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      • Record: found
      • Abstract: found
      • Article: found

      A Paradigm Shift in the Treatment and Management of Onychomycosis

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          Abstract

          There is an increase in the incidence of onychomycosis, especially in at-risk populations. Onychomycosis is difficult to treat, as the efficacy of most antifungal agents is relatively low. Nondermatophyte molds (NDMs) and mixed infection (dermatophyte plus NDM) onychomycosis are contributing to growing antifungal resistance, as they are often underestimated and ignored due to incorrect diagnosis. There is a need for a paradigm shift in the management of onychomycosis to a patient-centered, holistic approach with an emphasis on laboratory diagnosis prior to initiating treatment, which enables the rational choice of the antifungal agent. Additionally, in the case of resistant infections, antifungal susceptibility testing is recommended. Strategies for effective management of onychomycosis include disinfection of fungal reservoirs in shoes and socks and prophylaxis posttreatment using topical antifungal agents. These measures may reduce the recurrence of onychomycosis and improve long-term clinical success.

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          COVID-19 Associated Pulmonary Aspergillosis (CAPA)—From Immunology to Treatment

          Amir Arastehfar, Agostinho Carvalho, Frank van de Veerdonk … (2020)
          Like severe influenza, coronavirus disease-19 (COVID-19) resulting in acute respiratory distress syndrome (ARDS) has emerged as an important disease that predisposes patients to secondary pulmonary aspergillosis, with 35 cases of COVID-19 associated pulmonary aspergillosis (CAPA) published until June 2020. The release of danger-associated molecular patterns during severe COVID-19 results in both pulmonary epithelial damage and inflammatory disease, which are predisposing risk factors for pulmonary aspergillosis. Moreover, collateral effects of host recognition pathways required for the activation of antiviral immunity may, paradoxically, contribute to a highly permissive inflammatory environment that favors fungal pathogenesis. Diagnosis of CAPA remains challenging, mainly because bronchoalveolar lavage fluid galactomannan testing and culture, which represent the most sensitive diagnostic tests for aspergillosis in the ICU, are hindered by the fact that bronchoscopies are rarely performed in COVID-19 patients due to the risk of disease transmission. Similarly, autopsies are rarely performed, which may result in an underestimation of the prevalence of CAPA. Finally, the treatment of CAPA is complicated by drug–drug interactions associated with broad spectrum azoles, renal tropism and damage caused by SARS-CoV-2, which may challenge the use of liposomal amphotericin B, as well as the emergence of azole-resistance. This clinical reality creates an urgency for new antifungal drugs currently in advanced clinical development with more promising pharmacokinetic and pharmacodynamic profiles.
          Article 0 comments Cited 172 times – based on 0 reviews     Review now
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            The History of Ultraviolet Germicidal Irradiation for Air Disinfection

            Nicholas Reed (2010)
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              High terbinafine resistance in Trichophyton interdigitale isolates in Delhi, India harbouring mutations in the squalene epoxidase gene

              Ashutosh Singh, Aradhana Masih, Ananta Khurana … (2018)
              In the last few years, infections caused by dermatophytes along with a concomitant increase in the number of difficult to treat cases have increasingly been recognised, indicating that dermatophytosis remains a challenging public health problem. The majority of infections are caused by Trichophyton rubrum and Trichophyton mentagrophytes complex. Terbinafine, an allylamine antifungal used orally and topically is considered to be a first-line drug in the therapy of dermatophyte infections. Terbinafine resistance has been predominately attributed to point mutations in the squalene epoxidase (SQLE) target gene a key enzyme in the ergosterol biosynthetic pathway leading to single amino acid substitutions. Here, we report the largest series of 20 terbinafine-resistant Trichophyton interdigitale isolates obtained predominately from cases of tinea corporis/cruris in three hospitals in Delhi, India exhibiting elevated MICs (4 to ≥32 μg/mL) to terbinafine and all harbouring single-point mutations Leu393Phe or Phe397Leu in the SQLE gene. In 12 (60%) T. interdigitale isolates, the Phe397Leu substitution was observed, whereas in the remaining 8 (40%) isolates the substitution Leu393Phe was reported for the first time in T. interdigitale. Furthermore, 10 susceptible T. interdigitale isolates (0.125-2 μg/mL) had a wild-type genotype. Remarkably, considerably high terbinafine resistance rate of 32% was observed among 63 T. interdigitale isolates identified by sequencing of the internal transcribed spacer region. This high level of terbinafine resistance of Indian dermatophyte isolates is worrisome warranting antifungal susceptibility testing and mutation analysis for monitoring this emerging resistance.
              Article 0 comments Cited 80 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (publisher-id): SAD
                Journal ID (pmc): SAD
                Journal ID (doi): 10.1159/issn.2296-9160
                Title: Skin Appendage Disorders
                Publisher: S. Karger AG
                ISSN (Print): 2296-9195
                ISSN (Electronic): 2296-9160
                Publication date Subscription-year: 2021
                Publication date (Print): August 2021
                Publication date (Electronic): 11 May 2021
                Volume: 7
                Issue: 5
                Pages: 351-358
                Affiliations
                [_a] aDivision of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
                [_b] bMediprobe Research Inc., London, Ontario, Canada
                [_c] cSporometrics, Toronto, Ontario, Canada
                [_d] dDalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
                [_e] eDivision of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
                [_f] fDivision of Dermatology, Women’s College Hospital, Toronto, Ontario, Canada
                Article
                Publisher ID: 516112 Other ID: Skin Appendage Disord 2021;7:351–358
                DOI: 10.1159/000516112
                SO-VID: a538beaf-e51c-4e5e-b831-8ee285edca76
                Copyright © © 2021 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 04 February 2021
                Date accepted : 17 March 2021
                Page count
                Figures: 3, Pages: 8
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Oncology & Radiotherapy,Pathology,Surgery,Dermatology,Pharmacology & Pharmaceutical medicine
                Keywords: Paradigm,Onychomycosis,Treatment,Management,Superficial mycoses,Antifungal resistance
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy, Pathology, Surgery, Dermatology, Pharmacology & Pharmaceutical medicine
                Keywords: Paradigm, Onychomycosis, Treatment, Management, Superficial mycoses, Antifungal resistance

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