Onychomycosis Caused by Fusarium spp. in Dakar, Senegal: Epidemiological, Clinical, and Mycological Study

Abstract

Fusarium spp. represent 9 to 44% of onychomycoses caused by fungi other than dermatophytes. This retrospective study describes 17 cases of Fusarium onychomycosis diagnosed at the Laboratory of Parasitology and Mycology of Le Dantec University Hospital in Dakar, Senegal, from 2014 to 2016. It included all patients received in the laboratory for suspicion of onychomycosis between January 1, 2014, and December 31, 2016. Diagnosis was based on mycological examination including direct examination and culture. Mycological analysis was considered positive when direct examination and culture were positive after at least one repeat. Seventeen Fusarium onychomycosis cases representing 12.9% of all onychomycoses reported were diagnosed. There were 5 cases on the fingernails and 12 on the toenails in 6 males and 11 females, and the mean age was 44 years (range: 26–64). Onychomycoses were diagnosed in immunocompetent patients except in a diabetic patient. The mean duration of lesions was 4.9 years (range: 1–15), and distal subungual onychomycosis was predominant. Almost all patients were from suburban areas of Dakar region. The most frequent species isolated belong to Fusarium solani complex. Because of the risk of disseminated infection in immunocompromised patients, realization of susceptibility tests is necessary to ensure better therapeutic management.

Molecular identification of Fusarium species complex isolated from clinical samples and its antifungal susceptibility patterns

“…Another risk factor observed in our patients was trauma. The factors that increase the chance of fusarial onychomycosis include repeated micro trauma to the nails, hands and feet moist environment, prolonged exposure to pathogenic fungi, greater work activity, and venous insufficiency [30,31]. Similar factors were obtained in the present study.…”

Cutaneous Fusariosis in a Patient with Job’s (Hyper-IgE) Syndrome

“…in respiratory secretion from an immunocompromised individual should be considered diagnostic for fusariosis [7]. Fusarium is also a well-known etiologic agent for onychomycosis responsible for 10-40% of cases caused by fungi other than dermatophytes [13,14]. Fusarial infection in our case was associated with onychomycosis; however, a microbiologic confirmation for the causative organism was not sought.…”

“…Fusarial species tend to be resistant to most antifungals in vitro; hence, the choice of antifungal can be challenging. While universally resistant to echinocandins (i.e., caspofungin), successful treatment with favorable outcomes had been reported with amphotericin B [12,13,17], voriconazole [18,19], and posaconazole [20][21][22]. Optimum treatment duration remains obscure, but generally antifungals are recommended to be continued at least until all clinical signs of infection resolve.…”

Fusarium onychomycoses in Switzerland—A mycological and histopathological study

“…Non‐dermatophyte moulds cause about 10% of the onychomycoses with a range from 1.45% to 17.6% . Fusarium spp alone were estimated at 1%‐6% of onychomycoses, but were found in a higher percentage in other studies . The differences in prevalence may account to various geographical regions and climate zones and certainly also to techniques of examination .…”

“…The percentage of Fusarium spp as nail pathogens varies from 9% to 44% of mould infections . Women are more frequently affected and fingernails are apparently also involved in tropical countries . All types of onychomycoses may be due to Fusarium spp including onychomycoses with associated paronychia and melanonychia .…”