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Year : 2010  |  Volume : 53  |  Issue : 3  |  Page : 566-567
Onychomycosis due to ascomycete Chaetomium globosum: A case report


1 Department of Microbiology, Aarupadai Veedu Medical College and Hospital, Pondicherry, India
2 Postgraduate Institute of Medical Education and Research, Chandigarh, India

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Date of Web Publication22-Oct-2010
 

How to cite this article:
Latha R, Sasikala R, Muruganandam N, Shiva Prakash M R. Onychomycosis due to ascomycete Chaetomium globosum: A case report. Indian J Pathol Microbiol 2010;53:566-7

How to cite this URL:
Latha R, Sasikala R, Muruganandam N, Shiva Prakash M R. Onychomycosis due to ascomycete Chaetomium globosum: A case report. Indian J Pathol Microbiol [serial online] 2010 [cited 2021 Aug 1];53:566-7. Available from: https://www.ijpmonline.org/text.asp?2010/53/3/566/68279



   Introduction Top


Onychomycosis is a chronic fungal infection of the toe or fingernails that gradually leads to destruction of the nail plate. It is frequently caused by dermatophytes, but nondermatophytic agents like filamentous moulds and yeasts are increasingly recognized as potential pathogens. They are in fact commonly considered as insignificant nail contaminants rather than as etiological agents and, therefore, their presence must be interpreted with care. Here, we report a case of onychomycosis due to Chaetomium globosum, a nondermatophyte mould in an immunocompetent person. Only few cases of Chaetomium onychomycosis have been reported worldwide.


   Case Report Top


A 25-year-old male came to the dermatology department with complaints of nail dystrophy in the right hand for the past 7 months. The patient first noticed it on the nail plate of the small finger of the right hand about 6 months back. Later, the infection gradually spread to the nail of the ring, middle and index finger and then to the thumb. On examination, the finger nails were dystrophic and yellowish-brown in color and there was no onycholysis or any signs of inflammation. The patient gave a history of working in an electroplating company where he had to often dip his right hand into a dilute acid solution used for cleaning metals. He also gave a history of personal negligence in using hand gloves because of the discomfort. The finger nails on the left hand were normal.

Direct microscopic examination of the nail samples at 40% KOH revealed dematiaceous, branched and septate hyphae. The nail samples cultured onto Sabouraud's dextrose agar incorporating chloramphenicol grew white colonies and, after 2 weeks, the mature colonies became grey in color with black spots in between [Figure 1]. Lactophenol cotton blue mount showed septate hyphae, perithecia asci and ascospores. Ascocarps showed numerous olive-brown to black perithecia covered with long, hair-like, dematiaceous setae [Figure 2]. Mature perithecia were ostiolate (small round openings) and liberated many oval-shaped ascospores [Figure 3]. Based on the above morphological features, the isolate was identified as Chaetomium spp.

Repeated nail samples grew only Chaetomium spp. to rule out any contamination. A subculture of the isolate was sent to the Post Graduate Institute (PGI), Chandigarh (National Reference Centre for Mycology) for confirmation and speciation. The report from PGI Chandigarh confirmed that the isolate was Chaetomium globosum.
Figure 1: Chaetomium globosum culture on Sabouraud's dextrose agar slant showing black ascocarps

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Figure 2: Ascocarp of Chaetomium globosum showing black perithecia covered with long, hair-like, dematiaceous setae (unstained slide culture on Sabouraud's dextrose agar, ×100)

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Figure 3: Spores of Chaetomium globosum (lactophenol cott on blue mount, ×400)

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The patient was started on itraconozole 100 mg orally for 6 months and is under follow-up. During the recent years, there has been an increase in the reporting of nail infections caused by nondermatophyte moulds and yeasts. Isolation of non-dermatophytes is frequently considered as contaminants or secondary pathogens that invade nails that were previously damaged by trauma or disease, although in some cases they actually act as primary pathogens. A review of the literature reveals that most common saprophytic fungi isolated from nails belong to Scopulariopsis, Aspergillus, Acremonium and Fusarium species.

To the best of our knowledge, only a few cases of onychomycosis by Chaetomium spp have been reported worldwide. [1],[2] From India, only one case has been reported. [3] Here, we report the second case of onychomycosis caused by C. globosum.

Chaetomium spp. are saprobic ascomycetes that usually colonize cellulose-containing plant remains and are also found on dung, bird feathers and soil. [4] Although Chaetomium species are rarely implicated in human disease, systemic mycoses have been reported to occur in immunocompromised patients. [4]

The predisposing factors in case of onychomycosis and cutaneous lesions are trauma. [5] Any process that breaks down the integrity of the corneal layer of the nail will facilitate easy penetration by any fungi, including the species that are considered less pathogenic (i.e., Chaetomium spp.) [5] and also the occupation of the individual plays a very significant role. In our patient, longer duration of contact with caustic solvent accompanied with personal negligence in usage of gloves had caused microtrauma of his finger nails, which may have lead to colonization of Chaetomium in the nails. Direct microscopy using KOH mount plays a significant part in diagnosing nail fungal infections, but the clinical presentation of onychomycosis caused by these filamentous fungi is often unspecific and indistinguishable from those caused by dermatophytes. Thus, fungal culture becomes the only definitive test that can be used to identify the species of the infecting organism. As they have been increasingly reported in immunocompromised patients, the importance of correct etiological identification has to be emphasized as most of them are resistant to the currently available antifungals. Repeated isolation of nondermatophytes from a nail specimen should not be regarded as a contamination if predisposing factors are present, and the possible etiopathological significance should be clarified.

As Chaetomium spp. are now emerging as a cause of nondermatophyte onychomycosis, especially in traumatized nails, the spectrum of fungi responsible for nail infections should be expanded to include C. globosum.

 
   References Top

1.Hattori N, Adachi M, Kaneko T, Shimozuma M, Ichinohe M, Iozumi K. Case report- Onychomycosis due to Chaetomium globosum successfully treated with itraconazole. Mycoses 2000;43:89-92.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Aspiroz C, Genι J, Rezusta A, Charlez L, Summerbell RC. First Spanish case of onychomycosis caused by Chaetomium globosum. Med Mycol 2007;45:279-82.  Back to cited text no. 2      
3.Naidu J, Singh SM, Pouranik M. Onychomycosis caused by Chaetomium globosum kunze. Mycopathologia 1991;113:31-4.  Back to cited text no. 3  [PUBMED]    
4.Guarro J, Soler L, Rinaldi MG. Pathogenicity and antifungal susceptibility of Chaetomium species. Eur J Clin Microbiol Infect Dis 1995;14:613-8.  Back to cited text no. 4  [PUBMED]    
5.Vander Straten RM, Balkis MM, Ghannoum AM. The role of nondermatophyte molds in onychomycosis: Diagnosis and treatment. Dermatol Ther 2002;15:89-98.  Back to cited text no. 5      

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Correspondence Address:
R Latha
Department of Microbiology, Aarupadai Veedu Medical College and Hospital, Pondicherry- 607402
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.68279

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

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