Distal Lateral Subungual Onychomycosis Owing to Tritirachium oryzae: A Bystander or Invader?

• Published in: Mycopathologia (1975) Vol. 183; no. 2; pp. 459 - 463
• Main Authors: Vanam, Hari Pankaj, Rao, P. Narsimha, Mohanram, Kalyani, Yegneswaran, Prakash Peralam, Rudramurthy, Shiva Prakash Mandya
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01-04-2018; Springer; Springer Nature B.V
• Subjects: Amphotericin B; Azoles; Biomedical and Life Sciences; Case reports; Cornea; Cream; Dermatomycosis; Echinocandins; Eukaryotic Microbiology; Fungi; Fungicides; Health aspects; Heterocyclic compounds; Hydroxides; Infection; Ketoconazole; Life Sciences; Medical Microbiology; Microbial Ecology; Microbiology; Mycoses; Onychomycosis; Otomycosis; Pathogens; Plant Sciences; Potassium; Potassium hydroxide; Potassium hydroxides; Rare species; Regrowth; Scalp; Short Communication; Toenail; Topical application; Ulcers; Distal lateral subungual onychomycosis (DLSO); Non-dermatophytic molds (NDM); Tritirachium oryzae
• ISSN: 0301-486X; 1573-0832
• DOI: 10.1007/s11046-017-0226-5

The genus Tritirachium is a mitosporic fungus which inhabits in soil and decaying plant material and also a notable insect pathogen. Human infections with Tritirachium species though rare were previously reported to cause corneal ulcers, otomycosis, onychomycosis, and dermatomycosis of the scalp and hence may be considered as a potential pathogen. Here we report a case of distal lateral subungual onychomycosis involving right great toenail in a 22-year-old female, wherein direct potassium hydroxide preparations, fungal cultures, and molecular sequencing of the isolate established
Tritirachium oryzae
as the etiological agent. Antifungal susceptibility performed by the microbroth technique of CLSI revealed increased MICs to amphotericin B and low MICs to azoles and echinocandins. The case was managed with surgical nail avulsion followed by topical application of 2% ketoconazole cream resulting regrowth of normal nail. To the best of our knowledge, this is the first report of non-dermatophytic mold
T. oryzae
causing onychomycosis in India.