Fusarium onychomycosis: epidemiologcal and clinical characteristics from a retrospective multicenter study.

C. Hennequin1, C. Lacroix2, G. Buot3, G. Cremer1, F. Foulet3, C. Viguie4, M. Feuillade de Chauvin2, C. Bachmeyer5, O. Chosidow5, C. Hennequin1

Author address: 

1APHP-Hôpital St Antoine, PARIS, France 2APHP, Hôpital St Louis, PARIS, France 3APHP, Hôpital Henri Mondor, CRETEIL, France 4APHP, Hôpital Cochin, PARIS, France 5APHP, Hôpital Tenon, PARIS, France

Abstract: 

Objectives: Onychomycoses are one of the most frequent forms of fungal infections. They are mainly due to dermatophytes but molds seem to be increasingly reported as causative agents, particularly Fusarium spp. However, available data on Fusarium onychomycoses remain scarce. The aim of this study was to specify the incidence of Fusarium onychomycosis through a large multicenter study and to define their epidemiological and clinical characteristics. Methods: Dermato-mycologists from six Parisian centres were asked to review retrospectively data regarding the respective distribution of fungi isolated from ungual samples during the year 2006. Among patients with positive culture for Fusarium, those having twice a positive pure culture were enrolled for epidemiological and clinical charts review. Results: Among 6355 patients seen in 2006 for suspected onychomycosis, the main etiologic agents were dermatophytes (n=2557) and Candida spp (n=141). Fusarium was isolated in 118 patients among which, Fusarium onychomycosis was considered in 29 cases. There were 24 females and 5 males. The mean age was 52±18 year-old. No particular predisposing factors were noted except corticosteroid therapy and diabetes mellitus found in one patient each. Three patients had a history of ungual dermatophytosis and four reported a local traumatism. Four patients had involvement of two or more nails. Hand and foot nails were involved in 3 and 32 cases, respectively. In the latter, toe nail was involved in 21 cases. Main clinical forms included leuconychia, either superficial (n=6) or sub-ungual (n=11), onycholysis (n= 9) and hyperkeratosis (n= 5). Five patients had an associated paronichia. The course of the disease was chronic in 17 patients. The presence of irregular, vacuolated fungal elements sometimes associated with chlamydospores was noted on sample direct examination for all the cases. Identification of the causative species was only done for 7 patients and retrieved Fusarium solani (n=4) and Fusarium oxysporum (n=3). At least 6 different therapeutic regimens were found. They mainly included antifungal treatment single or associated, local amphotericin B (n=10), bifonazole (n=3), econazole (n=2), ciclopyroxolamine (n=1) or systemic terbinafine (n=1), and chemical avulsion with urea (n=7). Long-term follow-up was available for only 11 patients but failures appeared in 7 cases. Conclusion: Fusarium onychomycoses only represent a fraction of Fusarium isolated from nails. Careful direct examination of the nail samples and clinical presentation may suggest the diagnosis. Further prospective clinical trials are required regarding the high levels of therapeutic failures.
2009

abstract No: 

P306

Full conference title: 

4th Trends in Medical Mycology
    • TIMM 4th (2012)