Onychomycosis in immunocompromised population: Phenotypic and molecular identification

Borba, Orion Sant’Anna Motter; Ogawa, Marilia Marufuji; Kirsztajn, Gianna Mastroianni; Tomimori, Jane

doi:10.1111/myc.13634

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…Iatrogenic immune depression is a risk for onychomycoses [50,51]. Modern anti-inflammatory treatments with glucocorticosteroids, immunosuppressive cytostatic drugs and many biologics render the subjects more susceptible to fungal infections, also of the nails [51][52][53][54][55][56].…”

Section: Discussionmentioning

confidence: 99%

Onychomycosis in Foot and Toe Malformations

Haneke

2024

Preprint

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Introduction: It has long been accepted that trauma is one of the most important and frequent predisposing factors for onychomycoses . However, the role of direct trauma in the pathogenesis of fungal nail infections was only recently been elucidated in a series of 32 cases of post-traumatic single-digit onychomycosis. The importance of repeated trauma due to foot and toe abnormalities was rarely investigated.Aim of the study: This is a multicenter single-author observational study over a period of 6 years performed at a specialized nail clinic in three countries. All patient photographs taken by the author during this period were screened for toenail alterations and all toe onychomycosis cases were checked whether they contained enough information to evaluate potential foot and toe abnormalities. Particular attention was paid to the presence of hallux valgus, hallux valgus interphalangeus, hallux erectus, inward rotation of the big toe and outward rotation of the little toe, as well as splay foot. Only cases with unequivocal proof of fungal nail infection by either histopathology, mycologic culture or polymerase chain reaction (PCR) were accepted.Results: Of 1653 cases, 185 were onychomycoses proven by mycologic culture, PCR or histopathology. Of these, 179 involved at least one big toenail, 6 affected one or more lesser toenails. Three patients consulted us for another toenail disease and the onychomycosis was diagnosed as a second disease. Eight patients had a pronounced tinea pedum. Relatively few patients had a normal big toe position (n = 9). Most of the cases had a mild to marked hallux valgus (HV) (105) and a hallux valgus interphalangeus (HVI) (143), hallux erectus was observed in 43 patients, the combination of HV and HVI was observed 83 times. Discussion: The very high percentage of foot and toe deformations was surprising. It may be hypothesized that this is not only a pathogenetically important factor but may also play an important role for the localization of the fungal infection as no marked hallux deviation was noted in onychomycoses that affected the lesser toes only. As the management of onychomycoses is a complex procedure involving the exact diagnosis with determination of the pathogenic fungus, the nail growth rate, the type of onychomycosis, its duration and predisposing factors, anomalies of the toe position may be important. Among the most commonly mentioned predisposing factors are peripheral circulatory insufficiency, venous stasis, peripheral neuropathy, immune deficiency and iatrogenic immunosuppression whereas foot problems are not given enough attention. Unfortunately, many of these predisposing and aggravating factors are difficult to treat or to correct. Generally, when explaining the treatment of onychomycoses to the patients, the importance of these orthopedic alterations is not or only insufficiently discussed. In view of the problems encountered with the treatment of toenail mycoses, this attitude should be changed in order to make the patient understand why there is such a low cure rate despite excellent minimal inhibitory drug concentrations in the laboratory.

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Section: Discussionmentioning

confidence: 99%

Onychomycosis in Foot and Toe Malformations

Haneke

2024

Preprint

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“…Iatrogenic immune depression is a risk for onychomycoses [ 50 , 51 ]. Modern anti-inflammatory treatments with glucocorticosteroids, immunosuppressive cytostatic drugs, and many biologics render the subjects more susceptible to fungal infections, including of the nails [ 51 , 52 , 53 , 54 , 55 , 56 ].…”

Section: Discussionmentioning

confidence: 99%

Onychomycosis in Foot and Toe Malformations

Haneke

2024

JoF

View full text Add to dashboard Cite

Introduction: It has long been accepted that trauma is one of the most important and frequent predisposing factors for onychomycoses. However, the role of direct trauma in the pathogenesis of fungal nail infections has only recently been elucidated in a series of 32 cases of post-traumatic single-digit onychomycosis. The importance of repeated trauma due to foot and toe abnormalities was rarely investigated. Aimof the study: This is a multicenter single-author observational study over a period of 6 years performed at specialized nail clinics in three countries. All patient photographs taken by the author during this period were screened for toenail alterations, and all toe onychomycosis cases were checked for whether they contained enough information to evaluate potential foot and toe abnormalities. Particular attention was paid to the presence of hallux valgus, hallux valgus interphalangeus, hallux erectus, inward rotation of the big toe, and outward rotation of the little toe, as well as splay foot. Only cases with unequivocal proof of fungal nail infection by either histopathology, mycologic culture, or polymerase chain reaction (PCR) were accepted. Results: Of 1653 cases, 185 were onychomycoses, proven by mycologic culture, PCR, or histopathology. Of these, 179 involved at least one big toenail, and 6 affected one or more lesser toenails. Three patients consulted us for another toenail disease, and onychomycosis was diagnosed as a second disease. Eight patients had a pronounced tinea pedum. Relatively few patients had a normal big toe position (n = 9). Most of the cases had a mild to marked hallux valgus (HV) (105) and a hallux valgus interphalangeus (HVI) (143), while hallux erectus was observed in 43 patients, and the combination of HV and HVI was observed 83 times. Discussion: The very high percentage of foot and toe deformations was surprising. It may be hypothesized that this is not only a pathogenetically important factor but may also play an important role in the localization of the fungal infection, as no marked hallux deviation was noted in onychomycoses that affected the lesser toes only. As the management of onychomycoses is a complex procedure involving the exact diagnosis with a determination of the pathogenic fungus, the nail growth rate, the type of onychomycosis, its duration, and predisposing factors, anomalies of the toe position may be important. Among the most commonly mentioned predisposing factors are peripheral circulatory insufficiency, venous stasis, peripheral neuropathy, immune deficiency, and iatrogenic immunosuppression, whereas foot problems are not given enough attention. Unfortunately, many of these predisposing and aggravating factors are difficult to treat or correct. Generally, when explaining the treatment of onychomycoses to patients, the importance of these orthopedic alterations is not or only insufficiently discussed. In view of the problems encountered with the treatment of toenail mycoses, this attitude should be changed in order to make the patient understand why there is such a low cure rate despite excellent minimal inhibitory drug concentrations in the laboratory.

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Prevalence of onychomycosis among diabetic population of District Doda (UT of J&K, India) - a five year survey

Kotwal¹,

Sumbali

2023

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Onychomycosis, which is the chronic fungal infection of finger and toe nails, is too prevalent in persons suffering with diabetes mellitus. Diabetes generally make a person more prone to a number of diseases due to their weakened immune system. Diabetics are almost three times more likely to develop onychomycosis than non-diabetics. In our present study, out of the 370 detected diabetic patients (190 males and 180 females), a total of 45 cases were found to be positive for onychomycosis, which showed a prevalence percentage of 12.16%. 35 onychomycotic male patients with a prevalence percentage of 9.46% and 10 onychomycotic female patients with a prevalence percentage of 2.70% with different clinical symptoms viz., Distal lateral subungual onychomycosis (DLSO), Proximal subungual onychomycosis (PSO), White superficial onychomycosis (WSO) and Total dystrophic onychomycosis (TDO) were reported. A total of 5 dermatophytes, 12 non-dermatophytes (yeast-like fungi) and 28 non-dermatophytes (filamentous fungi) were isolated from the nails of detected diabetic patients. The study also indicates that diabetic males are 3.5 times more prone to onychomycosis than diabetic females. This high prevalence of onychomycosis in diabetics is attributed to a combination of host factors including impaired glycaemic index, ischaemia, neuropathy and local immune-suppression. Onychomycosis can be especially important for some specific occupational groups because of their regular contact with soil, dirt and dust. Such people of the society, which depend upon physical labour for earning, such as, the farmers, gardeners, sweepers, maidservants, labourers, miners, etc., may be more prone to dermatophytic and non-dermatophytic onychomycosis and if they are diabetic then situation will become more complicated for them. This study also found that among detected diabetic patients highest prevalence rate of onychomycosis was found in employees (35.6%), farmers (24.4%), house-wives (17.8%), business-men (11.1%) and labourers (11.1%). Onychomycosis is a significant predictor for the development of secondary infections and foot ulcers in diabetes. Since, diabetics have vascular and nerve impairment, any minor injury to feet including a nail fungal infection can lead to more serious complications. Diabetics may have increased difficulty in doing regular foot check-ups due to obesity or retinopathy or cataracts, which may contribute to higher risk of developing complications from onychomycosis. In addition, symptoms go away very slowly and may take a year or more for the entire replacement of the old and infected nail. The study also found a correlation between the increasing age, diabetes and onychomycosis.

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Onychomycosis in immunocompromised population: Phenotypic and molecular identification

Cited by 3 publications

References 25 publications

Onychomycosis in Foot and Toe Malformations

Onychomycosis in Foot and Toe Malformations

Onychomycosis in Foot and Toe Malformations

Prevalence of onychomycosis among diabetic population of District Doda (UT of J&K, India) - a five year survey

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Onychomycosis in immunocompromised population: Phenotypic and molecular identification

Cited by 3 publications

References 25 publications

Onychomycosis in Foot and Toe Malformations

Onychomycosis in Foot and Toe Malformations

Onychomycosis in Foot and Toe Malformations

Prevalence of onychomycosis among diabetic population of District Doda (UT of J&amp;K, India) - a five year survey

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Prevalence of onychomycosis among diabetic population of District Doda (UT of J&K, India) - a five year survey