Subject(s)
Candidiasis/microbiology , Job Syndrome/complications , Onychomycosis/microbiology , Antifungal Agents/therapeutic use , Candidiasis/diagnosis , Candidiasis/drug therapy , Candidiasis/immunology , Child , Female , Genetic Predisposition to Disease , Humans , Immunocompromised Host , Job Syndrome/diagnosis , Job Syndrome/genetics , Job Syndrome/immunology , Mutation , Onychomycosis/diagnosis , Onychomycosis/drug therapy , Onychomycosis/immunology , Phenotype , STAT3 Transcription Factor/genetics , Treatment OutcomeABSTRACT
Onychomycosis in children has a low incidence worldwide; certain conditions such as immunosuppression have been described as risk factors for it. We studied 72 children receiving chemotherapy for different neoplasms to determine the frequency of onychomycosis. Only one patient had white superficial onychomycosis from Trichophyton rubrum, a frequency of 1.3%, not different from that reported in healthy patients.
Subject(s)
Antineoplastic Agents/adverse effects , Immunocompromised Host , Neoplasms/drug therapy , Onychomycosis/immunology , Adolescent , Child , Child, Preschool , Female , Humans , Infant , MaleABSTRACT
BACKGROUND: Onychomycosis is frequent in patients with late and advanced HIV disease; immunocompromised patients may develop atypical clinical presentations that can be difficult to control. Current treatment for onychomycosis is based on the prolonged administration of antifungal therapies that may have significant interactions with combined antiretroviral therapy (cART). An improvement in certain HIV-associated opportunistic infections has been associated with initiation of cART. OBJECTIVES: The aim of this study was to analyze the influence of cART on the outcome of onychomycosis in HIV-infected patients. METHODS: HIV-infected patients with dermatologic lesions attending the National Institute of Respiratory Diseases were asked to undergo physical examination. Detailed clinical histories were recorded. Routine laboratory tests, CD4 T cell count, and HIV viral load were performed. Onychomycosis was diagnosed on the basis of clinical appearance. Nail scrapings were collected from toenails and fingernails. Specimens were analyzed using direct microscopy. Nail changes after cART initiation were assessed by clinical examination. RESULTS: Improvement in onychomycosis was observed in six patients with late and advanced HIV disease after initiation of cART. Complete resolution of onychomycosis was observed in one patient without the use of antifungal therapy; one patient required topical antifungal treatment, and two patients required systemic antifungal treatment to achieve complete resolution. CONCLUSIONS: Onychomycosis should be included in the group of pathologies that improve with cART-induced immune reconstitution. The pathogenesis of onychomycosis in HIV disease warrants investigation in the context of cell-mediated immunity restoration.
Subject(s)
Anti-Retroviral Agents/therapeutic use , Antifungal Agents/therapeutic use , Antiretroviral Therapy, Highly Active/methods , HIV Infections/drug therapy , Onychomycosis/drug therapy , Adult , CD4-Positive T-Lymphocytes/immunology , Drug Therapy, Combination , Foot Dermatoses/complications , Foot Dermatoses/drug therapy , Foot Dermatoses/immunology , HIV Infections/complications , HIV Infections/immunology , Hand Dermatoses/complications , Hand Dermatoses/drug therapy , Hand Dermatoses/immunology , Humans , Immunity, Cellular/immunology , Male , Middle Aged , Onychomycosis/complications , Onychomycosis/immunology , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: As far as we have sought for in Medline and PubMed, not one study until now has evaluated the prevalence of onychomycosis in patients with inflammatory bowel disease (IBD). As there are great evidence of immunological disturbances linked to IBD, a possible relationship of this nail infection in association with those diseases and the possible risk factors might be relevant in IBD patients. METHODS: A case-control prospective study using combined direct smear and cultures for fungus was performed. Sociodemographics, clinical and laboratorial data were recorded at baseline and samples of suspected nails were collected from 141 IBD (61 men and 80 women) and from a group of 100 non-IBD subjects (41 men and 59 women). Direct smear and cultures were performed on each suspected case to exclude other onychodystrophies. RESULTS: The incidence of onychomycosis in IBD patients was highly significant in comparison to non-IBD patients (14.9% vs. 6%, respectively, P < 0.05). The risk factors predisposing IBD patients to onychomycosis were older age (P = 0.02) and leucopoenia in those using azathioprine therapy (P = 0.04) beyond a trend to lymphopenia (P = 0.06). The dermatophytes predominated (76.2%) over yeasts (19%) and moulds (4.8%). CONCLUSION: The prevalence of onychomycosis in IBD patients was expressively high (14.9%) in comparison with non-IBD patients. Considering the sociodemographic factors, any one but two were related to fungal onychomycosis incidence. Therefore, as far as we are concerned, IBD must be included in the high-risk underlying conditions for onychomycosis occurrence.
Subject(s)
Foot Dermatoses/epidemiology , Hand Dermatoses/epidemiology , Inflammatory Bowel Diseases/epidemiology , Onychomycosis/epidemiology , Adult , Case-Control Studies , Female , Humans , Immunosuppressive Agents/therapeutic use , Incidence , Inflammatory Bowel Diseases/drug therapy , Inflammatory Bowel Diseases/immunology , Male , Middle Aged , Onychomycosis/immunology , Prevalence , Prospective Studies , Risk FactorsABSTRACT
Verificou-se a incidência de fungos em unhas aparentemente säs em dois grupos de pacientes. O primeiro grupo contava com 15 pacientes que apresentaram unha aparentemente sä e dermatofitose interdigital de uma ou mais pregas dos pododáctilos e/ou dermatofitose em um ou ambos calcanhares e o segundo grupo com 15 pacientes sem dermatofitose dos pés e com unhas aparentemente säs. No primeiro grupo encontrou-se um paciente que apresentava, em unha aparentemente sä, T. mentagrophytes var. Zoofílica, e na prega acometida E. floccosum. Realizaram-se testes de imunidade celular nos pacientes dos dois grupos para observar a correlaçäo do dermatófito como colonizador da unha aparentemente sä e a imunidade celular do indivíduo. Como nenhum paciente apresentava déficit da imunidade celular, tal correlaçäo näo foi possível