efinaconazole and Fusariosis

The patient was a 73-year-old healthy female farmer who had been treated with terbinafine for 25.5 months by a primary physician. She exhibited a discoloration and thickening of the right big toenail. She had no concomitant paronychia. Direct microscopy revealed chlamydoconidia and hyphae, and periodic acid-Schiff stained nail specimen showed septate hyphae. On the basis of these morphological features and gene analysis, the final diagnosis was ungual hyalohyphomycosis caused by Fusarium proliferatum. Topical application of 10% efinaconazole solution cured the disease in 10 months.

Topics: Administration, Topical; Aged; Antifungal Agents; Female; Foot Dermatoses; Fusariosis; Fusarium; Humans; Hyphae; Naphthalenes; Onychomycosis; Terbinafine; Triazoles

Fusarium species are opportunistic human pathogens that remarkably cause fungal infections ranging from superficial to fatal invasive disseminated infections. Fusarium species are notoriously resistant to the majority of antifungal agents.. Therefore, detailed studies regarding in vitro susceptibility are required and may lead to a better prognosis of severe infections.. We evaluated 25 antifungal drugs in vitro against 282 clinical and environmental Fusarium isolates.. Fusarium species demonstrated high MICs/MECs values to the most commonly used antifungal drugs in clinical practice. The geometric mean (GM) MICs for luliconazole (0.004 μg/ml) and lanoconazole (0.012 μg/ml) were the lowest, followed by efinaconazole (0.98 μg/ml) and amphotericin B (1.04 μg/ml).. Efinaconazole, a novel triazole, may be a promising candidate for the treatment of superficial Fusarium infections. Furthermore, the development of systemic formulations of these drugs as well as further in vitro and in vivo investigations could aid in the treatment of systemic fusariosis.

Topics: Antifungal Agents; Fusariosis; Fusarium; Humans; Iran; Microbial Sensitivity Tests; Triazoles