Fungal Infections and Nail Psoriasis: An Update.

The relationship between psoriasis and onychomycosis is controversial, and the exact nature of this association remains to be clearly elucidated. In healthy nails, the compact nail plate acts as a barrier, preventing any infection. In psoriatic nails, the nail plate involvement, together with abnormalities in the blood capillaries, may lead to decreased natural defenses against microorganisms. Moreover, onycholysis (detachment of the nail plate) induces a humid environment that may favor fungal proliferation. Treatment with immunosuppressive drugs may additionally enhance onychomycosis. In this comprehensive review, we present data regarding the incidence and pathogenic action of dermatophytes and other fungi in the development of fungal infection in psoriatic nails.

Epidemiology of Dermatophytes in Belgium: A 5 Years' Survey.

Dermatophytes are among the most common fungal agents causing superficial skin infections worldwide. Epidemiology of these infections is evolving and variable in every country. This report presents the Belgian epidemiological data regarding the distribution of dermatophytes species isolated by the two national reference centers for mycosis during a period of 5 years (2012-2016). Trichophyton rubrum was the most frequently isolated species, considering all sampling sites (60.3% on average between 2012 and 2016). More precisely, this dermatophyte was the major agent of Tinea unguium and Tinea corporis during this period, followed by species of the Trichophyton mentagrophytes complex. Moreover, Microsporum audouinii was the main etiological agent of Tinea capitis (TC) with a frequency of 52.5% on average between 2012 and 2016. Other African dermatophytes species such as Trichophyton soudanense and Trichophyton violaceum were also agents of TC with a respective prevalence of 11.6% and 11.5% on average. This study highlights a different dermatophyte distribution in Belgium in comparison with other European countries.

[Clinical and mycological characteristics of onychomycosis due to Candida at Institut Pasteur of Côte d'Ivoire]. / Caractéristiques cliniques et mycologiques des onychomycoses à Candida à l'Institut Pasteur de Côte d'Ivoire.

OBJECTIVE: This study aims to study the clinical and mycological characteristics of onychomycosis due to Candida in mycology unit of Institut Pasteur of Côte d'Ivoire. PATIENTS AND METHODS: This is a retrospective study which was carried out on patients from 1990 to 2016 for mycological diagnosis of onychomycosis and which socio-demographic characteristics, direct examination and culture results were recorded. RESULTS: In this study, 1898 patient files were selected. The average age of the patients was 31.69 years (standard deviation=15.11) with a sex ratio of 0.87. The frequency of Candida onychomycosis from patients received was 61.7%. Finger nails (67.7%) were more affected by this condition, followed by those of the toes (25.3%). Ninety cases of double localization of the nails of the hands and toes have been found. Candida albicans was the most frequent species accounting for 79.1% of isolated yeasts. Among the non-albicans, C. parapsilosis and C. tropicalis were isolated at the level of the toenails with frequencies rate of 11.2 and 9.6%. CONCLUSION: Onychomycosis due to Candida are relatively common in Abidjan and are dominated by C. albicans. The mycological confirmation of the fungal etiology in onychopathy and a good hygiene of the nails will allow a better management.

[Mycological profile of hand onychomycosis amongs "Garba" sellers in Abidjan (Côte d'Ivoire)]. / Profil mycologique des onychomycoses des mains chez les vendeurs de « Garba ¼ à Abidjan (Côte d'Ivoire).

OBJECTIVE: The aim of this study is to determine the prevalence and the fungi involved in onychomycosis located on fingers in Abidjan. MATERIAL AND METHODS: This study includes the sellers of cooked cassava semolina served with fried tuna fish called "garba". Fines squames specimen was processed with 30% KOH for a direct microscope examination. Serous collection were done in physiological serum. Part of the original sample was cultured on Sabouraud medium with antibiotics (chloramphénicol, actidione). Species distribution and antifungal susceptibility by the technique on agar were noted. RESULTS: A total of 205 male sellers were involved. The Onychomycosis prevalence was 6.3%; (95% CI : 3.6-10.3). Five species of yeasts were identified. Candida spp were the most frequent (84.6%) and Candida albicans represented 30.8% of isolated yeasts. Trichosporon cutaneum were isolated in two case (15.4%). Susceptibility for amphotericin-B was 92.3% contrary to 5-fluorocytosine 30.8%. The subjects aged between 15 to 24 (69.2%), with a higher seniority (84.6%) and illiterate (69.2%) were the most affected. The main risk factors of fungal infections were the presence of previous fingernail onychomycosis (P<0.0001) and the frequent fingernail cutting (P=0.0009). CONCLUSION: Onychomycosis caused by yeast is infrequent among "garba" sellers in Abidjan. The main fungi involved in fingernail onychomycosis were Candida species. It is nevertheless necessary to implement sensitization for them on contributing factors.

[Mycological profile of onychomycosis in Yaoundé, Cameroon]. / Profil mycologique des onychomycoses vues en consultation de dermatologie à Yaoundé, Cameroun.

BACKGROUND: The lack of data concerning the mycological spectrum of onychomycosis in Cameroon prompted us to conduct the present study, which aimed to determine the mycological profile of onychomycosis diagnosed during dermatologic consultations in Yaoundé, Cameroon. METHODS: This was a cross-sectional study held from October 2014 to March 2015 in six hospitals of Yaoundé. Patients suspected of onychomycosis were consecutively recruited during dermatologic consultations; anamnestic and clinical data were recorded and one or several nail fragments sampled for mycological examination (direct examination or culture). RESULTS: A total of 3457 patients were examined during the study period, 117 of whom were suspected of onychomycosis; 133 samplings were performed. The distolateral subungual form was the dominating one: 72/110; 65.5%. The diagnosis was confirmed with 110 of the 133 samples (82.7%), these collected among 96 patients, hence a prevalence of 2.8% (96/3457). We isolated 99 germs, among which two-co-infestations. Dermatophytes (52/99; 52.5%), especially Trichophyton rubrum (23/52; 44.2%) and Trichophyton verrucosum (11/52; 21.2%) were the main pathogens causing onychomycois of the toes whereas yeasts (43/99; 43.4%), Candida albicans (31/43; 72.1%) in majority, were the prevailing germs incriminated in onychomycosis of the fingers. There were few cases of molds infestation (4/99; 4%). CONCLUSION: Onychomycosis are common in dermatology consultations in Yaoundé. Candida albicans, Trichophyton rubrum and Trichophyton verrucosum are the main pathogens in cause.

A comparative study of three extraction protocols of DNA from nails: Potential use in the diagnosis of onychomycoses.

Molecular techniques can be useful adjuncts to the diagnosis of onychomycoses. However, the nail presents difficulties in the extraction of its DNA. The comparison of three extraction protocols of DNA from nails and their ranking for possible use in the molecular diagnosis of onychomycoses are described. Extraction was performed on weighed nail clippings of equal size from positive (31) or negative (14) samples, according to the culture result. At Prot1, the extraction was performed according to Tahir and Watson, with an additional step implementing silica columns. At Prot2, the methodology proposed by the Statens Serum Institute of Copenhagen was used. At Prot3, DNA was extracted by the use of magnetic separation after homogenisation with glass beading. The evaluation parameters were DNA purity, DNA concentration, total DNA yield/g of tissue, cost and duration. The multiples of the means of medians of the first three parameters, for each protocol, were calculated. Prot3 showed the highest DNA purity. Prot2 presented the highest DNA concentration and DNA yield/g of tissue, while it was the cheapest and shortest. In total, the three protocols were graded as Prot2>Prot1>Prot3. The second method, although had a lower DNA purity, presented the higher DNA concentration and DNA yield, while its duration and cost were also favourable.

Micosis superficiales: casuística del Departamento de Micología del Instituto Nacional de Higiene “Rafael Rangel”, Caracas,Venezuela (2001-2014) / Superficial mycoses: casuistry of the Mycology Department of the Instituto Nacional de Higiene “Rafael Rangel”, Caracas, Venezuela (2001-2014)

Las micosis superficiales son muy comunes y por ello son motivo de consulta médica frecuente. El objetivo de este trabajo fue conocer la frecuencia de diagnóstico de las micosis superficiales en el Departamento de Micología del Instituto Nacional de Higiene “Rafael Rangel” en Caracas, Venezuela, durante 14 años (2001-2014). Se realizó un estudio transversal y retrospectivo de revisión de historias micológicas de pacientes con diagnóstico presuntivo de micosis superficial. Las muestras procesadas fueron uñas, pelos y escamas epidérmicas. La identificación de los hongos se realizó mediante observación macro y microscópica de las colonias y pruebas de identificación bioquímicas y fisiológicas, según requerimiento del agente aislado. Para la investigación de Malassezia spp. solo se realizó examen directo. De las 3228 muestras procesadas, 1098 (34%) resultaron positivas y su distribución según el agente etiológico fue: 79,5% dermatofitos; 10,9% levaduras; 5,1% hongos no dermatofitos y 4,5% Malassezia spp. El dermatofito más aislado fue el Complejo Trichophyton rubrum (70,1%), seguido del Complejo T. mentagrophytes (15,1%), Microsporum canis (9,4%) y Epidermophyton floccosum (4%). Las tiñas más frecuentes fueron: Tinea unguium (66,8%), seguida de Tinea pedis (16,4%) y Tinea capitis (8,1%). En el grupo de levaduras el Complejo Candida parapsilosis (37,5%) fue el más aislado y entre los hongos no dermatofitos el más frecuente fue Fusarium spp. (53,6%), seguido de Aspergillus spp. (19,6%) y Acremonium spp. (10,7%). La identificación del agente etiológico es fundamental para orientar un tratamiento adecuado. Esta casuística constituye un aporte importante para el conocimiento de la epidemiología de las micosis superficiales en nuestro país.

The superficial mycoses are very common infectious diseases and therefore are a frequent reason for medical consultation. The aim of this study was to determine the diagnostic frequency of superficial mycoses in the Mycology Department of the Instituto Nacional de Higiene “Rafael Rangel” during 14 years (2001-2014). A retrospective cross-sectional study was performed to review the mycological records of patients with presumptive diagnosis of superficial mycosis. Nails, hairs and epidermal scales were the processed samples. The identification of fungi was performed by macro and microscopic observation of colonies and biochemical and physiological tests, as required of the isolated agent. For the investigation of Malassezia spp. only direct examination was performed. Of the 3 228 samples processed, 1 098 (34%) were positive and their distribution according to the etiological agent was: dermatophytes 79.5%; 10.9% yeasts; non-dermatophytes fungi 5.1% and 4.5% Malassezia spp. The most frequently isolated dermatophyte was Trichophyton rubrum Complex (70.1%), followed by T. mentagrophytes complex (15.1%), Microsporum canis (9.4%) and Epidermophyton floccosum (4%). The most frequent ringworms were: Tinea unguium (66.8%), followed by Tinea pedis (16.4%) and Tinea capitis (8.1%). Candida parapsilosis complex (37.5%) was the most frequently isolated yeast and Fusarium spp. (53.6%) was the most isolated among non-dermatophyte fungi, followed by Aspergillus spp. (19.6%) and Acremonium spp. (10.7%). The identification of the etiological agent is essential to guide appropriate treatment. This study constitutes an important contribution to the knowledge of the epidemiology of superficial mycoses in our country.

[What's new in clinical dermatology?] / Quoi de neuf en dermatologie clinique ?

Zika virus: what the dermatologist should know. Probably a new vaccine against herpes zoster and postherpetic neuralgia in older adults. Defining moderate, significant and extensive types of pemphigus with ABSIS et PDAI scores. Biologic Therapies and serious infections in patients with psoriasis. We can be cautiously optimistic, in that tuberculosis is rare but still occurs despite adherence to tuberculosis prevention guidelines. Others serious infections are rare, mainly pneumonia and cellulitis. Hidradenitis suppurativa: an unrecognized paradoxical effect of biologic agents. There is an association between Inflammatory Bowel Disease (IBD) and Hidradenitis suppurativa (HS), mostly with Crohn's disease, suggesting the need to look for signs and symptoms of IBD in HS patients. A study of 550 twins found that genetic and environmental factors each contribute to approximately half of the score of rosacea. Telangiectasia Macularis Eruptiva Perstans is a difficult to diagnose type of mastocytosis, often with a delay and which is associated with a systemic involvement in 50% of cases. Vitiligo. Management and development of new scores for the dermatologist and the patient. Livedoid vasculopathy. Anticoagulation with new molecules could prove an efficient means of treatment. Pyoderma Gangrenosum. Don't forget the toxic etiology. Daily practice: Laboratory monitoring for liver function tests and serum lipid profile during isotretinoin therapy for acne is currently recommended at baseline and every 3 months, depending on the results. Daily practice: Mikailov and al., challenge our habits by their medico economic study and propose an empirical treatment with terbinafine for patients with suspected onychomycosis that is cost effective with minimal effect on patient safety as terbinafine-induced liver injury is very rare. It makes think and especially propose studies to update our recommendations.

A study of onychomycosis in patients attending a dermatology center in Tehran, Iran.

OBJECTIVE: To determine the incidence of onychomycosis based on age and sex, morphological pattern of the disease, predisposing factors and identification of fungus by direct microscopy and culture methods. METHODS: A prospective study was conducted on 140 patients with nail disorders. A detailed history and thorough examination was done in all patients. The samples were taken from patients clinically suspected of fingernails and toenails infections attending a dermatology center in Tehran, Iran. The nails were subjected to potassium hydroxide (KOH) examination and fungal culture on Sabouraud's dextrose agar (SDA) medium. RESULTS: Specimens from 79 patients (56.4%) were positive for onychomycosis. The mycological observations showing positive fining with KOH were observed in 79 (56.4%) and culture positive in 35 (25%) cases. Females were more infected than males. The most common age group infected was 41-60 years (40.7%). Toenails were affected more frequently than fingernails and dystrophic onychomycosis was the most common clinical type seen in 39.2% patients. From the culture-positive samples, yeasts were the most common pathogens isolated from 25 (71.4%) patients, followed by non-dermatophytic moulds in 6 (17.1%) and dermatophytes in 4 (11.5%) patients. CONCLUSION: This study demonstrated that Candida species were the main agents causing onychomycosis in our region and accurate diagnosis of onychomycosis was based on direct microscopy and fungal culture.

Comparison of modified Chicago sky blue stain and potassium hydroxide mount for the diagnosis of dermatomycoses and onychomycoses.

The diagnostic value of modified Chicago sky blue (CSB) stain and potassium hydroxide (KOH) mount for superficial mycoses was compared using fungal culture as gold standard. The sensitivity and screening time of the CSB stain were superior to the KOH mount. The CBS stain is simple, quick and reliable for diagnosing superficial mycoses.

[New clinical classification for onychomycoses]. / Nouvelle classification clinique des onychomycoses.

We have updated our clinical classification on onychomycosis (2011) to render it of more practical value for the clinician. It should provide a better understanding of onychomycosis and facilitate an improved approach to treatment, taking into account, for example, the link between the proximal subungual variety and some superficial forms emerging from beneath the cuticle.

[Onychomycoses due to molds]. / Les onychomycoses à moisissures.

Onychomycoses represent about 30% of superficial mycosis that are encountered in Dermatology consults. Fungi such as dermatophytes, which are mainly found on the feet nails, cause nearly 50% of these onychopathies. Yeasts are predominantly present on hands, whereas non-dermatophytic moulds are very seldom involved in both foot and hand nails infections. According to literature, these moulds are responsible for 2 to 17% of onychomycoses. Nevertheless, we have to differentiate between onychomycoses due to pseudodermatophytes such as Neoscytalidium (ex-Scytalidium) and Onychocola canadensis, which present a high affinity for keratin, and onychomycoses due to filamentous fungi such as Aspergillus, Fusarium, Scopulariopsis, Acremonium... These saprophytic moulds are indeed most of the time considered as colonizers rather than real pathogens agents. Mycology and histopathology laboratories play an important role. They allow to identify the species that is involved in nail infection, but also to confirm parasitism by the fungus in the infected nails. Indeed, before attributing any pathogenic role to non-dermatophytic moulds, it is essential to precisely evaluate their pathogenicity through samples and accurate mycological and/or histological analysis. The treatment of onychomycoses due to non-dermatophytic moulds is difficult, as there is today no consensus. The choice of an antifungal agent will first depend on the species that is involved in the infection, but also on the severity of nail lesions and on the patient himself. In most cases, the onychomycosis will be cured with chemical or mechanical removing of the infected tissues, followed by a local antifungal treatment. In some cases, a systemic therapy will be discussed.

[Mycological diagnosis of onychomycosis]. / Méthodes de diagnostic d'une onychomycose.

Onychomycosis represents about 50% of ungueal pathology. Dermatophytes (especially Trichophyton rubrum and Trichophyton interdigitale) are the main species involved in tinea pedis. Yeasts of the Candida (Candida albicans, Candida parapsilosis,...) genus are predominant on hands and very often associated with ungueal disease and perionyxis. Fungi other than the classic dermatophytes and yeasts can be rarely isolated from nail diseases. Among them, species belonging to Scopulariopsis, Aspergillus and Fusarium genus are mainly found, but their involvement in the disease must be proved. Other fungi, presenting a special affinity to keratin (pseudodermatophytes), such as Neoscytalidium dimidiatum (ex Scytalidium dimidiatum) from tropical and subtropical areas and Onychocola canadensis from Northern America and Europe, are considered as real pathogens in nail diseases. A multidisciplinary approach, including clinicians and biologists, is required to confirm the mycosis. This comparative review emphasizes the importance of histological examination, as well as molecular approaches, which are very contributive to the diagnosis of onychomycosis. The role of the laboratory is to identify at the species level the fungus isolated from nail scrapings and to show its involvement in the ungueal lesions.

[Biological diagnosis of onychomycoses. Direct examination after simplified technique of PAS staining]. / Diagnostic biologique des onychomycoses. Examen direct après coloration PAS simplifiée.

Confirmation of fungal origin of onychopathy by mycological examination is essential. For that purpose, in parallel to the cultivation of biological samples, achieving a sensitive and informative direct examination of nail fragments and subungual material is primordial. Among the direct examination techniques, and inspired from a technique of reference in histo-pathology (the "periodic acid-Schiff reagent" reaction), the simplified technique of PAS staining according to Hotchkiss and MacManus is the technique of choice. Easy to implement and very sensitive, it can immediately and formally confirm the diagnosis of onychomycosis, mention the type of fungus (yeast, dermatophyte, Hyphomycete opportunistic) and suspect a possible multiple involvement.

[Onychomycosis mycological profile in Abidjan (Cote d'Ivoire)]. / Profil mycologique des onychomycoses à Abidjan (Côte d'Ivoire).

AIM OF THE STUDY: The epidemiological profile of onychomycosis is poorly determined in Cote d'Ivoire. This study aimed to determine the fungal aetiologies of these onychomycosis in Abidjan. PATIENTS AND METHODS: This cross-sectional study was conducted from February to August 2011 at the Department of Dermatology of the University Hospital of Treichville. All patients who consulted for onycholysis were interviewed. All samples were analyzed by direct examination and Sabouraud-chloramphenicol and Sabouraud-chloramphenicol-actidione culture was performed. Species identification was based on microscopic characteristics of the fungus observed. RESULTS: A total of 53 patients were included. The prevalence of onychomycosis was estimated at 66%. The unilateral lesions were statistically different from bilateral lesions (P=0.010). Women were more affected at the hands than men (P=0.010). Five species of yeasts and two dermatophytes species were identified. Yeasts species were essentially Candida tropicalis (36.4%) and Candida albicans (30.3%). Trichophyton rubrum and Trichophyton soudanense were the only dermatophytes isolated. No contributing factors were statistically related to the occurrence of onychomycosis in our series. CONCLUSION: The observed onychomycosis in Côte d'Ivoire are mainly caused by yeasts. Although in our series the risk factors have not been identified, hygiene of the nails should provide effective prevention.

Epidemiología de las dermatomicosis en 30 años de estudio en el Instituto de Medicina Tropical Daniel A. Carrión, Universidad Nacional Mayor de San Marcos, Lima, Perú / Epidemiology of dermatomycoses in 30 years of study at Daniel A. Carrion Institute of Tropical Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru

Objetivos: Determinar la evolución epidemiológica de las dermatomicosis en pacientes de consultorio externo durante el periodo 1976-2005. Diseño: Estudio descriptivo, retrospectivo y analítico. Lugar: Instituto de Medicina Tropical æDaniel Alcides CarriónÆ, Universidad Nacional Mayor de San Marcos, Lima, Perú. Participantes: Pacientes positivos a dermatomicosis. Intervenciones: Se revisó las historias clínicas de 7 185 (55,3 por ciento) casos positivos a dermatomicosis. El instrumento de investigación empleado fue la ficha de levantamiento de información. Principales medidas de resultados: Agente etiológico, estación del año, sexo, edad y forma clínica. Resultados: El estudio demostró que los más afectados fueron del grupo etario de 16 a 30 años (42,7 por ciento) y sexo femenino (52,1 por ciento). La dermatomicosis más frecuente fue la onicomicosis (43,6 por ciento). Los agentes patógenos de mayor prevalencia fueron Trichophyton rubrum (33,2 por ciento), Cándida albicans (15,3 por ciento), Cándida no albicans (11,8 por ciento), Trichophyton mentagrophytes (9,4 por ciento), Malassezia spp (9,1 por ciento) y las infecciones mixtas (7,2 por ciento). Las micosis de cuero cabelludo muestran continuo aumento durante todo el estudio. El dermatofito Epidermophyton floccosum fue aislado por última vez en la década del 90. A partir de 1995 ha aumentado la prevalencia de Cándida no albicans y se encontró como especie re-emergente a la levadura Cándida tropicalis. Conclusiones: Entre los años 1976 y 2005 hubo importantes variaciones epidemiológicas en relación a las formas clínicas y a la etiología de las dermatomicosis...

Objectives: To determine dermatomycoses epidemiological evolution in outpatients during the period 1976-2005. Design: Descriptive, retrospective, and analytical study. Setting: Daniel Alcides Carrion Institute of Tropical Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru. Participants: Patients positive to dermatomycoses. Interventions: Medical records of 7 185 (55.3 per cent) dermatomycoses-positive patients were reviewed. Main outcome measures: Etiologic agent, season, gender, age, and clinical forms. Results: Females (52.1 per cent) and the 16 to 30 year-old group (42.7 per cent) were the most affected. Most frequent dermatomycoses was onychomycosis (43.6 per cent). Most prevalent pathogens were Trichophyton rubrum (33.2 per cent), Candida albicans (15.3 per cent), Candida non albicans (11.8 per cent), Trichophyton mentagrophytes (9.4 per cent), Malassezia spp. (9.1 per cent), and mixed infections (7.2 per cent). The fungal scalp infection showed steady increase during the period studied. Epidermophyton floccosum dermatophyte was isolated for the last time in the 1990s. Since 1995 prevalence of Candida non albicans has increased and Candida tropicalis yeast species are re-emerging. Conclusions: Epidemiological changes in dermatomycoses clinical forms and etiology were found between 1976 and 2005...

[Mycological profile of onychomycosis in Dakar (Senegal)]. / Profil mycologique des onychomycoses à Dakar (Sénégal).

OBJECTIVE: Onychomycosis are a mycose of nail due to fungi. According to published data, they stands for half of all nail abnormalities. This survey was carried out to determine the frequency and the fungi involved in onychomycosis in Dakar. MATERIAL AND METHODS: This study was carried out at the laboratory of parasitology and mycology at Le Dantec Hospital, in Senegal from January 2008 to December 2012 and includes 507 patients. RESULTS: Onychomycosis were mycologically proved in 58.78% (298/507) of patients. Patient's age varies between 02 years to 82 years with a mean of 34.24 years. Women were more infected than men (sex-ratio was 2.38). Onychomycosis due to dermatophyte represented 37.92% (113/298) of patients and were essentially located on toes (60.71%). Distal and lateral subungual onychomycosis was the most frequent clinical form. Trichophyton rubrum and Trichophyton interdigitale were isolated respectively in 53.6% and 26.1% on toes. Yeasts represented 59.06% (176/298) of onychomycosis and were essentially located on fingernails (80.11%). Candida albicans represented 90.86% of isolated yeasts. Molds were isolated in nine cases (3.02%) and predominated in toenails. CONCLUSION: Among 507 patients with onychopathy, this study identified 298 cases of onychomycosis. T. rubrum was the main dermatophytes and was isolated on toenails whereas on fingernails C. albicans was more often observed.

Fingernail Onychomycosis Due to Aspergillus niger.

Onychomycosis is usually caused by dermatophytes, but some species of nondermatophytic molds and yeasts are also associated with nail invasion. Aspergillus niger is a nondermatophytic mold which exists as an opportunistic filamentous fungus in all environments. Here, we report a case of onychomycosis caused by A. niger in a 66-year-old female. The patient presented with a black discoloration and a milky white base and onycholysis on the proximal portion of the right thumb nail. Direct microscopic examination of scrapings after potassium hydroxide (KOH) preparation revealed dichotomous septate hyphae. Repeated cultures on Sabouraud's dextrose agar (SDA) without cycloheximide produced the same black velvety colonies. No colony growth occurred on SDA with cycloheximide slants. Biseriate phialides covering the entire vesicle with radiate conidial heads were observed on the slide culture. The DNA sequence of the internal transcribed spacer region of the clinical sample was a 100% match to that of A. niger strain ATCC 16888 (GenBank accession number AY373852). A. niger was confirmed by KOH mount, colony identification, light microscopic morphology, and DNA sequence analysis. The patient was treated orally with 250 mg terbinafine daily and topical amorolfine 5% nail lacquer for 3 months. As a result, the patient was completely cured clinically and mycologically.

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

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 < 0,05). En las onicomicosis candidiásicas predominaron especies diferentes a Candida albicans. Las onicomicosis fueron más frecuentes en los hombres que en las mujeres. A su vez, en los hombres hubo más aislamientos de T. rubrum en pies (p < 0,05) y mayor proporción de exámenes directos (ED) y cultivos positivos (ambos, p < 0,05). La correlación entre los resultados del ED y del cultivo fue del 68 %. El rédito de ambos métodos se asoció a un mayor tamaño de la lesión ungueal. El ED fue más efectivo en onicodistrofias que superaban los 5 años de evolución. La positividad del cultivo fue independiente de la cronicidad de la onicodistrofia.

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.

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

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 < 0,05). En las onicomicosis candidiásicas predominaron especies diferentes a Candida albicans. Las onicomicosis fueron más frecuentes en los hombres que en las mujeres. A su vez, en los hombres hubo más aislamientos de T. rubrum en pies (p < 0,05) y mayor proporción de exámenes directos (ED) y cultivos positivos (ambos, p < 0,05). La correlación entre los resultados del ED y del cultivo fue del 68 %. El rédito de ambos métodos se asoció a un mayor tamaño de la lesión ungueal. El ED fue más efectivo en onicodistrofias que superaban los 5 años de evolución. La positividad del cultivo fue independiente de la cronicidad de la onicodistrofia.(AU)

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.(AU)