THERAPEUTIC MANAGEMENT OF A GREEN NAIL SYNDROME – PSEUDOMONAS AERUGINOSA AND TRICOPHYTON TONSURANS COINFECTION DETECTED BY MASS SPECTROMETRY CONDUITA TERAPEUTICĂ A SINDROMULUI UNGHIILOR VERZI – COINFECŢIA CU PSEUDOMONAS AERUGINOSA ŞI TRICOPHYTON TONSURANS

Alin Laurentiu Tatu, Cristiana Voicu, Victor Gabriel Clatici

Abstract


Background:  Fungal infection stimulates bacterial colonization within the nail and overgrowth of Pseudomonas aeruginosa in culture inhibits the isolation of fungus. We present the case of a 51-year-old patient who was referred from the general practitioner for the evaluation of an old green yellowish discoloration of a painful nail and to establish a treatment to control the disease.

Materials and methods: On examination there was a green yellowish discoloration of the finger nail starting from the distal part of the nail and extending to the proximal part. On the distal nail area there was also onychodistrophy, central onycholysis and a degeree of subungual hyperkeratothic deposit. Around the nail plate there were scales and a slight basal erythema with pruritus. Laboratory investigations were performed.

Results: The laboratory findings were normal except the bacteriologic culture from nail scraping that came up positive for P. aeruginosa and was also confirmed by MALDI-TOF spectrometry. Direct mycological microscopy (with KOH) of nail scrapings was negative, but the mycological culture was positive for Trichophyton tonsurans. One year after initiating treatment, the nail was normal.
Conclusions: Because P. aeruginosa expresses pyocyanin, a blue-green exopigment, green coloration of the nails should raise suspicion for Pseudomonas infection. Broad-spectrum antibiotics enhance fungal colonization by destroying competing bacterial flora.

Introducere:Infecţia fungică stimulează colonizarea bacteriană la nivelul unghiei şi dezvoltarea de Pseudomonas aeruginosa pe mediul de cultură împiedică izolarea fungilor. Prezentăm cazul unui pacientîn varstă de 51 ani care se prezintă pentru evaluarea unei unghii dureroase, cu modificări pigmentare galben-verzui şi pentru stabilirea conduitei terapeutice adecvate.

Materiale şi metode: Examenul clinic a evidenţiat prezenţa discoloraţiei verzi-gălbui, începând de la extremitatea distală a lamei unghiale şi întinzându-se până la extremitatea proximală, la nivelul unei unghii
ale unui membru superior. În plus, extremitatea distală prezenta
de asemenea zone de onicodistroie, onicoliză centrală şi depozite hiperkeratozice subunghiale. Zona periunghială prezenta scuame
şi zone eritematoase, pruriginoase. Au fost efectuate investigaţii de laborator.
Rezultate: Rezultatele examenelor de laborator au fost în limite normale, cu excepţia culturii bacteriene care a fost pozitivă pentru P. aeruginosa, confirmată prin spectrometrie MALTI_TOF. Examenul micologic direct (cu KOH) a fost negativ, dar cultura micologică a evidenţiat prezenţa de Trichophyton tonsurans. La un an de la iniţierea tratamentului, unghia a avut aspect normal.
Concluzii: Întrucât P. aeruginosa secretă piocianina, un exopigment albastru-verzui, coloraţia veruzie a unghiilor ar trebui să ridice suspiciunea de infecţie cu P. aeruginosa. Antibioticele cu spectru larg augmentează colonizarea fungică prin distrugerea florei bacteriene rezidente.

 


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—Print : ISSN 2392–7461, ISSN-L 2392–7461 
—Online : ISSN 2392-8697, ISSN-L 2392-7461

Editor-In-Chief and Managing Editor - Victor Gabriel Clatici
 

 

 

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