Onicomicose por Scytalidium spp.: estudo clínico-epidemiológico em um hospital universitário do Rio de Janeiro, Brasil

Abstract

FUNDAMENTOS: O Scytalidium spp. é fungo filamentoso, saprobio do solo e plantas, considerado, atualmente, patógeno primário das unhas. A prevalência das infecções ungueais causadas por este fungo vem aumentando nas últimas décadas, embora ainda sejam poucos os trabalhos publicados sobre sua epidemiologia. OBJETIVO: Estudo clínico-epidemiológico dos pacientes portadores de onicomicose por Scytalidium spp. em um hospital universitário do Rio de Janeiro. MÉTODOS: Foram avaliados os dados clínico-epidemiológicos de 30 pacientes com onicomicose por Scytalidium spp. por meio do estudo observacional de 1.295 pacientes que se submeteram a exame micológico ungueal no período de 16 meses. RESULTADOS: A maioria dos pacientes era do sexo feminino (66,6%), a média de idade foi de 56,7 anos e 63,3% eram não-brancos. O nível de escolaridade em 53,3% dos pacientes era o ensino fundamental e a renda familiar predominante foi de 3 a 5 salários mínimos em 36,6% dos entrevistados. Em 90% dos casos, as unhas dos pododáctilos foram acometidas, sendo a alteração clínica mais comum a onicólise (18 pacientes) e em 66,6% dos casos observou-se melanoníquia. O tempo de evolução da doença foi maior do que cinco anos em 43,3% dos casos. Dezenove pacientes (63,3%) já haviam realizado tratamento medicamentoso para o quadro atual. CONCLUSÕES: Os dados mostram que a infecção ungueal pelo Scytalidium spp. é crônica, mais comum no sexo feminino (2:1) e atinge indivíduos adultos. Clinicamente, é semelhante às dermatofitoses. A prevalência na amostra estudada foi de 4,86% e correspondeu a 26,92% dos exames positivos

Distinct characteristics of Scytalidium dimidiatum and non‐dermatophyte onychomycosis as compared with dermatophyte onychomycosis

“…The common clinical type of onychomycosis in this study was DLSO and the most common site of involvement was the toenail, which was in accordance with previous studies . Clinical manifestations between the DMP and NDM groups showed no statistical difference.…”

“…Few studies reported that approximately 10% of patients infected with Scytalidium spp. had hand involvement and one study reported groin involvement . However, this study demonstrated that patients with NDM onychomycosis had no superficial fungal glabrous skin infection at other sites beyond the feet, which statistically differed from the DMP group.…”

“…NDM were found in soil and plants, so infection may be acquired by direct contact individually. Many factors such as contact with animals, repeated nail trauma, using swimming pools and public showers, as well as many systemic diseases such as chronic venous disease, hypothyroidism, diabetes mellitus, psoriasis and immunosuppression, had been previously reported to be associated with NDM onychomycosis . This study demonstrated that these factors are associated with onychomycosis but had no significant correlation with NDM, when compared with DMP.…”

“…Therefore, the route of NDM transmission and predisposing factors remained unclear and further study may be required. Home floors may also have an important role in the spreading of the disease …”

Performance of mycology and histopathology tests for the diagnosis of toenail onychomycosis due to filamentous fungi: Dermatophyte and non‐dermatophyte moulds

“…Dermatophytes are the main causal agents of toenail mycoses; however, the prevalence of non‐dermatophyte moulds (NDM) has been increasing, particularly in tropical and subtropical regions, generally in developing countries where the costs of public and private health require careful consideration . Accurate diagnosis of the disease and identification of its aetiological agent are equally important; thereby, specific treatment may be initiated as soon as possible in cases of disease, and in cases of non‐infectious onychopathies, the ramifications of the expensive, long‐term use of medications with potential risks may be avoided.…”