Lim J T, Chua H C, Goh C L
National Skin Centre, Singapore.
Australas J Dermatol. 1992;33(3):159-63. doi: 10.1111/j.1440-0960.1992.tb00110.x.
Onychomycosis is caused by dermatophytes, moulds and yeasts. It is important to identify the non-dermatophyte moulds as they are resistant to the usual anti-fungals. A prospective study was undertaken in the National Skin Centre, Singapore to study the pattern of dermatophyte and non-dermatophyte onychomycosis. 53 male and 47 female patients seen between June 1990 and June 1991 were entered into the study. Direct microscopy was done and the nail clippings were cultured. Toe and finger nails were equally infected. Dermatophytes were isolated from 21 patients namely, T. rubrum (12/21), T. interdigitale (5/21), T. mentagrophytes (3/21) and T. violaceum (1/21). Candida onychomycosis occurred in 39 patients and was caused by C. albicans (38/39) and C. parapsilosis (1/39). 37/39 patients had associated paronychia. 5 types of moulds were isolated from 12 patients, namely Fusarium species (6/12), Aspergillus species (3/12), S. brevicaulis (1/12), Aureobasilium species (1/12) and Penicillium species (1/12). Although the clinical pattern and microscopy may predict the type of organisms, in practice this is difficult. Only cultures were confirmatory. 28% (28/100) had negative cultures despite a positive microscopy, and moulds (12/100) grown might be contaminants rather than pathogens.
甲癣由皮肤癣菌、霉菌和酵母菌引起。识别非皮肤癣菌性霉菌很重要，因为它们对常用抗真菌药耐药。在新加坡国家皮肤中心进行了一项前瞻性研究，以研究皮肤癣菌性和非皮肤癣菌性甲癣的模式。1990年6月至1991年6月间就诊的53例男性和47例女性患者纳入该研究。进行了直接显微镜检查并对指甲剪进行培养。脚趾甲和手指甲受感染的情况相同。从21例患者中分离出皮肤癣菌，即红色毛癣菌（12/21）、指间毛癣菌（5/21）、须癣毛癣菌（3/21）和紫色毛癣菌（1/21）。39例患者发生念珠菌性甲癣，由白色念珠菌（38/39）和近平滑念珠菌（1/39）引起。37/39的患者伴有甲沟炎。从12例患者中分离出5种霉菌，即镰刀菌属（6/12）、曲霉菌属（3/12）、短帚霉（1/12）、金孢子菌属（1/12）和青霉属（1/12）。尽管临床模式和显微镜检查可能预测病原体类型，但在实际中这很难做到。只有培养结果具有确诊性。28%（28/100）患者显微镜检查呈阳性但培养结果为阴性，培养出的霉菌（12/100）可能是污染物而非病原体。
