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      Onychomycosis Due to Rhizomucor in Psoriatic Patient with HIV Infection

      case-report

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          Abstract

          Onychomycosis is frequently seen in dermatological clinical practice worldwide. The causative agents are usually two pathogenic groups of fungi namely, dermatophytes and yeasts of the genus Candida. In some cases, non-dermatophytic molds belonging to different genera and species may be the etiological agents. We report an unusual case of onychomycosis in an HIV-positive psoriatic patient caused by Rhizomucor pusillus, which has not been mentioned in the literature before. Our finding underline the fact that fungal species appearing as contaminants should be evaluated by proper clinical-mycological correlation to ensure an accurate diagnosis.

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          Onychomycosis: pathogenesis, diagnosis, and management.

          Boni Elewski (1998)
          Although not life-threatening, onychomycosis (a fungal infection of the nail, usually caused by a dermatophyte) constitutes an important public health problem because of its high prevalence (about 10% of the U.S. population) and associated morbidity. The disease can have certain negative consequences for patients, such as pain, and can potentially undermine work and social lives. This review discusses the etiology, classification, diagnosis, and treatment of onychomycosis. Four types of onychomycosis are recognized based on the site and pattern of fungal invasion. Dermatophyte fungi are the predominant pathogens, but yeasts (especially Candida albicans) and nondermatophyte molds may also be implicated. Accurate diagnosis requires direct microscopy and fungal culture. The differential diagnosis includes psoriasis, lichen planus, onychogryphosis, and nail trauma. Onychomycosis is more difficult to treat than most dermatophytoses because of the inherent slow growth of the nail. Older antifungal agents (ketoconazole and griseofulvin) are unsuitable for onychomycosis because of their relatively poor efficacy and potential adverse effects. Three recently developed antimycotic agents (fluconazole, itraconazole, and terbinafine) offer high cure rates and good safety profiles. In addition, the short treatment times (< 3 months) and intermittent dosing schedules are likely to enhance compliance and reduce the costs of therapy.
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            A large-scale North American study of fungal isolates from nails: the frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns.

            P Krusinski, M Zaiac, João R. Daniel … (2000)
            Onychomycosis, a fungal infection of the nail bed, is responsible for up to 50% of nail disorders. Although several surveys have been conducted in different parts of the world, there have been no multicenter epidemiologic surveys of onychomycosis in North America. A 12-center study was undertaken to (1) determine the frequency of onychomycosis, (2) identify organisms recovered from the nails, and (3) determine the antifungal susceptibility of isolates. A total of 1832 subjects participated in this study and completed a comprehensive questionnaire, and nail clippings were collected for potassium hydroxide examination and culturing. The frequency of onychomycosis, as defined by the presence of septate hyphae on direct microscopy and/or the recovery of a dermatophyte, was found to be 13.8%. In general, the dermatophyte isolates were susceptible to the antifungals tested. Because of the limited number of large-scale studies, the baseline incidence is not firmly established. However, the higher frequency of onychomycosis in this study may confirm the suspected increase in incidence of disease in North America.
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              A higher prevalence of onychomycosis in psoriatics compared with non-psoriatics: a multicentre study.

              G N Watteel, Z. C. T. R. Daniel, B Elewski … (1997)
              There is some controversy about the prevalence of onychomycosis in patients with psoriasis compared to non-psoriatics. We therefore measured the prevalence of toenail onychomycosis in psoriatics and non-psoriatics attending dermatologists' offices. None of the patients had a referring diagnosis of onychomycosis. The prevalence of pedal onychomycosis in psoriatics (n = 561) was 13%. The odds of patients with psoriasis having onychomycosis was 56% greater than non-psoriatics of the same age and sex (P = 0.02). In the psoriatics, when the toenails were clinically abnormal, the prevalence of onychomycosis was 27%. The odds of developing onychomycosis increased with age (P < 0.0001) and the odds of men developing onychomycosis was 2.5 times that of women (P = 0.0001). The duration of psoriasis did not significantly affect the odds of developing onychomycosis. The fungal organisms recovered from psoriasis subjects with onychomycosis were similar to those in the normal population with onychomycosis (P = 0.58).
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Dermatol
                Journal ID (iso-abbrev): Indian J Dermatol
                Journal ID (publisher-id): IJD
                Title: Indian Journal of Dermatology
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0019-5154
                ISSN (Electronic): 1998-3611
                Publication date (Print): May-Jun 2013
                Volume: 58
                Issue: 3
                Page: 242
                Affiliations
                [1] From the Department of Microbiology, Maulana Azad Medical College, New Delhi, India
                Author notes
                Address for correspondence: Dr. Monika Matlani, Department of Microbiology, Maulana Azad Medical College, New Delhi, India. E-mail: monikamatlani@ 123456yahoo.com
                Article
                Publisher ID: IJD-58-242e
                DOI: 10.4103/0019-5154.110860
                PMC ID: 3667311
                PubMed ID: 23723499
                SO-VID: a46e6a0d-8053-4a71-9966-61a07031fa80
                Copyright © Copyright: © Indian Journal of Dermatology
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : January 2012
                Date accepted : October 2012
                Categories
                Subject: E-Case Report

                ScienceOpen disciplines: Dermatology
                Keywords: hiv-positive psoriatic patient,onychomycosis,rhizomucor pusillus
                Data availability:
                ScienceOpen disciplines: Dermatology
                Keywords: hiv-positive psoriatic patient, onychomycosis, rhizomucor pusillus

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