Abstract
Onychomycosis refers to fungal infection of the nail and is commonly caused by dermatophytes, while yeasts and non-dermatophytic molds (NDM) are increasingly recognized as pathogens in nail infections. The present study was done to delineate molecular epidemiology of Fusarium onychomycosis in India. Five hundred nail samples of Indian patients clinically suspected of onychomycosis were subjected to direct microscopy and fungal culture. Representative Fusarium isolates were further identified to species level by multi-locus sequencing for internal transcribed spacer, translation elongation factor 1 alpha (tef1-α) and RNA polymerase II subunit (rpb2) regions (primer pairs: ITS1/ITS4, EF1/EF2, 5f2/7cr, respectively). These representative strains were also tested for in vitro antifungal susceptibility by the broth microdilution method. Members of the genus Fusarium proved to be the most common NDM responsible for onychomycosis. The Fusarium spp. responsible for onychomycosis belonged to the Fusarium solani species complex (F. keratoplasticum and F. falciforme) and Fusarium fujikuroi species complex (F. proliferatum, F. acutatum and F. sacchari). Antifungal susceptibility results indicated that amphotericin B was the most effective antifungal across all isolates (MIC ranging 0.5–2 mg/L), followed by voriconazole (MIC ranging 1–8 µg/ml). However, a large variation was shown in susceptibility to posaconazole (MIC ranging 0.5 to >16 µg/ml). To conclude, we identified different Fusarium spp. responsible for onychomycosis in India with variation within species in susceptibility to antifungal agents, showing that fusariosis requires correct and prompt diagnosis as well as antifungal susceptibility testing.
Similar content being viewed by others
References
Weitzman I, Summerbell RC. The dermatophytes. Clin Microbiol Rev. 1995;8:240–59.
Murray SC, Dawber RP. Onychomycosis of toenails: orthopedic and podiatric considerations. Australas J Dermatol. 2002;43:105–12.
Shobhanadari C, Rao DT, Babu KS. Clinical and mycological study of superficial fungal infection at Government General Hospital: Guntur and their response to treatment with Hamycin, Dermatostatin and Dermamycin. Indian J Dermatol Venerol. 1970;36:209–14.
Kaur R, Kashyap B, Bhalla P. Onychomycosis-epidemiology, diagnosis and management. Indian J Med Microbiol. 2008;26:108–16.
Grover C, Khurana A. Onychomycosis: newer insights in pathogenesis and diagnosis. Indian J Dermatol Venereol Leprol. 2012;78(3):263–70.
Degreef H. Clinical forms of dermatophytosis (ringworm infection). Mycopathologia. 2008;166(5–6):257–65.
Gupta AK, Drummond-Main C, Cooper EA, et al. Systematic review of nondermatophyte mold onychomycosis: diagnosis, clinical types, epidemiology, and treatment. Am Acad Dermatol. 2012;66(3):494–502.
Tosti A, Piraccini BM, Lorenzi S, et al. Treatment of non-dermatophyte mold and Candida onychomycosis. Dermatol Clin. 2003;21(3):491–7.
Haneke E, Roseeuw D. The scope of onychomycosis: epidemiology and clinical features. Int J Dermatol. 1999;38(Suppl 2):7–12.
van Diepeningen AD, Feng P, Ahmed S, et al. Spectrum of Fusarium infections in tropical dermatology evidenced by MLST diagnostics. Mycoses. 2015;58(1):48–57.
Rippon JW. Medical mycology. The pathogenic fungi and the pathogenic actinomycetes. 3rd ed. Philadelphia: WB Saunders; 1988.
Fisher F, Cook NB. Fundamentals of diagnostic mycology. Philadelphia, PA: WB Saunders; 1998.
English MP. Nails and fungi. Br J Dermatol. 1976;94(6):697–701.
White TJ, Bruns T, Lee S, et al. Amplification and direct sequencing of fungal ribosomal RNA genes for phylogenetics. In: Innis MA, Gelfand DH, Sninsky JJ, White TJ, editors. PCR protocols: a guide to methods and applications. New York: Academic Press; 1990. p. 315–22.
Geiser DM, Jimenez-Gasco M, Kang S, et al. FUSARIUM-ID v. 1.0: a DNA sequence database for identifying Fusarium. Eur J Plant Pathol. 2004;110:473–9.
Reeb V, Lutzoni F, Roux C. Contribution ofRPB2 to multilocus phylogenetic studies of the euascomycetes (Pezizomycotina, Fungi) with special emphasis on the lichen-forming Acarosporaceae and evolution of polyspory. Mol Phylogenet Evol. 2004;32(3):1036–60.
Liu YJ, Whelen S, Hall BD. Phylogenetic relationships among ascomycetes: evidence from an RNA polymerase II subunit. Mol Biol Evol. 1999;16(12):1799–808.
O’Donnell K, Sutton DA, Rinaldi MG, et al. Internet-accessible DNA sequence database for identifying fusaria from human and animal infections. J Clin Microbiol. 2010;48:3708–18.
Tamura K, Stecher G, Peterson D, et al. MEGA6: molecular Evolutionary Genetics Analysis Version 6.0. Mol Biol Evol. 2013;30:2725–9.
Ronquist F, Teslenko M, van der Mark P, et al. MrBayes 3.2: efficient Bayesian phylogenetic inference and model choice across a large model space. Syst Biol. 2012;61:539–42.
Clinical and Laboratory Standards Institute (CLSI). Reference method for broth dilution antifungal susceptibility testing of filamentous fungi; approved standard—Second edition. CLSI document M38-A2. 2008, CLSI, Wayne.
Hwang SM, Suh KY, Ha GY. Onychomycosis due to non-dermatophytic molds. Ann Dermatol. 2012;24(2):175–80.
Ahuja S, Shalini M, Charoo H. Etiological agents of Onychomycosis from a Tertiary Care Hospital in Central Delhi, India. Indian J Fundam Appl Life Sci. 2011;1(2):11–4.
Kaur R, Kashyap B, Bhalla P. A five-year survey of onychomycosis in New Delhi, India: epidemiological and laboratory aspects. Indian J Dermatol. 2007;52(1):39–42.
Galletti J, Negri M, Grassi FL, et al. Fusarium spp. is able to grow and invade healthy human nails as a single source of nutrients. Eur J Clin Microbiol Infect Dis. 2015;34(9):1767–72.
Veer P, Patwardhan NS, Damle AS. Study of onychomycosis: prevailing fungi and pattern of infection. Indian J Med Microbiol. 2007;25(1):53–6.
Gupta M, Sharma NL, Kanga AK, et al. Onychomycosis: clinicomycologic study of 130 patients from Himachal Pradesh, India. Indian J Dermatol Venereol Leprol. 2007;73(6):389–92.
Lim JT, Chua HC, Goh C. Dermatophyte and nondermatophyte onychomycosis in Singapore. Australas J Dermatol. 1992;33:159–63.
Zahra LV, Gatt P, Boffa MJ, et al. Characteristics of superficial mycoses in Malta. Int J Dermatol. 2003;42:265–71.
van Diepeningen AD, Al-Hatmi AMS, Brankovics B, et al. Taxonomy and clinical spectra of Fusarium species: Where do we stand in 2014? Curr Clin Microbiol Rep. 2014;1:10–8.
O’Donnell K, Sutton DA, Fothergill A, et al. Molecular phylogenetic diversity, multilocus haplotype nomenclature, and in vitro antifungal resistance within the Fusarium solani species complex. J Clin Microbiol. 2008;46(8):2477–90.
Short DP, O’Donnell K, Thrane U, et al. Phylogenetic relationships among members of the Fusarium solani species complex in human infections and the descriptions of F. keratoplasticum sp. nov. and F. petroliphilum stat.nov. Fungal Genet Biol. 2013;53:59–70.
Leslie JF, Summerell BA. The Fusarium laboratory manual. Oxford: Blackwell Publishing Ltd; 2006.
Taj-Aldeen SJ, Gene J, Al Bozom I, et al. Gangrenous necrosis of the diabetic foot caused by Fusarium acutatum. Med Mycol. 2006;44(6):547–52.
Chander J, Singla N, Gulati N, et al. Fusarium sacchari: a cause of exogenous fungal endophthalmitis: first case report and review of literature. Mycopathologia. 2011;171:431–4.
Migheli Q, Balmas V, Harak H, et al. Molecular phylogenetic diversity of dermatologic and other human pathogenic fusarial isolates from hospitals in Northern and Central Italy. J Clin Microbiol. 2010;48:1076–84.
Al-Hatmi AMS, van Diepeningen AD, Curfs-Breuker I, et al. Specific antifungal susceptibility profiles of opportunists in the Fusarium fujikuroi complex. J Antimicrob Chemother. 2015;70(4):1068–71.
Tortorano AM, Richardson M, Roilides E, et al. European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group. ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis: Fusarium spp., Scedosporium spp. and others. European Confederation of Medical Mycology. Clin Microbiol Infect. 2014;20(Suppl 3):27–46.
Acknowledgments
The authors are thankful to Dr. Arunaloke Chakrabarty, Professor Department of Medical Microbiology, and Centre of Advanced Research in Medical Mycology, Post Graduate Institute of Medical Education and Research, Chandigarh, India, for confirming our isolates.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Gupta, C., Jongman, M., Das, S. et al. Genotyping and In Vitro Antifungal Susceptibility Testing of Fusarium Isolates from Onychomycosis in India. Mycopathologia 181, 497–504 (2016). https://doi.org/10.1007/s11046-016-0014-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11046-016-0014-7