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Clinical and Histological Aspects of Toenail Onychomycosis Caused by <i>Aspergillus</i> spp.: 34 Cases Treated with Weekly Intermittent Terbinafine

2004; Karger Publishers; Volume: 209; Issue: 2 Linguagem: Inglês

10.1159/000079593

1421-9832

Claudia Gianni, Clara Romano,

Plant Pathogens and Fungal Diseases

<i>Background:</i> Non-dermatophytic onychomycoses represent 1.45–17.6% of all fungal nail infections. Epidemiological studies have shown that <i>Aspergillus</i> spp. are emerging fungal agents of toenail onychomycosis. Indeed, after <i>Scopulariopsis</i> spp. the genus <i>Aspergillus</i> is the second most common agent of non-dermatophytic onychomycosis. The diagnosis and treatment of toenail onychomycosis caused by non-dermatophyte moulds are not always straightforward. <i>Objectives:</i> The aims of this study were to describe the clinical appearance of toenail onychomycosis due to <i>Aspergillus</i> spp., to investigate the pathogenetic role of these agents and to evaluate the efficacy and safety of weekly intermittent terbinafine (500 mg/day for 1 week each month for 3 months) in the treatment of these patients. <i>Patients and Methods:</i> Mycological study of 2,154 patients with onychodystrophy revealed 1,228 onychomycoses (57%) including 71 cases due to non-dermatophytic fungi (5.6%). Non-dermatophytic onychomycosis caused by <i>Aspergillus</i> spp. represented 2.6% of all onychomycoses. The subjects were 34 patients (22 females, 12 males, age range 30–82 years) observed between September 1999 and December 2001, with toenail onychomycosis caused by <i>Aspergillus</i> spp. confirmed by standard techniques (microscopic examination and culture according to the criteria of English), histological examination of nail clippings and scanning electron microscope examination of the cultures whenever necessary. <i>Results:</i> The clinical features suggesting onychomycosis due to <i>Aspergillus</i> spp. are chalky deep white nail, rapid involvement of lamina and painful perionyxis without pus. Standard mycological tests (direct microscopy and fungal culture) and histological examination confirmed the pathogenetic role of <i>Aspergillus</i> spp. in onychomycoses. In particular, the histological examination was positive in 28 cases (82%) and useful in identifying typical aspects of <i>Aspergillus</i> spp. nail infections. At the follow-up, 12 months after the start of therapy with pulsed terbinafine, clinical and mycological recovery was confirmed in 30 of the 34 patients (88%). <i>Conclusions:</i> Treatment of non-dermatophytic onychomycosis with terbinafine usually requires at least 3 months of continuous systemic therapy. Our study of 34 patients confirms that terbinafine is particularly effective in the treatment of <i>Aspergillus</i> spp. nail infections and that a pulsed regimen is more economical and less demanding.