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Journal of the American Academy of Dermatology
Volume 43, n° 4
pages 641-648 (octobre 2000)
Doi : 10.1067/mjd.2000.107754
accepted : 28 Mars 2000
A large-scale North American study of fungal isolates from nails: The frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns

M.A. Ghannoum, PhD a, R.A. Hajjeh, MD b, R. Scher, MD c, N. Konnikov, MD d, A.K. Gupta, MD e, R. Summerbell, PhD f, S. Sullivan, MD, PhD g, R. Daniel, MD g, P. Krusinski, MD h, P. Fleckman, MD i, P. Rich, MD j, R. Odom, MD k, R. Aly, MD k, D. Pariser, MD l, M. Zaiac, MD m, G. Rebell, MD m, J. Lesher, MD n, B. Gerlach, MD o, G.F. Ponce-de-Leon b, A. Ghannoum a, J. Warner, BA a, N. Isham, BA, M(ASCP) a, B. Elewski, MD a
Cleveland and Hudson, Ohio; Atlanta and Augusta, Georgia; New York, New York; Boston, Massachusetts; Toronto, Ontario, Canada; Jackson, Mississippi; Burlington, Vermont; Seattle, Washington; Portland, Oregon; San Francisco, California; Norfolk, Virginia; and Miami Beach, Florida 
From the Department of Dermatology, University Center for Medical Mycologya; Division of Bacterial and Mycotic Infections, Centers for Disease Control and Prevention, Atlantab; Columbia Presbyterian Medical Center, New Yorkc; the Department of Dermatology, New England Medical Center, Bostond; Division of Dermatology, Department of Medicine, Sunnybrook Health Science Center and the University of Torontoe; Ontario Ministry of Health Mycology Laboratory and the Department of Laboratory Medicine and Pathobiology, University of Torontof; Department of Medicine, University Medical Center, Jacksong; One South Prospect, Burlingtonh; Department of Medicine, Division of Dermatology, University of Washington, Seattlei; Department of Dermatology, Oregon Health Sciences University, Portlandj; University of California, San Francisco Hospitals and Clinicsk; Division of Dermatology, Eastern Virginia Medical School, Norfolkl; Greater Miami Skin and Laser Center, Mt Sinai Hospital, Miami Beachm; Section of Dermatology, Department of Medicine, Medical College of Georgia, Augustan; and Hudson, Ohio.o 


Background: Onychomycosis, a fungal infection of the nail bed, is responsible for up to 50% of nail disorders. Although several surveys have been conducted in different parts of the world, there have been no multicenter epidemiologic surveys of onychomycosis in North America. Objective: A 12-center study was undertaken to (1) determine the frequency of onychomycosis, (2) identify organisms recovered from the nails, and (3) determine the antifungal susceptibility of isolates. Methods: A total of 1832 subjects participated in this study and completed a comprehensive questionnaire, and nail clippings were collected for potassium hydroxide examination and culturing. Results: The frequency of onychomycosis, as defined by the presence of septate hyphae on direct microscopy and/or the recovery of a dermatophyte, was found to be 13.8%. In general, the dermatophyte isolates were susceptible to the antifungals tested. Conclusion: Because of the limited number of large-scale studies, the baseline incidence is not firmly established. However, the higher frequency of onychomycosis in this study may confirm the suspected increase in incidence of disease in North America. (J Am Acad Dermatol 2000;43:641-8.).

The full text of this article is available in PDF format.

 Supported by Pfizer Pharmaceutical Group.
 Reprint requests: M. A. Ghannoum, PhD, University Center for Medical Mycology, 11100 Euclid Ave, Cleveland, OH 44106-5028. E-mail:
 J Am Acad Dermatol 2000;43:641-8.

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