High Diversity of Fusarium Species in Onychomycosis: Clinical Presentations, Molecular Identification, and Antifungal Susceptibility
Abstract
:1. Introduction
2. Materials and Methods
2.1. Sample Collection, Culture, and Microscopic/Histopathological Examination
2.2. Molecular Identification
2.3. Antifungal Susceptibility
3. Results
3.1. Demographic Data and Clinical Manifestations
3.2. Direct Microscopic and Histological Findings
3.3. Molecular Identification
3.4. Antifungal Susceptibility Testing
3.5. Treatment Response and Prognosis
3.6. Presentation of Two Special Cases
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Sex/Age | Immune Status | Location | Duration (Month) | Species | Treatment | Prognosis | Contact to Soil | |
---|---|---|---|---|---|---|---|---|
FFSC | F/77 | IC | Right big toenail | 2 | Fusarium denticulatum | TAF | GR | Yes |
F/61 | IC | Right middle finger | 1 | Fusarium annulatum | Surgery | GR | Yes | |
F/84 | Lung cancer | Fingernails | 6 | Fusarium annulatum | ITC + TAF | GR | No | |
FIESC | F/65 | Paraneoplastic pemphigus | Fingernails | 108 | Fusarium pernambucanum (FIESC 17) | ITC + TAF | PoR | No |
M/46 | Tuberous sclerosis, left RCC | Toenails | 3 | Fusarium arcuatisporum (FIESC 7) | TAF | PaR | No | |
FOSC | F/54 | IC | Right big toenail | 53 | Fusarium curvatum | TAF | Los | No |
M/36 | IC | Bilateral big toenails | 4 | Fusarium sp. | ITC + TAF | GR | No | |
FSSC | F/60 | SLE | Fingernails | 7 | Fusarium keratoplasticum (FSSC 2) Fusarium solani (FSSC 5) | ITC/TRB + TAF | GR | No |
M/21 | IC | Left big toenail | 4 | Fusarium solani (FSSC 5) | TAF | PaR | No | |
M/43 | IC | Bilateral big toenail | 1 | Fusarium falciforme (FSSC 3 + 4) | TAF | PoR | No | |
F/58 | DM | Right big toenail | 32 | Fusarium falciforme (FSSC 3 + 4) | TRB + TAF | PoR | No | |
F/45 | IC | Left big toenail | 4 | Fusarium keratoplasticum (FSSC 2) | TRB +TAF | GR | No | |
F/67 | IC | Bilateral big toenail | 60 | Fusarium keratoplasticum (FSSC 2) | TRB + TAF | PoR | No | |
M/77 | IC | Bilateral thumb | 48 | Fusarium keratoplasticum (FSSC 2) | TRB +TAF | PoR | Yes | |
F/3 | IC | Fingernails + Toenails | 15 | Fusarium keratoplasticum (FSSC 2) | TAF | PoR | No | |
F/31 | IC | Left big toenail | 32 | Fusarium keratoplasticum (FSSC 2) | ITC/TRB + TAF | GR | No | |
M/34 | IC | Bilateral toenails | 4 | Fusarium keratoplasticum (FSSC 2) | TRB + TAF | GR | No | |
F/79 | IC | Fingernails + Toenails | 25 | Fusarium keratoplasticum (FSSC 2) | TAF | PoR | No | |
F/55 | IC | Bilateral big toenail | 41 | Fusarium keratoplasticum (FSSC 2) | Laser + Griseolfulbin + TAF | GR | No | |
M/60 | IC | Fingernails + Toenails | 41 | Fusarium keratoplasticum (FSSC 2) | TRB + TAF | PaR | No | |
M/45 | IC | Right big toenail | 2 | Fusarium keratoplasticum (FSSC 2) | TAF | PoR | No | |
F/65 | IC | Right big toenail | 24 | Fusarium keratoplasticum (FSSC 2) | TRB + TAF | PoR | No | |
M/48 | IC | Fingernails + Toenails | 9 | Fusarium keratoplasticum (FSSC 2) | TAF | PoR | No | |
F/87 | Terminal ileal cancer | Bilateral big toenail | 36 | Fusarium keratoplasticum (FSSC 2) | TAF | PoR | No | |
M/70 | DM | Left thumb | 2 | Fusarium suttonianum (FSSC 20) | TAF | GR | Yes | |
M/77 | IC | Fingernails + Toenails | 6 | Fusarium lichenicola (FSSC 16) | TAF | PoR | Yes | |
M/65 | IC | Right big toenail | 5 | Nectria bolbophylli | TRB + TAF | GR | No | |
M/20 | IC | Left 2nd fingernail | 1 | Fusarium sp. | TAF | Los | No | |
F/61 | IC | Fingernails + Toenails | 5 | Fusarium sp. | TRB + TAF | GR | Yes |
(a) Frequently Branching Irregularly Septated Hyphae | (b) Arbitrarily Widening Hyphae | (c) Dermatophytoma Like Fungal Mass | (d) Thin Hyphae | (e) Moniliform Hyphae | (f) Hyphae with Terminal Swelling | |
---|---|---|---|---|---|---|
FSSC (N = 23) | ||||||
F. keratoplasticum | 4 | 1 | 3 | 7 | 4 | |
F. falciforme | 1 | 1 | ||||
F. solani SC | 1 | |||||
F. suttonianum | 1 | 1 | ||||
F. lichenicola | 1 | |||||
Nectria bolbophylli | 1 | |||||
Fusarium species | 1 | 1 | 1 | |||
FFSC (N = 3) | ||||||
F. denticulatum | 1 | 1 | ||||
F. annulatum | 2 | |||||
FOSC (N = 2) | ||||||
F. curvatum | 1 | |||||
FIESC (N = 2) | ||||||
F. pernambucanum | 1 | |||||
F. arcuatisporum | 1 | |||||
Total | 14 | 2 | 4 | 1 | 10 | 5 |
Species | RLMM No. | Accession Number | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
AMB | TRB | FLC | ITC | EFC | LNC | LLC | VRC | NAT | ITS | EF1a | |||
FFSC | F. annulatum | CGMHD0248 | 1 | 4 | >64 | >32 | 0.25 | 0.063 | 0.031 | 4 | 4 | LC687503 | LC697741 |
F. annulatum | CGMHD2913 | 2 | 4 | >64 | >32 | 0.5 | 0.125 | 0.063 | 4 | 8 | LC687504 | LC697742 | |
F. denticulatum | CGMHD1101 | 1 | 2 | >64 | 4 | 0.125 | 0.031 | <0.008 | 1 | 4 | LC687507 | LC697745 | |
FIESC | F. arcuatisporum | CGMHD0667 | ND | ND | ND | ND | ND | ND | ND | ND | ND | LC687505 | LC697743 |
F. pernambucanum | CGMHD0550 | 1 | >32 | >64 | 32 | 0.5 | 0.063 | 0.063 | 2 | 4 | LC687537 | LC697775 | |
FOSC | F. curvatum | CGMHD0436 | 1 | 8 | >64 | >32 | 0.5 | 0.125 | 0.063 | 4 | 4 | LC687506 | LC697744 |
Fusarium sp. | CGMHD3594 | 2 | 4 | >64 | >32 | 0.5 | 0.125 | 0.063 | 8 | 8 | LC687546 | LC697784 | |
Fusarium sp. | CGMHD3699 | 4 | 2 | >64 | >32 | 0.5 | 0.125 | 0.063 | 8 | 8 | LC687547 | LC697785 | |
FSSC | F. falciforme | CGMHD0414 | 1 | >32 | >64 | >32 | 1 | 0.5 | 0.25 | 8 | 8 | LC687508 | LC697746 |
F. falciforme | CGMHD2876 | 2 | >32 | >64 | >32 | 1 | 0.125 | 0.031 | 4 | 8 | LC687509 | LC697747 | |
F. keratoplasticum | CGMHD0234 | 2 | >32 | >64 | >32 | 2 | 0.5 | 0.125 | 8 | 4 | LC687510 | LC697748 | |
F. keratoplasticum | CGMHD0321 | 1 | >32 | >64 | >32 | 4 | 0.25 | 0.125 | 8 | 4 | LC687511 | LC697749 | |
F. keratoplasticum | CGMHD0549 | 2 | >32 | >64 | >32 | 2 | 0.5 | 0.125 | 8 | 4 | LC687512 | LC697750 | |
F. keratoplasticum | CGMHD0562 | >16 | >32 | >64 | >32 | >4 | >4 | >4 | >16 | >32 | LC687513 | LC697751 | |
F. keratoplasticum | CGMHD0658 | 2 | >32 | >64 | >32 | 2 | 0.25 | 0.063 | 8 | 4 | LC687514 | LC697752 | |
F. keratoplasticum | CGMHD0666 | 2 | >32 | >64 | >32 | 2 | 0.25 | 0.125 | 8 | 4 | LC687515 | LC697753 | |
F. keratoplasticum | CGMHD0683 | 2 | >32 | >64 | >32 | 2 | 0.25 | 0.125 | 8 | 4 | LC687516 | LC697754 | |
F. keratoplasticum | CGMHD0693 | 2 | >32 | >64 | >32 | 2 | 0.25 | 0.063 | 8 | 4 | LC687517 | LC697755 | |
F. keratoplasticum | CGMHD0702 | 1 | >32 | >64 | >32 | 1 | 0.25 | 0.063 | 8 | 4 | LC687518 | LC697756 | |
F. keratoplasticum | CGMHD0740 | 4 | >32 | >64 | >32 | 2 | 0.25 | 0.063 | 8 | 4 | LC687519 | LC697757 | |
F. keratoplasticum | CGMHD0821 | 4 | >32 | >64 | >32 | 2 | 0.25 | 0.063 | 8 | 4 | LC687520 | LC697758 | |
F. keratoplasticum | CGMHD0862 | 2 | >32 | >64 | >32 | 2 | 0.5 | 0.125 | 8 | 4 | LC687521 | LC697759 | |
F. keratoplasticum | CGMHD0974 | >16 | >32 | >64 | >32 | >4 | 0.25 | >4 | >16 | >32 | LC687522 | LC697760 | |
F. keratoplasticum | CGMHD1078 | 2 | >32 | >64 | >32 | 2 | 0.5 | 0.125 | 8 | 4 | LC687523 | LC697761 | |
F. keratoplasticum | CGMHD1220 | 2 | >32 | >64 | >32 | 2 | 0.25 | 0.063 | 8 | 4 | LC687524 | LC697762 | |
F. keratoplasticum | CGMHD1235 | 2 | >32 | >64 | >32 | 0.5 | 0.125 | 0.031 | 2 | 4 | LC687525 | LC697763 | |
F. keratoplasticum | CGMHD1268 | 2 | >32 | >64 | >32 | 2 | 1 | 0.125 | 16 | 4 | LC687526 | LC697764 | |
F. keratoplasticum | CGMHD1420 | 1 | >32 | >64 | >32 | 2 | 0.25 | 0.063 | 8 | 4 | LC687527 | LC697765 | |
F. keratoplasticum | CGMHD1875 | 2 | >32 | >64 | >32 | 0.5 | 0.125 | 0.031 | 4 | 4 | LC687528 | LC697766 | |
F. keratoplasticum | CGMHD1983 | 4 | >32 | >64 | >32 | 2 | 0.25 | 0.063 | 16 | 4 | LC687529 | LC697767 | |
F. keratoplasticum | CGMHD2223 | 4 | >32 | >64 | >32 | 2 | 0.25 | 0.063 | 8 | 4 | LC687530 | LC697768 | |
F. keratoplasticum | CGMHD2617 | 4 | >32 | >64 | >32 | 2 | 0.25 | 0.063 | 8 | 4 | LC687531 | LC697769 | |
F. keratoplasticum | CGMHD3297 | 2 | >32 | >64 | >32 | 0.5 | 0.125 | 0.063 | 2 | 4 | LC687532 | LC697770 | |
F. keratoplasticum | CGMHD3335 | 2 | >32 | >64 | >32 | 1 | 0.25 | 0.063 | 4 | 4 | LC687533 | LC697771 | |
F. keratoplasticum | CGMHD3978 | 4 | >32 | >64 | >32 | 2 | 0.25 | 0.063 | 8 | 4 | LC687534 | LC697772 | |
F. keratoplasticum | CGMHD4568 | 2 | >32 | >64 | >32 | 1 | 0.25 | 0.063 | 8 | 4 | LC687535 | LC697773 | |
F. lichenicola | CGMHD2213 | 1 | >32 | >64 | >32 | 0.5 | 0.125 | 0.063 | 4 | 16 | LC687536 | LC697774 | |
F. solani | CGMHD0530 | 0.5 | >32 | >64 | >32 | 1 | 0.25 | 0.063 | 8 | 8 | LC687538 | LC697776 | |
F. solani | CGMHD0975 | 1 | >32 | >64 | >32 | 2 | 0.5 | 0.063 | 8 | 4 | LC687539 | LC697777 | |
F. solani | CGMHD0976 | 1 | >32 | >64 | >32 | 2 | 0.5 | 0.063 | 8 | 4 | LC687540 | LC697778 | |
F. solani | CGMHD0977 | 1 | >32 | >64 | >32 | 2 | 0.5 | 0.063 | 8 | 4 | LC687541 | LC697779 | |
F. solani | CGMHD1080 | 1 | >32 | >64 | >32 | 2 | 0.5 | 0.063 | 8 | 4 | LC687542 | LC697780 | |
F. solani | CGMHD1329 | 0.5 | >32 | >64 | >32 | 1 | 0.5 | 0.125 | 8 | 4 | LC687543 | LC697781 | |
Fusarium sp. | CGMHD0943 | >16 | >32 | >64 | >32 | >4 | 0.5 | >4 | >16 | >32 | LC687544 | LC697782 | |
Fusarium sp. | CGMHD0944 | 4 | 32 | >64 | >32 | 0.5 | 0.125 | 0.031 | 4 | 8 | LC687545 | LC697783 | |
F. suttonianum | CGMHD1911 | 0.5 | >32 | >64 | >32 | 1 | 0.5 | 0.25 | 4 | 8 | LC687548 | LC697786 | |
Nectria bolbophylli | CGMHD0225 | 4 | >32 | >64 | >32 | 2 | 0.5 | 0.125 | 16 | 4 | LC687549 | LC697787 |
Treatment Methods | GR | PaR | PoR | Los |
---|---|---|---|---|
Itraconazole + topical antifungals (N = 2) | 1 | 0 | 1 | 0 |
Terbinafine + topical antifungals (N = 9) | 3 | 1 | 5 | 0 |
Itraconazole/Terbinafine + topical antifungals (N = 3) | 3 | 0 | 0 | 0 |
Topical antifungals only (N = 13) | 2 | 2 | 7 | 2 |
Laser + Griseofulvin + topical antifungals (N = 1) | 1 | 0 | 0 | 0 |
Surgery (N = 1) | 1 | 0 | 0 | 0 |
Total number (N = 29) | 11 | 3 | 13 | 2 |
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Lu, L.-Y.; Ou, J.-H.; Hui, R.C.-Y.; Chuang, Y.-H.; Fan, Y.-C.; Sun, P.-L. High Diversity of Fusarium Species in Onychomycosis: Clinical Presentations, Molecular Identification, and Antifungal Susceptibility. J. Fungi 2023, 9, 534. https://doi.org/10.3390/jof9050534
Lu L-Y, Ou J-H, Hui RC-Y, Chuang Y-H, Fan Y-C, Sun P-L. High Diversity of Fusarium Species in Onychomycosis: Clinical Presentations, Molecular Identification, and Antifungal Susceptibility. Journal of Fungi. 2023; 9(5):534. https://doi.org/10.3390/jof9050534
Chicago/Turabian StyleLu, Lai-Ying, Jie-Hao Ou, Rosaline Chung-Yee Hui, Ya-Hui Chuang, Yun-Chen Fan, and Pei-Lun Sun. 2023. "High Diversity of Fusarium Species in Onychomycosis: Clinical Presentations, Molecular Identification, and Antifungal Susceptibility" Journal of Fungi 9, no. 5: 534. https://doi.org/10.3390/jof9050534