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      Prevalence of Candida tropicalis and Candida krusei in onychomycosis in João Pessoa, Paraiba, Brazil from 1999 to 2010

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          Abstract

          ABSTRACTOver time, as the etiology of onychomycosis has developed, yeasts from the genus Candida have emerged as important etiological agents. This study aimed to determine the frequency of yeast caused onychomycosis in Joao Pessoa, Paraíba, Brazil from 1999 to 2010. A retrospective study from January 1999 to December 2010 evaluated the results of onychomycosis positive direct mycological exams (DME) - for yeast and realized in the Hemato(r) Clinical Laboratory. Women were the most affected by onychomycosis which occur preferentially in adults, and the toenails are the favorite yeast targets. The prevalent yeasts were Candida tropicalis and C. krusei.

          Translated abstract

          RESUMOAo longo do tempo, se modificou a etiologia das onicomicoses, leveduras do gênero Candida têm emergido como agentes etiológicos importantes. O objetivo desse trabalho foi determinar a frequência de onicomicoses causadas por leveduras em João Pessoa, Paraíba, Brasil de 1999 a 2010. Um estudo retrospectivo de janeiro de 1999 a dezembro de 2010 avaliou os resultados de exames micológicos diretos (EMD) positivos para leveduras provenientes de onicomicoses, realizados no Laboratório Clínico Hemato(r). As mulheres foram as mais afetadas por onicomicoses, as unhas dos pés são os alvos preferidos e ocorrem preferencialmente em adultos. As leveduras prevalentes foram Candida tropicalis e C. krusei.

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          Epidemiology, clinical presentation and diagnosis of onychomycosis.

          Onychomycosis is a common nail disease, responsible for up to 50% of diseases of the nail. The distribution of different pathogens is not uniform; it depends on various factors such as climate, geography and migration. However, studies have revealed that two dermatophytes, Trichophyton rubrum and Trichophyton mentagrophytes, account for more than 90% of onychomycoses. Onychomycosis can be divided into four major clinical presentations: distal subungal (the most common form of the disease), proximal subungal (the most common form found in patients with human immunodeficiency virus infection), and superficial and total dystrophic onychomycosis. Onychomycosis is a multifactorial disease. Age has a very important effect on the occurrence of onychomycosis, with a correlation between increasing age and infection. Genetics has also been identified as a factor governing the epidemiology of onychomycosis; T. rubrum infection shows a familial pattern of autosomal dominant inheritance. Disease and lifestyle may also play a role in the epidemiology of fungal nail infections. Studies have shown that diabetes, acquired immunodeficiency syndrome and peripheral arterial disease may be independent predictors of onychomycosis. Because of the multifactorial nature of the epidemiology, accurate diagnosis, pertinent treatment and patient education must be paramount when treating the disease.
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            Patients at risk of onychomycosis--risk factor identification and active prevention.

            The aims of this workshop were to identify risk factors for onychomycosis and to reach consensus on the management of high-risk groups to allow the development of guidelines to help doctors recognize risk factors that complicate treatment. Previous Trichophyton rubrum infection, older age, abnormal nail morphology, immunodeficiency and genetic factors were identified as risk factors for initial infections. Risk factors for recurrence (relapse and re-infection) are largely the same. The experts agreed that the prevention of onychomycosis and its recurrence should be based on the correct treatment of tinea pedis, screening family members and adequate patient education. In addition, generic management recommendations for each high-risk group were discussed: * Immunosuppressed patients Usual dose and treatment length not appropriate Follow-up required Beware of drug interactions * Diabetics Prophylactic foot care combined with nail treatment Good opportunity for patient education, footwear, foot care, etc. Beware of drug interactions * Psoriatics and patients with abnormal nails Dermatophyte eradication does not restore normal nails * Children High failure rate possibly due to compliance problems.
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              Freqüência de onicomicoses por leveduras em Maringá, Paraná, Brasil

              FUNDAMENTOS: Onicomicoses são afecções ungueais de origem infecciosa causadas por fungos e estão entre as principais onicopatias em todo o mundo. OBJETIVOS: Determinar a freqüência de leveduras como agentes etiológicos de onicomicoses na cidade de Maringá, PR, Brasil. MATERIAL E MÉTODOS: Realizou-se um estudo retrospectivo do período entre janeiro de 1997 e dezembro de 2004, em que foram avaliados os resultados de 1.295 pacientes com suspeita de onicomicose, recebidos no Laboratório de Ensino e Pesquisa em Análises Clínicas da Universidade Estadual de Maringá, Paraná, Brasil. RESULTADOS: A confirmação micológica de onicomicose ocorreu em 761 (58,76%) desses pacientes. As mulheres foram responsáveis por 71% das onicomicoses, e os homens, por 29%. A prevalência nas unhas das mãos foi de 28,67% e nas unhas dos pés, 71,33%. Em relação aos agentes, as leveduras foram mais freqüentemente isoladas (46,39%), seguidas pelos dermatófitos (40,60%) e pelos fungos filamentosos não dermatófitos (13,01%). CONCLUSÃO: A alta freqüência de fungos leveduriformes em onicomicoses indica aprimoramento nas técnicas diagnósticas de confirmação laboratorial de fungos oportunistas. Esses resultados, associados à abordagem clínica do paciente, possibilitam maior segurança no diagnóstico e tratamento.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                aabc
                Anais da Academia Brasileira de Ciências
                An. Acad. Bras. Ciênc.
                Academia Brasileira de Ciências (Rio de Janeiro )
                1678-2690
                September 2015
                : 87
                : 3
                : 1819-1822
                Affiliations
                [1 ] Universidad Nacional de Asunción Paraguay
                [2 ] Universidade Federal da Paraíba Brazil
                [3 ] Universidade Federal de Campina Grande Brazil
                Article
                S0001-37652015000401819
                10.1590/0001-3765201520130418
                26375021
                9a50bfef-5482-4350-9f8d-2ac6d195cafd

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0001-3765&lng=en
                Categories
                MULTIDISCIPLINARY SCIENCES

                Candida non-albicans,epidemiology,candidiasis,nails,Candida não-albicans,epidemiologia,candidíases,unhas

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