amphotericin-b and Onychomycosis

Onychomycosis is a common superficial fungal infection, which usually caused by dermatophytes, yeast and non-dermatophytic moulds. Recently, we isolated a Rhodotorula minuta isolate from a 15-year-old immunocompetent girl student in Hangzhou (China) that was identified using microscopy, culture morphology, histological diagnosis, API 20C AUX Yeast Identification Kit and sequencing of the Internal Transcribed Spacer region. In vitro, antifungal susceptibility tests showed that this yeast isolate was susceptible to low concentrations of amphotericin B, itraconazole, voriconazole and 5-flvoriconaz but that it appeared to be dose-dependent susceptible to fluconazole(MIC = 16 μg/ml). Furthermore, the effective result of therapy with itraconazole against R. minuta was consistent with that of susceptibility tests.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Asian People; China; Drug Resistance, Fungal; Female; Fluconazole; Humans; Itraconazole; Microbial Sensitivity Tests; Onychomycosis; Pyrimidines; Rhodotorula; Triazoles; Voriconazole

The management of superficial fungal infections differs significantly from the management of systemic fungal infections. Most superficial infections are treated with topical antifungal agents, the choice of agent being determined by the site and extent of the infection and by the causative organism, which is usually readily identifiable. One exception is onychomycosis, which usually requires treatment with systemically available antifungals; the accumulation of terbinafine and itraconazole in keratinous tissues makes them ideal agents for the treatment of onychomycosis. Oral candidiasis in immunocompromised patients also requires systemic treatment; oral fluconazole and itraconazole oral solution are highly effective in this setting. Systemic fungal infections are difficult to diagnose and are usually managed with prophylaxis or empirical therapy. Fluconazole and itraconazole are widely used in chemoprophylaxis because of their favourable oral bioavailability and safety profiles. In empirical therapy, lipid-associated formulations of amphotericin-B and intravenous itraconazole are safer than, and at least as effective as, conventional amphotericin-B (the former gold standard). The high acquisition costs of the lipid-associated formulations of amphotericin-B have limited their use.

Topics: Administration, Oral; Administration, Topical; Amphotericin B; Antifungal Agents; Aspergillosis; Candidiasis; Chemistry, Pharmaceutical; Dermatomycoses; Fluconazole; Humans; Intestinal Absorption; Itraconazole; Onychomycosis

Not only have the systemic mycoses clearly increased in number but also mycoses of the skin are more common than presumed in the past. Today onychomycosis is found in up to 10% of human beings. Onychomycosis can compromise quality of life markedly. Common tinea pedis is one of the most important risk factors for erysipelas of the lower legs. The clinical presentation of oral candidosis in HIV-infected patients is changing; Candida dubliniensis has been identified as another important causative microorganism. Onychomycosis today in most cases can be cured using terbinafine or itraconazole. When choosing the ideal drug in a given case, both the benefit risk ratio and the benefit cost ratio have to be taken into account. Liposomally encapsulated amphotericin B represents a major breakthrough in the treatment of systemic mycoses or fever of unknown origin. The same applies to liposomally encapsulated econazole with respect to tinea pedis. In regard to the pathogenesis of Candida infections the family of secreted aspartic proteinases plays a major role as a virulence factor and possible future target for antimycotic treatment.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Aspartic Acid Endopeptidases; Axilla; Candida albicans; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Case-Control Studies; Child; Clinical Trials as Topic; Dermatomycoses; Female; Humans; Liposomes; Microscopy, Immunoelectron; Multicenter Studies as Topic; Multivariate Analysis; Naphthalenes; Onychomycosis; Practice Guidelines as Topic; Prospective Studies; Risk Factors; Terbinafine; Tinea; Tinea Pedis; Trichophyton

Onychomycosis is a common nail infection mainly caused by species belonging to the

Topics: Amphotericin B; Anti-Infective Agents; Antifungal Agents; Biological Products; Drug Repositioning; Esters; Ethers; Fusariosis; Fusarium; Humans; Microbial Sensitivity Tests; Onychomycosis; Terbinafine

Cutaneous fungal infections include onychomycosis, an infection of the nail that affects both healthy and immunocompromised patients. This study investigated the in vitro hydrolytic enzymes production, adhesion and biofilm formation capacity of Candida parapsilosis complex species and Kodamaea ohmeri isolates from onychomycoses of HIV/AIDS patients and also established the antifungal sensitivity profiles of these isolates. Onychomycosis in HIV/AIDS patients showed a high prevalence of emerging yeasts, among which C. parapsilosis complex species and K. ohmeri were the most frequent. Three C. parapsilosis sensu stricto and two C. orthopsilosis isolates were resistant to amphotericin B and 83% of isolates were resistant to terbinafine. All three different species evaluated were proteinase and hemolysin producers. All isolates adhered to stainless steel and siliconized latex surfaces, and carbohydrates intensified adhesion of all isolates. Isolates adhered to keratinous nail and 50% formed biofilms with strong intensity. In multispecies or polymicrobial biofilms, C. albicans and Staphylococcus aureus regulated the biofilm formation of the analyzed species, decreasing the number of their cells in biofilms. The isolation of emerging yeast species from onychomycosis which are great producers of hydrolytic enzymes and with high adhesion and biofilm formation capacity is a result that should be considered relevant in clinical practice. In addition, half of the isolates was resistant to at least one of the tested antifungals. Taken together these data corroborate the infectious capacity and viability of these isolates under favorable conditions.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Antifungal Agents; Biofilms; Candida parapsilosis; DNA, Fungal; Drug Resistance, Fungal; Female; HIV; Humans; Latex; Male; Microbial Sensitivity Tests; Middle Aged; Onychomycosis; Saccharomycetales; Stainless Steel; Terbinafine; Virulence; Young Adult

The genus Tritirachium is a mitosporic fungus which inhabits in soil and decaying plant material and also a notable insect pathogen. Human infections with Tritirachium species though rare were previously reported to cause corneal ulcers, otomycosis, onychomycosis, and dermatomycosis of the scalp and hence may be considered as a potential pathogen. Here we report a case of distal lateral subungual onychomycosis involving right great toenail in a 22-year-old female, wherein direct potassium hydroxide preparations, fungal cultures, and molecular sequencing of the isolate established Tritirachium oryzae as the etiological agent. Antifungal susceptibility performed by the microbroth technique of CLSI revealed increased MICs to amphotericin B and low MICs to azoles and echinocandins. The case was managed with surgical nail avulsion followed by topical application of 2% ketoconazole cream resulting regrowth of normal nail. To the best of our knowledge, this is the first report of non-dermatophytic mold T. oryzae causing onychomycosis in India.

Topics: Administration, Topical; Amphotericin B; Antifungal Agents; Azoles; Basidiomycota; Echinocandins; Female; Humans; India; Microbial Sensitivity Tests; Microbiological Techniques; Microscopy; Nails; Onychomycosis; Sequence Analysis, DNA; Young Adult

Fusarium species have emerged as an important human pathogen in skin disease, onychomycosis, keratitis and invasive disease. Onychomycosis caused by Fusarium spp. The infection has been increasingly described in the immunocompetent and immunosuppressed hosts. Considering onychomycosis is a difficult to treat infection, and little is known about the genetic variability and susceptibility pattern of Fusarium spp., further studies are necessary to understand the pathogenesis and better to define the appropriate antifungal treatment for this infection. Accordingly, the objective of this study was to describe the in vitro susceptibility to different antifungal agents and the genetic diversity of 35 Fusarium isolated from patients with onychomycosis. Fusarium spp. were isolated predominantly from female Caucasians, and the most frequent anatomical location was the nail of the hallux. Results revealed that 25 (71.4%) of isolates belonged to the Fusarium solani species complex, followed by 10 (28.5%) isolates from the Fusarium oxysporum species complex. Noteworthy, the authors report the first case of Neocosmospora rubicola isolated from a patient with onychomycosis. Amphotericin B was the most effective antifungal agent against the majority of isolates (60%, MIC ≤4 μg/mL), followed by voriconazole (34.2%, MIC ≤4 μg/mL). In general, Fusarium species presented MIC values >64 μg/mL for fluconazole, itraconazole and terbinafine. Accurate pathogen identification, characterisation and susceptibility testing provide a better understanding of pathogenesis of Fusarium in onychomycosis.

Topics: Amphotericin B; Antifungal Agents; Female; Fluconazole; Fusariosis; Fusarium; Genetic Variation; Humans; Itraconazole; Microbial Sensitivity Tests; Nails; Naphthalenes; Onychomycosis; Terbinafine; Voriconazole

Fusariosis have been increasing in Colombia in recent years, but its epidemiology is poorly known. We have morphologically and molecularly characterized 89 isolates of Fusarium obtained between 2010 and 2012 in the cities of Bogotá and Medellín. Using a multi-locus sequence analysis of rDNA internal transcribed spacer, a fragment of the translation elongation factor 1-alpha (Tef-1α) and of the RNA-dependent polymerase subunit II (Rpb2) genes, we identified the phylogenetic species and circulating haplotypes. Since most of the isolates studied were from onychomycoses (nearly 90 %), we carried out an epidemiological study to determine the risk factors associated with such infections. Five phylogenetic species of the Fusarium solani species complex (FSSC), i.e., F. falciforme, F. keratoplasticum, F. lichenicola, F. petroliphilum, and FSSC 6 as well as two of the Fusarium oxysporum species complex (FOSC), i.e., FOSC 3 and FOSC 4, were identified. The most prevalent species were FOSC 3 (38.2%) followed by F. keratoplasticum (33.7%). In addition, our isolates were distributed into 23 haplotypes (14 into FOSC and nine into FSSC). Two of the FSSC phylogenetic species and two haplotypes of FSSC were not described before. Our results demonstrate that recipients of pedicure treatments have a lower probability of acquiring onychomycosis than those not receiving such treatments. The antifungal susceptibility of all the isolates to five clinically available agents showed that amphotericin B was the most active drug, while the azoles exhibited lower in vitro activity.

Topics: Amphotericin B; Antifungal Agents; Colombia; DNA, Ribosomal Spacer; Foot Dermatoses; Fusariosis; Fusarium; Haplotypes; Humans; Microbial Sensitivity Tests; Multilocus Sequence Typing; Onychomycosis; Peptide Elongation Factor 1; Phylogeny; RNA Polymerase II; Sequence Analysis, DNA

Onychomycosis is an infection of the nail unit by a fungus. This is a very common infection amongst diabetics. Its occurrence among diabetics in Fako division is unknown. In this study we provide information on the characteristics of onychomycosis in diabetics in Fako division, Cameroon.. A cross-sectional descriptive and analytical hospital-based study was conducted in two diabetic clinics in the Buea and Limbe regional hospitals. We recruited 152 consenting diabetics into the study. Demographic, behavioural, and clinical data of patients were obtained through the use of structured questionnaires. Toenail, finger nail, skin scrapings and nail clippings were collected from participants, KOH mounts were prepared and observed under the microscope and cultured on Sabouraud Dextrose Agar supplemented with chloramphenicol to isolate causative fungi. Identification of isolates was done to species level using the cello tape flag method and slide culture. The presence of a dermatophyte by either microscopy or culture or both methods was considered positive for onychomycosis. Antifungal susceptibility testing was carried out using selected antifungals by the Kirby-Bauer disk diffusion method on Sabouraud Dextrose Agar.. Clinical onychomycosis was found in 77 of the 152 diabetics tested giving a prevalence of 50.7% (95% CI 42.4-58.9) in diabetics in Fako. No socio-demographic or clinical factor studied was significantly associated with onychomycosis. Trichophyton rubrum was the most common isolate (62%). Other isolates included Trichophyton metagraphyte (22%) and Trichophyton tonsurans (16%). Dermatophytes were sensitive to miconazole (66%), amphotericin B (19%) and ketoconazole (14%).. Onychomycosis is common in diabetics in Fako signifying the need for regular screening by either microscopy or culture. Infected nails could be treated with miconazole.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Cameroon; Cross-Sectional Studies; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Drug Resistance, Fungal; Female; Humans; Ketoconazole; Male; Miconazole; Microbial Sensitivity Tests; Middle Aged; Nails; Onychomycosis; Prevalence; Trichophyton

PCR methods are reliable and suitable to in situ identify dermatophytes, yeasts and non dermatophyte moulds (NDM) in onychomycosis. Onychomycosis insensitive to standard treatment with topical agents as well as with oral terbinafine or itraconazole revealed Fusarium spp., Acremonium spp. and Aspergillus spp. as infectious agents. However, NDM onychomycosis could be efficiently cured using topical amphotericin B. In conclusion, correct fungal species identification is important in onychomycoses in order to prescribe adequate treatments since dermatophytes and moulds have different sensitivities to antifungal drugs.

Topics: Acremonium; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Fusariosis; Fusarium; Humans; Itraconazole; Naphthalenes; Onychomycosis; Polymerase Chain Reaction; Reproducibility of Results; Terbinafine

Dermatophytes are the main cause of onychomycosis, but various non-dermatophyte moulds (NDMs) are often the infectious agents in abnormal nails. In particular, Fusarium spp. and other NDMs are mostly insensitive to standard onychomycosis treatment with topical agents as well as with oral terbinafine and itraconazole.. The aim of this work is to report the efficacy of a topical amphotericin B solution on NDM onychomycosis in a series of 8 patients resistant to multiple conventional topical and systemic treatments.. Treatment consisted in the application of an optimized amphotericin B solution once daily to the affected nails and surrounding tissue. No mechanical debridement or medications were allowed except for trimming excessively long nails or in some cases occasionally applying urea-based cream to soften thickened nail plates.. Onychomycosis was clinically cured in all patients after a 12-month treatment. Mycological cure was obtained in all but 1 patient.. Topical amphotericin B is an efficacious, safe, cheap and easy-to-apply treatment which should be considered as first-line therapy for NDM onychomycosis.

Topics: Acremonium; Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Female; Fusariosis; Hand Dermatoses; Humans; Middle Aged; Onychomycosis; Treatment Outcome

In this study the molecular identification and susceptibility profile of 21 clinical isolates, from a Brazilian hospital, belongs to six different species of Trichosporon were described. Trichosporon asahii was the predominant species and corresponded to 43% of isolates. Eighty three percent of the strains isolated from deep sites were identified as T. asahii, while only 17% belong to a non-T. asahii species (Trichosporon inkin). In general, the MICs were high and independent of the species of Trichosporon as well as the clinical origin of strain. Amphotericin B and fluconazole were less effective against Trichosporon spp. and high MIC values of voriconazole, posaconazole and ravuconazole were observed. Fifty-six percent (5/9) of T. asahii strains were isolated from deep sites, whereas 8% (1/12) of non-T. asahii species were isolated from those sites. A total of 89% of T. asahii isolates exhibited resistance to amphotericin B in vitro.

Topics: Amphotericin B; Antifungal Agents; Brazil; Cross Infection; Dermatomycoses; Drug Resistance, Fungal; Echinocandins; Female; Flucytosine; Fungemia; Hospitals, University; Humans; Mycological Typing Techniques; Mycoses; Onychomycosis; Opportunistic Infections; Organ Specificity; Triazoles; Trichosporon; Urine; Vaginitis

Fusarium spp. are nondermatophyte filamentous fungi, frequently reported as an etiologic agent of opportunistic infections in humans; however, their involvement in the etiology of cutaneous lesions is still debatable, especially in immunocompetent patients, where they are often considered as contaminant fungi.. The aims of this study were to report the high prevalence of onychomycosis by Fusarium spp. in immunocompetent patients in the region of Maringá, Paraná, Brazil, to establish clinical and laboratory criteria for this genus as a causal agent of onychomycosis, and to determine the susceptibility profile to the systemic antifungal drugs most frequently used in Brazil (itraconazole, ketoconazole, terbinafine, and amphotericin B).. The fungi were isolated and identified through the classical method, and sensitivity tests were carried out according to the National Committee for Clinical Laboratory Standards (NCCLS) M38-A protocol.. Of the 360 confirmed cases of onychomycosis, 27 (7.5%) were attributed to the genus Fusarium, and F. oxysporum was the most commonly isolated species. Nail lesions with paronychia and pain, combined with direct suggestive microscopy and a high concentration of microorganisms, were predictive of onychomycosis by Fusarium spp. The minimum inhibitory concentration was high for itraconazole, ketoconazole, and terbinafine, but low for amphotericin B.. It is recommended that more attention should be given to the interpretation and identification of species of the Fusarium genus in superficial clinical samples. This fungus may be considered as an agent of onychomycosis, even in immunocompetent individuals, by identifying criteria that separate situations of clinical significance from those of simple contamination.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Brazil; Female; Fluconazole; Foot Dermatoses; Fusarium; Humans; Immunocompetence; Itraconazole; Male; Microbial Sensitivity Tests; Middle Aged; Nails; Naphthalenes; Onychomycosis; Terbinafine

Although aspergillosis remains the most common mould infection in patients with haematologic malignancies, disseminated Fusarium infection is an emerging problem with a poor prognosis in this patient population. The treatment options are limited due to relative resistance of the fungus to standard antifungals. We present a patient with acute lymphoblastic leukaemia successfully treated with AmBisome for a disseminated Fusarium solani infection that did not respond to first line treatment with voriconazole. Despite the fact that he received additional myelosuppressive chemotherapy and underwent two stem cell transplantations from HLA mismatched donors the Fusarium infection did not recur during the subsequent phases of neutropenia. The clinical presentation, diagnosis, prognosis and therapeutic options of fusariosis in immunocompromised patients are briefly discussed.

Topics: Abscess; Amphotericin B; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Benzamides; Combined Modality Therapy; Cytarabine; Foot Dermatoses; Fusarium; Humans; Imatinib Mesylate; Immunocompromised Host; Liposomes; Male; Middle Aged; Muscular Diseases; Onychomycosis; Peripheral Blood Stem Cell Transplantation; Piperazines; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pyrimidines; Recurrence; Remission Induction; Reoperation; Rituximab; Teniposide; Triazoles; Voriconazole

Topics: Adrenal Cortex Hormones; Adult; Amphotericin B; Antifungal Agents; CD4 Lymphocyte Count; Histoplasma; Histoplasmosis; Humans; Magnetic Resonance Imaging; Male; Muscle Weakness; Nails; Neurologic Examination; Onychomycosis; Spinal Cord; Spinal Cord Diseases

Onychomycoses caused by opportunistic moulds are not well understood, and many are due to Scopulariopsis brevicaulis and other species. Aspergillus versicolor is not documented as an etiological agent in most studies. We have found an increasing prevalence of this species which is involved in 5.8% of all fungal infections of toe nails.. To study the clinical and mycological characteristics of the onychomycosis caused by A. versicolor and the in vitro susceptibility of this mould to antifungal agents.. Onychomycosis due to A. versicolor is mainly seen in people over 60 and presents with chronic involvement of the big toe nails. Predisposing factors are not always present and the infection does not respond to conventional topical antifungals. In vitro, A. versicolor has been shown to be resistant to griseofulvin and fluconazole as well as to amphotericin B, whereas MICs for itraconazole and ketoconazole are variable but within a range of 0.50-4.0 microg/ml; on the contrary, MICs for terbinafine are very low (<0.125 microg/ml).. Aspergillus versicolor could be considered as an emergent pathogen causing toenail onychomycosis. Local treatment seems not to be effective. Of the various systemic antifungal agents studied terbinafine appears to be the most effective in treating onychomycosis.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillus; Female; Foot Dermatoses; Humans; Itraconazole; Ketoconazole; Male; Microbial Sensitivity Tests; Middle Aged; Nails; Naphthalenes; Onychomycosis; Spain; Terbinafine

A 35-year-old man with B lymphoblastic lymphoma was treated with bone marrow transplant and aggressive chemotherapy. He developed a Fusarium infection of the great toenail. Septicemic dissemination of a Fusarium sp. occurred 9 months later during a lymphoma relapse. The clinical course of the hyalohyphomycosis was then rapidly fatal despite institution of amphotericin B therapy.

Topics: Adult; Amphotericin B; Antifungal Agents; Antineoplastic Agents; Bone Marrow Transplantation; Fatal Outcome; Foot Dermatoses; Fungemia; Fusarium; Humans; Immunocompromised Host; Lymphoma, B-Cell; Male; Mycoses; Neoplasm Recurrence, Local; Onychomycosis; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Topics: Adult; Amphotericin B; Antifungal Agents; Fusarium; Humans; Immunocompromised Host; Leukemia, Myelomonocytic, Acute; Male; Mycoses; Neutropenia; Onychomycosis

Molds are vegetable microorganisms, which differ from dermatophytes sensitive to griseofulvin, and from yeasts, which do not form aerial mycelium. Most of the molds, phytopathogenic or which live from dead organic substances, are apathogenic to humans. Only a couple of dozen species can parasitize on the skin, usually together with dermatophytes or yeasts. Onychomycoses with molds appear mostly in elderly people, and fungus affections of external auditory passage in seborrheic eczema of the ear. The hair can be infected by Piedraia hortae, resulting in hard black nodules. After the identification of molds on the skin, criticism is necessary, since in more than 95% of the cases they are accidental germs. Several cultures and microscopic tests are necessary to assure the diagnosis. Broad-spectrum antimycotics is the predominant choice for treatment, but also amphotericin B, nystatin and pimaricin.

Topics: Amphotericin B; Dermatitis, Seborrheic; Dermatomycoses; Humans; Natamycin; Nystatin; Onychomycosis; Piedra

A verrucose dermatitis of the face, accompanied by onychomycosis was observed in a 30 years old male living in Algeria. He was born there and 15 years previously he had been treated successfully for "Dermatophytic disease" due to Trichophyton verrucosum. A deficiency in his cellular immune mechanism was noted at that time. On this occasion Hendersonula toruloidea was isolated from facial lesions and affected nails. The infection of the face, but not the nails, responded to treatment with amphotericin B. In the facial lesions, the fungus was present as single cell units sometimes with a false bud or a short hyphal extension. Cross walls were occasionally present but the cell walls were not pigmented. Intratesticular inoculation of the isolates to guinea pigs resulted in an infection in which the morphology of the fungus conformed to that found in the facial lesions. In cultures, the isolates of H. toruloidea conformed to the descriptions in literature, although pycnidia were not formed.

Topics: Adult; Amphotericin B; Dermatomycoses; Facial Dermatoses; Humans; Male; Mitosporic Fungi; Onychomycosis

Topics: Acute Disease; Adult; Aged; Amphotericin B; Antibodies, Fungal; Antigens, Fungal; Arthrodermataceae; Candidiasis; Cell Adhesion; Cell Count; Chronic Disease; Dermatomycoses; Female; Hand Dermatoses; Humans; Immune Adherence Reaction; Immunity, Cellular; Inguinal Canal; Leukocytes; Male; Middle Aged; Onychomycosis; Prednisone; Scrotum; Tinea; Tinea Pedis

Topics: Amphotericin B; Griseofulvin; Humans; Natamycin; Onychomycosis; Tinea; Tinea Pedis