Are there any differences between onychomycosis because of C. albicans and C. pararugosa?
Which is the best treatment option?
I havent encountered either C rugosa or pararugosa in my last 10 years of laboratory practice , but as far as i have read it is rare environmental opportunistic pathogen .May be in patient with suppressed immunity this is one of the emerging opportunistic candida spp.
this spp is usually less sensitive or rather say resistant to fluconazole but voriconazole can work. if the onychomycosis is not responding to treatment ,use caspofungin which may give good result .
Thanks a lot for your answer. The patient is a young healthy women. Occasionally she works as a swimming teacher. She has one yellow fingernail. I wonder whether C. pararugosa is the real cause of this nail change, as I always do in those onychomycosis of a single nail when Candida spp. is isolated.
Get a nail clipping of affected part and scraping of affected skin /nail if possible.divide the sample in two .to one part of sample in one drop of DMSO or KOH over a slide covering with cover slip .leave in a wet petri dish for 3-4 hours .observe for yeast cells or hyphae in 40 X objective . to the second part inoculate on DTM(dermatophyte test media)/SDA and incubate for 48 hours . if this shows yeast growth then u can very well confirm this is cause of nail infection.
I had seen and even published a paper on non dermatophytic fungal organism causing dermatophytic infection .I hope it will help you .
i will be interested in knowing the final diagnosis dr Marko and outcome of treatment. please share with us .
The patient was taking fluconazole 50 mg per day for three months and her nail not only didn't improve, but some edge yellowing and thickening of some other nails appeared. So, I assume that Candida pararugosa was not the cause of the nail change. The condition is suspicious for nail psoriasis.
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