Congenital Candidal Onychomycosis -A Case Report
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Objective Onychomycosis is a most common lesion in dermatologic clinics.This study was to obtain the general information and etiologic agents of onychomycosis in apparently healthy individuals.Methods We collected 163 nail samples from 127 cases of onychomycosis in apparently healthy individuals attending the dermatology clinic from November 2011 to May 2012,which were all subjected to fungal culture and microscopic examination.Results Of the 127 patients,54(42.52%) were office clerks,with a male∶ female ratio of 1 ∶ 1.12.Of the 163 nail samples,46 fingernail and 117 toenail,120(73.62%) were positive at fungal culture,with dermatophytes isolated from 101(84.17%),Trichophyton rubrum from 89(74.17%),mixed infections with dermatophytes from 13(10.83%),yeasts from 5(4.17%),and the non-dermatophyte molds from 1(0.83%).Conclusion The etiologic agents of onychomycosis in apparently healthy individuals are mainly dermatophytes.Although yeast and non-dermatophyte mold infections are rare in this cohort.The rate of mixed infections with dermatophytes is significant.So in clinical practice,mycological examination plays an important role and,if necessary,broad-spectrum antifungal agents should be chosen for the treatment.
Dermatophyte
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Onychomycosis, a fungal infection of the nail is responsible for up to 50.0% of all nail diseases. Though, dermatophytes are most frequently implicated as the causative agents in onychomycosis, yeast and molds are increasingly recognized as causative pathogens. This study was aimed to know the clinical and mycological pattern of onychomycosis in eastern Nepal. Eighty-two clinically diagnosed patients of onychomycosis attending the Dermatology Outpatient department of a tertiary hospital over a period of one year were enrolled in this study. Clipping from the severely affected nail and skin scrapping from active border of the skin lesions if associated were collected from each patient and subjected to microscopy and culture for identification of fungi. The commonest affected age group was 21-40 years. The male: female ratio was 2.7:1. Fifty-one patients had isolated fingernail involvement, while involvement of toenails was seen in 15 patients. Distolateral subungual onychomycosis (67%) was the commonest clinical type followed in decreasing order by superficial white onychomycosis (14.6%), proximal subungual onychomycosis (9.8%), candidal onychomycosis (7.4%) and total dystrophic onychomycosis (1.2%). Trichophyton mentagrophytes (28.8%) was the most common pathogen isolated followed by Trichophyton rubrum (21.2%), Trichophyton tonsurans (11.5%), Candida albicans (11.5%), Trichospron beigelii, (9.6%), Epidermophyton floccosum (7.7%), Trichophyton violaceum (5.8%), and Aspergillus flavus (3.9%). Distolateral subungual onychomycosis was the most common clinical presentation and T. mentagrophytes and T. rubruni were the most frequently isolated fungi for onychomycosis in eastern Nepal.
Trichophyton tonsurans
Nail disease
Epidermophyton floccosum
Dermatophyte
Outpatient clinic
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Onychomycosis is the most common disease of the nails.This retrospective study aimed at evaluating the epidemiology of onychomycosis in adult patients in South Greece during the 2015-2017 period.A total of 3,226 patients with clinical signs of possible onychomycosis were included. Diagnosis was confirmed by microscopy with KOH 20% and by culture in Sabouraud agar with and without actidione.Diagnosis of onychomycosis was confirmed in 27.99% of the patients. Men were infected more often (40.04%) than women (23.30%). Toenails (68.77%) were infected more than fingernails (31.23%) in both sexes. Onychomycosis in fingernails was more common among women (39.74%) than men (18.51%). Men were more often diagnosed with onychomycosis in toenails (81.49%) than women (60.26%). Dermatophytes were the most frequently isolated fungi (34.11%), followed by Candida(29.79%) and non-dermatophyte molds (NDM) (7.20%). In fingernails, the most frequently isolated fungus was Candida spp. (84.04%), followed by dermatophytes (3.55%) and NDM (0.71%). In toenails, dermatophytes (47.99%) were more commonly identified, followed by NDM (10.14%) and Candida spp. (5.15%).Onychomycosis in Greece follows a pattern of higher incidence in males, with toenails more frequently infected with T. rubrum and fingernails more frequently infected with C. albicans in the present era.
Dermatophyte
Nail disease
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Background: Candidiasis are different groups of infection which is caused by Candida albicans and other spesies in the genus Candida can invade hair, skin, nail, mucous membrane and systemic. Purpose: To evaluate profile, process of diagnosis, treatment and follow up of patient with candida infection on the skin and nails. Methods: This research was performed retrospectively to new patients with candida infection of skin and nails in period of 2011-2013. Result: There were 137 patients in period 2011-2013, which are 114 new patients with infection in skin and 23 patients with nails involvement. Most of them were women, respectively in 2011 (54.3%) 2012 (80%) and 2013 (56.6%). Most types of skin disorder is candida intertriginosa (62.2%) and candidiasis of skin and nails (91.3%). Conclusion: Overview of new cases of candida infections of skin and nails tend to decrease. Key words: Candidiasis spp , candida infection of skin and nails.
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Introduction: Onychomycosis is the term used to describe the fungal infection of nail units and onycholysis is described as painless separation of nail plate from its nail bed. It is reported to have an incidence of 0.5 / 5% population worldwide. Materials and methods: 100 patients clinically suspected to have onychomycosis were taken up for this study. Nail scrapings and clippings were obtained from deeper part of discoloured or dystrophic parts of nail. All samples were subjected to direct microscopy (40% KOH) and for culture, all samples were inoculated onto three sets of Sabouraud’s dextrose agar with cycloheximide and Sabouraud’s dextrose agar with cycloheximide and chloramphenicol and incubated at 25˚C and 37˚C and observed for growth for six weeks. Results: Out of 100 patients examined, 42 were males and 58 females.Out of these 100 patients 49 cases yielded growth on culture (culture positive) and 46 cases were positive in direct examination (KOH positive). Out of 100 patients suspected of onychomycosis, 27 cases were found to be Candida albicans , 4 cases infected with dermatophytes , 12 cases infected with non/dermtophytic moulds , 3 cases of Trichosporon spp and 2 Geotrichium cases . Conclusion: In conclusion, our study shows that, fingernails in females were more infected with Candida species, microtrauma being most common cause and often associated with paronychia and nondermatophytes were predominant in toenail infections associated with occlusive footwear.
Onycholysis
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Onychomycosis is the fungal infection of the nails with worldwide occurrence, caused by various species of dermatophytes, yeasts
and molds. In addition, of pain and physical effect of onychomycosis that may interfere with individual’s personal and professional
life, it may also causes negative psychosocial consequences in patients. Concerning increase of onychomycosis during recent decades
and effect of different climates, professional and socio-economic conditions in prevalence of onychomycosis, local investigation for
defining of incidence and causative agents of onychomycosis seems necessary.
In the present study, 252 patients suspected to onychomycosis were examined by direct microscopy and cultural methods. 28.3% of
patients were male and the rest were female. Specimens were tested by direct microscopic examination using potassium hydroxide
20% and culturing on Sabouraud’s dextrose agar (S) and Sabouraud’s containing cyclohexamide and chloramphenicol (Scc
mediums). Direct microscopy test were negative in 61.1% nail specimens and positive in rest of them. Among these positive cases,
12.3%(n=31) specimens presented branching mycelium with arthroconodia, and 21%(n=53) specimens presented blastoconidia and
pseudohyphe. Beside, saprophytic mycelium has been observed in 5.6 %( n=14) of positive cases. The isolated causative agents from
culture of specimens according to their frequencies were as follows: Candida albicans (13.7%), Trichophyton mentagrophytis
(8.3%), Candida species (6.9%), Aspergillus flavus (2.9%), Aspergillus niger (1.5%), Scopolariopsis (1%), Trichophyton rubrum
(1%) and Fusarium (0.5%).
The majority of the patients were women and in both sexes, the most cases of infections were observed in the individuals who were
60-70 year old. The rate of effected fingernails and toenails were almost equal. Concerning the results of culture of specimens,
Candida was the most prevalent causative agent in the fingernails such as Trichophyton (esp. Trichophyton mentagrophytis) in
toenails. The most prevalent none dermatophytic moulds were Aspergillus species in particular in toe nails.
Aspergillus niger
Etiology
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A case of infantile capital candidiasis with crust form lesions was reported.A 16-month-old child had a history of pustular crust covered on the right corona capitis right after she was born.Diagnosis of Candida albicans infection was confirmed by direct microscopic examination,fungal culture,germ tube test,and CHR Candida Magar examination.The infant was cured by topical use of erythromycin ointment 1% miconazole cream for 1 week.
Direct examination
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Vulvovaginal Candidiasis
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ONYCHOMYCOSIS FINGER AND TOE NAIL BY Cryptococcus laurentii, Trychophyton verrucosum, and Candida sp Dhelya Widasmara, Diane Tantia SariDepartment of Dermatology and Venereology, Medical Faculty, Brawijaya Universitydr.Saiful Anwar Regional Public Hospital, Malang, IndonesiaEmail: dhelya.widasmara@gmail.com AbstractIntroduction : Onychomycosis is included in most common nail disease and contributes to 50% of onychodystropic events. So far, there are rare cases of onychomycosis due to Cryptoccus laurentii and Trychophyton verrucosum. Case : Woman, 54 y.o, complaining of brittle nails and cracked on the soles of the feet and hands since 6 months ago. Patients have daily habits to go to rice fields without gloves and footwear, and rarely wash their hands and feet after the rice fields. Dermatologic examination of all unguium digiti manus and the right and left hand, obtained discolorization of yellow and white and some blackish, subungual hyperkeratosis, onikolisis, and onikodistrofik. In plantar dekstra et sinistra, obtained erythema plaque, multiple, irregular shape, varied size, with rough skuama, as well as multiple yellow and white hyperkeratotic plaques with fissures. A 20% KOH examination of a hand and foot nail, both of which obtained a long septae hyphae. Periodic Acid-Schiff coloration (PAS) obtained a description of spores. Fungal culture from fingernail obtained growth of Criptococcus laurentii and Trichophyton spp., culture of toenails obtained growth Trichophyton verrucosum and Candida sp. Patients were treated with itraconazole tablet dose of 2x200mg / day dose for a week every month, gentamicin ointment, and 20% urea cream, myologic improvement after 4 weeks of therapy. Discussion : The incidence of onychomycosis due to Cryptoccus laurentii and Trychophyton verrucosum is still rare. The predisposing factor of infection in these patients is due to the patient's habitual contact with the paddy fields. Keywords : onychomycosis, Cryptococcus laurentii, Trychophyton verrucosum
Erythema
Onycholysis
Foot (prosody)
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Onychomycosis is a collective term for fungal infections of nail plate. T. rubrum accounts for 90% of all the causative organisms, followed by T. mentagrophytes and E. floccosum. Although Aspergillus terreus and Candida parapsilosis are known cause of onychomycosis, there are only few cases reported so far. A 3-year-old male patient presented with a scaly brownish change on nail plate of right thumb which lasted for 4 months. The patient had no underlying medical or trauma history. Histopathologic examination showed hyperkeratosis and focal parakeratosis but failed to identify fungal hyphae on PAS and GMS stains. However Candida parapsilosis was isolated on concurrent fungus culture of nail plate, hence confirming onychomycosis. A 3-year-old male patient presented with a scaly change on nail plate of left first toe which appeared 6 months prior to the visit. The patient had no underlying medical or trauma history. Nail plate biopsy revealed fungal hyphae on PAS and GMS stains. On concurrent fungual culture of the nail plate Aspergillus terreus was isolated. Onychomycosis is much more rare in children, and the aforementioned pathogens were also as rare as adults. Reports on onychomycosis due to C. parapsilosis is scarce in number, and infection due to A. terreus has not been reported within Korea up to today. Herein the authors report 2 cases of unusual fungal infections in pediatric nail plate.
Candida parapsilosis
Aspergillus terreus
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