Large-scale epidemiological study of the causal agents of onychomycosis: mycological findings from the Multicenter Onychomycosis Study of Terbinafine

Elewski, B. E.

doi:10.1001/archderm.133.10.1317

Cited by 12 publications

(4 citation statements)

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“…Dermatophytes have also represented the large majority of confirmed infections in largescale epidemiological studies of heterogeneous patient populations (2,12,26,27). Candida species were isolated in 3 of the 110 (3%) culture-positive diabetic patients studied by Gupta et al (1) but were not isolated in any of the fungal cultures in this study.…”

Section: Discussionmentioning

confidence: 43%

Dermatophyte Test Medium Culture for Evaluating Toenail Infections in Patients With Diabetes

2003

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OBJECTIVE -To evaluate the performance of the in-office dermatophyte test medium (DTM) culture when used to confirm the diagnosis of onychomycosis in diabetic patients.RESEARCH DESIGN AND METHODS -Nail samples from 184 diabetic patients who exhibited symptoms consistent with toenail onychomycosis were screened for dermatophyte fungal infection using DTM, potassium hydroxide evaluation, and central mycology laboratory culture tests. The diabetic patient group investigated in this study is a subset of a heterogeneous set of patients who participated in a nationwide survey designed to investigate the use of fungal culture tests by dermatologists, podiatrists, and primary care physicians described in detail elsewhere. The overall sensitivity of the DTM and central laboratory culture methods was estimated and compared. Sensitivity differences between DTM and central laboratory culture methods were tested for statistical significance using the McNemar statistic.RESULTS -DTM culture was positive in 102 of 184 patients (55%), while the central laboratory culture test detected the existence of fungal infection in 78 of 184 (42%). The two tests were in agreement (both positive or both negative) in 114 of 184 patients (62%). Central laboratory culture identified dermatophytes as the pathogen in 91% of positive cases.CONCLUSIONS -DTM is a convenient and inexpensive culture test that can be used to confirm dermatophyte infections in diabetic patients with presumed onychomycosis. We found this test to be well suited for use in the primary care setting. Because oral antifungal agents are effective against dermatophyte species, which cause the vast majority of nail infections, diagnosis of onychomycosis requires confirmation of dermatophyte infection only, not identification of genus and species. DTM fulfills this requirement and has a diagnostic yield comparable to central laboratory culture.

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Section: Discussionmentioning

confidence: 43%

Dermatophyte Test Medium Culture for Evaluating Toenail Infections in Patients With Diabetes

2003

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“…In a large multicenter study, 91.3% of all culture-positive nail samples were dermatophyte (97.4% T. rubrum), 8.0% were molds, and 0.7% were yeasts (all Candida). 2 Terbinafine, the first allylamine antifungal drug developed for oral use, inhibits the biosynthesis of ergosterol, a component of the fungal cell membrane, by selectively inhibiting squalene epoxidase, 3 thereby producing a deficiency in ergosterol as well as a fungicidal accumulation of squalene. In contrast, azole antifungal agents, such as itraconazole, block the fungal enzyme 14-α-demethylase and are primarily fungistatic.…”

Section: Discussionmentioning

confidence: 99%

Terbinafine vs. placebo for onychomycosis in black patients

1999

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Eight US centers enrolled in a multicenter, randomized, double‐blind, placebo‐controlled, parallel‐group trial comparing the efficacy of 12, 16, and 24 weeks of oral therapy with terbinafine, 250 mg/day, and placebo in patients aged 18 to 75 years with both a positive KOH wet mount and mycologic culture of one or more dermatophytes from the large toenail, designated as the target toenail, or another infected toenail if no large toenail was infected. Primary exclusion criteria included: systemic antifungal therapy during the previous 3 months; topical antifungal therapy for the infected toenail(s) during the previous month; white superficial toenail onychomycosis; immunosuppression or immunodeficiency, including known human immunodeficiency virus (HIV) infection; hepatic enzymes >1.5 times the upper limit of normal at screening; and any marked laboratory abnormalities. Patients were randomized into four treatment groups: (i) 12 weeks of terbinafine (250 mg/day) followed by 12 weeks of placebo; (ii) 16 weeks of terbinafine followed by 8 weeks of placebo; (iii) 24 weeks of terbinafine; and (iv) 24 weeks of placebo. Both patient and physician were blinded to the treatment for the 24‐week treatment period. Blinding was maintained through the end of the study. Assessments were done at week −6 (screening visit) and at weeks 4, 8, 12, 16, 20, and 24 during the treatment period. Follow‐up assessments were scheduled for weeks 30, 36, 42, 48, 60, and 72. The mycologic efficacy variables included the percentage of patients with negative mycologic cultures, with negative KOH wet mounts, and with mycologic cure (both negative culture and negative KOH). The evaluations at week 48 and week 72 are reported here. The primary clinical variable was clinical cure, defined as 0% involvement of the target toenail. The efficacy analysis included all patient who were randomized to therapy, fulfilled the mycologic criteria at screening, took at least one dose of study drug, and had at least one post‐baseline assessment. For each variable, the percentage in each treatment group showing efficacy was compared with the percentage in the corresponding placebo group.

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“…2,3 Although the exact incidence of onychomycosis is unknown, studies suggest that between 2% and 26% of the general population world-wide are affected. [4][5][6][7][8] In general, onychomycosis and tinea pedis are more common in men, middle-aged adults and elderly individuals. 8,9 Infections appear to be least common in children, 5,10,11 but when they occur in these younger subjects they are frequently misdiagnosed.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of superficial fungal infections among sports-active individuals: results from the Achilles survey, a review of the literature

Caputo¹,

Boulle²,

Rosso³

et al. 2001

J Eur Acad Dermatol Venerol

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Large-scale epidemiological study of the causal agents of onychomycosis: mycological findings from the Multicenter Onychomycosis Study of Terbinafine

Cited by 12 publications

References 0 publications

Dermatophyte Test Medium Culture for Evaluating Toenail Infections in Patients With Diabetes

Dermatophyte Test Medium Culture for Evaluating Toenail Infections in Patients With Diabetes

Terbinafine vs. placebo for onychomycosis in black patients

Prevalence of superficial fungal infections among sports-active individuals: results from the Achilles survey, a review of the literature

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