Molecular Identification of Fusarium proliferatum from toenails: A case report

Abstract = 210 times | PDF = 101 times

Main Article Content

Sazan Jamal Gharib Nawroz Abdul-razzak Tahir


Fusarium is a saprophytic fungus which is broadly disseminated in soil, plant debris and other organic substrates. These fungi can affect indigenous tissue in immunocompromised patients and result in some fungal infections such as Onychomycosis, bone and joint disease, or sinusitis. In this paper, we report a 56-year-old female has Diabetes milletus who established to disseminate Fusarium infection in her left first toenail from the Dermatology Department / Khabat Skin Center, Sulaimani Province, Iraq. To study of these fungi as the true causative agents of nail infection, we describe a PCR/sequencing assay to confirm routinely diagnosis of the infecting fungi in this case with toenail Onychomycosis. Designation of the ordinary laboratory of Fusarium is very challenging because of the septate hyphae of Fusarium are hard to discriminate from those of Aspergillus, which has a more favourable consequence and this time-consuming. Therefore, molecular tools were used for identification of F. proliferatum from this case by amplifying ITS region of rDNA using a pair of universal primers ITS1 and ITS4. Infectious fungal molecular detection advances the select of right antifungal therapy, in that way improving the medication rate of nails infections. DNA sequence analysis and Phylogenetic tree of the amplified ITS-rDNA was used for species identification of this strain of F. proliferatum. For final identification sequencing of DNA has been carried out by [Macrogen Korea] using forward primer ITS1, The obtained consensus of query sequence was compared with the ITS DNA database on the BLAST homepage, aligned and diagnosed strain deposited to the GenBank and we received an accession number (MK112619). The sequence of the F. proliferatum amplicon was aligned using ClustalW and the alignment was used to make phylogenetic analysis using MEGA software version X. To the best of our knowledge, the isolated Fusarium in this paper is the first case of its kind to be sequenced and reported by the molecular method in Kurdistan region of Iraq


Fusarium proliferatum, Toenail, Onychomycosis, PCR, ITS region, Iraq.


Download data is not yet available.

Article Details


[1] A. Banu, M. Anand, L. Eswari,” A rare case of onychomycosis in all 10 fingers of an immunocompetent
patient”, Indian Dermatol Online J.;4(4):302-4, 2013. doi:10 /2229-5178.120649.
[2] E. Haneke , D. Roseeuw ,” The scope of onychomycosis: epidemiology and clinical features”, Int J
Dermatol 38 Suppl 2: 7–12,1999.
[3] Y. Ogasawara,“Prevalence and patient's consciousness of tinea pedis and onychomycosis”, Nihon Ishinkin
Gakkai Zasshi 44: 253–260,2003.
[4] MA. Ghannoum, RA. Hajjeh, R. Scher, N. Konnikov, AK. Gupta, et al, “A large-scale North American study of
fungal isolates from nails: the frequency of onychomycosis, fungal distribution, and antifungal susceptibility
patterns”, J A Acad Dermatol 43: 641–648, .2000.
[5] RK. Scher, “Onychomycosis is more than a cosmetic problem. Br J Dermatol 130: 15,1994.
[6] MA. Ghannoum, N. Isham , “Fungal Nail Infections (Onychomycosis): A Never-Ending Story?”, PLoS
Pathogens 10(6): , 2014 .
[7] S. Ahuja, S. Malhotra, H. Charoo,” Etiological agents of onychomycosis from a tertiary care hospital in central Delhi”, India. Indian J Fundam Appl Life Sci;1:11–4 ,2011.
[8] DW. Denning, EGV. Evans,CC. Kibbler, MD. Richardson, MM. Roberts, TR. Rogers, et al. ,”Fungal nail diseases: a guide to good practice” (report or a working group of the British society for medical mycology). BMJ; 311: 1277-81, 1995.
[9] AK. Gupta, CB. Horgan-Bell, RC. Summerbell, “Onychomycosis associated with Onychocola canadensis: Ten case reports and review of the literature”, J Am Acad Dermatol; 39: 410-7, 1998.
[10] AK. Gupta, EA. Cooper, P. MacDonald, RC. Summerbell, “Utility of inoculum counting (Walshe and
English Criteria) in clinical diagnosis of onychomycosis caused by nondermatophyte filamentous fungi’,J
Clin Microbiol ; 39(6): 2115-21, 2001.
[11] AK. Gupta, JE. Ryder, R. Baran, RC. Summerbell, “Nondermatophyte onychomycosis”, Dermatol Clin; 21: 257-68, 2003.
[12] DH. Ellis, JE. Marley, AB. Watson, TG. Williams, “Significance of non-dermatophyte molds and yeasts in onychomycosis”,Dermatology; 194(Suppl 1): 40-2,1997.
[13] T. J. Walsh, and A. H. Groll, “Emerging fungal pathogens: evolving challenges to immunocompromised patients for the twenty-first century”, Transpl. Infect. Dis.1:247–26, 1999.
[14] M. Nucci, and E. Anaissie, “Cutaneous infection by Fusarium species in health and immunocompromised hosts: implications for diagnosis and management”, Clin. Infect. Dis. 35:909–920, 2002.
[15] N. Hattori, A. Shirai, Y. Sugiura, W. Li, K. Yokoyama, Y. Misawa, K. Okuzumi, and K. Tamaki, “Onychomycosis caused by Fusarium proliferatum”,Br. J. Dermatol.153:647–649, 2005.
[16] C. Ferrer, J. Alio, A. Rodriguez, M. Andreu, and F. Colom, “Endophthalmitis caused by Fusarium proliferatum’, J. Clin. Microbiol. 43:5372–5375, 2005.
[17] R. V. Fleming, T. J. Walsh, and E. J. Anaissie, “Emerging and less common fungal pathogens”, Infect. Dis. Clin. North Am. 16:915–933, 2002 .
[18] R. Ray, M. Ghosh, M. Chatterjee, N. Chatterjee,M. Banerjee, “Onychomycosis Caused by Fusarium dimerum“, J Clin Sci Res, 5:44-8,2016.
[19] GF. Orr, HH. Kuehn, OA Plunkett, “A new genus of the Gymnoascaceae with swollen peridial septa”, Can J Bot 41:1439– 1456. doi:10.1139/b63-126, 1963.
[20] J. Kane, R. C. Summerbell, L. Sigler, S. Krajden, & G. Land, Laboratory handbook of dermatophytes. Belmont CA: Star Piblishers, 1997.
[21] I. Weitzman, & R. Summerbell, “The dermatophytes”, Microbiology Review, 8 (2), 240-259, 1995.
[22] B. L. Hainer, “Dermatophyte Infections”, American family physician. 67(1):101-108, 2003.
[23] G.Rebell & D. Taplin, “ Dermatophytes; their recognition and identification”, University of Miami Press, Coral Gables, Florida, 1970.
[24] K. Makimura, Y. Tamura, T. Mochizuki, A. Hasegawa , Y. Tajiri, R. Hanazawa, et al., Phylogenetic classification and species identification of dermatophyte strains based on DNA sequences of nuclear ribosomal internal transcribed spacer 1 regions”, J Clin Microbiol, 37 ,pp. 920-924, 1999.
[25] R. B. Corley , A guide to methods in the biomedical sciences. New York:Springer, 2005.
[26] P. Desjardins, D. Conklin ,”NanoDrop Microvolume Quantitation of Nucleic Acids. JoVE. 45, 2010.
[27] S. I. Ismail,” Morphological and molecular identification of dermatophytes isolated from patients in Erbil City”, M.Sc.Thesis. College of Science. Salahaddin University. Erbil-Iraq, 2015.
[28] N. Saitou, M. Nei, “The neighbor-joining method: a new method for reconstructing phylogenetic trees”, Molecular Biology and Evolution 4: 406–425, 1987.
[29] S. Kumar , Li M. Stecher, C. Knyaz, and K.Tamura, “MEGA X: Molecular Evolutionary Genetics Analysis across computing platforms “, Molecular Biology and Evolution 35:1547-1549,2018.
[30] H. C. Li, J. P. Bouchara, M. M.Hsu, R. Barton, S. Su, & T. C. Chang , “Identification of dermatophytes by sequence analysis of the of the rDNA gene internal transcribed spacer regions”, J. Med Microbial, 57, 592-600, 2008.
[31] P. Nenoff & U. F. Haustein , “Tinea corporis due to Trichophyton tonsurans”, Malmsten-report of a patient
from Zaire. J. Mycosis, 40 (3-4), 127-129, 1997.
[32] C. J. Jackson, Barton, R. C., & Evans, G. V, “Species identification and strain differentiation of Dermatophyte fungi by analysis of Ribosomal- DNA intergenic spacer regions”, Journal of Clinical Microbiology, 37 (4), 931-936,1999.
[33] B. Ahmadi, H. Mirhendi, , M. R. Shidfar, S. Nouripour-Sisakht, N. Jalalizand, , M. Geramishoar, , & G. R. Shokoohi, “A comparative study on morphological versus molecular identification of dermatophyte isolates”, J Mycol Med, 25 (1), 29-35, 2015.
[34] K. Al-Khafajii ,”Myco epidemiologic and genetic study of rermatophytosis an non dermatophytes in middle euphrates Iraq”, African Journal of Microbiology Research, 8 (24), 2381-2386, 2014.
[35] K. Tamura, D. Peterson, N. Peterson, G. Stecher, M. Nei, S. Kumar, MEGA5: “Molecular evolutionary genetics
analysis using maximum likelihood evolutionary distance, and maximum parsimony methods”, Molecular
Biology and Evolution 28: 2731–2739, 2011.
[36] M. Kimura, “A simple method for estimating evolutionary rates of basesubstitutions through comparative studies of nucleotide sequences”, Journal of Molecular Evolution 16: 111–120, 1980.