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Brazilian Journal of Microbiology :... Mar 2023Keratinophilic fungi are mostly soil-inhabiting organisms with occasional infections in humans and animals. Even though most dermatophytes are host-adapted,... (Review)
Review
Keratinophilic fungi are mostly soil-inhabiting organisms with occasional infections in humans and animals. Even though most dermatophytes are host-adapted, cross-species infections are common by zoophilic and geophilic dermatophytes. N. nana is considered an etiological agent of ringworm in pigs but has also been isolated from other animals, including humans. However, it also possesses many characteristics of geophilic dermatophytes including the ability to grow in soil. N. nana produces characteristic pear-shaped macroconidia and usually exhibits an ectothrix pattern of hair infection. It has been isolated from dermatitis lesions as well as from soil. N. nana infections in pigs are not of much concern as far as economy or health is concerned. But it has been associated with onychomycosis and gonathritis in humans, which are significant in human medicine. The shift in the predominance of dermatophytes in humans and the ability to evolve into a potential tinea pathogen necessitates more understanding of the physiology and genetics of N. nana. In this review, we have attempted a detailed analysis of the studies about N. nana, emphasizing growth and cultural characters, physiology, isolation, infection in humans and animals, molecular characterization and antifungal susceptibility.
Topics: Humans; Animals; Swine; Arthrodermataceae; Dermatomycoses; Onychomycosis; Antifungal Agents; Cross Infection
PubMed: 36437438
DOI: 10.1007/s42770-022-00880-5 -
Frontiers in Cellular and Infection... 2021Onychomycosis is one of the most common and recurrent dermatological diseases worldwide. The antimycotic activity of prescribed medications varies according to the...
BACKGROUND
Onychomycosis is one of the most common and recurrent dermatological diseases worldwide. The antimycotic activity of prescribed medications varies according to the causative agents, and treatment failure rates exceeding 30%. This study aimed to assess the epidemiological profile of onychomycosis in Iran. Also, the susceptibilities to conventional and new antifungals were investigated.
METHODS
In this descriptive cross-sectional study, during the period of 18 months starting from September 2019 until March 2020, 594 nail specimens were obtained from patients who presented nail changes compatible with a clinical diagnosis of onychomycosis. The patients were referred from different cities, including Tehran, Kermanshah, Arak, Kashan, Rasht, Qom, Urmia, Zahedan, Hamadan, Zanjan, Borujerd, Bushehr, and Yazd. All the samples were subjected to microscopic examination and fungal culture. Fungi identified were confirmed through the PCR-sequencing method. The susceptibility to itraconazole, fluconazole, terbinafine, griseofulvin, posaconazole, ravuconazole, efinaconazole, luliconazole, and tavaborole was evaluated according to the Clinical and Laboratory Standards Institute (CLSI) guidelines, document M38-A2 for filamentous fungi, and document M27-A3 for yeasts.
RESULTS
594 patients were included. Of these, in 179 cases (30.1%) (95% CI:0.3 ± 0.037) onychomycosis was confirmed. The majority of patients were ≥ 60 years of age (n=58, 32.6%) and female (n=113, 63.1%). Saprophytic fungi accounted for the vast majority of the nail isolates (n=92, 51.4%) (95% CI:0.051 ± 0.0.073), followed by dermatophytes (n=45, 25.1%) (95% CI:0.25 ± 0.063), and yeasts (n=42, 23.5%) (95% CI:0.23 ± 0.061). Diabetes mellitus (77.3%), hypothyroidism (18.2%), and solid tumors (4.5%) were documented as the most prevalent underlying conditions. Antifungal susceptibility testing was performed against 60 fungal isolates (20 each of species, saprophytic fungi, and dermatophytes). Efinaconazole, ravuconazole, and luliconazole were the most active agents against species. Also, luliconazole, posaconazole, and efinaconazole were most potent against dermatophytes. Luliconazole had the greatest antifungal activity against saprophytic fungi.
CONCLUSIONS
The prevalence of onychomycosis in Iranian patients was relatively high. LUL exhibited potent antifungal activity against the three groups of fungi tested, determining its broad-spectrum antimycotic activity and its probable use as the first-line therapy for onychomycosis.
Topics: Antifungal Agents; Cross-Sectional Studies; Female; Fungi; Humans; Iran; Microbial Sensitivity Tests; Onychomycosis
PubMed: 34336717
DOI: 10.3389/fcimb.2021.693522 -
Indian Journal of Dermatology 2021Dermatoscopy has been used recently for identifying the specific features of onychomycosis. Very few studies have used it as a diagnostic tool. Our study highlights the...
Dermatoscopic Features of Onychomycosis and its Correlation with Nail Plate Potassium Hydroxide Mount (KOH), Culture, and Periodic Acid Schiff Stain (PAS) in North East India.
CONTEXT
Dermatoscopy has been used recently for identifying the specific features of onychomycosis. Very few studies have used it as a diagnostic tool. Our study highlights the specific patterns in different clinical types of onychomycosis and the novel features that have never been reported previously.
AIMS
To study the dermatoscopic patterns in patients with onychomycosis and determine the sensitivity, specificity, positive, and negative predictive values of the different features.
STUDY DESIGN
A cross-sectional study.
MATERIALS AND METHOD
Dermatoscopic picture using dinolite video dermatoscope was taken in patients diagnosed with onychomycosis either with a positive KOH, culture, and/or PAS.
RESULT
A total of 80 patients were included. Onychomycosis was identified in 68 individuals. Clinically, 73.52% presented with distal lateral subungual onychomycosis (DLSO) and 26.47% had total dystrophic (TD). PAS was positive in 85.29% of patients, KOH in 75%, and culture in 66.17%. species were isolated in 53.33%, whereas species in 40% of patients. Dermatoscopic features were seen in all 68 patients (100%). The most common finding in decreasing order includes spike pattern, ruin appearance, distal irregular terminations (DIT), longitudinal striations, chromonychia, focal homogeneous opacities, microsplitting, and uniform homogeneous pattern. Three novel patterns were observed: homogeneous opacity with a-z pattern border, microsplitting in a Christmas tree pattern, and focal homogeneous opacities.
CONCLUSION
To our knowledge, this is the first study conducted in northeast India where dermatoscopy was used as a diagnostic tool and it was found to have the highest sensitivity. New features that have not been described before have been identified.
PubMed: 35283518
DOI: 10.4103/ijd.ijd_261_21 -
Cureus Dec 2023Hepatic injuries attributable to terbinafine usage are a well-documented yet infrequent phenomenon. This case study details the clinical presentation and management of a...
Hepatic injuries attributable to terbinafine usage are a well-documented yet infrequent phenomenon. This case study details the clinical presentation and management of a 70-year-old Hispanic female, with no previous medical history, subsequently hospitalized for progressive jaundice, right upper quadrant abdominal discomfort, and worsening pruritus. A comprehensive review of her prior records revealed a recent terbinafine prescription for onychomycosis, which she took consistently for five weeks and then self-discontinued four weeks before her current admission. Laboratory tests on admission revealed a cholestatic pattern of liver injury, evident by transaminitis and conjugated hyperbilirubinemia. The R factor used to determine whether a liver injury is hepatocellular or cholestatic was 0.9. Further diagnostic imaging, including abdominal ultrasound, CT of the abdomen, and magnetic resonance cholangiopancreatography, failed to disclose an obstructive pathology, revealing only cholelithiasis and chronic cholecystitis. Therapeutically, the patient was initiated on hydroxyzine to address symptoms of pruritus, and then subsequently underwent a liver biopsy. Histopathologic findings from the biopsy revealed benign hepatic parenchyma demonstrating focal canalicular cholestasis, mild chronic inflammation involving select portal tracts, and chronic lobular inflammation, suggesting terbinafine-induced hepatotoxicity. This case highlights the challenges of diagnosing terbinafine-induced liver injury, emphasizing the need for a high index of clinical suspicion and recognizing the potential for prolonged symptomatic manifestation after drug discontinuation. This article provides valuable insights into the complexities inherent in such diagnoses and significantly enriches a medical provider's approach to diagnosing and treating unexplained liver injuries.
PubMed: 38239534
DOI: 10.7759/cureus.50749 -
Skin Health and Disease Mar 2022Treatment of onychomycosis is challenging, and there is much literature on optimal treatment strategies. In contrast, information on how onychomycosis is actually...
BACKGROUND
Treatment of onychomycosis is challenging, and there is much literature on optimal treatment strategies. In contrast, information on how onychomycosis is actually treated in primary care is scarce. Information on practice is important as it can reveal much, such as, to what extent national guidelines are followed and which population groups seek/receive treatment or do not do so.
OBJECTIVES
To describe the pattern of onychomycosis treatment in primary care in the UK, by patient's gender and age.
METHODS
A population-based retrospective cross-sectional study was conducted. The Health Improvement Network (THIN) database was used to calculate incidence rates of onychomycosis in the years 2001-2017. The prescription of oral and topical anti-fungal drugs to patients with onychomycosis was reviewed.
RESULTS
THIN data showed an onychomycosis incidence rate of about 50 per 100,000. More males than females (52% vs. 48%), and more people aged 50-59 years had received treatment for onychomycosis. Oral terbinafine was the most commonly prescribed drug, followed by topical amorolfine, although terbinafine was used more commonly by men and amorolfine by women. Patients with onychomycosis were also prescribed other antifungals, including itraconazole, griseofulvin, tioconazole, ketoconazole shampoo, fluconazole and clotrimazole. A greater proportion of women, compared to men, were prescribed fluconazole.
CONCLUSIONS
Onychomycosis treatment in primary care in the UK is broadly in concordance with national guidelines.
PubMed: 35665209
DOI: 10.1002/ski2.84 -
Journal of Fungi (Basel, Switzerland) Jun 2023Cutaneous fungal infection of the skin and nails poses a significant global public health challenge. Dermatophyte infection, mainly caused by spp., is the primary... (Review)
Review
Cutaneous Fungal Infections Caused by Dermatophytes and Non-Dermatophytes: An Updated Comprehensive Review of Epidemiology, Clinical Presentations, and Diagnostic Testing.
Cutaneous fungal infection of the skin and nails poses a significant global public health challenge. Dermatophyte infection, mainly caused by spp., is the primary pathogenic agent responsible for skin, hair, and nail infections worldwide. The epidemiology of these infections varies depending on the geographic location and specific population. However, epidemiological pattern changes have occurred over the past decade. The widespread availability of antimicrobials has led to an increased risk of promoting resistant strains through inappropriate treatment. The escalating prevalence of resistant spp. infections in the past decade has raised serious healthcare concerns on a global scale. Non-dermatophyte infections, on the other hand, present even greater challenges in terms of treatment due to the high failure rate of antifungal therapy. These organisms primarily target the nails, feet, and hands. The diagnosis of cutaneous fungal infections relies on clinical presentation, laboratory investigations, and other ancillary tools available in an outpatient care setting. This review aims to present an updated and comprehensive analysis of the epidemiology, clinical manifestations, and diagnostic testing methods for cutaneous fungal infections caused by dermatophytes and non-dermatophytes. An accurate diagnosis is crucial for effective management and minimizing the risk of antifungal resistance.
PubMed: 37367605
DOI: 10.3390/jof9060669 -
Cureus Feb 2024Nail abnormalities, or onychodystrophy, can be caused by various pathologies, including fungal and nonfungal infections. These can result in difficulties with nail...
Nail abnormalities, or onychodystrophy, can be caused by various pathologies, including fungal and nonfungal infections. These can result in difficulties with nail trimming, pain, and social discomfort that can significantly impact a patient's quality of life. Even experienced physicians may find it challenging to diagnose due to the lack of specificity in these changes. We present the case of a 60-year-old female who was initially diagnosed with onychodystrophy but was later found to have subungual verruca vulgaris after a nail avulsion and biopsy. This case highlights the importance of thorough diagnostic procedures and considering a broad range of differential diagnoses. We also discuss the challenges of treating subungual warts and the need for a precise therapeutic approach to ensure the best possible outcomes.
PubMed: 38550418
DOI: 10.7759/cureus.55085 -
Nutrients Jun 2021Human skin acts as a physical barrier; however, sometimes the skin gets infected by fungi, which becomes more severe if the infection occurs on the third layer of the... (Review)
Review
Human skin acts as a physical barrier; however, sometimes the skin gets infected by fungi, which becomes more severe if the infection occurs on the third layer of the skin. Azole derivative-based antifungal creams, liquids, or sprays are available to treat fungal infections; however, these formulations show various side effects on the application site. Over the past few years, herbal extracts and various essential oils have shown effective antifungal activity. Additionally, autoxidation and epimerization are significant problems with the direct use of herbal extracts. Hence, to overcome these obstacles, polysaccharide-based nanohydrogels embedded with natural plant extracts and oils have become the primary choice of pharmaceutical scientists. These gels protect plant-based bioactive compounds and are effective delivery agents because they release multiple bioactive compounds in the targeted area. Nanohydrogels can be applied to infected areas, and due to their contagious nature and penetration power, they get directly absorbed through the skin, quickly reaching the skin's third layer and effectively reducing the fungal infection. In this review, we explain various skin fungal infections, possible treatments, and the effective utilization of plant extract and oil-embedded polysaccharide-based nanohydrogels.
Topics: Antifungal Agents; Azoles; Fungi; Gels; Humans; Microbial Sensitivity Tests; Nanostructures; Oils, Volatile; Onychomycosis; Plant Extracts; Plant Oils; Polysaccharides
PubMed: 34203999
DOI: 10.3390/nu13062055 -
Journal of Fungi (Basel, Switzerland) Mar 2021To evaluate the combination effects of anti-onychomycosis drugs, the minimum inhibitory concentrations of topical (efinaconazole, luliconazole, and tavaborole) and oral...
To evaluate the combination effects of anti-onychomycosis drugs, the minimum inhibitory concentrations of topical (efinaconazole, luliconazole, and tavaborole) and oral (itraconazole and terbinafine) drugs for and (8 each, with a total of 16 strains) were determined using the microdilution checkerboard technique based on the Clinical and Laboratory Standard Institute guidelines. No antagonism was observed between the topical and oral drugs against all the tested strains. Efinaconazole with terbinafine exerted a synergistic effect on 43.8% of the strains tested (7/16 strains) and efinaconazole with itraconazole on 12.5% (2/16 strains). Conversely, luliconazole showed no synergistic effect with terbinafine but was synergistically effective with itraconazole against 31.3% of the strains (5/16 strains). Tavaborole showed no synergistic effect with terbinafine and was synergistically effective with itraconazole against 18.8% of the strains (3/16 strains). The results suggest that a combination of topical and oral drugs could be a potential clinical option for onychomycosis treatment, and overall, the efinaconazole and oral drug combination would be the most advantageous among the tested combinations.
PubMed: 33809181
DOI: 10.3390/jof7030208 -
PloS One 2021In order to develop a fast combined method for onychomycosis treatment using an in vitro and an ex vivo models, a combination of two dual-diode lasers at 405 nm and 639...
In order to develop a fast combined method for onychomycosis treatment using an in vitro and an ex vivo models, a combination of two dual-diode lasers at 405 nm and 639 nm wavelengths, in a continuous manner, together with different ozone concentrations (until 80 ppm), was used for performing the experiments on fungal strains growing on PDA agar medium or on pig's hooves samples. In the in vitro model experiments, with 30 min combined treatment, all species are inhibited at 40 ppm ozone concentration, except S. brevicaulis, which didn't show an inhibition in comparison with only ozone treatment. In the ex vivo model experiments, with the same duration and ozone concentration, A. chrysogenum and E. floccosum showed total inhibition; T. mentagrophytes and T. rubrum showed a 75% growth inhibition; M. canis showed a delay in sporulation; and S. brevicaulis and A. terreus did not show growth inhibition. This combined laser and ozone treatment may be developed as a fast therapy for human onychomycosis, as a potential alternative to the use of antifungal drugs with potential side effects and long duration treatments.
Topics: Animals; Fungi; Humans; Lasers; Microbial Viability; Models, Biological; Onychomycosis; Ozone; Swine
PubMed: 34191858
DOI: 10.1371/journal.pone.0253979