Onychomycosis caused by Fusarium sp in Sri Lanka: prevalence, clinical features and response to itraconazole pulse therapy in six cases.

Objectives: The aims of our study were to ascertain the proportion of Fusarium onychomycosis among patients with suspected onychomycosis, to record clinical features and to assess the efficacy of itraconazole pulse therapy in treatment.

Methods: Six patients with positive isolates of Fusarium sp were treated in an open, prospective manner with itraconazole: two pulses for fingernails and three pulses for toenails. Significant growth of Fusarium sp was considered when both microscopy of direct mounts in KOH and culture were positive for mold. Efficacy parameters were mycological cure and clinical cure. Mycological cure was negative direct microscopy (KOH) and culture. Clinical cure was complete absence of signs of onychomycosis.

Results: Prevalence of Fusarium onychomycosis was 6.25% (8/128). Three women and three men were studied. All had bilateral big toenails involved which were of the distal and lateral onychomycosis. Three of them had associated fingernail onychomycosis with periungual inflammation. All our patients were immunocompetent. At month 12 from the start of treatment, mycological cure was 100% while only three out of five patients showed normal nail growth and clinical cure. There were no significant clinical or laboratory adverse effects.

Conclusions: Our data reconfirmed that Fusarium nail infections are difficult to eradicate. Since the therapeutic reservoir in toenails is 11 months, these patients should be followed up for a total of 12 months before coming to the final conclusion.