Onychomycosis due to Scopulariopsis brevicaulis: clinical features and response to systemic antifungals

Abstract

Six cases of Scopulariopsis onychomycosis, including four patients with onychomycosis exclusively caused by Scopulariopsis brevicaulis and two patients with a mixed nail infection (S. brevicaulis + Tricophyton rubrum and S. brevicaulis + T. interdigitale), are reported. Four patients presented with a typical distal subungual onychomycosis characterized by subungual hyperkeratosis and onycholysis of the distal nail plate. In two patients, Scopulariopsis infection produced a total dystrophic onychomycosis associated with painful periungual inflammation. Three patients were treated with four pulses of itraconazole, 400 mg daily for 1 week a month, and three patients with terbinafine, 250 mg daily for 4 months. The mycological examination 8 months after discontinuation of treatment showed that one patient was mycologically cured whereas the remaining five patients still carried S. brevicaulis in their nails. The clinical examination at the end of the follow-up period showed a complete cure of the nail abnormalities in only one patient.

Efficacy of Itraconazole, Terbinafine, Fluconazole, Griseofulvin and Ketoconazole in the Treatment of <i>Scopulariopsis brevicaulis</i> Causing Onychomycosis of the Toes

“…In other reports the effectiveness of itraconazole in toe onychomycosis caused by S. brevicaulis has been: De Doncker et al [19], CC 8/10, MC 8/10; Tosti et al [20], CC 2/6, MC 2/6; Tosti et al [21], CC 1/3, MC 1/3, and Gianni et al [22], CC 3/3, MC 3/3.…”

“…The data suggest that terbinafine may have efficacy against S. brevicaulis. In other reports the effectiveness of terbinafine in toe onychomycosis caused by S. brevicaulis has been: Nolting et al [23], CC 1/2, MC 1/2; Tosti et al [20], CC 1/1, MC 1/1; Tosti et al [21], CC 0/3, MC 0/3, and Gianni et al [22], CC 15/15, MC 15/15. In the report by Nolting et al [23], a longer duration of therapy than that used to treat dermatophytes was administered, that is terbinafine 250 mg/day for up to 48 weeks.…”

Nouvelle classification clinique des onychomycoses

“…Contrairement à l'infection candidosique, des moisissures comme le Fusarium peuvent produire une paronychie subaiguë accompagnée d'une onychomycose sous-unguéale proximale leuconychique, en particulier chez les sujets immuno-déprimés [10,40] (Fig. Contrairement à l'infection candidosique, des moisissures comme le Fusarium peuvent produire une paronychie subaiguë accompagnée d'une onychomycose sous-unguéale proximale leuconychique, en particulier chez les sujets immuno-déprimés [10,40] (Fig.…”

In Vitro Triple Combination of Antifungal Drugs against Clinical Scopulariopsis and Microascus Species

“…These species are usually saprophytic and are commonly isolated from the soil, air, plant debris, and moist indoor environments (1,2). The most frequently occurring species in clinical cases is Scopulariopsis brevicaulis (3)(4)(5)(6)(7).…”

“…These filamentous fungi commonly act as opportunistic pathogens in humans and are mainly associated with superficial tissue infections, such as onychomycosis (3,8) and corneal ulcers (4). However, during the last 2 decades, Scopulariopsis species have been found as pathogens involved in deep mycoses in immunocompromised and occasionally in immunocompetent hosts, causing pneumonia (9), sinusitis (5), prosthetic valve endocarditis (6), pulmonary or brain abscesses (7,10), and other fatal infections.…”