Background: Dermatophytes are the main cause of onychomycoses, but various non-dermatophyte filamentous fungi are often isolated from abnormal nails. Objective: Our aim was the in situ identification of the fungal infectious agent in 8 cases of onychomycoses which could not be cured after systemic terbinafine and itraconazole treat- ment. Methods: Fungal DNA was extracted from nail samples, and infectious fungi were identified by restriction fragment length polymorphism (RFLP) of amplified fungal ribosomal DNA using a previously described PCR/RFLP assay. Results: PCR/RFLP identification of fungi in nails allows the identification of the infectious agent: Fusarium sp., Acremonium sp. and Aspergillus sp. were found as a sole infectious agent in 5, 2 and 1 cases, respectively. Conclusions:Fusarium spp. and other non-dermatophyte filamentous fungi are especially difficult to cure in onychomycoses utilising standard treatment with terbinafine and itraconazole. PCR fungal identification helps demonstrate the presence of moulds in order to prescribe alternative antifungal treatments.
We report a case of a 33-year-old woman who presented a Mediterranean spotted fever with the classical triad of high fever, black ulcer at the inoculation site and maculopapular rash with palmo-plantar lesions.The diagnosis was confirmed by seroconversion.The particularity in this case is the fact that the disease was contracted in Switzerland, probably through the patient’s dog which left Portugal 2 years before the onset of the disease was declared.
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