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Journal of the American Academy of Dermatology
Volume 39, n° 3
pages 410-417 (septembre 1998)
Doi : 10.1016/S0190-9622(98)70316-0
accepted : 13 April 1998
Onychomycosis associated with Onychocola canadensis: Ten case reports and a review of the literature
 

Aditya K. Gupta, MD, FRCPCa, Caroline B. Horgan-Bell, MD, FRCPCb, Richard C. Summerbell, PhDc
Toronto and London, Ontario, Canada 
From the Division of Dermatology, Department of Medicine, Sunnybrook Health Science Center and the University of Toronto, Ontario ,a the Division of Dermatology, Department of Medicine, University of Western Ontario, London ,b and the Ontario Ministry of Health, Laboratory Services Branch, and Department of Laboratory Medicine and Pathobiology, University of Toronto.c 

Correspondence: Aditya K. Gupta, MD, FRCPC, 490 Wonderland Rd South, Ste 6, London, Ontario, Canada N6K 1L6. E-mail: agupta@execulink.com

Abstract

Background: Onychocola canadensis is a nondermatophyte mold associated with onychomycosis particularly in temperate climates (eg, Canada, New Zealand, and France). The slow growth rate of O canadensis and lack of resemblance to any other known nail-infecting fungus may have delayed its discovery. We are aware of 23 mycologically confirmed cases of O canadensis in the literature. Objective: We describe 10 previously unreported Canadian patients, specimens from whom grew O canadensis . We also review the literature on infections associated with this organism. Methods: Cases of O canadensis onychomycosis were diagnosed on the basis of (1) the finding of compatible filaments on direct microscopy of nail and (2) consistent culture from repeated specimens. All patients from whom O canadensis was isolated were followed up, but those in whom outgrowth was not consistent were not accepted as having “authentic” infections. Results: In 10 patients O canadensis was found to be associated with distal lateral subungual onychomycosis (6 patients), white superficial onychomycosis (1 patient), and as an insignificant contaminant in the nails of 3 patients. Less commonly the organism may cause tinea manuum or tinea pedis interdigitalis. O canadensis appears to be more frequent in the elderly, especially females. It is not unusual for a patient with onychomycosis caused by O canadensis to be a gardener or farmer, suggesting that the infectious inoculum may originate from the soil. The optimal therapy for onychomycosis caused by this organism remains unclear. Conclusion: O canadensis may be the etiologic agent of distal and lateral subungual or white superficial onychomycosis; however, it may sometimes be present in an abnormal-appearing nail as an insignificant finding, not acting as a pathogen. (J Am Acad Dermatol 1998;39:410-7.)

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