A Mycological and Molecular Epidemiologic Study on Onychomycosis and Determination
Onychomycosis
antifungal susceptibility testing
conventional antifungals
dermatophytes
new antifungals
saprophytic agents
yeasts
Journal
Frontiers in cellular and infection microbiology
ISSN: 2235-2988
Titre abrégé: Front Cell Infect Microbiol
Pays: Switzerland
ID NLM: 101585359
Informations de publication
Date de publication:
2021
2021
Historique:
received:
01
05
2021
accepted:
29
06
2021
entrez:
2
8
2021
pubmed:
3
8
2021
medline:
5
8
2021
Statut:
epublish
Résumé
Onychomycosis is one of the most common and recurrent dermatological diseases worldwide. The antimycotic activity of prescribed medications varies according to the causative agents, and treatment failure rates exceeding 30%. This study aimed to assess the epidemiological profile of onychomycosis in Iran. Also, the susceptibilities to conventional and new antifungals were investigated. In this descriptive cross-sectional study, during the period of 18 months starting from September 2019 until March 2020, 594 nail specimens were obtained from patients who presented nail changes compatible with a clinical diagnosis of onychomycosis. The patients were referred from different cities, including Tehran, Kermanshah, Arak, Kashan, Rasht, Qom, Urmia, Zahedan, Hamadan, Zanjan, Borujerd, Bushehr, and Yazd. All the samples were subjected to microscopic examination and fungal culture. Fungi identified were confirmed through the PCR-sequencing method. The susceptibility to itraconazole, fluconazole, terbinafine, griseofulvin, posaconazole, ravuconazole, efinaconazole, luliconazole, and tavaborole was evaluated according to the Clinical and Laboratory Standards Institute (CLSI) guidelines, document M38-A2 for filamentous fungi, and document M27-A3 for yeasts. 594 patients were included. Of these, in 179 cases (30.1%) (95% CI:0.3 ± 0.037) onychomycosis was confirmed. The majority of patients were ≥ 60 years of age (n=58, 32.6%) and female (n=113, 63.1%). Saprophytic fungi accounted for the vast majority of the nail isolates (n=92, 51.4%) (95% CI:0.051 ± 0.0.073), followed by dermatophytes (n=45, 25.1%) (95% CI:0.25 ± 0.063), and yeasts (n=42, 23.5%) (95% CI:0.23 ± 0.061). Diabetes mellitus (77.3%), hypothyroidism (18.2%), and solid tumors (4.5%) were documented as the most prevalent underlying conditions. Antifungal susceptibility testing was performed against 60 fungal isolates (20 each of The prevalence of onychomycosis in Iranian patients was relatively high. LUL exhibited potent antifungal activity against the three groups of fungi tested, determining its broad-spectrum antimycotic activity and its probable use as the first-line therapy for onychomycosis.
Sections du résumé
Background
Onychomycosis is one of the most common and recurrent dermatological diseases worldwide. The antimycotic activity of prescribed medications varies according to the causative agents, and treatment failure rates exceeding 30%. This study aimed to assess the epidemiological profile of onychomycosis in Iran. Also, the susceptibilities to conventional and new antifungals were investigated.
Methods
In this descriptive cross-sectional study, during the period of 18 months starting from September 2019 until March 2020, 594 nail specimens were obtained from patients who presented nail changes compatible with a clinical diagnosis of onychomycosis. The patients were referred from different cities, including Tehran, Kermanshah, Arak, Kashan, Rasht, Qom, Urmia, Zahedan, Hamadan, Zanjan, Borujerd, Bushehr, and Yazd. All the samples were subjected to microscopic examination and fungal culture. Fungi identified were confirmed through the PCR-sequencing method. The susceptibility to itraconazole, fluconazole, terbinafine, griseofulvin, posaconazole, ravuconazole, efinaconazole, luliconazole, and tavaborole was evaluated according to the Clinical and Laboratory Standards Institute (CLSI) guidelines, document M38-A2 for filamentous fungi, and document M27-A3 for yeasts.
Results
594 patients were included. Of these, in 179 cases (30.1%) (95% CI:0.3 ± 0.037) onychomycosis was confirmed. The majority of patients were ≥ 60 years of age (n=58, 32.6%) and female (n=113, 63.1%). Saprophytic fungi accounted for the vast majority of the nail isolates (n=92, 51.4%) (95% CI:0.051 ± 0.0.073), followed by dermatophytes (n=45, 25.1%) (95% CI:0.25 ± 0.063), and yeasts (n=42, 23.5%) (95% CI:0.23 ± 0.061). Diabetes mellitus (77.3%), hypothyroidism (18.2%), and solid tumors (4.5%) were documented as the most prevalent underlying conditions. Antifungal susceptibility testing was performed against 60 fungal isolates (20 each of
Conclusions
The prevalence of onychomycosis in Iranian patients was relatively high. LUL exhibited potent antifungal activity against the three groups of fungi tested, determining its broad-spectrum antimycotic activity and its probable use as the first-line therapy for onychomycosis.
Identifiants
pubmed: 34336717
doi: 10.3389/fcimb.2021.693522
pmc: PMC8319826
doi:
Substances chimiques
Antifungal Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
693522Informations de copyright
Copyright © 2021 Halvaee, Daie-Ghazvini, Hashemi, Khodavaisy, Rahimi-Foroushani, Bakhshi, Rafat, Ardi, Abastabar, Zareei, Borjian-Boroujeni and Kamali Sarvestani.
Déclaration de conflit d'intérêts
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Références
Am Fam Physician. 2013 Dec 1;88(11):762-70
pubmed: 24364524
J Clin Pharm Ther. 2010 Oct;35(5):497-519
pubmed: 20831675
Mycopathologia. 2009 Oct;168(4):165-73
pubmed: 19484505
Nihon Ishinkin Gakkai Zasshi. 2009;50(4):235-42
pubmed: 19942795
Antimicrob Agents Chemother. 2013 Apr;57(4):1610-6
pubmed: 23318803
J Am Acad Dermatol. 2000 Oct;43(4):641-8
pubmed: 11004620
Antimicrob Agents Chemother. 2006 Jun;50(6):2009-15
pubmed: 16723559
J Infect Chemother. 2004 Aug;10(4):216-9
pubmed: 15365862
Br J Dermatol. 2003 Sep;149 Suppl 65:5-9
pubmed: 14510969
Mycoses. 1996 Jul-Aug;39(7-8):293-7
pubmed: 9009648
Br J Dermatol. 2003 Sep;149 Suppl 65:1-4
pubmed: 14510968
Am J Clin Dermatol. 2003;4(1):39-65
pubmed: 12477372
Indian J Med Microbiol. 2008 Apr-Jun;26(2):108-16
pubmed: 18445944
Antimicrob Agents Chemother. 2002 Jun;46(6):1723-7
pubmed: 12019081
Mycopathologia. 2004 Feb;157(2):163-9
pubmed: 15119851
Med Mycol. 2005 Mar;43(2):179-85
pubmed: 15832561
Med Mycol. 2016 Oct 1;54(7):757-63
pubmed: 27118804
Clin Exp Dermatol. 2010 Aug;35(6):658-63
pubmed: 19874354
Mycoses. 2005 Nov;48(6):413-20
pubmed: 16262878
Can Fam Physician. 2011 Feb;57(2):173-81
pubmed: 21321168
Antimicrob Agents Chemother. 2018 Nov 26;62(12):
pubmed: 30224524
J Mycol Med. 2019 Sep;29(3):265-272
pubmed: 31285126
Br J Dermatol. 1992 Feb;126 Suppl 39:23-7
pubmed: 1531924
Infect Dis Clin North Am. 2007 Sep;21(3):711-43, ix
pubmed: 17826620
Expert Rev Clin Pharmacol. 2016 Sep;9(9):1145-52
pubmed: 27347905
J Eur Acad Dermatol Venereol. 2005 Sep;19 Suppl 1:17-9
pubmed: 16120201
Clin Geriatr Med. 2001 Nov;17(4):631-41, v
pubmed: 11535420