Topography of dermatophyte infection in onychomycosis - fluorescent and electron microscopic investigations

Vennewald, Irina; Fischer, Reiner; Koch, Andrè; Wollina, Uwe
March 2008
Medical Mycology / Mikologia;2008, Vol. 15 Issue 1, p7
Academic Journal
Background: Despite the commonness of fungal infections of human nails, there is only scanty work on the detailed mechanisms of invasion and the effect of fungal treatment in onychomycosis on the invasive pattern. Aim: Detailed knowledge would help to better understand the factors contributing to relapses or non-response to anti-fungal therapies in onychomycosis. Material and methods: We investigated 598 nail samples of 408 patients by fluorescence microscopy. The positive fungal samples (n=279) were studied further by morphological investigations including transmission electron microscopy and detailed morphology in Blancophor® stains as well as with cultural investigations on three different media. Results: By morphology three different morphological types could be differentiated: a) septated elongated hyphae (true mycelium), b) arthrospores, c) dystrophic broad hyphae. The last type showed damage of cell membranes and vacuolisation of cytoplasm. Within the nail material there was the presence of large, hollow-like spaces. We also investigated the effect of different treatment regiments on morphology and topography of hyphae types (a) to (c). Conclusion: The findings argue for hidden fungal infections in insufficiently treated onychomycosis which might be responsible for relapses. These findings are therefore of clinical relevance in the optimisation of treatment strategies.


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