Candidal onychomycosis: A Mini-Review

Abstract

Onychomycosis is a common fungal infection affecting nails. The primary cause for onychomycosis is dermatophytes, while Candida species have emerged as second-line pathogens. Onychomycosis due to Candida (candidal onychomycosis) is increasingly found in individuals having defective immunity consequential to aging, diabetes mellitus, vascular diseases, HIV infection and drug therapies such as immunosuppressives and broad-spectrum antibiotics. Breached local immunity at the nail complex due to trauma, chronic exposure to moisture and chemicals including smoke, detergents, soap, etc., also contribute to candidal onychomycosis. Adhesion, filamentation, secretion of extracellular enzymes and the development of antifungal resistance are some of the virulence mechanisms of Candida species associated with onychomycosis. Diagnosis of onychomycosis depends on history and clinical examination, direct microscopic investigation, mycological culture and histopathology. Restoration of immune defenses, elimination of fungi using appropriate drug therapy and improvement of nail hygiene with the removal of predisposing factors are key aspects in the management of candidal onychomycosis.

Epidemiology, Causative Agents and Clinical Features of Onychomycosis in El-Gharbia Governorate

“…The most cases found in patients aged between 41 and 50 years. Similar observation was reported by Jayatilake et al (2009) who observed that onychomycosis prevalence increases with age reaching its maximum 40-60 years old. On the contrary Grover (2003) reported a high prevalence in the age group of 20-40 years.…”

Study of fungal pathogen in onycomycoses patients attending the teaching hospital

“…2,22 Candida species have emerged as second-line pathogens. 23 Onychomycosis is a chronic disease having therapeutic difficulties. In the present study, we have focused the microbiological aspect of onychomycosis, necessary for definitive identification of etiological agents.…”

Pathogenic Attributes of Non-Candida albicans Candida Species Revealed by SEM

“…Far more than being a simple esthetics problem, infected nail serves as a reservoir of infections of the skin and mucous membrane. Multiple virulence mechanisms of Candida are involved in the pathogenesis of nail infections (reviewed in Jayatilake et al, 2009). …”

“…For instance, Jayatilake et al (2008Jayatilake et al ( , 2009 have demonstrated that multiple host-fungal interactions such as cavitations, thigmotropism, and morphogenesis take place during candidal tissue invasion.…”