Učestalost onihomikoze na području Zagreba - uloga Sabouraud agara bez cikloheksimida u dijagnostici i terapiji

Mycological analysis is considered the gold standard in the diagnosis of very common fungal diseases of nails. The purpose of the article is to present the prevalence of onychomycosis obtained by using direct microscopic examination (DME) and cultivation on Sabouraud media without cycloheximide. The quantitative retrospective research was conducted on 2706 patients of both sexes (mostly middle-aged to elderly) with various toenail lesions, who had undergone mycological analyses in the Mycological Laboratory of our Department of Dermatovenereology in 2013 and 2014. Analysis of the results obtained revealed that there were 35.4% of positive DME results; of these, there were 39.2% of dermatophytes, 59.1% of yeasts and 1.7% of molds. The percentage of dermatophytes (Trichophyton spp.) was twice as high in men as in women. A considerable percentage (12%) of mixed isolates was also observed. Particularly worrisome was the high percentage (one-third) of suppressed and insufficiently developed dermatophytes (a possible indicator of inappropriate preparation of patients for mycological analysis). Cultivation on culture media without cycloheximide requires frequent inspections because of the fast-growing molds while not allowing sporulation for a great number of dermatophytes. However, it has certain advantages, i.e. it offers an insight into the wide range of the present fungi. As part of the biofilm, they can be potentially pathogenic in dystrophic nails under certain circumstances because, according to our results, the percentage of dermatophytes does not change substantially with aging; however, what does change is the percentage of molds, yeasts and mixed isolates.Mikološka obrada smatra se zlatnim standardom pri dijagnosticiranju vrlo čestih gljivičnih bolesti noktiju i predstavlja temelj za propisivanje antimikotične terapije. Cilj ovoga rada bio je ispitati učestalost onihomikoza na temelju izrade izravnog mikroskopskog preparata i kultivacije uzoraka na Sabouraud podlogama bez cikloheksimida. Provedeno je kvantitativno retrospektivno istraživanje na 2706 ispitanika oba spola kojima je učinjena mikološka obrada zbog različitih vrsta oštećenja noktiju stopala tijekom 2013. i 2014. godine u Mikološkom laboratoriju Klinike za kožne i spolne bolesti Kliničkoga bolničkog centra Sestre milosrdnice u Zagrebu. Analizom dobivenih rezultata utvrđeno je 35,4% pozitivnih izravnih mikroskopskih preparata i izolirano 297 (39,2%) dermatofita, 447 (59,1%) kvasnica i 13 (1,7%) plijesni kao potencijalnih uzročnika onihomikoza. Dermatofiti (Trichophyton spp.) nađeni su u dvostruko većem postotku kod muškog spola. Primijećen je i visok postotak miješanih izolata (12%). Naročito zabrinjava visok postotak suprimiranih (jedna trećina) i nedovoljno razvijenih dermatofita, što se može tumačiti kao pokazatelj nedostatne pripremljenosti bolesnika za mikološku obradu. Iako kultivacija na hranjivim podlogama bez cikloheksimida zahtijeva učestalu inspekciju zbog brzorastućih plijesni, ona ipak nosi određene prednosti. Prvenstveno pruža uvid u širi spektar prisutnih gljiva koje, kao dio biofilma u oštećenim noktima, mogu biti potencijalno patogene u određenim okolnostima. Naime, prema našim rezultatima, sa starenjem populacije ne mijenja se značajno postotak dermatofita, nego se mijenja postotak plijesni, kvasnica i miješanih izolata