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Goldman-Fox syndrome is a rare pathology, first described in 1944, which is defined as the greenish coloration of the nail apparatus, caused by bacterial and infectious fungal processes. The case of a 37-year-old female patient is presented, who refers chloronychia in her fingernails, of one-year course. She is treated with multiple topical antifungals, without clinical improvement, so she goes to the dermatological clinic of the Ciudad Hospitalaria Dr. Enrique Tejera-Venezuela, where mycological and bacteriological cultures are evaluated and performed, reporting mixed growth. Therefore, it is essential to suspect coinfection in these cases, to carry out the appropriate diagnostic methods and establish an optimal and timely treatment. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the prevalence of superficial mycoses and the related risk factors among cyclists in a selected municipality of Boyaca's department, Colombia. MATERIALS AND METHODS: A descriptive cross-sectional study was carried in out from November 2022 to January 2023 on athletes of the "Evolution cycling club" of Tuta, Boyacá, Colombia. A collection of samples was taken from different affected anatomical areas (skin, hair and nails). The skin and nail samples were subjected to different concentrations of KOH (10-40%) and cultured on PDA agar which was supplemented with chloramphenicol. In order to finally observe the morphological structures Gram stain and lactophenol blue were performed, and then the samples were placed under a microscope in a 40X objective for the lactophenol blue stained ones and under the 100X objective for the Gram-stained sample. RESULTS: Samples of nails/scales from 28 patients were analyzed, 18 of these showed some type of mycosis, of which 6 were diagnosed with pityriasis capitis, 4 with different types of onychomycosis, two presented tinea pedis vesiculosa and 8 interdigital tinea pedis. In some of these patients, one to five etiological agents were observed. CONCLUSIONS: Superficial mycoses are very frequent in athletes due to different predisposing factors such as sweating, environmental factors and factors related to the gear and equipment used during competitions such as helmets, shoes, uniforms and other protective elements that can turn into fomites and reservoirs that can increase the development and growth of a wide variety of different microorganisms. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To characterize Costa Rican clinical isolates of the T. mentagrophytes complex to determine the predominant species and their susceptibility pattern. MATERIALS AND METHODS: An experimental study was conducted to typify and determine the antifungal susceptibility of isolates from the T. mentagrophytes complex, obtained from skin and nail samples, done from 2019 to 2020. Molecular typification was performed by sequencing the ITS region. Broth microdilution M38-A method, as described by the Clinical Laboratory and Standards Institute, was employed to determine the antifungal susceptibility patterns of the isolates. RESULTS: Fifteen isolates were analyzed and all were identified as Trichophyton interdigitale. The MIC50 and MIC90 were 0.13 and 0.50 μg/mL for amorolfine, 0.25 and 0.50 μg/mL for bifonazole, 0.50 and 5.60 μg/mL for ciclopirox, 0.25 and 6.70 μg/mL. for itraconazole, 32 and 89.60 μg/mL for fluconazole, and 0.13 and 0.35 μg/mL for terbinafine respectively. CONCLUSIONS: In the present study, only T. interdigitale was identified among the species belonging to T. mentagrophytes complex, which demonstrates a person-toperson transmission. All isolates were susceptible to amorolfine, bifonazole, ciclopirox and terbinafine. However, the majority exhibited resistance to itraconazole and fluconazole. [ABSTRACT FROM AUTHOR]

Copyright of Revista Médica Clínica Las Condes is the property of Editorial Sanchez y Barcelo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: to describe the effects of low-level laser therapy and of topical drug treatment for onychomycosis in people with diabetes. Method: a qualitative study of the case-series type. The participants were 21 individuals with diabetes divided into two groups, the first treated with laser and the second with topical medication from October 2020 to August 2021. The data were collected in a clinical history and examination of the nail plates and organized in a database, whose analysis took place through descriptive statistics. Results: it was identified that 30% and 26% of the nail plates attained clinical cure in groups I and II, respectively. When assessing the satisfactory response, groupsI and II presented 63% and 53%, respectively. Conclusion: the onychomycosis treatment with laser therapy presented higher prevalence of satisfactory response and clinical cure than the topical drug treatment. [ABSTRACT FROM AUTHOR]

Tinea pedis and onychomycosis are common superficial skin infections and are seen in both tropical and subtropical regions. Tinea pedis is distinguished by lesions in the sole of the foot, while onychomycosis affects the morphological structure of the nail. It is recognized that the main microorganisms related to these two diseases are Trichophyton rubrum and Trichophyton interdigitale. These diseases are an important cause of medical consultation and although they do not have a significant mortality rate, they have a high emotional and physiological impact, can even cause stigmatization and social exclusion. Nail changes can cause pain when walking or standing for a long time, with mobility impairment, or when performing some activities; they are common among athletes, especially soccer players. The aim of the present bibliographic review was to describe the clinical presentation of tinea pedis and onychomycosis, their pathogenesis, the main pathogens involved and the prevalence in soccer players. For the development of this topic review, a literature search was carried out in English and Spanish languages, published between 2015 and 2021. Electronic databases such as PUBMED, NCBI, Science Direct and Journal using the keywords validated in DeCS. With the present review, it was possible to show that onychomycosis occurs in 3 characteristic forms, and it was possible to establish that the prevalence of onychomycosis and tinea pedis in soccer players is of 60.7% and 36.9%, respectively. [ABSTRACT FROM AUTHOR]

Objetivo: Identificar la autoestima de los pacientes con onicomico-sis de la clínica de consulta externa Huixquilucan, ISSEMyM.Material y Métodos: Fue estudio descriptivo, transversal y obser-vacional, que se realizó en la clínica de Consulta Externa Huixquilu-can del 1° de agosto al 31 de septiembre de 2019. Se trató de una muestra a conveniencia de 100 derechohabientes con diagnóstico de onicomicosis; para determinar la autoestima se utilizó el cues-tionario de Rosemberg, previa autorización del comité de ética e investigación y el consentimiento informado del paciente. Para el análisis estadístico se utilizó el programa SPSS V22.Resultados: Se incluyeron 100 derechohabientes de 20 a 76 años con un promedio de 49 años; de estos 45% son hombres y 55% mujeres; el 78% presentó autoestima alta y de estos al 62% le ge-neró vergüenza padecer onicomicosis. Discusión: Este estudio no concordó con estudios realizados en Latinoamérica, donde sí se ve afectada la autoestima.Conclusiones: La mayoría de los pacientes presentó autoestima alta a pesar de padecer onicomicosis.

Introduction: foot diseases in the elderly are varied, so that they often suffer from one or several alterations in the same or in both feet, it is stated that 70% of people over 65 years of age have some disorder related to the foot, there being no history of studies in our environment to prove it. Objective: to determine the most frequent podiatric disorders in older adults seen at the podiatry office of the "Chiqui Gómez Lubián" polyclinic. Method: an observational, descriptive, cross-sectional research was carried out with 327 older adults attended in the podiatry office of the polyclinic "Chiqui Gómez Lubián" of Santa Clara municipality. Villa Clara, from January to December 2018. Results: the female sex was the one who most attended consultation and within them the age group from 70 to 79 years, the inadequate use of footwear was found in 67.58% of the population, 80.1% of patients had two or more podiatric conditions, predominantly onicopathies in 90.1% of these, an association was found between hyperkeratosis and deformities of the toes. Conclusions: the female sex was the most affected, the use of inadequate footwear was associated with the appearance of podiatric conditions, which in order of frequency were onychopathies, dermatological conditions and toe deformities.

Copyright of Revista de Ciencias Médicas de Pinar del Río is the property of Editorial Ciencias Medicas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Onychomycosis is the most common nail disease and represents around 50-60% of nail disorders. A PAS-stained biopsy is considered the gold standard for diagnosis. The objective of the study was to determine the diagnostic performance using KOH by pressing to evaluate the presence of onychomycosis compared to the gold standard. Materials and methods: 102 nail plates, 51 clinically healthy and 51 clinically diseased, were taken, and two methods were performed: KOH by pressing and nail biopsy by distal cut with PAS staining, independently evaluated by two experienced dermatopathologists. Sensitivity, specificity, negative predictive value, positive predictive value, validity (likelihood ratios), efficiency (proportion of correctly diagnosed patients), and reproducibility (Kappa index) were calculated. Results: In the 102 samples evaluated, 3 of the 5 clinical subtypes were found: superficial white (1.8%), distal subungular (47.2%), and total dystrophic (50.9%). The direct examination (KOH) test by pressing presented a sensitivity of 67.3%, a specificity of 74.5%, a positive predictive value of 75.5%, and a negative predictive value of 66.0% (p <0.001). The likelihood ratios were also calculated: LR+ 2.63; 95% CI: 1.56-4.44; and LR-0.44; CI 95%: 0.29-0.67. The efficiency was 70.58%. The concordance between the two tests was moderate (Kappa index: 0.414). Conclusion: The direct examination method (KOH) by pressing is a useful and easy diagnostic tool to perform with results obtained in a maximum period of 72 hours, which allow a diagnostic approach in onychomycosis, with the possibility of rapid decision-making. [ABSTRACT FROM AUTHOR]

The use of nail beautification products is becoming more frequent and widespread in the general population, but the effects and complications that the components or the applied techniques can produce are largely unknown. This article reviews the effects of the use and abuse of cosmetics on nails, dividing them according to their nature into inflammatory, mechanical and infectious. The objective of this review is to provide tools for the adequate approach to the alterations of the nail units, taking as a premise the exposure history for the recognition of these conditions, and thus preventing them, as well as provide adequate treatment and recommendations for their use. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Ciencias Médicas de Pinar del Río is the property of Editorial Ciencias Medicas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Enfermagem e Atenção à Saúde (REAS) is the property of Revista de Enfermagem e Atencao a Saude - Reas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Enfermagem e Atenção à Saúde (REAS) is the property of Revista de Enfermagem e Atencao a Saude - Reas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Enfermagem e Atenção à Saúde (REAS) is the property of Revista de Enfermagem e Atencao a Saude - Reas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJECTIVE: To report the epidemiological and clinical characteristics and the distribution of etiological agents in the ungueal infections observed in patients assisted to a high specialty hospital during a period of 21 years. MATERIALS AND METHODS: An observational, retrospective and analytical study reviewing the positive onychomycoses studies of the Specialty Hospital, CMN Siglo XXI, Mexico City, over a period of 21 years, recording the epidemiological data of patients and comorbidity to stablish a correlation between onychomycosis and patient conditions. We counted the causal agents and frequency of positivity of the diagnostic methods. RESULTS: Of 12,813 mycoses diagnosed, 6547 corresponded to onychomycosis. Sixty percent were women, the average age was 47 years old. Diabetes mellitus increased the risk of infection in 2.2 1 times. Dermatophytes and molds caused onychomycosis in 5446 cases and yeasts in 1101 patients. Microscopic test was positive in 6484 patients. There were 2046 positive cultures, 53.8% were yeasts. The frequency of dermatophytes was 32.8%. Of the molds the most common genera were Aspergillus spp and Fusarium spp. CONCLUSIONS: Onychomycosis has been shown to be a very common infection in patients treated in high specialty hospitals. Diabetes and hypertension greatly increase the risk of this infection. [ABSTRACT FROM AUTHOR]

Cosmetic nail polishes aim to superimpose a colored or transparent layer on the fingernails and toenails. They are made up of solvents (homogenize and dissolve), resins (give shine and hardness), film fixers (form a thin layer), plasticizers (give adhesion and flexibility), driers and colorants. Unfortunately, we barely know about the effects on the skin secondary to its components, for example, brittle nails syndrome and onychomycosis secondary to nail enamel. Also, the use of long-lasting enamels (gels) can be a trigger of allergic contact dermatitis, which is why they are now included in patch tests. An intervention to considerer includes cosmetic nail polishes 3-, 4-, 5-free (3-free: free of toluene, formaldehyde, and dibutyl phthalates, and the 4- and 5-free which are additionally free of formaldehyde resins and camphor, respectively). This review is proposed to address some topics of dermatological interest associated with the use of cosmetic nail polishes. [ABSTRACT FROM AUTHOR]

Introducción: las infecciones fúngicas en piel, cabello y uñas son comunes a nivel mundial, en este marco, la onicomicosis constituye la enfermedad más prevalente de la que la provincia no es ajena. Objetivo: describir factores de riesgo, características y dermatosis asociadas en pacientes mayores de 18 años con onicomicosis en un área de salud. Métodos: estudio observacional, descriptivo y transversal en la consulta de Dermatología del Policlínico Universitario “Raúl Sánchez Rodríguez”, en el período 2017-2018. Resultados: predominó el sexo femenino (55,1 %) y el grupo de edades entre 40 y 59 años (43,8 %), el factor de riesgo predominante fue el empleo de calzado oclusivo (84,9 %). Predominó la localización en pies (unilateral) (45,9 %), la forma clínica lateral + superficial distal (33 %), así como de la onicolisis + incurvación (54,6 %) como principal alteración ungueal. La principal modificación ungueal fueron las líneas longitudinales (70,8 %), en cuanto a la consistencia un engrosamiento de las uñas (68,1 %), siendo la leuconiquia (47 %) y melnoniquia (36,8 %) las principales coloraciones detectadas. La tiña pedis (55 %) y la crural (10,8 %) fueron las dermatosis asociadas más frecuentes. Conclusiones: es importante el conocimiento del comportamiento clínico epidemiológico de las onicomicosis para de esta manera poder actuar y modificar los factores de riesgo e incidir sobre las dermatosis asociadas y de alguna manera disminuir la incidencia de onicomicosis.

Introduction: foot diseases in the elderly are varied, so that they often suffer from one or several alterations in the same or in both feet, it is stated that 70% of people over 65 years of age have some disorder related to the foot, there being no history of studies in our environment to prove it. Objective: to determine the most frequent podiatric disorders in older adults seen at the podiatry office of the "Chiqui Gómez Lubián" polyclinic. Method: an observational, descriptive, cross-sectional research was carried out with 327 older adults attended in the podiatry office of the polyclinic "Chiqui Gómez Lubián" of Santa Clara municipality. Villa Clara, from January to December 2018. Results: the female sex was the one who most attended consultation and within them the age group from 70 to 79 years, the inadequate use of footwear was found in 67.58% of the population, 80.1% of patients had two or more podiatric conditions, predominantly onicopathies in 90.1% of these, an association was found between hyperkeratosis and deformities of the toes. Conclusions: the female sex was the most affected, the use of inadequate footwear was associated with the appearance of podiatric conditions, which in order of frequency were onychopathies, dermatological conditions and toe deformities. [ABSTRACT FROM AUTHOR]

Una proporción importante de infecciones en el pie diabético consisten en onicomicosis y tinea pedis, problema común en el pie, amenazante de la viabilidad del tejido que puede provocar infecciones bacterianas secundarias. Requieren períodos prolongados de tratamiento antimicótico con alta tasas de recaídas y reinfección. Diversos estudios han mostrado la seguridad y eficacia de las nanopartículas de plata (NP Ag) como agente antimicrobiano. Realizamos un estudio donde se evaluó el tratamiento con NP Ag en dermatomicosis del pie de pacientes diabéticos. Método: estudio piloto, abierto, prospectivo, randomizado y controlado en pacientes que asisten a una policlínica de pie diabético. Dieciocho pacientes cumplieron con los criterios de inclusión conformándose dos grupos homogéneos. Ambos grupos recibieron tratamiento estándar que consistió en antimicótico tópico y desbastado mecánico. El grupo intervención utilizó un textil (medias) confeccionadas con hilos con NP Ag. Se realizó control clínico y microbiológico hasta las 12 semanas. Se evaluó el porcentaje de remisión y el tiempo hasta alcanzar el mismo. Resultados: predominó la onicomicosis y el germen Trichophyton rubrum. En el grupo intervención se logró un mayor porcentaje de remisión de lesiones y en un tiempo menor que el grupo control. Conclusiones: el uso de medias confeccionadas con hilos de NP Ag se asoció con una mayor probabilidad de curación completa en un período de 12 semanas a pesar de que el número de pacientes no permitió llegar al nivel de significación estadística, pudiendo contribuir a la prevención de infecciones o úlceras suplementarias en el pie diabético.

BACKGROUND: Onychomatricoma is a benign fibroepithelial tumor of the nail, first described in 1992 by Baran and Kint. The classic tetrad signs include thickening of the nail plate, xantonychia, transverse overcurvature of the nail plate and splinter hemorrhages. Some of these clinical features are also seen in onychomycosis, which leads to a misdiagnosis and delay in tumor detection. When nail plate is avulsed, a villous tumor emerging from the matrix is observed. The diagnosis is based on clinical findings, where dermatoscopy plays an important role, as do images such as magnetic resonance and ultrasound, but diagnosis is confirmed by histopathological findings. Complete surgical excision is the treatment of choice. CLINICAL CASE: A 56-year-old female patient with an initial diagnosis of onychomycosis, in who an onychomatricoma was suspected by clinical findings, dermoscopy and imaging, which was finally confirmed by histopathology. CONCLUSIONS: Onychomatricoma diagnosis is often delayed due to lack of knowledge about this disease, which sometimes causes an initial diagnosis of onychomycosis. [ABSTRACT FROM AUTHOR]

Introducción: los hongos miceliales no dermatofitos (HMND) pueden causar un gran número de infecciones, entre ellas, la onicomicosis. Su implicancia como agentes patógenos y su significado clínico en esta afección, se encuentran sujetos al cumplimiento de los criterios de Walshe y Mary P. English. Presentamos un caso de onicomicosis causada por un hongo hifomiceto poco frecuente, del género Aspergillus sección Candidi, en una paciente inmunocompetente y su estrategia terapéutica. Materiales y métodos: se estudió una paciente inmunocompetente, de 43 años de edad, con lesión en uña de primer dedo del pie derecho, de 10 años de evolución. Se realizó toma de muestra para examen micológico. Resultados: el examen directo reveló la presencia de hifas hialinas irregulares, ramificadas y tabicadas, compatibles con HMND. En muestras seriadas, desarrollaron colonias blanco algodonosas, cuya micromorfología fue concordante con Aspergillus sección Candidi. La identificación fue confirmada en la Unidad de Micología del Hospital de Infecciosas Francisco Javier Muñiz de la Ciudad Autónoma de Buenos Aires, Argentina. Allí también se realizaron pruebas de sensibilidad a antifúngicos, resultando sensible a itraconazol y terbinafina. Conclusión: exponemos un caso de onicomicosis causada por Aspergillus sección Candidi, HMND no queratinolítico, de escasa frecuencia de aparición, siendo el primer caso descripto y publicado en Argentina. También se planteó una estrategia terapéutica efectiva, que condujera a la cura clínica y microbiológica, de la uña de la paciente.

BACKGROUND: Onychomycosis caused by yeasts are rising, Candida species are the most common; however, Rhodotorula, Trichosporon and Malassezia can also cause this type of infection. OBJECTIVE: To determine the clinical and epidemiological characteristics of cases of onychomycosis caused by yeasts. MATERIAL AND METHOD: A prospective, descriptive and observational study including patients with yeast onychomycosis confirmed by mycological study was done from January to July 2019. The strains were identified by CHROMagar Candida® medium and zymogram technique. A clinical epidemiological questionnaire was applied. RESULTS: Seventy-seven patients with onychomycosis in yeast were included. It was more common in females (74.1%). The mean age of patients was 54.5 years, those over 60 were the most frequent (n = 32). Regarding occupation, housewives were the most common (n = 43, 55.9%). The fingernails were affected in 39 cases (50.6%). Total dystrophic onychomycosis was the most frequent clinical presentation in 51 patients (66.2%). Direct microscopy with KOH was positive in 38/77 (49.4%) patients and the culture showed growth in 100%. C. krusei was the most common agent identified in 26 cultures (33.7%), followed by C. albicans with 17 (22%). CONCLUSIONS: Total dystrophic onychomycosis and C. krusei were the most frequent in this study; we recommend performing a mycological study when suspecting onychomycosis to identify the fungal etiology, so that, in case of finding yeast, an adequate treatment should be given. [ABSTRACT FROM AUTHOR]

BACKGROUND: Onychomycosis is the infection of the nails by fungi, dermatophytes, yeasts or non-dermatophyte molds. It is associated with a high rate of therapeutic failure (20-50%) due to resistance to different therapeutic agents. OBJECTIVE: To perform a systematic review of the literature to establish the clinical effectiveness of topical antifungals to treat onychomycosis. METHOD: A systematic review of the literature was carried out; original articles were included in English, Spanish and Portuguese, between 1999 and 2016, in five indexed databases. RESULTS: Eight studies were included, classified with a low and indeterminate risk of biases, and a quantitative summary of the results was made: the clinical effectiveness was higher in the 8% water soluble cyclopiroxolamin group vs the 5% amorolfine group with a duration of treatment between 9 and 12 months), as well as in the group of 10% topical efinaconazole solution vs placebo whose treatment time was 12 months and in the group of tavaborole topical solution at 5% vs placebo for 12 months. CONCLUSIONS: When the lamina is less than 60% compromised, in patients without immunosuppression, 8% water soluble cyclopiroxolamin lacquer is superior to 5% amorolfine lacquer, and efinaconazole solution at 10% and tavaborole topical solution at 5% are superior to placebo; however, the complete cure rates found were not greater than 40% in any study, during a maximum treatment time of 12 months. [ABSTRACT FROM AUTHOR]

BACKGROUND: Scopularíopsis sp is a causal agent of onychomycosis; however, its therapeutical regimen hasn't been established. OBJECTIVE: To evaluate the in vitro activity of fluconazole, itraconazole, terbinafine, ciclopirox and amorolfine against clinical isolates of Scopulariopsis sp. MATERIAL AND METHOD: An experimental study was done to assess the in vitro susceptibility of 11 clinical isolates of Scopulariopsis sp using the microdilution method M38-A, as described by the Clinical Laboratory Standards Institute, from August to December 2017. The final concentrations were: 0.13-64 pg/mL for amorolfine and terbinafine, 0.06-32 pg/mL for ciclopirox, 0.03-16 pg/mL for itraconazole and 0.25- 128 pg/mL for fluconazole. RESULTS: The MICS0 and MICgo were 0.13 and 24 pg/mL for amorolfine, 2 and 4 pg/mL for terbinafine, 4 and 8 pg/mL for ciclopirox, > 16 y > 16 pg/mL for itraconazole and > 128 and> 128 pg/mL for fluconazole, respectively. CONCLUSIONS: Amorolfine and terbinafine exhibited the highest antifungal activity and fluconazole the lowest against clinical isolates of Scopulariopsis sp. [ABSTRACT FROM AUTHOR]

La onicomicosis afecta a entre el 2 y el 30% de la población mundial; la biopsia ungueal facilita el diagnóstico y diferencia invasión de colonización. Evaluar la utilidad diagnóstica de la biopsia ungueal con coloración de PAS en las onicomicosis frente al examen directo con KOH, el cultivo y su combinación en un laboratorio de referencia de Colombia. Se incluyó a 66 pacientes, a quienes se les realizó lectura ciega e independiente de las tres pruebas; la utilidad se definió a partir de los resultados de validez (sensibilidad, especificidad, índice de Youden, cocientes de probabilidad), desempeño (valores predictores), eficiencia (proporción de pacientes correctamente diagnosticados) y reproducibilidad (índice kappa). La edad media de los pacientes fue 55 ± 16 años, el 76% fueron mujeres y el 66,7% (n = 44) de los exámenes directos con KOH resultaron positivos; para el cultivo, el 62,1% (n = 41) de las muestras fueron positivas y con la biopsia lo fueron el 56,1% (n = 37). Los principales agentes causales fueron mohos no dermatofitos en un 36,4% (n = 24) y las especies con la mayor frecuencia fueron Neoscytalidium dimidiatum (n = 11), Trichophyton rubrum (n = 11) y Candida parapsilosis (n = 13). La sensibilidad de la biopsia ungueal frente al KOH o el cultivo fue del 71%, la especificidad del 83%, el índice de Youden 0,54, el cociente de probabilidad positivo de 4,25, el cociente de probabilidad negativo de 0,35, el valor predictivo positivo el 92%, el valor predictivo negativo el 52%, la eficiencia el 74% y el coeficiente kappa 0,45. Al evaluar la biopsia solo en pacientes con onicólisis de la lámina ungueal superior al 50%, aumentaron todos los parámetros de utilidad diagnóstica. La utilidad global de la biopsia fue moderada para pacientes con mayor sintomatología, por lo que se recomienda su uso en presencia de onicólisis extensa y en los casos en los que se requiera discriminar colonización de invasión. Onychomycosis affects between 2% to 30% of the world population. Nail biopsy may help in making a diagnosis and can distinguish between invasion and colonisation. To evaluate the diagnostic usefulness of nail biopsy with Periodic acid–Schiff (PAS) staining for onychomycosis, compared to direct KOH examination, culture and its combination in a reference laboratory in Colombia. The study included 66 patients in whom a blind and independent reading of the three tests was performed. The usefulness was defined based on the validity (sensitivity, specificity, Youden's index, likelihood ratios), performance (predictive values) efficiency (proportion of correctly diagnosed patients), and reproducibility (kappa coefficient). The mean age of the patients was 55 ± 16 years, and included 76% women. The direct tests with KOH were positive in 66.7% (n = 44), 62.1% (n = 41) were positive with culture, and 56.1% (n = 37) with the biopsy. The main causal agents were non-dermatophytes moulds in 36.4% (n = 24). The most frequent species were Neoscytalidium dimidiatum (n = 11), Trichophyton rubrum (n = 11), and Candida parapsilosis (n = 13). The sensitivity of nail biopsy, when compared to the standard (KOH and/or culture), was 71%, specificity 83%, Youden's index 0.54, positive likelihood ratio 4.25, negative likelihood ratio 0.35, positive predictive value 92%, negative predictive value 52%, efficiency 74% and kappa coefficient 0.45. When biopsy was evaluated only in patients with onycholysis of the nail plate greater than 50%, all the parameters of diagnostic usefulness increased. The overall usefulness of the biopsy was moderate for patients with more severe symptomatology, which makes its use advisable in cases of extensive onycholysis, and when discriminating colonisation from invasion is required. [ABSTRACT FROM AUTHOR]

Introduction: Onychomycosis is the infection caused by pathogen or saprophyte fungi in the nail structure of hands or foot. Associated factors show differences according to the analyzed region. Therefore, the purpose if this study was to determine the epidemiologic characteristics of adult patients with onychomycosis diagnoses from the rural province of Los Ríos, Ecuador. Methodology: A descriptive, transversal study was performed in 384 adult patients diagnosed with onychomycosis in 3 health centers of the Vinces and Urdaneta counties in Los Rios province from May 2016 to May 2017. The Dermatology Life Quality Index was applied in which demographic, clinical and psychological characteristics were investigated. Results: Out of the studied subjects, 56.8% (n=218) were female; the mean age was 50.7±13.7. The age group 40-55 years old was the most prevalent (37.8%, n=145). In men, prevalence rose proportionally with age. 21.1% (n=81) of the sample had diabetes, the most affected body parts were the hands (50% n=192), especially in women (72.9%) (p<0.01). 76.5% of the subjects showed worry regarding the disease, especially women (84.4%) (p<0.01), and the majority also reported that onychomycosis had great influence over their daily lives (69.8%; n=268). Conclusion: Onychomycosis is a disease with a wide variety of risk factors, which must be taken into account for appropriate treatment, including the psychological effects that are usually ignored in primary attention. [ABSTRACT FROM AUTHOR]

BACKGROUND: Superficial mycoses are generated by direct contact with the fungus or with an infected person or animal, and affect the skin, the attachments and mucous membranes; pregnant patients are susceptible to skin changes, both physiological and pathological. OBJECTIVE: To know the frequency of superficial mycoses in pregnant patients from the obstetrics service of the Hospital General Dr. Manuel Gea González. MATERIAL AND METHOD: A descriptive, observational, prospective and cross-sectional study carried out in pregnant patients of the Gineco-Obstetrics Service of the Hospital General Dr. Manuel Gea González, Mexico City, from July 2016 to July 2017. RESULTS: Twenty-three patients were included in the mycology department for their physical examination; the most affected group was between 21 and 40 age years (86.9%); 17 patients presented tinea pedis (73.9%) and 4 (17.9%) onychomycosis. CONCLUSIONS: Superficial mycosis were not frequent in the group of study: 17 patients had tinea pedis and 4 onychomycosis. The causal agent isolated was Trichophyton rubrum. [ABSTRACT FROM AUTHOR]

Antecedentes. La onicomicosis es una enfermedad que compromete las uñas y afecta el 5% de la población mundial. Objetivo. Determinar la efectividad y seguridad de la terbinafina oral en pauta intermitente versus continua para la onicomicosis en mayores de 18 años. Materiales y métodos. A través de una búsqueda sistemática electrónica en Cochrane, Medline, Embase, LILACS y Opengrey se identificaron ensayos clínicos aleatorizados paralelos, excluyendo cruzados, conglomerados o clúster. Se aplicó el RevMan 5.3 para revisiones sistemáticas de ensayos clínicos. Mediante búsqueda sistemática se identificaron ensayos clínicos aleatorizados paralelos en pacientes mayores de 18 años, de sexo masculino o femenino, humanos, en idioma inglés y español, sin límite de tiempo de publicación y cuyo desenlace fue la curación clínica y micológica, incluyendo efectos adversos leves. Se valoró el riesgo de sesgo; se utilizó RR como medida del efecto, IC95% para variables dicotómicas; la unidad de análisis fue el paciente y la estimación agrupada se calculó usando un modelo de efectos aleatorios para variables dicotómicas —método de Mantel-Haenszel en RevMan 5.3—. Resultados. El RR agrupado fue de 1.13 (IC95%: 1.06-1.2) indicando que la falla del tratamiento con terbinafina intermitente es 1.1 veces más probable que con terbinafina continua. Su RR agrupado dio 0.923 (IC95%: 0.77-1.09) indicando 7.7% de mayor probabilidad de desarrollar eventos adversos con terbinafina continua que con intermitente. Conclusiones. La terbinafina intermitente tiene menor éxito de cura clínica y micológica que la continua; su RR corregido demuestra que la pauta intermitente es 13% menos eficiente que la continua. Clínicamente los hallazgos son significativos pero estadísticamente falta poder en los estudios y un mayor tamaño de muestra agrupado para mejorar la evidencia.

Introduction: Onychomycosis is the most frequent nail-bed pathology and different pathogenic agents can cause it. Even though mortality caused by onychomycosis is not significant, the impact in the quality of life for those that suffer it can be both physiological and psychological. Consequently, their ability to work, as well as their self-esteem and ability to interact with others can be affected. Methodology: A descriptive and transversal study was performed in 384 adult patients that went to three health centers in the Vinces and Urdaneta counties. A probabilistic or intentional sampling process was enforced, including all the individuals diagnosed with onychomycosis. A data collection instrument that included sociodemographic characteristics was applied. After evaluating medical history and performing a physical exam, the Dermatology Life Quality Index (DLQI) questionnaire was used in order to evaluate the impact of the disease in the quality of life of the subjects. The SPSS program, version 19 was used for the statistical analysis, considering the results as significant when p<0.05. Results: Of the 384 evaluated individuals, 38.3% (n=147) suffered extreme impact in their quality of life, being greater in women (82.6% vs 67.5%, p=0.001). There was a higher frequency in diabetic patients (90.1%) with 82.8% of hands involvement. The mean score of the DLQI was 18; it was highest in older adults with 21 points. Diabetic individuals have 24 points and patients with hands or hands and feet involved had higher scores than those with toe onychomycosis only. Conclusion: There is a high impact in the quality of life of onychomycosis patients that must be considered at the time of treating this pathology. In our population, this is especially prevalent in women and diabetic patients. Therefore, it is necessary to pay special attention to those risk factors that might be affecting these specific groups. [ABSTRACT FROM AUTHOR]

BACKGROUND: Onychomycosis is the most common onychopathy in the world. The treatment itself continues to be a challenge for the medical community. OBJECTIVE: To determine the effectiveness of combined treatment (bifonazol 1% + urea 40%) compared with topical monotherapy (urea 40%) and placebo. MATERIAL AND METHOD: A randomized, controlled, double blind study was executed from April to July 2016. Patients had clinical and microbiological diagnosis (20% KOH test) of onychomycosis. Each patient was randomized into one of the three possible treatment branches: Combined therapy (1% bifonazole with 40% urea), monotherapy (40% urea) and placebo. Follow-up was performed during a six-week period and patients were reevaluated with a 20% KOH test and clinical response. RESULTS: Sixty patients were included; patients treated with placebo had no mycological cure (n = 0). The group treated with combined therapy (1% bifonazole with 40% urea) presented a 45% (n = 9) of mycological cure. The group treated with monotherapy (40% urea) showed a 35% (n = 7) of mycological cure; 13% (n = 8) of the patients abandoned the study; 57% (n = 34) of the patients presented a good treatment response with a reduction in the size of the lesion (< 1.5 mm) and 44% (n = 23) showed positive results with a 0.5 mm reduction of the nail's thickness. CONCLUSIONS: The combined therapy (1% bifonazole with 40% urea) turned out to be more effective than monotherapy (40% urea) and placebo, but studies with a broader sample are required. [ABSTRACT FROM AUTHOR]

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.

Objetivos: Determinar la evolución epidemiológica de las dermatomicosis en pacientes de consultorio externo durante el periodo 1976- 2005. Diseño: Estudio descriptivo, retrospectivo y analítico. Lugar: Instituto de Medicina Tropical ‘Daniel Alcides Carrión’, Universidad Nacional Mayor de San Marcos, Lima, Perú. Participantes: Pacientes positivos a dermatomicosis. Intervenciones: Se revisó las historias clínicas de 7 185 (55,3%) casos positivos a dermatomicosis. El instrumento de investigación empleado fue la ficha de levantamiento de información. Principales medidas de resultados: Agente etiológico, estación del año, sexo, edad y forma clínica. Resultados: El estudio demostró que los más afectados fueron del grupo etario de 16 a 30 años (42,7%) y sexo femenino (52,1%). La dermatomicosis más frecuente fue la onicomicosis (43,6%). Los agentes patógenos de mayor prevalencia fueron Trichophyton rubrum (33,2%), Cándida albicans (15,3%), Cándida no albicans (11,8%), Trichophyton mentagrophytes (9,4%), Malassezia spp (9,1%) y las infecciones mixtas (7,2%). Las micosis de cuero cabelludo muestran continuo aumento durante todo el estudio. El dermatofito Epidermophyton floccosum fue aislado por última vez en la década del 90. A partir de 1995 ha aumentado la prevalencia de Cándida no albicans y se encontró como especie re-emergente a la levadura Cándida tropicalis. Conclusiones: Entre los años 1976 y 2005 hubo importantes variaciones epidemiológicas en relación a las formas clínicas y a la etiología de las dermatomicosis.

Antecedentes: Trichophyton rubrum es el dermatofito más frecuentemente aislado a nivel mundial y afecta principalmente: piel glabra, uñas de las manos y de los pies. El fluconazol es utilizado con frecuencia para el tratamiento de las onicomicosis en nuestra población, por lo que el objetivo de la presente investigación fue estudiar la sensibilidad a este antifúngico, de aislamientos costarricenses de T. rubrum. Métodos: se investigó la sensibilidad in vitro al fluconazol de 80 aislamientos de T. rubrum, obtenidos de muestras de piel y sus anexos. El método utilizado fue el de microdilución M-38A, descrito por el “National Committee for Clinical Laboratory Standards”. Las diluciones finales del fluconazol fueron de 0,25 a 128 μg/ml. Resultados: la mayoría de los aislamientos fueron obtenidos de uñas de los pies (68,75%). El 86,25% de los aislamientos analizados presentaron una concentración mínima inhibitoria entre 0,25-8 μg/ml, el 8,75% entre 16-32 μg/ml y un 5% > 64 μg/ml. De estos aislamientos resistentes, dos fueron de uñas de los pies y dos de plantas de pie. Conclusión: debido a que la mayoría de los aislamientos de T. rubrum demostraron ser sensibles al fluconazol, solo se recomienda realizar la prueba de sensibilidad a este antifúngico en casos de falla terapéutica, especialmente en pacientes con onicomicosis en la cual el tratamiento es prolongado.

Se presenta el caso clínico de una paciente que consultó por una lesión onicodistrófica blanquecina en ambos hallux, de 3 meses de evolución. El examen micológico determinó que el agente causal de la infección era un moho, Curvularia lunata var. aeria. El género Curvularia se asocia a la producción de feohifomicosis. Curvularia lunata es una especie que ocasionalmente puede producir onicomicosis. Se administró tratamiento por pulsos con itraconazol 200 mg/día durante 6 meses, con remisión completa de las lesiones. Es importante tener en cuenta a estos hongos como agentes oportunistas causales de micosis ungueales, ya que el lugar inicial de infección puede significar una vía para la diseminación sistémica en pacientes inmunodeprimidos.

BACKGROUND: Diabetes mellitus is a major public health problem and many skin conditions have been associated with it. OBJECTIVE: To determine the prevalence of skin conditions in patients with diabetes, and its correlation with adequate metabolic control or lack thereof, which have never been studied in Ecuadorian patients. MATERIAL AND METHOD: An analytical cross-sectional study was done from October 2015 to March 2016 with a population of patients with type-2 diabetes from a primary health care centre in Quito, Ecuador. Patients were randomly assigned to one of three certified dermatologists for a complete evaluation. Clinical and demographic variables were obtained from the medical files and the level of glycosylated haemoglobin (HbA1c) was measured in all patients to categorise them as well controlled (HbA1c ≤ 7%) or poorly controlled (HbA1c > 7%). The prevalence of skin conditions between groups was compared using Yate's ϰ2 test. RESULTS: There were included 267 patients with type-2 diabetes; 97% of patients presented at least one skin condition, and 32 different conditions were identified. The most prevalent cutaneous abnormalities were onychomycosis (45%), acrochordons (42%) and xerosis (39%); 41% of the population was considered to have adequate metabolic control as per the value of HbA1c. Onychomycosis was the only skin disease that had a significantly higher prevalence in poorly controlled patients (p = 0.04). CONCLUSIONS: Skin problems, especially fungal infections, are present in a great majority of patients with diabetes. Such problems are easy to evaluate during the physical examination. An adequate metabolic control could potentially protect patients with diabetes from onychomycosis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Onychomycosis represents the leading cause of nail dystrophies, responsible for up to 50% of nail disorders. Chronic venous insufficiency can cause onycopathy; however, few studies exist that determine the frequency of onychomycosis. OBJECTIVE: To determine the prevalence of onychomycosis in patients with chronic venous insufficiency. MATERIAL AND METHOD: A descriptive cross-sectional study included patients with clinical diagnosis of chronic venous insufficiency confirmed by Doppler ultrasound, at Thoracic and Cardiovascular Surgery service (Hospital General de Occidente, Mexico) from September 11 to December 31st 2013. Patients were classified according to the clinical, etiologic, anatomic and pathophysiologic (CEAP) scale and by the clinical venous severity score. Samples of nail scrapings were collected for direct microscopy and fungal culture. RESULTS: Our sample included 44 patients, from which 23 (52%) tested positive for onychomycosis in direct microscopy; 34/44 patients (77%) had some nail disorder, from which 23/34 were positive for onychomycosis. Total dystrophic onychomycosis was the commonest presentation (65%), as well as Trichophyton rubrum was isolated most frequently. CONCLUSIONS: The prevalence of onychomycosis was 52%, and an evolution less than 5 years of chronic venous insufficiency is related to lower prevalence of onychomycosis (p=0.04). [ABSTRACT FROM AUTHOR]

BACKGROUND: Onychomycosis caused by F. solani are difficult to treat since this fungus presents high levels of resistance against commonly prescribed antifungal agents. OBJECTIVE: To evaluate the in vitro activity of itraconazole, terbinafine, ciclopirox and amorolfine against clinical isolates of F. solani. MATERIAL AND METHOD: A study was done in which the in vitro susceptibility of 29 clinical isolates of F. solani was determined using the microdilution method M38-A, as described by the Clinical Laboratory Standards Institute. The final dilutions were: 0.03-16 μg/mL for itraconazole, 0.13-64 μg/mL for terbinafine and amorolfine and 0.06-32 μg/mL for ciclopirox. RESULTS: The MIC50 and MIC90 for itraconazole were ≥16 μg/mL and ≥16 μg/mL, for terbinafine ≥64 μg/mL and ≥64 μg/mL, for amorolfine 1.25 μg/mL and ≥64 μg/mL and for ciclopirox 16 μg/mL and 20 μg/mL, respectively. CONCLUSIONS: Amorolfine exhibited the highest antifungal activity against clinical isolates of F. solani. [ABSTRACT FROM AUTHOR]

Justificación y objetivos: Entre las onicodistrofias, la onicomicosis es la afección más frecuente. Esta infección no solo representa un problema estético para el paciente, sino que puede afectar sus actividades diarias. Para el dermatólogo se hace indispensable realizar el diagnóstico diferencial, por lo que el laboratorio de micología médica es de gran ayuda para este propósito. En cuanto a los agentes etiológicos incriminados, los dermatofitos son los más frecuentes; sin embargo, otros hongos filamentosos no dermatofitos se han aislado, cuya sensibilidad a los antimicóticos es menor. En este trabajo se estudió la frecuencia de las onicomicosis diagnosticadas en el laboratorio de Micología Médica de la UCR durante cuatro años, según edad y sexo de los pacientes, así como agentes etiológicos identificados. Métodos: Se incluyó a todos los pacientes que solicitaron el servicio de acción social que brinda la sección de Micología Médica, Facultad de Microbiología, Universidad de Costa Rica, entre enero del 2007 a diciembre del 2010 y que presentaban alteraciones ungueales sospechosas de onicomicosis. Se registró la edad y sexo de los pacientes y las muestras se procesaron por examen directo y cultivo. Resultados: Se procesaron 431 muestras de uñas, el 85,4% eran de pie y el 14,6% de mano, la edad promedio de los pacientes fue de 49 años, el 64% eran mujeres y el 36% eran hombres. En el 73,4% se diagnosticó onicomicosis, ya sea por examen directo positivo y cultivo positivo, o solo con el examen directo, de las cuales 89,4% eran uñas de pie y 10,6% uñas de manos. De las uñas de los pies se aisló más frecuentemente Trichophyton rubrum y en segundo lugar Fusarium spp. En uñas de manos C. albicans fue el agente etiológico más frecuente. Conclusión: En el diagnóstico de las onicomicosis se debe considerar tanto la clínica como los hallazgos de laboratorio. En la población estudiada se identificaron dermatofitos, levaduras y hongos filamentosos no dermatofitos, lo que es importante tener en cuenta por las implicaciones en la elección del tratamiento.Background and aim: Among the onychodistrophies, onychomycosis are the most frequently encountered. This infection not only constitutes an esthetic problem for the patients, but can also affect their daily activities. For dermatologists, it is crucial to make a differential diagnosis; thus, the medical mycology laboratory plays an important role to achieve this purpose. The fungal agents most frequently encountered are the dermatophytes, however, other filamentous non-dermatophyte fungi have been isolated and are known to be less susceptible to antifungals. In the present work, the frequency of onychomycosis among patients attending the medical mycology laboratory, UCR, was studied during four years, according to the age and sex of the patients, as well as the isolated etiological agents identified. Methods: The study included all patients that requested the community service provided by the Department of Medical Mycology, School of Microbiology, UCR, between January 2007 and December 2010 and that showed nail alterations suspicious for onychomycosis. The age and sex of each patient were registered and samples were processed for direct microscopy and culture. Results: A total of 431 nail samples were collected, of which 85.4% were toenails and 14.6% fingernails. The mean age of the patients was 49 years, of which 64% were females and 36% males. Onychomycosis was diagnosed, either by direct microscopy and culture, or only with positive direct microscopy, in 73.4% of the sample population, of which 89.4% were toenails and 10.6% fingernails. Trichophyton rubrum was the etiological agent most frequently isolated from toenails, followed by Fusarium spp. C albicans was the most frequent fungal agent observed in fingernails. Conclusion: The diagnosis of onychomycosis relies upon both the clinical and laboratory diagnosis. Dermatophytes, yeasts and non-dermatophyte filamentous fungi were identified in the population studied. These findings should be considered due to their implications to the choice of the most appropriate treatment.

The incidence of Trichosporon spp. yeast isolates from clinical samples tested in the Mycology Laboratory at the Institute of Biomedicine over a period of 10 years (2000-2010) was evaluated. There were a total of 14 cases, representing an incidence of 0.13%; the cases showed 71% positivity on direct examination. 57% of the cases were in nails of the hand and foot. In contrast to cases reported for Candida, toenails were the most affected (50%) by Trichosporon spp. in this study.

Abstract: The incidence of Trichosporon spp. yeast isolates from clinical samples tested in the Mycology Laboratory at the Institute of Biomedicine over a period of 10 years (2000-2010) was evaluated. There was a total of 14 cases, representing an incidence of 0.13%; the cases showed 71% positivity on direct examination. 57% of the cases were in nails of the hand and foot. In contrast to cases reported for Candida, toenails were the most affected (50%) by Trichosporon spp. in this study. Resumen: Se evaluó la incidencia de aislados de la levadura de Trichosporon spp. a partir de las muestras clínicas procesadas en el Laboratorio de Micología del Instituto de Biomedicina en un lapso de 10 años (2000-2010). Encontrándose un total de 14 casos, lo que represento una incidencia del 0,13%, los casos mostraron 71% de positividad en el examen directo. El 57% de los casos fueron uñas de mano y pie, al contrario de lo reportado en Candida, las uñas de pie fueron las más afectadas (50%) por el Trichosporon spp. en este estudio.

Justificación y objetivo: Las infecciones de las uñas producidas por hongos son un problema de frecuente consulta dermatológica. Los dermatofitos son la mayor causa de estas infecciones, siendo Trichophyton rubrum el agente etiológico más importante. Sin embargo, los hongos no dermatofitos, tanto hialinos como fuliginosos, pueden ser también responsables de estos cuadros clínicos. Debido a que estos hongos tienden a ser resistentes a los antimicóticos comúnmente usados para tratar las onicomicosis, es que se hace indispensable que el clínico se asegure por medio de un examen de laboratorio de la etiología de la infección. Métodos: Se estudiaron tres casos de pacientes con lesiones en uñas, que acudieron al laboratorio de Micología Médica, Facultad de Microbiología, Universidad de Costa Rica. Se realizaron los análisis de rutina para aislamiento e identificación de hongos patógenos. Resultados: En los tres casos estudiados se observó al examen directo micelio fuliginoso. En uno de los casos se aisló e identificó Scytalidium dimidiatum, hongo que presenta resistencia a los antifúngicos utilizados para tratar onicomicosis. Conclusión. El reporte de hongos diferentes a los dermatofitos como agentes etiológicos de onicomicosis es importante para que el médico pueda elegir el tratamiento más recomendado para este tipo de infección.Background and aim: Onychomycosis is one of the commonest dermatological conditions. Dermatophytes, especially Trichophyton rubrum, are responsible for the majority of infections. However, hyaline non-dermathophyte and demataceous fungi may also cause nail infections. The antifungal agents commonly use to treat non-dermatophyte nail infections are of low efficacy. Thus, the medical doctor must be provided with a laboratory diagnosis of the etiological agent before treating the patient. Methods: Three clinical cases of nail infections were studied in the laboratory of Medical Mycology, School of Microbiology, University of Costa Rica. Routine analysis for the isolation and identification of fungal pathogens were performed. Results: In the three clinical cases studied demataceous mycelia was observed in the direct mount. In one of the cases Scytalidium dimidiatum, a fungus resistant to antifungal therapy, was isolated. Conclusion: It is important to report non-dermathophyte fungi that are known to cause onychomycosis to guide the medical doctor in the treatment of this infection.

El rol de los hongos filamentosos hilalinos no dermatofitos, como agentes causales de onicomicosis, ha sido documentado en las últimas tres décadas por diferentes autores y son considerados oportunistas emergentes. El objetivo de este trabajo es presentar un caso de onicomicosis producido por Acremonium kiliense, cuya evolución fue estudiada. Se presentó al laboratorio de micología un paciente de 18 años de edad de sexo femenino con traumatismo en la uña del primer dedo del pie derecho. Se tomaron muestras seriadas de la lesión para la observación microscópica directa con OHK 40% p/v y para cultivos en Agar Sabouraud, Agar Lactrimel y DTM (medio selectivo para dermatofitos) y con las colonias recuperadas se efectuaron microcultivos. Se implementó tratamiento con ciclopirox laca al 8% combinado al principio con Itraconazol vía oral (100 mg/día), con buena evolución. Es importante tener en cuenta a estos hongos oportunistas como agentes etiológicos potenciales de micosis ungueales, en especial en pacientes inmunodeprimidos, ya que la afección ungueal puede ser la puerta de entrada para la diseminación de la infección.The role of non-dermatophytic hyaline filamentous fungi as agents of onychomycosis has been documented in the last three decades by different authors, who have considered these fungi emerging opportunists. A 18-year-old female patient with trauma to the first toenail of the right foot came to the mycology laboratory. Serial samples of the lesion were collected for direct microscopic observation using 40% (w/v) potassium hydroxide (KOH) and for culture in Sabouraud agar, Lactrimel agar and DTM (dermatophyte selective medium). Microcultures were grown from the colonies recovered. Treatment with 8% ciclopirox nail lacquer, combined at the beginning with oral administration of itraconazole (100 mg a day), was implemented with good evolution. It is important to consider these opportunist fungi as potential etiological agents for nail mycosis, specially in immunosuppressed patients, since nail disease can be the entry point for the spread of infections.

White piedra caused by Trichosporon spp is a chronic, asymptomatic and superficial hair mycosis. Disseminated infections are uncommon. Diagnosis is confirmed by a mycological test and the culture allow us to identify these fungi. Treatment includes systemic and topical antifungals agents. [ABSTRACT FROM AUTHOR]

BACKGROUND: Onychomycosis is the most common disease of the nail apparatus, laboratory diagnosis routinely includes direct exami-nation with KOH and cultures, but its sensitivity and specificity are variable, this is influenced by the mycologist's experience and by the performance of one or more serial studies. OBJECTIVE: To determine whether conducting serial mycological studies in patients with clinically suspected feet onychomycosis increases the detection of the disease. MATERIAL AND METHOD: A descriptive, prospective, longitudinal study was conducted, 154 patients were included with clinical suspicion of feet onychomycosis. All patients underwent a first direct examination with KOH and mycological culture (Sabouraud dextrose agar with and without antibiotics) for diagnostic confirmation. Patients that presented negative results on examination underwent these same tests with a maximum of 3 times. RESULTS: Of the 154 enrolled patients diagnostic confirmation was obtained by direct and/or mycological culture in 62% in the first study, 78% with two studies and 82.5% after three serial mycological studies. Finally 27 patients persisted with negative results. The most common clinical presentation was total dystrophic onychomycosis found in 62% of patients and the most frequent isolated fungus was Trichophyton rubrum in 55%. CONCLUSIONS: In patients with clinically suspected onychomycosis, we recommend performing two mycological studies, leaving to the discretion of the physician the request of a third study. [ABSTRACT FROM AUTHOR]

BACKGROUND: Onychomycosis are fungal infections of the fingernails and/or feet. Among the groups with the highest prevalence of onychomycosis, individuals with HIV/AIDS highlight. These patients have important morbidity, clinical presentations are more aggressive and unusual and they are more likely to develop resistance to conventional treatment. OBJECTIVE: To determine the frequency of onychomycosis in patients with HIV and nail disorders. MATERIAL AND METHOD: A cross-sectional study in 250 patients with HIV and nail changes was carried out. A target nail was selected and it has been made a mycological study (direct examination with potassium hydroxide 20% and cultures in Sabouraud dextrose agar simple and antibiotics) was performed. In addition, a clinical, epidemiological questionnaire was conducted. RESULTS: A frequency of onychomycosis of 55% was obtained, the male gender predominated in 88%; the most frequent age group was 38 to 47 years (40%). The toenails were affected in 91%. The distal subungual onychomycosis was the most observed with 69%. Trichophyton rubrum prevailed in the isolates. We found no statistically significant link between CD4 count and onychomycosis. CONCLUSIONS: We found a frequency of onychomycosis of 55% in patients with HIV/AIDS and nail changes; in this group of patients with nail changes it is important to do a mycological study, as they may be a likely focus of systemic infection. [ABSTRACT FROM AUTHOR]

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Introduction: The nails present various changes and diseases due to age, and the elderly are no exception to this. Aims: To learn about the most frequent nail diseases in elderly patients of our hospital unit. Methodology: A descriptive study was performed on patients hospitalized at Hospital General de Enfermedades IGSS in medical services during February and March 2015, to investigate the occurrence of nail diseases in hands and feet of elderly patients. All the patients had a complete exam of finger and toe nails. Results: The alterations detected in fingernails were: onychorrhexis, 36 (22.99%); half-and-half nails, 5 (5.75%); Leukonychia apparent, 3 (3.45%), onychoschizia, 3 (3.45%); proximal fold hematoma due to oximeter, 3 (3.45%); onycholysis, 3 (3.45%); splinter hemorrhages, 3 (3.45%); pterygium, 2 (2.30); worn-down nails, 2 (2.30); onychodystrophy, 1 (1.15%); nail biting, 1 (1.15%); parrot beak nails, 1 (1.15%), Beau's lines, 1 (1.15%); paronychia, 1 (1.15%); trauma, 1 (1.15%); Beau's ridges, 1 (1.15%). At feet level the alterations found were: onychomycosis, 31 (29.52%); onychogryphosis, 16 (15.24%); pterygium, 8 (7.62%); overriding toes, 5 (4.76%); platonychia, 5 (4.76%); pincer nails, 4 (3.81%); frictional melanonychia, 4 (3.81%); onychorrhexis, 4 (3.81%); onychodystrophy, 4 (3.81%); hematoma, 3 (2.86%), onycholysis, 2 (1.90%), koilonychias, 2 (1.90%), Beau's ridges, 2 (1.90%); Onychomadesis, 1 (0.95%); tile-shaped nails, 1 (0.95%); longitudinal groove, 1 (0.95%); distal nail embedding, 1 (0.95%); anonychia, 1 (0.95%); micronychia, 1 (0.95%); pachionychia, 1 (0.95%); dyschromia, 1 (0.95%). Conclusions: The alterations of finger and toe nails in the elderly are not exclusive of this group as they occur in the general population except that in the elderly, the most frequent are onychorrhexis in hands and onychogryphosis in feet. [ABSTRACT FROM AUTHOR]

BACKGROUND: Onychomycosis is a nail infection caused by dermatophytes, yeasts or non-dermatophyte molds. In Mexico the frequency has been reported close to 30%. Onychomycosis affecting the fifth toe with nail dystrophy has been observed in 6 to 21%. OBJECTIVE: To determine the frequency of onychomycosis in diabetic patients with onychodystrophy of the fifth toenail, and compare our data with the literature. MATERIAL AND METHOD: A prospective, cross-sectional, observational and descriptive study was done in diabetic patients with onychodystrophy of fifth toenail in the 23th Race of Patient with Diabetes in Mexico City on October 17th and at Dr. Manuel Gea Gonzalez General Hospital. We selected those with dystrophy of the fifth toe and performed a direct examination with KOH-chlorazol black and culture in Sabouraud with antibiotics. RESULTS: 178 diabetic patients were included; 93 presented onychodystrophy of the fifth toenail and in 39% onychomychosis was confirmed. We found a female predominance (70%), between 60 and 69 years of age. Time of evolution was 4 months to 30 years, predominantly 1 to 5 years (34%). The main causal agent was Trichophyton rubrum (72%). CONCLUSIONS: We found dystrophy of the fifth toenail in 52% of patients with diabetes mellitus. In these cases the frequency of onychomycosis was 39%. The most common isolated dermatophyte was Trichophyton rubrum. [ABSTRACT FROM AUTHOR]