The importance of bacteria-suspending media and fingertip positions on the survival of Vibrio cholerae on human fingertips were examined. Vibrios were suspended in phosphate-buffered saline (PBS), PBS with albumin, and PBS with agarose. Each type of preparation was inoculated on the fingerpads, the hyponychia, or the eponychia and lateral nail grooves of the fourth, third and second fingers of a volunteer's hand. The last finger inoculated was immediately washed with PBS and the washing collected for examination ("0 minute" exposure). The third and fourth inoculated fingers were likewise washed for examination 2 and 5 minutes later, respectively. The vibrios obtained from the washings were enumerated by culture. For each of the different groups, which consisted of a different inoculated fingertip position, bacteria-suspending medium and exposure period of 2 or 5 minutes, the proportion of replicate inoculated fingers which retained viable vibrios (isolation rate) and the mean number of surviving vibrios, as a percentage of the inoculated vibrios at "0 minute exposure" (survival rate) were as follows: finger pads: vibrios in PBS, 2 minutes post-inoculation (isolation rate, 25%; mean survival rate, 0.002%); 5 minutes post-inoculation (isolation rate, 0%; mean survival rate, 0%). PBS-albumin: 2 minutes post-inoculation (60%, 0.004%); 5 minutes post-inoculation (40%, 0.03%). PBS-agarose: 2 minutes post-inoculation (100%, 24%); 5 minutes post-inoculation (38%, 0.005%). Lateral nail grooves and eponychia: PBS: 2 minutes post-inoculation (100%, 2.2%); 5 minutes post-inoculation (44%, 0.2%). PBS-agarose: 2 minutes post-inoculation (100%, 32%); 5 minutes post-inoculation (100%, 0.7%). Hyponychia: PBS: 2 minutes post-inoculation (100%, 8%); 5 minutes post-inoculation (100%, 0.2%). PBS-agarose: 2 minutes post-inoculation (100%, 46%); 5 minutes post-inoculation (100%, 8%). The results show that vibrios in moisture-retaining medium (PBS-agarose) and inoculated on a sheltered fingertip locations (hyponychium) have the best survival rates. However, the high survival rate was maintained briefly.
Onychomycosis is a common nail disease with numerous etiological pathogens. In order to determine and trend the local mycological pattern of culture-positive diseased nail samples sent from the Department of Dermatology, Hospital Kuala Lumpur, a five-year retrospective audit was carried out, which revealed that non-dermatophyte molds were the predominant fungi isolated, followed by yeasts and dermatophytes. This is similar to two previous studies in Malaysia, but varies greatly from other studies around the world which showed a dermatophyte-predominant prevalence. This could be due to the nature of the environment our patients encountered.
Although non-sporulating molds (NSM) are frequently isolated from patients and have been recognized as agents of pulmonary disease, their clinical significance in cutaneous specimens is relatively unknown. Therefore, this study aimed to identify NSM and to determine the keratinolytic activity of isolates from cutaneous sites. NSM isolates from clinical specimens such as skin, nail, and body fluids were identified based on their ribosomal DNA sequences. Of 17 NSM isolates (7 Ascomycota, 10 Basidiomycota), eleven were identified to species level while five were identified to the genus level. These include Schizophyllum commune, a known human pathogen, Phoma multirostrata, a plant pathogen, and Perenniporia tephropora, a saprophyte. To determine fungal pathogenicity, keratinolytic activity, a major virulence factor, was evaluated ex vivo using human nail samples by measuring dye release from keratin azure, for NSM along with pathogens (Trichophyton mentagrophytes, Trichophyton rubrum, Microsporum canis and Fusarium spp.) and nonpathogenic (endophyte) fungi for comparison. This study showed that pathogenic fungi had the highest keratinolytic activity (7.13 ± 0.552 keratinase units) while the nonpathogenic endophytes had the lowest activity (2.37 ± 0.262 keratinase units). Keratinolytic activity of two Ascomycota NSM (Guignardia mangiferae and Hypoxylon sp.) and one Basidiomycota NSM (Fomitopsis cf. meliae) was equivalent to that of pathogenic fungi, while Xylaria feejeensis showed significantly higher activity (p
Onychomycosis increases the risk of developing secondary bacterial infection and cellulitis if left untreated. The aim of this study was to determine the prevalence of onychomycosis among diabetics and its associated factors. A cross sectional study using universal sampling of all type 1 and 2 diabetic patients attending a primary care facility of the Universiti Kebangsaan Malaysia (UKM) from January to March 2011 was conducted. Samples were taken from clinically abnormal nails and from the first right toenail in the absence of nail abnormalities and cultured for fungal elements. A total of 151 diabetics participated in the study. The mean patient age was 60.7 +/- 9.1 years. A total of 123 nail samples (81.5%) were culture positive for fungal elements. A positive correlation was found between onychomycosis and increasing age (p = 0.011) and clinically abnormal nails (p < 0.05). There were no significant correlations with gender, ethnic group, duration of diabetes, types of diabetes or glycemic control. The prevalence of onychomycosis among diabetics in our study was high.
Patients treated with external fixation for limb reconsturciton or fracture stabilization equire regular and prolongedperiod of pin-tract care involving frequent visits to clinic and dressing traditionally carried out by trained nurses or medical assistants. A simple method of do-it-yourself dressing was introduced in our institution and this study was undertaken to evaluate the effectiveness of the protocol. Sixty patients (40 trauma-related problems and 20 congenital or developmental disorders) were enrolled into the study. Following application of external fixation, the patients and/or their caretakers were taught on how to do pin-site dressing using normal saline or drinking water as cleansing solution on daily basis. Patients were discharged on the second or third post-operative day and were followed-up every two weeks for an average 182 days (range 66 to 379 days) with special attention on identifying pin-tract infection. A simple grading system for pin-tract infections was proposed. Of 40 patients with trauma-related problems. 65% were post-traumatic infections. There were 788 metal-skin interfaces (239 half-pin fixations and 549 tensioned wire fixations. A total 143 metal-skin interface infections (18.1%) involving half-pin sites (41.3%) and tensioned wire sites (58.7%) was noted. Majority were grade I infections (79.7%), 18.8% grade II and only 1.4% grade III. Most infections (81%)were caused by Staphylococcus aureus. Grade I infections were successfully treated with frequent dressing, grade II by adjunctive oral antibiotic but grade III infections required removal of fixator. All eventually healed. Do yourself non-sterile dressing of metal-skin interfaces is a cost-effective method of pin-site care with a low infection rate. The infections were sucessfully treated using guidelines according to the proposed classification of pin-tract infections.