Türkiye'de sunulan ilk vaka; Immunocompetent hasta daChaetomium globosum türünün etken olduğu tırnak onikomikozu.

Öz

25 yaşında kadın hastanın sağ ayak başparmağındaki distal subungual onikomikoz rapor olarak sunuldu. Tırnak muayenesi laboratuvarımızda yapıldı ve hastada distal subungual onikomikoz saptandı. %20 KOH kullanılarak yapılan direkt mikroskobik incelemede; septalı hifler gözlemlendi. Hastadan alınan tırnak örnekleri Sabouraud’s Dextrose Agara ekildi ve 25 °C’de, bir hafta bekletildi. Fungal büyüme saptandıktan sonra direkt preparat hazırlandı, kahverengi septalı hifler, perithecia, limon benzeri askosporlar görüldü. Etken sekanslama ve konvansiyonel yöntemle Chaetomium globosum olarak tanımlandı. M38-A2 yöntemi kullanılarak amfotericin B, fluconazole, itraconazole, miconazole, ketoconazole, flucytosine voriconazole MİK değerleri sırasıyala 4->64, 1-0, 125, 0,125->64, 0,5 μg/mL olarak belirlendi. Chaetomium globosum için fluorocytosine ve fluconazole dirençli olarak saptanırken miconazole ve ketoconazole MİK değerleri en etkili olarak saptandı. Hasta günlük 250 mg/gün oral itraconazole ve amorolfin %5 tırnak cilası kullandı ve 12 haftada iyileşme kayıt edildi

Anahtar Kelimeler

• chaetomium, onikomikoz

The first Turkish case of onychomycosis caused by Chaetomium globosum in an immunocompetent patient

Abstract

It was reported as a case of distal subungual onychomycosis of the thumb of the right foot of a 25-year-old female patient in this article. Nail was examined in our laboratory and it was detected distal subungual onycomycosis. In direct microbiological examination septate hyphae was observed by using 20% KOH. Scraping of nail taken from patient was cultured on two Sabouraud’s Dextrose Agar with cycloheximide and without cycloheximide and it was keept at 25 °C for one week. After growth of fungal was detected slide cultures were prepared and brown-colored septated hyphae, perithecia, lemon-shaped ascospores were observed by light microscopy. The causative agent was identified as Chaetomium globosum. It was determnied by using M38-A2 microdilution method, minimum inhibitory concentration values of, amphotericin B fluconazole, itracanozole, miconazole, ketoconazole, flucytosine voriconazole were determined as 4->64, 1-0.125, 0.125->64-0.5 μg/mL, respectively. Fluorocytosine and fluconazole were determined as resistant for Chaetomium globosum while miconazole and ketoconazole MIC values was determined as the best effective antifungal. The patient was treated by using oral itraconazole daily 250 mg /a day and local application of amorolfine 5% nail lacquer was used and it was seen to heal in 12 weeks

Keywords

• chaetomium, onychomycosis, antifungal susceptibiltiy

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