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Onychomycosis caused by Alternaria spp. in Tuscany, Italy from 1985 to 1999
C Romano1, E Paccagnini, E M Difonzo
1Istituto di Scienze Dermatologiche, Università degli Studi di Siena, Italy.
Abstract:
Cutaneous phaeohyphomycosis due to Alternaria spp. is reported with increasing frequency, especially in patients with immune deficiency. Onychomycosis caused by this mould is still rarely observed. Here we report nine cases observed in Tuscany in the period 1985-99; the agent was Alternaria alternata in eight cases and Alternaria chlamidospora in one. Diagnosis was made on the basis of repeated direct microscopic mycological examination and culture, confirmed by scanning electron microscope observation of fragments of colonies. In most cases, the clinical manifestations were dystrophy and distal subungual hyperkeratosis of one or two nails of the feet or hands. Seven cases were treated with oral itraconazole, successfully in six cases, as clinical and mycological recovery was confirmed at follow-up 1 year later.
Insights
Cutaneous phaeohyphomycosis, a fungal infection, is increasingly seen in immunocompromised patients. This study details nine cases of onychomycosis (nail infection) caused by Alternaria species, with successful treatment using oral itraconazole in most patients.
Area of Science:
- Medical Mycology
- Dermatology
- Infectious Diseases
Background:
- Cutaneous phaeohyphomycosis, caused by fungi like Alternaria, is rising, particularly in immunocompromised individuals.
- Onychomycosis (nail fungal infection) due to Alternaria species is uncommon.
Observation:
- Nine cases of Alternaria onychomycosis were observed in Tuscany between 1985 and 1999.
- The causative agents were identified as Alternaria alternata (eight cases) and Alternaria chlamidospora (one case).
- Clinical presentation typically involved nail dystrophy and subungual hyperkeratosis affecting one or two nails.
Findings:
- Diagnosis was confirmed via direct microscopy, culture, and scanning electron microscopy.
- Oral itraconazole treatment was administered to seven patients.
- Six out of seven patients achieved successful clinical and mycological recovery after one year of follow-up.
Implications:
- This study highlights Alternaria species as a potential cause of onychomycosis, especially in susceptible populations.
- It demonstrates the efficacy of oral itraconazole in treating Alternaria onychomycosis.
- Further research into Alternaria nail infections and their management is warranted.