Distal and lateral subungual onychomycosis of the finger nail in a neonate: a rare case

Abstract

Background Onychomycosis is extremely rare in neonates, infrequently reported in children and is considered to be exclusively a disease of adults. Case presentation We, herein report a case of fingernail onychomycosis in a 28-day-old, healthy, male neonate. The child presented with a history of yellowish discoloration of the fingernail of the left hand for one week. The etiological agent was demonstrated both by microscopic examination and culture of nail clippings. The isolate grown on culture was identified as Candida albicans by phenotypic characteristics and by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Antifungal sensitivity testing was performed by broth dilution method as per the Clinical & Laboratory Standards Institute guidelines. An oral swab culture of the child also yielded C. albicans with the same antibiogram as the nail isolate. The case was diagnosed as distal and lateral subungual candida onychomycosis of severity index score 22 (severe) and was treated with syrup fluconazole 6 mg/kg body weight/week and 5% amorolfine nail lacquer once/week for three months. After three months of therapy, the patient completely recovered with the development of a healthy nail plate. Conclusions The case is presented due to its rarity in neonates which, we suppose is the first case report of onychomycosis from Nepal in a 28-day-old neonate. Oral colonization with pathogenic yeasts and finger suckling could be risk factors for neonatal onychomycosis.

Onychomycosis: An Updated Review

“…Non-dermatophyte molds account for approximately 10% of onychomycosis cases globally [ 6 , 32 ]. Onychomycosis caused by yeasts is uncommon [ 33 ]. Candida albicans accounts for approximately 70% of onychomycosis caused by yeasts [ 1 ].…”

“…Candida albicans accounts for approximately 70% of onychomycosis caused by yeasts [ 1 ]. Other Candida species include Candida tropicalis and Candida parapsilosis [ 12 , 17 , 28 , 33 - 35 ]. Patients with chronic mucocutaneous candidiasis and immunodeficiency are more likely infected with the yeast organism, especially in the fingernails [ 11 , 28 , 33 , 36 , 37 ].…”

Atypical and Unpredictable Superficial Mycosis Presentations: A Narrative Review

“…Oral colonization by pathogenic yeasts and finger suckling could be advanced as potential risk factors for the unexpected neonatal onychomycosis. Uncommon cases were attributed to Candida albicans, Candida parapsilosis, Candida tropicalis, Trichophyton rubrum, and Fusarium oxysporum [42,142,143].…”

“…Even the well-known yeast Candida albicans, rather than any other Candida species, often clinically presents as a misleading paronychia, or onycholysis [142], some of the unusual forms of onychomycosis are depicted in table…”

Comparison of diagnostic methods in onychomycosis

“…Yeast-induced onychomycosis is rare. Candida albicans accounts for approximately 70% of yeast-induced onychomycosis cases (9). There is a need for effective and sensitive diagnostic tests that can confirm the diagnosis of onychomycosis before initiating systemic antifungal therapy.…”