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INTRODUCTION: Onychomycosis is common in immunocompromised patients, but emerging species have been verified, thereby modifying the epidemiological profile of this mycosis. Thus, the aim of this study was to evaluate clinical and mycological profile of onychomycosis among HIV/AIDS patients. METHODS: Clinical samples were collected and processed for direct examination, and cultures were maintained at a temperature of 30 °C and 37 °C for 15 days. RESULTS: Out of 100 patients, 32 had onychomycosis. The etiological agents isolated were Candida albicans, C. parapsilosis, C. tropicalis, C. guilliermondii, Trichophyton rubrum, T. mentagrophytes, Fusarium solani, Scytalidium hialinum, S. japonicum, Aspergillus niger, Cylindrocarpon destructans and Phialophora reptans. CONCLUSIONS: Onychomycosis in HIV/AIDS patients presents various clinical manifestations and may be caused by emerging fungi. The peculiarities presented by different fungal agents justify the need for identification to species level, with the purpose of guiding better therapeutic approaches and minimizing these patients' exposure to conditions presenting a risk of disseminated infection.

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INTRODUÇÃO: Onicomicoses são comuns em pacientes imunocomprometidos embora espécies emergentes tenham sido verificadas, modificado o perfil epidemiológico desta micose. Assim, o objetivo desta pesquisa é avaliar o perfil clínico e micológico da onicomicose em pacientes com infecção pelo HIV/AIDS. MÉTODOS: Amostras clínicas foram coletadas, processados para exame direto e a cultura mantida a temperatura de 30°C e 37ºC durante 15 dias. RESULTADOS: Dos 100 pacientes, 32 apresentavam onicomicose. Os agentes isolados foram Candida albicans, C. parapsilosis, C. tropicalis, C. guilliermondii, Trichophyton rubrum, T. mentagrophytes, Fusarium solani, Scytalidium hialinum, S. japonicum, Aspergillus niger, Cylindrocarpon destructans e Phialophora reptans. CONCLUSÕES: Onicomicoses em HIV/AIDS apresentam variadas manifestações clínicas e podem ser causadas por fungos emergentes. As peculiaridades apresentadas pelos diferentes agentes de origem fúngica justificam a necessidade de identificação ao nível da espécie, com a finalidade de orientar uma melhor abordagem terapêutica e minimizar a exposição desses pacientes a condições de risco de uma infecção disseminada.

INTRODUCTION: Onychomycosis is common in immunocompromised patients, but emerging species have been verified, thereby modifying the epidemiological profile of this mycosis. Thus, the aim of this study was to evaluate clinical and mycological profile of onychomycosis among HIV/AIDS patients. METHODS: Clinical samples were collected and processed for direct examination, and cultures were maintained at a temperature of 30°C and 37°C for 15 days. RESULTS: Out of 100 patients, 32 had onychomycosis. The etiological agents isolated were Candida albicans, C. parapsilosis, C. tropicalis, C. guilliermondii, Trichophyton rubrum, T. mentagrophytes, Fusarium solani, Scytalidium hialinum, S. japonicum, Aspergillus niger, Cylindrocarpon destructans and Phialophora reptans. CONCLUSIONS: Onychomycosis in HIV/AIDS patients presents various clinical manifestations and may be caused by emerging fungi. The peculiarities presented by different fungal agents justify the need for identification to species level, with the purpose of guiding better therapeutic approaches and minimizing these patients' exposure to conditions presenting a risk of disseminated infection.

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Objetivo Identificar leveduras do gênero Candida responsáveis por onicomicose e as respectivas suscetibilidades antifúngicas in vitro em pacientes ambulatoriais com vírus da imunodeficiência humana e alterações ungueais sugestivas de onicomicose. Métodos Avaliaram-se 23 cepas de leveduras isoladas de 21 amostras ungueais das mãos e/ou pés. As colônias foram identificadas por CHROMagar Candida® e testes padrões. Para o antifungigrama, utilizou-se o ATB-Fungus 3®, e quando o fluconazol apresentou resistência neste kit, utilizou-se, para confirmação, o teste de disco difusão. Resultados Em dois casos houve infecção mista por duas espécies de Candida. Das 23 espécies, 48% eram C. albicans, 26% C. parapsilosis, 8,5% C. tropicalis, 8,5% C. glabrata, 4,3% C. guilliermondii e 4,3% C. famata. Nos testes de suscetibilidade, 48% das espécies apresentaram resistência aos azólicos, sendo 36% C. albicans e 64% espécies não albicans. Todas as cepas resistentes ao fluconazol no ATB-Fungus 3® apresentaram resistência no método de disco difusão. Pacientes com cepas resistentes utilizaram antifúngicos previamente para tratamento de candidíase oral ou onicomicose recorrente. Conclusão Candida albicans é a espécie mais isolada nos casos de onicomicoses causadas por leveduras do gênero Candida em unhas de pacientes com vírus da imunodeficiência humana. Entretanto, neste grupo de pacientes, as espécies não albicans isoladas nas unhas mostram-se menos suscetíveis aos azólicos. A resistência das leveduras ao fluconazol, droga frequentemente utilizada para candidíase, pode ter sido consequência de seu uso prévio. Desta forma, os antifúngicos devem ser utilizados com cautela e apenas quando houver certeza do diagnóstico micológico e da suscetibilidade antifúngica.

Objective The objective of this study was to identify yeasts from the genus Candida responsible for onychomycosis and their respective in vitro antifungal susceptibilities in outpatients with the human immunodeficiency virus and nail changes suggestive of onychomycosis. Methods Twenty-three strains of yeasts from 21 nail samples from fingers or toes were assessed. The colonies were identified using CHROMagar Candida® and standard tests. ATB-Fungus 3® method was used for the antifungal susceptibility testing and when there was resistance to fluconazole, the disk diffusion test was used for confirmation. Results A mixed infection with two species of Candida was found in two cases. Out of the 23 species found, 48% were C. albicans, 26% were C. parapsilosis, 8.5% were C. tropicalis, 8.5% were C. glabrata, 4.3% were C. guilliermondii and 4.3% were C. famata. In the susceptibility tests, 48% of the species were resistant to azoles, where 36% were C. albicans and 64% were non-albicans species. All luconazoleresistant strains in the ATB-Fungus 3® method were also resistant in the disk diffusion test. Patients with resistant strains had used antifungal agents before to treat oral candidiasis or recurrent onychomycosis. Conclusion Candida albicans is the most commonly isolated species in cases of onychomycosis caused by yeasts of the Candida genus in nails of patients with the human immunodeficiency virus. However, in this group of patients, the albicans species isolated from the nails are less susceptible to azoles. Yeast resistance to fluconazole, a drug routinely used to treat candidiases, could be due to its previous use. Thus, antifungal agents should be used with caution and only when the diagnosis and antifungal susceptibility are proven.

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O presente estudo analisa um caso de onicomicose por espécies de Candida com resistência in vitro a fluconazol e itraconazol em portadora do vírus da imunodeficiência humana (HIV). A paciente apresentava onicomicose distrófica parcial com paroníquia crônica e já havia feito uso de fluconazol para tratamento de candidíase oral. No exame microscópico direto de escamas ungueais das mãos, foram observadas células de leveduras arredondadas, blastosporadas, hialinas e pseudohifas: em cultura após crescimento, duas espécies de Candida foram identificadas como C. albicans e C. tropicalis. Foram realizados testes de sensibilidade com ATB FUNGUS 2 e método de disco-difusão. Ambas as espécies apresentaram resistência a fluconazol e itraconazol. As peculiaridades apresentadas por diferentes espécies de Candida justificam a necessidade de se identificar leveduras no nível da espécie, bem como determinar o perfil de sensibilidade aos antifúngicos, com a finalidade de orientar uma melhor abordagem terapêutica e minimizar a exposição desses pacientes a condições de risco de uma infecção disseminada.

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Patients infected with human immunodeficiency virus (HIV) are a risk group for onychomycosis, fungal infections caused mainly by dermatophytes and yeast. However, non-dermatohytic moulds are becoming common agents for nail infections in this population of patients. We report four cases of onychomycosis caused by non-dermatophytic moulds (Aspergillus niger, Scytalidium hyalinum, Scytalidium dimidiatum and Fusarium solani) in patients infected with HIV from Recife, Pernambuco, Brazil. Onychomicosis by non-dermatophytic species in HIV-positive patients requires special attention in the clinical and the laboratory. A proper diagnosis is necessary to establish the specific and adequate treatment, preventing fungal invasion.

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Os autores apresentam dois casos de Atrofia Varioliforme Idiopática. Estudam os aspectos clínicos e descrevem pela primeira vez o quadro histológico

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