Molecular Characterization of Non Dermatophytic Fungi Causing Onychomycosis

Abstract

Onychomycosis is a common and difficult-to-treat fungal infection of the nail that gradually leads to dystrophic changes of the nail plate and nail bed. If untreated, infection progresses and may lead to discomfort, reduced quality of life, and risk of complications in patients with comorbid conditions (eg, diabetes, human immune deficiency virus, peripheral vascular disease), thus accurate diagnosis of the disease before treatment is important. The aim of this investigation was to study the prevalence of Onychomycosis due to non dermatophytes, yeast and mould in Egypt, Cairo, in the period between August 2016 to October 2017 from Wadi- El Neel Hospital and, Ain Shams University Specialized Hospital. The frequently used mycological tests include direct microscopic examination with (10%) potassium hydroxide (KOH), fungal culture, antifungal sensitivity test, molecular typing of the isolated mould fungal strains based on ITS1- 5.8S-ITS2 region sequences and Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry analysis (MALDI-TOF MS) to confirmed yeast fungi identification. Out of 102 cases of Onychomycosis isolated from finger nail or toe nail specimens, their age ranged from 8 to 95 years, 28 cases (27.5) % were male and 74 cases (72%) were female, 86 cases were positive fungal infection(84.3 %), 16 cases were negative (15.6%), the most common isolated species were Aspergillus niger 47 isolates (46.1%), Aspergillus flavus 19 isolates (18.6%), Aspergillus terreus 4 isolates(3.9%), Aspergillus fumigatus 2 isolates (2.0%), followed by Candida albicans 8 isolates (7.8 %) and Trichosporon begilii 2 isolates(2.0%) ,Alernaria alternate 1 isolat (1.0%) and Cladosporium sphaerospermum 3 isolates(2.9%).it was found that Ketoconazole has most potent effect on the isolates using disk diffusion method followed by Itraconazle and Voriconazole.