From the Guidelines
Yes, aspergillosis can occur as a fungal nail infection (onychomycosis) in immunocompetent patients, though it is relatively uncommon. Aspergillus species can invade the nail plate, causing discoloration, thickening, and brittleness of the affected nails, as noted in the practice guidelines for diseases caused by Aspergillus by the Infectious Diseases Society of America 1.
Key Points to Consider
- Aspergillus nail infections develop when the fungus penetrates through small breaks in the nail or surrounding skin, with risk factors including nail trauma, excessive moisture, and pre-existing nail disorders.
- Treatment typically involves oral antifungal medications, with oral itraconazole, with or without topical therapy, such as 8% ciclopirox nail lacquer, being used for onychomycotic infections 1.
- Complete cure can be difficult to achieve, and treatment often requires patience and persistence.
- While Aspergillus species more commonly cause pulmonary or invasive infections in immunocompromised hosts, they can opportunistically infect the nails of otherwise healthy individuals, especially in environments with high fungal spore counts.
Management and Treatment
- The mainstay of therapy for cutaneous infections, including onychomycosis, is systemic antifungal therapy 1.
- Surgical excision may occasionally be necessary when the local infection cannot be controlled in certain settings 1.
- Topical solutions like ciclopirox 8% nail lacquer may be used as adjunctive therapy for onychomycotic infections 1.
From the Research
Aspergillosis in Nail as a Fungal Infection
- Aspergillosis can occur in the nail as a fungal infection, and it is considered a type of non-dermatophytic onychomycosis 2, 3.
- The clinical features of onychomycosis due to Aspergillus spp. include chalky deep white nail, rapid involvement of lamina, and painful perionyxis without pus 2.
- Aspergillus spp. are emerging causative agents of non-dermatophyte mould onychomycosis (NDMO), and they can affect both toenails and fingernails, although toenails are more frequently involved 3.
Diagnosis and Treatment
- The diagnosis of onychomycosis due to Aspergillus spp. requires positive direct microscopy and repeated culture or molecular detection of Aspergillus spp. 3.
- Treatment of onychomycosis due to Aspergillus spp. consists of systemic therapy with terbinafine or itraconazole 2, 3.
- Other antifungal agents, such as voriconazole, posaconazole, and caspofungin, may also be effective against Aspergillus spp. 4.
Immune Competent Patients
- Onychomycosis due to Aspergillus spp. can occur in immune competent patients, although it is more common in immunocompromised individuals 5.
- The study by 2 included 34 patients with toenail onychomycosis caused by Aspergillus spp., and the majority of them were immune competent.
- The treatment outcome of onychomycosis due to Aspergillus spp. in immune competent patients is generally good, with a high rate of clinical and mycological recovery 2.