Scopulariopsis brevicaulis as the cause of dermatomycosis

Scopulariopsis (S.) brevicaulis (Saccardo) Bainier 1907 is a ubiquitous fungus frequently isolated as a saprophyte from various layers of the soil, wood, straw, paper, food, and occasionally in animals and humans. This nondermatophyte filamentous fungus is multiresistant and is frequently associated with onychomycosis in humans. In the last two decades, the number of reports on its pathogenic role in different localized and disseminated infections has been on an increase. Identification was done by native KOH microscopy and culture on the Mycobios selective agar (Biolife). From January 1, 2002 till January 23, 2008, a total of 7161 samples were examined by use of mycology methods; S. brevicaulis accounted for 39 (2.2%) of 1834 (25.6%) positive samples. During the study period, S. brevicaulis was isolated from nail, skin and scalp scrapings of 39 patients (17 male and 22 female), mean age ( SD) 43.920.7 (range 8-87) years. Specimens were most frequently obtained from the foot (n=16; 41%), i.e. great toe nail in 10 and other foot areas in 6 cases, followed by palm and fingers in 8 (20.5%), scalp in 3 (7.7%) and other parts of the body in 12 (30.8%) cases. Most of the study subjects lived in a rural setting (n=22; 56%), working as farmers in close contact with the soil and domestic animals. Seventeen (44%) subjects were from urban setting (n=9) or unknown place of residence (n=8). Underlying risk factors were present in 29 (74%) of 39 study subjects, some of them with multiple risk factors. Besides close contact with the soil, the most common predisposing factors were various dermatoses (atopic dermatitis, psoriasis, dysseborrhea, etc.), lower extremity circulatory insufficiency, trauma, microtrauma, and metabolic disorders. Although the clinical picture of onychomycosis caused by S. brevicaulis shows some specific features, timely sampling for mycology is crucial to verify the diagnosis and to identify the causative agent prior to the introduction of appropriate therapy for dermatomycosis.