Clinical significance of Candida isolation from dystrophic fingernails.
Candida
anti-fungal treatment
azole
fingernail
fingernail dystrophy
onycholysis
onychomycosis
treatment efficacy
Journal
Mycoses
ISSN: 1439-0507
Titre abrégé: Mycoses
Pays: Germany
ID NLM: 8805008
Informations de publication
Date de publication:
Sep 2020
Sep 2020
Historique:
received:
05
05
2020
revised:
06
06
2020
accepted:
12
06
2020
pubmed:
21
6
2020
medline:
13
7
2021
entrez:
21
6
2020
Statut:
ppublish
Résumé
Candida onychomycosis mostly involves fingernails. Yet, in contrast to dermatophytes, Candida isolation from dystrophic fingernails does not prove casualty, as sample contamination and non-pathogenic Candida growth occur. Characterising treatment outcome of Candida-positive dystrophic nails is crucial to avoid unnecessary treatment. To investigate predicators associated with treatment outcome among Candida-positive dystrophic fingernails. A retrospective cohort study was carried out among 108 adults with Candida-positive dystrophic fingernails not cured with adequate systemic anti-fungal course. Diagnosis was based on a single mycological culture. Patients with treatment failure (n = 85; 78.7% of the cases) were compared to patients with partial response (mild to almost cure; n = 23; 21.3% of the cases) at 9 to 12 months following treatment initiation. Treatment failure was significantly associated with primary onycholysis (odds ratio [OR] 2.8; 95% confidence interval [CI] 1.1-7.4) and prolonged dystrophy (12.8 vs. 3.7 years in average), compared to partial treatment response. Non-responders had lower odds to present with distal lateral subungual onychomycosis, compared to partial responders (OR 0.3; 95% CI 0.1-0.7). Demographic and mycological characteristics, as well as number of nails affected, co-presence of paronychia, and treatment regime were not found to be associated with treatment response. Candida-positive primary onycholysis was shown to be non-responsive to systemic anti-fungal treatment, suggesting that anti-fungal treatment is not indicated. For other clinical scenarios, high proportions of treatment non-response suggest that determining causality of Candida should not be based on a single positive mycological culture.
Sections du résumé
BACKGROUND
BACKGROUND
Candida onychomycosis mostly involves fingernails. Yet, in contrast to dermatophytes, Candida isolation from dystrophic fingernails does not prove casualty, as sample contamination and non-pathogenic Candida growth occur. Characterising treatment outcome of Candida-positive dystrophic nails is crucial to avoid unnecessary treatment.
OBJECTIVE
OBJECTIVE
To investigate predicators associated with treatment outcome among Candida-positive dystrophic fingernails.
PATIENTS AND METHODS
METHODS
A retrospective cohort study was carried out among 108 adults with Candida-positive dystrophic fingernails not cured with adequate systemic anti-fungal course. Diagnosis was based on a single mycological culture. Patients with treatment failure (n = 85; 78.7% of the cases) were compared to patients with partial response (mild to almost cure; n = 23; 21.3% of the cases) at 9 to 12 months following treatment initiation.
RESULTS
RESULTS
Treatment failure was significantly associated with primary onycholysis (odds ratio [OR] 2.8; 95% confidence interval [CI] 1.1-7.4) and prolonged dystrophy (12.8 vs. 3.7 years in average), compared to partial treatment response. Non-responders had lower odds to present with distal lateral subungual onychomycosis, compared to partial responders (OR 0.3; 95% CI 0.1-0.7). Demographic and mycological characteristics, as well as number of nails affected, co-presence of paronychia, and treatment regime were not found to be associated with treatment response.
CONCLUSION
CONCLUSIONS
Candida-positive primary onycholysis was shown to be non-responsive to systemic anti-fungal treatment, suggesting that anti-fungal treatment is not indicated. For other clinical scenarios, high proportions of treatment non-response suggest that determining causality of Candida should not be based on a single positive mycological culture.
Substances chimiques
Antifungal Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
964-969Informations de copyright
© 2020 Blackwell Verlag GmbH.
Références
Jayatilake JA, Tilakaratne WM, Panagoda GJ. Candidal onychomycosis: a mini-review. Mycopathologia. 2009;168:165-173.
Otašević S, Barac A, Pekmezovic M, et al. The prevalence of Candida onychomycosis in Southeastern Serbia from 2011 to 2015. Mycoses. 2016;59:167-172.
Figueiredo VT, de Assis SD, Resende MA, Hamdan JS. Identification and in vitro antifungal susceptibility testing of 200 clinical isolates of Candida spp. responsible for fingernail infections. Mycopathologia. 2007;164:27-33.
Shemer A. Update: medical treatment of onychomycosis. Dermatol Ther. 2012;25:582-593.
Elewski BE, Rich P, Tosti A, et al. Onchomycosis: an overview. J Drugs Dermatol. 2013;12:s96-103.
Finch J, Arenas R, Baran R. Fungal melanonychia. J Am Acad Dermatol. 2012;66:830-841.
Zaias N, Escovar SX, Zaiac MN. Finger and toenail onycholysis. J Eur Acad Dermatol Venereol. 2015;29:848-853.
Shemer A, Daniel CR III. Common nail disorders. Clin Dermatol. 2013;31:578-586.
Hay RJ. The management of superficial candidiasis. J Am Acad Dermatol. 1999;40:S35-42.
Avner S, Nir N, Henri T. Fifth toenail clinical response to systemic antifungal therapy is not a marker of successful therapy for other toenails with onychomycosis. J Eur Acad Dermatol Venereol. 2006;20:1194-1196.
Lipner SR, Scher RK. Onychomycosis: clinical overview and diagnosis. J Am Acad Dermatol. 2019;80:835-851.
Gupta AK, Foley KA, Mays RR, Shear NH, Piguet V. Monotherapy for toenail onychomycosis: a systematic review and network meta-analysis. Br J Dermatol. 2020;182:287-299.
Sigurgeirsson B. Prognostic factors for cure following treatment of onychomycosis. J Eur Acad Dermatol Venereol. 2010;24:679-684.
Lipner SR, Scher RK. Onychomycosis: treatment and prevention of recurrence. J Am Acad Dermatol. 2019;80:853-867.
Widaty S, Miranda E, Bramono K, et al. Prognostic factors influencing the treatment outcome of onychomycosis Candida. Mycoses. 2020;63:71-77.
Shemer A, Gupta A, Farhi R, Daigle D, Amichai B. When is onychomycosis onychomycosis? A cross-sectional study of fungi in normal-appearing nails. Br J Dermatol. 2015;172:380-383.
Cauchie M, Desmet S, Lagrou K. Candida and its dual lifestyle as a commensal and a pathogen. Res Microbiol. 2017;168:802-810.
Shemer A, Davidovici B, Grunwald MH, Trau H, Amichai B. New criteria for the laboratory diagnosis of nondermatophyte moulds in onychomycosis. Br J Dermatol. 2009;160:37-39.
Gupta AK, Drummond-Main C, Cooper EA, Brintnell W, Piraccini BM, Tosti A. Systematic review of nondermatophyte mold onychomycosis: diagnosis, clinical types, epidemiology, and treatment. J Am Acad Dermatol. 2012;66:494-502.
Dominguez-Cherit J, Daniel RC. Simple onycholysis: an attempt at surgical intervention. Dermatol Surg. 2010;36:1791-1793.
Daniel CR 3rd, Iorizzo M, Piraccini BM, Tosti A. Simple onycholysis. Cutis. 2011;87:226.