[P241] Two cases of unusual fungal infection in pediatric nail plates
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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.Keywords:
Candida parapsilosis
Aspergillus terreus
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Objective To study the main clinical features,risk factors and the causative pathogens on onychomycosis in children.Methods From 2003.3-2006.12,direct microscopic examination,culture and epidemiological survey were performed on 82 samples from children 18 years old or younger with onychomycosis in our department.Results The most common(48.78%)infected type was distal and lateral subungual onychomycosis,infected patients were more fingernails than toenails.Tinea manuum,tinea pedis,nail trauma,occlusive footgear were risk factors for onychomycosis in children.64 strains of pathogenic fungi were isolated.59 were dermatophytes(92.19%),57 were Trichophyton rubrum(89.06%);5 yeast(7.81%),Candida albicans was the most;mold and mixed fungal infection were never isolated.Conclusion The most common pathogenic fungus of onychomycosis in children is Trichophyton rubrum,next is Candida albicans.It is important for prevention and treatment to analyse the clinical features and risk factors of onychomycosis in children.
Pathogenic fungus
Direct examination
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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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Objective: Onychomycosis is a diagnosis of fungal organisms in the nail unit. It frequently occurs in both the immunocompetent and immunocompromised patient. A variant of onychomycosis is proxiaml onychomycosis that occurs on the most proximal aspect of the nail. Proximal onychomycosis is known to be commonly associated with immunocompromised status. Study Design: A case report of a veteran who presented a dermatology clinic with complaint of solitary nail discoloration that was recalcitrant to over-the-counter therapy including topical hydrogen peroxide and foot soaks without improvement. Results and Conclusions: This individual case report demonstrates that pedal proximal onychomycosis can be associated with non-dermatophyte organisms, identified as Fusarium species, in immunocompetent individuals. The finding of pedal proximal onychomycosis caused by a Fusarium non-dermatophytic mold has not been reported. The veteran was successfully cured of the condition with treatment via oral terbinafine for a ninety-day course while monitoring patient’s liver function test for any complications.
Terbinafine
Nail disease
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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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ASPERGILLI when found in mycologic cultures of the skin and of the nails have long been considered incidental clinic or laboratory contaminants and of no pathogenic significance. However, increasing evidence over the past twenty-five years has led to the realization that species of this genus of the fungi might actually be primary or secondary invaders of the human nail.1In 1941 one of us (E. S. B.) had the opportunity to investigate a case of primary invasion of the human nail by a species of Aspergillus. In this case each time nail scrapings were cultured they yielded large numbers of colonies of Aspergillus flavus, but no other species of fungus was recovered. It was observed in this case that the infected nail plate had a dull green discoloration in addition to the usual characteristics of onychomycosis, such as thickening, brittleness, vertical striations and crumbling of the
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Onychomycosis, the commonest presentation of deformed nails is caused by dermatophytes, non-dermatophyte moulds (NDM) or yeast. Clinical presentation varies from onychodystrophy, subungual hyperkeratosis, onycholysis or discolouration of nail plate.
Objectives: Identification of the causative fungal organisms and to compare the clinical diagnosis with positivity of KOH examination and fungal culture.
Materials and Methods: 78 clinically suspected cases of onychomycosis were taken. After disinfecting the nails with 70% alcohol, KOH mount and fungal culture was done followed by LPCB mount.
Results: 44 patients had onychomycosis with 31-40 yrs (40.9%) as common age group and male preponderance (63.63%). Male:Female ratio 1.75:1. Toe nails (61.36%) were predominantly involved with Distal and lateral subungual onychomycosis (56.8%) as the most common presentation. KOH positivity (63.1%) was more than culture positivity (57.8%). Dermatophytes (54.54%) were the commonest group isolated followed by NDM (25%) and yeasts (20.45%). Trichophyton rubrum(31.81%) was the commonest among dermatophyteswhile among NDM, Fusarium spp (9.09%) was most common. Candida albicans (11.36%) was most common among yeasts.
Conclusion: Clinical diagnosis of onychomycosis should be confirmed both by KOH and fungal culture to prescribe species specific antifungal drugs for optimal outcome.
Keywords: Onychomycosis, Dermatophytes, Non-dermatophyte moulds, Yeasts
Dermatophyte
Onycholysis
Nail disease
Presentation (obstetrics)
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Objective To determine the causative pathogens and the various clinical patterns of onychomycosis in a community hospital.Methods To isolate the causative fugi from nail samples of 306 patients with onychomycosis during the period of January 2005 to August 2007.Material from the affected nails was obtained for KOH microscopic examination and culture.A history of onychomycosis from each patient was recorded.The association between various factors and the distribution of pathogens was analysed.Clinical patterns of onychomycosis were noted and correlated with causative pathogens.Results 62.1 % patients had toenail involvement alone,while 9.5 % had fingernail involvement alone.28.4% patients had both fingernail and toenail involvement.Distolateral subungual onychomycosis was the most common clinical type,being encountered in 195 patients(63.7%),followed by total dystrophic onychomycosis(82 patients;26.8%),proximal subungual onychomycosis without paronychia(18 patients;5.9%),and proximal subungual onychomycosis with paronychia(8 patients;2.6%),superficial white onychomycosis(three patients;0.98%).306 strains of pathogens were isolated,of which mostly were dermatophytes(68.0 %),such as T.rubrum(80.3%),yeasts(22.5%),and C.albicans(73.9%).Nondermatophyte molds were at the third(9.5 %),most were Aspergillus spp.Conclusions Distolateral subungual onychomycosis and total dystrophic onychomycosis were the common clinical Presentation;however,proximal subungual onychomycosis and superficial white onychomycosis were not uncommon in this community hospital.Tricophyton rubrum and Candida albicans were the major pathogens.The clinicoetiologic correlation revealed that a single pathogen could give rise to more than one clinical type.
Nail disease
Onycholysis
Fungal pathogen
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Onychomycosis is the most common cause of deformed nails. It is often confused clinically with other nail diseases such as psoriasis. A cross sectional study was carried out in 120 clinically suspected onychomycosis patients to assess the diagnostic utility of nail unit histopathology. The majority of the patients were males (72.5%) in the age group of 20-40 years (55%). Involvement of fingernails alone (37.5%) was found to be more common than toenails (12.5%). Distal and lateral subungual onychomycosis [DLSO] (76.6%) was the predominant morphological type noted. Direct microscopy with 10% potassium hydroxide (KOH) preparation revealed fungal filaments in 82.5% of the cases. Mycological culture on Sabouraud's dextrose agar with and without cycloheximide indicated fungal isolates in 44% of the cases, with Trichophyton mentagrophytes being the most common isolate (38.3%). The combined approach with KOH preparation and culture showed the evidence of fungus in 103 cases (85.8%). Of the rest of the 17 cases in whom both these procedures failed to confirm a diagnosis, nail unit biopsy was carried out in 15 consenting patients. Fungal hyphae (better demonstrable on PAS staining) were evident in 14 cases (93.3%). Other histopathological features observed among these patients were subungual hyperkeratosis, neutrophilic infiltrate, parakeratosis, hemorrhage, and serum crusts. We concluded that histopathological examination of nails is a valuable diagnostic aid in onychomycosis, especially if routine parameters fail to establish a diagnosis.
Onycholysis
Direct examination
Histopathology
Nail disease
Pemphigus vulgaris
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