Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
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
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
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 - 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
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
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
Review Article
Review Articles
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analysis
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Net letter
doi: 10.4103/0378-6323.93658
PMID: 22421671

Fusarial onychomycosis among gardeners: A report of two cases

Shaveta Jandial, Geeta Sumbali
 Department of Botany, Pathology Lab, University of Jammu, Jammu, India

Correspondence Address:
Geeta Sumbali
Department of Botany, University of Jammu, Jammu - 180 006
How to cite this article:
Jandial S, Sumbali G. Fusarial onychomycosis among gardeners: A report of two cases. Indian J Dermatol Venereol Leprol 2012;78:229
Copyright: (C)2012 Indian Journal of Dermatology, Venereology, and Leprology


Onychomycosis refers to fungal nail infection that causes the fingernails or toenails to thicken, discolor, disfigure and split. Frequently, it is caused by dermatophytes but now non-dermatophytic moulds are known to account for 2-12% of the nail infections. [1]

In many cases, continuous exposure to physical and chemical aggressions facilitates penetration by different fungal species including the less pathogenic species. One such case is that of gardeners who are commonly exposed to soil saprophytes, which increases their risk of developing onychomycosis. A survey was conducted for onychomycosis among gardeners of Jammu University. Here we report two cases of fusarial onychomycosis caused by Fusarium equiseti and Fusarium heterosporum. These species have not been described previously as agents of onychomycosis.

Nail clippings and scrapings of the suspected gardeners were collected for mycological examination after thorough cleaning with alcohol. These were processed by preparing a wet mount of 20% KOH in DMSO and then counterstained by using Chlorazol Black E. All the samples from suspected cases were cultured irrespective of the negative or positive examination result. Samples were cultured on 2 types of growth medium: DTM (dermatophyte test medium) with cycloheximide and SDA (Sabouraud′s dextrose agar) with chloramphenicol and incubated at 28-30°C for 4-6 weeks. Each sample was subcultured atleast thrice to confirm the results.

Case I of onychomycosis was detected in a 37-year- old gardener who noticed symptoms first on the nail plate of right thumb, followed by nail of the ring and index finger, which then spread to the skin. The nails were thickened, brittle, deformed, opaque and pale to brown, showing nail bed hyperkeratosis but no onycholysis. All these symptoms suggest a case of total dystrophic onychomycosis.

Microscopic examination was negative, but the nail sample cultured on SDA yielded a non-dermatophytic fungus, whose colonies on PSA were initially white, floccose with a tinge of peach. After 7-10 days of incubation, the color changed to beige and finally deep olive buff; reverse was peach coloured. On PSA, SDA and PYE media, the pathogenic isolate did not sporulate. However, on water agar (WA) medium, sparse mycelial growth and abundant sporulation was observed. Macroconidia (3-6 septate) were produced from monophialidic (short, obclavate to doliform) or compact penicillately branched conidiophores. Macroconidia were falcate, with well-developed pedicellate foot cell and an attenuated apical cell. Chlamydospores were present. Based on the above features, the isolate was identified as Fusarium equiseti [Figure - 1].

Figure 1: Case I showing detection of onychomycosis in a male gardener of Botanical garden: (a, b) Finger and thumb nails showing signs of total dystrophic onychomycosis. (c) Skin showing signs of fungal infection. (d) Colony of Fusarium equiseti arising from affected nail clippings/scrapings. (e) Culture characteristics of Fusarium equiseti on PSA. (f-i) Microscopic details of Fusarium equiseti

Case II of onychomycosis was detected in a 32-year- old gardener, whose big toenail and little toe fingers of right foot showed disfiguration and discoloration. Affected nails were hard, deformed and pale brown at the edges. Direct mycological test was positive showing hyphal segments.

Nail samples on SDA yielded non-dermatophytic fungal growth. Colonies on PSA were floccose and pale pink. On PSA and PCA, fungus showed very little sporulation; chlamydospores were present. On WA, sparse fungal growth with heavy sporulation was observed. Macroconidia were 1-4 septate, pedicellate with apical cell subulate and narrowing gradually to a point. Based on the above features, the isolate was identified as Fusarium heterosporum [Figure - 2].

Figure 2: Case II showing detection of onychomycosis in a male gardener of Botanical garden: (a, b) Big toe and little toe finger nails showing signs of onychomycosis. (c) Fungal hyphal segments in a mount of 20% KOH in DMSO. (d) Colonies of fungal pathogen arising from affected nail clippings and scrappings. (e) Culture characteristics of Fusarium heterosporum on PSA. (f-h) Microscopic details of Fusarium heterosporum

Repeated isolations were performed for both the cases. Same fungal species were consistently isolated with no dermatophytic growth.

Among the causal agents of non-dermatophytic onychomycosis, a number of Fusarium species viz., F. solani, F. oxysporum, F. proliferatum and F. moniliforme have been reported. [2],[3] However, there is no previous report of F. equiseti and F. heterosporum as causal agents.

According to the different workers, these reports are still debatable as none of these fungi are keratlytic. Sometimes they live on unkeratinized intercellular cement or take advantage of partially denatured nail keratin. Therefore, they are generally considered as secondary invaders with pre-existing disease or trauma. [4]

Like other gardeners, predisposing factors in these two cases included poor living conditions, walking barefoot, wearing nylon socks and rubber shoes and doing wet work. All these factors lead to occlusion and perspiration, which results in the maceration of foot tissue and easy germination and penetration of the opportunistic fungal organism. [5] In addition, regular preparation and handling of manure for flower beds may also be responsible for the dissemination of inoculum. Similar results have been reported earlier for gardeners, farmers, forestry workers and housewives working with soil. [4],[5] Garden soils due to their rich humus content and keratinic matter, represents a potential site for myco-keratinophilic species and this increases the risk. In addition, occupation related trauma also paves a way for fungal invasion. This survey suggests that gardeners are also at a risk of onychomycosis. Therefore, to avoid onychomycosis, gardeners need to wear shoes, keep their feet cool and dry, wounds should not be kept open, hands and feet should be properly washed after work and gloves should be worn during work.

Moreno G, Arenas R. Other fungi causing onychomycosis. Clin Dermatol 2010;28:160-3.
[Google Scholar]
Gupta AK, Baran R, Summerbell RC. Fusarium infections of the skin. Curr Opin Infect Dis 2000;13:121-8.
[Google Scholar]
Hattori N, Shirai A, Sugiura Y, Li W, Yokoyama K, Misawa Y, et al. Onychomycosis caused by Fusarium proliferatum. Br J Dermatol 2005;153:647-9.
[Google Scholar]
Gupta M, Sharma NL, Kanga AK, Mahajan VK, Tegta GR. Onychomycosis: Clinico-mycologic study of 130 patients from Himachal Pradesh, India. Indian J Dermatol Venereol Leprol 2007;73:389-92.
[Google Scholar]
Sahin I, Kaya D, Parlak AH, Oksuz S, Behset MSO. Dermatophytoses in forestry workers and farmers. Mycoses 2005;48:260-4.
[Google Scholar]

Fulltext Views

PDF downloads
Show Sections