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Onychomycosis was considered uncommon in children. This survey was carried out to estimate the frequency of fungal nail infections in children and adolescents (0-18 years of age) attending our clinic in the last decade and gain more insight into the aetiology and clinics of this entity in the paediatric age group. This study is based on data obtained from 2320 children and adolescents suspected of superficial fungal infection. Onychomycosis was diagnosed in 99 cases, representing 19.8% of all mycologically confirmed superficial mycoses (500 cases) in our material. Fingernail onychomycosis was recognized in 52 (10.4%) cases; children under 3 years of age were predominantly involved. Candida albicans was the most common isolated pathogen. Toenail onychomycosis concerned 47 (9,4%) patients; the incidence increased steadily with increasing age. Trichophyton rubrum was the most common aetiological agent with respect to toenail infection followed by T. mentagrophytesvar. interdigitale and T. mentagrophytes var. granulosum. The majority of fungal nail infections were characterized clinically by distal and lateral subungual onychomycosis. The growing trend towards the frequency of toenail and fingernail onychomycosis in children and adolescents was found in the last decade in north Poland. The results of our study show that onychomycosis in prepubertal children is not exceptional and should be considered in differential diagnosis of nail plate disorders.
Onychomycosis in primary school children: association with socioeconomic conditions. Mycoses. 2006 Sep;49(5):431-3
Gunduz T, Metin DY, Sacar T, Hilmioglu S, Baydur H, Inci R, Tümbay E
Onychomycosis in childhood is reported to be unusual. The aim of this study was to determine the prevalence of onychomycosis in primary school children and to make comparison between different socioeconomic status in the rural and urban areas of the city. Hand and foot nails of 23235 children aged 7-14 were examined. Onychomycosis was suspected and nail scrapings for mycological examination were taken in 116 of them. Hyphae or spores were seen in 41 (0.18%) by direct microscopic examination, and mycological cultures were positive in 24 (0.1%) of them. Toenails were affected in all of the fungal culture positive cases. Trichosporon spp, Trichophyton rubrum, Candida albicans and Candida glabrata grew in 11, 6, 5 and 2 of the cultures repectively. Onychomycosis prevalence was significantly higher in the children living in the rural areas (p = 0.016) [Odds ratio = 3.43 (%95 CI 1.11<OR<11.84)], and onychomycosis was more frequent in boys than girls (p = 0.001) [(Odds ratio = 5.85 (1.66<OR<24.61)].
ScienceDaily are reporting: Tinea Of The Nails Underdiagnosed In Children
Two doctors from Hospital del Mar in Barcelona and UAB professors have observed, through a research carried out during the past 9 years, an increase in the number of children affected by tinea of the nails, as well as an underdiagnosis of this affection by paediatricians.
In Europe, Tinea unguium has an incidence rate between 0 and 2.6% (average 0.3%) in general population. The symptoms of tinea of the nails are generally well tolerated by patients, causing a delay in medical consultation. Together these two factors represent a challenge for a pediatrician faced with diagnosis and treatment of tinea of the nails.
An increase in the number of cases of tinea of the nails was observed in our Pediatric Unit in Barcelona. From 1976 to 1984, one patient was diagnosed with tinea of the nails, whereas this number has augmented considerably in the past 9 years, in which 12 patients have been diagnosed with this pathology.
Etiologic evaluation was carried out by: a) direct examination with 40% KOH at 400X; b) culture in specific medium; c) macro/micro morphologic evaluation of the colonies. Twelve cases of T. unguium were identified, of which four patients were 12 years old or younger, seven presented onycholysis and five demonstrated enlargements and change of color of the affected nails. The average duration of disease before diagnosis was 21.6 months (range 2-60 weeks). In eight patients, tinea of the nails coincided with tinea pedis. The etiology in 10 patients was T. rubrum and in 2 patients was T. tonsurans.
Although T. unguium is a disease that presents itself at all ages, it is more frequent among the adult population, leading pediatricians to overlook T. unguium as a possible diagnosis. Possibility of T. unguium occurring in younger children should not be discarded. In our study, three patients with T. unguium were 4-8 years old. A susceptible host is necessary for infection to proceed, and susceptibility can arise from external as well as endogenous factors.
We believe that T. unguium is frequently underdiagnosed by pediatricians. A pediatrician should be aware of the following:
1) tinea of the feet could coincide as well as predispose to tinea of the nails, as was observed in 66.6% of patients in the present study,
2) environmental epidemiological factors, and
3) broken, hyperkeratinized nails with color change or uneven structure, especially on the first and/or fifth toe(s) suggest T. unguium infection. In these situations, it is paramount to conduct an etiologic study to establish proper diagnosis and treatment.
Onychomycosis: a new emerging infectious disease in childhood population and adolescents. Report on treatment experience with terbinafine and itraconazole in 36 patients.
Ginter-Hanselmayer G, Weger W, Smolle J. J Eur Acad Dermatol Venereol. 2008 Apr;22(4):470-5.
BACKGROUND: Onychomycosis is a rare disease in children with an estimated prevalence ranging from 0% to 2.6%. Thus far, only limited experience with itraconazole and terbinafine treatment in children with onychomycosis is available in the literature.
AIM OF THE STUDY: Evaluation of treatment experience with itraconazole or terbinafine in childhood onychomycosis. SUBJECTS: Thirty-six children and adolescents (aged 4-17 years, 18 males and 18 females) with clinical and mycologically proven onychomycosis were enrolled in the present study.
METHODS AND OUTCOME: In 27 of 36 patients, the causative agent (Trichophyton rubrum in 26 cases and Trichophyton interdigitale in one patient) could be identified by means of cultivation. Nineteen patients were treated with itraconazole 200 mg once daily for 12 weeks, and 17 patients were treated with terbinafine for 12 weeks in a dosage according to their body weight, respectively. Clinical cure was achieved within 1 to 5 months after discontinuation in all patients treated with itraconazole and in all but two patients after cessation of terbinafine treatment. Neither in the itraconazole nor in the terbinafine group were serious adverse events reported. Clinical cure was achieved within 1 to 5 months after discontinuation in all patients treated with itraconazole and in all but two patients after cessation of terbinafine treatment. Neither in the itraconazole nor in the terbinafine group were serious adverse events reported.
CONCLUSION: To our experience, a mycological and clinical cure appears in children in a shorter time after treatment discontinuation (average 2-5 months) compared with adults. Itraconazole and terbinafine seem to be safe and effective in childhood onychomycosis; therefore, these antifungals seem to be potential alternatives to griseofulvin.
Onychomycosis in children is rare and in different countries prevalence varies from 0.2 to 0.4%. Herein, we describe clinical features, mycology and treatment options of onychomycosis in children, based on 15 cases seen at our department from 2002 to 2007 and on a review of the literature. Nail invasion by fungi in children may occur in both healthy and immunodepressed individuals, and is usually due to dermatophytes, mostly Trichophyton rubrum and Trichophyton interdigitale. Predisposing factors to dermatophyte onychomycosis (i.e., family history for onychomycosis, contact with fungi in the environment and sports activities) are quite common in children, being present in 53% of children with onychomycosis. True Candida onychomycosis in children may be mainly seen in three instances: in premature newborns, where it is due to incomplete development of the immune system; in children affected by chronic mucocutaneous candidiasis; and in children with iatrogenic immunodepression.
Prevalence of tinea pedis, tinea unguium of toenails and tinea capitis in school children from Barcelona.
Pérez-González M, Torres-Rodríguez JM, Martínez-Roig A, Segura S, Griera G, Triviño L, Pasarín M. Rev Iberoam Micol. 2009 Dec 31;26(4):228-32.
OBJECTIVE: To evaluate the prevalence of tinea capitis, tinea pedis, and tinea unguium in children from several schools of Barcelona city.
METHODS: During the period of 2003-2004, a prospective cross-sectional study was carried out in 1,305 children (9% immigrant population) between the ages 3 and 15 in 17 schools in Barcelona. A systematic examination of the feet, (including nails and scalp), was performed to identify lesions compatible with tinea. Cultures of scalp and feet samples were done and analysis of environmental samples was performed for dermatophyte isolation.
RESULTS: Dermatophytes were isolated in 2.9% of the samples with a prevalence of 2.5% in feet, 0.23% in scalp, and 0.15% in nails of the feet. The predominant etiologic agents in feet were Trichophyton mentagrophytes in 45.7% of the cases and Trichophyton rubrum in 31.4%. In the nails, T. rubrum and Trichophyton tonsurans were isolated, while T. mentagrophytes (2 cases) and Trichophyton violaceum (1 case) were identified in scalp samples. Forty-five per cent of dermatophytes were isolated from healthy feet, the majority of cases in children 13- 15-years-old (p < 0.05). Microsporum gypseum was the only agent identified in the environmental samples, and was also found in one of the cases of tinea pedis.
CONCLUSION: The results of this study demonstrate a low prevalence of tinea capitis and tinea unguium in school children of Barcelona. On the contrary, high prevalence of dermatophytes in feet was found. It highlights the high prevalence of healthy carriers of dermatophytes in feet.
An 8-week-old infant presented with 7 weeks history of nail involvement and discoloration. Lesions started over the middle fingernail of right hand at 1 week of age, spreading over to other nails within 2 weeks. Only two nails of the feet were spared. On KOH examination, fungal hyphae were seen and culture showed growth of Trichophyton rubrum. The purpose is to report the earliest case of onychomycosis having multiple nail involvement of fingers and toes (18 nails).