Published Studies

Fungal Nails? DNA Facts Challenge Dystrophic Etiology

JAPMA Volume 112: Issue 2

Research Article: Nail unit infections have historically been difficult to treat, affecting around 10% to 20% of the US population and causing cosmetic concerns, pain, and dystrophic changes. While fungal agents have been widely recognized as the main culprits, bacterial involvement in the clinical course of dystrophic nails has been overlooked or disregarded. Traditional diagnostic methods relied on clinical presentation, microscopic examinations, or PCR assays, each with its limitations. However, with the advancement of molecular-age medicine, DNA-based tools now offer rapid and accurate sequencing of any known microbe or pathogen. In this article, DNA sequencing-based diagnostics revealed the presence of significant bacterial pathogens, challenging the prevailing mycotic-based assumptions and raising questions about current treatment standards. These new findings have the potential to reshape our understanding and management of nail infections. Read Article

Fungal Diversity and Onychomycosis

JAPMA Volume 109: Issue 1

Research Article: Onychomycosis, a challenging fungal nail infection, often resists treatment and can relapse. Traditional diagnostic methods like potassium hydroxide and culture are time-consuming and costly. To address this, researchers explored molecular techniques for diagnosis and quantifying the microbial flora that might contribute to the disease. They collected 8,816 clinically suspicious toenail samples from patients aged 0 to 103 years across the US, along with 20 control samples. Next-generation sequencing and quantitative polymerase chain reaction were used to identify and measure dermatophytes, nondermatophyte molds, and bacteria. The results revealed that around 50% of suspicious toenails contained both fungi and bacteria, with the dermatophyte Trichophyton rubrum being the most abundant, present in 40% of these samples. The remaining 50% had either bacterial species (34%) or neither fungi nor bacteria (16%). Fungi alone were present in less than 1% of samples, and nondermatophyte molds accounted for 11.0% of occurrences in fungus-positive samples. In contrast, all control samples were negative for fungi, mainly comprising commensal bacterial species. In conclusion, molecular methods efficiently quantified microbial and mycologic presence in the nails. Surprisingly, contributions from dermatophytes were lower than expected, while nondermatophyte molds had a more significant presence. The clinical implications of these findings are yet to be fully understood. Read Article