Síndrome de la uña verde: revisión actualizada de una patología emergente en la era COVID-19 / 19Green nail syndrome: updated review of an emerging disease in the era of COVID-19

El síndrome de la uña verde o cloroniquia corresponde a la infección por Pseudomonas aeruginosa de una lámina ungueal dañada en pacientes con algún factor de riesgo identificable, siendo los más frecuentes la inmunosupresión, el ambiente húmedo constante y la patología ungueal preexistente. Su diagnóstico es relativamente sencillo si se logra observar la tríada característica de coloración verdosa de la lámina ungueal, paroniquia proximal crónica y onicolisis distal; en casos de duda diagnóstica se puede enviar una muestra de la uña afectada para cultivos o estudio histopatológico. El pilar de su tratamiento corresponde al uso de antibióticos tópicos o sistémicos en conjunto con medidas generales que protejan de la humedad. Es muy importante enfatizar la prevención de esta patología en el personal de salud, especialmente en el contexto del lavado de manos frecuente y riguroso implementado durante la pandemia COVID-19, ya que existen reportes de transmisión nosocomial de P. aeruginosa por profesionales de la salud con infección ungueal.(AU)

Green nail syndrome or chloronychia is the infection of a damaged nail plate by Pseudomonas aeruginosa in a patient with an identifiable risk factor; the most frequently described are immunosuppression, a persistent moist environment and preexisting nail disease. Its diagnosis is relatively simple if the characteristic triad of green discoloration of the nail plate, chronic proximal paronychia and distal onycholysis can be observed, in cases of doubt a sample of the affected nail can be sent for cultures or histopathology. The cornerstone of treatment is the use of topical or systemic antibiotics along with measures to protect the nail from moisture. Prevention of this disease must be emphasized in health care personnel, especially in the context of frequent and rigorous handwashing practices implemented during the COVID-19 pandemic, since there are reports of nosocomial transmission of P. aeruginosaby health care professionals with nail infection.(AU)

Relationship between antifungal susceptibility profile and virulence factors in Candida albicans isolated from nail specimens

Abstract INTRODUCTION: The aim of this study was to evaluate some virulence factors in Candida albicans isolates from patients with onychomycosis and determine the correlation between these factors and the antifungal resistance profile. METHODS: Seventy species of C. albicans were confirmed using polymerase chain reaction amplification of the HWP1 gene. According to the Clinical & Laboratory Standards Institute guidelines, the susceptibility profile of four antifungal agents was investigated, and the production of aspartyl protease, phospholipase, haemolysin, and biofilm was determined. The correlation between these profiles was also investigated. RESULTS: The isolates indicated different levels of resistance and production of virulence factors. Significant correlations were observed between the minimum inhibitory concentration (MIC) of fluconazole/itraconazole and biofilm production, between phospholipase production and fluconazole/itraconazole MIC, and between fluconazole MIC and hemolytic activity in C. albicans isolates. The results also showed significant correlations between phospholipase activity and biofilm production. CONCLUSIONS: Our findings will contribute to a better understanding of the pathogenesis of C. albicans and characterize the relationship between virulence factors and antifungal resistance, which may suggest new therapeutic strategies considering the possible involvement of the virulence mechanism in the effectiveness of treatment.

Occurrence of dermatophytoses in patients from the Sistema Único de Saúde

Abstract: Background: Dermatophytosis is a cutaneous disease caused by filamentous keratinophilic fungi belonging to the genera Trichophyton, Microsporum and Epidermophyton, which present a high prevalence in the general population, being among the most common mycoses affecting about 20% of the world's population. Objective: To carry out the epidemiological survey of cases of dermatophytosis in patients from the Sistema Único de Saúde in a regional Laboratory in the period of 5 years (2009 to 2013). Methods: A retrospective study (January 2009 to December 2013) was carried out with a qualitative and quantitative design, through the registry book of the laboratory, Mycology Sector, where cases of patients with suspected dermatomycosis were analyzed. Results: In a 5-year period, a total of 4467 cases were suspected of having a fungal infection. Of these, 68.74% (3071) cases were of dermatomycosis. In relation to cultures with fungal growth, 12.54% (385 cases) were dermatophyte fungi and 7.97% (245 cases) non-dermatophyte fungi were isolated. Among the species identified, there was a higher prevalence of T. rubrum complex (75%), T. mentagrophytes complex (11.68%) and M. canis (7.01%). Regarding the sites analyzed, nail involvement was the most frequent in 75% of the cases. Study Limitations: This work is representative in the studied region. Conclusions: Dermatomycosis samples are the most frequent among all samples of fungal infections from these patients, with the nail being the most affected area and the fungi T. rubrum complex and T. mentagrophytes complex the most frequent.

Nail clipping in onychomycosis and comparison with normal nails and ungual psoriasis

Abstract: Background: Of all nail disorders seen in dermatology offices, half of them are due to onychomycosis. The main differential diagnosis is nail psoriasis. The objective of this study was to compare the microscopic findings, other than the presence of fungi, in the clipping of onychomycosis versus normal nails and nail psoriasis. Methods: Cross-sectional study of onychomycosis cases, analyzed by clipping and compared with data on normal nails and those with nail psoriasis. Results: Sixty-two onychomycosis samples were compared with 30 normal nails and 50 nails with psoriasis. In onychomycosis, measurement of subungual region, serous lakes, neutrophils and number of layers of parakeratosis are more intense than in psoriasis. Onychocariosis is less common in psoriasis, while bacteria are more frequent. The nail transition zone is more commonly blurred and irregular in onychomycosis. Conclusion: Clipping helps in the differential diagnosis of onychomycosis and nail psoriasis and may be useful even when fungi are not found.

Dermatophytes and other associated fungi in patients attending to some hospitals in Egypt

Dermatophytes are keratinophilic fungi that infect keratinized tissues causing diseases known as dermatophytoses. Dermatophytes are classified in three genera, Epidermophyton, Microsporum, and Trichophyton. This investigation was performed to study the prevalence of dermatomycosis among 640 patients being evaluated at the dermatology clinics at Kasr elainy, El-Husein and Said Galal hospitals in Cairo and Giza between January 2005 and December 2006. The patients were checked for various diseases. Tinea capitis was the most common clinical disease followed by tinea pedis and tinea corporis. Tinea cruris and tinea unguium were the least in occurrence. Tinea versicolor also was detected. The most susceptible persons were children below 10 years followed by those aged 31–40 years. Unicellular yeast was the most common etiological agent and T. tonsuranswas the second most frequent causative agent followed by M. canis.

Comparative efficacy of continuous and pulse dose terbinafifine regimes in toenail dermatophytosis: A randomized double-blind trial.

Introduction: Dermatophytes are the most frequently implicated agents in toenail onychomycosis and oral terbinafi ne has shown the best cure rates in this condition. The pharmacokinetics of terbinafi ne favors its effi cacy in pulse dosing. Objectives: To compare the effi cacy of terbinafi ne in continuous and pulse dosing schedules in the treatment of toenail dermatophytosis. Methods: Seventy-six patients of potassium hydroxide (KOH) and culture positive dermatophyte toenail onychomycosis were randomly allocated to two treatment groups receiving either continuous terbinafi ne 250 mg daily for 12 weeks or 3 pulses of terbinafi ne (each of 500mg daily for a week) repeated every 4 weeks. Patients were followed up at 4, 8 and12 weeks during treatment and post-treatment at 24 weeks. At each visit, a KOH mount and culture were performed. In each patient, improvement in a target nail was assessed using a clinical score; total scores for all nails and global assessments by physician and patient were also recorded. Mycological, clinical and complete cure rates, clinical effectivity and treatment failure rates were then compared. Results: The declines in target nail and total scores from baseline were signifi cant at each follow-up visit in both the treatment groups. However, the inter-group difference was statistically insignifi cant. The same was true for global assessment indices, clinical effectivity as well as clinical, mycological, and complete cure rates. Limitations: The short follow-up in our study may have led to lower cure rates being recorded. Conclusion: Terbinafi ne in pulse dosing is as effective as continuous dosing in the treatment of dermatophyte toenail onychomycosis.

Prevalence and Etiological Agents of Onychomycosis.

Onychomycosis is a common nail infection caused by dermatophytes, yeast or other non-dermatophyte molds and have been known to be associated with significant physical and psychological morbidity. This study was performed to determine the prevalence and the etiologic agents of onychomycosis in patients attending RIMS, Imphal, Manipur for a period of two years (January 2010 to December 2012). Nail samples of 347 clinically suspected cases of onycomycosis attending dermatology OPD RIMS, Manipur were collected and were subjected to potassium hydroxide (KOH) mounts for direct microscopy and fungal culture on Sabouraud’s dextrose agar (SDA). The male female ratio of the participants was 1:1.81 (165 male and 302 female). Out of 467, 399 (85.44.%) were positive by culture and KOH mount. Young adults in the age group of 21-30 years were commonly affected. In female patients finger nail infection was more common than toe nail infection. Both toe and finger nails involvement were noticed in nine patients of which two were male and seven were female. The most frequently isolated fungus was dermatophytes, in 107 (40.38%) patients followed by Aspergillus spp in 101 (38.11%) and Candida spp in 17 (6.4%). This study demonstrated that dermatophytes, as well as moulds especially Aspergillus spp are commonly isolated from onychomycosis patients in our region.

Superficial mycoses at the Hospital do Servidor Público Municipal de São Paulo between 2005 and 2011

BACKGROUND: Superficial mycoses are fungal infections limited to the outermost layers of the skin. Dermatophytic filamentous fungi and yeasts are the major causative agents of these mycoses. Dermatophytosis is one of the clinical conditions caused by fungal infections most commonly found in dermatological practice. Thus, knowledge of the ecology of dermatophytes provides a better understanding of the natural history of dermatophytosis. OBJECTIVE: This study aimed to investigate epidemiological and mycological features of superficial mycoses diagnosed from 2005 to 2011 in the Dermatology Clinic of the Hospital do Servidor Público Municipal de São Paulo, Brazil. METHOD: This retrospective study was conducted in the Laboratory of Medical Mycology at the Dermatology Clinic of the Hospital do Servidor Público Municipal de São Paulo. Mycological examinations of 9042 patients with clinical suspicion of superficial mycoses performed between 2005 and 2011 were reviewed. RESULTS: Of 9042 direct microscopic examinations, 2626 (29%) were positive for dermatophytes, 205 (2.3%) were positive for Malassezia, 191 (2.1%) were positive for other types of yeast, 48 (0.5%) were positive for bacteria, and 5972 (66%) were negative. Mean age of patients was 48 years, 6920 (77%) patients were female and 2112 (23%) were male. CONCLUSION: The biota consisted of six dermatophyte species: T. rubrum, T. mentagrophytes, M. gypseum, T. tonsurans, E. floccosum, and M. canis. The most common site of involvement was the nail and foot in adults and scalp in children, with a female predominance. Both Candida and Malassezia were more prevalent in adult women, the former most commonly affecting the interdigital region and nails and the latter the chest and neck. .

[Prevalence of Staphylococcus aureus [SA] and methicillin resistant Staphylococcus aureus [MRSA] in personnel of operation room of Shahid Sadoughi hospital, Yazd, Iran]

Staphylococcus aureus [SA] may cause infection in all body organs. Many personnel and patients in hospitals may become carriers of this species. The aim of this study was to investigate relative frequency of SA and its resistance to Methicillin. A couple of swabs were taken from nose and nails of 151 personnels working in operation room of Shahid Sadoughi Hospital in Yazd. Samples were inoculated into Mannitol salt agar medium and S. aureus colonies were antibiogramed to determine the rate of resistance to methicillin. Statistical analyses were performed by chi-square and Fishers' exact test. Overall prevalence of SA was 35.09%[19.2% and 15.9% in noses and nails, respectively]. Prevalence of methicillin-resistant SA [MRSA] was 11.92%[5.3% and 6.6% in noses and nails, respectively]. Surgeons had the highest, and workers the lowest prevalence of nasal SA carrier rate. In contrast, the nails of servants had the highest, and surgeons the lowest SA carrier rate. No significant difference was found between carrier rate and age, sex and duration of employment. But a meaningful relation was found between type of job and MRSA in both noses and nails. All of the MRSA isolates were sensitive to vancomycin. Since employees of operation room are continuously working with patients undergone operation, screening both the personnel and patients to determine the rate of carriage, preventing transfusions of fore mentioned bacterium is necessary and highly recommended

Fungal agents in different anatomical sites in Public Health Services in Cuiabá, state of Mato Grosso, Brazil / Agentes fúngicos em diferentes sítios anatômicos nos Serviços de Saúde Pública em Cuiabá, Mato Grosso, Brasil

INTRODUCTION: A contribution to the regional epidemiological profile of the most common fungal agents in Public Health Services in Cuiabá, state of Mato Grosso, including university hospitals and polyclinics. METHODS: Clinical specimens (n = 1,496) from 1,078 patients were collected, submitted to direct mycological exam (potash or stick tape method) and cultured in specific mediums. Dermatophytic and non-dermatophytic agents were identified according to micromorphology (Ridell technique). RESULTS: The majority of the 1,496 specimens were skin (n = 985) and nail exams (n = 472). Of the 800 positive cultures, 246 (30.8 percent) corresponded to dermatophytes and 336 (42 percent) to yeasts of the genus Candida, 190 (23.7 percent) to other yeasts, 27 (3.4 percent) to non-dermatophytic filamentous fungi and one (0.1 percent) the agent of subcutaneous mycosis. Lesions considered primary occurred in greater numbers (59.5 percent) than recurrent lesions (37.4 percent), with a greater concentration of positivity occurring on the arms and legs. CONCLUSIONS: Comorbidities, allergies and diabetes mellitus were conditions associated with greater positivity in direct mycological exams and cultures. Positive culture was considered a definitive diagnosis of fungal infection and confirmed 47.8 percent of diagnostic hypotheses.

INTRODUÇÃO: Contribuição sobre o perfil epidemiológico regional referente aos agentes fúngicos mais freqüentes nos Serviços de Saúde Pública em Cuiabá-MT, incluindo policlínicas e hospitais universitários. MÉTODOS: Foram examinados 1.496 espécimes clínicos colhidos a partir de 1.078 pacientes, os quais foram submetidos ao exame direto (potassa e/ou fita gomada) e cultivos em meios específicos. Os agentes foram identificados segundo micromorfologia (técnica de Ridell). RESULTADOS: Os 1.496 espécimes foram relacionados na maioria a exames de pele (n = 985), e unhas (n = 472). Dos 800 cultivos positivos, 246 (30,8 por cento) corresponderam a dermatófitos, 336 (42 por cento) a leveduras do gênero Candida, 190 (23,7 por cento) a outras leveduras, 27 (3,4 por cento) a fungos filamentosos não dermatofíticos e um (0,1 por cento) a agente de micoses subcutâneas. Lesões consideradas primárias compareceram em maior número (59,5 por cento), comparadas as recidivantes (37,4 por cento). Foi observada maior positividade em membros inferiores e superiores. CONCLUSÕES: Co-morbidades, quadros alérgicos e diabetes mellitus representaram condições associadas à maior positividade em exames micológicos diretos e cultivos. O cultivo positivo foi considerado como diagnóstico definitivo de infecção fúngica, e confirmou 47,8 por cento de hipóteses diagnósticas.

[Report of 34 cases of saprophytic fungi isolated from dystrophic nails of patients referred to Razi Hospital [2010 - 2011]]

Saprophytes are one of the agents causing nail dystrophy. Saprophytes can invade healthy nail or may invade nails previously damaged in the course of other diseases and grow with suitable conditions. The reported incidence of saprophytic nails is between 1.43-17.6%. Saprophytes preferably invade the nails on the big toes, especially in individuals above 60 years. The most etiologic agents of saprophyte nail are Aspergillus spp, Acremonium spp, Scopulariopsis spp, Penicillium spp, and fusarium. The purpose of this study was to determine the prevalence agents of saprophytic nails in patient that had referred to Razi hospital. This was a cross sectional study and nail samples were analyzed by direct microscopy and culture. Microscopic examination of these specimens was carried out in potassium hydroxide solution [20%]. These specimens were cultured on two media of sabourad dextrose Agar [S]. Czapek-Dox Agar [CZA] medium was used for identification of Aspergillus species. For investigation of relevance between the variables, Chi-square test and Fisher exact tests were used. In this study, 34 cases were positive by both direct microscopy and culture. Of those, 17 patients were females and 17 patients were males. The most frequently isolated saprophytes from nails was Aspergilus flavous [35.3%]. Meanwhile 58.8% of saprophytes were isolated from toe nails. In this study the distal subungual onychomycosis was the most frequent [% 64.7%]. The age group 50-59 years [29.4%] had the highest prevalence of saprophytic nail infections.In this study the prevalence of saprophytic nails infections was 17.2%. A proper diagnosis, consisting of both clinical and mycological examinations, may aid the clinician in selecting the most appropriate therapy. Knowledge of epidemiology and mycology characteristics of nail infections has been noted by many authors as being an important tool for control of these fungal infections

Como o clipping pode auxiliar o dermatologista / How the Nail clipping helps the dermatologist

Alterações ungueais são queixas muito frequentes nos consultórios dermatológicos. Onicomicoses representam cerca de 50% das onicopatias, daí a importância de se estabelecer o diagnóstico correto antes de se iniciar o tratamento. Neste artigo, relataremos a utilidade de um exame que é de fácil execução pelo clínico, de baixo custo e sensível: esse exame consiste na análise histopatológica da queratina ungueal distal, atualmente já consagrado com o termo clipping.

Onycodystrophies are common problems in dermatologic practice. About 50% of dystrophic nails have a fungal cause, so it is very important to establish a correct diagnosis before treatment. In this article we relate the usefulness of an easydoing exam, free from pain, cheap and sensible. This exam is the histopathology of the nail keratin or nail clipping.

Fungal nail infections in Tehran, Iran

Onychomycosis results from invasion of the nail plate by dermatophytes, yeasts or mould species of fungi. The objective was to determine the etiological agents of onychomycosis. A total of 549 patients clinically suspected of onychomycosis were examined for causative fungal agents. Both direct microscopy and the cultures of the nail material were performed to identify the causative agents between 2004-2005 in Tehran, Iran. Out of 549 cases examined, 263 [47.9%] were mycologically proven cases of onychomycosis [139 finger, 124 toe nails], among those 33 [6.09%] were only positive in direct microscopic examination. From an etiological point of view, 21.85% of nail infections were caused by yeasts, 10.55% were infected by dermatophytes and 15.5% by non-dermatopyte moulds.Candida albicans was the common yeast causative agent [16.73%] followed by A. flavus [11.78%], T. mentagrophytes [10.26%], [2.66%], Aspergillus spp [1.90%], each of Rhizopus spp and Cladosporium spp [1.52%], C.giulliermondii [1.14%], Scopolariopsis spp. [1.14%], each of C. famata, C.glabrata, C. krusei, S. lusitania, Acremonium spp. [0.76%] and C. homicola [0.38%], T. rubrum [4.94%]. Candida species were most common responsible agent for onychomycosis in female hands [74.1%] followed by 17.26% non-dermatophyte moulds. Dermatophytes caused tinea unguim of hand [8.63%] and peduum [37.1%] in males. The yeasts of the Genus Candida and non-dermatophyte moulds are dominant cause of female finger nail onychomycosis and dermathophytes are principal causes of both finger and toe nails in males in Tehran

Colonización por Staphylococcus aureus y riesgo de desarrollar episodio de peritonitis causado por cepa idéntica en pacientes pediátricos en diálisis peritoneal continua ambulatoria / Staphylococcus aureus colonization and risk of developing a subsequent peritonitis episode caused by an identical strain, among pediatric patients admitted for continuous ambulatory peritoneal dialysis

Objetivo: Determinar el riesgo de los pacientes pediátricos con insuficiencia renal crónica terminal en programa de diálisis peritoneal continua ambulatoria (DPCA), portadores de Staphylococcus aureus (SA) en nariz, manos o sitio de salida del catéter, para desarrollar episodio de peritonitis causado por una cepa idéntica. Métodos: Estudio longitudinal en un centro de DPCA perteneciente a un hospital pediátrico de tercer nivel. Al ingresar al estudio se tomaron cultivos de las narinas, sitio de salida del catéter y manos, de 29 pacientes vigilados por un periodo promedio de 369 ± 80 días (de 224 a 516 días), y de las narinas y manos de sus madres. Las cepas de SA aisladas se conservaron en glicerol BHI a –20°C para análisis posterior. Los episodios de peritonitis se monitorearon y registraron. Cuando se aisló una cepa de SA del líquido de diálisis efluente se comparó con la previa identificada por electroforesis en gel de campos pulsados. Resultados: Se presentaron siete episodios de peritonitis causados por SA en seis pacientes, uno de los cuales era portador previo de la misma cepa en la nariz y dos en el sitio de salida del catéter. El riesgo relativo de desarrollar un episodio de peritonitis causado por una cepa preexistente localizada en el sitio de salida del catéter fue de 0.948, y de 0.525 por una cepa preexistente localizada en la nariz. Conclusiones: Los portadores de SA no parecen tener riesgo más alto de desarrollar peritonitis causada por una cepa de SA relacionada que los no portadores. No se sustenta la recomendación de monitorear el estado de portador nasal o en el sitio de salida del catéter en los pacientes tratados con DPCA. La conveniencia de erradicar el SA de la nariz o el sitio de salida del catéter también es cuestionable.

OBJECTIVE: To determine the risk of pediatric end stage renal disease patients undergoing continuous ambulatory peritoneal dialysis to develop a subsecuent peritonitis episode caused by an identical Staphylococcus aureus (SA) strain. METHODS: Longitudinal survey carried out in a CAPD center at the nephrology department of a tertiary care (reference) pediatric hospital. At recruitment, swabs were collected from the nares, exit site, and hands, respectively from 29 patients who were followed-up for a mean period of 369 +/- 80 days (range 224-516 days), and from the nares and hands of their mothers. Isolated SA strains were kept in BHI glycerol at -20 degrees C for subsequent analysis. Peritonitis episodes were monitored and registered. When a SA strain was isolated from the dialysate effluent it was compared with the preexisting strain by PFGE. RESULTS: We report 7 SA-mediated peritonitis episodes among 6 patients. Only one of these patients was a previous nasal carrier, and 2 were previous exit site carriers of the same SA strain. The relative risk of developing a peritonitis episode caused by a preexistent SA strain colonizing the exit site was 0.948. The relative risk of developing a peritonitis episode caused by a preexistent SA strain colonizing the nares was 0.525. CONCLUSIONS: SA carriers do not appear to be at higher risk of developing peritonitis by an SA related strain than non-carriers. Our results do not lend support to the recommendation of monitoring nasal or exit site carrier status in CAPD patients. The need of attempting to eradicate SA from nose or exit site is also questioned.

Survival of Vibrio cholerae on different finger locations of a volunteer following artificial inoculation.

The importance of bacteria-suspending media and fingertip positions on the survival of Vibrio cholerae on human fingertips were examined. Vibrios were suspended in phosphate-buffered saline (PBS), PBS with albumin, and PBS with agarose. Each type of preparation was inoculated on the fingerpads, the hyponychia, or the eponychia and lateral nail grooves of the fourth, third and second fingers of a volunteer's hand. The last finger inoculated was immediately washed with PBS and the washing collected for examination ("0 minute" exposure). The third and fourth inoculated fingers were likewise washed for examination 2 and 5 minutes later, respectively. The vibrios obtained from the washings were enumerated by culture. For each of the different groups, which consisted of a different inoculated fingertip position, bacteria-suspending medium and exposure period of 2 or 5 minutes, the proportion of replicate inoculated fingers which retained viable vibrios (isolation rate) and the mean number of surviving vibrios, as a percentage of the inoculated vibrios at "0 minute exposure" (survival rate) were as follows: finger pads: vibrios in PBS, 2 minutes post-inoculation (isolation rate, 25%; mean survival rate, 0.002%); 5 minutes post-inoculation (isolation rate, 0%; mean survival rate, 0%). PBS-albumin: 2 minutes post-inoculation (60%, 0.004%); 5 minutes post-inoculation (40%, 0.03%). PBS-agarose: 2 minutes post-inoculation (100%, 24%); 5 minutes post-inoculation (38%, 0.005%). Lateral nail grooves and eponychia: PBS: 2 minutes post-inoculation (100%, 2.2%); 5 minutes post-inoculation (44%, 0.2%). PBS-agarose: 2 minutes post-inoculation (100%, 32%); 5 minutes post-inoculation (100%, 0.7%). Hyponychia: PBS: 2 minutes post-inoculation (100%, 8%); 5 minutes post-inoculation (100%, 0.2%). PBS-agarose: 2 minutes post-inoculation (100%, 46%); 5 minutes post-inoculation (100%, 8%). The results show that vibrios in moisture-retaining medium (PBS-agarose) and inoculated on a sheltered fingertip locations (hyponychium) have the best survival rates. However, the high survival rate was maintained briefly.

Comparison of potassium hydroxide mount and mycological culture with histopathologic examination using periodic acid-Schiff staining of the nail clippings in the diagnosis of onychomycosis.

BACKGROUND: Onychomycosis is a common problem noticed in clinical practice. Currently available standard laboratory methods show inconsistent sensitivity; hence there is a need for newer methods of detection. AIMS: This study involves comparison of standard laboratory tests in the diagnosis of onychomycosis, namely, potassium hydroxide mount (KOH mount) and mycological culture, with histopathologic examination using periodic acid-Schiff (PAS) staining of the nail clippings. METHODS: A total of 101 patients with clinically suspected onychomycosis were selected. Nail scrapings and clippings were subjected to KOH mount for direct microscopic examination, culture using Sabouraud's dextrose agar (with and without antibiotics) and histopathologic examination with PAS staining (HP/PAS). Statistical analysis was done by McNemar's test. RESULTS: Direct microscopy with KOH mount, mycological culture, and HP/PAS showed positive results in 54 (53%), 35 (35%), and 76 (75%) patients respectively. Laboratory evidence of fungal infection was obtained in 84 samples by at least one of these three methods. Using this as the denominator, HP/PAS had a sensitivity of 90%, which was significantly higher compared to that of KOH mount (64%) or mycological culture (42%). CONCLUSIONS: Histopathologic diagnosis with PAS staining of nail clippings was the most sensitive among the tests. It was easy to perform, rapid, and gave significantly higher rates of detection of onychomycosis compared to the standard methods, namely KOH mount and mycological culture.

Espécies fúngicas responsáveis por onicomicose em Recife, Pernambuco / Fungal species causing onychomycosis in Recife, Pernambuco

Onicomicose é a infecção fúngica ungueal causada por leveduras, dermatófitos ou fungos filamentosos não-dermatófitos. O presente trabalho tem como objetivo demonstrar fungos em unhas de pacientes encaminhados a exame micológico em Recife, PE. Foram avaliadas 181 amostras ungueais dos pés e 107 das mãos oriundas de 251 pacientes. O exame direto foi realizado com KOH a 20% e a cultura em Agar Sabourand e Mycosel®. Das amostras estudadas, 167 (58%) foram positivas, 97 (34%) de unhas dos pés e 70 (24%) de unhas das mãos. Leveduras foram isoladas em 86 casos, representando 51% das amostras positivas, principalmente espéciesde Candida; os fungos filamentosos não dermatófitos foram isolados em 32 (19%) casos, com ênfase para espécies de Fusarium e Scytalidium; dermatófitos foram identificados em 26 (16%) amostras, com predominância de Trichophyton rubrum. Entretanto, nãofoi possível isolar o agente etiológico em 23 (14%) amostras com exame direto positivo. Os resultados obtidos demonstraram a ampla gama de espécies fúngicas envolvidas em patologias ungueais com destaque para os fungos filamentosos não-dermatófitos que constituíram o segundo grupo mais isolado. O diagnóstico micológico com identificação das espécies envolvidas é essencial para o tratamento mais específico de doenças fúngicas ungueais.

Onychomycosis in eastern Nepal.

Onychomycosis, a fungal infection of the nail is responsible for up to 50.0% of all nail diseases. Though, dermatophytes are most frequently implicated as the causative agents in onychomycosis, yeast and molds are increasingly recognized as causative pathogens. This study was aimed to know the clinical and mycological pattern of onychomycosis in eastern Nepal. Eighty-two clinically diagnosed patients of onychomycosis attending the Dermatology Outpatient department of a tertiary hospital over a period of one year were enrolled in this study. Clipping from the severely affected nail and skin scrapping from active border of the skin lesions if associated were collected from each patient and subjected to microscopy and culture for identification of fungi. The commonest affected age group was 21-40 years. The male: female ratio was 2.7:1. Fifty-one patients had isolated fingernail involvement, while involvement of toenails was seen in 15 patients. Distolateral subungual onychomycosis (67%) was the commonest clinical type followed in decreasing order by superficial white onychomycosis (14.6%), proximal subungual onychomycosis (9.8%), candidal onychomycosis (7.4%) and total dystrophic onychomycosis (1.2%). Trichophyton mentagrophytes (28.8%) was the most common pathogen isolated followed by Trichophyton rubrum (21.2%), Trichophyton tonsurans (11.5%), Candida albicans (11.5%), Trichospron beigelii, (9.6%), Epidermophyton floccosum (7.7%), Trichophyton violaceum (5.8%), and Aspergillus flavus (3.9%). Distolateral subungual onychomycosis was the most common clinical presentation and T. mentagrophytes and T. rubruni were the most frequently isolated fungi for onychomycosis in eastern Nepal.

Ocorrência de dermatófitos em amostras de unhas, pés e mãos coletadas de estudantes universitários / Occurrence of dermatophyte, in nails, feet and hands of universitary students

Este trabalho teve como objetivo, avaliar a presença de dermatófitos, especificamente em unhas, pés e mãos de estudantes universitários com e sem lesões sugestivas de dermatofitose. Foram coletadas 280 amostras dessas regiões, das quais 31 (11,1 por cento) apresentaram positividade apenas pelo exame direto, e 20 (7,1 por cento) tiveram, além do exame direto positivo, crescimento de dermatófito, mediante cultivo da amostra biológica. T. rubrum foi o dermatófito isolado com maior freqüência (80 por cento), seguido por T. mentagrophytes (20 por cento). Considerando os sítios analisados neste trabalho, a ocorrência de dermatófitos foi observada em 10,4 por cento nas unhas dos pés, 5 por cento nas escamas de pés, 2,5 por cento nas unhas das mãos e apenas 0,4 por cento nas escamas das mãos.