Onychomycosis in immunocompromised population: Phenotypic and molecular identification

Area of Science:

• Mycology
• Immunology
• Dermatology

Background:

• Onychomycosis is prevalent in immunocompromised individuals, including renal transplant recipients (RTR), lupus nephritis (LN) patients, and those with diabetes mellitus (DM).
• These patient groups often undergo immunosuppressive therapies or have intrinsic immune deficiencies.

Purpose of the Study:

• To characterize and identify fungal nail infections in immunocompromised patients.
• To compare fungal infection patterns between different immunocompromised groups and a control group.

Main Methods:

• Nail samples were collected from 47 RTR, 66 LN, 67 DM patients, and 78 controls.
• Phenotypic and molecular analyses, including DNA sequencing of ITS regions, were performed for fungal identification.

Main Results:

• Lateral distal subungual onychomycosis was the most frequent type, primarily affecting the hallux.
• Dermatophytes were predominant on toenails, while Candida species were more common on fingernails.
• Molecular methods confirmed 87.2% of diagnoses, identifying Trichophyton rubrum, Trichophyton interdigitale, Candida parapsilosis, and Candida albicans as the most frequent agents.

Conclusions:

• Molecular techniques enhance diagnostic accuracy for fungal nail infections.
• Clinical presentation and fungal species in immunocompromised patients may differ from the general population.
• Immunosuppression did not significantly increase the overall positivity of fungal detection in this study.