Onychomycosis - epidemiology, diagnosis and management

Kaur, Ravinder; Kashyap, Bineeta

doi:10.4103/0255-0857.40522

Cited by 155 publications

(49 citation statements)

References 27 publications

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“…Trichophyton species have dozens subtypes although T. rubrum and T. mentagrophytes are common pathogens of onychomycosis [11]. In this case, the type of Trichophyton species was not identified.…”

Section: Discussionmentioning

confidence: 95%

A case of fungal keratitis and onychomycosis simultaneously infected by Trichophyton species

et al. 2014

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BackgroundFungal keratitis is difficult to treat that can result in corneal blindness requiring penetrating keratoplasty and in fungal endothalmitis. We report a case of fungal keratitis and onychomycosis simultaneously infected by Trichophyton.Case presentationA 77-year old male presented with ocular pain, conjunctival injection, and severe loss of vision in his left eye. His best corrected visual acuity was hand movements in the left eye, and slit-lamp examination showed a corneal ulcer with feathery margin and hypopyon. Bacterial and fungal smear/culture showed no organism, and there was no improvement in spite of treatment with topical fortified 5% cefazolin and 2% tobramycin. Trichophyton species was identified by repeated cultures. We found onychomycosis on the patient’s foot, where the same fungal species were identified. Regimen was changed to topical itraconazole and systemic intravenous itraconazole. No clinical improvement was observed, so therapeutic penetrating keratoplasty and cryotherapy was done with continuation of antifungal therapy. The graft was clear at postoperative 1 month and no evidence of recurrence was found.ConclusionIt is important to identify the pathogen of keratitis because early identification of pathogen causing keratitis provides the appropriate treatment in early phase of keratitis. It is necessary to search for other fungal skin infections such as onychomycosis and athelete’s foot considering the fungal keratitis following skin infection. In addition, fungal skin infection including onychomycosis should be treated for prevention of fungal keratitis as soon as possible.

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Section: Discussionmentioning

confidence: 95%

A case of fungal keratitis and onychomycosis simultaneously infected by Trichophyton species

et al. 2014

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“…14,15 These data are in agreement with literature reports that characterize DLSO as the most commonly observed clinical pattern. 16 . 17 …”

Section: Discussionmentioning

confidence: 99%

Onychomycosis: clinical, mycological and in vitro susceptibility testing of isolates of Trichophyton rubrum

Azambuja

Pimmel

Klafke

et al. 2014

An. Bras. Dermatol.

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BACKGROUND Onychomycosis or nail fungal infection is the most common nail disease. Despite the wide range of studies on this condition, it remains difficult to establish the correct diagnosis and effective treatment. OBJECTIVES To evaluate the efficacy of classical laboratory methods for the diagnosis of onychomycosis, and the in vitro susceptibility of the its main etiological agent to antifungals used in routine. METHODS Nail samples of 100 patients with clinically suspected feet onychomycosis were collected to confirm the diagnosis by direct mycological examination and fungal culture. In vitro antifungal susceptibility testing was performed against strains of the main dermatophyte isolated by microdilution, according to the standardized protocol (M38-A2 - CLSI) RESULTS Clinical diagnosis of onychomycosis was confirmed by laboratory analysis in 59% of patients. Of these, 54.2% were positive only in direct mycological examination, 44.1% in direct mycological examination and culture, and one case (1.7%) was positive only in culture, resulting in weak agreement between these tests (Kappa = 0.385; p <0.001) High minimum inhibitory concentration values of fluconazole and itraconazole were observed in 66.7% and 25.0% of isolates of T. rubrum tested. Additionally, high MIC values of terbinafine and ciclopirox was detected in only one isolate, and this was one of the strains in which in vitro activity of itraconazole and fluconazole has not been proven. CONCLUSIONS Poor agreement was observed between direct mycological examination and culture for the diagnosis of onychomycosis, with direct mycological examination being significantly more sensitive. Except for fluconazole, the other three antifungals tested showed good in vitro activity against clinical isolates of T. rubrum.

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“…[1] Onychomycosis results from invasion of the nail plate by dermatophytes, yeasts, or mold species of Fungi and represents about 30% of mycotic cutaneous infections. [234]…”

Section: Introductionmentioning

confidence: 99%

Current mycological profile of onychomycosis in Kashmir valley: A hospital-based study

Nazir

Kanth

2017

J Lab Physicians

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INTRODUCTION:Onychomycosis is a common nail ailment associated with significant physical and psychological morbidity. It is caused by dermatophytes, nondermatophytic molds, and yeasts. Increased prevalence in the recent years is attributed to enhanced longevity, comorbid conditions such as diabetes, avid sports participation, and emergence of HIV.AIMS AND OBJECTIVES:This study was undertaken to identify the mycological profile and etiological agents associated with this infection.MATERIALS AND METHODS:One hundred and twenty-nine cases of clinically suspected onychomycosis were included in this study. Clinical patterns were noted, and samples collected from most severely affected nail. They were subjected to direct microscopy and culture.RESULTS:The microscopic and/or culture examination was positive in 64.34% of cases. The most common clinical type was distal lateral subungual onychomycosis in 42 (50.60%) Candida sp. was the most common fungal agent among yeasts, followed by Trichophyton sp among dermatophytes and Aspergillus among nondermatophytic molds. Females were affected more than males and fingernails were affected more frequently than toenails.CONCLUSION:Onychomycosis is a significant and important disease which can cause many physical, physiological, and occupational problems, considerably impairing patient quality of life. Hence, fungal cultures are of paramount importance in all suspected cases of onychomycosis because the antifungal agent with an appropriate spectrum of activity can only be used if the underlying fungal pathogen is identified correctly.

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Onychomycosis - epidemiology, diagnosis and management

Cited by 155 publications

References 27 publications

A case of fungal keratitis and onychomycosis simultaneously infected by Trichophyton species

A case of fungal keratitis and onychomycosis simultaneously infected by Trichophyton species

Onychomycosis: clinical, mycological and in vitro susceptibility testing of isolates of Trichophyton rubrum

Current mycological profile of onychomycosis in Kashmir valley: A hospital-based study

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