"MiVEGEC" and Department of Mycology and Parasitology, CNRS, IRD, University Hospital Center of Montpellier, University Montpellier, Montpellier, France.
Mycoses. 2021 Dec;64(12):1546-1553. doi: 10.1111/myc.13366. Epub 2021 Sep 13.
Moulds are often wrongly considered contaminants, not very sensitive to conventional antifungal treatments, but they may cause ungual hyphomycosis, particularly Aspergillus. Due to the lack of precise diagnostic criteria, their real impact is underestimated.
Retrospective descriptive analysis of all ungual hyphomycosis cases diagnosed at Montpellier Hospital from 1991 to 2019 to: (i) determine the incidence of onychomycosis by pseudo-dermatophytes and moulds; (ii) perform an epidemiological analysis of nail aspergillosis; and (iii) provide simple criteria for mould involvement in onychopathy.
PATIENTS/METHODS: Data concerning 4053 patients were collected: age, sex, onychomycosis location, direct examination results, species(s) identified and fungal co-infections. Moreover, clinical data of patients with nail aspergillosis were analysed to identify potential contributing factors, and the classical criteria for mould involvement in onychopathy were critically reviewed.
A pseudo-dermatophyte or a mould was involved in nail colonisation in 17.25% of patients (men/women ratio: 0.70; mean age: 53.1 years). The identified hyphomycetes belonged mainly to the genera Fusarium (45.68%), Scopulariopsis (30.23%) and Aspergillus (16.94%). Analysis of the clinical reports of 102 patients with ungual aspergillosis (men/women ratio: 0.67; mean age: 56.3 years) identified cardiovascular (43.9%), endocrine (25.8%), cancer (19.7%) and skin (18.2%) diseases as contributing factors.
The adoption of simple and reliable criteria (ie, characteristic filaments on direct microscopic examination after periodic acid-Schiff staining, growth at seeding points in culture) allows determining the formal involvement of a mould in chronic onychopathies and avoiding possible side effects and costs of empirical or inappropriate and repetitive treatments.
霉菌常被错误地认为是污染物，对常规抗真菌治疗不敏感，但它们可能引起甲真菌病，尤其是曲霉菌。由于缺乏精确的诊断标准，它们的实际影响被低估了。
回顾性分析 1991 年至 2019 年蒙彼利埃医院诊断的所有甲真菌病病例，以：（i）确定由拟真菌和霉菌引起的甲真菌病的发病率；（ii）对指甲曲霉病进行流行病学分析；（iii）提供霉菌参与甲病的简单标准。
患者/方法：收集了 4053 名患者的数据：年龄、性别、甲真菌病位置、直接检查结果、鉴定的种（s）和真菌感染。此外，还分析了指甲曲霉病患者的临床数据，以确定潜在的促成因素，并对霉菌参与甲病的经典标准进行了批判性回顾。
17.25%的患者（男女比例：0.70；平均年龄：53.1 岁）的指甲存在拟真菌或霉菌定植。鉴定的丝状真菌主要属于镰孢菌属（45.68%）、枝孢属（30.23%）和曲霉属（16.94%）。对 102 例指甲曲霉病患者（男女比例：0.67；平均年龄：56.3 岁）的临床报告分析发现，心血管疾病（43.9%）、内分泌疾病（25.8%）、癌症（19.7%）和皮肤疾病（18.2%）为促成因素。
采用简单可靠的标准（即直接显微镜检查后过碘酸希夫染色的特征性丝、接种点培养的生长）可以确定霉菌在慢性甲病中的正式参与，并避免可能的副作用和经验性或不适当和重复治疗的费用。
