The First Case of Total Dystrophic Onychomycosis Caused by Aspergillus clavatus Resistant to Antifungal Drugs

Abstract

Onychomycosis is a common fungal infection of nails which is mainly caused by dermatophyte species and less often by yeasts and non-dermatophyte molds. We present a case of onychomycosis due to Aspergillus clavatus for the first time worldwide. The patient was an immunocompetent 32-year-old woman who identified with Psoriasis of the nail. The presence of A. clavatus in a nail sample was confirmed using microscopic and culture analysis followed by PCR of the β-tubulin gene. After antifungal susceptibility test, it is revealed that the isolate was resistant to the majority of common antifungal drugs, but finally the patient was treated with itraconazole 200 mg daily. A. clavatus and drug-resistant A. clavatus have not previously been reported from onychomycosis.

The Curious Case of “Case Report” of Infections Caused by Human and Animal Fungal Pathogens: An Educational Tool, an Online Archive, or a Format in Need of Retooling

“…Severe paracoccidioidomycosis in a 14-year-old boy 200 1/1 [63] a Google Scholar/Scopus [41,42], France [43,44], India [45,46], Italy [47], Iran [48], Japan [49], Malaysia [50], Poland [51], UK [52], and USA [53,54]. There were no other discernible features among this group of case reports to account for the high downloads and citations except for a novelty or rarity of fungal pathogens, for example reports of two cases of multidrug-resistant yeast (Fereydounia khargensis) and of black-grain eumycetoma caused by the rare fungal pathogen Medicopsis romeroi [50,52].…”

Novel Point Mutations in cyp51A and cyp51B Genes Associated with Itraconazole and Posaconazole Resistance in Aspergillus clavatus Isolates

“…3,4 Aspergillus clavatus, a cosmopolitan fungus usually isolated from soil, dung, and grains, has been reported to be responsible for malt worker's lung, 5 tremorgenic neurotoxicosis, 6 endocarditis, 7 otomycosis, 8 and onychomycosis. 9 The production of patulin by A. clavatus, a mycotoxin with gastrointestinal, immunological, and neurological outcomes, has raised concerns about contaminated foods and fruit-based products. 10,11 In general, Aspergillus species are susceptible to triazole compounds for the treatment and prophylaxis of aspergillosis, such as voriconazole, itraconazole, and posaconazole; however, resistance leading to clinical failure has been shown to be increasing.…”

“…14,15 To our knowledge, in vitro antifungal susceptibility data are relatively limited for A. clavatus and other members of section Clavati. 9 Also, despite global reports on the resistance of A. fumigatus and A. flavus isolates to antifungal agents specifically azoles, 1,[13][14][15][16][17][18][19] no report describing the mechanism of intrinsic or acquired resistance in this species has been published to date. Only recently, high minimum inhibitory concentrations (MICs) of A. clavatus isolated from onychomycosis to voriconazole and other lanosterol demethylase inhibitors (i.e., itraconazole, posaconazole, econazole, and miconazole) have been documented.…”

“…Only recently, high minimum inhibitory concentrations (MICs) of A. clavatus isolated from onychomycosis to voriconazole and other lanosterol demethylase inhibitors (i.e., itraconazole, posaconazole, econazole, and miconazole) have been documented. 9 The current study shows that variations in the cyp51A and cyp51B genes of A. clavatus are associated with resistance and investigates the potential mechanism of resistance in azole-resistant A. clavatus isolates by modeling the 3D structure of these proteins and assessing the effects of mutations on the structure and possible drug access.…”

The first report of onychomycosis caused by Cryptococcus friedmannii ( Naganishia friedmannii ) a basidiomycetous yeast

“…Onychomycosis is a common nail infection due to yeasts and filamentous fungi [1] , [2] . The uncommon fungi such as Trichosporon mucoides [3] Aspergillus clavatus [4] and Cryptococcus spp. (basidiomycetous yeasts) [5] were reported as emerging pathogens of onychomycosis.…”