RESUMO
La prevalencia global de la onicomicosis pedis es de 4,3%, y en hospitalizados puede llegar hasta 8,9%. Aun así, se propone que está ampliamente subdiagnosticada. Personas añosas con comorbilidades presentan mayor riesgo de onicomicosis pedis y de sus complicaciones. Se examinaron aleatoriamente a 64 pacientes hospitalizados en el Servicio de Medicina del Hospital San José. A aquellos con signos clínicos de onicomicosis pedis se les realizó un examen micológico directo (MD) y estudio histopatológico de un corte de uña teñido con PAS (Bp/PAS). Muestra de 64 pacientes, un 78,1% presentó onicomicosis pedis clínica y en un 70,3% se confirmó el diagnóstico con MD y/o Bp/PAS positivo. De los pacientes con onicomicosis confirmada, el promedio de edad fue de 67,8 +/- 12,3 años. Un 44% correspondió al sexo femenino y un 56% al sexo masculino. La onicomicosis pedis en el servicio de medicina interna del Hospital San José es una condición frecuente. El conjunto de MD y Bp/PAS podría ser considerado como una buena alternativa diagnóstica. (AU)
Onychomycosis of the toenails has a global prevalence of 4,3% and can reach up to 8,9% in hospitalized patients. It has been hypothesized that it is widely under diagnosed. Aged patients with multiple diseases have an increased risk of Onychomycosis and its complications. 64 patients of the internal medicine ward were randomly selected. Those who had clinical signs of onychomycosis of the toenails were tested with direct microscopy and histological study of the nail plate with PAS staining. Of the 64 patients, 78,1% (50) had clinical signs of onychomycosis of the toenails and in 70,3% (45) the diagnosis was confirmed either by direct microscopy and/or by histological study of the nail plate with PAS staining. The mean age for the group with onychomycosis was 67,8 +/- 12,3 ages. 44% were female and 56% were male. Onychomycosis of the toenails is a frequent condition at the internal medicine ward of the San José Hospital. The direct microscopy together with the histological study of the nail plate with PAS staining seem to be a good diagnosis alternative. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Onicomicose/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Dermatoses do Pé/epidemiologia , Chile/epidemiologia , Prevalência , Onicomicose/diagnóstico , Onicomicose/microbiologia , Onicomicose/patologia , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/microbiologia , Dermatoses do Pé/patologia , Hospitalização/estatística & dados numéricosRESUMO
BACKGROUND: Multiple sclerosis (MS) is a chronic demyelinating disease related to HLA-DR8. Susceptibility to onychomycosis has been found in Mexican mestizos with HLA-DR8. The frequency of onychomycosis in this neurological disease is unknown. OBJECTIVES: To determine the frequency of onychomycosis and its clinical, mycological, and dermoscopic characteristics in patients with MS in comparison with the general population. METHODS: Observational, cross-sectional, case-control study in patients with MS from October 2017 to February 2018. Age, gender, MS type, and time of progression from diagnosis to date and baseline treatment were collected after signed informed consent. A neurological exploration and clinical examination of fingernails and toenails for onychomycosis was conducted. Mycological and dermoscopic studies of the infected nails were performed on patients with clinical diagnosis of onychomycosis. A healthy control group was taken for each case (1:1), paired by age and gender. RESULTS: The frequency of onychomycosis in patients with MS was higher than the healthy population (32% vs. 26%, P = 0.509). A higher frequency of non-dermatophyte fungi was found, although it was not statistically significant. The clinical manifestations and dermoscopic findings in patients with MS and onychomycosis were similar to those of the general population. CONCLUSION: The frequency of onychomycosis in patients with MS is slightly higher than that of the general population. A possible association of HLA-DR8 as a susceptibility factor for onychomycosis is proposed. The etiology of opportunistic fungi in MS patients with onychomycosis may be related to immunosuppressive treatment.
Assuntos
Dermatoses do Pé , Esclerose Múltipla , Onicomicose , Estudos de Casos e Controles , Estudos Transversais , Dermatoses do Pé/epidemiologia , Humanos , Esclerose Múltipla/epidemiologia , Onicomicose/epidemiologia , PrevalênciaRESUMO
Onychomycosis is estimated at a prevalence of 10% worldwide with the infecting organism most commonly Trichophyton rubrum (T. rubrum). Traditional culture identification of causative organisms has inherent risks of overestimating dermatophytes, like T. rubrum, by inhibiting the growth of possible nondermatophyte mould (NDM) environmental contaminants which could be causative agents. Recently, molecular methods have revealed that a proportion of onychomycosis cases in North America may be caused by mixed infections of T. rubrum as an agent co-infecting with one or more NDM. Determining the global burden of mixed infections is a necessary step to evaluating the best therapies for this difficult-to-treat disease. To determine the prevalence of mixed infections in a global population, nail samples from onychomycosis patients in Brazil, Canada, and Israel (n = 216) were analyzed by molecular methods for the presence of dermatophytes and five NDMs. If an NDM was detected, repeat sampling was performed to confirm the NDM. T. rubrum was detected in 98% (211/216) of infections with 39% mixed (84/216). The infection type was more likely to be mixed in samples from Brazil, but more likely to be a dermatophyte in samples from Canada and Israel (Χ2 = 16.92, df = 2, P<0.001). The most common cause of onychomycosis was T. rubrum. In all countries (Brazil, Canada and Israel combined) the prevalence of dermatophyte (Χ2 = 211.15, df = 3, P<0.001) and mixed (dermatophyte and NDM; Χ2 = 166.38, df = 3, P<0.001) infection increased with patient age. Our data suggest that mixed infection onychomycosis is more prevalent than previously reported with the aging population being at increased risk for mixed infections.
Assuntos
Coinfecção/diagnóstico , Onicomicose/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Arthrodermataceae/genética , Arthrodermataceae/isolamento & purificação , Brasil/epidemiologia , Canadá/epidemiologia , Criança , Coinfecção/epidemiologia , Coinfecção/microbiologia , DNA Fúngico/isolamento & purificação , DNA Fúngico/metabolismo , Feminino , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/epidemiologia , Dermatoses do Pé/microbiologia , Carga Global da Doença , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Onicomicose/epidemiologia , Onicomicose/microbiologia , Prevalência , Adulto JovemRESUMO
The study reported in this article aimed to analyse factors associated with the risk of ulceration in the feet of patients with diabetes using a conceptual hierarchic model. It was a cross-sectional study carried out with 1515 people with diabetes mellitus aged 40 years and older. The risk of foot ulceration was of higher significance in male patients with diabetes (adjusted odds ratio (OR)=1.39 (95% confidence interval (CI) 1.11 to 1.73); p=0.020), who did not practise a regular physical activity (adjusted OR=1.58 (95% CI 1.15 to 2.15); p=0.013), with time since diagnosis over 10 years (adjusted OR=1.42 (95% CI 1.10 to 1.86); p=0.011), who used insulin (adjusted OR=1.40 (95% CI 1.09 to 1.84); p=0.012), with retinopathy (adjusted OR=1.84 (95% CI 1.38 to 2.45); p=0.001) and who had had a previous stroke (adjusted OR=1.47 (95% CI 1.09 to 2.04); p=0.018). Mycosis on the nails and the interdigital spaces of the feet was statistically associated with ulceration risk independent of other variables of the model (adjusted OR=2.48 (95%CI 1.70 to 3.63); p=0.001). Finding the factors associated with ulceration contributes to the provision of quality care by nurses.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Pé Diabético/epidemiologia , Retinopatia Diabética/epidemiologia , Exercício Físico , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Brasil/epidemiologia , Estudos Transversais , Dermatomicoses/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/etiologia , Retinopatia Diabética/etiologia , Feminino , Dermatoses do Pé/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Onicomicose/epidemiologia , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de TempoRESUMO
Fusariosis have been increasing in Colombia in recent years, but its epidemiology is poorly known. We have morphologically and molecularly characterized 89 isolates of Fusarium obtained between 2010 and 2012 in the cities of Bogotá and Medellín. Using a multi-locus sequence analysis of rDNA internal transcribed spacer, a fragment of the translation elongation factor 1-alpha (Tef-1α) and of the RNA-dependent polymerase subunit II (Rpb2) genes, we identified the phylogenetic species and circulating haplotypes. Since most of the isolates studied were from onychomycoses (nearly 90 %), we carried out an epidemiological study to determine the risk factors associated with such infections. Five phylogenetic species of the Fusarium solani species complex (FSSC), i.e., F. falciforme, F. keratoplasticum, F. lichenicola, F. petroliphilum, and FSSC 6 as well as two of the Fusarium oxysporum species complex (FOSC), i.e., FOSC 3 and FOSC 4, were identified. The most prevalent species were FOSC 3 (38.2%) followed by F. keratoplasticum (33.7%). In addition, our isolates were distributed into 23 haplotypes (14 into FOSC and nine into FSSC). Two of the FSSC phylogenetic species and two haplotypes of FSSC were not described before. Our results demonstrate that recipients of pedicure treatments have a lower probability of acquiring onychomycosis than those not receiving such treatments. The antifungal susceptibility of all the isolates to five clinically available agents showed that amphotericin B was the most active drug, while the azoles exhibited lower in vitro activity.
Assuntos
DNA Espaçador Ribossômico/genética , Dermatoses do Pé/epidemiologia , Fusariose/epidemiologia , Fusarium/classificação , Fusarium/genética , Onicomicose/epidemiologia , Fator 1 de Elongação de Peptídeos/genética , RNA Polimerase II/genética , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Colômbia/epidemiologia , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/microbiologia , Fusariose/tratamento farmacológico , Fusariose/microbiologia , Fusarium/efeitos dos fármacos , Fusarium/isolamento & purificação , Haplótipos/genética , Humanos , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Onicomicose/tratamento farmacológico , Onicomicose/microbiologia , Filogenia , Análise de Sequência de DNARESUMO
BACKGROUND: Mexican diabetic population frequently presents mycosis under foot hyperkeratosis; however, in another type of onychomycosis as the ones that is assumed Candida albicans is the causal agent, it is unknown the frequency, the prevalence and if another Candida species or other yeasts are found. OBJECTIVE: Evaluate the frequency of yeasts causing onychomycosis in diabetic patients looked after in public institutions of health of the State of Hidalgo, Mexico, and its association with clinical epidemiological variables. MATERIALS AND METHODS: An observational, descriptive and transversal study was made on 261 patients, from which one nail sample of each one was obtained, used to isolate and identify dermatophytes and yeasts; the results were statistically correlated with 24 epidemiological parameters. The clinical study was done through interrogation and by medical exploration in order to evaluate Tinea pedis and onychomycosis. RESULTS: Onychomycosis were caused by Candida guilliermondii, Candida parapsilosis, Candida glabrata, Candida krusei, Candida spp., Kodamaea ohmeri, Prototheca wickerhamii and unidentified yeasts. The prevalence for general onychomycosis, by dermatophytes, mixed onychomycosis and by yeasts were: 24.1, 19.5, 2.3 and 14.6%, respectively. Patients with significant probability to be diagnosed as having onychomycosis by yeasts are those wearing open shoes (2.59%); technicians and professionals (10.49%) and alcohol drinkers (3.72%). CONCLUSION: The fact that Candida albicans is not present in this study as causal agent of onychomycosis, and emerging and non-common yeasts were indeed isolated, creates new challenges. It is remarked the clinical criterion that when onychomycosis is suspected in diabetics, the diagnosis for culturing dermatophytes and yeasts should be included.
Assuntos
Arthrodermataceae/isolamento & purificação , Candida/isolamento & purificação , Dermatomicoses/microbiologia , Diabetes Mellitus Tipo 2/complicações , Dermatoses do Pé/microbiologia , Onicomicose/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Arthrodermataceae/classificação , Candida/classificação , Candidíase/diagnóstico , Candidíase/epidemiologia , Candidíase/etiologia , Candidíase/microbiologia , Estudos Transversais , Dermatomicoses/diagnóstico , Dermatomicoses/epidemiologia , Dermatomicoses/etiologia , Diabetes Mellitus Tipo 2/microbiologia , Feminino , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/epidemiologia , Dermatoses do Pé/etiologia , Humanos , Masculino , México , Pessoa de Meia-Idade , Onicomicose/diagnóstico , Onicomicose/epidemiologia , Onicomicose/etiologia , PrevalênciaRESUMO
BACKGROUND: The changes in psoriatic nails can closely resemble an onychomycosis. Therefore, the fungal infection may be underdiagnosed. It was investigated the frequency of mycosis in fingernails and toenails in 150 patients with psoriasis in a dermatology department. METHODS: The clinical data suggestive of onychomycosis were investigated. Nail scales were obtained and cultured on Sabouraud dextrose agar with and without antibiotic. A direct examination with KOH was also performed. RESULTS: Out of 150 patients, 67 (45 %) had healthy nails; 42 (28 %) presented onychomycosis and 41 (27 %) showed nail changes without infection. Fingernail changes were more associated with psoriatic onychopathy (82.5 %), unlike toenail changes that were more frequently caused by fungal infection (26.4 % vs. 9.45 % in psoriasis). Out of 20 positive cultures, 22 fungi were isolated, of which 11 belonged to Candida spp. (50 %). As risk factor to develope an onychomycosis, only the psoriasis evolution time showed a significant difference (p = 0.033). CONCLUSIONS: In patients with psoriasis, fingernail disorders are mainly due to the own disease, while toenail disorders changes can be associated with onychomycosis. The main etiological agents were yeasts from the genus Candida. The only factor associated with a higher incidence of onychomycosis in these patients was a long lasting psoriasis.
Introducción: los cambios ungueales en los pacientes con psoriasis pueden ser muy parecidos a la onicomicosis y, por lo tanto, las infecciones fúngicas pueden ser subdiagnosticadas. Se investigó la frecuencia de onicomicosis en manos y pies de 150 pacientes con psoriasis de un servicio de dermatología. Métodos: se obtuvieron los datos clínicos de la psoriasis. Se cultivaron escamas de las uñas en agar dextrosa Sabouraud con y sin antibióticos y se hizo un examen directo con KOH. Resultados: de los 150 pacientes, 67 (45 %) presentaron uñas sanas; 42 (28 %) tuvieron onicomicosis, y 41 (27 %) onicopatía sin infección. Las alteraciones ungueales en las manos estuvieron más asociadas con onicopatía psoriásica (82.5 %); los cambios de las uñas de los pies se asociaron más frecuentemente a infección fúngica (26.4 frente a 9.45 % en psoriasis). De 20 cultivos positivos, se aislaron 22 agentes: 11 Candida spp. (50 %). Como factor de riesgo para desarrollar onicomicosis, el tiempo de evolución de la psoriasis mostró una diferencia significativa (p = 0.03). Conclusión: en los pacientes con psoriasis, las alteraciones ungueales de manos se deben principalmente a psoriasis, mientras que los cambios ungueales en los pies se asocian a onicomicosis. Esta fue causada principalmente por Candida sp. El único factor de riesgo asociado para onicomicosis fue la larga evolución de la psoriasis.
Assuntos
Dermatoses do Pé/etiologia , Dermatoses da Mão/etiologia , Onicomicose/etiologia , Psoríase/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Dermatoses do Pé/epidemiologia , Dermatoses da Mão/epidemiologia , Humanos , Incidência , Masculino , México , Pessoa de Meia-Idade , Onicomicose/epidemiologia , Estudos Prospectivos , Fatores de Risco , Centros de Atenção TerciáriaAssuntos
Candidíase Cutânea/microbiologia , Dermatoses do Pé/microbiologia , Dermatoses da Mão/microbiologia , Onicomicose/microbiologia , Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candida/isolamento & purificação , Candidíase Cutânea/epidemiologia , Chile/epidemiologia , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Farmacorresistência Fúngica , Feminino , Dermatoses do Pé/epidemiologia , Dermatoses da Mão/epidemiologia , Humanos , Masculino , Onicomicose/epidemiologia , Estudos Prospectivos , Trichosporon/efeitos dos fármacos , Trichosporon/isolamento & purificação , Tricosporonose/epidemiologia , Tricosporonose/microbiologiaRESUMO
BACKGROUND: Dermatophytes are the main causative agent of all onychomycosis, but genus Microsporum is infrequent and the risk of acquiring the infection is often associated with exposure to risk factors. OBJECTIVES: To describe clinical characteristics of onychomycosis due to Microsporum onychomycosis in an urban population. METHODS: This was a retrospective analysis of the epidemiological and clinical features of 18Microsporum onychomycosis cases of a total of 4220 of onychomycosis cases diagnosed between May 2008 and September 2011 at the tertiary referral center for mycology in Guatemala. RESULTS: Eighteen cases of Microsporum onychomycosis (M. canis, n=10; M. gypseum, n=7; M. nanum, n=1) were identified (prevalence=0.43%). Infection was limited to nails only and disease duration ranged from 1 month to 20 years (mean=6.55 years). The toenails were affected in all cases except for a single M. gypseum case of fingernail. The most common clinical presentation was distal lateral subungual onychomycosis (12/18) followed by total dystrophic onychomycosis (5/18), and superficial white onychomycosis (1/18). M. gypseumpresented in 6 cases as distal lateral subungual onychomycosis and in 1 case like total dystrophic onychomycosis. Five cases (27.78%) were associated with hypertension, diabetes, and psoriasis. Treatment with terbinafine or itraconazole was effective. Two cases of M. canisdistal lateral subungual onychomycosis responded to photodynamic therapy. CONCLUSION: This is the largest reported series of Microsporum onychomycosis and demonstrates such a disease in an urban population. In 27.78% of the cases risk factors for infection were associated to comorbid states. We also report the first 2 cases of successfully treated M. canis onychomycosis with photodynamic therapy and a rare case of M. canis associated dermatophytoma. .
Assuntos
Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Dermatoses do Pé , Microsporum , Onicomicose , Antifúngicos/uso terapêutico , Fluconazol/uso terapêutico , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/epidemiologia , Dermatoses do Pé/microbiologia , Guatemala/epidemiologia , Itraconazol/uso terapêutico , Naftalenos/uso terapêutico , Onicomicose/tratamento farmacológico , Onicomicose/epidemiologia , Onicomicose/microbiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , População UrbanaRESUMO
BACKGROUND: Tungiasis is endemic in poverty-stricken communities of South and Central America, Africa, Asia, and the Caribbean. This ectoparasitosis, caused by the female sand flea Tunga penetrans, is associated with considerable longterm morbidity in severely affected patients, including toe deformation and limited mobility. In Haiti, tungiasis is poorly documented but is known to occur. This study is the first formal investigation of tungiasis in Haiti. METHODS: A total of 383 patients in four regions (Belle Fontaine, Vallue, Savanette, Cerca Carvajal) were examined and interviewed to determine disease prevalence, demographics and clinical presentation, and tungiasis-related behaviors. RESULTS: Prevalences of tungiasis ranged from 10.6 to 81.8% across the four regions. The overall prevalence of tungiasis in the patients examined was 31.1%. Of the affected patients, 63% were male and 37% were female, 37% were aged 0-10 years, and 100% reported pain and pruritus. Lesions occurred on the feet in 93.3% and on the hands in 22.7% of affected patients. The most common complications observed were chronic inflammation (54.2%) and hyperkeratosis (48.2%). CONCLUSIONS: This study establishes tungiasis as endemic in four regions of Haiti and reveals disease characteristics similar to those reported previously, suggesting that there are common factors underlying this disease in various regions, which are likely to be poverty-related. These findings emphasize the need to acknowledge tungiasis as a clinically relevant public health issue in order to decrease the frequency of tungiasis-related morbidity in endemic areas.
Assuntos
Dermatoses do Pé/epidemiologia , Dermatoses da Mão/epidemiologia , Tungíase/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Feminino , Dermatoses do Pé/parasitologia , Haiti/epidemiologia , Dermatoses da Mão/parasitologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , Tungíase/complicações , Adulto JovemRESUMO
BACKGROUND: Onychomycosis is a common disorder, and high prevalence figures are commonly cited in the literature. OBJECTIVES: Evaluate the prevalence of onychomycosis based on published studies. METHODS: Relevant studies were identified in Medline by using specific search criteria. RESULTS: Eleven population-based and 21 hospital-based studies were identified. The mean prevalence in Europe and North America was 4.3% [95% Confidence Interval (CI): 1.9-6.8] in the population-based studies, but it was 8.9% (95% CI: 4.3-13.6) for the hospital-based studies. Both population-based and hospital-based studies showed that onychomycosis is more common in toenails and is seen more frequently in males. The main causative agent was a dermatophyte in 65.0% (95% CI: 51.9-78.1) of the cases. Trichophyton rubrum was the single most common fungus and was cultured on average in 44.9% of the cases (95% CI: 33.8-56.0). Moulds were found on average in 13.3% (95% CI: 4.6-22.1) and yeasts in 21.1% (95% CI: 11.0-31.3). LIMITATIONS: We may not have been able to locate all studies. CONCLUSIONS: Onychomycosis is a common disorder, but it may not be as common as cited in the literature, because hospital-based studies might overestimate the prevalence of onychomycosis. It is more frequent in males, and toenails are more commonly affected. Dermatophytes, particularly T. rubrum, are the main causative agents.
Assuntos
Dermatoses do Pé/epidemiologia , Saúde Global , Dermatoses da Mão/epidemiologia , Onicomicose/epidemiologia , Adolescente , Adulto , África/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Ásia/epidemiologia , Criança , Europa (Continente)/epidemiologia , Feminino , Dermatoses do Pé/microbiologia , Dermatoses da Mão/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , América do Norte/epidemiologia , Onicomicose/microbiologia , Prevalência , América do Sul/epidemiologia , Tinha/complicações , Trichophyton , Adulto JovemRESUMO
BACKGROUND: Dermatophytes are the main causative agent of all onychomycosis, but genus Microsporum is infrequent and the risk of acquiring the infection is often associated with exposure to risk factors. OBJECTIVES: To describe clinical characteristics of onychomycosis due to Microsporum onychomycosis in an urban population. METHODS: This was a retrospective analysis of the epidemiological and clinical features of 18 Microsporum onychomycosis cases of a total of 4220 of onychomycosis cases diagnosed between May 2008 and September 2011 at the tertiary referral center for mycology in Guatemala. RESULTS: Eighteen cases of Microsporum onychomycosis (M. canis, n=10; M. gypseum, n=7; M. nanum, n=1) were identified (prevalence=0.43%). Infection was limited to nails only and disease duration ranged from 1 month to 20 years (mean=6.55 years). The toenails were affected in all cases except for a single M. gypseum case of fingernail. The most common clinical presentation was distal lateral subungual onychomycosis (12/18) followed by total dystrophic onychomycosis (5/18), and superficial white onychomycosis (1/18). M. gypseum presented in 6 cases as distal lateral subungual onychomycosis and in 1 case like total dystrophic onychomycosis. Five cases (27.78%) were associated with hypertension, diabetes, and psoriasis. Treatment with terbinafine or itraconazole was effective. Two cases of M. canis distal lateral subungual onychomycosis responded to photodynamic therapy. CONCLUSION: This is the largest reported series of Microsporum onychomycosis and demonstrates such a disease in an urban population. In 27.78% of the cases risk factors for infection were associated to comorbid states. We also report the first 2 cases of successfully treated M. canis onychomycosis with photodynamic therapy and a rare case of M. canis associated dermatophytoma.
Assuntos
Dermatoses do Pé , Microsporum , Onicomicose , Adolescente , Adulto , Idoso , Antifúngicos/uso terapêutico , Criança , Feminino , Fluconazol/uso terapêutico , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/epidemiologia , Dermatoses do Pé/microbiologia , Guatemala/epidemiologia , Humanos , Itraconazol/uso terapêutico , Masculino , Pessoa de Meia-Idade , Naftalenos/uso terapêutico , Onicomicose/tratamento farmacológico , Onicomicose/epidemiologia , Onicomicose/microbiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Terbinafina , População Urbana , Adulto JovemRESUMO
BACKGROUND: Superficial fungal infections are caused by dermatophytes, yeasts or filamentous fungi. They are correlated to the etiologic agent, the level of integrity of the host immune response, the site of the lesion and also the injured tissue. OBJECTIVE: The purpose of this study is to isolate and to identify onychomycosis agents in institutionalized elderly (60 years old +). METHODS: The identification of the fungi relied upon the combined results of mycological examination, culture isolation and micro cultures observation under light microscopy from nail and interdigital scales, which were collected from 35 elderly with a clinical suspicion of onychomycosis and a control group (9 elderly with healthy interdigital space and nails). Both groups were institutionalized in two nursing homes in Sao Bernardo do Campo, SP, Brazil. RESULTS: The nail scrapings showed 51.40% positivity. Of these, dermatophytes were found in 44.40% isolates, 27.78% identified as Trichophyton rubrum and 5.56% each as Trichophyton tonsurans, Trichophyton mentagrophytes and Microsporum gypseum. The second more conspicuous group showed 38.89% yeasts: 16.67% Candida guilliermondii, 11.11% Candida parapsilosis, 5.56% Candida glabrata, and 5.56% Trichosporon asahii. A third group displayed 16.70% filamentous fungi, like Fusarium sp, Aspergillus sp and Neoscytalidium sp (5.56% each). The interdigital scrapings presented a positivity rate of 14.29%. The agents were coincident with the fungi that caused the onychomycosis. In the control group, Candida guilliermondii was found at interdigital space in one person. CONCLUSION: Employing a combination of those identification methods, we found no difference between the etiology of the institutionalized elderly onychomycosis from that reported in the literature for the general population.
Assuntos
Dermatoses do Pé/microbiologia , Institucionalização , Fungos Mitospóricos/isolamento & purificação , Onicomicose/microbiologia , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Dermatoses do Pé/epidemiologia , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Onicomicose/epidemiologia , Fatores SexuaisRESUMO
BACKGROUND: Superficial fungal infections are caused by dermatophytes, yeasts or filamentous fungi. They are correlated to the etiologic agent, the level of integrity of the host immune response, the site of the lesion and also the injured tissue. OBJECTIVE: The purpose of this study is to isolate and to identify onychomycosis agents in institutionalized elderly (60 years old +). METHODS: The identification of the fungi relied upon the combined results of mycological examination, culture isolation and micro cultures observation under light microscopy from nail and interdigital scales, which were collected from 35 elderly with a clinical suspicion of onychomycosis and a control group (9 elderly with healthy interdigital space and nails). Both groups were institutionalized in two nursing homes in Sao Bernardo do Campo, SP, Brazil. RESULTS: The nail scrapings showed 51.40% positivity. Of these, dermatophytes were found in 44.40% isolates, 27.78% identified as Trichophyton rubrum and 5.56% each as Trichophyton tonsurans, Trichophyton mentagrophytes and Microsporum gypseum. The second more conspicuous group showed 38.89% yeasts: 16.67% Candida guilliermondii, 11.11% Candida parapsilosis, 5.56% Candida glabrata, and 5.56% Trichosporon asahii. A third group displayed 16.70% filamentous fungi, like Fusarium sp, Aspergillus sp and Neoscytalidium sp (5.56% each). The interdigital scrapings presented a positivity rate of 14.29%. The agents were coincident with the fungi that caused the onychomycosis. In the control group, Candida guilliermondii was found at interdigital space in one person. CONCLUSION: Employing a combination of those identification methods, we found no difference between the etiology of the institutionalized elderly onychomycosis from that reported in the literature for the general population. .
FUNDAMENTOS: As infecções fúngicas superficiais se correlacionam com o agente etiológico, a resposta imune do hospedeiro, o local da lesão e o tecido lesado, sendo causadas por dermatófitos, leveduras ou fungos filamentosos. OBJETIVO: O objetivo é isolar e identificar os agentes das onicomicoses em idosos institucionalizados. MÉTODO: A identificação dos fungos baseou-se nos resultados combinados do exame micológico, isolamento em cultura e da observação de microculturas sob microscopia de luz, do material subungueal e escamas interdigitais, coletado de 35 idosos com suspeita clínica de onicomicose e de um grupo controle (9 idosos com espaço interdigital e unhas saudáveis). Ambos os grupos eram institucionalizados em duas casas de assistência em São Bernardo do Campo, SP, Brasil. RESULTADOS: As unhas raspadas apresentaram 51,40% de positividade. Os dermatófitos foram encontrados em 44,40% de isolados, sendo 27,78% identificados como Trichophyton rubrum e 5,56%, cada, como Trichophyton tonsurans, Trichophyton mentagrophytes e Microsporum gypseum. O segundo grupo mais frequente (38,89%) foi o de leveduras, identificadas como 16,67% Candida guilliermondii, 11,11% Candida parapsilosis, 5,56% Candida glabrata e 5,56% Trichosporon asahii. Um terceiro grupo exibia 16,70% fungos filamentosos, como Fusarium sp, Aspergillus sp e Neoscytalidium (5,56% de cada). Os raspados interdigitais exibiram positividade de 14,29%. Os agentes foram coincidentes com os fungos que causaram a onicomicose. No grupo controle, a Candida guilliermondii foi identificada no espaço interdigital em apenas uma pessoa. CONCLUSÃO: Empregando-se a combinação destes métodos de identificação, não houve diferença entre a etiologia da onicomicose ...
Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dermatoses do Pé/microbiologia , Institucionalização , Fungos Mitospóricos/isolamento & purificação , Onicomicose/microbiologia , Brasil/epidemiologia , Dermatoses do Pé/epidemiologia , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Onicomicose/epidemiologia , Fatores SexuaisRESUMO
BACKGROUND: Onychomycosis is a type of fungal infection that accounts for over 50% of all onycopathies. Some authors consider superficial mycosis the most difficult to be treated. Very few studies have been carried out in order to assess the epidemiology of onychomycosis in Brazil. OBJECTIVE: To describe the epidemiological profile of onychomycosis in Brazilian dermatology offices and to assess the etiology of the disease, how often mycosis exams are requested, and the treatment adopted. METHODS: A descriptive, observational study was carried out between May and July, 2010. Thirty-eight dermatologists from different Brazilian regions participated in the study, and 7,852 patients with any skin diseases who had all of their nails examined were included in the study. RESULTS: Of the 7,852 patients, 28.3% were clinically diagnosed as having onychomycosis. Women over 45 years old who practiced exercises or with a personal history of the disease showed greater likelihood of having onychomycosis. The disease was most seen in the feet, and the majority of cases involved the hallux. On the hands, the index finger was the most affected. Mycosis exams were not requested for all clinically suspected cases. When exams were done, results showed that the most common fungus was Trichophyton rubrum. The most common clinical lesion was distal-lateral. The most prescribed topical treatments were amorolfine and ciclopirox olamine, while systemic treatments included fluconazole and terbinafine. CONCLUSION: This study was important to describe the epidemiological behavior of onychomycosis in Brazilian dermatology offices and to determine important risk factors, such as gender, age, practice of exercises, personal history of the disease, and comorbidities.
Assuntos
Dermatologia/estatística & dados numéricos , Dermatoses do Pé/epidemiologia , Dermatoses da Mão/epidemiologia , Onicomicose/epidemiologia , Onicomicose/terapia , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Comorbidade , Exercício Físico/fisiologia , Feminino , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/microbiologia , Dermatoses do Pé/terapia , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/microbiologia , Dermatoses da Mão/terapia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Onicomicose/diagnóstico , Prevalência , Fatores de Risco , Adulto JovemRESUMO
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Dermatologia/estatística & dados numéricos , Dermatoses do Pé/epidemiologia , Dermatoses da Mão/epidemiologia , Onicomicose/epidemiologia , Onicomicose/terapia , Brasil/epidemiologia , Comorbidade , Exercício Físico/fisiologia , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/microbiologia , Dermatoses do Pé/terapia , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/microbiologia , Dermatoses da Mão/terapia , Onicomicose/diagnóstico , Prevalência , Fatores de RiscoRESUMO
Onychomycosis is known to have predisposing factors and a high prevalence within families that cannot be explained by within-family transmission. We determined the frequency of HLA-B and HLA-DR haplotypes in 25 families of Mexican patients with onychomycosis in order to define the role of the class II major histocompatibility complex (MHC) in genetic susceptibility to this infection. Seventy-eight subjects participated in the study, 47 with onychomycosis and 31 healthy individuals. The frequencies of the HLA-B and HLA-DR haplotypes were compared with those found in first-degree relatives without onychomycosis and in a historic control group of healthy individuals. The frequencies in the controls were similar to those of the healthy relatives of the patients. However, on comparison of the patients with historic controls, we detected a higher frequency of the HLA-DR8 haplotype (P=.03; odds ratio, 1.89; 95% confidence interval, 0.98-36). These findings suggest that there are polymorphisms in genes of the MHC that increase susceptibility to onychomycosis, particularly haplotype HLA-DR8.
Assuntos
Dermatoses do Pé/genética , Genes MHC da Classe II , Genes MHC Classe I , Antígenos HLA-B/genética , Antígenos HLA-DR/genética , Dermatoses da Mão/genética , Onicomicose/genética , Polimorfismo Genético , Tinha do Couro Cabeludo/genética , Alelos , Etnicidade/genética , Saúde da Família , Dermatoses do Pé/epidemiologia , Dermatoses do Pé/etnologia , Frequência do Gene , Predisposição Genética para Doença , Subtipos Sorológicos de HLA-DR/genética , Dermatoses da Mão/epidemiologia , Dermatoses da Mão/etnologia , Haplótipos , Humanos , México/epidemiologia , Onicomicose/epidemiologia , Onicomicose/etnologia , Tinha do Couro Cabeludo/epidemiologiaRESUMO
BACKGROUND: Onychomycosis accounts for up to 50% of all nail disorders. They can be caused by: yeasts, dermatophytes and non-dermatophyte moulds. OBJECTIVES AND METHODS: A multicentre study designed to determine the prevalence, mycological test results, aetiological agents, and clinical presentation of onychomycosis was carried out. All fingernail and toenail samples taken during a one year period at 9 diagnostic centres were included. RESULTS: A total of 5,961 samples were analysed, of which 82.3% were from toenails and 17.7% from fingernails. The mean age of the patients was 49.7 years, and 66% were females. Direct microscopic examination was positive in 61% of the samples. In adults, 61.2% of toenails were positive using potassium hydroxide (KOH), and 43.7% were positive in cultures. The prevailing aetiological agents belong to the dermatophyte group (82.8%), and distal subungual was the most common clinical form. In fingernails, direct examination showed 59.8% positive samples, and cultures were positive in 52.9%. The prevailing agents were yeasts belonging to Candida species, and onycholysis was the most common lesion. CONCLUSIONS: Direct mycological examinations were positive in 61%, a higher value than that found in other series. Dermatophytes were prevalent in toenails of both sexes, and in finger nails yeast were prevalent in females, and dermatophytes in males. Non-dermatophyte moulds corresponded to 4.8% of toenail and 2.05% of fingernails isolates.
Assuntos
Dermatoses do Pé/epidemiologia , Dermatoses da Mão/epidemiologia , Onicomicose/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Criança , Pré-Escolar , Feminino , Dermatoses do Pé/microbiologia , Dermatoses da Mão/microbiologia , Humanos , Hidróxidos , Lactente , Masculino , Pessoa de Meia-Idade , Micologia/métodos , Onicomicose/microbiologia , Especificidade de Órgãos , Compostos de Potássio , Prevalência , Estudos Prospectivos , Distribuição por Sexo , Adulto JovemRESUMO
BACKGROUND: Scytalidium sp. is a filamentous (thread-like), saprobic fungus which affects soil and plants. It is currently considered a primary pathogen of the nail. The prevalence of nail infections caused by this fungus has been increasing in recent decades, although few published studies have been done on its epidemiology. OBJECTIVE: To study clinico-epidemiological data referring to patients with onychomycosis caused by Scytalidium spp. at a University Hospital in Rio de Janeiro. METHODS: We evaluated the clinical and epidemiological data of 30 patients with onychomycosis by Scytalidium sp. through an observational study of 1295 patients who underwent mycological nail tests over a period of 16 months. RESULTS: The majority of the patients were female (66.6%), with an average age of 56.7 years. 63.3% of them were nonwhite. 53.3% of the patients had attended elementary school and 36.6% referred a family income of 3 to 5 minimum wages. In 90% of cases, the toenails were affected, primarily with onycholysis (18 patients), and in 66% of the cases melanonychia was observed. In 43.3% of cases the disease had progressed for more than 5 years. 19 patients (63.3%) had undergone some medical treatment for their current condition. CONCLUSIONS: Our data show that nail infection by Scytalidium sp. is chronic, affecting adults, particularly females (2:1). Clinically the disease resembles dermatophytosis. Prevalence of the disease in our sample was 4.86%, accounting for 26.92% of the positive tests.
Assuntos
Ascomicetos/isolamento & purificação , Dermatoses do Pé/microbiologia , Dermatoses da Mão/microbiologia , Hospitais Universitários/estatística & dados numéricos , Onicomicose/microbiologia , Adulto , Brasil/epidemiologia , Feminino , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/epidemiologia , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Onicomicose/diagnóstico , Onicomicose/epidemiologia , Prevalência , Fatores SocioeconômicosRESUMO
FUNDAMENTOS: O Scytalidium spp. é fungo filamentoso, saprobio do solo e plantas, considerado, atualmente, patógeno primário das unhas. A prevalência das infecções ungueais causadas por este fungo vem aumentando nas últimas décadas, embora ainda sejam poucos os trabalhos publicados sobre sua epidemiologia. OBJETIVO: Estudo clínico-epidemiológico dos pacientes portadores de onicomicose por Scytalidium spp. em um hospital universitário do Rio de Janeiro. MÉTODOS: Foram avaliados os dados clínico-epidemiológicos de 30 pacientes com onicomicose por Scytalidium spp. por meio do estudo observacional de 1.295 pacientes que se submeteram a exame micológico ungueal no período de 16 meses. RESULTADOS: A maioria dos pacientes era do sexo feminino (66,6 por cento), a média de idade foi de 56,7 anos e 63,3 por cento eram não-brancos. O nível de escolaridade em 53,3 por cento dos pacientes era o ensino fundamental e a renda familiar predominante foi de 3 a 5 salários mínimos em 36,6 por cento dos entrevistados. Em 90 por cento dos casos, as unhas dos pododáctilos foram acometidas, sendo a alteração clínica mais comum a onicólise (18 pacientes) e em 66,6 por cento dos casos observou-se melanoníquia. O tempo de evolução da doença foi maior do que cinco anos em 43,3 por cento dos casos. Dezenove pacientes (63,3 por cento) já haviam realizado tratamento medicamentoso para o quadro atual. CONCLUSÕES: Os dados mostram que a infecção ungueal pelo Scytalidium spp. é crônica, mais comum no sexo feminino (2:1) e atinge indivíduos adultos. Clinicamente, é semelhante às dermatofitoses. A prevalência na amostra estudada foi de 4,86 por cento e correspondeu a 26,92 por cento dos exames positivos.
BACKGROUND: Scytalidium sp. is a filamentous (thread-like), saprobic fungus which affects soil and plants. It is currently considered a primary pathogen of the nail. The prevalence of nail infections caused by this fungus has been increasing in recent decades, although few published studies have been done on its epidemiology. OBJECTIVE: To study clinico-epidemiological data referring to patients with onychomycosis caused by Scytalidium spp. at a University Hospital in Rio de Janeiro. METHODS: We evaluated the clinical and epidemiological data of 30 patients with onychomycosis by Scytalidium sp. through an observational study of 1295 patients who underwent mycological nail tests over a period of 16 months. RESULTS: The majority of the patients were female (66.6 percent), with an average age of 56.7 years. 63.3 percent of them were nonwhite. 53.3 percent of the patients had attended elementary school and 36.6 percent referred a family income of 3 to 5 minimum wages. In 90 percent of cases, the toenails were affected, primarily with onycholysis (18 patients), and in 66 percent of the cases melanonychia was observed. In 43.3 percent of cases the disease had progressed for more than 5 years. 19 patients (63.3 percent) had undergone some medical treatment for their current condition. CONCLUSIONS: Our data show that nail infection by Scytalidium sp. is chronic, affecting adults, particularly females (2:1). Clinically the disease resembles dermatophytosis. Prevalence of the disease in our sample was 4.86 percent, accounting for 26.92 percent of the positive tests.