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Onychomycosis Associated with Superficial Skin Infection Due to Aspergillus sydowii in an Immunocompromised Patient

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Abstract

Opportunistic fungal infections of the skin and nail are frequently encountered in human. Recent years have shown increased incidence of fungal infections especially in immunocompromised patients. Onychomycosis in HIV-infected patients is reported to occur in 15–40%, four times more than in the general population. Here, we report a case of fingernail proximal subungual onychomycosis with associated skin infection caused by an opportunistic mold, Aspergillus sydowii, in a HIV positive individual. Isolation of A. sydowii from nail and skin of an immunocompromised person needs accurate identification for successful treatment.

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References

  1. Ahmadi B, Hashemi SJ, Zaini F, Shidfar MR, Moazeni M, Mousavi B, Noorbakhsh F, Gheramishoar M, Rezaie S. A case of onychomycosis caused by Aspergillus candidus. Med Mycol Case Rep. 2012;3:45–8. https://doi.org/10.1016/j.mmcr.2012.06.003.

    Article  Google Scholar 

  2. Al-Hatmi AM, Castro MA, De Hoog GS, Badali H, Alvarado VF, Verweij PE, Meis JF, Zago VV. Epidemiology of Aspergillus species causing keratitis in Mexico. Mycoses. 2019;62:144–51. https://doi.org/10.1111/myc.12855.

    Article  PubMed  Google Scholar 

  3. Banu A, Anand M, Eswari L. A rare case of onychomycosis in all 10 fingers of an immunocompetent patient. Indian Dermatol Online J. 2013;4:302–4. https://doi.org/10.4103/2229-5178.120649.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Barua P, Mahanta J, Barua N. Onychomycosis in green tea leaf pluckers: a clinicomycological study. Int J Infect Dis. 2012;2012(16):319. https://doi.org/10.1016/j.ijid.2012.05.360.

    Article  Google Scholar 

  5. Bongomin F, Batac CR, Richardson MD, Denning DW. A review of onychomycosis due to Aspergillus species. Mycopathologia. 2018;183:485–93. https://doi.org/10.1007/s11046-017-0222-9.

    Article  PubMed  Google Scholar 

  6. Bonnal C, Leleu C, Brugiere O, Chochillon C, Porcher R, Boelle PY, Menotti J, Houze S, Lucet JC, Derouin F. Relationship between fungal colonisation of the respiratory tract in lung transplant recipients and fungal contamination of the hospital environment. PLoS ONE. 2015;10:e0144044. https://doi.org/10.1371/journal.pone.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Bouchara JP, Chaturvedi V. The curious case of “Case Report” of infections caused by human and animal fungal pathogens: an educational tool, an online archive, or a format in need of retooling. Mycopathologia. 2018;183:879–91. https://doi.org/10.1007/s11046-018-0314-1.

    Article  PubMed  Google Scholar 

  8. Brasch J, Varga J, Jensen JM, Egberts F, Tintelnot K. Nail infection by Aspergillus ochraceopetaliformis. Med Mycol. 2009;47:658–62.

    Article  CAS  Google Scholar 

  9. Castro C, Galan-Sanchez F, Linares MJ, Tejero R, Ruiz M, Serrano ML, Rodriguez-Iglesias M, Martin-Mazuelos E. FUNGAE-IFI Study Group. A prospective survey of Aspergillus spp. in respiratory tract samples: Species identification and susceptibility patterns. Med mycol. 2018;57:412–20. https://doi.org/10.1093/mmy/myy080.

    Article  Google Scholar 

  10. Choudhary VS, Koley S, Mallick S, Bose S, Basak S. Proximal subungual proximal subungual onychomycosis caused by onychomycosis caused by Aspergillus flavus in a in a HIV-positive patient. Indian J Dermatol Venereol Leprol. 2009;75:410–2. https://doi.org/10.4103/0378-6323.53152.

    Article  PubMed  Google Scholar 

  11. Conant MA. The AIDS epidemic. J Am Acad Dermatol. 1994;31:47–50.

    Article  Google Scholar 

  12. Cribier B, Mena ML, Rey D, Partisani M, Fabien V, Lang JM, Grosshans E. Nail changes in patients infected with human immunodeficiency virus: a prospective controlled study. Arch Dermatol. 1998;134:1216–20.

    CAS  PubMed  Google Scholar 

  13. Ein-Gil N, Ilan M, Carmeli S, et al. Presence of Aspergillus sydowii, a pathogen of gorgonian sea fans in the marine sponge Spongia obscura. ISME J. 2009;3:752–5.

    Article  Google Scholar 

  14. Elewski BE, Charif MA. Prevalence of onychomycosis in patients attending a dermatology clinic in northeastern Ohio for other conditions. Arch Dermatol. 1997;133:1172–3.

    Article  CAS  Google Scholar 

  15. Elewski BE, Hay RJ. Update on the management of onychomycosis: highlights of the Third Annual International Summit on Cutaneous Antifungal Therapy. Clin Infect Dis. 1996;23:305–13.

    Article  CAS  Google Scholar 

  16. English MP. Nails and fungi. Br J Dermatol. 1976;94:697–701.

    Article  CAS  Google Scholar 

  17. Fernandez M, Cattana M, Rojas F, Sosa LM, Aguirre C, Vergara M, Giusiano G. Aspergillus species in hospital environments with pediatric patients in critical condition. Rev Iberoam Micol. 2014;31:176–81. https://doi.org/10.1016/j.riam.2013.09.007.

    Article  PubMed  Google Scholar 

  18. Ganju SA, Bhagra S, Kanga AK. Onychomycosis due to Aspergillus niger with concomitant multiple fungal infections in a human immunodeficiency virus infected person. CHRISMED J Health Res. 2015;2:257–61. https://doi.org/10.4103/2348-3334.158710.

    Article  Google Scholar 

  19. Ghannoum M, Isham N. Fungal nail infections (onychomycosis): a never-ending story? PLoS Pathog. 2014;10:1–5. https://doi.org/10.1371/journal.ppat.1004105.

    Article  CAS  Google Scholar 

  20. Ghannoum MA, Hajjeh RA, Scher R, Konnikov N, Gupta AK, et al. A large-scale North American study of fungal isolates from nails: the frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns. J Am Acad Dermatol. 2000;43:641–8.

    Article  CAS  Google Scholar 

  21. Gianni C, Romano C. Clinical and histological aspects of toenail onychomycosis caused by Aspergillus spp.: 34 cases treated with weekly intermittent terbinafine. Dermatology. 2004;209:104–10. https://doi.org/10.1159/000079593.

    Article  CAS  PubMed  Google Scholar 

  22. Goodman DS, Teplitz ED, Wishner A, Klein RS, Burk PG, Hershenbaum E. Prevalence of cutaneous disease in patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex. J Am Acad Dermatol. 1987;17:210–20.

    Article  CAS  Google Scholar 

  23. Gupta AK, Taborda P, Taborda V, Gilmour J, Rachlis A, Salit I, Gupta MA, MacDonald P, Cooper EA, Summerbell RC. Epidemiology and prevalence of onychomycosis in HIV positive individuals. Int J Dermatol. 2000;39:746–53.

    Article  CAS  Google Scholar 

  24. 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;73:389–92. https://doi.org/10.4103/0378-6323.37055.

    Article  PubMed  Google Scholar 

  25. Haneke E, Roseeuw D. The scope of onychomycosis: epidemiology and clinical features. Int J Dermatol. 1999;38(Suppl 2):7–12.

    Article  Google Scholar 

  26. Harika DR, Usharani A. A study of Onychomycosis in Krishna district of Andhra Pradesh, India. Our Dermatol Online. 2015;6:384–91. https://doi.org/10.7241/ourd.20154.105.

    Article  Google Scholar 

  27. Herman LG. Aspergillus in patient care areas. Ann N Y Acad Sci. 1980;353:140–6.

    Article  CAS  Google Scholar 

  28. Hwang SM, Suh MK, Ha GY. Onychomycosis due to nondermatophytic molds. Ann Dermatol. 2012;24:175–80. https://doi.org/10.5021/ad.2012.24.2.175.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kaplan MH, Sadick N, McNutt NS, Meltzer M, Sarngadharan MG, Pahwa S. Dermatologic findings and manifestations of acquired immunodeficiency syndrome (AIDS). JAAD. 1987;16:485–506.

    Article  CAS  Google Scholar 

  30. Kara AY, Erdogan GF, Cologlu D. A case of onychomycosis due to Aspergillus flavus in all fingernails and toenails of an immunocompromised patient. J Clin Exp Dermatol Res. 2018;9:1–3.

    Google Scholar 

  31. Karmakar S, Kalla G, Joshi KR, Karmakar S. Dermatophytosis in a desert district of western Rajasthan. Indian J Dermatol Venereal Leprol. 1995;61:280–3.

    CAS  Google Scholar 

  32. Kaur R, Kashyap B, Bhalla P. Onychomycosis-epidemiology, diagnosis and management. Indian J Med Microbiol. 2008;26:108–16. https://doi.org/10.4103/0255-0857.40522.

    Article  CAS  PubMed  Google Scholar 

  33. Kim DM, Suh MK, Ha GY, Sohng SH. Fingernail onychomycosis due to Aspergillus niger. Ann Dermatol. 2012;24:459–63. https://doi.org/10.5021/ad.2012.24.4.459.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kim K, Harvell CD. The rise and fall of a six-year coral-fungal epizootic. Am Nat. 2004;164(Suppl 5):S52–63.

    Article  Google Scholar 

  35. McCarthy JD. Origins of onychomycosis. Clin Podiatr Med Surg. 1995;12:221–48.

    CAS  PubMed  Google Scholar 

  36. Nagarajan C, Thayanidhi P, Kindo AJ, Ramaraj V, Mohanty S, Arunachalam R. Fungal Rhinosinusitis: report of uncommon Aspergillus species as etiological agents. Int J Case Rep Images. 2014;5:13–7.

    Article  Google Scholar 

  37. Nouripour-Sisakht S, Mirhendi H, Shidfar MR, Ahmadi B, Rezaei-Matehkolaei A, Geramishoar M, Zarei F, Jalalizand N. Aspergillus species as emerging causative agents of onychomycosis. J Mycol Med. 2015;25:101–7. https://doi.org/10.1016/j.mycmed.2014.12.001.

    Article  CAS  PubMed  Google Scholar 

  38. Ogasawara Y. Prevalence and patient’s consciousness of tinea pedis and onychomycosis. Nihon Ishinkin Gakkai Zasshi. 2003;44:253–60.

    Article  Google Scholar 

  39. Phillips P. New drugs for the nail fungus prevalent in elderly. JAMA. 1996;276:12–3.

    Article  CAS  Google Scholar 

  40. Piraccini MB, Alessandrini A. Onychomycosis: a review. J Fungi. 2015;1:30–43. https://doi.org/10.3390/jof1010030.

    Article  Google Scholar 

  41. Pitt JI, Hocking AD. Aspergillus flavus link. Fungi and food spoilage. 3rd ed. New York: Springer; 2009. p. 305–11.

    Book  Google Scholar 

  42. Ravnborg L, Baastrup N, Svejgaard E. Onychomycosis in HIV-infected patients. Acta Derm Venereol. 1998;78:151–2.

    Article  CAS  Google Scholar 

  43. Schmidt BM, Holmes C. Proximal white onychomycosis in an immunocompetent patient: a case report. CRCM. 2015;4:41–4. https://doi.org/10.4236/crcm.2015.41010.

    Article  Google Scholar 

  44. Seyedmousavi S, Guillot J, Arné P, De Hoog GS, Mouton JW, Melchers WJ, Verweij PE. Aspergillus and aspergilloses in wild and domestic animals: a global health concern with parallels to human disease. Med Mycol. 2015;53:765–97. https://doi.org/10.1093/mmy/myv067.

    Article  Google Scholar 

  45. Shivaprakash MR, Singh G, Gupta P, Dhaliwal M, Kanwar AJ, Chakrabarti A. Extensive white piedra of the scalp caused by Trichosporon inkin: a case report and review of literature. Mycopathologia. 2011;172:481–6. https://doi.org/10.1007/s11046-011-9454-2.

    Article  CAS  PubMed  Google Scholar 

  46. Sobhanadri C, Rao DT, Babu KS. Clinical and mycological study of superficial fungal infections at Government General Hospital: Guntur and their response to treatment with Hamycin, Dermostatin and Dermamycin. Indian J Dermatol Venereol. 1970;36:209–14.

    Google Scholar 

  47. Suh JC, Yeum JS, Na GY, Seo SK, Suh MK. A simple detection method of the resistance to the treatment of onychomycosis: a case report of Aspergillus sydowii onychomycosis. Ann Dermatol. 2001;13:62–5.

    Article  Google Scholar 

  48. Summerbell R, Howard DH. Pathogenic fungi in humans and animals. Ascomycetes: Aspergillus, Fusarium, Sporothrix, Piedraia and their relatives. 2nd ed. New York: Marcell Decker; 2003.

    Google Scholar 

  49. Takahata Y, Hiruma M, Sugita T, Muto M. A case of onychomycosis due to Aspergillus sydowii diagnosed using DNA sequence analysis. Mycoses. 2008;51:170–3.

    Article  Google Scholar 

  50. Tsang CC, Hui TW, Lee KC, Chen JH, Ngan AH, Tam EW, Chan JF, Wu AL, Cheung M, Brian PH, Wu AK. Genetic diversity of Aspergillus species isolated from onychomycosis and Aspergillus hongkongensis sp. nov., with implications to antifungal susceptibility testing. Diagn Microbiol Infect Dis. 2016;8:125–34. https://doi.org/10.1016/j.diagmicrobio.2015.10.027.

    Article  CAS  Google Scholar 

  51. Walshe MM, English MP. Fungi in nails. Br J Dermatol. 1966;78:198–207.

    Article  CAS  Google Scholar 

  52. Ward J (2018) Aspergillus sydowii. https://www.bustmold.com/resources/mold-library/aspergillus-sydowii/. Published 12 Sept 2018

  53. Wayne PA (2008) Reference method for broth dilution antifungal susceptibility testing of filamentous fungi; approved standard. CLSI document M38-A2

  54. Yamada A, Noguch H, Sakae H, Sugita T, Hiruma M, Hiruma M. A case of onychomycosis caused by Aspergillus sydowii. Med Mycol J. 2012;53:205–9. https://doi.org/10.1111/j.1439-0507.2007.01458.x.

    Article  PubMed  Google Scholar 

  55. Zaias N, Glick B, Rebell G. Diagnosing and treating onychomycosis. J Fam Pract. 1996;42:513–9.

    CAS  PubMed  Google Scholar 

  56. Zaias N, Oertel IN, Elliott DF. Fungi in toe nails. J Invest Dermatol. 1969;53:140–2.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Microbiology, Jorhat Medical College, Jorhat, Assam, 785001, India

    Parismita Borgohain & Purnima Barua

  2. Department of Dermatology, Jorhat Medical College, Jorhat, Assam, 785001, India

    Pranjal Jyoti Dutta

  3. Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Dipika Shaw & Shivaprakash M. Rudramurthy

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  1. Parismita Borgohain
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  2. Purnima Barua
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  3. Pranjal Jyoti Dutta
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  4. Dipika Shaw
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  5. Shivaprakash M. Rudramurthy
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We declare that this work was done by the authors named in this case report with equal contributions.

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Correspondence to Purnima Barua.

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Obtained (Reference No. SMEJ/JMCH/MEU/841/Pt-1/2011/3050).

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Both verbal and written consents were obtained from the patient.

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Borgohain, P., Barua, P., Dutta, P.J. et al. Onychomycosis Associated with Superficial Skin Infection Due to Aspergillus sydowii in an Immunocompromised Patient. Mycopathologia 184, 683–689 (2019). https://doi.org/10.1007/s11046-019-00383-2

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