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Ng, Kee Peng; Saw, T.L.; Madasamy, M.; Hoo, T. S. Soo

doi:10.1023/a:1007044720147

Cited by 35 publications

(5 citation statements)

References 15 publications

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“…A summary of NDM prevalence reported across studies stratified by the geographical location, as well as by the sampling method used (all studies vs. repeated sampling), is shown in Table 1 4–77 . Although the adoption of repeated sampling can increase the diagnostic confidence in a case of NDM onychomycosis, ruling out isolation of the facultatively pathogenic agent as a random contaminant, we did not find significant differences in the predominant NDM strain detected from studies with repeated and unrepeated sampling procedures except in North America 7–13 …”

Section: Epidemiology Of Ndm Onychomycosismentioning

confidence: 77%

A comprehensive review of nondermatophyte mould onychomycosis: Epidemiology, diagnosis and management

Gupta,

Wang,

Cooper

et al. 2023

Acad Dermatol Venereol

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Nondermatophyte moulds (NDMs) are widely distributed and can be detected in association with mycotic nails; however, sometimes it can be challenging to establish the role of NDMs in the pathogenesis of onychomycosis (i.e. causative vs. contaminant). In studies where the ongoing invasive presence of NDMs is confirmed through repeat cultures, the global prevalence of NDMs in onychomycosis patients is estimated at 6.9% with the 3 most common genus being: Aspergillus, Scopulariopsis and Fusarium. NDM onychomycosis can, in many cases, appear clinically indistinguishable from dermatophyte onychomycosis. Clinical features suggestive of NDMs include proximal subungual onychomycosis with paronychia associated with Aspergillus spp., Fusarium spp. and Scopulariopsis brevicaulis, as well as superficial white onychomycosis in a deep and diffused pattern associated with Aspergillus and Fusarium. Longitudinal streaks seen in patients with distal and lateral onychomycosis may serve as an additional indicator. For diagnosis, light microscopic examination should demonstrate fungal filaments consistent with an NDM with at least two independent isolations in the absence of a dermatophyte; the advent of molecular testing combined with histological assessment may serve as an alternative with improved sensitivity and turnover time. In most instances, antifungal susceptibility testing has limited value. Information on effective treatments for NDM onychomycosis is relatively scarce, unlike the situation in the study of dermatophyte onychomycosis. Terbinafine and itraconazole therapy (continuous and pulsed) appear effective to varying extents for treating onychomycosis caused by Aspergillus, Fusarium or Scopulariopsis. There is scant literature on oral treatments for Neoscytalidium.

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Section: Epidemiology Of Ndm Onychomycosismentioning

confidence: 77%

A comprehensive review of nondermatophyte mould onychomycosis: Epidemiology, diagnosis and management

Gupta,

Wang,

Cooper

et al. 2023

Acad Dermatol Venereol

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“…The prevalence of NDMs isolated from nail infections in various parts of the world ranges between 1.49% and 33.5% (30-33); however, it seems that this rate has increased dramatically in the past several years (34, 35). Although our study is not a comprehensive epidemiological survey and we did not test all samples, these random data demonstrate an increasing occurrence of onychomycosis due to NDMs.…”

Section: Discussionmentioning

confidence: 99%

Growing Incidence of Non-Dermatophyte Onychomycosis in Tehran, Iran

Motamedi

Ghasemi

Shidfar

et al. 2016

Jundishapur J Microbiol

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BackgroundNon-dermatophyte onychomycosis (NDO) is caused by a wide range of mold fungi other than dermatophytes, and has been reported at various rates in different countries worldwide. Studies on the incidence of NDO in the community are essential for understanding its epidemiology and control, as well as for the appropriate treatment of these infections.ObjectivesIn this study, the incidence of NDO in Tehran, Iran, was compared to the incidence of onychomycoses due to dermatophytes and yeasts.MethodsFrom 2014 through 2015, samples from a total of 1,069 patients with suspected fungal nail diseases, who were referred to three medical mycology laboratories in Tehran, were collected and subjected to direct examination (all samples) and culture (788 samples). Differentiation of the causative agents of onychomycosis was based on microscopic observation of characteristic fungal elements in the nail samples and growth of a significant number of identical colonies on the culture plate.ResultsBased on only direct microscopy, onychomycosis was diagnosed in 424 (39.6%) cases, among which 35.8% were caused by dermatophytes, 32.7% by yeasts, and 29.3% by non-dermatophyte molds (NDMs), while 2.2% were mixed infections. Direct exam was significantly more sensitive than culture for the diagnosis. The most commonly isolated NDMs were Aspergillus spp. (69.3%, n = 52), followed by Fusarium spp. (n = 7). The other isolated species were Paecilomyces spp., Scopulariopsis spp., Acremonium spp., Cladosporium spp., and Chrysosporium spp., with only one case of each.ConclusionsAn increasing frequency of NDO compared to onychomycosis due to other causative agents has been noticeable over the past few years in Iran. This epidemiological data may be useful in the development of preventive and educational strategies.

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“…have been reported more and more frequently by various authors, both as single case reports [23, 24, 25, 26]and also and above all in epidemiological studies on non-dermatophyte onychomycoses [2, 3, 4, 27, 28, 29, 30, 31]. In most of the latter, the main non-dermatophyte mould involved in onychomycosis as primary pathogen appears to be Scopulariopsis (1.4–6% of all nail mycotic infections), whereas cases of onychomycosis caused by Aspergillus spp.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Histological Aspects of Toenail Onychomycosis Caused by <i>Aspergillus</i> spp.: 34 Cases Treated with Weekly Intermittent Terbinafine

Gianni

Romano

2004

Dermatology

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Background: Non-dermatophytic onychomycoses represent 1.45–17.6% of all fungal nail infections. Epidemiological studies have shown that Aspergillus spp. are emerging fungal agents of toenail onychomycosis. Indeed, after Scopulariopsis spp. the genus Aspergillus is the second most common agent of non-dermatophytic onychomycosis. The diagnosis and treatment of toenail onychomycosis caused by non-dermatophyte moulds are not always straightforward. Objectives: The aims of this study were to describe the clinical appearance of toenail onychomycosis due to Aspergillus spp., to investigate the pathogenetic role of these agents and to evaluate the efficacy and safety of weekly intermittent terbinafine (500 mg/day for 1 week each month for 3 months) in the treatment of these patients. Patients and Methods: Mycological study of 2,154 patients with onychodystrophy revealed 1,228 onychomycoses (57%) including 71 cases due to non-dermatophytic fungi (5.6%). Non-dermatophytic onychomycosis caused by Aspergillus spp. represented 2.6% of all onychomycoses. The subjects were 34 patients (22 females, 12 males, age range 30–82 years) observed between September 1999 and December 2001, with toenail onychomycosis caused by Aspergillus spp. confirmed by standard techniques (microscopic examination and culture according to the criteria of English), histological examination of nail clippings and scanning electron microscope examination of the cultures whenever necessary. Results: The clinical features suggesting onychomycosis due to Aspergillus spp. are chalky deep white nail, rapid involvement of lamina and painful perionyxis without pus. Standard mycological tests (direct microscopy and fungal culture) and histological examination confirmed the pathogenetic role of Aspergillus spp. in onychomycoses. In particular, the histological examination was positive in 28 cases (82%) and useful in identifying typical aspects of Aspergillus spp. nail infections. At the follow-up, 12 months after the start of therapy with pulsed terbinafine, clinical and mycological recovery was confirmed in 30 of the 34 patients (88%). Conclusions: Treatment of non-dermatophytic onychomycosis with terbinafine usually requires at least 3 months of continuous systemic therapy. Our study of 34 patients confirms that terbinafine is particularly effective in the treatment of Aspergillus spp. nail infections and that a pulsed regimen is more economical and less demanding.

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Untitled

Cited by 35 publications

References 15 publications

A comprehensive review of nondermatophyte mould onychomycosis: Epidemiology, diagnosis and management

A comprehensive review of nondermatophyte mould onychomycosis: Epidemiology, diagnosis and management

Growing Incidence of Non-Dermatophyte Onychomycosis in Tehran, Iran

Clinical and Histological Aspects of Toenail Onychomycosis Caused by <i>Aspergillus</i> spp.: 34 Cases Treated with Weekly Intermittent Terbinafine

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