Infektionen an Finger- und Zehennägeln durch Pilze und Bakterien

Abstract

Infections of the finger and the toe nails are most frequently caused by fungi, primarily dermatophytes. Causative agents of tinea unguium are mostly anthropophilic dermatophytes. Both in Germany, and worldwide, Trichophyton rubrum represents the main important causative agent of onychomycoses. Yeasts are isolated from fungal nail infections, both paronychia and onychomycosis far more often than generally expected. This can represent either saprophytic colonization as well as acute or chronic infection of the nail organ. The main yeasts causing nail infections are Candida parapsilosis, and Candida guilliermondii; Candida albicans is only in third place. Onychomycosis due to molds, or so called non-dermatophyte molds (NDM), are being increasingly detected. Molds as cause of an onychomycosis are considered as emerging pathogens. Fusarium species are the most common cause of NDM onychomycosis; however, rare molds like Onychocola canadensis may be found. Bacterial infections of the nails are caused by gram negative bacteria, usually Pseudomonas aeruginosa (recognizable because of green or black coloration of the nails) but also Klebsiella spp. and gram positive bacteria like Staphylococcus aureus. Treatment of onychomycosis includes application of topical antifungal agents (amorolfine, ciclopirox). If more than 50 % of the nail plate is affected or if more than three out of ten nails are affected by the fungal infection, oral treatment using terbinafine (in case of dermatophyte infection), fluconazole (for yeast infections), or alternatively itraconazole are recommended. Bacterial infections are treated topically with antiseptic agents (octenidine), and in some cases with topical antibiotics (nadifloxacin, gentamicin). Pseudomonas infections of the nail organ are treated by ciprofloxacin; other bacteria are treated according to the results of culture and sensitivity testing.

Green Nail Syndrome (Pseudomonas aeruginosa Nail Infection): Two Cases Successfully Treated with Topical Nadifloxacin, an Acne Medication

“…Pseudomonas aeruginosa is the most prevalent pathogen of bacterial nail infections [1]. Green nail syndrome (GNS) is characterized by greenish chromonychia caused by pyocyanin, a metabolite produced by P. aeruginosa .…”

“…GNS is usually restricted to one or two nails [2, 3]. Predisposing factors are onychomycoses, nail diseases, working in wet conditions, diabetes mellitus, paronychia and immunosuppression, among others [1, 4, 5]. P. aeruginosa can be transmitted from GNS to wounds or surgical sites [6, 7] and thus lead to local and possibly systemic complications in immunocompromised individuals.…”

“…Reported treatment options are systemic fluoroquinolones, topical octenidine 0.1% [2], topical aminoglycoside [5] and nail extraction [1, 8]. Moreover, three patients with GNS successfully treated with topical nadifloxacin have been reported [3, 4].…”

“…Moreover, three patients with GNS successfully treated with topical nadifloxacin have been reported [3, 4]. However, clinical trials of patients with GNS are currently lacking [1]. …”

Padrões de dermatoscopia da placa ungueal nas onicomicoses

“…Neoscytalidium dimidiatum115 . A cromoníquia de coloração esverdeada é causada por Pseudomonas sp 116.…”