Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor
2009:75:4;410-412
doi: 10.4103/0378-6323.53152
PMID: 19584475

Proximal subungual onychomycosis caused by Aspergillus flavus in a HIV-positive patient

Sanjiv V Choudhary1 , Sankha Koley1 , Sanjay Mallick2 , Seema Bose2 , Silpi Basak2
1 Department of Dermatology, Jawaharlal Nehru Medical College, Sawangi, Mahrasthra, India
2 Department of Microbiology, Jawaharlal Nehru Medical College, Sawangi, Mahrasthra, India

Correspondence Address:
Sanjiv V Choudhary
28, Modern Nagpur Society, Chhatrapati Nagar, Nagpur - 15 (M.S)
India
How to cite this article:
Choudhary SV, Koley S, Mallick S, Bose S, Basak S. Proximal subungual onychomycosis caused by Aspergillus flavus in a HIV-positive patient. Indian J Dermatol Venereol Leprol 2009;75:410-412
Copyright: (C)2009 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Onychomycosis is defined as a fungal infection of the nail caused by dermatophytes, nondermatophyte moulds (NDM) and yeasts. Types of onychomycosis are distal-lateral subungual onychomycosis (DLSO), proximal subungual onychomycosis (PSO), white superficial onychomycosis and total dystrophic onychomycosis. D0 LSO is the most common clinical type. PSO is uncommon in the general population but is frequently associated with human immunodeficiency virus (HIV) infection and is mostly caused by Trichophyton rubrum and Trichophyton megninii . PSO is nearly pathognomonic of HIV infection. [1],[2] Multiple fungal species and unusual opportunistic fungi are frequently cultured from HIV-infected patients and may be a reflection of the degree of immunosuppresion. [3] Previously regarded as contaminants, yeasts and moulds are now being increasingly recognized as pathogens in fungal nail infection. [4] Aspergillus flavus is a widespread saprophyte found in soil, seeds, fruits and decaying vegetation. We report a rare case of PSO caused by Aspergillus flavus in an HIV-positive patient.

A 30-year-old male patient, farmer by occupation, presented with severe tingling sensation and burning pain affecting both the lower extremities for the past 2 months. He gave history of unprotected heterosexual genito- genital exposure and loss of weight for the past 1.5 years. General examination revealed thin, cachexis built of the patient. Cutaneous examination revealed diffuse greasy scales involving the scalp, eyebrow and retroauricular region. The oral mucous membrane showed a curdy-white plaque involving the dorsum of the tongue. The left great toe nail revealed whitish discoloration of the proximal nail plate with brittleness [Figure - 1]. Nail folds were normal. Clinically, the possibility of Hansen′s disease was ruled out. With this history and clinical examination, the possibility of underlying immunosuppresion was thought and the case was investigated. Routine investigations revealed gross anemia . Blood sugar levels were normal. Enzyme-linked immunosorbent assay test was positive for HIV antibodies. The proximal nail plate of the left great toe was scraped and pared with surgical blade no. 15. With the help of a curette, material from the proximal nail bed was taken. The sample was sent to the microbiology department for KOH examination and culture. KOH examination revealed septate branching mycelium. Culture carried out on Sabouraud′s dextrose agar with chloramphenicol revealed the characteristic green-colored colony suggestive of Aspergillus flavus [Figure - 2]. Slide culture revealed septate branching mycelium, conidiophore, phialide and conidia of Aspergillus flavus [Figure - 3]. Fruiting bodies of Aspergillus flavus are similar to Syncephalastrum racemosum , but Syncephalastrum racemosum has aseptate hyphae and a merosporangial sac surrounding the sporangiospores. KOH examination of the curdy-white plaque from the dorsum of the tongue revealed budding yeast-like cells with pseudohyphae. The final diagnosis was peripheral neuropathy with seborrhoeic dermatitis, oral candidiasis and PSO due to Aspergillus flavus of the left great toe in an HIV-positive patient.

Nondermatophyte moulds (NDM) were the rare cause of onychomycosis. Tosti et al. in their study found that PSO was the most common type of onychomycosis caused by NDM and that those cases were not associated with significant systemic illness or immunosuppresion. [5] Goettmann-Bonvallot, in his article, reported that PSO without fingernail or toenail paronychia is generally caused by Trichophyton rubrum in immunodepressed subjects (patients with acquired immunodeficiency syndrome). [6] Recently published reports from India revealed increased incidence of NDM causing onychomycosis in HIV-infected patients. [7] Several authors have reported cases of onychomycosis due to Aspergillus species. To the best of our knowledge, there are only few reports of Aspergillus flavus (green mould) causing onychomycosis. [8],[9],[10] In our case, Aspergillus flavus species was the pathogen and not a contaminant as (1) KOH examination of nail scrapings revealed a septate branching mycelium, (2) three repeated cultures performed on Sabouraud′s dextrose agar with chloramphenicol revealed characteristic morphology and color suggestive of Aspergillus flavus and (3) slide culture findings were suggestive of Aspergillus flavus only.

PSO is more frequently seen when the CD4 cell count falls below 450 cells/mm 3 . [11],[12] But we did not have follow-up of the patient and CD4 cell counts. Usually, periungual inflammation is seen in onychomycosis (especially PSO) caused by Aspergillus species. [5] But in our case no periungual inflammation was seen. So far, we know that onychomycosis caused by Aspergillus flavus species is a rare finding. To the best of our knowledge, there are only few reports in the international literature and not a single one from India.

Acknowledgment

The authors would like to acknowledge Dr. Priyesh Jaiswal, 3 rd year MD resident of Medicine of Jawaharlal Nehru Medical College, Sawangi.

References
1.
Prose NS, Abson KG, Scher RK. Disorders of the nails and hair associated with human immunodeficiency virus infection. Int J Dermatol 1992;31:453-7.
[Google Scholar]
2.
Sehgal VN, Join S. Onychomycosis- clinical perspective. Int J Dermatol 2000;39:241-9.
[Google Scholar]
3.
Cribier B, Mena ML, Rey D, Partisani M, Fabien V, Lang JM, et al . Nail changes in patients infected with human immunodeficiency virus. A prospective controlled study. Arch Dermatol 1998;134:1216-20.
[Google Scholar]
4.
Midgley G, Moore MK, Cook C, Phan QG. Mycology of nail disorders. J Am Acad Dermatol 1994;31:S68-74.
[Google Scholar]
5.
Tosti A, Piraccini BM, Lorenzi S. Onychomycosis caused by nondermatophytic molds: Clinical features and response to treatment of 59 cases. J Am Acad Dermatol 2000;42:217-24.
[Google Scholar]
6.
Goettmann-Bonvallot S. Clinical types of onychomycosis. Ann Dermatol Venereol 2003;130:1237-43.
[Google Scholar]
7.
Surjushe A, Kamath R, Oberai C, Saple D, Thakre M, Dharmshale S, et al . A clinical and mycological study of onychomycosis in HIV infection. Indian J Dermatol Venereol Leprol 2007;73:397-401.
[Google Scholar]
8.
Gianni C, Romano C. Clinical and histological aspects of toenail onychomycosis caused by Aspergillus spp. Dermatology 2004;209:104-10.
[Google Scholar]
9.
Mahmoudabadi AZ, Zarrin M. Onychomycosis with Aspergillus flavus : A case report from Iran. Pak J Med Sci 2005;21:497-8.
[Google Scholar]
10.
Hilimoglu-Polat S, Metin DY, Inci R, Dereli T, Kilinc I, Tumbay E. Nondermatophyte molds as agents of onychomycosis in Turkey: A prospective study. Mycopathologica 2005;160:125-8.
[Google Scholar]
11.
Kaplan MH, Sadick N, McNutt NS, Meltzer M, Sarngadharan MG, Pahwa S. Dermatologic findings and manifestations of AIDS. J Am Acad Dermatol 1987;16:485-506.
[Google Scholar]
12.
Conant MA. The AIDS epidemic. J Am Acad Dermatol 1994;31:47-50.
[Google Scholar]

Fulltext Views
2,947

PDF downloads
1,567
Show Sections