High prevalence of mixed infections in global onychomycosis.

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.

Global perspectives for the management of onychomycosis.

Onychomycosis is a fungal nail infection caused by dermatophytes, nondermatophyte molds, and yeasts. This difficult-to-treat chronic infection has a tendency to relapse despite treatment. This paper aims to offer a global perspective on onychomycosis management from expert physicians from around the world. Overall, the majority of experts surveyed used systemic, topical, and combination treatments approved in their countries and monitored patients based on the product insert or government recommendations. Although the basics of treating onychomycosis were similar between countries, slight differences in onychomycosis management between countries were found. These differences were mainly due to different approaches to adjunctive therapy, rating the severity of disease and use of prophylaxis treatment. A global perspective on the treatment of onychomycosis provides a framework of success for the committed clinician with appreciation of how onychomycosis is managed worldwide.

Correlação clinicopatológica em 40 casos novos de lobomicose / Clinic-pathological correlation in 40 cases of lobomycosis

A lobomicose é micose cutâneo-subcutânea causada pela Lacazia Loboi, fungo não cultivável invitro e de terapêutica insatisfatória, que merece observações clínicas e histopatológicas. O objetivo era correlacionar aspectos clínicos e histopatológicos em 40 casos de lobomicose. Lesões de 40 acreanos com lobomicose foram fotografadas e estudadas histologicamente. Clinicamente, a maioridos pacientes (34/40) apresentava lesões monomórficas queloidiformes, predominantemente nos pavilhões auriculares (18/40). Pontilhados enegrecidos das lesões correlacionavam-se à eliminação transepidérmicas de fungos. Nervos eram íntegros no interior dos granulomas dérmicos. Classificaram-se células histiocitárias de cinco tipos: a. histiócitos isolados contendo fungos; b. histiócitos agrupados em sincício; c. células gigante de corpo estranho; d. células gigantes de langerhans; e. células epitelióides rendilhadas. No interior das células gigantes de corpo estranho e nas formações sinciais, os fungos eram numerosos; ao contrário, nas células gigantes de Langerhans e nas células epitelióides rendilhadas, eram escassos. Conclusões, na lobomicose o fungo multiplica-se muito lentamente, paralelo a deficiência imunológica do hospedeiro humano, traduzida por grandes acúmulhos de fungos, imaturidade das células gigantes, pequeno número de linfócitos, raros granulomas tuberculóides típicos e ineficiência na eliminação fos fungos mortos

Constitutive melanin in the cell wall of the etiologic agent of Lobo's disease

Doenca de Jorge Lobo e uma doenca cronica granulomatosa causada por um fungo obrigatorio, em cuja parede celular demonstra-se a presenca de melanina constitutiva. Ao contrario, no P. brasiliensis, e em descricoes de outros ascomicetos filogeneticamente relacionados da familia Onygenaceae, a melanina nao e detectavel pela tecnica de coloracao histoquimica de Fontana-Masson