, Volume 168, Issue 3, pp 111–116 | Cite as

Onychomycosis in São Paulo, Brazil

  • Patricio Godoy-Martinez
  • Fabiane G. Nunes
  • Jane Tomimori-Yamashita
  • Milton Urrutia
  • Luis Zaror
  • Victor Silva
  • Olga Fischman


Onychomycosis is a fungal infection of the nails with broad aetiological scope, and it represents 18–40% of all onychopathies and 39% of all superficial mycotic infections. From July 1996 to December 1999, samples of nails were collected from 588 patients with presumptive diagnosis of onychomycosis at the Dermatology and Mycology Divisions EPM\UNIFESP, Brazil, and the diagnosis was confirmed in 247 of these cases. The most common pathogens isolated in this study were yeasts in 52% of positive cultures (Candida albicans 18.3%, Candida parapsilosis 13.8%, other species of Candida 15.4% and other yeasts 4.6%), followed by dermatophytes in 40.6% of positive cultures (the most commonly isolated organisms were Trichophyton rubrum in 33.2%, followed by Trichophyton mentagrophytes in 6.3% and others 1.2%). Non-dermatophyte moulds were isolated in 7.4% of positive cultures (Fusarium spp. 4.5%, Nattrassia mangiferae 2.3% and Aspergillus spp. 0.6%). Distal and lateral subungual onychomycosis (DLSO) was the commonest clinical pattern 44.6% followed by free edge onycholysis (FEO) 38.8% and others. In conclusion, this study demonstrated that T. rubrum is the main agent causing onychomycosis in toenails, and species of genus Candida were the main agents isolated in fingernail onychomycosis in our region.


Onychomycosis Trichophyton rubrum Candida albicans 



This study was partially supported by grants from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP).


  1. 1.
    Midgley GM, Moore MK. Mycology of nail disorders. J Am Acad Dermatol. 1994;31:S68–74. doi: 10.1016/S0190-9622(08)81272-8.PubMedCrossRefGoogle Scholar
  2. 2.
    Ellabib MS, Agaj M, Khalifa Z, Kavanagh K. Yeasts of the genus Candida are the dominant cause of onychomycosis in Libyan women but not men: results of a 2-year surveillance study. Br J Dermatol. 2002;146:1038–41. doi: 10.1046/j.1365-2133.2002.04688.x.PubMedCrossRefGoogle Scholar
  3. 3.
    Svejgaard EL, Nilsson J. Onychomycosis in Denmark: prevalence of fungal nail infection in general practice. Mycoses. 2004;47:131–5. doi: 10.1111/j.1439-0507.2004.00968.x.PubMedCrossRefGoogle Scholar
  4. 4.
    Sehgal VN, Jain S. Onychomycosis: clinical perspective. Int J Dermatol. 2000;39:241–9. doi: 10.1046/j.1365-4362.2000.00812.x.PubMedCrossRefGoogle Scholar
  5. 5.
    Faergemann J, Baran R. Epidemiology, clinical presentation and diagnosis of onychomycosis. Br J Dermatol. 2003;149(65):1–4. doi: 10.1046/j.1365-2133.149.s65.4.x.PubMedCrossRefGoogle Scholar
  6. 6.
    Scher RK. Onychomycosis: a significant medical disorder. J Am Acad Dermatol. 1996;35(3 Pt 2):S2–5. doi: 10.1016/S0190-9622(96)90061-4.PubMedCrossRefGoogle Scholar
  7. 7.
    Vélez A, Linares MJ, Fenández-Roldán JC, Casal M. Study of onychomycosis in Córdoba, Spain: prevailing fungi and pattern of infection. Mycopathologia. 1997;137(1):1–8. doi: 10.1023/A:1006874303991.PubMedCrossRefGoogle Scholar
  8. 8.
    El Sayed F, Ammoury A, Haybe RF, Dhaybi R. Onychomycosis in Lebanon: a mycological survey of 772 patients. Mycoses. 2006;49(3):216–9. doi: 10.1111/j.1439-0507.2006.01224.x.PubMedCrossRefGoogle Scholar
  9. 9.
    Godoy P, Nunes F, Silva V, Tomimori-Yamashita J, Zaror L, Fischman O. Onychomycosis caused by Fusarium solani and Fusarium oxysporum in São Paulo, Brazil. Mycopathologia. 2004;157:287–90. doi: 10.1023/B:MYCO.0000024186.32367.d4.PubMedCrossRefGoogle Scholar
  10. 10.
    De Hoog GS, Guarro J, Gene J, et al. Atlas of clinical fungi. 2nd ed. Netherlands/Reus: Centraalbureau voor Schimmelcultures/Universitat Rovira i Virgili; 2000.Google Scholar
  11. 11.
    Warren NG, Hazen KC. Candida, Cryptococcus and other yeasts of medical importance. In: Murray PR, editor. Manual of clinical microbiology. Washington, DC: ASM; 1995. p. 723–37.Google Scholar
  12. 12.
    Baumgartner C, Freydiere AM, Gille Y. Direct identification and recognition of yeast species from clinical material by using albicans ID and CHROMagar Candida plates. J Clin Microbiol. 1996;34(2):454–6.PubMedGoogle Scholar
  13. 13.
    Guilhermetti E, Takahachi G, Shinobu CS, Svidzinski TI. Fusarium spp. as agents of onychomycosis in immunocompetent hosts. Int J Dermatol. 2007;46(8):822–6. doi: 10.1111/j.1365-4632.2007.03120.x.PubMedCrossRefGoogle Scholar
  14. 14.
    Kam KM, Au WF, Wong PY, Cheung MM. Onychomycosis in Hong Kong. Int J Dermatol. 1997;36:757–61. doi: 10.1046/j.1365-4362.1997.00048.x.PubMedCrossRefGoogle Scholar
  15. 15.
    Gupta AK, Jain HC, Lynde CW, Watteel GN, Summerbell RC. Prevalence and epidemiology of unsuspected onychomycosis in patients visiting dermatologists’ offices in Ontario, Canada—a multicenter survey of 2001 patients. Int J Dermatol. 1997;36(10):783–7. doi: 10.1046/j.1365-4362.1997.00349.x.PubMedCrossRefGoogle Scholar
  16. 16.
    Elewski BE. Onychomycosis: pathogenesis, diagnosis, and management. Clin Microbiol Rev. 1998;11(3):415–29.PubMedGoogle Scholar
  17. 17.
    Anane S, Aoun K, Zallagua N, Bouratbine A. Onychomycosis in Tunis area: epidemiological and mycological data. Ann Dermatol Venereol. 2001;128(6–7):733–6.PubMedGoogle Scholar
  18. 18.
    Alvarez MI, González LA, Castro LA. Onychomycosis in Cali, Colombia. Mycopathologia. 2004;158:181–6. doi: 10.1023/B:MYCO.0000041866.85314.e4.PubMedCrossRefGoogle Scholar
  19. 19.
    Mügge C, Haustein UF, Nenoff P. Causative agents of onychomycosis—a retrospective study. J Dtsch Dermatol Ges. 2006;4(3):218–28. doi: 10.1111/j.1610-0387.2006.05877.x.PubMedCrossRefGoogle Scholar
  20. 20.
    Goodman GJ, Nicolopoulos J, Howard A. Diseases of the generative nail apparatus. Part II: nail bed. Australas J Dermatol. 2002; 43:157–170. doi: 10.1046/j.1440-0960.2002.00588.x.
  21. 21.
    Ioannidou DJ, Maraki S, Krasagakis SK, Tosca A, Tselentis Y. The epidemiology of onychomycoses in Crete, Greece, between 1992 and 2001. J Eur Acad Dermatol Venereol. 2006;20(2):170–4. doi: 10.1111/j.1468-3083.2006.01412.x.PubMedCrossRefGoogle Scholar
  22. 22.
    Romano C, Gianni C, Difonzo EM. Retrospective study of onychomycosis in Italy: 1985–2000. Mycoses. 2005;48(1):42–4. doi: 10.1111/j.1439-0507.2004.01066.x.PubMedCrossRefGoogle Scholar
  23. 23.
    Gupta M, Sharma NL, kanga AK, Mahajan VK, Tegta GR. Onychomycosis: clinico-mycologic study of 130 patients from Himachal Pradesh, India. Indian J Dermatol Venereol Leprol. 2007;73(6):389–92.PubMedCrossRefGoogle Scholar
  24. 24.
    Khosravi AR, Mansouri P. Onychomycosis in Tehran, Iran: prevailing fungi and treatment with itraconazole. Mycopathologia. 2000;150(1):9–13. doi: 10.1023/A:1011028730323.CrossRefGoogle Scholar
  25. 25.
    Tosti A, Piraccini BM, Lorenzi S. Onychomycosis caused by nondermatophytic molds: clinical features and response to treatment of 59 cases. J Am Acad Dermatol. 2000;42(2Pt 1):217–24. doi: 10.1016/S0190-9622(00)90129-4.PubMedCrossRefGoogle Scholar
  26. 26.
    Ramesh V, Singh R, Reddy BSN, Kumari S. Clinic-mycological study of onychomycosis. Indian J Dermatol Venereol Leprol. 1982;48:145–50.Google Scholar
  27. 27.
    Gupta AK, Jain HC, Lynde CW, MacDonald P, Cooper EA, Summerbell RC. Prevalence and epidemiology of onychomycosis. J Am Acad Dermatol. 2000;43:244–8. doi: 10.1067/mjd.2000.104794.PubMedCrossRefGoogle Scholar
  28. 28.
    Veer P, Patwardhan NS, Damle AS. Study of onychomycosis: prevailing fungi and pattern of infection. Indian J Med Microbiol. 2007;25(1):53–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Patricio Godoy-Martinez
    • 1
    • 2
  • Fabiane G. Nunes
    • 3
  • Jane Tomimori-Yamashita
    • 4
  • Milton Urrutia
    • 5
  • Luis Zaror
    • 2
  • Victor Silva
    • 6
  • Olga Fischman
    • 3
  1. 1.Disciplina de InfectologiaUniversidade Federal de São Paulo (UNIFESP)ValdiviaChile
  2. 2.Instituto de Microbiologia ClínicaUniversidad Austral de ChileValdiviaChile
  3. 3.Disciplina de Biologia CelularUniversidade Federal de São Paulo (UNIFESP)São PauloBrazil
  4. 4.Departamento de DermatologiaUniversidade Federal de São Paulo (UNIFESP)São PauloBrazil
  5. 5.Pós-Graduação em Informática em SaúdeUniversidade Federal de São Paulo (UNIFESP)São PauloBrazil
  6. 6.Universidad MayorSantiagoChile

Personalised recommendations