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Avalia??o clínica e micológica de onicomicose em pacientes brasileiros com HIV/AIDS
Cambuim, Idalina Inês Fonsêca Nogueira;Macêdo, Danielle Patrícia Cerqueira;Delgado, Marília;Lima, Kedma de Magalh?es;Mendes, Genilda Pereira;Souza-Motta, Cristina Maria de;Lima, Débora Maria Massa;Fernandes, Maria José;Magalh?es, Oliane Maria Correia;Queiroz, Lusinete Acioli de;Neves, Rejane Pereira;
Revista da Sociedade Brasileira de Medicina Tropical , 2011, DOI: 10.1590/S0037-86822011000100010
Abstract: introduction: onychomycosis is common in immunocompromised patients, but emerging species have been verified, thereby modifying the epidemiological profile of this mycosis. thus, the aim of this study was to evaluate clinical and mycological profile of onychomycosis among hiv/aids patients. methods: clinical samples were collected and processed for direct examination, and cultures were maintained at a temperature of 30°c and 37°c for 15 days. results: out of 100 patients, 32 had onychomycosis. the etiological agents isolated were candida albicans, c. parapsilosis, c. tropicalis, c. guilliermondii, trichophyton rubrum, t. mentagrophytes, fusarium solani, scytalidium hialinum, s. japonicum, aspergillus niger, cylindrocarpon destructans and phialophora reptans. conclusions: onychomycosis in hiv/aids patients presents various clinical manifestations and may be caused by emerging fungi. the peculiarities presented by different fungal agents justify the need for identification to species level, with the purpose of guiding better therapeutic approaches and minimizing these patients' exposure to conditions presenting a risk of disseminated infection.
The Effect of Q-Switched Nd:YAG 1064?nm/532?nm Laser in the Treatment of Onychomycosis In Vivo  [PDF]
Kostas Kalokasidis,Meltem Onder,Myrto-Georgia Trakatelli,Bertrand Richert,Klaus Fritz
Dermatology Research and Practice , 2013, DOI: 10.1155/2013/379725
Abstract: In this prospective clinical study, the Q-Switched Nd:YAG 1064?nm/532?nm laser (Light Age, Inc., Somerset, NJ, USA) was used on 131 onychomycosis subjects (94 females, 37 males; ages 18 to 68 years). Mycotic cultures were taken and fungus types were detected. The laser protocol included two sessions with a one-month interval. Treatment duration was approximately 15 minutes per session and patients were observed over a 3-month time period. Laser fluencies of 14?J/cm2 were applied at 9 billionths of a second pulse duration and at 5?Hz frequency. Follow-up was performed at 3 months with mycological cultures. Before and after digital photographs were taken. Adverse effects were recorded and all participants completed “self-evaluation questionnaires” rating their level of satisfaction. All subjects were well satisfied with the treatments, there were no noticeable side effects, and no significant differences were found treating men versus women. At the 3-month follow-up 95.42% of the patients were laboratory mycologically cured of fungal infection. This clinical study demonstrates that fungal nail infections can be effectively and safely treated with Q-Switched Nd:YAG 1064?nm/532?nm laser. It can also be combined with systemic oral antifungals providing more limited treatment time. 1. Introduction Onychomycosis is defined as a fungal infection of the nail that expands slowly and if left untreated leads to complete destruction of the nail plate. Onychomycosis can be dermatophytic (99%) and/or nondermatophytic (1%) (including yeasts) infections of the nail plate. The dermatophytes Trichophyton rubrum and Trichophyton mentagrophytes are the most common causative pathogens responsible for up to 90% of all cases [1]. Onychomycosis represents about 30% of all dermatophyte infections and accounts for 18%–40% of all nail disorders. The prevalence of onychomycosis ranges between 2% and 28% of the general population and it is estimated to be significantly higher in specific populations such as in diabetes mellitus, the immunosuppressed, and elderly [2, 3]. Among the nondermatophytes, the yeast Candida albicans, Candida tropicalis, aspergillus, and other molds may be responsible. It usually represents contamination and is an emerging problem in HIV patients. Toenails are far more likely to be involved than fingernails. Initially solitary nails are involved; later, many may be infected, but often one or more can stay disease-free. Onychomycosis has no tendency for spontaneous remission and should be considered as a problem with serious medical, social, and emotional
Successive mycological nail tests for onychomycosis: a strategy to improve diagnosis efficiency
Meireles, Tereza Elizabeth Fernandes;Rocha, Marcos Fábio Gadelha;Brilhante, Raimunda Samia Nogueira;Cordeiro, Rossana de Aguiar;Sidrim, José Júlio Costa;
Brazilian Journal of Infectious Diseases , 2008, DOI: 10.1590/S1413-86702008000400016
Abstract: onychomycosis is a fungal infection of nails caused by dermatophytes, yeasts and moulds, accounting for about 50% of onychopathies. a high frequency of onychomycosis caused by candida species has been reported during the last few years in northeast brazil, as well as in other regions of the world. a clinical diagnosis of onychomycosis needs to be confirmed through laboratory exams. we evaluated the importance of serial repetition of direct microscopic exams and fungal culture for the diagnosis of onychomycosis in the city of fortaleza, ceará, in northeast brazil. we first made a retrospective study of 127 patients with onychomycosis, identifying the fungi that had been isolated from fingernails and toenails. we then made a prospective study of 120 patients, who were submitted to three successive mycological examinations. ungual residues were scraped off and directly examined with a microscope and fungal cultures were made. in the retrospective study, in which only one sample was analyzed, the incidence of onychomycosis was 25.0%. in our prospective study, in which we had data from successive mycological examinations, 37.8% had onychomycosis. the most commonly isolated fungi in both studies were yeasts from the genera candida, especially c albicans, c. parapsilosis and c. tropicalis. we found a high proportion of onychomycosis caused by candida species. we also concluded that serial repetition of direct microscopic examination and fungal culture, with intervals of 2-5 days improved the diagnosis of onychomycosis. we suggest that this laboratorial strategy is necessary for accurate diagnosis of this type of mycosis, especially when the standard procedures fail to diagnose fungal infection, despite strong clinical suspicion.
Onchomycosis – a clinical and mycological study of 75 cases  [PDF]
Neerja Puri
Our Dermatology Online , 2012,
Abstract: Onychomycosis or fungal infection of the nails is a common disease, especially in older persons. A mycological study of onchomycosis was undertaken in 75 patients. The nails were judged to be infected by their clinical appearance. There were a total of 75 suspected cases of onychomycosis. Of these 75 cases 22.6% were positive by direct microscopy and 33.3% were culture positive. Of these 75 cases, 18 were males (24%) and 57 (76 %) were females, male to female ratio being. The commonest age group was 31-40 years followed by 21-30 years. The finger nails were more frequently involved. i.e. 45 (60 %), followed by toe nails 30 (40 %) and both in 18 (24%) cases. Ratio of finger nail to toe nail infection was 1.5:1. Distal and lateral subungual onychomycosis (DLSO) was the commonest clinical pattern (76%) followed by total dystrophic onychomycosis (18.66%) and then superficial white onychomycosis (4%) and proximal subungual onychomycosis (1.33%). The most common fungal isolates were dermatophytes of which 44% were Trytophyton rubrum, 4% were Trytophyton mentagrophytes. Non dermatophyte moulds constituted 16% of the fungus isolates. Onychomycosis was found to be the commonest in housewives (52%), followed by serviceman / businessman (32%) followed by farmers (8%) and labourer and student 4% each.
Comparison of potassium hydroxide mount and mycological culture with histopathologic examination using periodic acid-Schiff staining of the nail clippings in the diagnosis of onychomycosis  [cached]
Shenoy M,Teerthanath S,Karnaker Vimal,Girisha B
Indian Journal of Dermatology, Venereology and Leprology , 2008,
Abstract: Background: Onychomycosis is a common problem noticed in clinical practice. Currently available standard laboratory methods show inconsistent sensitivity; hence there is a need for newer methods of detection. Aims: This study involves comparison of standard laboratory tests in the diagnosis of onychomycosis, namely, potassium hydroxide mount (KOH mount) and mycological culture, with histopathologic examination using periodic acid-Schiff (PAS) staining of the nail clippings. Methods: A total of 101 patients with clinically suspected onychomycosis were selected. Nail scrapings and clippings were subjected to KOH mount for direct microscopic examination, culture using Sabouraud′s dextrose agar (with and without antibiotics) and histopathologic examination with PAS staining (HP/PAS). Statistical analysis was done by McNemar′s test. Results: Direct microscopy with KOH mount, mycological culture, and HP/PAS showed positive results in 54 (53%), 35 (35%), and 76 (75%) patients respectively. Laboratory evidence of fungal infection was obtained in 84 samples by at least one of these three methods. Using this as the denominator, HP/PAS had a sensitivity of 90%, which was significantly higher compared to that of KOH mount (64%) or mycological culture (42%). Conclusions: Histopathologic diagnosis with PAS staining of nail clippings was the most sensitive among the tests. It was easy to perform, rapid, and gave significantly higher rates of detection of onychomycosis compared to the standard methods, namely KOH mount and mycological culture.
Clinico-mycological evaluation of onychomycosis at Bangalore and Jorhat
Grover S
Indian Journal of Dermatology, Venereology and Leprology , 2003,
Abstract: Introduction: Clinical and mycological features of onychomycosis show variation with time and place. Material and Methods: A study to analyze the morphological variants and mycological isolates of onychomycosis was carried out in 50 patients attending the dermatology out-patient departments at the Air Force Hospitals at Bangalore and at Jorhat. Nail clippings were subjected to direct microscopy and cultured on Sabouraud's Dextrose Agar. Results: The commonest age group affected (56%) was the 20-40 year age group. The fingernails alone were involved in 24 (48%) patients, the toenails alone in 15 (30%) patients, and both in 11 (22%) patients. Distal and lateral subungual onychomycosis was encountered in 41 (82%) patients, proximal superficial onychomycosis and total dystrophic onychomycosis in 3 each (6%), paronychia in 2 (4%) and superficial white onychomycosis in 1. Of the 59 samples cultured, dermatophytes were grown in 14 (23.7%), non-dermatophyte moulds (NDM) in 13 (22.0%), candida in 10 (16.8%) and no growth in 22 (37.2%) samples. Conclusion: Among the dermatophytes, Trichophyton rubrum, and among the NDM, Aspergillus spp., were the commonest isolates.
A five-year survey of onychomycosis in New Delhi, India: Epidemiological and laboratory aspects
Kaur Ravinder,Kashyap Bineeta,Bhalla Preena
Indian Journal of Dermatology , 2007,
Abstract: Context: The worldwide incidence of onychomycosis is increasing and it continues to spread and persist. Knowledge of the epidemiological and mycological characteristics is an important tool for control of this infection. Aims: This study seeks to improve knowledge of onychomycosis epidemiology and mycological features. Settings and Design: Over a period of five years (Jan 2000 - Dec 2005) samples from 400 patients with clinical suspected fungal nail infections, who attended dermatology out patient department at a tertiary care hospital, were obtained. Materials and Methods: 400 nail specimens of suspected onychomycosis were evaluated clinically, KOH examination and fungal culture was done. Results: Onychomycosis was present in 218 (54.5%) by culture and /or direct examination. Fingernails and toenails were infected in 65% and 32% respectively and remaining 3% had both. Conclusions: This study demonstrated that dermatophytes were main agents causing onychomycosis in our region, as well as the importance of performing direct examination and culture in diagnosis of onychomycosis.
A clinico - Mycological evaluation of onychomycosis
Vinod Sujatha,Grover Sanjiv,Dash K,Singh Gurcha
Indian Journal of Dermatology, Venereology and Leprology , 2000,
Abstract: Even though dermatophytes, especially Trichophyton rubrum, are most frequently implicated as the causative agents in onychomycosis, yeasts and moulds are increasingly recognised as causative pathogens. A study to analyse the morphological variants and mycological and cultural positivity of onychomycosis was carried out in 35 patients attending the Dermatology outpatient department of Command Hospital, Air Force, Banglore.
Clinical profile of HIV infection  [cached]
Khopkar Uday,Raj Sujata,Sukthankar Ashish,Kulkarni M
Indian Journal of Dermatology, Venereology and Leprology , 1992,
Abstract: HIV seropositivity rate of 14 percent was observed amongst STD cases. Heterosexual contact with prostitutes was the main risk factor. Fever, anorexia, weight loss, lymphadenopathy and tuberculosis were useful clinical leads. Genital ulcers, especially chancroid, were common in seropositivies. Alopecia of unknown cause, atypical pyoderma, seborrhea, zoster, eruptive mollusca and sulfa-induced erythema multiforme were viewed with suspicion in high risk groups. Purpura fulminans, fulminant chancroid, vegetating pyoderma and angioedema with purpura were unique features noted in this study.
An open randomized comparative study to test the efficacy and safety of oral terbinafine pulse as a monotherapy and in combination with topical ciclopirox olamine 8% or topical amorolfine hydrochloride 5% in the treatment of onychomycosis  [cached]
Jaiswal Amit,Sharma R,Garg A
Indian Journal of Dermatology, Venereology and Leprology , 2007,
Abstract: Background: Onychomycosis is a fungal infection of nails caused by dermatophytes, yeasts and molds. Aims: To study the efficacy and safety of oral terbinafine pulse as a monotherapy and in combination with topical ciclopirox olamine 8% or topical amorolfine hydrochloride 5% in onychomycosis. Methods: A clinical comparative study was undertaken on 96 Patients of onychomycosis during the period between August 2005 to July 2006. Forty-eight patients were randomly assigned in group A to receive oral terbinafine 250 mg, one tablet twice daily for seven days every month (pulse therapy); 24 patients in group B to receive oral terbinafine pulse therapy plus topical ciclopirox olamine 8% to be applied once daily at night on all affected nails; and 24 patients in group C to receive oral terbinafine pulse therapy plus topical amorolfine hydrochloride 5% to be applied once weekly at night on all the affected nails. The treatment was continued for four months. The patients were evaluated at four weekly intervals till sixteen weeks and then at 24 and 36 weeks. Results: We observed clinical cure in 71.73, 82.60 and 73.91% patients in groups A, B and C, respectively; Mycological cure rates against dematophytes were 88.9, 88.9 and 85.7 in groups A, B and C, respectively. The yeast mycological cure rates were 66.7, 100 and 50 in groups A, B and C, respectively. In the case of nondermatophytes, the overall response was poor: one out of two cases (50%) responded in group A, while one case each in group B and group C did not respond at all. Conclusion: Terbinafine pulse therapy is effective and safe alternative in treatment of onychomycosis due to dermatophytes; and combination therapy with topical ciclopirox or amorolfine do not show any significant difference in efficacy in comparison to monotherapy with oral terbinafine.
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