Journal of Postgraduate Medicine
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Year : 1994  |  Volume : 40  |  Issue : 2  |  Page : 87-8  

Penicillium species causing onychomycosis.

R Ramani, A Ramani, PG Shivananda 
 Dept of Microbiology, Kasturba Medical College, Manipal, Karnataka.

Correspondence Address:
R Ramani
Dept of Microbiology, Kasturba Medical College, Manipal, Karnataka.

Abstract

Onychomycosis caused by mould infection is rare. A 40 year old male patient presented with dystrophic finger nails and multiple, erythematous lesions with slightly raised borders and scaling all over the body. The patient was a known diabetic. He did not respond to griseofulvin. Samples from nails and skin scales were cultured. From the nails, Penicillium species and from the skin scales. Trichophyton rubrum were isolated. Ketoconazole therapy (200 mg twice daily x 4 mths) led to complete cure with negative cultures and normalization of nails.



How to cite this article:
Ramani R, Ramani A, Shivananda P G. Penicillium species causing onychomycosis. J Postgrad Med 1994;40:87-8


How to cite this URL:
Ramani R, Ramani A, Shivananda P G. Penicillium species causing onychomycosis. J Postgrad Med [serial online] 1994 [cited 2023 Feb 3 ];40:87-8
Available from: https://www.jpgmonline.com/text.asp?1994/40/2/87/555


Full Text




  ::   IntroductionTop


Onychomycosis is defined as infection of nail by fungus. The etiological agents are dermatophytes, candida and rarely moulds[1]. Among the moulds Aspergillus species, Fusarium species, Hendersenula tarulesidea, Scapularlosis bravicaulis[2] etc have been reported as causative organisms of onychomycosis.

We report a case of a diabetic patient suffering from infection of the finger nails and skin due to Penicillium species and trichophyton respectively.


  ::   Case reportTop


A 40-year-old male, farmer presented with dystrophy of finger nails and recurrent itchy skin lesions all over the body for 5 years. There was no localised pain at the affected site. On examination, the right finger nails were lustreless and dystrophied. The distal part of the nail appeared soft, black coloured with irregular margin [Figure:1]

Multiple, well defined erythematous lesions with slightly raised borders and cealing were seen all over the body patient was a known diabetic for the past 6 years and also had an attack of glomerulonephritis. He was treated with griseofulvin for 2-3 months for the skin lesions and nail infections without improvement. Samples of the nails were examined three times in 40% KOH preparation and cultured on slopes containing (a) Sabouraud's dextrose agar (SDA) incorporating cycloheximide 0.05 mg/ml and chloramphenicol 0.5 mg/ml and (b) Sabouraud's dextrose agar incorpora ing chloramphenicol 0.05 mg/ml only and incubated at room temperature.

Skin scales were examined microscopically and were also inoculated in the same manner. Nail specimens on three occasions showed fungal elements in squash preparation and in 6 days time Penicillium species grew on SDA containing chloramphenicol which was identified by standard methods[3] [Figure:2].

From the skin scales, Trichophyton rubrum grow on SDA containing chloramphenicol and SDA containing chloramphenicot and cycloheximide, which was identified by standard methods[3].

As there was no response to griseofulvin, he was treated with oral ketoconazole (200 mg twice daily) for 4 months resulting in cure. Every month the enzyme levels were tested to ascertain the liver function. After six months, the fungal cultures from nail samples and also from skin scrapings were negative. After one year, the patient had normal nails and the lesions on the body were minimal.


  ::   DiscussionTop


Moulds causing nail infection are rare. Moulds are opportunistic and frequently invade altered keratin, particularly that of the big toe[4]. In our case, Penicillium species was isolated from finger nails of a patient who had dermatophytic skin infection. It is likely that the dermatophyte reduced the resistance of the finger nail keratin, paving the way for mould[5]. In vitro the fungus readily utilizes the nail as a source of nutrient. Convincing evidence include a) direct microscopic examination of nail sample showing hyphae, b) repeated isolation of Pencillium species on culture and c) absence of dermatophytes from the nail samples. Pencillium species have been found as soil saprophytes[3], and our patient being a farmer, had probably acquired the infection from the soil.

Griseofulvin in adequate amounts results in cure of onychomycosis[2], but Penicillium species are not suspectible to griseofulvin[3]. Hence Ketoconazole was used and found to be successful.

References

1 Paldrok H, Hollstrom E. Onychomycosis due to Aspergillus terreus. Acta Dermato Vener 01 1962; 28-9:225-230.
2Zaiss N. Onychomcosis Arch Dermatol 1972; 105:263-274
3Rippon JW. The Pathogenic fungi and the Pathogenic Actinomycetes, 2nd ed. Philadelphia: WB Saunders Company; 1972.
4Andre J, Achetan G. Onychomycosis. Int J Dermatol 1987; 26:481-490.
5Ramesh V, Singh R, Reddy BSN, Kumari S. Clinicomycological study of onychomycosis. Indian J Dermatol Venerol Leprol 1982; 48:145-150.

 
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