The prevalence of dermatophytoses in Brazil: a systematic review.

Dermatophytosis is a common cutaneous mycosis worldwide whose prevalence in Brazil is still unknown. This systematic review has estimated the burden of dermatophytoses from updated literature data reported in the general Brazilian population. We used the following databases: Web of Science, Medline/PubMed, Embase, The Cochrane Library and Scopus for studies published between 2011 and 2020. Original articles with an emphasis on prevalence data for dermatophytosis in the Brazilian population, and diagnosed by culture exam or molecular biology were eligible. We also assessed the methodological quality of the studies. A total of 24 articles met the inclusion criteria and were reviewed. The occurrence of dermatophytoses found in the studies ranged from 4-88.50 %. The pooled prevalence of dermatophytosis for the population studies was 25 % (95 % CI: 24.7-25.3 %). The size of the samples used in the studies ranged from 45 to 36 446 participants, and ages ranged up to 98 years old. The populations studied involved mostly women. The presence of tinea unguium (toenail and fingernail) and tinea pedis were the most frequent dermatophytosis, and we observed a predominance of Trichophyton rubrum, T. interdigitale and T. mentagrophytes. The studies were primarily conducted in patient groups with suspected mycoses and were not entirely representative of the general population. Yet we believe that in the future, more collaborative strategies would improve both diagnostic capacity and epidemiological methodologies, associating the prevalence of dermatophytosis with social and environmental risk factors. This review helps to better understand future epidemiological trends in Brazil and the world.

Neoscytalidium dimidiatum un raro agente de onicomicosis no dermatofítica en Chile / Neoscytalidium dimidiatuma rare agent ofnon dermatophyticonychomycosisin Chile

El término de onicomicosis se emplea para describir las infecciones de las uñas causadas por diferentes grupos taxonómicos fúngicos ya sea filamentosos como levaduriformes. A pesar de que estas patologías son causadas en los vertebrados principalmente por integrantes de la Familia Artrodermatáceae (Onygenales), la micología médica aplicó para ellos la terminología más específica de dermatofitosis, por ser un grupo ecológico de mayor importancia y presencia clínica. Las dermatomicosis de piel y fanéreos, representan un conjunto de infecciones producidas por especies fúngicas distribuidas en ambientes diversos, capaces de crecer a temperaturas de 37° y que actúan usualmente como patógenos oportunistas cuando existe generalmente un factor predisponente en el huésped. Se destaca la colonización en una uña de los pies en un hombre de 49 años por Neoscytalidium dimidiatum(Penz.) Crous & Slippers, un reconocido fitopatógeno de rápido crecimiento, común en zonas tropicales y subtropicales, que presentó la capacidad de invadir tejidos queratinizados con un aspecto clínico indistinguible de los causadas por dermatofitos. Por la rara presencia de este hongo en nuestra zona geográfica (provincia de Valparaíso, Chile), se aportan los principales datos morfofisiológicos,taxonómicos y moleculares utilizados en su diagnóstico. (AU)

The term onychomycosis is used to describe nail infections caused by different fungal taxonomic groups, either filamentous or yeast. Despite the fact that these pathologies are caused in vertebrates mainly by members of the Artrodermatáceae Family (Onygenales), medical mycology applied the more specific terminology of dermatophytosis for them, as it is an ecological group of greater importance and clinical presence. Skin and pharynx dermatomycosis represent a set of infections produced by fungal species distributed in diverse environments, capable of growing at temperatures of 37° and that usually act as opportunistic pathogens when there is a predisposing factor in the host. The colonization on a toenail in a 49-year-old man by Nesoscytalidium dimidiatumis highlighted (Penz.) Crous & Slippers, a recognized fast-growing phytopathogen, common in tropical and subtropical areas, which presented the ability to invade keratinized tissues with a clinical appearance indistinguishable from those caused by dermatophytes. Due to the rare presence of this fungus in our geographical area (Valparaíso province, Chile), the main morphophysiological, taxonomic and molecular data used in its identificationare provided. (AU)

Hemodialysis and Kidney Transplantation as Predisposing Conditions to Onychomycosis.

BACKGROUND/AIM: Onychomycosis (OM) is one of the commonest superficial fungal infections. Patients undergoing hemodialysis (HD) treatment and kidney transplant recipients (KTR) are considered at risk of contracting fungal infections, but the few published data do not reach the conclusion of whether they are predisposed to OM. This study aimed to determine the prevalence and etiology of OM in these patients and to determine the antifungal susceptibility profile of the isolated fungal species. METHODS: We recruited 149 HD patients, 187 KTR, and a control group comprising 174 patients attending an internal medicine service with other diseases than renal diseases. All patients underwent an examination of all toenails to check for the presence of OM. Antifungal susceptibility tests were performed following the Clinical and Laboratory Standards Institute (CLSI) recommendations. RESULTS: The prevalence rates of OM in HD patients (23.4%) and KTR (23.0%) were significantly higher than those in age- and sex-matched control groups (13.2%). In HD patients, OM was associated with diabetes but not with the duration of dialysis. In KTR, OM was more prevalent in those without diabetes and likely also in those using mycophenolate mofetil or azathioprine but was not associated with the duration of transplantation. Trichophyton rubrum was the most prevalent species (45.9%) followed by T. mentagrophytes (24.5%) and Candida parapsilosis (18.0%). Fluconazole, itraconazole, voriconazole, and terbinafine were all efficient against the isolates of dermatophyte, with terbinafine showing the lowest and fluconazole the highest minimal inhibitory concentrations. All isolates of C. parapsilosis were sensitive to the antifungals according to the CLSI criteria. CONCLUSION: We found a high prevalence of OM in HD and KTR patients and suggest that these conditions should be considered a risk factor of OM. All 4 antifungals evaluated in the study showed good in vitro activity against the etiologic agents.

[Onychomycosis by yeast not common in diabetics of a health center]. / Onicomicosis por levaduras no comunes en diabéticos de un centro de salud.

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.

[Onychomycosis frequency in psoriatic patients in a tertiary care hospital]. / Frecuencia de onicomicosis en pacientes con psoriasis en un hospital de especialidades.

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.

Manifestações dermatológicas em pacientes infectados pelo HIV: um estudo de prevalência / Dermatological manifestations in HIV-infected patients: a prevalence study

Na infecção pelo HIV, a pele pode ser tanto um indicador precoce de doença quanto de gravidade. Este estudo analisou a frequência e a apresentação clínica de manifestações dermatológicas em pacientes portadores de HIV, destacando as lesões mais encontradas, e correlacionou suas características com o estado imunológico. Foram encontradas 129 lesões mucocutâneas dentre os 57 pacientes portadores de HIV examinados, havendo em média 2,25 lesões por paciente. As dermatoses mais comuns, em ordem decrescente de frequência, foram candidíase oral, onicomicose e dermatite seborreica. As lesões oportunistas mostraram relação significativa com deficiência imunológica, e as afecções de pele mais encontradas mostraram-se bons indicadores do estado imunológico do paciente e da progressão da doença.

In the HIV infection the skin can be either an early indicator of disease and severity. This study examined the frequency and clinical presentation of skin manifestations in patients with HIV, highlighting the most frequent injuries, and correlated their characteristics with the immune status. We found 129 mucocutaneous lesions among 57 patients with HIV, with an average of 2.25 lesions per patient. The most common skin diseases in descending order of frequency were oral candidiasis, onychomycosis and seborrheic dermatitis. Opportunistic lesions showed significant relationship with immune deficiency and the most frequent skin diseases proved to be good indicators of the immune status of the patient and disease progression.

Onychomycosis in patients with chronic leg ulcer and toenail abnormalities.

Nails have a limited number of reactive patterns to disease. Accordingly, toenail changes of different etiologies may mimic onychomycosis. OBJECTIVE To determine the prevalence of toenail onychomycosis among patients with leg ulcer and toenail abnormalities attending a dermatology clinic. METHODS A cross-sectional study was conducted through the analysis of clinical records and results of mycological examination. RESULTS A total of 81 patients were included, with a median age of 76.0 years. Most ulcers were of venous etiology, followed by those of mixed and arterial pathogenesis. The mycological evaluation confirmed the diagnosis of onychomycosis in 27.2% of the patients. The etiologic agent was a dermatophyte in 59.1% of isolates in nail samples, while Trichophyton interdigitale was the most frequent fungal species (40.9%). CONCLUSIONS Most toenail abnormalities in patients with chronic leg ulcer were not onychomycosis. This study highlights the importance of systematic mycological examination in these patients, in order to avoid overtreatment with systemic antifungals, unnecessary costs and side effects.

Distrofias ungueais no ambiente de trabalho: uma breve abordagem / Nail dystrophy in the workplace: a brief approach

Contexo: O trabalhador em sua atividade laboral está em contato frequente com diversos agentes que em determinadas situações podem comprometer as unhas, a eficiência e produtividade do trabalho exercido. Objetivos: Este estudo constitui-se de uma revisão da literatura com uma breve discussão acerca da distrofia ungueal ocupacional, abordando etiologias, tratamento e prevenção. Métodos: Foi realizada uma consulta por normas e artigos científicos selecionados através de busca no banco de dados do SciELO e da Bireme, a partir das fontes Medline e Lilacs, entre dezembro de 2013 e janeiro de 2014. Resultados: Distrofias são alterações ungueais e em seus anexos, causadas ou agravadas por agentes biológicos, químicos e/ou físicos presentes no ambiente de trabalho. O diagnóstico se baseia em uma anamnese minuciosa, a qual é passível de elucidar a etiologia da doença, e a terapêutica da mesma pode exigir o afastamento do trabalho. A retirada do agente causal e o uso correto dos equipamentos de proteção individual são as melhores formas de prevenção de tal doença ocupacional. Conclusões: O médico do trabalho, detendo condições de observação e avaliação do ambiente de trabalho, deve reconhecer riscos potenciais e reais para o empregado e propor medidas que neutralizem esses riscos.

Context: Worker in their labor activity is in frequent contact with many agents in certain situations that may affect the nails and the efficiency and productivity of their occupation. Objectives: This study consisted of a literature review with a brief discussion of occupational nail dystrophy, addressing causes, treatment and prevention. Methods: A query for standards and selected by searching the database SciELO/Bireme and scientific articles from Medline and Lilacs sources between December 2013 and January 2014. Results: Dystrophies are nail changes and its annexes, caused or aggravated by biological, chemical and/or physical agents in the workplace. The diagnosis is based on a thorough medical history, which is likely to elucidate the etiology of the disease, and its therapy may require absence from work. The withdrawal of the causative agent and the correct use of personal protective equipment are the best ways to care involvement. Conclusions: The occupational physician, in conditions of observation and evaluation of the work environment should know actual and potential risks to the employee and propose measures to neutralize these risks.

Aislamiento de Sporothrix pallida complex en muestras clínicas y ambientales de Chile / Isolation of Sporothrix pallida complex in clinical and environmental samples from Chile

Se informa para Chile el aislamiento de S. pallida complex desde muestras médicas y del suelo del hogar de una paciente. Los hongos del complejo Sporothrix schenckii pueden causar distintas infecciones. En Chile, los aislamientos médicos y ambientales de este complejo son poco frecuentes. El objetivo de este trabajo fue identificar un agente atípico en un caso de onicomicosis y detectar su presencia en el suelo del jardín del hogar de la paciente. Para esto, las muestras clínicas se obtuvieron por raspado subungueal del primer dedo del pie derecho, y las muestras de suelo, de diferentes sectores del jardín. La identificación de las especies se realizó por morfofisiología y para la confirmación molecular se envió una de las cepas aisladas de la uña de la paciente al CBS (14.062). Se identificó S. pallida complex tanto de las muestras de uña como de aquellas provenientes del suelo del jardín

The isolation of S. pallida complex from medical samples and home garden soil of a patient in Chile is here in reported. Fungi of the Sporothrix schenckii complex can cause various infections. In Chile, the medical and environmental isolates of these this complex are rare. The aim of this study was to identify an unusual agent in a case of onychomycosis and to detect its presence in the patient's home garden. For this purpose, clinical samples were obtained by scraping the patient's subungueal first right toe nail as well as by taking soil samples from different areas of her home garden. Species identification was performed by morphophysiology and one of the strains isolated from the patient's toe nail was sent to CBS for molecular confirmation (14.062). S. pallida complex was identified both from the patient's toe nail and samples taken from her home garden

Epidemiología presentación clínica y agente etilógico de la onicomicosis de pies en pacientes diabeticos / Epidemiological, clinical features and etiologic agent of the feet onychomycosis in diabetic patients

Para determinar algunos aspectos epidemiológicos y clínicos de la onicomicosis de pies en pacientes diabéticos se realizó el presente estudio descriptivo en pacientes atendidos en el Hospital Regional Docente de Trujillo desde enero a noviembre del 2005. Entraron al estudio 49 pacientes diabéticos condiagnósticos clínico de onicomicosis de pies, recolectándose la muestra para estudio histológico y micológico. Se encontró un mayor predominio del sexo femenino en un 71,4 por ciento. La edad nínima due de 42 años y la máxima de 93 con una media de 65.8. El tiempo de enfermedad de la onicomicosis osciló entre 2 meses a 30 años. El tiempo desde cuando se hizo el diagnóstico del diabetes mellitus fue de 1 día a 45 años. La mayoría de los pacientes tuvieron ocupación "su casa" y procedían del distrito de Trujillo. La forma cllínica "distrófica total" fue la más frecuente, seguida por la forma "subungueal latero distal". El 63.3 por ciento de los pacientes tuvo la forma severa de la enfermedad. De los 49 pacientes estudiados obtuvimos positividad histológica y/o micológica en el 67.4 por ciento de los casos y de estos los agentes que predominaron fueron los dermatofitos, siendo Trychophyton rubrum el más común.

To determine some clinica and epidemiological aspects in diabetic patients with toenail onychomycosis we realized thihs descriptive study in outpatients that assisted to the Regional Hospital in Trujillo city, Peru over a period of january to november 2005, In 49 clinically suspected cases we confirmed the diagnosis by histological and mycologic culture in 67,4% the females were 71,4 per cent. The mean age was beetween 42 and 93 year old. The mean duration of the ocychohmycosis was between 2 mounths until 30 year. The mean duration of diagnostic of diabetes mellitus was about one day and 45 years. The majority of our patients were housewives and lived in Trujillo. The clinical types noted were dystrophic onychomycosis and distolateral subungueal onychomycosis. The 63,3 per cent had the severe form of onychomycosis. Only 67,4 per cent had histological and or mycological evidence mostly due to dermatophytes mainly. Trichopyhton rubrum.

Aspectos epidemiológicos das micoses dos pés em um time chinês de futebol / Epidemiological aspects of the feet mycosis in a Chinese soccer team

As infecções fúngicas podais podem interferir no desempenho esportivo ao provocar desconforto e dor nos atletas. O objetivo deste estudo foi avaliar a prevalência das infecções fúngicas podais em um time profissional de futebol, verificando os agentes mais freqüentes e os fatores predisponentes. O delineamento da pesquisa foi transversal e descritivo. A amostra foi composta de 22 homens, com idades entre 23 e 36 anos, integrantes do time de futebol profissional chinês, quando de sua participação de jogos em Curitiba (PR). Todos foram avaliados clinicamente e submetidos a exames micológicos (direto e cultura) de escamas de pele e unha dos pés e estudo histopatológico de fragmento ungueal. Os resultados encontrados foram: 12 casos (54,5 por cento) não apresentavam micose; cinco casos (22,72 por cento) apresentavam onicomicose isolada e cinco casos (22,72 por cento) apresentavam onicomicose associada a tinea pedis, tendo como principal agente isolado o Trichophyton rubrum. Os fatores predisponentes apontados pelos atletas incluíram: banho em local público (85 por cento), prática de esporte (76 por cento), uso de calçados fechados (70 por cento), contato com animal doméstico (63 por cento) e irregularidade na higiene dos pés (50 por cento). CONCLUSÃO: A freqüência da onicomicose em atletas chineses foi maior do que na população em geral. O agente mais freqüente foi o Trichophyton rubrum. Os hábitos individuais podem contribuir para a aquisição dessas infecções fúngicas, além do trauma direto pelo calçado e bola, bem como pelo contato físico durante treinos e jogos que podem favorecer lesões cutâneas e ungueais.

Podal fungal infections can interfere in the sportive performance, since they provoke discomfort and pain in the athletes. The purpose of this study was to assess the prevalence of podal fungal infections in a professional soccer team, verifying the more frequent agents and the predisposing factors to that condition. The research had a transversal and descriptive outlining. The sampling was composed by twenty-two 23 to 36 years old male athletes from the professional Chinese soccer team on the occasion they participated in a game series in Curitiba (PR). All athletes were clinically assessed, and they were submitted to mycological examinations (direct and culture) of the skin and nail's squamas from their feet, as well as to a histopathologic study of the ungual fragment. The results found were: twelve cases (54.5 percent) did not present mycosis; 5 cases (22.72 percent) presented isolated onychomycosis, and 5 cases (22.72 percent) presented onychomycosis associated to tinea pedis, having as major isolated agent the Trichophyton rubrum. The predisposing agents pointed by athletes included: bath in a public place (85 percent), sports practice (76 percent), use of closed shoes (70 percent), contact with pets (63 percent), and irregular feet hygiene (50 percent). CONCLUSION: The frequency of the onychomycosis in Chinese athletes was higher than in the general population. The most frequent agent found it was the Trichophyton rubrum. The individual habits may contribute to the acquisition of these fungal infections added to the direct trauma provoked by the shoe and the ball, as well as to the physical contact during the trainings and games that may favor the cutaneous and ungual injuries.

Las infecciones fúngicas pueden interferir en la acción deportiva por provocar incomodidad y dolor en los atletas. El objetivo de este estudio fue evaluar el predominio de infecciones fúngicas en los pies que afectan a un equipo profesional de fútbol, mientras se verifican los agentes más frecuentes y los factores predisponentes. El delineamento de la investigación fue cruzado y descriptivo. La muestra estaba compuesta de 22 hombres, con las edades entre 23 y 36 años, íntegrantes del equipo de fútbol profesional chino, cuando participaron en juegos en Curitiba (PR). Todos fueron evaluados clínicamente y sometidos a los exámenes micológicos respectivos (directo y cultivo) de escamas de piel y uña de los pies y estudio histopatológico de fragmento ungueal. Los resultados que se encontraron fueron: 12 casos (54,5 por ciento) que no presentaron micosis; 5 casos (22,72 por ciento) que presentaron onicomicosis aislada y 5 casos (22,72 por ciento) que presentaron onicomicosis asociada a tinea pedis, que tiene como agente aislado principal el Trichophyton rubrum. Los factores predisponentes para los atletas incluidos consignados fueron: bañarse en lugares públicos (85 por ciento), la práctica deportiva (76 por ciento), el uso de zapatos cerrados (70 por ciento), tener un animal doméstico (63 por ciento) y la irregularidad en la higiene de los pies (50 por ciento). CONCLUSIONES: La frecuencia de la onicomicosis en los atletas chinos es más grande que en la población en general. El agente más frecuente fué el Trichophyton rubrum. Los hábitos individuales pueden contribuir a la adquisición de esas infecciones fúngicas, además del trauma directo por el zapato, así como el contacto físico durante los entrenamientos y juegos que pueden favorecer lesiones cutáneas y ungueales.

Onicomicosis en pacientes pediátricos / Onychomycosis in pediatric patients

La onicomicosis es menos frecuente en niños que en adultos, aumentando su prevalencia hacia la adolescencia. Se relaciona con tinea pedis o manum y con infección concomitante de un adulto en la casa. Es considerada una enfermedad multifactorial. Los principales agentes etiológicos son Trichophyton rubrum y Trichophyton mentagrophytes; sin embargo, una búsqueda activa del agente causal es muy importante. Cuando el compromiso ungueal es moderado a severo, se debe tratar con terapiaoral. Los nuevos antifúngicos orales para el tratamiento de la onicomicosis son Itraconazol, Terbinafina y Fluconazol, los cuales parecen ser alternativas efectivas y seguras. En este artículo revisaremos la prevalencia, presentación clínica, principales opciones terapéuticas y diagnóstico diferencial de la onicomicosis pediátrica.

Frequencia dos agentes etiologicos de onicomicose em pacientes hansenianos / ?

A anestesia de extremidades e uma caracteristica da hanseniase; os danos neural e vascular levam a deformidade. Uma das consequencias comuns e o comprometimento ungueal, apresentando-se principalmente sob a forma de distrofia, que pode ser colonizada por fungos. A infeccao micotica facilita o aparecimento de infeccoes bacterianas secundarias, que podem desencadear reacoes hansenicas, comprometendo a qualidade de vida do paciente. Neste trabalho, estudou-se a frequencia de agentes de onicomicose em 104 pacientes hansenianos com lesoes clinicamente compativeis. Foram utilizados exame micologico direto e cultura, que foi repetida por tes vezes. Encontrou-se frequencia de 91,3 por cento de onicomicose, com predominio de leveduras (60,0 por cento). Houve discordancia entre exame micologico direto e cultura em 27,6 por cento dos casos. Em 21,6 por cento dos exames diretos microscopicamente positivos nao foi observado crescimento fungico na respectiva cultura e em 6 por cento dos casos verificou-se exame micologico direto negativo e cultura positiva. Os dermatofitos represemtam 26, 7 por cento dos isolamentos, sendo Trichophyton rubrum o mais frequente (15, 3 por cento). Os fungos filamentosos nao dermatofitos foram 13,3 por cento das cepas isoladas, com maior frequencia do genero Scytalidium (10,5 por cento). Candida parapsilosis foi a especie de levedura mais frequente (21,53) por cento), seguida de C. tropicalis (7,69 por cento) e C. albicans (7,69 por cento). Os achados surgerm que as unhas destes pacientes sao suscetiveis as onicomicoses, principalmente com predisposicao a infeccao por agentes oportunistas...

Onicomicosis: revisión del tema / Onychomycosis: review

El término onicomicosis se refiere a la enfermedad de la uña causada por hongos. En el origen de la misma se involucran tres grupos de hongos: los dermatofitos, las levaduras y los mohos no dermatofitos. Las onicomicosis constituyen una enfermedad frecuente en la práctica médica, con impacto considerable en lo emocional, social, laboral y económico. En este artículo se revisan las principales características clínicas y epidemiológicas de las onicomicosis, se analizan los diferentes agentes causantes y se actualizan los aspectos relevantes de esta enfermedad haciendo énfasis en el manejo diagnóstico y terapéutico, ya que estos puntos son los que ocasionan mayores dificultades en la práctica clínica. Finalmente, se hacen consideraciones sobre la importancia del diagnóstico micológico y el rol del laboratorio y del especialista en dicho diagnóstico y con respecto al tratamiento se enumeran recomendaciones en relación al uso de los diferentes fármacos y pautas terapéuticas. (AU)

Frequency of toenail onychomycosis in patients with cutaneous manifestations of chronic venous insufficiency.

BACKGROUND: Chronic venous insufficiency (CVI) can originate onychopathy per se. We have anecdotally observed nail changes in patients with CVI, but there are few studies which determine the frequency of both onychopathy and onychomycosis in these patients OBJECTIVE: The aim of the study was to determine the frequency of nail pathology and onychomycosis in patients with CVI PATIENTS AND METHODS: We included 36 adult patients, both men and women, aged from 18 to 59 years, with clinically documented venous leg ulcers. All patients were examined by a dermatologist and the venous leg ulcers were classified according to severity in three grades. The nail changes were described and a mycological examination was performed. We obtained a small fragment of the nail for histological examination. In 27 patients, we also performed functional studies to determine the type of venous insufficiency. RESULTS: The ratio of women to men was 5 : 1. The mean age of patients was 46.39 +/- 8.51 years, men being slightly younger than women. Ten patients had ulcers of grade I severity, 12 had grade II, and 14 had grade III. The overall time of evolution of the cutaneous lesions was 11.02 +/- 10.11. Fourteen patients had superficial venous insufficiency, whereas 13 had deep venous insufficiency. Twenty-two (61.11%) of our patients had nail alterations. These nail changes were related more to the type of vascular affection than with the severity of cutaneous involvement. In more than half of the cases (59.09%), onychomycosis was the cause of the nail changes. The overall frequency of onychomycosis was 36.11%. The etiologic agent of onychomycosis was isolated in 38.46% of the cases, and Trichophyton rubrum was the most frequent agent. The histologic examination of the nail plate showed a low sensitivity (62%) but a high specificity (100%) in the detection of nail plate parasitization. No clinical differences could be established between the nail changes observed in patients with true onychomycosis and those with nonfungal onychopathy. CONCLUSIONS: Nail changes are common in patients with venous leg ulcer, and onychomycosis accounts for slightly more than half of the cases. We therefore recommend a routine mycological examination in patients wit nail changes and cutaneous manifestations of CVI, to diagnose or rule out onychomycosis, and therefore avoid overtreating patients without onychomycosis with antimycotics.

Epidemiology and prevalence of onychomycosis in HIV-positive individuals.

BACKGROUND: Patients who are human immunodeficiency virus (HIV) positive are predisposed to the development of infections including tinea pedis and onychomycosis. While smaller studies have been reported, there has been no large study evaluating the prevalence of onychomycosis in HIV-positive individuals, or comparing the development of onychomycosis in a typical temperate area with that in a typical tropical area. METHODS: HIV-positive individuals were evaluated at five clinics: four in Ontario, Canada and one in Sao Paulo, Brazil. The subjects were asked questions to determine the epidemiology of onychomycosis in HIV-positive individuals. The feet were examined and nail material was obtained for mycologic examination to determine the causative organism of onychomycosis. RESULTS: A total of 500 subjects were examined (415 men and 85 women; age (mean +/- SE), 39 +/- 0.4 years; 400 Canadian, 100 Brazilian). The racial origins of the Canadian patients were: Caucasian, 83.8%; Asian, 4.3%; African-American, 8.1%; Hispanic, 3.3%; American Indian, 0.3%. The Brazilian origins were: Caucasian, 68.7%; African, 18.1%; mixed race, 13.3%. Abnormal appearing nails and mycologic evidence of onychomycosis were present in 200 (40.0%) and 116 (23.2%), respectively, of 500 subjects. The prevalence of onychomycosis in the Canadian and Brazilian samples was 24.0% (96 of 400) and 20.0% (20 of 100), respectively. The projected prevalence of onychomycosis in HIV-positive individuals in Canada was 19.9% (95% CI: 16.0-23.9%) after taking into account the age and sex distribution of HIV-positive individuals in the population. When nails appeared clinically abnormal, the prevalence of onychomycosis was 50.5% (Canada, 51.3%; Brazil, 45.5%). For comparison, published data indicate that the prevalence of onychomycosis in immunocompetent individuals living in Canada is 6.9%. The clinical presentation of onychomycosis for the whole sample (n=500) was: distal and lateral subungual onychomycosis (DLSO), 20.0%; white superficial onychomycosis (WSO), 3.6%; proximal subungual onychomycosis (PSO), 1.8% (Canadian and Brazilian samples: DLSO 21.2% vs. 15.0%, WSO 3.3% vs. 5.0%, and PSO 1.5% vs. 3.0%). The distribution of the causative fungal organisms was: dermatophytes: Candida species: nondermatophyte molds, 73:2:2 (Canadian and Brazilian samples: dermatophytes 95.5% vs. 90.9%, Candida species 3.0% vs. 0%, and nondermatophyte molds 1.5% vs. 9.0%). The use of protease inhibitors, reverse transcriptase inhibitors, or oral antifungal agents did not make a significant difference in the prevalence of onychomycosis for both the Canadian and Brazilian groups. Patients with onychomycosis were aware of their abnormal appearing nails (chi2(1)=69.7, P<0.001), embarrassed by the appearance of their nails (chi2(1)=29.7, P<0.001), and took measures to hide their nails from other individuals. A higher proportion of individuals with onychomycosis experienced discomfort compared with those without the disease (chi2(1)=9.0, P=0.003). Also, individuals who experienced pain in the nail unit were more likely to have onychomycosis (risk odds ratio (ROR), 2.2; 95% CI: 1.0-4.7, P=0.05). CONCLUSIONS: The prevalence of onychomycosis in HIV-positive individuals in the sample of 500 patients was 23.2%. In the Canadian (n=400) and Brazilian (n=100) samples, the corresponding figures were 24% and 20%, respectively, with the predominant causative organisms being dermatophytes. The projected prevalence of onychomycosis in HIV-positive Canadians is 19.9%. Predisposing factors include a CD4 count of approximately 370, a positive family history of onychomycosis, a history of tinea pedis, and walking barefoot around pools. Onychomycosis can be symptomatic, a source of embarrassment, and a potential cause of morbidity.