Skip to main content

Advertisement

SpringerLink
Log in

Onychomycosis Due to Aspergillus spp.: a Current Review

  • Fungal Infections of Skin and Subcutaneous Tissue (A Bonifaz, Section Editor)
  • Published:
Current Fungal Infection Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The incidence of onychomycosis by Aspergillus has shown an increase in recent years, representing 34–60% of onychomycosis due to non-dermatophyte molds. At least 26 species of Aspergillus causing onychomycosis have been reported, some of which may be morphologically indistinguishable but genetically distinct, even in their susceptibility profile to antifungals. So in the diagnosis of this pathology, it is necessary to use both conventional and molecular methods to get to the identification of the fungus at the species level and thus establish the appropriate treatment.

Recent Findings

The current taxonomy of the genus Aspergillus includes sections that are made up of species whose morphology is almost identical but have different patterns of susceptibility to antifungals. Advances in the taxonomy of these fungi reveal the need to combine phenotypic methods (analysis of microscopic and macroscopic characteristics) with molecular ones (amplification and sequencing of fragments of the β-tubulin and calmodulin genes) to achieve their correct identification at the level of species.

Summary

From the demonstration of Aspergillus as the primary agent of onychomycosis, an increase in the incidence of this pathology worldwide has been reported, whose treatment is usually complicated. Various species of Aspergillus can cause nail infection but may respond differently to antifungal treatment, so it is important to know their epidemiology, clinical characteristics, etiologic agents, diagnostic methods, and treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Martínez-Herrera EO, Arroyo-Camarena S, Tejada-García DL, Porras-López CF, Arenas R. Onychomycosis due to opportunistic molds. An Bras Dermatol. 2015;90(3):334–7. This paper mentions general aspects of onychomycosis by Aspergillus.

    Article  PubMed  PubMed Central  Google Scholar 

  2. •• López-Jodra O, Torres-Rodríguez JM. Unusual fungal species causing onychomycosis. Rev Iberoam Micol. 1999;16(S):S11–5. This paper mentions aspects of the epidemiology of onychomycosis by Aspergillus.

    PubMed  Google Scholar 

  3. •• Wijesuriya T, Kottahachchi J, Gunasekara TDCP, Bulugahapitiya U, Ranasinghe KNP, Neluka Fernando S, et al. Aspergillus species: An emerging pathogen in onychomycosis among diabetics. Indian J Endocrinol Metab. 2015;19(6):811. This paper reports clinical aspects of onychomycosis by Aspergillus.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. de Magalhães LK, Machado Barbosa de Castro CM, Nogueira Cambuim F II, de Oliveira JC, Delgado M, de Melo Rego RS. Hongos filamentosos no dermatofitos: onicomicosis en cuatro pacientes infectados con el virus de la inmunodeficiencia humana. Rev Iberoam Micol. 2008;25(1):45–9.

    Article  Google Scholar 

  5. •• Nouripour-Sisakht S, Mirhendi H, Shidfar MR, Ahmadi B, Rezaei-Matehkolaei A, Geramishoar M, et al. Aspergillus species as emerging causative agents of onychomycosis. J Mycol Med. 2015;25(2):101–7. This paper mentions aspects of the epidemiology of onychomycosis by Aspergillus.

    Article  PubMed  CAS  Google Scholar 

  6. Ballesté R, Mousqués N, Gezuele E. Onicomicosis. Revisión del tema. Rev Medica Urug. 2003;19:93–106.

    Google Scholar 

  7. Baran R, Tosti A, Piraccini BM. Uncommon clinical patterns of Fusarium nail infection: report of three cases. Br J Dermatol. 1997;136(3):424–7.

    Article  PubMed  CAS  Google Scholar 

  8. • Escobar ML, Carmona-Fonseca J. Onicomicosis por hongos ambientales no dermatofíticos. Rev Iberoam Micol. 2003;20:6–10. This paper mentions general aspects of onychomycosis by Aspergillus.

    PubMed  Google Scholar 

  9. Cavallera E, Asbati M. Onicomicosis por hongos filamentosos no dermatófitos en Cádiz. Dermatol Venezol. 2006;44(1):4–10.

    Google Scholar 

  10. Palacio A, Pazos C, Cuétara S. Onicomicosis por hongos filamentosos no dermatófitos en Cádiz. Enferm Infecc Microbiol Clin. 2001;19(7):345–6.

    Article  PubMed  Google Scholar 

  11. • Bonifaz A, Cruz-Aguilar P, Ponce RM. Onychomycosis by molds. Report of 78 cases. Eur J Dermatol. 2007;17(1):70–2. This paper mentions aspects of the epidemiology of onychomycosis by Aspergillus.

    PubMed  Google Scholar 

  12. Ramirez Hobak L, Gomez-Stenz A, Vega Sanchez DC, Arenas R. Onicomicosis por mohos no dermatofitos. Una revisión. Dermatol CMQ. 2017;15(3):184–94.

    Google Scholar 

  13. •• Gupta AK, Drummond-Main C, Cooper EA, Brintnell W, Piraccini BM, Tosti A. Systematic review of nondermatophyte mold onychomycosis: Diagnosis, clinical types, epidemiology, and treatment. J Am Acad Dermatol. 2012;66(3):494–502. This paper mentions general aspects of onychomycosis by Aspergillus .

    Article  PubMed  Google Scholar 

  14. • Negroni R, Arechavala A, Bohnvel P. Hongos miceliales no dermatofitos en onicodistrofias. Experiencia de un centro médico privado en Buenos Aires. Dermatol Argent. 2008;14(2):118–23. This paper mentions general aspects of onychomycosis by Aspergillus .

    Google Scholar 

  15. • Mahmoudabadi AZ, Zarrin M. Onychomycosis with Aspergillus flavus; a case report from Iran. Pak J Med Sci. 2005;21(4):497–8. This paper mentions aspects of the epidemiology of onychomycosis by Aspergillus.

    Google Scholar 

  16. • Godoy-Martinez P, Nunes FG, Tomimori-Yamashita J, Urrutia M, Zaror L, Silva V, et al. Onychomycosis in São Paulo, Brazil. Mycopathologia. 2009;168(3):111–6. This paper mentions aspects of the epidemiology of onychomycosis by Aspergillus.

    Article  PubMed  Google Scholar 

  17. • Hilmioǧlu-Polat S, Metin DY, Inci R, Dereli T, Kilinç I, Tümbay E. Non-dermatophytic molds as agents of onychomycosis in Izmir, Turkey—a prospective study. Mycopathologia. 2005;160(2):125–8. This paper mentions aspects of the epidemiology of onychomycosis by Aspergillus.

    Article  PubMed  Google Scholar 

  18. Bereston MES, Waring WS. Onychomycosis and dermatomycosis caused by Trichophyton Rubrum and Aspergillus nidulans. Arch Dermatol Syphilol. 1945;52(3):162–5.

    Article  Google Scholar 

  19. • Nkondjo Minkoumou S, Fabrizi V, Papini M. Onychomycosis in Cameroon: A clinical and epidemiological study among dermatological patients. Int J Dermatol. 2012;51(12):1474–7. This paper mentions aspects of the epidemiology of onychomycosis by Aspergillus.

    Article  PubMed  Google Scholar 

  20. • Chadeganipour M, Nilipour S, Ahmadi G. Study of onychomycosis in Isfahan, Iran. Mycoses. 2010;53(2):153–7. This paper mentions aspects of the epidemiology of onychomycosis by Aspergillus.

    Article  PubMed  Google Scholar 

  21. • Ranawaka RR, de Silva N, Ragunathan RW. Non-dermatophyte mold onychomycosis in Sri Lanka. Dermatol Online J. 2012;18(1):7. This paper mentions aspects of the epidemiology of onychomycosis by Aspergillus.

    PubMed  Google Scholar 

  22. • Hajoui ZM, Zeroual Z, Ghfir B, Moustachi A, Lyagoubi M, Aoufi S. The mold onychomycosis in Morocco: About 150 isolated cases in 20 years. J Mycol Med. 2012;22(3):221–4. This paper mentions aspects of the epidemiology of onychomycosis by Aspergillus.

    Article  PubMed  Google Scholar 

  23. •• Gupta AK, Nakrieko KA. Molecular determination of mixed infections of dermatophytes and nondermatophyte molds in individuals with onychomycosis. J Am Podiatr Med Assoc. 2014;104(4):330–6. This paper reports diagnostic methods for onychomycosis by Aspergillus .

    Article  PubMed  Google Scholar 

  24. • Raghavendra K, Yadav D, Kumar A, Sharma M, Bhuria J, Chand A. The nondermatophyte molds: Emerging as leading cause of onychomycosis in south-east Rajasthan. Indian Dermatol Online J. 2015;6(2):92. This paper mentions aspects of the epidemiology of onychomycosis by Aspergillus.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. •• Ramani R, Srinivas CR, Ramani A, Kumari TGR, Shivananda PG. Molds in Onychomycosis. Int J Dermatol. 1993;32(12):877–8. This paper mentions general aspects of onychomycosis by Aspergillus.

    Article  PubMed  CAS  Google Scholar 

  26. • Romano C, Gianni C, Difonzo EM. Retrospective study of onychomycosis in Italy: 1985–2000. Mycoses. 2005;48(1):42–4. This paper mentions aspects of the epidemiology of onychomycosis by Aspergillus.

    Article  PubMed  Google Scholar 

  27. • Leelavathi M, Tzar MN, Adawiah J. Common microorganisms causing onychomycosis in tropical climate. Sains Malays. 2012;41(6):697–700. This paper mentions aspects of the epidemiology of onychomycosis by Aspergillus.

  28. • Bokhari MA, Hussain I, Jahangir M, Haroon TS, Aman S, Khurshid K. Onychomycosis in Lahore, Pakistan. Int J Dermatol. 1999;38(8):591–5. This paper mentions aspects of the epidemiology of onychomycosis by Aspergillus.

    Article  PubMed  CAS  Google Scholar 

  29. • Hashemi SJ, Gerami M, Zibafar E, Daei M, Moazeni M, Nasrollahi A. Onychomycosis in Tehran: Mycological study of 504 patients. Mycoses. 2010;53(3):251–5. This paper mentions aspects of the epidemiology of onychomycosis by Aspergillus.

    Article  PubMed  CAS  Google Scholar 

  30. •• English MP, Atkinson R. Onychomycosis in elderly chiropody patients. Br J Dermatol. 1974;91(1):67–72. This paper reports clinical aspects of onychomycosis by Aspergillus.

    Article  PubMed  CAS  Google Scholar 

  31. • Soltani M, Khosravi AR, Shokri H, Sharifzadeh A, Balal A. A study of onychomycosis in patients attending a dermatology center in Tehran, Iran. J Mycol Med. 2015;25(2):e81–7. This paper mentions aspects of the epidemiology of onychomycosis by Aspergillus.

    Article  PubMed  CAS  Google Scholar 

  32. Bereston MES, Keil H. Onychomycosis due to Aspergillus flavus. Arch Dermatol Syphilol. 1941;44(3):420–5.

    Article  Google Scholar 

  33. • Tsang CC, Hui TWS, Lee KC, Chen JHK, Ngan AHY, Tam EWT, et al. Genetic diversity of Aspergillus species isolated from onychomycosis and Aspergillus hongkongensis sp. nov., with implications to antifungal susceptibility testing. Diagn Microbiol Infect Dis. 2016;84(2):125–34. This paper reports a new species in onychomycosis.

    Article  PubMed  CAS  Google Scholar 

  34. •• Gianni C, Romano C. Clinical and histological aspects of toenail onychomycosis caused by Aspergillus spp.: 34 cases treated with weekly intermittent terbinafine. Dermatology. 2004;209(2):104–10. This paper mentions the treatment for onychomycosis by Aspergillus .

    Article  PubMed  CAS  Google Scholar 

  35. • Kim DM, Suh MK, Ha GY, Sohng SH. Fingernail onychomycosis due to Aspergillus niger. Ann Dermatol. 2012;24(4):459–63. This paper mentions general aspects of onychomycosis by Aspergillus.

    Article  PubMed  PubMed Central  Google Scholar 

  36. • Gugnani HC, Vijayan VK, Tyagi P, Sharma S, Stchigel AM, Guarro J. Onychomycosis due to Emericella quadrilineata. J Clin Microbiol. 2004;42(2):914–6. This paper reports a new species in onychomycosis.

    Article  PubMed  PubMed Central  Google Scholar 

  37. • Garcia-Martos P, Guarro J, Gene J, Mira J, Linares M, Ortoneda M. Onychomycosis caused by Aspergillus sclerotiorum. J Mycol Med. 2001;11(4):222–4. This paper reports a new species in onychomycosis.

    Google Scholar 

  38. • Zotti M, Machetti M, Persi A, Barabino G, Parodi A. Onychomycosis: First case due to Aspergillus nomius. Acta Derm Venereol. 2011;91(5):591–2. This paper reports a new species in onychomycosis.

    Article  PubMed  Google Scholar 

  39. • Falahati M, Ghojoghi A, Abastabar M, Ghasemi Z, Farahyar S, Roudbary M, et al. The first case of total dystrophic onychomycosis caused by Aspergillus clavatus resistant to antifungal drugs. Mycopathologia. 2016;181(3–4):273–7. This paper reports a new species in onychomycosis.

    Article  PubMed  Google Scholar 

  40. • Zarei F, Mirhendi H, Fakhim H, Geramishoar M. The first case of onychomycosis due to Aspergillus uvarum (section Nigri). Mycoses. 2015;58(4):239–42. This paper reports a new species in onychomycosis.

    Article  PubMed  Google Scholar 

  41. Brasch J, Varga J, Jensen JM, Egberts F, Tintelnot K. Nail infection by Aspergillus ochraceopetaliformis. Med Mycol. 2009;47(6):658–62. This paper reports a new species in onychomycosis.

    Article  PubMed  CAS  Google Scholar 

  42. • Zotti M, Machetti M, Perotti M, Barabino G, Persi A. A new species, Aspergillus persii, as an agent of onychomycosis. Med Mycol. 2010;48(4):656–60. This paper reports a new species in onychomycosis.

    Article  PubMed  CAS  Google Scholar 

  43. • Kristensen L, Stenderup J, Otkjær A. Onychomycosis due to Aspergillus tamarii in a 3-year-old boy. Acta Derm Venereol. 2005;85:261–2. This paper reports a new species in onychomycosis.

    PubMed  Google Scholar 

  44. Nyongesa BW, Okoth S, Ayugi V. Identification key for Aspergillus species isolated from maize and soil of Nandi Country, Kenya. Adv Microbiol. 2015;5:205–29.

    Article  Google Scholar 

  45. Chen AJ, Frisvad JC, Sun BD, Varga J, Kocsubé S, Dijksterhuis J, et al. Aspergillus section Nidulantes (formerly Emericella): Polyphasic taxonomy, chemistry and biology. Stud Mycol. 2016;84:1–118.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  46. •• Balajee SA, Houbraken J, Verweij PE, Hong SB, Yaghuchi T, Varga J, et al. Aspergillus species identification in the clinical setting. Stud Mycol. 2007;59:39–46. This paper reports diagnostic methods for onychomycosis by Aspergillus .

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  47. • Lee BJ, Kim IJ, Suh SB. Two cases of onychomycosis due to Aspergillus repens. Korean J Dermatol. 1981;19:881–6. This paper reports a new species in onychomycosis.

    Google Scholar 

  48. Uribe B, Colin J, Arce M, Arenas R. Aspergillus niger. Dermatol CMQ. 2017;15(3):197–8.

  49. • Moore M, Weiss RS. Onychomycosis caused by Aspergillus terreus. J Invest Dermatol. 1948;11(3):215–23. This paper mentions historical aspects of onychomycosis by Aspergillus.

    Article  PubMed  CAS  Google Scholar 

  50. • Rosenthal SA, Stritzler R, Villafane J. Onychomycosis ca 52(3): used by Aspergillus fumigatus. Report of a case. Arch Derm. 1968;97:685–7. This paper mentions historical aspects of onychomycosis by Aspergillus.

    Article  PubMed  CAS  Google Scholar 

  51. • Torres-Rodriguez JM, Madrenys-Brunet N, Siddat M, López-Jodra O, Jimenez T. Aspergillus versicolor as cause of onychomycosis: Report of 12 cases and susceptibility testing to antifungal drugs. J Eur Acad Dermatol Venereol. 1998;11(1):25–31. This paper mentions the treatment for onychomycosis by Aspergillus.

    Article  PubMed  CAS  Google Scholar 

  52. • Takahata Y, Hiruma M, Sugita T, Muto M. A case of onychomycosis due to Aspergillus sydowii diagnosed using DNA sequence analysis. Mycoses. 2008;51(2):170–3. This paper reports a new species in onychomycosis.

    Article  PubMed  Google Scholar 

  53. Choudhary SV, Koley S, Mallick S, Bose S, Basak S. Proximal subungual onychomycosis caused by Aspergillus flavus in a HIV- positive patient. Indian J Dermatol Venereol Leprol. 2009;75(4):410–2.

    Article  PubMed  Google Scholar 

  54. • Veraldi S, Chiaratti A, Harak H. Onychomycosis caused by Aspergillus versicolor. Mycoses. 2009;53(4):363–5. This paper reports a new species in onychomycosis.

  55. • Ahmadi B, Hashemi SJ, Zaini F, Shidfar MR, Moazeni M, Mousavi B, et al. A case of onychomycosis caused by Aspergillus candidus. Med Mycol Case Rep. 2012;1(1):45–8. This paper reports a new species in onychomycosis.

    Article  PubMed  PubMed Central  Google Scholar 

  56. •• Banu A, Anand M, Eswari L. A rare case of onychomycosis in all 10 fingers of an immunocompetent patient. Indian Dermatol Online J. 2013;4(4):302–4. This paper reports clinical aspects of onychomycosis by Aspergillus.

    Article  PubMed  PubMed Central  Google Scholar 

  57. • Zotti M, Agnoletti AF, Vizzini A, Cozzani E, Parodi A. Onychomycosis from Aspergillus melleus, a novel pathogen for humans. Fungal identification and in vitro drug susceptibility. Exp Dermatol. 2015;24(12):966–8. This paper reports a new species in onychomycosis.

  58. • Noguchi H, Hiruma M, Miyashita A, Makino K, Miyata K, Ihn H. A case of fingernail onychomycosis due to Aspergillus flavus. Jpn J Med Mycol. 2016;57(2):21–5. This paper reports clinical aspects of onychomycosis by Aspergillus.

    Article  Google Scholar 

  59. Matsuyama Y, Nakamura T, Hagi T, Asanuma K, Sudo A. Subungual onychomycosis due to Aspergillus niger mimicking a glomus tumor: A case report. Biomed Rep. 2017;6:532–4.

    Article  CAS  Google Scholar 

  60. Álvarez-Salafranca M, Hernández-Ostiz S, Salvo Gonzalo S, Ara MM. Onicomicosis subungueal proximal por Aspergillus niger: un simulador de melanoma maligno subungueal. Actas Dermosifiliogr. 2016;108(5):482–5.

  61. Tamer F, Yuksel ME. Onychomycosis due to Aspergillus niger without black nail discoloration: A case report. Our Dermatol Online. 2017;8(2):233–4.

  62. Akpinar Kara Y, Erdogan FG, Cologlu D. A case of onychomycosis due to Aspergillus flavus in all fingernails and toenails of an immunocompromised patient. J Clin Exp Dermatol Res. 2017;9(1):9–11.

    Article  Google Scholar 

  63. Fernández MS, Rojas FD, Cattana ME, Sosa MA, Mangiaterra ML, Giusiano GE. Aspergillus terreus complex: An emergent opportunistic agent of Onychomycosis. Mycoses. 2013;56(4):477–8.

    Article  PubMed  Google Scholar 

  64. •• Grover C, Reddy BSN, Chaturvedi KU. Onychomycosis and the diagnostic significance of nail biopsy. J Dermatol. 2003;30(2):116–22. This paper reports diagnostic methods for onychomycosis by Aspergillus .

    Article  PubMed  Google Scholar 

  65. • Afshar P, Khodavaisy S, Kalhori S, Ghasemi M, Razavyoon T. Onychomycosis in North-East of Iran. Iran J Microbiol. 2014;6(2):98–103. This paper mentions aspects of the epidemiology of onychomycosis by Aspergillus.

    PubMed  PubMed Central  Google Scholar 

  66. •• Bonifaz A, Rios-Yuil JM, Arenas R, Araiza J, Fernández R, Mercadillo-Pérez P, et al. Comparison of direct microscopy, culture and calcofluor white for the diagnosis of onychomycosis. Rev Iberoam Micol. 2013;30(2):109–11. This paper reports diagnostic methods for onychomycosis by Aspergillus .

    Article  PubMed  Google Scholar 

  67. Frías-De-León MG, Rosas-de Paz E, Arenas R, Atoche C, Duarte-Escalante E, Molina de Soschin D, et al. Identification of Aspergillus tubingensis in a primary skin infection. J Mycol Med. 2018; https://doi.org/10.1016/j.mycmed.2018.02.013.

  68. • Tupaki-Sreepurna A, Jishnu B, Thanneru V, Sharma S, Gopi A, Sundaram M, et al. An assessment of in vitro antifungal activities of efinaconazole and itraconazole against common non-dermatophyte fungi causing onychomycosis. J Fungi. 2017;3(2):20. This paper mentions the treatment for onychomycosis by Aspergillus .

Download references

Author information

Authors and Affiliations

  1. Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Carretera Federal México – Puebla Km. 34.5, Pueblo de Zoquiapan, 56530, Ixtapaluca, Estado de México, Mexico

    María Guadalupe Frías-De-León, Víctor Manuel Espinosa-Hernández & Erick Martínez-Herrera

  2. Sección de Micología, Hospital General “Dr. Eduardo Liceaga”, Ciudad de México, Mexico

    Alexandro Bonifaz

Authors
  1. María Guadalupe Frías-De-León
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Víctor Manuel Espinosa-Hernández
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexandro Bonifaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Erick Martínez-Herrera
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Erick Martínez-Herrera.

Ethics declarations

Conflict of Interest

The authors declare that they have no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This paper is part of the Topical Collection on Fungal Infections of Skin and Subcutaneous Tissue

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Frías-De-León, M.G., Espinosa-Hernández, V.M., Bonifaz, A. et al. Onychomycosis Due to Aspergillus spp.: a Current Review. Curr Fungal Infect Rep 12, 112–119 (2018). https://doi.org/10.1007/s12281-018-0319-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12281-018-0319-8

Keywords

Search

Navigation