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Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2012.tde-27072012-135045
Document
Author
Full name
Carolina de Queiroz Moreira Pereira
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2012
Supervisor
Committee
Vasconcellos, Cidia (President)
Longo Junior, Luiz Sidney
Pagliari, Carla
Title in Portuguese
Identificação de espécies de fungos causadores de onicomicoses em idosos institucionalizados no município de São Bernardo do Campo
Keywords in Portuguese
Dermatófitos
Fungos filamentosos
Idoso
Leveduras
Onicomicose
Abstract in Portuguese
INTRODUÇÃO: Infecções fúngicas superficiais podem ser causadas por dermatófitos, leveduras ou fungos filamentosos não dermatófitos. O tipo de lesão desenvolvida eventualmente se correlaciona ao agente etiológico, à capacidade de resposta imunológica do hospedeiro, ao sítio anatômico da lesão e tecido afetado. A proposta desse trabalho é isolar e identificar agentes de onicomicose em pessoas idosas (acima de 60 anos de idade), que frequentemente apresentam alteração da resposta imune. CASUISTICA E MÉTODOS: A técnica de identificação de fungos foi a análise do resultado conjunto do exame micológico direto, isolamento e microcultura do raspado ungueal. Escamas subungueais e escamas interdigitais foram coletadas de 35 pessoas idosas, com suspeita clínica de onicomicose, institucionalizados em duas casas assistenciais no município de São Bernardo do Campo, SP, Brasil. RESULTADOS: Os materiais coletados foram analisados e, no raspado ungueal, observou-se 18 (51,40%) resultados positivos no exame direto e 15 (44,40%) no isolamento. Os dermatófitos foram evidenciados em 8 (44,40%) dos isolados, identificando-se 5 (27,80%) como Trichophyton rubrum e 1 (5,60%) de cada um como Trichophyton tonsurans, Trichophyton mentagrophytes e Microsporum gypseum. O segundo grupo mais isolado foram 7 (38,90%) leveduras, identificadas como: 3 (16,70%) Candida guilliermondii, 2 (11,10%) Candida parapsilosis e 1 (5,60%) Candida glabrata, 1 (5,60%) Trichosporon asahii. O último grupo foi representado por 3 (16,70%) isolados de fungos filamentosos não dermatófitos, identificados como: Fusarium sp, Aspergillus sp e Neoscytalidium sp, 1 (5,60%) de cada um. Trinta (85,70%) dos raspados interdigitais foram negativos e em 5 (14,30%), a identificação dos agentes coincidiu com o fungo causador da onicomicose (2 Trichophyton rubrum, 1 Trichophyton mentagrophytes, 1 Candida guilliermondii e 1 Fusarium sp). No grupo controle (9 pessoas idosas clinicamente sem lesão ungueal) realizou-se coleta interdigital, isolando-se Candida guilliermondii em apenas 1 (11,0%). CONCLUSÕES: Pelo método de identificação empregado, observou-se que os fungos causadores de onicomicoses encontrados neste trabalho estão de acordo com relatos da literatura recente; a apresentação clínica da unha com onicomicose por fungos filamentosos não dermatófitos foi indistinguível daquela por dermatófitos ou candidoses e, do ponto de vista etiológico, não se observou diferença entre a onicomicose de pessoas idosas institucionalizadas com os dados da ocorrência de onicomicose na população geral divulgados pela literatura
Title in English
Identification of species of fungi that cause skin lesions in institutionalized elderly in São Paulo state
Keywords in English
Dermatophytes
Elderly
Filamentous fungi
Onychomycosis
Yeasts
Abstract in English
INTRODUCTION: Superficial fungal infections can be caused by dermatophytes, yeasts or filamentous non-dermatophyte fungi. The type of injury eventually correlates to the the etiologic agent, the ability of the host immune response, the anatomical site of the lesion and the kind of the affected tissue. The purpose of this study is to isolate and identify agents of onychomycosis in the elderly (people over 60 years old), who often have alterations in the immune response. MATERIAL AND METHODS: The technique for the identification of fungi was the analysis of the combined result of mycological examination, isolation and microcultures of nail scrapings. Subungual and interdigital scales were collected from 35 elderly with a clinical suspicion of onychomycosis, institutionalized in two care houses in the city of Sao Bernardo do Campo, SP, Brazil. RESULTS: The collected materials were analyzed and the nail scrapings displayed 18 (51.40%) positive results on direct examination and 15 (44.40%) in isolation. Dermatophytes were found in 8 (44.40%) isolates, 5 (27.80%) beeing identified as Trichophyton rubrum and 1 (5.60%) of each others as Trichophyton tonsurans, Trichophyton mentagrophytes and Microsporum gypseum. The second more isolated group were composed by 7 (38.90%) yeasts, identified as: 3 (16.70%) Candida guilliermondii, 2 (11.10%) Candida parapsilosis, 1 (5.60%) Candida glabrata, and 1 ( 5.60%) Trichosporon asahii. The last group was represented by 3 (16.70%) isolated of non-dermatophyte filamentous fungi, identified as Fusarium sp, Aspergillus sp and Neoscytalidium sp 1 (5.60%) of each. Thirty (85.70%) of the interdigital scrapings were negative and 5 (14.30%) positive, being the agents coincident with the onychomycosis causing fungi (2 Trichophyton rubrum, 1 Trichophyton mentagrophytes, 1 Candida guilliermondii and 1 Fusarium sp) . In the control group (9 elderly with clinically uninjured nail) interdigital collecting was held, isolating Candida guilliermondii in only one (11.0%). CONCLUSIONS: Using this identification method, it was observed that the fungi that cause onychomycosis found in this study are consistent with the reports in the recent medical literature, the clinical presentation of toenail onychomycosis caused by non-dermatophyte molds was indistinguishable from that due to candidosis or dermatophyte and, in terms of etiology, no difference was observed between the onychomycosis of the institutionalized elderly from the occurrence of onychomycosis in the general population disclosed in the literature
 
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Publishing Date
2012-07-31
 
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