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Atlas of the Diabetic Foot - part 8

Nhiễm nấm subungual gần, hình thức thứ hai phổ biến nhất, Trichophyton rubrum tích tụ các mảnh vụn sừng dưới móng tay và nới lỏng các móng tay, cuối cùng tách nó ra khỏi giường của mình. Nấm này nhiễm vào ma trận cơ bản và móng tay để lại bề mặt móng tay | 160 Atlas of the Diabetic Foot and subungual debris develop. In proximal subungual fungal infection the second commonest form Trichophyton rubrum accumulates hyperkeratotic debris under the nail plate and loosens the nail eventually separating it from its bed. This fungus infects the underlying matrix and nail plate leaving the nail surface intact. Leuconychia mycotica caused by Trichophyton metagrophytes infects the nail superficially. The nail surface becomes dry soft and friable but the nail remains attached to its bed. In addition to these fungi Epidermophyton floccosum may also be isolated from infected areas. Itraconazole and fluconazole are also effective in the treatment of chronic onychomycosis. Keywords Onychomycosis distal subungual onychomycosis proximal subungual fungal infection leuconychia mycotica Trichophyton metagrophytes Trichophyton rubrum or Epidermophyton floccosum ter-binafine itraconazole fluconazole FUNGAL INFECTION WITH MULTIMICROBIAL COLONIZATION Superficial ulcers of 10 days duration on the facing sides of the left first and second toe of a 70-year-old type 2 diabetic lady with diabetic neuropathy before debridement are shown in Figures 8.8 and 8.9. Note soaking of the skin. An X-ray excluded osteomyelitis. Staphylococcus coagulase-negative Pseudomonas aeruginosa and enterobacteriaceae were recovered after swab cultures in addition to Candida albicans. She was treated successfully with itraconazole for 5 weeks. The patient used a clear gauze in order to keep her toes apart together with local hygiene procedures twice daily. Weekly debridement was carried out and no antimicrobial agent was needed. Keywords Fungal infection Figure 8.8 Neuro-ischemic ulcers facing each other on the first and second toe with fungal infection and soaked skin in addition to claw toes. Foot shown from the plantar aspect Infections 161 Figure 8.9 Neuro-ischemic ulcers facing each other on first and second toe with fungal infection. Front aspect of Figure 8.8 .