Medical Mycology Laboratory, Pedro Ernesto University Hospital, Universidade do Estado do Rio de Janeiro, RJ, Brazil.
Mycopathologia. 2013 Feb;175(1-2):75-82. doi: 10.1007/s11046-012-9580-5. Epub 2012 Sep 14.
Onychomycosis by Neoscytalidium constitutes chronic infection of the nails, and its frequency has increased in recent decades. Currently, no effective standard treatment exists and literature data remain scarce. This work aimed to conduct a pilot project of combined treatment for this infection.
Thirty patients were divided into three treatment groups: oral terbinafine plus ciclopirox nail lacquer twice a week; ciclopirox nail lacquer twice a week; and ciclopirox nail lacquer 5 days a week, all associated with nail abrasion when required, for 12 months, with 6 months posttreatment follow-up. Clinical and mycological criteria were used for evaluation.
Twenty-five patients completed the study. Significant clinical lesion reduction in disease occurred in all three treatment groups: 21 patients (84%) entered the study with more than 50% of diseased nail plate, at the end of treatment, and at 6-month follow-up, 84 and 96%, respectively, presented less than 25% nail lesion. Negative microscopy was observed in 36% of the patients at the end of treatment and in 24% of the patients at 6-month follow-up. At treatment completion (12 months), culture was negative in 21 patients (84%) and in 18 (72%) at follow-up. It was not possible to establish any clinical or mycological statistical differences between groups (p > 0.05). Global medical evaluation upon treatment completion revealed that one patient (4%) presented complete cure, 8 (32%) presented partial cure, 16 (64%) presented therapeutic failure. At the end of follow-up period, 6 patients (24%) were considered to have recurrence/reinfection.
The results obtained at the 6-month period of follow-up showed marked improvement (96% of clinical improvement and 72% of negative culture) of the patients treated for onychomycosis caused by Neoscytalidium in the three tested groups with no statistical differences between them. Multicentric studies with greater number of patients enrolled are necessary to confirm these results.
新生隐球菌引起的甲真菌病是一种慢性指甲感染，近年来其发病率有所增加。目前，尚无有效的标准治疗方法，文献数据仍然很少。本研究旨在开展针对这种感染的联合治疗的初步研究。
将 30 名患者分为三组进行治疗：口服特比萘芬加环吡酮胺甲涂剂，每周两次；环吡酮胺甲涂剂，每周两次；环吡酮胺甲涂剂，每周 5 天，均根据需要配合指甲锉磨，治疗 12 个月，治疗后 6 个月进行随访。采用临床和真菌学标准进行评估。
25 名患者完成了研究。三组治疗均显著降低了临床疾病评分：21 名（84%）患者入组时病变指甲面积超过 50%，治疗结束时，84%和 96%的患者分别有不到 25%的指甲病变；6 个月随访时，分别有 36%和 24%的患者真菌镜检为阴性。治疗结束时（12 个月），21 名（84%）患者的培养结果为阴性，18 名（72%）患者在随访时为阴性。组间无统计学差异（p>0.05）。治疗结束时的总体医疗评估显示，1 名（4%）患者完全治愈，8 名（32%）患者部分治愈，16 名（64%）患者治疗失败。随访期末，6 名（24%）患者被认为复发/再感染。
在 6 个月的随访期间，三组接受新生隐球菌所致甲真菌病治疗的患者的临床改善率（96%）和真菌培养阴性率（72%）均有显著提高，且组间无统计学差异。需要开展纳入更多患者的多中心研究来证实这些结果。
