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Onychomycosis is estimated at a prevalence of 10% worldwide with the infecting organism most commonly Trichophyton rubrum (T. rubrum). Traditional culture identification of causative organisms has inherent risks of overestimating dermatophytes, like T. rubrum, by inhibiting the growth of possible nondermatophyte mould (NDM) environmental contaminants which could be causative agents. Recently, molecular methods have revealed that a proportion of onychomycosis cases in North America may be caused by mixed infections of T. rubrum as an agent co-infecting with one or more NDM. Determining the global burden of mixed infections is a necessary step to evaluating the best therapies for this difficult-to-treat disease. To determine the prevalence of mixed infections in a global population, nail samples from onychomycosis patients in Brazil, Canada, and Israel (n = 216) were analyzed by molecular methods for the presence of dermatophytes and five NDMs. If an NDM was detected, repeat sampling was performed to confirm the NDM. T. rubrum was detected in 98% (211/216) of infections with 39% mixed (84/216). The infection type was more likely to be mixed in samples from Brazil, but more likely to be a dermatophyte in samples from Canada and Israel (Χ2 = 16.92, df = 2, P<0.001). The most common cause of onychomycosis was T. rubrum. In all countries (Brazil, Canada and Israel combined) the prevalence of dermatophyte (Χ2 = 211.15, df = 3, P<0.001) and mixed (dermatophyte and NDM; Χ2 = 166.38, df = 3, P<0.001) infection increased with patient age. Our data suggest that mixed infection onychomycosis is more prevalent than previously reported with the aging population being at increased risk for mixed infections. [ABSTRACT FROM AUTHOR]

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AbstractBlastomycosis, a potentially fatal fungal disease, is well known from defined areas of endemicity in Ontario, primarily in the northern part of the province. We present 2 unusual cases that appear to extend the area of endemicity into urban southern Ontario, specifically Toronto. Both patients presented to a dermatology clinic with skin lesions. Chest radiography, history and general physical evaluation indicated no disease at other body sites. Both cases appeared to represent "inoculation blastomycosis" connected with minor gardening injuries and a cat scratch respectively. Atypical dissemination could not be completely excluded in either case. Neither patient had travelled recently to a known area of high endemicity for blastomycosis, nor had the cat that was involved in one of the cases. Physicians must become aware that blastomycosis may mimic other diseases, including dermal infections, and may occur in patients whose travel histories would not normally suggest this infection.Case 1The patient was a 59-year-old immunocompetent woman with no history of recent travel to known areas of endemicity for blastomycosis. She had, however, been gardening in a ravine area of western Toronto near a stream.In March 1998 a lesion developed over the patient's right lateral malleolus, gradually increasing in size. She described the initial lesion as being similar to a pimple. Approximately 2 months later, similar lesions developed on 2 fingers. Several biopsies revealed no distinctive features. A variety of antimicrobial agents were administered without effect. She was referred to a dermatology centre.Dermatological examination indicated a large, erythematous, scaling plaque on the right lateral malleolus and verrucous, indurated lesions on the left index and right ring fingers. The areas surrounding the plaques were slightly violaceous, and pressure led to purulent discharge. Samples were obtained for repeat biopsy. Histopathologic findings were interpreted as... [ABSTRACT FROM AUTHOR]

Background Questionnaire studies have been used to determine the prevalence of onychomycosis in the United Kingdom and Europe One disadvantage of this methodology is that the patient self-diagnoses the onychomycosis. There have been very few large studies involving clinical examination of the nails of subjects, followed by mycological confirmation of the onychomycosis We therefore determined the prevalence of onychomycosis in patients visiting dermatologists' offices in Ontario, Canada Methods In a prospective, multicenter study, the finger- and toenails of all new patients presenting to dermatoIogists, offices were examined by a board-certified dermatologist If there was clinical suspicion of onychomycosis, then nail samples were obtained for mycoIogicaI examination at a central laboratory Patients referred specificalIy for the management of onychomycosis were excluded Results Toenails appeared abnormal in 455 (22.7% ) of 2001 patients. Mycologically- confirmed pedal onychomycosis was present in 182 (9.1%) of the 2001 patents. The estimated value of the prevalence of onychomvcosis in Ontario 6. 86% (95% Confidence interval (Cl) 5.8-8.0%), when corrected for age and sex of the general population using census data Onychomycosis increased with age (P < 0.0001). The odds of males having onychomycosis was 84.3% greater than females of the same age (P = 0.0003). The distribution of organisms in the 141 patients with pedal onychomycosis who were culture positive was, dermatophytes 131 (92.9%), Candida species 4 (2.8%) and non-dermatophyte molds 6 (4.3%). Conclusions The prevalence of mycologically-confirmed toenail onychomycosis was 9.1%, with the estimated prevalence in Ontario being 6.86%. The majority of patients with abnormal-appearing nails were unaware they might have onychomycosis, that it is infectious and potentially treatable, suggesting that there is potential for increased public [ABSTRACT FROM AUTHOR]

Background: Trichophyton mentagrophytes type VIII (segregated as Trichophyton indotineae ) is a new strain of antifungal resistant Trichophyton spp. that has been found in different countries around the world. This new strain has been found to be resistant to terbinafine., Objectives: We present the clinical characteristics, diagnosis and treatment approach of Canadian patients with mycology and molecular confirmation of superficial mycosis caused by T. indotineae ., Methods: Mycology testing from cultures and PCR were used to confirm T. indotineae . We collected clinical information from patients with a confirmed diagnosis., Results: We report eight Canadian patients mainly presenting with extensive superficial mycosis due to T. indotineae . Three patients presented lesions on the face in addition to lesions on their body. Four patients were initially started on itraconazole or fluconazole, one patient was started on topical therapy, and three patients were referred to infectious disease., Conclusions: This new strain represents a dermatology and public health concern. Treatment guidelines are lacking. We include a practical approach and treatment recommendations for clinicians who will be encountering these emerging cases in Canada while waiting for evidence-based treatment guidelines.