relationship was obtained between nail infection and occupation as well as quality of life. More than half of participants did not know about the routes of nail infections or the precautions needed to avoid spreading. However, good level of hygiene was observed among the participants.Conclusion: Factors like age, gender and socio economic status had a significant relationship on nail infection. Nail infection affects the Quality of Life (QoL and manual workers or even professionals are prone to nail infections.

  5. [Chronotherapy and relativity theory].

    Science.gov (United States)

    Polishchuk, N A

    2008-01-01

    The course of time itself in alive organisms is treated from positions of the special theory of the relativity created by A. Einstein in 1905 and added by the Nobel winners H.A.Lorentsem, M. Plankom, M. fon Laue. These achievements of fundamental physics have been put in a basis of special medical technology "Resonant chronophytotherapy" (SMT RCPT) which is applied in practice of treatment of chronic diseases for 27 years. Grass tinctures in various dosages are used in SMT RCPT, which patients take once a day during precisely designated time. Parameters "dosage-time" daily vary. SMT RCPT have been conducted in treatment of epilepsy bronchial asthma, rheumatism, sclerodermia, hypertension, chronic glomerulonephritis, vegeto-vascular dystonia, female sterility, circular alopecia, vitiligo, eczema, psoriasis, onychomycosis. SMT RCPT does have adverse events, has no contra-indications to its use, directed, first of all, on elimination of nonspecific signs of a disease, reduces dependence and complications of the use of chemical synthetic preparations. SMT RCPT can be combined with any kind of specific treatment. Internet-variant of SMT RCPT has been developed. Chronomedicine is priority tendency in industrialized countries of the world--the USA, the Great Britain, Germany, France, Russia, China, Japan and appears on lead positions among alternative methods of treatment, both traditional, and non-traditional.

  6. Cutaneous Manifestations in Patients with Chronic Kidney Disease on Maintenance Hemodialysis

    Science.gov (United States)

    Kolla, Praveen Kumar; Desai, Madhav; Pathapati, Ram Mohan; Mastan Valli, B.; Pentyala, Suneetha; Madhusudhan Reddy, G.; Vijaya Mohan Rao, A.

    2012-01-01

    Cutaneous disorders can precede or follow the initiation of hemodialysis treatment. We evaluated the prevalence of various dermatological manifestations in patients undergoing hemodialysis at least twice a week for minimum of three months at our center. Patients were excluded if they were undergoing hemodialysis less than twice a week or on hemodialysis secondary to ESRD following graft dysfunction. One hundred and forty-three patients were evaluated. Among them, there were 113 male and 30 females. Among the skin changes, pruritus accounted for 56%, Xerosis was observed in 52%, Diffuse blackish hyper pigmentation was seen in 40%. Skin infections was seen in 53% of patients, of these fungal, bacterial and viral infections were 27.2%, 14.6%, and 11.2%, respectively. Kyrle's disease was observed only in 6.9%. Other skin manifestations include eczema 4.8%, psoriasis 2.7%, and drug rash 2.1%. Nail changes were observed in 46 patients of whom 27 patients had onychomycosis. Other changes include discoloration, onycholysis, and splinter hemorrhages. Hair changes were observed in 21.7%. Mucosal changes were seen in 27.3%. In our study, pruritus, xerosis, and pigmentation were higher among skin changes. Recognition and management of some of these dermatological manifestations vastly reduce the morbidity and improve the quality of life. PMID:22830039

  7. In vitro model of infected stratum corneum for the efficacy evaluation of poloxamer 407-based formulations of ciclopirox olamine against Trichophyton rubrum as well as differential scanning calorimetry and stability studies.

    Science.gov (United States)

    Täuber, Anja; Müller-Goymann, Christel C

    2015-10-15

    Superficial fungal skin infections are a common disease and concern 20-25% of the world's population with the dermatophyte Trichophyton rubrum being the main trigger. Due to autoinoculation, fungal skin infections of the feet (tinea pedis) often occur simultaneously with fungal nail infections (onychomycosis). Therefore, the overall objective was the development and characterisation of poloxamer 407-based formulations with the antimycotic active ingredient ciclopirox olamine (CPX) for simultaneous antifungal therapy. The formulations consisted of poloxamer 407, water, isopropyl alcohol, propylene glycol and medium chain triglycerides in given ratios. The in vitro antifungal efficacy against T. rubrum was tested in a novel in vitro model of infected stratum corneum in comparison to a marketed semi-solid formulation containing 1% (w/w) ciclopirox olamine and a marketed nail lacquer containing 8% ciclopirox. Several liquid poloxamer 407-based formulations with only 1% CPX completely inhibited fungal growth after 6 days of incubation, whereas the marketed semi-solid formulation did not inhibit fungal growth. Differential scanning calorimetry studies revealing the interaction between the formulations and the SC showed that increasing isopropyl alcohol/propylene glycol concentrations as well as increasing CPX concentrations caused increasing endothermic transition shifts. Moreover, stability studies at 30 °C exhibited only a slight decrease of the CPX amount after 12 months of storage. Each formulation contained >90% of the initial CPX concentration after termination of the stability studies.

  8. Role of nail biopsy as a diagnostic tool

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    Chander Grover

    2012-01-01

    Full Text Available Nail biopsy (NB is an investigation that is not routinely resorted to by most of the dermatologists. The commonly cited reasons are the complexity of the procedure, risk of scarring and the reluctance of the patient. However, in cases with isolated nail psoriasis, isolated nail lichen planus, onychomycosis not confirmed on direct microscopy and culture, or longitudinal melanonychia, the treating dermatologist is left with no choice but to resort to this procedure. Nail as a unit, is capable of projecting only a limited number of clinical manifestations. This is responsible for the more or less similar clinical presentation of many different nail disorders. Hence, a practical knowledge of the indications, appropriate patient selection, procedural details and histopathological interpretation of a NB is a must-have for any practicing dermatologist. The risk of scarring is none to minimal if appropriate type of biopsy is performed, not to mention the wealth of histopathological data that can be retrieved from the nail unit. This article aims to explore the various practical do′s and don′ts for the NB and tells us what to expect from of the procedure.

  9. Evaluation of Cutaneous Manifestations According to the Time in Renal Transplant Recipients

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    Burhan Engin

    2013-05-01

    Full Text Available Background and Design: This study is conducted to determine the prevalence and clinical characteristics of cutaneous manifestations in renal transplant patients.Materials and Methods: Hospital records of 116 renal transplant patients were retrospectively investigated. The data obtained from patients who had 6 months follow-up period were evaluated. There were 68 (58.6% males and 48 (41.4% females aged between 10 and 68 years (mean=36.6 years. Detailed dermatologic examination was performed. The patients were grouped according to gender (male-female, posttransplant period (1-5 years, 5-10 years, >10 years and the drugs used (cyclosporin, tacrolimus, other than these two immunosuppressant drugs.Results: The most common cutaneous manifestations were infectious. The dermatological findings were onychomycosis (13, tinea pedis (9, acneiform disorders (15, and warts (9. The clinical evaluation after 6 months has also demonstrated the same result. Among the evaluated patients, 7% showed premalignant or malignant manifestations on clinical examination. According to the results obtained from the patient groups, it was found that gender, length of post-transplant period, and use of immunosuppressant drugs do not influence the clinical manifestations of patients.Conclusion: Dermatologic examinations and long-term follow-up should be performed in renal transplant patients.

  10. Investigation of a cluster of Candida albicans invasive Candidiasis in a neonatal intensive care unit by pulsed-field gel electrophoresis.

    Science.gov (United States)

    Ben Abdeljelil, Jihene; Saghrouni, Fatma; Khammari, Imene; Gheith, Soukeina; Fathallah, Akila; Ben Said, Moncef; Boukadida, Jalel

    2012-01-01

    Nosocomial invasive candidiasis (IC) has emerged as a major problem in neonatal intensive care units (NICUs). We investigated herein the temporal clustering of six cases of neonatal IC due to Candida albicans in an NICU. Eighteen isolates obtained from the six neonates and two isolates from two health care workers (HCWs) working at the same unit and suffering from fingers' onychomycosis were genotyped by electrophoretic karyotyping (EK) and restriction endonuclease analysis of genomic DNA by using Sfi I (PFGE-Sfi I). PFGE-Sfi I was more effective in discriminating between temporally related isolates. It showed that (i) both HCWs had specific strains excluding them as a source of infections in neonates. (ii) Isolates collected from three neonates were identical providing evidence of their clonal origin and the occurrence of a horizontal transmission of C. albicans in the unit. (iii) The three remaining neonates had specific strains confirming that the IC cases were coincidental. (iv) Microevolution occurred in one catheter-related candidemia case. Our results illustrate the relevance of the molecular approach to investigate suspected outbreaks in hospital surveys and the effectiveness of PFGE-Sfi I for typing of epidemiologically related C. albicans isolates.

  11. Systemic neonatal candidosis: the karyotyping of Candida albicans strains isolated from neonates and health-workers.

    Science.gov (United States)

    Ben Abdeljelil, J; Ben Saida, N; Saghrouni, F; Fathallah, A; Boukadida, J; Sboui, H; Ben Said, M

    2010-01-01

    Candida albicans has become an important cause of nosocomial infections in neonatal intensive care units (NICUs). The aim of the present study was to compare C. albicans strains isolated from neonates (NN) suffering from systemic candidosis and from nurses in order to determine the relatedness between NN and health workers' strains. Thirty-one C. albicans strains were isolated from 18 NN admitted to the NICU of the neonatology service of Farhat Hached Hospital of Sousse, Tunisia and suffering from systemic candidosis, together with five strains recovered from nurses suffering from C. albicans onychomycosis. Two additional strains were tested, one from an adult patient who developed a systemic candidosis and the second from an adult with inguinal intertrigo. All strains were karyotyped by pulsed-field gel electrophoresis (PFGE) with a CHEF-DR II system. Analysis of PFGE patterns yielded by the 38 strains tested led to the identification of three pulsotypes that were designated I, II and III, and consisted of six chromosomal bands with a size ranging from 700 to >2500 kbp. The most widespread was the pulsotype I, which was shared by 17 NN and the five nurses' strains. The identity between NN and nurses' strains is very suggestive of a nosocomial acquisition from health-workers.

  12. Temporal similarity between Candida albicans genotypes in a Tunisian neonatal intensive care unit suggests several nosocomial cross-contamination episodes.

    Science.gov (United States)

    Ben Abdeljelil, Jihene; Saghrouni, Fatma; Cabaret, Odile; Boukadida, Jalel; Bretagne, Stéphane; Ben Saïd, Moncef

    2012-07-01

    The nosocomial transmission of Candida albicans in neonatal intensive care units (NICUs) is an increasing concern and understanding the route of this transmission is critical for adequate infection control measures. The aim of our study was to assess the likeliness of nosocomial acquisition of C. albicans in the NICU of Farhat Hached hospital in Sousse (Tunisia). We genotyped 82 isolates from 40 neonates and 7 isolates from 5 health care workers (HCWs) with onychomycosis, by using CDC3 microsatellite length polymorphism (MLP) and the high-resolution melting (HRM) analysis. Combined MLP and HRM CD3 analysis led to the delineation of 12 genotypes. Five temporal clustering caused by five genotypes occurred during the study period. Three of these genotypes were isolated in both neonates and HCWs. The first clustering included 28 isolates obtained between January 2003 and May 2004 from 16 neonates and 2 HCWs. The second clustering included three isolates collected in 2004 from three neonates and two HCWs. The third clustering included 11 isolates obtained from 6 neonates and 1 HCW in 2006. The two remaining clustering could not be associated with any HCW's contamination. These results argue for the nosocomial transmission of C. albicans in our NICU. The combined MLP and HRM analysis is a rapid first approach for tracking cross-contamination.

  13. Trichophyton onychocola sp. nov. isolated from human nail.

    Science.gov (United States)

    Hubka, Vit; Cmokova, Adela; Skorepova, Magdalena; Mikula, Peter; Kolarik, Miroslav

    2014-04-01

    A previously undescribed Trichophyton species was isolated from the nail of a 33-year-old man with a history of probable distal lateral subungual onychomycosis (without confirmation by mycological examination). The infection occurred for the first time five years earlier (in 2006) and affected the right great toenail, with complete clinical remission after treatment with ciclopirox olamine. This undescribed species was isolated during probable relapse in 2011, but its etiological significance was not confirmed, that is, direct microscopy was negative and additional clinical samples were not collected. The species is probably geophilic based on phylogenetic analysis (internal transcribed spacer [ITS] rDNA) and is most closely related to the anamorphic T. thuringiense, homothallic Arthroderma ciferrii (anamorph T. georgiae), and heterothallic A. melis. The new species is characterized by yellowish colonies, red reverse on several media, positive urease test, negative hair-perforation test, absence of growth at 34°C, absence of macroconidia, formation of one-celled clavate microconidia, and spiral hyphae. The species grows well on sterilized human hairs placed on agar medium without any additional nutrients and forms gymnothecium-like structures covered by peridial hyphae. The combination of unique micro- and macromorphological features and physiological and sequence data from four unlinked loci (ITS, benA, RPB2, and act1 gene) justified the proposal of a new species T. onychocola sp. nov.

  14. NOSOCOMIAL URINARY TRACT INFECTION DUE TO TRICHOSPO RON ASAHII: A RARE CASE REPORT

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    Kumudini

    2012-12-01

    Full Text Available ABSTRACT: Trichosporon asahii is a basidiomycetous yeast which causes white piedra and onychomycosis in immunocompetent hosts. In immunocom promised hosts this species may cause a number of localized and disseminated infect ions. Urinary tract infection by Trichosporon asahii is a rare occurrence .Few cases have been reported from India. We present a microbiologically confirmed urinary tract infecti on with T. asahii in a 52 year old diabetic, female patient who had undergone hysterectomy for dy sfunctional uterine bleeding. Her urine sample was subjected to culture and sensitivity for postoperative rigor. Gram stain examination of the centrifuged urine revealed septate hyphae with arthroconidia and pus cells. Yeast like fungus was isolated in pure culture in three consecu tive samples which was confirmed as Trichosporon asahii by standard tests. The response to antifungal therapy was dramatic. Trichosporon species though occasionally a part of nor mal flora, may be involved in causing nosocomial opportunistic infection more so in immunoc ompromised hosts. Very few cases of microbiologically confirmed urinary tract infection have been reported so far. Its diagnosis is likely to be missed or misinterpreted because of lac k of awareness. Therefore T. asahii deserves recognition as a pathogen

  15. A Case of Follicular Occlusion Triad%毛囊闭锁三联征1例

    Institute of Scientific and Technical Information of China (English)

    郭生红; 彭科; 王婷婷; 汪盛; 李薇

    2012-01-01

    患者男,33岁,头面部反复粉刺、丘疹、结节、脓肿伴破溃10年,累及颈部、腋窝、臀部6年.红肿皮损组织病理检查示;表皮呈假上皮瘤样增生,真皮内弥漫性浆细胞、较多淋巴细胞、中性粒细胞浸润.诊断:毛囊闭锁三联征;库欣综合征;糖尿病;体癣;甲真菌病;脂肪肝;骨质疏松症;低蛋白血症.子敏感抗生素、维甲酸类、性激素、手术治疗、理疗及对症支持等治疗,疗效较好.%A 33-year-old male had recurrent comedones, papules, nodules, abscesses with uleeration on the head and face for 10 years, and involved his neek, axillary fossa and gluteal region for6 years. Hislopathology examination showed pseudoepithpliomatous hyperplasia in the epidermis and plasmaeytes, lymphocytes and neutro-phils infdlralion in the dermis. The diagnosis was follicular occlusion triad, compliraled vvith cushing syndrome, diabetes mellitus, tinea corporis, onychomycosis, fatly liver, osteoporosis and hypoproteinemia. Thf patient got improvmenl after receicing treatment with sensitive antibiotics, retinoid, sex hormone, surgery, physiotherapy etc.

  16. Skin Conditions in Patients with Human Immunodeficiency Virus

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    Yoan Bernárdez Cruz

    2015-12-01

    Full Text Available Background: patients with human immunodeficiency virus frequently develop skin conditions that affect their quality of life and modify their prognosis. Objective: to describe the most common skin conditions in patients with human immunodeficiency virus. Methods: a case-series study of patients with human immunodeficiency virus was conducted in the province of Cienfuegos. It included all patients diagnosed until February 2008 attending the internal medicine consultation for their follow-up. Forty-seven deceased patients, 12 patients not living in the province and 2 inmates were excluded from the study. Variables analyzed were: age, sex, skin color, self-reported skin conditions and diagnosed skin diseases. Results: Thirty-eight percent of patients were aged 25 to 34 years. Fifty-seven were white-skinned and 75% were male. Approximately half of the patients had AIDS and were under antiretroviral therapy. The skin infection of viral origin most commonly found was herpes simplex (30.0%; of fungal origin, onychomycosis (44 %; and of bacterial origin, folliculitis (43 %. Among papulosquamous disorders, seborrheic dermatitis (74 % predominated and among other skin disorders, lipodystrophy (23.6 %. Xerosis and pruritus shared equal percentage (16.3 %. Conclusions: viral and fungal skin infections predominated. An important number of these skin conditions were diagnosed during the study, particularly in AIDS patients.

  17. Recent Advances In Topical Therapy In Dermatology

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    Mohan Thappa Devinder

    2003-01-01

    Full Text Available With changing times various newer topical agents are introduced in the field of dermatology. Tacrolimus and pimecrolimus are immunisuppressants, which are effective topically and are tried in the management of atopic dermatitis as well as other disorders including allergic contact dermatitis, atrophic lichen planus, pyoderma gangrenosum. Imiquimod, an immune response modifier, is presently in use for genital warts but has potentials as anti- tumour agent and in various other dermatological conditions when used topically. Tazarotene is a newer addition to the list of topical reginoids, which is effective in psoriasis and has better effect in combination with calcipotriene, phototherapy and topical costicosteroids. Tazarotene and adapelene are also effective in inflammatory acne. Calcipotriol, a vitamin D analogue has been introduced as a topical agent in the treatment of psoriasis. Steroid components are also developed recently which will be devoid of the side effects but having adequate anti-inflammatory effect. Topical photodynamic therapy has also a wide range of use in dermatology. Newer topical agents including cidofovir, capsaicin, topical sensitizers, topical antifungal agents for onychomycosis are also of use in clinical practice. Other promising developments include skin substitutes and growth factors for wound care.

  18. Heat profiles of laser-irradiated nails.

    Science.gov (United States)

    Paasch, Uwe; Nenoff, Pietro; Seitz, Anna-Theresa; Wagner, Justinus A; Kendler, Michael; Simon, Jan C; Grunewald, Sonja

    2014-01-01

    Onychomycosis is a worldwide problem with no tendency for self-healing, and existing systemic treatments achieve disease-free nails in only 35 to 76% of cases. Recently, treatment of nail fungus with a near-infrared laser has been introduced. It is assumed that fungal eradication is mediated by local heat. To investigate if laser treatment has the potential to eradicate fungal hyphae and arthrospores, laser heat application and propagation needs to be studied in detail. This study aimed to measure nail temperatures using real-time videothermography during laser irradiation. Treatment was performed using 808- and 980-nm linear scanning diode lasers developed for hair removal, enabling contact-free homogeneous irradiation of a human nail plate in one pass. Average and peak temperatures increased pass by pass, while the laser beam moved along the nail plates. The achieved mean peak temperatures (808 nm: 74.1 to 112.4°C, 980 nm: 45.8 to 53.5°C), as well as the elevation of average temperatures (808 nm: 29.5 to 38.2°C, 980 nm: 27.1 to 32.6°C) were associated with pain that was equivalent to that of hair removal procedures and was not significantly different for various wavelengths. The linear scanning laser devices provide the benefits of contact-free homogeneous heating of the human nail while ensuring adequate temperature rises.

  19. Disease severity scoring systems in dermatology

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    Cemal Bilaç

    2016-06-01

    Full Text Available Scoring systems have been developed to interpret the disease severity objectively by evaluating the parameters of the disease. Body surface area, visual analogue scale, and physician global assessment are the most frequently used scoring systems for evaluating the clinical severity of the dermatological diseases. Apart from these scoring systems, many specific scoring systems for many dermatological diseases, including acne (acne vulgaris, acne scars, alopecia (androgenetic alopecia, tractional alopecia, bullous diseases (autoimmune bullous diseases, toxic epidermal necrolysis, dermatitis (atopic dermatitis, contact dermatitis, dyshidrotic eczema, hidradenitis suppurativa, hirsutismus, connective tissue diseases (dermatomyositis, skin involvement of systemic lupus erythematosus (LE, discoid LE, scleroderma, lichen planoplaris, mastocytosis, melanocytic lesions, melasma, onychomycosis, oral lichen planus, pityriasis rosea, psoriasis (psoriasis vulgaris, psoriatic arthritis, nail psoriasis, sarcoidosis, urticaria, and vitiligo, have also been developed. Disease severity scoring methods are ever more extensively used in the field of dermatology for clinical practice to form an opinion about the prognosis by determining the disease severity; to decide on the most suitable treatment modality for the patient; to evaluate the efficacy of the applied medication; and to compare the efficiency of different treatment methods in clinical studies.

  20. Application of Hansen Solubility Parameters to predict drug-nail interactions, which can assist the design of nail medicines.

    Science.gov (United States)

    Hossin, B; Rizi, K; Murdan, S

    2016-05-01

    We hypothesised that Hansen Solubility Parameters (HSPs) can be used to predict drug-nail affinities. Our aims were to: (i) determine the HSPs (δD, δP, δH) of the nail plate, the hoof membrane (a model for the nail plate), and of the drugs terbinafine HCl, amorolfine HCl, ciclopirox olamine and efinaconazole, by measuring their swelling/solubility in organic liquids, (ii) predict nail-drug interactions by comparing drug and nail HSPs, and (iii) evaluate the accuracy of these predictions using literature reports of experimentally-determined affinities of these drugs for keratin, the main constituent of the nail plate and hoof. Many solvents caused no change in the mass of nail plates, a few solvents deswelled the nail, while others swelled the nail to varying extents. Fingernail and toenail HSPs were almost the same, while hoof HSPs were similar, except for a slightly lower δP. High nail-terbinafine HCl, nail-amorolfine HCl and nail-ciclopirox olamine affinities, and low nail-efinaconazole affinities were then predicted, and found to accurately match experimental reports of these drugs' affinities to keratin. We therefore propose that drug and nail Hansen Solubility Parameters may be used to predict drug-nail interactions, and that these results can assist in the design of drugs for the treatment of nail diseases, such as onychomycosis and psoriasis. To our knowledge, this is the first report of the application of HSPs in ungual research.

  1. [Treatment of onychomycoses].

    Science.gov (United States)

    Halmy, Klára

    2003-10-12

    The author reviews the prevalence of onychomycoses and the factors influencing it. Among the precipitating factors, age and various predisposing diseases play a role in the development of the disease play a role in the development of the disease. The problem affects the toenails more frequently than the fingernails. Distal subungual onychomycosis caused by dermatophytons is most often seen among the various types of the disease. Yeasts and moulds mainly act as contaminants. New diagnostic methods facilitate more precise diagnosis but they cannot replace basic mycological investigations. Orally administered antifungal agents have appeared in the foreground of treatment. Among them fluconazole, itraconazole and terbinafin derivatives can safely be applied in combination with certain cauterants. Each of the three agents are effective in approximately 70-80% of cases, especially when applied on fingernails. Combined therapy, such as the application of oral antimycotics and antifungal lacquerers or oral treatment accompanied by the surgical, laser or chemical removal of the affected nail regions, can improve the results. Surviving fungal residues in the substance of the nail may restart the disease. Relapse may also be attributed to neglecting the desinfection of shoes. When choosing the drugs, drug interaction should also be considered. The above three oral antimycotics have few (1-20%) side effects, gastrointestinal ones being the most common among them. A transitory elevation in hepatic enzyme levels may sometimes occur but the changes go back to normal after treatment is over.

  2. The Malassezia Genus in Skin and Systemic Diseases

    Science.gov (United States)

    Magiatis, Prokopios; Hantschke, Markus; Bassukas, Ioannis D.; Velegraki, Aristea

    2012-01-01

    Summary: In the last 15 years, the genus Malassezia has been a topic of intense basic research on taxonomy, physiology, biochemistry, ecology, immunology, and metabolomics. Currently, the genus encompasses 14 species. The 1996 revision of the genus resulted in seven accepted taxa: M. furfur, M. pachydermatis, M. sympodialis, M. globosa, M. obtusa, M. restricta, and M. slooffiae. In the last decade, seven new taxa isolated from healthy and lesional human and animal skin have been accepted: M. dermatis, M. japonica, M. yamatoensis, M. nana, M. caprae, M. equina, and M. cuniculi. However, forthcoming multidisciplinary research is expected to show the etiopathological relationships between these new species and skin diseases. Hitherto, basic and clinical research has established etiological links between Malassezia yeasts, pityriasis versicolor, and sepsis of neonates and immunocompromised individuals. Their role in aggravating seborrheic dermatitis, dandruff, folliculitis, and onychomycosis, though often supported by histopathological evidence and favorable antifungal therapeutic outcomes, remains under investigation. A close association between skin and Malassezia IgE binding allergens in atopic eczema has been shown, while laboratory data support a role in psoriasis exacerbations. Finally, metabolomic research resulted in the proposal of a hypothesis on the contribution of Malassezia-synthesized aryl hydrocarbon receptor (AhR) ligands to basal cell carcinoma through UV radiation-induced carcinogenesis. PMID:22232373

  3. Glycolic Acid peels for nail rejuvenation.

    Science.gov (United States)

    Banga, Gurvinder; Patel, Kalpana

    2014-01-01

    With the increasing use of nail paints, nail art, acetone, repeated manicures, cosmetic nail procedures and detergents, the nail plate undergoes regular damage resulting in rough, lusterless and pigmented nails. Besides that onychomycosis, nail lichen planus, nail pitting and ridging due to various diseases also cause cosmetically disfiguring nails. The study is directed toward use of 70% glycolic acid for controlled keratolysis of the nail-plate, resulting that could result in shinier, smoother and brighter nails. A prospective single-center open-label uncontrolled study of 31 patients, 22 with dry, rough, discolored nails and 9 with hyperkeratotic nails were included in the study group. After examination and ruling out any infection, petroleum jelly was applied on the cuticle margins of the nails for protection and 70% glycolic acid was applied over the nail plate for 45 minutes. In dry rough discolored nails, only a single sitting was done while in hyper-keratotic nail conditions multiple weekly sittings were done. In 22 patients with dry rough nails, 80% showed good improvement, 10% showed average improvement, whereas 10% were non-responsive. Nine patients with thickened nail plate showed good improvement in 60% average improvement in 25% improvement and 15% were non-responsive, after multiple sessions. Controlled keratolysis of the nail plate with application of 70% glycolic acid can be a promising treatment for modality for thick, uneven, rough and pigmented nail-plate conditions with cosmetically pleasing results.

  4. The spectrum of cutaneous infection in diabetic patients with hepatitis C virus infection: A single-center study from Egypt

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    Mohamed A El-Khalawany

    2014-01-01

    Full Text Available Context: Hepatitis-C virus (HCV infection and diabetes mellitus (DM have a significant association with skin disorders. Aims: The aim of this study was to assess the impact of HCV infection on the pattern of cutaneous infections among diabetic patients. Methods and Material: A prospective study included diabetic patients who attended Al-Hussein University hospital, Cairo during the period from 2008 to 2010. Patients were examined for skin infections, and investigated for HCV infection. Statistical Analysis Used: SPSS (version 11.5. Results: The study included 163 patients (102 males and 61 females with a mean age of 46.2 ± 4.83 years. Ninety five patients (58.3% were HCV+ve (group A while 68 patients (41.8% were HCV-ve (group B. Skin infections in group A included fungal (48.4%, viral (26.3%, bacterial (22.1% and parasitic (3.2% while in group B, the spectrum included bacterial (41.2%, fungal (39.7%, viral (11.7% and parasitic (7.4%. Onychomycosis was the commonest infection in group A (25.2% compared with folliculitis in group B (19.1%. Cutaneous infections in HCV+ patients were more characterized by increased severity, aggressive course, resistance to treatment and rapid relapse. Conclusions: HCV infection has a significant impact in increasing and changing the spectrum of skin infections in diabetic patients. Severe and resistant infections in diabetics could be an important sign of HCV infection.

  5. Antifungal activity of nanocapsule suspensions containing tea tree oil on the growth of Trichophyton rubrum.

    Science.gov (United States)

    Flores, F C; de Lima, J A; Ribeiro, R F; Alves, S H; Rolim, C M B; Beck, R C R; da Silva, Cristiane Bona

    2013-04-01

    The aim of this study was to evaluate, for the first time, the antifungal efficacy of nanocapsules and nanoemulsions containing Melaleuca alternifolia essential oil (tea tree oil) in an onychomycosis model. The antifungal activity of nanostructured formulations was evaluated against Trichophyton rubrum in two different in vitro models of dermatophyte nail infection. First, nail powder was infected with T. rubrum in a 96-well plate and then treated with the formulations. After 7 and 14 days, cell viability was verified. The plate counts for the samples were 2.37, 1.45 and 1.0 log CFU mL(-1) (emulsion, nanoemulsion containing tea tree oil and nanocapsules containing tea tree oil, respectively). A second model employed nails fragments which were infected with the microorganism and treated with the formulations. The diameter of fungal colony was measured. The areas obtained were 2.88 ± 2.08 mm(2), 14.59 ± 2.01 mm(2), 40.98 ± 2.76 mm(2) and 38.72 ± 1.22 mm(2) for the nanocapsules containing tea tree oil, nanoemulsion containing tea tree oil, emulsion and untreated nail, respectively. Nail infection models demonstrated the ability of the formulations to reduce T. rubrum growth, with the inclusion of oil in nanocapsules being most efficient.

  6. Nail abnormalities in patients with vitiligo*

    Science.gov (United States)

    Topal, Ilteris Oguz; Gungor, Sule; Kocaturk, Ozgur Emek; Duman, Hatice; Durmuscan, Mustafa

    2016-01-01

    Background Vitiligo is an acquired pigmentary skin disorder affecting 0.1-4% of the general population. The nails may be affected in patients with an autoimmune disease such as psoriasis, and in those with alopecia areata. It has been suggested that nail abnormalities should be apparent in vitiligo patients. Objective We sought to document the frequency and clinical presentation of nail abnormalities in vitiligo patients compared to healthy volunteers. We also examined the correlations between nail abnormalities and various clinical parameters. Methods This study included 100 vitiligo patients and 100 healthy subjects. Full medical histories were collected from the subjects, who underwent thorough general and nail examinations. All nail changes were noted. In the event of clinical suspicion of a fungal infection, additional mycological investigations were performed. Results Nail abnormalities were more prevalent in the patients (78%) than in the controls (55%) (p=0.001). Longitudinal ridging was the most common finding (42%), followed by (in descending order): leukonychia, an absent lunula, onycholysis, nail bed pallor, onychomycosis, splinter hemorrhage and nail plate thinning. The frequency of longitudinal ridging was significantly higher in patients than in controls (p<0.001). Conclusions Nail abnormalities were more prevalent in vitiligo patients than in controls. Systematic examination of the nails in such patients is useful because nail abnormalities are frequent. However, the causes of such abnormalities require further study. Longitudinal ridging and leukonychia were the most common abnormalities observed in this study. PMID:27579738

  7. A metoprolol-terbinafine combination induced bradycardia.

    Science.gov (United States)

    Bebawi, Emmanuel; Jouni, Suhail S; Tessier, Andrée-Anne; Frenette, Anne Julie; Brindamour, Dave; Doré, Maxime

    2015-09-01

    To report a sinus bradycardia induced by metoprolol and terbinafine drug-drug interaction and its management. A 63 year-old Caucasian man on metoprolol 200 mg/day for stable coronary artery disease was prescribed a 90-day course of oral terbinafine 250 mg/day for onychomycosis. On the 49th day of terbinafine therapy, he was brought to the emergency room for a decrease of his global health status, confusion and falls. The electrocardiogram revealed a 37 beats/min sinus bradycardia. A score of 7 on the Naranjo adverse drug reaction probability scale indicates a probable relationship between the patient's sinus bradycardia and the drug interaction between metoprolol and terbinafine. The heart rate ameliorated first with a decrease in the dose of metoprolol. It was subsequently changed to bisoprolol and the heart rate remained normal. By inhibiting the cytochrome P450 2D6, terbinafine had decreased metoprolol's clearance, leading in metoprolol accumulation which has resulted in clinically significant sinus bradycardia.

  8. [Cutaneous Malassezia infections and Malassezia associated dermatoses: An update].

    Science.gov (United States)

    Nenoff, P; Krüger, C; Mayser, P

    2015-06-01

    The lipophilic yeast fungus Malassezia (M.) spp. is the only fungal genus or species which is part of the physiological human microbiome. Today, at least 14 different Malassezia species are known; most of them can only be identified using molecular biological techniques. As a facultative pathogenic microorganism, Malassezia represents the causative agent both of superficial cutaneous infections and of blood stream infections. Pityriasis versicolor is the probably most frequent infection caused by Malassezia. Less common, Malassezia folliculitis occurs. There is only an episodic report on Malassezia-induced onychomycosis. Seborrhoeic dermatitis represents a Malassezia-associated inflammatory dermatosis. In addition, Malassezia allergenes should be considered as the trigger of "Head-Neck"-type atopic dermatitis. Ketoconazole possesses the strongest in vitro activity against Malassezia, and represents the treatment of choice for topical therapy of pityriasis versicolor. Alternatives include other azole antifungals but also the allylamine terbinafine and the hydroxypyridone antifungal agent ciclopirox olamine. "Antiseborrhoeic" agents, e.g. zinc pyrithione, selenium disulfide, and salicylic acid, are also effective in pityriasis versicolor. The drug of choice for oral treatment of pityriasis versicolor is itraconazole; an effective alternative represents fluconazole. Seborrhoeic dermatitis is best treated with topical medication, including topical corticosteroids and antifungal agents like ketoconazole or sertaconazole. Calcineurin inhibitors, e.g. pimecrolimus and tacrolimus, are reliable in seborrhoeic dermatitis, however are used off-label.

  9. Infectious endotheliitis: a rare case of presumed mycotic origin

    Science.gov (United States)

    Zapata, Luis Fernando; Paulo, José David; Restrepo, Carlos A; Velásquez, Luis Fernando; Montoya, Andrés E Toro; Zapata, Melissa A

    2013-01-01

    Purpose To report an interesting case of infectious endotheliitis of presumed mycotic origin. Methods A case report of a 56-year-old male farmer who sought medical attention after a month-long evolution of irritative symptoms in his right eye, accompanied by visual acuity (VA) impairment. The patient received topical and oral broad-spectrum antibiotic treatment with no improvement before being referred to a cornea specialist, where he was found to have VA of 20/150 and was noted on biomicroscopy to have endothelial feathery coalescent lesions. The patient was admitted to the hospital for an aqueous humor sample and intravenous voriconazole. Results The microbiological studies did not isolate any micro-organisms. However, clinical evidence of improvement was confirmed after 5 days of antimycotic intravenous therapy. Complete clinical resolution was achieved at 1 month after treatment completion with oral voriconazole, as evidenced by VA of 20/20 and disappearance of endothelial lesions. Conclusion Endothelial involvement by fungi is a rare condition. In this case, no microbes were isolated, but the characteristic morphology of the lesions, the history of onychomycosis, and the spectacular response to voriconazole turn this case into a valid presumptive diagnosis. PMID:23901253

  10. Doubly robust and multiple-imputation-based generalized estimating equations.

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    Birhanu, Teshome; Molenberghs, Geert; Sotto, Cristina; Kenward, Michael G

    2011-03-01

    Generalized estimating equations (GEE), proposed by Liang and Zeger (1986), provide a popular method to analyze correlated non-Gaussian data. When data are incomplete, the GEE method suffers from its frequentist nature and inferences under this method are valid only under the strong assumption that the missing data are missing completely at random. When response data are missing at random, two modifications of GEE can be considered, based on inverse-probability weighting or on multiple imputation. The weighted GEE (WGEE) method involves weighting observations by the inverse of their probability of being observed. Imputation methods involve filling in missing observations with values predicted by an assumed imputation model, multiple times. The so-called doubly robust (DR) methods involve both a model for the weights and a predictive model for the missing observations given the observed ones. To yield consistent estimates, WGEE needs correct specification of the dropout model while imputation-based methodology needs a correctly specified imputation model. DR methods need correct specification of either the weight or the predictive model, but not necessarily both. Focusing on incomplete binary repeated measures, we study the relative performance of the singly robust and doubly robust versions of GEE in a variety of correctly and incorrectly specified models using simulation studies. Data from a clinical trial in onychomycosis further illustrate the method.

  11. Survey of mycotic infection in patients with AIDS

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    Kazemi A

    1998-07-01

    Full Text Available In an attempt to investigate the fungous infections of AIDS stricken patients, a study which lasted 1.5 years was conducted, in which 21 patients were examined. The subjects were 20 males and a female. One of the male patients was from Uganda, another was an intravenous drug addict, and one had been abroad for sometimes and had received blood there. All other patients had also blood transfusion instances before 1984. To do the research, 414 laboratory specimens were gathered and examined regarding fungus involvement. The result showed 104 negative and 310 positive cases. Based on these findings and also clinical examination, all patients suffered from one or more fungous infections in the forms of oral candidiasis, perleche, candidal onychomycosis, perianal candidiasis, mucocutaneous candidiasis, tinea versicolor, pityrosporosis and rhodotrulosis. The latter caused skin lesion with scaling and is being reported for the first time. Candida parapsilosis and trichosporon pololans were also isolated specimens. However, concerning the diagnostic value of trichosporon pololans more investigation is needed.

  12. The frequency of superficial mycoses according to agents isolated during a ten-year period (1999-2008) in Zagreb area, Croatia.

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    Miklić, Paola; Skerlev, Mihael; Budimcić, Dragomir; Lipozencić, Jasna

    2010-01-01

    Fungal infections involving the skin, hair and nails represent one of the most common mucocutaneous infections. Significant changes in the epidemiology, etiology and clinical pattern of mycotic infections have been observed during the last years. The aim of this retrospective study was to determine the incidence and the etiologic factors of superficial fungal infections in Zagreb area, Croatia, over a 10-year period (1999-2008). A total of 75828 samples obtained from 67 983 patients were analyzed. Dermatomycosis was verified by culture in 17410 (23%) samples obtained from 16086 patients. Female patients were more commonly affected than male (59% vs. 41%). Dermatophytes were responsible for 63% of all superficial fungal infections, followed by yeasts (36%) and molds (1%). Trichophyton (T.) mentagrophytes (both var. interdigitalis and var. granulosa) was the most frequent dermatophyte isolated in 58% of all samples, followed by Microsporum (M). canis (29%) and T. rubrum (10%). The most common clinical forms of dermatomycosis were onychomycosis (41%), tinea corporis (17%) and tinea pedis (12%). Candida spp. was mainly isolated from fingernail debris.

  13. [Mycoses frequency in three communities in the North mountain of the State of Puebla].

    Science.gov (United States)

    Méndez-Tovar, Luis Javier; Lemini-López, Alicia; Hernández-Hernández, Francisca; Manzano-Gayosso, Patricia; Blancas-Espinosa, Roberto; López-Martínez, Rubén

    2003-01-01

    In order to know mycosis frequency in the North of the State of Puebla, Mexico, in habitants from the communities of Ayotoxco, Mazatepec and Zacatipan were studied. Previous medical study biological samples were submitted to direct examination, smear and culture. Histoplasmin and sporotrichin skin test were applied to 57 individual from Zacatipan. From 110 patients 146 mycological studies were performed. Eighty six cases (59%) of mycosis were detected: 43 finger or toenails onychomycosis, 25 tinea pedis, seven tinea capitis, four cases of tinea manum and, finally, five cases of seborrhoeic dermatitis and two of pitiriasis versicolor. We isolated: 18 streins of dermatophytes, mainly Trichophyton rubrum and T. mentagrophytes (11 and 5 strains respectively); 12 cultures of non-dermatophytes filamentous fungi; six cases of mycelia sterile; six yeast strains, most of them Candida spp but none C. albicans. From 57 patients to whom skin tests were applied, five of them (8.8%) were positive to both antigens; ten positive (17.6%) only to histoplasmin and eight (14%) to sporotrichin. This study showed that rural population from Puebla present a high frequency of superficial mycosis (61% of mycological studies). Considering the percentage of positive skin test we suppose that there are many not diagnosed sporotrichosis and histoplasmosis cases.

  14. Skin Findings in Renal Transplantation Patients

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    Demet Kartal

    2013-03-01

    Full Text Available Objective: It was aimed to identify skin findings those were seen in patients who undergone renal transplantation. Methods: Patients who have been followed in Erciyes University Nephrology Hospital renal transplantation outpatient clinic were included in the study. They were evaluated for dermatologic findings during routine controls. Age, gender, transplantation date, identity of organ donor, history of medications, dermatological history and dermatological findings during examination were recorded. Biopsy was performed when needed. Results: In total 94 patients, 25 female (26.6% and 69 male (73.4%, were recruited to the study. Mean age was 36±10 years. The most frequent skin finding was drug-related acne (n=20. Most common infectious disease was verruca (n=17. There were viral disease other than verruca such as herpes zoster (n=3, superficial mycosis such as onychomycosis (n=5, tinea versicolor, tinea pedis and bacterial skin disease (n=2, and paronychia (n=1 and pre-malign lesions such as actinic cheilitis and bowenoid papulosis. Besides these, stria (n=3, kserosis (n=2, cornu cutaneum, café-au-lait spots, sebaceous hyperplasia and seborrheic dermatitis, skin tag, hypertrichosis, unguis incarinatus and calcinosis were other skin findings those were seen. No malign skin lesion was observed in any of patients. Conclusion: Miscellaneous skin lesions should develop in patients those undergone renal transplantation due to long-term utilization of various immunosuppressive drugs.

  15. Spectrum of Fusarium infections in tropical dermatology evidenced by multilocus sequencing typing diagnostics.

    Science.gov (United States)

    van Diepeningen, Anne D; Feng, Peiying; Ahmed, Sarah; Sudhadham, Montarop; Bunyaratavej, Sumanas; de Hoog, G Sybren

    2015-01-01

    Fusarium species are emerging causative agents of superficial, cutaneous and systemic human infections. In a study of the prevalence and genetic diversity of 464 fungal isolates from a dermatological ward in Thailand, 44 strains (9.5%) proved to belong to the genus Fusarium. Species identification was based on sequencing a portion of translation elongation factor 1-alpha (tef1-α), rDNA internal transcribed spacer and RNA-dependent polymerase subunit II (rpb2). Our results revealed that 37 isolates (84%) belonged to the Fusarium solani species complex (FSSC), one strain matched with Fusarium oxysporum (FOSC) complex 33, while six others belonged to the Fusarium incarnatum-equiseti species complex. Within the FSSC two predominant clusters represented Fusarium falciforme and recently described F. keratoplasticum. No gender differences in susceptibility to Fusarium were noted, but infections on the right side of the body prevailed. Eighty-nine per cent of the Fusarium isolates were involved in onychomycosis, while the remaining ones caused paronychia or severe tinea pedis. Comparing literature data, superficial infections by FSSC appear to be prevalent in Asia and Latin America, whereas FOSC is more common in Europe. The available data suggest that Fusarium is a common opportunistic human pathogens in tropical areas and has significant genetic variation worldwide. © 2014 Blackwell Verlag GmbH.

  16. The investigation and analysis of pathogenic bacteria of epidemiology in Changshu area%常熟地区甲真菌病流行病学调查及病原菌分析

    Institute of Scientific and Technical Information of China (English)

    王雪松; 贾淑琳; 仲亚平; 李静; 张红明; 孙嘉俊

    2016-01-01

    目的了解常熟地区甲真菌病流行病学情况,为常熟地区甲真菌防治提供参考。方法选取2011年1~12月医院皮肤科疑似甲真菌病患者1228例,进行真菌确诊,并对所感染的真菌种类进行分析。结果1228例中确认为甲真菌症患者800例,患者中≤15岁的39例,16~25岁77例,26~35岁95例,36~45岁126例,46~55岁158例,56~65岁146例,>65岁159例。皮肤癣菌664例(83.00%),其中断发毛癣菌54例(6.75%),石膏样毛癣菌70例(8.75%),红色毛癣菌540例(67.50%);酵母菌94例(11.75%);霉菌42例(5.25%)。结论常熟地区甲真菌感染以皮肤癣菌为主,其次为酵母样菌,再次为霉菌。%Objective To understand the situation of onychomycosis epidemiology in Changshu area, provide a refer-ence for the prevention and treatment of nail fungi in Changshu area.Methods Selected Hospital dermatologist suspected onychomycosis in patients with a total of 1 228 cases, diagnosis of fungal and carries on the analysis to the infection of fungi species.Results Patients under 15 years old in 39 cases, 16 cases from 25 to 77 years old, 26 cases from 35 to 95 years old, 36 cases from 45 to 126 years old, 46 cases from 55 to 158 years old, 56 cases from 65 to 146 years old, 159 cases of 65 years old.664 cases of skin tinea bacteria, The Trichophyton tonsurans 54 cases (6.75%);Plaster of 70 cases (8.75%);540 cases (67.5%) of red hair tinea;Yeast in 94 cases (11.75%);Fungus in 42 cases (5.25%).Conclusion A fun-gus infection in Changshu area is mainly caused by the fungus infection, followed by yeast like bacteria, again for mold.

  17. Onicomicose por Scytalidium spp.: estudo clínico-epidemiológico em um hospital universitário do Rio de Janeiro, Brasil Onycomychosis due to Scytalidium spp.: a clinical and epidemiologic study at a University Hospital in Rio de Janeiro, Brazil

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    Ígor Brum Cursi

    2011-08-01

    : To study clinico-epidemiological data referring to patients with onychomycosis caused by Scytalidium spp. at a University Hospital in Rio de Janeiro. METHODS: We evaluated the clinical and epidemiological data of 30 patients with onychomycosis by Scytalidium sp. through an observational study of 1295 patients who underwent mycological nail tests over a period of 16 months. RESULTS: The majority of the patients were female (66.6%, with an average age of 56.7 years. 63.3% of them were nonwhite. 53.3% of the patients had attended elementary school and 36.6% referred a family income of 3 to 5 minimum wages. In 90% of cases, the toenails were affected, primarily with onycholysis (18 patients, and in 66% of the cases melanonychia was observed. In 43.3% of cases the disease had progressed for more than 5 years. 19 patients (63.3% had undergone some medical treatment for their current condition. CONCLUSIONS: Our data show that nail infection by Scytalidium sp. is chronic, affecting adults, particularly females (2:1. Clinically the disease resembles dermatophytosis. Prevalence of the disease in our sample was 4.86%, accounting for 26.92% of the positive tests

  18. Enhanced Ungual Permeation of Terbinafine HCl Delivered Through Liposome-Loaded Nail Lacquer Formulation Optimized by QbD Approach.

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    Shah, Viral H; Jobanputra, Amee

    2017-07-05

    The present investigation focused on developing, optimizing, and evaluating a novel liposome-loaded nail lacquer formulation for increasing the transungual permeation flux of terbinafine HCl for efficient treatment of onychomycosis. A three-factor, three-level, Box-Behnken design was employed for optimizing process and formulation parameters of liposomal formulation. Liposomes were formulated by thin film hydration technique followed by sonication. Drug to lipid ratio, sonication amplitude, and sonication time were screened as independent variables while particle size, PDI, entrapment efficiency, and zeta potential were selected as quality attributes for liposomal formulation. Multiple regression analysis was employed to construct a second-order quadratic polynomial equation and contour plots. Design space (overlay plot) was generated to optimize a liposomal system, with software-suggested levels of independent variables that could be transformed to desired responses. The optimized liposome formulation was characterized and dispersed in nail lacquer which was further evaluated for different parameters. Results depicted that the optimized terbinafine HCl-loaded liposome formulation exhibited particle size of 182 nm, PDI of 0.175, zeta potential of -26.8 mV, and entrapment efficiency of 80%. Transungual permeability flux of terbinafine HCl through liposome-dispersed nail lacquer formulation was observed to be significantly higher in comparison to nail lacquer with a permeation enhancer. The developed formulation was also observed to be as efficient as pure drug dispersion in its antifungal activity. Thus, it was concluded that the developed formulation can serve as an efficient tool for enhancing the permeability of terbinafine HCl across human nail plate thereby improving its therapeutic efficiency.

  19. Optimal management of nail disease in patients with psoriasis

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    Piraccini BM

    2015-01-01

    Full Text Available Bianca Maria Piraccini, Michela Starace Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy Abstract: Psoriasis is a common skin disease, with nail involvement in approximately 80% of patients. Nail psoriasis is often associated with psoriatic arthropathy. Involvement of the nails does not always have relationship with the type, gravity, extension, or duration of skin psoriasis. Nail psoriasis can occur at any age and all parts of the nails and the surrounding structures can be affected. Two clinical patterns of nail manifestations have been seen due to psoriasis: nail matrix involvement or nail bed involvement. In the first case, irregular and deep pitting, red spots of the lunula, crumbling, and leukonychia are seen; in the second case, salmon patches, onycholysis with erythematous border, subungual hyperkeratosis, and splinter hemorrhages are observed. These clinical features are more visible in fingernails than in toenails, where nail abnormalities are not diagnostic and are usually clinically indistinguishable from other conditions, especially onychomycosis. Nail psoriasis causes, above all, psychosocial and aesthetic problems, but many patients often complain about functional damage. Diagnosis of nail psoriasis is clinical and histopathology is necessary only in selected cases. Nail psoriasis has an unpredictable course but, in most cases, the disease is chronic and complete remissions are uncommon. Sun exposure does not usually improve and may even worsen nail psoriasis. There are no curative treatments. Treatment of nail psoriasis includes different types of medications, from topical therapy to systemic therapy, according to the severity and extension of the disease. Moreover, we should not underestimate the use of biological agents and new therapy with lasers or iontophoresis. This review offers an investigation of the different treatment options for nail

  20. Nail disorders in children, a clinical study

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    Ayşe Akbaş

    2016-04-01

    Full Text Available Introduction: Aims of the study to investigate the frequency and the nature ofnail disorders in children significant clinical data is available. Nail disorders although common in children in some parts of our country. This study was carried out to document the clinical and demographic pattern of nail disorders in a dermatology outpatient clinic of a pediatric hospital in Ankara, Turkey. Material and Methods: All consecutive patients a total of 3000 children from age 0-16 were admitted to dermatology outpatient clinic of Ankara Pediatric Hematology and Oncology Education and Research Hospital during January 2011 to December 2011 were studied and retrospectively evaluated for age, gender, drug use, diseases, systemic or genetic disorders and demographic features. Diagnostic evaluation results were noted and patients were categorized for demographic features and diagnosis. Results: These 133 patients (M: F 58:75, %44 vs 56, respectively were under 16 years of age and have 17 different dermatological disorders related with nail symptoms. Fifty three of (39,8% these patient were under 2 years of age, 31 (23.3% were between 3-5 years, 30 (22.5% were between 6-11 years old, 19 of 133 (14%, 2 were between 11-16 years of age. Through all of ages and independent of gender the most etiologies of nail disorders were, onychomadesis, paronychia, onycholysis, onychomycosis and systemic nail presentation of systemic dermatosis. Conclusion: Nail disorders are different in children than in adults. In our study, the first 5 years of age was found in 53% of nail disorders. Nail disorders are uncommon but may be seen as a part of a systemic disease and may be associated with cosmetic and psychologic problem.

  1. MDGC-MS analysis of essential oils from Protium heptaphyllum (Aubl. and their antifungal activity against Candida specie

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    M. MOBIN

    Full Text Available ABSTRACT Protium heptaphyllum is found in the Amazon region, and in various Brazilian states and South American countries. Also Known as almecega, it produces an oil resin used in traditional medicine as analgesic, anti-inflammatory, cicatrizant and expectorant, it is rich in pentacyclic triterpenes and essential oil. The main objective of this study was to analyze the chemical composition of P. heptaphyllumresin (OEPh over different extraction times and to evaluate their antifungal activity against Candida species, obtained from gardeners with onychomycosis, using the disk diffusion method. The OEPh was obtained by hydrodistillation and analyzed by Multidimensional Gas Chromatography coupled with Mass Spectrometry (MDGC / MS. Candida species were obtained from lesions on the nails of horticulturist from a community garden in the city of Teresina, Piauí, Brazil. The antifungal activity in concentrations of 1000 µg/L, 500 µg/L and 250 µg/L, PROTOCOL M44-A2 (CLSI 2009 OEPh was tested. The main constituents identified were: l-limonene, α-terpineol, p-cineol, o-cymene and α-phellandrene, however, its composition varies significantly with extraction time. All species, except C. rugosa, were inhibited with halo (≥ 14 mm at 1000 μg / L. C. krusei is naturally resistant to the drug fluconazole, but when tested with OEPh the clinical species (case 9 demonstrated sensitivity in three dilutions (halo ≤ 10 ≥ 14 and the standard strain was inhibited at concentration of 1000 μg/Lg / L (halo 14mm. A similar situation also occurred with the standard strain of C. parapsilosis (halo ≥ 11mm. OEPh has considerable antifungal activity, which merits further investigation for alternative clinical applications, since this species is widely distributed in our community, and it presents good yields, and also has important therapeutic applications.

  2. Multilaboratory Evaluation of In Vitro Antifungal Susceptibility Testing of Dermatophytes for ME1111

    Science.gov (United States)

    Chaturvedi, V.; Diekema, D.; Ostrosky-Zeichner, L.; Rennie, R.; Walsh, T.; Wengenack, N.; Fothergill, A.; Wiederhold, N.

    2015-01-01

    ME1111 is a novel small molecule antifungal agent under development for the topical treatment of onychomycosis. Standardization of the susceptibility testing method for this candidate antifungal is needed. Toward this end, 8 independent laboratories determined the interlaboratory reproducibility of ME1111 susceptibility testing. In addition, we subsequently identified 2 strains as quality control (QC) isolates for the method. In the reproducibility study, 5 blinded clinical strains each of Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum were tested, while the QC study tested 6 blinded T. rubrum or T. mentagrophytes ATCC strains. Testing was performed in frozen microtiter panels according to the Clinical and Laboratory Standards Institute (CLSI) M38-A2 methodology. In the reproducibility study, 9 of 15 clinical strains showed interlaboratory agreement of >90% at the 80% inhibition endpoint, with a range of agreement of 76.2% to 100%. In the QC study, 4 of the 6 ATCC strains showed interlaboratory agreement of >90%. ME1111 demonstrated excellent interlaboratory agreement when tested against dermatophytes. Based on this data, the CLSI Subcommittee on Antifungal Susceptibility Tests approved the susceptibility testing of ME1111 against dermatophytes according to M38-A2 methodology, which stipulates RPMI 1640 as the test medium, an inoculum size of 1 to 3 × 103 CFU/ml, and an incubation time and temperature of 96 h at 35°C. The MIC endpoint should be 80% inhibition compared with the growth control. T. rubrum ATCC MYA-4438 and T. mentagrophytes ATCC 28185 were selected as QC isolates, with an acceptable range of 0.12 to 1 μg/ml for the two strains. PMID:26719434

  3. Genotyping of Fusarium Isolates from Onychomycoses in Colombia: Detection of Two New Species Within the Fusarium solani Species Complex and In Vitro Antifungal Susceptibility Testing.

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    Guevara-Suarez, Marcela; Cano-Lira, José Francisco; de García, María Caridad Cepero; Sopo, Leticia; De Bedout, Catalina; Cano, Luz Elena; García, Ana María; Motta, Adriana; Amézquita, Adolfo; Cárdenas, Martha; Espinel-Ingroff, Ana; Guarro, Josep; Restrepo, Silvia; Celis, Adriana

    2016-04-01

    Fusariosis have been increasing in Colombia in recent years, but its epidemiology is poorly known. We have morphologically and molecularly characterized 89 isolates of Fusarium obtained between 2010 and 2012 in the cities of Bogotá and Medellín. Using a multi-locus sequence analysis of rDNA internal transcribed spacer, a fragment of the translation elongation factor 1-alpha (Tef-1α) and of the RNA-dependent polymerase subunit II (Rpb2) genes, we identified the phylogenetic species and circulating haplotypes. Since most of the isolates studied were from onychomycoses (nearly 90 %), we carried out an epidemiological study to determine the risk factors associated with such infections. Five phylogenetic species of the Fusarium solani species complex (FSSC), i.e., F. falciforme, F. keratoplasticum, F. lichenicola, F. petroliphilum, and FSSC 6 as well as two of the Fusarium oxysporum species complex (FOSC), i.e., FOSC 3 and FOSC 4, were identified. The most prevalent species were FOSC 3 (38.2%) followed by F. keratoplasticum (33.7%). In addition, our isolates were distributed into 23 haplotypes (14 into FOSC and nine into FSSC). Two of the FSSC phylogenetic species and two haplotypes of FSSC were not described before. Our results demonstrate that recipients of pedicure treatments have a lower probability of acquiring onychomycosis than those not receiving such treatments. The antifungal susceptibility of all the isolates to five clinically available agents showed that amphotericin B was the most active drug, while the azoles exhibited lower in vitro activity.

  4. [Fungal keratitis caused by Scedosporium apiospermum: first report from Turkey-comment].

    Science.gov (United States)

    Atalay, Mustafa Altay; Koc, Ayşe Nedret

    2014-04-01

    Scedosporium apiospermum is a saprophytic fungus which is isolated worldwide in soil, fertilizers, polluted water, rotten vegetables, and other natural environments. It is the cause of mycetoma, a subcutaneous infection, characterized by granule formation. It may also cause severe local or diffuse infections in immunosuppressive patients. S.apiospermum-induced arthritis, endocarditis, keratitis, scleritis, endophthalmitis, meningitis, osteomyelitis, otomycosis, onychomycosis, chronic prostatitis, peritonitis, esophagitis, renal infection, and hepatosplenic abscess have been previously reported in the literature. Possible risk factors of fungal keratitis, one of the major causes of fungal ocular infection, include ocular injury, long-term therapy with topical or systemic steroids, immunosuppressive agents, and underlying diseases such as pre-existing corneal surface abnormality and diabetes mellitus, and wearing contact lenses. We paid great attention to the case report presented by Kalkan Akçay E et al. titled "Fungal keratitis caused by Scedosporium apiospermum: first report from Turkey", which was published in the October 2013 issue of Bulletin of Microbiology [Mikrobiyol Bul 2013; 47(4): 727-33]. Although it is deemed as the first case report of S.apiospermum-related fungal keratitis in Turkey, there were several previous case reports of ocular infections associated with this type of fungus in Turkey, including those of Yucel A titled "An eye mycosis caused by Scedosporium apiospermum (Monosporium apiospermum)" published in 1989, Kiratli et al. titled "Scedosporium apiospermum chorioretinitis" in 2001, Saracli et al. titled "Scedosporium apiospermum keratitis treated with itraconazole" in 2003 and Erdem et al. titled "Clinical follow up of a keratomycosis case with total corneal melting" in 2005. In conclusion, it should be highlighted that the report of Kalkan Akcay et al. is not the first case report of Scedosporium apiospermum-related fungal keratitis in

  5. Eco-epidemiologic study of emerging fungi related to the work of babaçu coconut breakers in the State of Maranhão, Brazil

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    Maria do Desterro Soares Brandão Nascimento

    2014-01-01

    Full Text Available Introduction: There are more than 300,000 extractors using the babaçu coconut as a source of income in the States of Maranhão, Pará, Tocantins and Piauí, and this activity is associated with fungal infections. The objective of this study was to examine the occurrence of emergent fungi in the conjunctiva, nails and surface and subcutaneous injuries of female coconut breakers in Esperantinópolis, Maranhão. Additionally, soil samples and palm structures were collected. Methods: The obtained samples were cultured in Petri dishes containing potato-dextrose-agar and chloramphenicol. The etiological agent was confirmed by a direct mycological exam and growth in culture. Results: In total, 150 domiciles were visited, and samples were collected from 80 patients. From the ground, the most frequently isolated fungus was Aspergillus niger (53. 8%. the most frequently detected fungus in babaçu coconut was Aspergillus niger (66.7%. Conjunctival fungal growth occurred in 76.3% of the women. The ocular fungal microbiota consisted of filamentous fungi (80.6%, and yeasts were present in 19.4% of cases. Onychomycosis was diagnosed in 44% (11/25 of the women. Conclusions: The identification of the genera Neosartorya, Rhizopus and Curvularia in onychomycoses shows that emergent filamentous fungi can be isolated. Aspergillus sp., Penicillium sp. and Scedosporium sp. were the predominant genera found in the babaçu coconut. From ocular conjunctiva, Candida spp. were the most prevalent species isolated, and Fusarium sp. was present only in one woman. The nearly permanent exposure of coconut breakers to the external environment and to the soil is most likely the reason for the existence of a mycotic flora and fungal infections, varying according to the individual's practices and occupation.

  6. Eco-epidemiologic study of emerging fungi related to the work of babaçu coconut breakers in the State of Maranhão, Brazil.

    Science.gov (United States)

    Nascimento, Maria do Desterro Soares Brandão; Leitão, Valéria Maria Sousa; Neto Silva, Marcos Antonio Custódio da; Maciel, Leonardo Bezerra; Filho Muniz, Walbert Edson; Viana, Graça Maria de Castro; Bezerra, Geusa Felipa de Barros

    2014-01-01

    There are more than 300,000 extractors using the babaçu coconut as a source of income in the States of Maranhão, Pará, Tocantins and Piauí, and this activity is associated with fungal infections. The objective of this study was to examine the occurrence of emergent fungi in the conjunctiva, nails and surface and subcutaneous injuries of female coconut breakers in Esperantinópolis, Maranhão. Additionally, soil samples and palm structures were collected. The obtained samples were cultured in Petri dishes containing potato-dextrose-agar and chloramphenicol. The etiological agent was confirmed by a direct mycological exam and growth in culture. In total, 150 domiciles were visited, and samples were collected from 80 patients. From the ground, the most frequently isolated fungus was Aspergillus niger (53. 8%). the most frequently detected fungus in babaçu coconut was Aspergillus niger (66.7%). Conjunctival fungal growth occurred in 76.3% of the women. The ocular fungal microbiota consisted of filamentous fungi (80.6%), and yeasts were present in 19.4% of cases. Onychomycosis was diagnosed in 44% (11/25) of the women. The identification of the genera Neosartorya, Rhizopus and Curvularia in onychomycoses shows that emergent filamentous fungi can be isolated. Aspergillus sp., Penicillium sp. and Scedosporium sp. were the predominant genera found in the babaçu coconut. From ocular conjunctiva, Candida spp. were the most prevalent species isolated, and Fusarium sp. was present only in one woman. The nearly permanent exposure of coconut breakers to the external environment and to the soil is most likely the reason for the existence of a mycotic flora and fungal infections, varying according to the individual's practices and occupation.

  7. NAIL AS A PROMISING DRUG DELIVERY SYSTEM FOR CONTROLLED RELEASE

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    G. Sai Krishna*, P. Prem Kumar, K. Bala Murugan

    2013-03-01

    Full Text Available ABSTRACT: The effectiveness of topical therapies is limited by minimal drug permeability through the nail plate. Nail permeability is however quite low and limits topical therapy to early/mild disease states such as onychomycosis (fungal infections of the nail. Current research on nail permeation that focuses on altering the nail plate barrier by means of chemical treatments, penetration enhancers as well as physical and mechanical methods is reviewed also the recent research into ungual drug delivery is reviewed, a new method of nail sampling is examined. Topical therapy is worth pursuing however, as local action is required in many nail disorders. Drug transport into the nail plate can be assisted by filing the nail plate before topical application of drug formulations as well as by the use of chemical enhancers. Finally limitations of current ungual drug permeability studies are briefly discussed and the factors, which affect drug uptake and permeation through the nail plate such as solute molecular size, hydrophilicity/hydrophobicity, charge, and the nature of the vehicle, are then discussed, and drug-containing nail lacquers which, like cosmetic varnish, are brushed onto the nail plates to form a film, and from which drug is released and penetrates into the nail are reviewed. The nail plate behaves like a concentrated hydrogel to permeating molecules and diffusion of molecules through the nail plate has been compared to the diffusion of non-electrolytes through polymer gels. Thus, for optimal ungual permeation and uptake, drug molecules must be of small size and be uncharged.

  8. Sporothrix chilensis sp. nov. (Ascomycota: Ophiostomatales), a soil-borne agent of human sporotrichosis with mild-pathogenic potential to mammals.

    Science.gov (United States)

    Rodrigues, Anderson Messias; Cruz Choappa, Rodrigo; Fernandes, Geisa Ferreira; de Hoog, G Sybren; de Camargo, Zoilo Pires

    2016-02-01

    A combination of phylogeny, evolution, morphologies and ecologies has enabled major advances in understanding the taxonomy of Sporothrix species, including members exhibiting distinct lifestyles such as saprobes, human/animal pathogens, and insect symbionts. Phylogenetic analyses of ITS1/2 + 5.8s sequences split Sporothrix genus in two well-defined groups with dissimilar ecologies. Species embedded in the Sporothrix schenckii complex are frequently agents of human and animal sporotrichosis, and some of these are responsible for large sapronoses and zoonoses around the warmer temperate regions of the world. At the other extreme, basal saprophytic species evolved in association with decaying wood and soil, and are rarely found to cause human disease. We propose to create a new taxa, Sporothrix chilensis sp. nov., to accommodate strains collected from a clinical case of onychomycosis as well as from environmental origins in Chile. Multigene analyses based on ITS1/2 + 5.8s region, beta-tubulin, calmodulin and translation elongation factor 1α revealed that S. chilensis is a member of the Sporothrix pallida complex, and the nearest taxon is Sporothrix mexicana, a rare soil-borne species, non-pathogenic to humans. The ITS region serves as a primary barcode marker, while each one of the protein-coding loci easily recognized species boundaries providing sufficient information for species identification. A disseminated model of murine sporotrichosis revealed a mild-pathogenic potential, with lung invasion. Although S. chilensis is not a primary pathogen, accidental infection may have an impact in the immunosuppressed population. With the introduction of distinct species with similar routes of transmission but different virulence, identification of Sporothrix agents at the species level is mandatory.

  9. Diabetic peripheral neuropathy in ambulatory patients with type 2 diabetes in a general hospital in a middle income country: a cross-sectional study.

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    María de Los Angeles Lazo

    Full Text Available AIM: We aimed to estimate the morbidity rate and associated factors for diabetic peripheral neuropathy (DPN in a low-middle income country setting. METHODS: Cross-sectional study, data was gathered at Peru's Ministry of Health national specialized hospital for endocrinological conditions through standardized interviews, anthropometric measurements and blood tests for glycated haemoglobin (HbA1c. DPN was evaluated using two techniques: the Semmes-Weinstein monofilament test and the diabetic neuropathy symptom score. Overall prevalence and 95% confidence intervals (95% CI were calculated. Potential factors related to DPN explored included body mass index, years with disease (<10 vs. ≥10 years, glycaemic control (HbA1c <7% vs. ≥7%, microalbuminuria, retinopathy, and current pharmacological treatment. Multivariable analysis was performed using Poisson analysis to calculate prevalence ratios. RESULTS: DPN was observed in 73/129 (56.6% patients. In multivariable analysis adjusted by age and sex, the prevalence ratio of neuropathy was 1.4 times higher (95% CI 1.07-1.88 in patients who took insulin plus metformin compared to patients who used one treatment alone, and 1.4 higher (95% CI 1.02-1.93 in patients with ≥10 years of disease compared to those with a shorter duration of disease. Also we found some characteristics in foot evaluation associated to neuropathy such as deformities (p<0.001, onychomycosis (p = 0.012, abnormal Achilles reflex (p<0.001, pain perception (p<0.001 and vibration perception (p<0.001. CONCLUSION: DPN is highly frequent among patients with diabetes in a national specialized facility from Peru. Associated factors to DPN included being a diabetic patient for over ten years, and receiving insulin plus metformin.

  10. Molecular identification and antifungal susceptibility profiles of Candida parapsilosis complex species isolated from culture collection of clinical samples

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    Fábio Silvestre Ataides

    2015-08-01

    Full Text Available AbstractINTRODUCTION:Candida parapsilosis is a common yeast species found in cases of onychomycosis and candidemia associated with infected intravascular devices. In this study, we differentiated Candida parapsilosis sensu stricto, Candida orthopsilosis , and Candida metapsilosis from a culture collection containing blood and subungual scraping samples. Furthermore, we assessed the in vitro antifungal susceptibility of these species to fluconazole, itraconazole, voriconazole, posaconazole, amphotericin B, and caspofungin.METHODS:Differentiation of C. parapsilosis complex species was performed by amplification of the secondary alcohol dehydrogenase (SADH gene and digestion by the restriction enzyme Ban I. All isolates were evaluated for the determination of minimal inhibitory concentrations using Etest, a method for antifungal susceptibility testing.RESULTS:Among the 87 isolates, 78 (89.7% were identified as C. parapsilosis sensu stricto , five (5.7% were identified as C. orthopsilosis , and four (4.6% were identified as C. metapsilosis . Analysis of antifungal susceptibility showed that C. parapsilosis sensu strictoisolates were less susceptible to amphotericin B and itraconazole. One C. parapsilosis sensu stricto isolate was resistant to amphotericin B and itraconazole. Moreover, 10.2% of C. parapsilosis sensu stricto isolates were resistant to caspofungin. Two C. parapsilosis sensu strictoisolates and one C. metapsilosis isolate were susceptible to fluconazole in a dose-dependent manner.CONCLUSIONS:We reported the first molecular identification of C. parapsilosiscomplex species in State of Goiás, Brazil. Additionally, we showed that although the three species exhibited differences in antifungal susceptibility profiles, the primary susceptibility of this species was to caspofungin.

  11. Antimycotics susceptibility testing of dermatophytes

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    Arsić-Arsenijević Valentina

    2010-01-01

    Full Text Available Dermatophytes are moulds that produce infections of the skin, hair and nails of humans and animals. The most common forms among these infections are onychomycosis and tinea pedis affecting 20% of world population. These infections are usually chronic. The treatment of dermatophytoses tends to be prolonged partly because available treatments are not very effective. Antifungal drug consumption and public health expenditure are high worldwide, as well as in Serbia. For adequate therapy, it is necessary to prove infection by isolation of dermatophytes and to test the antifungal susceptibility of isolates. Susceptibility testing is important for the resistance monitoring, epidemiological research and to compare in vitro activities of new antifungal agents. The diffusion and dilution methods of susceptibility tests are used, and technical issues of importance for the proper performance and interpretation of test results are published in the document E.DEF 9.1 (EUCAST and M38-A2 (CLSI. The aim of our paper is to promptly inform the public about technical achievements in this area, as well as the new organization of laboratory for medical mycology in our country. The formation of laboratory networks coordinated by the National Reference Laboratory for the cause of mycosis need to enable interlaboratory studies and further standardization of methods for antifungal susceptibility testing of dermatophytes, reproducibility of tests and clinical correlation monitoring (MIK values and clinical outcome of dermatophytosis. The importance of the new organization is expected efficient improvement in the dermatophytosis therapy at home, better quality of patient's life and the reduction of the cost of treatment.

  12. Basidiomycosis: a review of the literature Basidiomicoses: revisão da literatura

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    Carlos da Silva Lacaz

    1996-10-01

    Full Text Available The basidiomycosis, fungal infections provoked by basidiomycetes or agaric fungi have been recorded at growing frequencies in the medical literature, especially after the advent of AIDS in 1991. The basidiospores of these fungi, scattered in the atmosphere and transported by winds or air currents, reach the maxillary sinuses through the nasal route, most of the times causing signs and symptoms of chronic sinusitis. Basidiomycetes have also been isolated from sputum, especially Schizophyllum commune. Lesions of the buccal mucosa, brain abscesses, onychomycosis and endocarditis have been described, with a growing interest in this type of deep mycosis on the part of mycologists and infectologists. The present paper reports descriptions of mycetism as well as infectious processes caused by basidiomycetes, such as Schizophyllum commune, Ustilago maydis (= Ustilago zeae and Coprinus cinereusAs basidiomicoses, infecções fúngicas provocadas por basidiomicetos ou agáricos vêm sendo registradas cada vez com maior frequência na literatura médica, principalmente após o advento da AIDS/SIDA, em 1981. Os basidiosporos desses fungos, espalhados na atmosfera e veiculados através do vento ou de correntes aéreas, atingem por via nasal os seios maxilares, provocando quadros de sinusite crônica, na maioria das vezes. Do escarro também têm sido isolados basidiomicetos, principalmente o Schizophyllum commune. Lesões da mucosa da boca, abscessos cerebrais, onicomicoses e endocardites já foram descritas, aumentando o interesse dos micologistas e infectologistas para este tipo de micose profunda. O presente trabalho assinala, ao lado dos quadros dc micetismo, processos infecciosos provocados por basidiomicetos, a exemplo do Schizophyllum commune, Ustilago maydis (= Ustilago zeae e Coprinus cinereus.

  13. 成都地区838例真菌培养阳性标本病原学特点分析%838 cases of eumycete-culture positive' clinical specimens characteristic analysis in chengdu region

    Institute of Scientific and Technical Information of China (English)

    陈伟; 阳眉; 梅晓锋; 赵静; 兰长贵

    2012-01-01

    目的 了解成都地区浅部真菌感染的病原学特点,为临床诊疗提供参考.方法 采用沙堡分离培养基、科玛嘉念珠菌显色培养基、铜圈小培养法,分离鉴定2006年7月~2011年3月我科真菌实验室培养阳性的标本.结果 838例标本中共培养出15个菌种,其中红色毛癣菌、马拉色菌、酵母菌、白念珠菌、须癣毛癣菌检出率居前五位.不同解剖部位标本其培养结果有所不同.结论 皮肤、甲、毛发以皮肤癣菌和马拉色菌感染为主,粘膜以念珠菌感染为主.红色毛癣菌是成都地区浅部真菌病的首位病原菌.%To investigate the fungal pathogen characteristic of superficial mycosis in chengdu region and to provide the reference of prevention and therapy. Methods By using cultivation methods, we can detect and identify eumycete-culture positive' clinical specimens from July 2006 to March 2011. Results There were 15 kinds strain in 838 cases, among the total, Trichophyton rubrum, Malassezia, Yeasts, Candida albicans and Trichophyton mentagrophytes are the most . Different anatomic location leads to different culture result. Conclusion Dennatophytes and Malassezia are the dominant causative pathogen lead to dermatophytosis, onychomycosis and tinea capitis. Candidas mainly lead to mucosa inflammation. In Chengdu region, Trichophyton rubrum is the first place pathogenic fungi in superficial mycosis.

  14. Study Of Nail Changes In Psoriasis

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    Ghosal Astikmoni

    2004-01-01

    Full Text Available Background: In psoriasis, nail involvement is quite a common phenomenon and the manifestation may range from pitting, Beau’s line, leuconychia, onychorrhexis, onycholysis, subungual hyperkeratosis, thinning of nail plate to less commonly splinter hemorrhage, oil drop sign and salmon patch. Objective: To study overall pattern of nail involvement in psoriatic patients along with making a comparison between the patterns of nail changes on finger and toenails and to analyze the association of nail changes with arthropathy and Koebner’s phenomenon. Subjects and settings: One hundred consecutive cases of psoriasis of all age and both sexes were selected for studying the nail changes, in whom diagnosis of psoriasis was made on clinical parameters. KOH preparation was also performed in all cases where onychomycosis was considered a possibility. Results: Thirty six Percent of patients of psoriasis had nail change and fingernails (32% were more commonly affected than toe nails (24%. Pitting was found to be the most common manifestation in fingernails (65.63% with significant difference between fingernails and toenails (p<0.001. The frequency of nail changes in psoriasis with joint pain was 73.33% whereas 29.41% in those without joint pain. Chi-square test with Yates correction for the association of nail changes with joint pain gave p value < 0.005 and for the association of nail changes with koebner’s phenomenon p value <0.05. The frequency of nail changes with Koebner’s phenomenon was 56% whereas in those without koebner’s phenomenon it was 29.33%. Conclustion : Pitting was the most common manifestation in fingernails although in toenails subungual hyperkeratosis was the commonest finding. A very strong association was seen between nail changes and joint pain. Association was also strong between nail changes and Koebner’s phenomenon in psoriasis.

  15. Occupational Dermatoses Among Kitchen Workers In A Chain Of Vegetarian Hotel

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    Rai Reena

    2003-01-01

    Full Text Available This study was undertaken to identify occupation related skin problems among hotel workers. One thousand three hindered and ninety employees of a chain of vegetarian hotels were examined. Of the 273 people working in the kitchen, 206 (75.4% had dermatosis related to work. The Kitchen workers were classified according to the type of work they routinely performed. Forty eight out of the 63 (76.1% cooks who were involved in stirring had callosity at sites of contact with ladle and 28 of the40 (70% cooks who were involved in frying had pigmentation and scars due to contact with hot oil and water. All the onion peelers had staining and fissuring of the palmer aspect of the fingers. Thirty two of the 46(69.5% vegetable cutters had callosity on the palm at areas of contact with knife. Poori markers had pigmentation and callosity of knuckles due to pressing the dough with their knuckles. Nine of the 12 (66% rice cleaners had chapping of nails. Seven of the 12 (58.3% paratha markers had erythema of palm due to contact with hot tava. Tandoori experts had singing of hair over right forearm. Two workers (0.73% had pigmentation of the face probably due to prolonged exposure to heat. Two of the16 (12.5% grinders had paronychia and onychomycosis due to constant contact with water and dough. Nine of the 15 (60% coconut graters had callosities of the palms. We conclude the minor occupational dermatosis is prevalent among kitchen workers employed in hotels

  16. Cutaneous manifestations in patients with chronic renal failure on hemodialysis

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    Udayakumar P

    2006-01-01

    Full Text Available Background: Chronic renal failure (CRF presents with an array of cutaneous manifestations. Newer changes are being described since the advent of hemodialysis, which prolongs the life expectancy, giving time for these changes to manifest. Aim: The aim of this study was to evaluate the prevalence of dermatologic problems among patients with chronic renal failure (CRF undergoing hemodialysis. Methods: One hundred patients with CRF on hemodialysis were examined for cutaneous changes. Results: Eighty-two per cent patients complained of some skin problem. However, on examination, all patients had at least one skin lesion attributable to CRF. The most prevalent finding was xerosis (79%, followed by pallor (60%, pruritus (53% and cutaneous pigmentation (43%. Other cutaneous manifestations included Kyrle′s disease (21%; fungal (30%, bacterial (13% and viral (12% infections; uremic frost (3%; purpura (9%; gynecomastia (1%; and dermatitis (2%. The nail changes included half and half nail (21%, koilonychia (18%, onychomycosis (19%, subungual hyperkeratosis (12%, onycholysis (10%, splinter hemorrhages (5%, Mees′ lines (7%, Muehrcke′s lines (5% and Beau′s lines (2%. Hair changes included sparse body hair (30%, sparse scalp hair (11% and brittle and lusterless hair (16%. Oral changes included macroglossia with teeth markings (35%, xerostomia (31%, ulcerative stomatitis (29%, angular cheilitis (12% and uremic breath (8%. Some rare manifestations of CRF like uremic frost, gynecomastia and pseudo-Kaposi′s sarcoma were also observed. Conclusions: CRF is associated with a complex array of cutaneous manifestations caused either by the disease or by treatment. The commonest are xerosis and pruritus and the early recognition of cutaneous signs can relieve suffering and decrease morbidity.

  17. Infectious endotheliitis: a rare case of presumed mycotic origin

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    Zapata LF

    2013-07-01

    Full Text Available Luis Fernando Zapata,1 José David Paulo,1 Carlos A Restrepo,1 Luis Fernando Velásquez,2 Andrés E Toro Montoya,2 Melissa A Zapata21Department of Ophthalmology Hospital Pablo Tobón Uribe; 2School of Medicine, Universidad Pontificia Bolivariana, Medellín, ColombiaPurpose: To report an interesting case of infectious endotheliitis of presumed mycotic origin.Methods: A case report of a 56-year-old male farmer who sought medical attention after a month-long evolution of irritative symptoms in his right eye, accompanied by visual acuity (VA impairment. The patient received topical and oral broad-spectrum antibiotic treatment with no improvement before being referred to a cornea specialist, where he was found to have VA of 20/150 and was noted on biomicroscopy to have endothelial feathery coalescent lesions. The patient was admitted to the hospital for an aqueous humor sample and intravenous voriconazole.Results: The microbiological studies did not isolate any micro-organisms. However, clinical evidence of improvement was confirmed after 5 days of antimycotic intravenous therapy. Complete clinical resolution was achieved at 1 month after treatment completion with oral voriconazole, as evidenced by VA of 20/20 and disappearance of endothelial lesions.Conclusion: Endothelial involvement by fungi is a rare condition. In this case, no microbes were isolated, but the characteristic morphology of the lesions, the history of onychomycosis, and the spectacular response to voriconazole turn this case into a valid presumptive diagnosis.Keywords: endotheliitis, mycotic, keratitis, voriconazole

  18. Aspectos epidemiológicos das micoses dos pés em um time chinês de futebol Aspectos epidemiologicos de las micosis de los pies en un equipo chino de fútbol Epidemiological aspects of the feet mycosis in a Chinese soccer team

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    Kátia Sheylla Malta Purim

    2006-02-01

    culture of the skin and nail's squamas from their feet, as well as to a histopathologic study of the ungual fragment. The results found were: twelve cases (54.5% did not present mycosis; 5 cases (22.72% presented isolated onychomycosis, and 5 cases (22.72% presented onychomycosis associated to tinea pedis, having as major isolated agent the Trichophyton rubrum. The predisposing agents pointed by athletes included: bath in a public place (85%, sports practice (76%, use of closed shoes (70%, contact with pets (63%, and irregular feet hygiene (50%. CONCLUSION: The frequency of the onychomycosis in Chinese athletes was higher than in the general population. The most frequent agent found it was the Trichophyton rubrum. The individual habits may contribute to the acquisition of these fungal infections added to the direct trauma provoked by the shoe and the ball, as well as to the physical contact during the trainings and games that may favor the cutaneous and ungual injuries.

  19. 260例浅部真菌病及致病菌种分析%Aanlysis on 260 cases of superficial mycosis and its causative agents

    Institute of Scientific and Technical Information of China (English)

    米拉; 帕丽达·阿布利孜; 刘旭; 董潇阳; 哈德丽亚; 周珊

    2011-01-01

    Objective To investigate the etiologic agents of superficial mycosis in Urmuqi and its distribution.Methods Direct microscopic check and fungi cultivation were performed on illness hairs, scales, nail debris of suspected superficial mycosis patients in the Department of Dermatology of the First Affiliated Hospital of Xinjiang Medical University during February 2004 to August 2010. For culture positive samples, bassed on the morphologic identification, the sequences of ITS region of ribosomal DNA (rDNA) were identified. The results were analysed by SPSS 17.0 statistical software. Results There were 260 cases showed positive results in both direct checking and cultivation. The positive rate of Tinea capitis culture was the highest (33. 1% ), followed by tinea corporis and cruris (28. 8% ), onychomycosis (21.5%) , and tinea manus and tinea pedis (16.5%). Strain identification revealed that Trichophyton (T.) rubrum was the most common agent in this study ( 28.5% ), followed by T. mentagrophytes ( 22.3% ), Microsporun ( M. ) canis ( 18.8% ) and T. tonsurans ( 10.0% ). M. canis was the most common causative agent of tinea capitis ( 16.2% ). Statistical analysis showed that in different genders and nations, tinea corporis and cruris, tinea manus and tinea pedis had statistical difference ( P < 0.05 ); those disease were all common for men, with the incidence in Han people higher than in Uyghur people. In different ages, tinea capitis, onychomycosis, tinea corporis and cruris, tinea manus and tinea pedis had statistical difference ( P < 0.05 ). Onychomycosis, tinea corporis and cruris, tinea manus and tinea pedis were common in middle-aged people, while tinea capitis was common in children. Conclusion T. rubrum is the main etiologic agent of superficial mycosis in Urmuqi. Tinea capitis is the moat important superficial mycosis for children in this area. M. canis is the most common causative agent of tinea capitis.%目的 了解新疆乌鲁木齐市

  20. Onicopatias en ancianos. Reporte de 71 casos

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    Patricia Chang

    2016-10-01

    Full Text Available Introduction: The nails present various changes and diseases due to age, and the elderly are no exception to this. Aims: To learn about the most frequent nail diseases in elderly patients of our hospital unit. Methodology: A descriptive study was performed on patients hospitalized at Hospital General de Enfermedades IGSS in medical services during February and March 2015, to investigate the occurrence of nail diseases in hands and feet of elderly patients. All the patients had a complete exam of finger and toe nails. Results: The alterations detected in fingernails were: onychorrhexis, 36 (22.99%; half-and-half nails, 5 (5.75%; Leukonychia apparent, 3 (3.45%, onychoschizia, 3 (3.45%; proximal fold hematoma due to oximeter, 3 (3.45%; onycholysis, 3 (3.45%; splinter hemorrhages, 3 (3.45%; pterygium, 2 (2.30; worn-down nails, 2 (2.30; onychodystrophy, 1 (1.15%; nail biting, 1 (1.15%; parrot beak nails, 1 (1.15%, Beau’s lines, 1 (1.15%; paronychia, 1 (1.15%; trauma, 1 (1.15%; Beau’s ridges, 1 (1.15%. At feet level the alterations found were: onychomycosis, 31 (29.52%; onychogryphosis, 16 (15.24%; pterygium, 8 (7.62%; overriding toes, 5 (4.76%; platonychia, 5 (4.76%; pincer nails, 4 (3.81%; frictional melanonychia, 4 (3.81%; onychorrhexis, 4 (3.81%; onychodystrophy, 4 (3.81%; hematoma, 3 (2.86%, onycholysis, 2 (1.90%, koilonychias, 2 (1.90%, Beau’s ridges, 2 (1.90%; Onychomadesis, 1 (0.95%; tile-shaped nails, 1 (0.95%; longitudinal groove, 1 (0.95%; distal nail embedding, 1 (0.95%; anonychia, 1 (0.95%; micronychia, 1 (0.95%; pachionychia, 1 (0.95%; dyschromia, 1 (0.95%. Conclusion: The alterations of finger and toe nails in the elderly are not exclusive of this group as they occur in the general population except that in the elderly, the most frequent are onychorrhexis in hands and onychogryphosis in feet.

  1. Epidemiology of superficial and cutaneous mycosis in 5500 suspected patients in Tehran

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    Ayatollah Nasrollahi Omran

    2010-04-01

    onychomycosis and Candida albicans was the most common etiological agent. The common sites of involvement of tinea versicolor were neck and trunk and Malassezia globosa was most common etiologic agent."n"nConclusion: This study highlights a common problem (Antropophilic species in Tehran and suggests that further measures regarding public health and especially personal hygiene should be undertaken to reduce the risk of superficial and cutaneous mycoses.

  2. Update on nail psoriasis%银屑病甲的研究进展

    Institute of Scientific and Technical Information of China (English)

    杨娟; 李薇; 张锡宝

    2016-01-01

    银屑病是一种常见的易复发的慢性炎症性皮肤病,约50%的患者会出现甲改变.在关节性银屑病中,银屑病甲的发病率高达80.5%,给患者带来负担,如手指功能障碍、心理压力、社交障碍等.若银屑病患者既有甲损害又有皮肤损害,诊断较容易,但5%~ 10%的患者仅有甲改变,临床容易误诊为甲癣、甲扁平苔藓、甲营养不良等.银屑病甲的治疗较困难,需长期治疗且疗效不理想.银屑病甲的治疗可选用传统疗法或新型生物制剂疗法.银屑病甲治疗目的是减轻疼痛、减少功能障碍、缓解情绪.%Psoriasis is a common chronic recurrent inflammatory skin disease,and nail involvement occurs in about 50% of patients with it.Among patients with psoriatic arthritis,the incidence of nail psoriasis is as high as 80.5%,and it may bring burdens to patients by causing compromised digital function,mental stress,social communication disorders,and so on.Nail psoriasis is easy to diagnose when skin involvement exists.However,it is the only presentation in 5%-10% of patients with psoriasis,and is usually misdiagnosed as onychomycosis,nail lichen planus,onychodystrophy,etc.The treatment of nail psoriasis is often difficult with unsatisfactory efficacy,and long-term treatment is usually required.Traditional therapies or new biological agents can be used to treat nail psoriasis.The goal of its treatment is to relieve pain,restore function,and modulate emotion.

  3. Prevalência de dermatoses em idosos residentes em instituição de longa permanência Prevalence of dermatoses in residents of institutions for the elderly

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    Sandra Lopes Mattos e Dinato

    2008-12-01

    -groups. RESULTS: The total number of diagnoses of dermatosis was 280 with an average number of 3. 73/ per elderly person and 32 different types of dermatosis: were found. The prevalence of the dermatosis most often found was respectively: melanosis (53.3%, seborrheic keratosis (46.6%, onychomycosis (37.3%, nevus (33.3%, senile purpura (29.3%, xerosis (14.6%, scabies (12.0% and malignant neoplasm (1.3%. The distribution of dermatosis was 70% (CI95%: 59% to 81% higher in the female population than in the male. CONCLUSION: Notwithstanding the small number of cases, these data are compatible with the few reports available in literature. This study of prevalence defined the distribution of dermatosis in a fraction of the elderly population. However the aggregate data of subsequent casuistries may provide the more precise information whose relevance is undeniable in the orientation of individual and collective future health measures.

  4. Prevalence and risk factors for superficial fungal infections among Italian Navy Cadets.

    Science.gov (United States)

    Ingordo, Vito; Naldi, Luigi; Fracchiolla, Stefania; Colecchia, Bruno

    2004-01-01

    Limited studies on the prevalence and risk factors for superficial mycoses are available. The aim of this paper was to evaluate the prevalence and risk factors for superficial mycoses (dermatophytes and Candida spp.) in a sample of young Italian people resident at a military school. A total of 1,024 young cadets from the Italian Navy Petty Officers School in Taranto, including 975 (95.21%) males and 49 (4.79%) females, mean age 22.5 +/- 3.0 years (range 18-30), were consecutively examined by the same observer. A complete dermatological examination was performed on all the subjects, and skin scrapings for microscopy and fungal culture were obtained from suspected lesions. All the subjects completed a questionnaire providing information on sports practice, swimming-pool attendance, marching, wearing shower sandals, frequent use of 'gummed' shoes, history of severe traumas to the nails, presence of hyperhidrosis and history of superficial mycoses. The affected subjects were also asked if they were aware of their condition. Data were analysed by the Statistical Analysis System, version 8.0. The Fisher exact test and odds ratios were calculated. A total of 33 subjects (3.2%) were found to suffer from a mycologically confirmed fungal infection (3% by dermatophytes and 0.2% by Candida albicans): tinea pedis/Candida intertrigo of the feet was suspected in 126 (12.1%) subjects and confirmed in 30 (2.9%), including 28 cases of tinea pedis and 2 cases of Candida intertrigo; tinea cruris/Candida intertrigo of the groin was suspected in 28 (2.7%) subjects, but confirmed in only 1 case (0.1%); onychomycosis was suspected in 64 (6.1%) subjects and confirmed in 2 cases (0.2%). The organism most frequently responsible in tinea pedis was Trichophyton mentagrophytes var. interdigitale (82.1%). The same species (50%) and T. mentagrophytes var. mentagrophytes (50%) were associated with tinea unguium, Epidermophyton floccosum was the only species detected in tinea cruris. Non

  5. Clinical Analysis of Malignant Melanoma Presenting as Foot Ulcer%表现为足溃疡的恶性黑色素瘤临床分析

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    陈大伟; 高伟; 康馨; 王椿; 岑石强; 冉兴无

    2012-01-01

    Objective To investigate the clinical features of malignant melanoma presenting as foot ulcer. Methods The clinical data of 46 patients (17 females and 29 males with the average age of 57 years) with malignant melanoma presenting as foot ulcer diagnosed in our hospital between January 2002 and December 2010 were retrospectively analyzed. Results All of the patients were diagnosed by biopsy, and it almost presented as masses, melanotic macules, naevus, blisters, onychomycosis, clavus, wart, etc, before the formation of foot ulcer. After the formation of the ulcer, it presented as nonhealed trauma or frequently ulcerates, central or marginal ulceration, uneven or granular scar-like surface, eschar, etc. Planta, calcar pedis, and hallux were the most predilection sites of malignant melanoma. The majority of lesions were located in foot sole, heel, and the first toe. There were 3 patients without pigment The course of ulcer was (10.74±0.94) months and 18 patients had far-distance metastasis before the diagnosis of malignant melanoma. Thirty-eighty cases were misdiagnosed as melanotic macules, naevus, chronic ulcers, etc. The median time of misdiagnosis was 6 (2.75-48) months. Conclusions The clinical manifestations of malignant melanoma are not typical, which leads to the misdiagnosis. We should pay more attention to the patients with foot ulcer which should be examined by biopsy as early as possible to reduce the misdiagnosis rate.%目的 探讨表现为足溃疡的恶性黑色素瘤临床特点.方法 回顾性分析2002年1月-2010年12月收治的46例表现为足溃疡的恶性黑色素瘤患者.结果 46例均病理组织活检确诊,男29例,女17例,平均年龄57岁.溃疡形成前多表现为包块、黑素斑、痣、水泡、灰指甲、鸡眼、疣等;溃疡形成后表现为外伤不愈或反复复发、溃疡中央或边缘破溃、不规则、表面凹凸不平、颗粒状或呈瘢痕状态、焦痂、菜花样新生物等;溃疡好发部位

  6. Study of dermatoses in kidney transplant patients Estudo das dermatoses em pacientes transplantados renais

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    Alexandre Moretti de Lima

    2013-06-01

    Full Text Available BACKGROUND: The increasing in the number of kidney transplant recipients has favored, more frequently than before, the emergence of dermatoses and warranted their study through subsequent publications. OBJECTIVES: to evaluate the frequency of dermatoses in kidney transplant recipients. METHODS: kidney transplant recipients with suspected dermatoses between March 1st 2009 and June 30th 2010. RESULTS: 53 patients (28 males and 25 females, aged between 22 and 69 (mean age = 45 years were evaluated. Most of them came from the cities of Ceilândia, Samambaia and São Sebastião/DF, and had already been transplanted for 5 to 10 years before (37.7%; 62.3% were recipients of living donors and 83% were prednisone-treated. The most prevalent dermatoses were of fungal (45.3% and viral (39.6% etiologies. Among the non-melanoma malignant neoplasms, the basal cell carcinoma prevailed (six cases, in spite of the low incidence. Concerning fungal dermatoses, 12 cases of onychomycosis, five of pityriasis versicolor and four of pityrosporum folliculitis were reported. For diagnosis, in most cases (64.2%, laboratory examinations (mycological and histopathological were performed. CONCLUSION: cutaneous manifestations in kidney transplant recipients are generally secondary to immunosuppression. The infectious dermatoses, especially those of fungal origin, are frequently found in kidney transplant recipients and their occurrence increases progressively according to the time elapsed from the transplantation, which makes follow-up important. FUNDAMENTOS: o crescente aumento do número dos transplantados renais tem favorecido o aparecimento mais frequente das dermatoses e permitido o estudo em sucessivos trabalhos. OBJETIVOS: avaliar a frequência das dermatoses em pacientes transplantados renais. MÉTODOS: captação de pacientes transplantados renais durante o período de 1° de março de 2009 a 30 de junho de 2010 com suspeita de dermatoses. RESULTADOS : foram

  7. Analysis of 1646 Cases of Children Superficial Mycosis in Kunming Region%昆明地区儿童浅部真菌病1646例分析

    Institute of Scientific and Technical Information of China (English)

    黄云丽; 张道军; 李红宾; 公丽红; 明迪; 张卫卫

    2012-01-01

    Objective To investigate the prevalence and pathogenic fungi species of dermatomycoses in children in Kunming region. Methods The specimens from patients (aged ≤14 years old) suspected of having dermatomycoses were examined microscopically in KOH preparations and cultured on Sabouraud dextrose agar (SDA). Results Among 2176 suspected cases, 1477 cases (67. 88% ) had positive result, 1226 strains (56, 34% ) pathogenic fungi were isolated- The diseases were consisted of tinea capitis(38, 88% ) , tinea corporis(28. 68% ) , tinea pedis( 11, 0% ) , pityriasis versicolor(6, 26% ) ,onychomycosis(5. 95% ) , tinea manus(3. 04% ) , tinea cruris(2. 49% ) , cutaneous candidiasis(2. 43% ) .malassezia folliculitis( L 28% ). The top three of the isolated pathogenic fungi are Microsporum canis (26- 26% ) , Grubyella ferruginea (26. 26% ) and Trichophyton rubrum (18. 11% ), Conclusion In Kunming district,tinea capitis is of the hightest prevalence in children, and Microsporum canis, Grubyella ferruginea and Trichophyton rubrum is the common pathogenic fungi.%目的 了解昆明地区儿童浅部真菌病的流行及病原菌的分布特点.方法 对该科门诊拟诊为浅部真菌病患儿(年龄≤14岁)行真菌镜检、培养及分离鉴定.结果 2176例拟诊为浅部真菌病患儿中,真菌直接镜检阳性1477例,阳性率67.88%,培养分离出真菌1226株,阳性率56.34%.镜检阳性和(或)培养阳性的1646例标本中,头癣、体癣、足癣发病例数居前3位,分别为640例(38.88%)、472例(28.68%)和181例(11.00%),余依次为花斑癣103例(6.26%)、甲真菌病98例(5.95%)、手癣50例(3.04%)、股癣41例(2.49%)、皮肤念珠菌病40例(2.43%)、马拉色菌毛囊炎21例(1.28%).分离的1226株致病菌株中前3位是犬小孢子菌(26.26%)、铁锈色小孢子菌(26.26%)和红色毛癣菌(18.11%).结论 昆明地区儿童浅部真菌病中头癣居首位,致病菌以犬小孢子菌、铁锈色小孢子菌、红色毛癣菌为主.

  8. A field investigation into the type and pathogen of superficial fungal infection at different countryside areas in Jiangxi Province,China%江西省农村地区浅部真菌病现场调查及致病菌的研究

    Institute of Scientific and Technical Information of China (English)

    邵丹; 喻玉华; 杨惠玲; 杨春华; 周柳华; 江情; 刘微娜; 罗来华; 万梅香; 刘琰; 丁世伟; 耿承芳; 刘红光; 占萍; 李智华; 薛玮; 王小兵; 陈琼霞; 徐标; 叶发舜; 罗宝香

    2008-01-01

    目的 了解江西省农村地区居民浅部真菌病构成情况及致病菌的种类.方法 2006年9月至2007年6月对江西省的11个地市、54个县区的66个乡(镇)、村居民以义诊的形式进行浅部真菌病现场调查,同时对513例具有典型临床表现且真菌镜检阳性的皮损进行真菌培养.结果 共调查浅部真菌病患者1284例,其中务农者947例,占73.75%.浅部真菌病包括足癣736例(57.32%)、手癣202例(15.73%)、甲真菌病72例(5.61%)、体癣47例(3.66%)、股癣29例(2.26%)、花斑癣23例(1.79%)、头癣1例、皮肤念珠菌病1例、手足癣135例(10.51%)、手癣合并指甲真菌病12例、足癣合并趾甲真菌病10例、手足癣合并指趾甲真菌病8例、体股癣3例、手癣合并体癣2例,以及手足癣合并体癣、足癣合并花斑癣、足癣合并体癣各1例.分离出致病真菌480株,其中红色毛癣菌301株、白念珠菌88株、须毛癣菌41株、其他菌50株.结论 浅部真菌病的致病菌以红色毛癣菌占优势,白念珠菌第二,各地市之间菌种分布构成差异无统计学意义.%Objective To profile the type and pathogen of superficial fungal inactions at rural areas of Jiangxi province in China.Methods A field investigation was conducted via benefit diagnosis in 66 towns,54 counties of 11 regions in Jiangxi province,China,from September 2006 to June 2007.Questionnaire was designed to collect demography and clinical data from local inhabitants.Additionally,when the lesion was positive for fungus on microscopic examination,fungal culture was performed.Results A total of 1,284 patients were recruited,and 73.75%(947)were peasants.Fungal culture was performed in specimens from 513 patients.Among the 1,284 cases,tinea pedis accouted for 57.32%(736),followed by tinea manum(15.73%),onychomycosis(5.61%),tinea corporis(3.66%),tinea cruris(2.26%),pityriasis versicolor(1.79%),tinea capitis(0.08%),cutaneous candidiasis (0.08%).and multiple-site fungal

  9. [DNA extraction and identification of Trichophyton rubrum by real-time polymerase chain reaction from direct nail scraping specimens of patients with onycomycosis].

    Science.gov (United States)

    Berk, Elife; Kuştimur, Semra; Kalkancı, Ayşe; Oztaş, O Murat

    2011-01-01

    Trichophyton rubrum is the most frequently encountered dermatophyte species causing onichomycosis. The routine diagnosis of dermatophytes depends on the direct microscopic examination (DME) and culture methods, however due to the phenotypic identification problems related to those agents, the molecular methods come into question. The aim of this study was to evaluate the diagnostic performance of real-time polymerase chain reaction (RT-PCR) for the identification of T.rubrum by comparing to DME and culture methods, from nail samples of patients with the complaints of onychomycosis. A total of 90 patients of whom 58 were male who were admitted to the dermatology outpatients clinics of our hospital with the complaints of color/shape changes in the nails and thickening of the nail, were included in the study, together with the 20 healthy volunteer subjects as controls. The nail scraping samples obtained from the patients and controls were examined with direct microscopy using 15% potassium hydroxide, dimethyl sulphoxide and chlorazole black mixture and cultivated onto Sabouraud dextrose agar with and without cycloheximide. For DNA isolation, after the disruption of nail samples with a steel tool, phenol-chloroform-isoamyl alcohol purification method were used. The amplification and demonstration of the T.rubrum DNA have been performed by using specific primers and probes following TaqMan protocol of RT-PCR (LightCycler-Roche, USA) method. Seventy-two of the patients yielded positive and 18 yielded negative results with DME. Growth of molds was detected in the cultures of 20 (27.8%) of the 72 DME positive patients and all of the isolates were identified as T.rubrum. No fungal growth was seen in the samples of 18 patients who were DME negative. In DME positive group, 67 (93%) patients were found to be positive in RT-PCR, while 8 (44.4%) patients were RT-PCR positive in DME negative group. All of the culture positive samples (n= 20) were also found positive in RT

  10. Genetic diagnosis of spondyloenchondrodysplasia with immune dysregulation:a case report and literature review%椎体软骨发育不良伴免疫调节异常1例基因诊断及文献复习

    Institute of Scientific and Technical Information of China (English)

    董辰; 孙碧君; 杨琳; 吴冰冰; 周文浩; 王慧君

    2016-01-01

    Objective To investigate the clinical and laboratory diagnosis in a rare case with dwarifsm and multisystem abnormalities. Methods Whole-exome sequencing was performed and data was processed using high-throughput data analysis pipeline. Genetic test result is veriifed by Sanger sequencing. Results This is a 14-year-old boy with short stature (the height is 132 cm) and autoimmune hemolytic anemia. He was treated with long-term oral prednisone. Head CT from other hospital found multiple calciifcations on both sides of the basal ganglia, two sides of the frontal lobe, and the left side of parietal lobe. Lateral spinal X-ray photography showed lfat in thoracolumbar vertebral body. Valgus was surgically corrected. He also has facial pigmentation spot and onychomycosis. Whole-exome sequencing combined with Sanger sequencing identiifed a known homozygous pathogenic mutation in ACP 5 genes (c. 643 G>A, p.G 215 R). Identiifcation of such a mutation results in the diagnosis of spondylo enchondrody splasia with immune dysregulation (SPENCDI). Conclusions Whole-exome sequencing is one of the effective methods for detection of rare disease, the SPENCDI case reported here is a good example of it.%目的:探讨1例罕见的矮小症伴多系统异常病例的临床和实验室诊断。方法采用全外显子组测序技术,结合高通量数据分析流程进行基因检测,并采用Sanger测序进行验证。结果患儿,男,14岁,发现身材矮小5年余。身高132cm,有面部色素沉着斑点和甲癣。外翻足已手术矫正,因自身免疫性溶血性贫血长期口服泼尼松治疗。头颅CT示两侧基底节、两侧额叶及左侧顶叶多发性钙化。脊柱平片示胸腰椎椎体变扁。全外显子组测序结合Sanger测序验证,发现ACP5基因纯合致病突变(c.643G> A, p.G215R),确诊为罕见的椎体软骨发育不良伴免疫调节异常(SPENCDI)。结论全外显子组测序是确诊疑难罕见病的有效方法之一。

  11. A STUDY ON CUTANEOUS FUNGAL DISORDERS IN DIABETES MELLITUS

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    Sampath Kumar G

    2016-09-01

    number of cases, which amounted to seven in number followed by sixty to eighty years, which amounted to five in number followed by age group of twenty to forty years, which amounted to four cases, followed by more than eighty years, which amounted to two cases. Least number of cases was seen in age group of zero to twenty years, which amounted to one case. Based on the type of fungal infections, total of twenty four patients suffered from tinea pedis infection out of which seventeen were males and seven were females. Eleven patients suffered from onychomycosis, out of which, ten were males and one was female. A total of four patients suffered from Candidal skin infection, out of which three were males and one was female. Four patients suffered from Candida angular cheilitis out of which male and female amounted to two cases each. Six males were noted to have Candidal balanitis and three females suffered from vaginal yeast infections. A total number of eight patients suffered from Candidal intertrigo out of which three cases were males and five cases were female. CONCLUSION Fungal infections, which are usually seen in the moist areas of the body are a common problem with diabetics and elderly. The study proves that in known diabetic patients of more than five years it is quiet common.

  12. Superficial Pathogenic Fungi in Shanwei High School Students%汕尾市中学生浅部真菌病致病性真菌菌种分析

    Institute of Scientific and Technical Information of China (English)

    谢瑶新; 吴伟芬; 庄建波

    2015-01-01

    目的:探讨汕尾市中学生皮肤浅部真菌病病种分布及致病真菌菌种的构成。方法对1000例临床诊断为浅部真菌病的中学生皮损处取样,分别进行真菌镜检和培养,对培养阳性者进一步进行菌种鉴定。结果1000份标本培养出真菌678份,678份阳性标本病种分布为股癣195例(28.71%),体癣143例(21.08%),手足癣253例(37.38%),甲真菌病78例(11.56%),头癣9例(1.27%);共分离培养出致病菌株12种,其中红色毛癣菌237株(34.96%),须癣毛癣菌169株(24.93%),絮状表皮癣菌2株(0.29%),犬小孢子菌9株(1.33%),铁锈色孢子菌23株(3.39%),白色念珠菌109株(16.08%),其他酵母样菌28株(4.13%),曲霉菌21株(3.10%),链格孢菌24株(3.54%),青霉菌19株(2.80%),混合感染29例(4.28%)。结论汕尾地区中学生浅部真菌感染以体股癣最多,致病菌仍以皮肤癣菌为主,但其他类真菌感染有明显上升趋势。%Objective To investigate the distribution and composition of superficial pathogenic fungi in Shanwei high school students.Methods The samples were obtained from skin lesions and fungal microscopy and culture were performed in 1 000 high school students with superficial mycoses.The strains were identified and cultured in culture-positive students.Results Among the 1 000 cases,tinea cruris was found in 195 (28.71%),tinea corporis in 143 (21.08%),tinea manuum and tinea pedis in 253(37.38%),onychomycosis in 78(11.56%),and tinea capitis in 9 (1.27%).A total of 12 pathogenic strains were isolated,including 237 strains of Trichophyton rubrum(34.96%),169 strains of Trichophyton mentagrophyte(24.93%),2 strains of Epidermo-phyton floccosum(0.29%),9 strains of Microsporum canis(1.33%),23 strains of Rust spore fun-gus(3.39%),109 strains of Candida albicans (16.08%),28 strains of other yeast

  13. δ氨基酮戊酸光动力疗法对体外培养三株嗜角质真菌杀伤效应的实验研究%Antifungal Effect of Delta-Aminolevulinic Acid Mediated Photodynamic Therapy on Three Strains of Kratinophilic Fungi in Vitro

    Institute of Scientific and Technical Information of China (English)

    黄望强; 史赢; 雷铁池

    2012-01-01

    Objective: To evaluate the killing effect of S-Aminolevulinic acid (ALA) -mediated photody-namic therapy on three strains of keratinophilic fungi in vitro and to investigate its mechanism. Methods: Trichophyton rubrum , Trichophyton mentagrophytes, and Candida albicans were inoculated in Sabouraud glucose peptone, for preparing fungi suspensions. The fungi suspensions were treated with different concentrations of ALA (3, 10, 30, 100, and 300 mmol/L) cultures in DMEM containing 2. 5% fetal calf serum. Confocal fluorescence microscope was used to examine proto-porphyrin IX (PpIX) formation. MTT assay was used to determine the inhibitory rates by different concentrations of ALA-PDT. The ult restructure changes of fungi were observed by transmission electron microscopy after the treatment of 100 mmol/L ALA-PDT. Results: After incubated with 100 mmol/L ALA, PpK was shown as brick-red fluorescent signal in the three stains of fungal inside by confocal laser scanning microscope. There is a positive correlation be-tween the concentration of ALA and the inhibition ratio of three strains of fungi (P<0. 05), but when the concentration of ALA increased to 300 mmol/L, the inhibition rate did not increase significantly. Simple laser and simple ALA treatment had no significant inhibition on fungal growth. The structures of cell wall, cell membrane, and organelles in all the three strains of fungi were destroyed at some extent after 100 mmol/L ALA-PDT treatment. Conclusion: 8-Aminolevulini-cacid-mediated photodynamic treatment have a definite killing effect in these, three strains fungi in vitro, which provides a theoretical basis for treatment of onychomycosis.%目的:探讨δ氨基酮戊酸(ALA)光动力学疗法(PDT)对体外培养的三株嗜角质真菌杀伤效应及作用机制.方法:将红色毛癣菌、须癣毛癣菌、白念珠菌三株标准菌株在沙氏葡萄糖琼脂培养基(SDA)活化培养后制备菌悬液,菌悬液与不同浓度ALA(3,10,30,100,300mmol

  14. CBIOS Science Sessions - 2016 - Part I and III National Symposium on Nanoscience and Biomedical Nanotechnology - Proceedings

    Directory of Open Access Journals (Sweden)

    L. Monteiro Rodrigues, et al.

    2016-05-01

    -ACTIVATABLE POLYMERIC NANOPARTICLES FOR INTRACELLULAR DELIVERY OF PROTEINS AND SMALL MOLECULES. A. Jiménez-Balsa, E. Costa and L. Ferreira. P.07 LIGHT CONTROLLED RELEASE OF PROTEINS FROM GOLD NANORODS. M.M. Lino, S. Simões, S. Pinho and L. Ferreira. P.08 PLGA NANOPARTICLES WITH ANTI-INFLAMMATORY AGENTS OBTAINED FROM PLECTRANTHUS PLANTS. J. Marçalo, B. Mourato, M. Nicolai, C.P. Reis, C. Faustino and P. Rijo. P.09 TABLETING NLC FOR ORAL DRUG DELIVERY. M. Mendes, M.B. Vaz, H.T. Soares, J.J. Sousa, A.A.C.C. Pais and C. Vitorino. P.010 NEW FORMULATION OF ORAL INSULIN. J. Moreira, I.V. Figueiredo, M. Silveira, P. Gonçalves, M. Nicolai, T. Almeida, N. Saraiva, M. Eduardo-Figueira, P. Faísca, I. Correia, L. Ascensão, P. Rijo and C.P. Reis. P.011 SELF MICROEMULSIFYING DRUG DELIVERY SYSTEMS (SMEDDS OF S-NITROSOGLUTATHIONE (GSNO/ SMEDDS OF GSNO. A.H. Mota, M. Socha and P. Maincent. P.012 ANTIMICROBIAL ACTIVITY OF NOVEL ABIETANES CATIONIC AMPHIPHILES ENCAPSULATED IN ALGINATE MICROSPHERES. I. Neto, C.P. Reis, C. Faustino and P. Rijo. P.013 DESIGN AND CHARACTERIZATION OF SUNFLOWER OIL NANOSTRUCTURED LIPID CARRIERS FOR RETINYL PALMITATE DELIVERY. F. Pinto, D.P.C. Barros and L.P. Fonseca. P.014 BIOCOMPATIBLE ANTIMICROBIAL PEPTIDE CONJUGATED GOLD NANOPARTICLES WITH ANTIMICROBIAL EFFICACY A SYSTEMIC INFECTION MODEL. A. Rai, S. Pinto, T. Velho, A. Ferreira, C. Moita, U. Trivedi, M. Evangelista, M. Comune, K. Rumbaugh, P.N. Simoes, L. Moita and L. Ferreira. P.015 INNOVATIVE ANTIMICROBIAL METALLIC-BASED NANOFORMULATION CONTAINING HERBAL EXTRACTS. L. Roque, A. Cândido, F. Rodrigues, I. Gomes, N. Cristo, R. Duarte, P. Rijo and C.P. Reis. P.016 INNOVATIVE NANOCARRIER-BASED TOPICAL FORMULATIONS FOR ALOPECIA TREATMENT. L. Roque, I. Dias, L. Palma, P. Rijo, A. Roberto and C.P. Reis. P.017 NEW FORMULATION FOR ONYCHOMYCOSIS TREATMENT. L. Roque, A. Pereira, A. Santos, M. Simões, V. Demchenko, P. Rijo and C.P. Reis. P.018 NOVEL GEL FORMULATION FOR FUNGAL INFECTIONS. L. Roque, A. Pereira, A. Santos, M. Sim