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Onychomykose – ein Update

Teil 2 – Vom Erreger zur Diagnose – konventionelle und molekularbiologische mykologische Diagnostik

Fungal nail infections – an update

Part 2 – From the causative agent to diagnosis – conventional and molecular procedures

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Zusammenfassung

Trichophyton (T.) rubrum ist in Deutschland und weltweit der bei Tinea unguium am häufigsten isolierte Dermatophyt, gefolgt von T. interdigitale (früher T. mentagrophytes var. interdigitale). Ein weiterer, jedoch selten isolierter ursächlicher Dermatophyt bei Onychomykose ist Epidermophyton floccosum. Candida parapsilosis, Candida guilliermondii und Candida albicans, gefolgt von Trichosporon spp. sind die wichtigsten Hefepilze, die bei einer Onychomykose isoliert werden können. Hauptsächliche Schimmelpilze als Erreger einer Onychomykose sind Scopulariopsis brevicaulis und diverse Aspergillus-Arten, u. a. Aspergillus versicolor sowie Fusarium spp. Diese sog. „non-dermatophyte moulds“ (NDM) werden als „emerging pathogens“ zunehmend als Erreger der Onychomykose gefunden. Die Diagnose einer Onychomykose sollte immer durch den mykologischen Erregernachweis gesichert werden. Neben dem mikroskopischen Präparat, am besten fluoreszenzmikroskopisch mittels Calcofluor®- oder Blancophor®-Färbung, und der kulturellen Untersuchung kommen neuerdings auch molekularbiologische Techniken zum Direktnachweis der Dermatophyten-DNS aus Hautschuppen und Nagelspänen zum Einsatz, insbesondere die PCR (Polymerasekettenreaktion). Die diagnostische Empfindlichkeit ist bei Kombination dieser konventionellen und molekularen Methoden am höchsten.

Abstract

Trichophyton (T.) rubrum is the most frequently isolated dermatophyte in onychomycosis, both in Germany and worldwide. T. interdigitale (formerly T. mentagrophytes var. interdigitale) follows in second place. A further however rarely isolated dermatophyte in onychomycosis is Epidermophyton floccosum. Candida parapsilosis, Candida guilliermondii, and Candida albicans, followed by Trichosporon spp. are the most important yeasts which are found in onychomycosis. The molds most often responsible include Scopulariopsis brevicaulis, and several Aspergillus species, e. g. Aspergillus versicolor, and Fusarium spp. These so called non-dermatophyte molds (NDM) are increasingly isolated as emerging pathogens in onychomycosis. The diagnosis of onychomycosis should be verified in the mycology laboratory. Conventional diagnostic methods include the direct examination, ideally using fluorescence staining with Calcofluor® or Blancophor®, and culture. However, new molecular biological methods primarily employing the polymerase chain reaction (PCR) for direct detection of dermatophyte DNA in skin scrapings and nail samples have been introduced into routine mycological diagnostics. The diagnostic sensitivity is higher when both conventional and molecular procedures are combined.

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Danksagung

Die exzellenten makroskopischen Fotografien der Pilzkulturen verdanken wir dem Leipziger Fotografen Uwe Schoßig.

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Tagungsunterstützung durch Firma SIFIN, Berlin, erhalten.

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Authors and Affiliations

  1. Haut- und Laborarzt/Allergologie, Andrologie, Labor für medizinische Mikrobiologie, Straße des Friedens 8, 04579, Mölbis, Deutschland

    P. Nenoff

  2. Department of Dermatology and Venerology, Medical University of Graz, Graz, Österreich

    G. Ginter-Hanselmayer

  3. Institut für Pilzkrankheiten und Mikrobiologie, Berlin, Deutschland

    H.-J. Tietz

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  1. P. Nenoff
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  2. G. Ginter-Hanselmayer
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  3. H.-J. Tietz
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Correspondence to P. Nenoff.

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Widmung

Herrn Prof. Dr. med. Uwe-Frithjof Haustein, Leipzig, zum 75. Geburtstag gewidmet.

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Nenoff, P., Ginter-Hanselmayer, G. & Tietz, HJ. Onychomykose – ein Update. Hautarzt 63, 130–138 (2012). https://doi.org/10.1007/s00105-011-2252-4

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