A 60-year-old woman complains to a physician because several of her toe nails are discolored. Physical examination demonstrates crumbling, friable nails with distal-lateral separation from the nail bed. Hyperkeratotic debris is present under the affected pa of the nail. Which of the following is the most likely pathogen?: (A) Aspergillus, (B) Candida, (C) Mucor, (D) Trichophyton
Answer is D. The patient has a fungal nail infection. These infections are seen most commonly in the elderly, and are usually caused by dermatophyte infection, typically Trichophyton rubrum, Trichophyton mentagrophytes, or Epidermophyton floccosum. Some of the more superficial lesions can be removed by simply scraping the fungus off the nail. Systemic fungal therapy (notably terbinafine) of months duration (because nails are grown so slowly) may be required for deeper nail lesions. Aspergillus (1st Choice) may be a lung saprophyte or cause invasive disease. Candida (2nd Choice) is a rare cause of fungal nail infection. Associate Mucor (3rd Choice) with sinonasal infection.