A Review of Onychomycosis Due to Aspergillus Species.

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terbinafine 4 infectiousdiseasesdrugs
AIDS 1 infectiousdiseases
ciclopirox 1 infectiousdiseasesdrugs
onychomycosis 65 infectiousdiseases

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ciclopirox 18489 best combined with chemical nail avulsion using 40% urea ointment for hyperkeratotic nails and topical ciclopirox olamine nail lacquers for SWO [[13]]. Terbinafine resistance has been reported with A. candidus onychomycosis,
terbinafine 1675 Aspergillus spp., as the causative agent of onychomycosis. Treatment consists of systemic therapy with terbinafine or itraconazole.IntroductionOnychomycosis are caused by dermatophytes, non-dermatophyte (saprophytic)
terbinafine 17717 Aspergillus spp. responds well to systemic antifungal agents, with itraconazole performing better than terbinafine in vitro [[31]]. Affected fingernails typically require 3-month therapy and toenails at least 6 months.
terbinafine 18027 complete cure in 30 of 34 cases on the 12-month follow-up [[2]]. Tosti et al. recommend either daily terbinafine (250 mg per day) or pulse itraconazole (400 mg per day for 1 week per month) for 2–4 months, completely
terbinafine 19833 the diagnosis of onychomycosis due to Aspergillus spp. Treatment consists of systemic therapy with terbinafine or itraconazole
Select Disease Character Offset Disease Term Instance
AIDS 10276 induced by hormonal disturbances (diabetes mellitus, Cushing’s syndrome and hypothyroidism) or by HIV/ AIDS immunosuppression or ongoing biological (immunosuppressive) therapies [[16]]. Among diabetics with onychomycosis
onychomycosis 317 date (ppub): /2018AbstractAspergillus spp. are emerging causative agents of non-dermatophyte mould onychomycosis (NDMO). New Aspergillus spp. have recently been described to cause nail infections. The following criteria
onychomycosis 463 have recently been described to cause nail infections. The following criteria are required to diagnose onychomycosis due to Aspergillus spp.: (1) positive direct microscopy and (2) repeated culture or molecular detection
onychomycosis 692 Aspergillus spp., provided no dermatophyte was isolated. A review of 42 epidemiological studies showed that onychomycosis due to Aspergillus spp. varies between < 1 and 35% of all cases of onychomycosis in the general population
onychomycosis 774 studies showed that onychomycosis due to Aspergillus spp. varies between < 1 and 35% of all cases of onychomycosis in the general population and higher among diabetic populations accounting for up to 71% and the elderly;
onychomycosis 1394 persii, A. sclerotiorum, A. uvarum, A. melleus, A. tamarii and A. nomius. The clinical presentation of onychomycosis due to Aspergillus spp. is non-specific but commonly distal–lateral pattern of onychomycosis. A negative
onychomycosis 1489 presentation of onychomycosis due to Aspergillus spp. is non-specific but commonly distal–lateral pattern of onychomycosis . A negative culture with a positive KOH may point to a NDM including Aspergillus spp., as the causative
onychomycosis 1616 culture with a positive KOH may point to a NDM including Aspergillus spp., as the causative agent of onychomycosis . Treatment consists of systemic therapy with terbinafine or itraconazole.IntroductionOnychomycosis are
onychomycosis 2040 reported to be responsible for approximately 2–25% of all the causes of onychomycoses [[1]–[3]]. NDM onychomycosis presents with clinical features mimicking dermatophytic onychomycosis, making clinical diagnosis difficult
onychomycosis 2110 onychomycoses [[1]–[3]]. NDM onychomycosis presents with clinical features mimicking dermatophytic onychomycosis , making clinical diagnosis difficult and unreliable [[4]]. Very little is known regarding the ability
onychomycosis 2350 intact nail plate. [[5]]Aspergillus spp. are increasingly being reported as primary causative agents of onychomycosis worldwide with prevalence as high as 34.4% in Guatemala [[6]], 69.3% in Iran [[4]] and up to 71% among
onychomycosis 2613 been previously thought that same species of Aspergillus were responsible for both superficial (e.g. onychomycosis ) and systemic infections; however, many new species of Aspergillus are increasingly being reported to
onychomycosis 2735 systemic infections; however, many new species of Aspergillus are increasingly being reported to cause onychomycosis and these were not previously reported to cause systemic infections [[8], [9]].The isolation of Aspergillus
onychomycosis 3455 for Aspergillus infections.The prevalence, clinical manifestations and mycological characteristics of onychomycosis caused by Aspergillus spp. are poorly understood. This review evaluates the clinicomycological characteristics
onychomycosis 3600 poorly understood. This review evaluates the clinicomycological characteristics and epidemiology of onychomycosis due to Aspergillus. We use the species name to describe both that species and closely related, often
onychomycosis 4091 skin and hair infections is about 1 billion cases [[12]], translating to nearly 300 million cases of onychomycosis globally. Aspergillus species accounts for 0.5–3% of all cases of onychomycosis [[13]]; therefore,
onychomycosis 4173 million cases of onychomycosis globally. Aspergillus species accounts for 0.5–3% of all cases of onychomycosis [[13]]; therefore, about 10 million cases of onychomycosis are attributable to Aspergillus spp.We reviewed
onychomycosis 4232 species accounts for 0.5–3% of all cases of onychomycosis [[13]]; therefore, about 10 million cases of onychomycosis are attributable to Aspergillus spp.We reviewed data from 42 epidemiological studies from 19 countries
onychomycosis 4407 epidemiological studies from 19 countries across the globe between 1974 and 2017. The prevalence of onychomycosis due to Aspergillus spp., both as percentage of all causes of onychomycosis and as percentage of NDM,
onychomycosis 4482 2017. The prevalence of onychomycosis due to Aspergillus spp., both as percentage of all causes of onychomycosis and as percentage of NDM, shows a marked geographical variation among countries, different regions of
onychomycosis 4743 and underlying co-morbid conditions or occupational predisposition (Table 1). As an overall cause of onychomycosis , the prevalence of onychomycosis due to Aspergillus spp. varies between < 1 and 35% in the general
onychomycosis 4776 or occupational predisposition (Table 1). As an overall cause of onychomycosis, the prevalence of onychomycosis due to Aspergillus spp. varies between < 1 and 35% in the general population and higher among diabetic
onychomycosis 4990 diabetic populations at 71% (Table 1). Aspergillus spp. constitutes 7.7–100% of the proportion of NDM onychomycosis . Over 50% (23/42) of the reviewed epidemiological studies reportedly isolated Aspergillus spp. in 50–100%
onychomycosis 5208 50–100% of the NDMs. Onychomycosis due to Aspergillus spp. is thus more prevalent and emerging cause of onychomycosis than previously thought.Table 1Prevalence of Aspergillus onychomycosisAuthor/referencesYearCountryNumber
onychomycosis 5280 prevalent and emerging cause of onychomycosis than previously thought.Table 1Prevalence of Aspergillus onychomycosis Author/referencesYearCountryNumber of cases*% of total cause of onychomycosis% of total non-dermatophyteMost
onychomycosis 5357 thought.Table 1Prevalence of Aspergillus onychomycosisAuthor/referencesYearCountryNumber of cases*% of total cause of onychomycosis % of total non-dermatophyteMost common Aspergillus speciesCommentsMoubasher et al. [[38]]2017Assiut,
onychomycosis 5606 and A. terreus–Martínez-Herrera et al. [[6]]2016Guatemala32–34.4Not statedOpportunistic mould onychomycosis Motamedi et al. [[4]]2016Tehran, Iran42412.369.3A. flavusChadeganipour et al. [[39]]2016Isfahan, Iran1,2849.162.2A.
onychomycosis 6826 retrospective studyHajoui et al. [[32]]2012Morocco150–35.3Not stated20-year retrospective study on only mould onychomycosis Leelavathi et al. [[45]]2012Malaysia23135.159.8Not stated5-year retrospective studyMinkoumou et al. [[46]]2012Cameroon5213.570.0A.
onychomycosis 8685 (21%), A. terreus (12%)Piraccini et al. [[60]]2004Italy79629.4Not statedCases of white superficial onychomycosis Grover et al. [[33]]2003Bangalore and Jorhat, India5018.684.6A. niger (100%)–Romano et al. [[61]]2003Italy4,0463.325.2Not
onychomycosis 9238 (40%), A. nidulans and A. candidus (3% each)Elderly chiropody patients*This refers to the number of onychomycosis cases investigated in the study, regardless of causeGenerally, A. niger (complex) and A. flavus (complex)
onychomycosis 10118 occupational exposures such as gardening and house chores, barefoot walking and paronychia predispose to onychomycosis [[15]]. Furthermore, damage can also be induced by hormonal disturbances (diabetes mellitus, Cushing’s
onychomycosis 10380 immunosuppression or ongoing biological (immunosuppressive) therapies [[16]]. Among diabetics with onychomycosis in Sri Lanka, onychomycosis due to Aspergillus spp. occurred in 71%, among which A. niger (76%) and
onychomycosis 10408 ongoing biological (immunosuppressive) therapies [[16]]. Among diabetics with onychomycosis in Sri Lanka, onychomycosis due to Aspergillus spp. occurred in 71%, among which A. niger (76%) and A. flavus (12%) were the most
onychomycosis 10618 most predominant species isolated [[7]]. The same study showed that the risk of having Aspergillus onychomycosis among diabetics increased with age and duration of diabetes.None of the above predisposing factors is
onychomycosis 10785 diabetes.None of the above predisposing factors is specific for Aspergillus spp. However, Aspergillus onychomycosis is seen more among individuals with occupational exposures such as vegetable vendors [[17]] and among
onychomycosis 11000 babassu coconut breakers [[18]], diabetics and the elderly [[19]]. Some individuals diagnosed with onychomycosis due to Aspergillus spp. do not have identifiable predisposing conditions/occupational risk factors.
onychomycosis 11214 In fact, Soltani and colleagues in their study reported that up to 70% of patients with Aspergillus onychomycosis had no predisposing conditions [[20]]. Onychomycosis due to Aspergillus spp. is very uncommon in children.
onychomycosis 12555 [[17]].Clinical ManifestationOnychomycosis due to Aspergillus spp. is usually a distal–lateral subungual onychomycosis (DLSO). The toenails are involved 25 times more frequently than fingernails due to increased exposure
onychomycosis 12936 causative fungal species. One of such studies from Saudi Arabia showed that 17 of the 23 (74%) cases of onychomycosis due to Aspergillus spp. were DLSO, 5/23 (22%) were proximal subungual onychomycosis (PSO), 2/23 (9%)
onychomycosis 13020 (74%) cases of onychomycosis due to Aspergillus spp. were DLSO, 5/23 (22%) were proximal subungual onychomycosis (PSO), 2/23 (9%) were superficial white onychomycosis (SWO) and 1/23 (4%) was total dystrophic onychomycosis
onychomycosis 13074 were DLSO, 5/23 (22%) were proximal subungual onychomycosis (PSO), 2/23 (9%) were superficial white onychomycosis (SWO) and 1/23 (4%) was total dystrophic onychomycosis (TDO) [[26]]. In a systemic review of NDM onychomycosis,
onychomycosis 13129 onychomycosis (PSO), 2/23 (9%) were superficial white onychomycosis (SWO) and 1/23 (4%) was total dystrophic onychomycosis (TDO) [[26]]. In a systemic review of NDM onychomycosis, Gupta and colleagues reported that Aspergillus
onychomycosis 13185 onychomycosis (SWO) and 1/23 (4%) was total dystrophic onychomycosis (TDO) [[26]]. In a systemic review of NDM onychomycosis , Gupta and colleagues reported that Aspergillus spp. manifest as PSO in 37.5% of the cases, DLSO in
onychomycosis 13391 DLSO in 26.1% and SWO in 25.5% [[2]]. A study in Italy showed that the clinical features suggesting onychomycosis due to Aspergillus spp. are (1) chalky deep white nail, (2) rapid involvement of lamina and (3) painful
onychomycosis 13851 contrast, A. niger was associated with 11.5% of DLSO, 10.1% of TDO, 9.1% of SWO and 6.3% of mixed pattern onychomycosis (MPO), whereas A. fumigatus was associated with DLSO in 2% of the patients, 5.8% TDO and 6.3% MPO [[28]].
onychomycosis 13985 fumigatus was associated with DLSO in 2% of the patients, 5.8% TDO and 6.3% MPO [[28]]. In A. terreus onychomycosis (Fig. 1), the observed clinical patterns in fingernail were DLSO (33.3%), SWO (33.3%) and onycholysis
onychomycosis 14279 followed by DLSO (42.0%) and DLSO plus SWO (5.9%) [[29]]. Another study showed that among those with onychomycosis due to Aspergillus spp., 93% manifested with hard nails, 89% with brittle nails and 85% had discoloured
onychomycosis 14535 is not common [[17]]. Subungual hyperkeratosis is almost always present in all patients with mould onychomycosis regardless of the genus of the fungi isolated [[30]]. Onychomycosis due to Aspergillus spp. are sometimes
onychomycosis 14766 with subungual dermatophytoma (“fungal ball”) formation. [[6]]Fig. 1Distal–lateral subungual onychomycosis caused by Aspergillus terreus in a 60-year-old immunocompetent man. A flaky, whitish, sharply demarcated
onychomycosis 15314 (Courtesy of Prof. David W. Denning, the National Aspergillosis Centre, Manchester, UK)DiagnosisNDM onychomycosis and therefore onychomycosis due to Aspergillus spp. may be considered in patients with fungal infection
onychomycosis 15342 Denning, the National Aspergillosis Centre, Manchester, UK)DiagnosisNDM onychomycosis and therefore onychomycosis due to Aspergillus spp. may be considered in patients with fungal infection in a diseased or traumatised
onychomycosis 15690 which were KOH positive and culture negative for dermatophytes [[31]].The differential diagnoses for onychomycosis due to Aspergillus spp. are very broad and include yeast nail infections, tinea unguium, non-Aspergillus
onychomycosis 15899 non-Aspergillus spp. NDMO and other non-fungal nail infections and disorders. Therefore, the diagnosis of onychomycosis due to Aspergillus spp. is both clinical and mycological. Since there are no specific signs associated
onychomycosis 16021 Aspergillus spp. is both clinical and mycological. Since there are no specific signs associated with onychomycosis due to Aspergillus spp., it is not possible to diagnose it based solely on physical appearance.Determining
onychomycosis 16167 not possible to diagnose it based solely on physical appearance.Determining the mycological cause of onychomycosis is helpful in guiding antifungal treatment and preventing complications [[32]]. Identification of the
onychomycosis 17021 detection of Aspergillus spp., provided no dermatophyte was isolated is sufficient to diagnose Aspergillus onychomycosis . Aspergillary heads may be observed with direct microscopic examination of nail specimens, especially
onychomycosis 17548 nail samples obtained by drilling compared to scraping (67%) [[34]].TreatmentTreatment options for NDM onychomycosis are still limited; however, onychomycosis caused by Aspergillus spp. responds well to systemic antifungal
onychomycosis 17590 scraping (67%) [[34]].TreatmentTreatment options for NDM onychomycosis are still limited; however, onychomycosis caused by Aspergillus spp. responds well to systemic antifungal agents, with itraconazole performing
onychomycosis 18189 per day for 1 week per month) for 2–4 months, completely curing 5 of 5 patients with Aspergillus onychomycosis who accepted treatment [[35]]. Interestingly, the nail discolorations in Aspergillus onychomycosis often
onychomycosis 18288 onychomycosis who accepted treatment [[35]]. Interestingly, the nail discolorations in Aspergillus onychomycosis often persist despite evidence of mycological cure [[17]]. Systemic antifungals are best combined with
onychomycosis 18596 ciclopirox olamine nail lacquers for SWO [[13]]. Terbinafine resistance has been reported with A. candidus onychomycosis , and mycological cure was achieved following 10 weeks of itraconazole therapy [[36]]. Total nail avulsion
onychomycosis 18912 management option (clinical cure rate 88% and mycological cure rate 100%) for patients with single or oligo- onychomycosis [[37]]. However, it should be noted that comparative clinical trials on the treatment of Aspergillus
onychomycosis 19027 [[37]]. However, it should be noted that comparative clinical trials on the treatment of Aspergillus onychomycosis have not been done to date and that recommendations have been based on case studies.ConclusionOnychomycosis
onychomycosis 19213 case studies.ConclusionOnychomycosis due to Aspergillus spp. is more prevalent and emerging cause of onychomycosis than previously thought. The prevalence ranges from 7.7 to 100% of all NDMO and between < 1 and 35%
onychomycosis 19390 of all NDMO and between < 1 and 35% in the general population. Since the clinical presentation of onychomycosis due to Aspergillus spp. is non-specific, it is necessary to perform laboratory procedures such as KOH,
onychomycosis 19751 Aspergillus spp., provided no dermatophyte was isolated is the required criteria for the diagnosis of onychomycosis due to Aspergillus spp. Treatment consists of systemic therapy with terbinafine or itraconazole

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