{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T04:12:48Z","timestamp":1772424768791,"version":"3.50.1"},"reference-count":23,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,7,31]],"date-time":"2021-07-31T00:00:00Z","timestamp":1627689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Onychomycosis is one of the most frequent reasons for visiting podiatrist clinics. Complementary tests and the accurate identification of the infectious agents are key issues for a successful treatment of onychomycosis. This is particularly important when lifestyle, age and immunodepressed patients increase the prevalence of non-dermatophyte fungal infection. In this paper, we describe issues related to onychomycosis prevalence in a population of patients, mostly with rural lifestyles, visiting a podiatry clinic in a rural area of Spain. A total of 51 cases were studied with an average age of 65.96 \u00b1 21.28 years (the youngest being 16 years and the oldest being 95 years). Fungal agents were isolated using conventional sampling and microbiological culture techniques. The results obtained with these techniques were compared with the results obtained with a direct methodology using molecular biology, by PCR and nucleotide sequencing of the ITS-5.8S rDNA fragment. The classical culture methodology confirmed the infection in 76.5% of the samples (n = 39), while the PCR confirmed the infection in 84.3% (n = 51) of the nails, although the difference between these results did not show statistical significance (p = 0.388). We found a high variability in agents, with more yeasts than dermatophytes as etiological agents of onychomycosis. However, only among individuals older than 65 years, was the difference between yeasts (82%) and dermatophytes (18%) was statistically significant (p = 0.004). Among the agents of non-dermatophyte onychomycosis, we found predominantly fungi (yeasts) of the Candida genus, interestingly with no isolates of Candida albicans, and moulds of the Aspergillus genus.<\/jats:p>","DOI":"10.3390\/jof7080623","type":"journal-article","created":{"date-parts":[[2021,8,1]],"date-time":"2021-08-01T21:51:07Z","timestamp":1627854667000},"page":"623","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Identification of Fungi Involved in Onychomycosis in Patients of a Spanish Rural Area"],"prefix":"10.3390","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4696-4705","authenticated-orcid":false,"given":"Felix","family":"Marcos-Tejedor","sequence":"first","affiliation":[{"name":"Department of Medical Sciences, Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain"}]},{"given":"Marta","family":"Mota","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"CNC\u2014Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal"}]},{"given":"Mar\u00eda Jos\u00e9","family":"Iglesias-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Therapy, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0798-7026","authenticated-orcid":false,"given":"Raquel","family":"Mayordomo","sequence":"additional","affiliation":[{"name":"Department of Anatomy and Human Embryology, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9347-0535","authenticated-orcid":false,"given":"Teresa","family":"Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"CNC\u2014Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/j.jaad.2018.03.062","article-title":"Onychomycosis: Clinical overview and diagnosis","volume":"80","author":"Lipner","year":"2019","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1177\/1203475417716362","article-title":"Onychomycosis in the 21st Century: An Update on Diagnosis, Epidemiology, and Treatment","volume":"21","author":"Gupta","year":"2017","journal-title":"J. Cutan. Med. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"4","DOI":"10.12788\/j.sder.0014","article-title":"The epidemiology, etiology, and pathophysiology of onychomycosis","volume":"32","author":"Scher","year":"2013","journal-title":"Semin. Cutan. Med. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1007\/s11046-017-0222-9","article-title":"A Review of Onychomycosis Due to Aspergillus Species","volume":"83","author":"Bongomin","year":"2018","journal-title":"Mycopathologia"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1111\/j.1468-3083.2005.01281.x","article-title":"Epidemiology and clinical classification of onychomycosis","volume":"19","author":"Effendy","year":"2005","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10354-012-0139-3","article-title":"Onychomycosis: Modern diagnostic and treatment approaches","volume":"163","author":"Tchernev","year":"2013","journal-title":"Wiene Medizinische Wochenschrift"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1177\/1203475416653734","article-title":"Improving Cure Rates in Onychomycosis","volume":"6","author":"Gupta","year":"2016","journal-title":"J. Cutan. Med. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1046\/j.1365-2133.2003.05180.x","article-title":"Observer agreement in recording the clinical signs of nail disease and the accuracy of a clinical diagnosis of fungal and non-fungal nail disease","volume":"148","author":"Fletcher","year":"2003","journal-title":"Br. J. Dermatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1111\/j.1365-2133.2010.09930.x","article-title":"Clinical diagnosis of toenail onychomycosis is possible in some patients: Cross-sectional diagnostic study and development of a diagnostic rule","volume":"163","author":"Cabo","year":"2010","journal-title":"Br. J. Dermatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.12788\/j.sder.0015","article-title":"Diagnosis, clinical implications, and complications of onychomycosis","volume":"32","author":"Rich","year":"2013","journal-title":"Semin. Cutan. Med. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/j.pop.2015.08.005","article-title":"Nail Deformities and Injuries","volume":"42","author":"Tucker","year":"2015","journal-title":"Prim. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"293","DOI":"10.2165\/00002512-200724040-00003","article-title":"Onychomycosis in the elderly: Drug treatment options","volume":"24","author":"Loo","year":"2007","journal-title":"Drugs Aging"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2115","DOI":"10.1128\/JCM.39.6.2115-2121.2001","article-title":"Utility of inoculum counting (Walshe and English criteria) in clinical diagnosis of onychomycosis caused by nondermatophytic filamentous fungi","volume":"39","author":"Gupta","year":"2001","journal-title":"J. Clin. Microbiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.mycmed.2014.10.008","article-title":"Molecular diagnosis of onychomycosis","volume":"24","author":"Petinataud","year":"2014","journal-title":"J. Mycol. Med."},{"key":"ref_15","first-page":"250","article-title":"The Prevalence of Fungi in Fingernail Onychomycosis","volume":"7","author":"Gelotar","year":"2013","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"233","DOI":"10.7547\/0003-0538-104.3.233","article-title":"Using a Polymerase Chain Reaction as a Complementary Test to Improve the Detection of Dermatophyte Fungus in Nails","volume":"104","year":"2014","journal-title":"J. Am. Pod. Med. Assoc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1128\/JCM.02072-06","article-title":"Five-hour diagnosis of dermatophyte nail infections with specific detection of Trichophyton rubrum","volume":"45","author":"Saunte","year":"2007","journal-title":"J. Clin. Microbiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2641","DOI":"10.1128\/JCM.00697-08","article-title":"Single-step PCR using (GACA)4 primer: Utility for rapid identification of dermatophyte species and strains","volume":"46","author":"Shehata","year":"2008","journal-title":"J. Clin. Microbiol."},{"key":"ref_19","first-page":"47","article-title":"Molecular techniques in mycology","volume":"26","author":"Cuesta","year":"2008","journal-title":"Enferm. Infecc. Microbiol. Clin."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3226","DOI":"10.1128\/JCM.38.9.3226-3230.2000","article-title":"Prevalence and risk factors of tinea unguium and tinea pedis in the general population in Spain","volume":"38","author":"Perea","year":"2000","journal-title":"J. Clin. Microbiol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Arag\u00f3n-S\u00e1nchez, J., L\u00f3pez-Valverde, M.E., V\u00edquez-Molina, G., Milagro-Beamonte, A., and Torres-Sopena, L. (2021). Onychomycosis and Tinea Pedis in the Feet of Patients with Diabetes. Int. J. Low Extrem. Wounds.","DOI":"10.1177\/15347346211009409"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1111\/j.1365-2672.2012.05384.x","article-title":"PCR inhibitors-occurrence, properties and removal","volume":"113","author":"Schrader","year":"2012","journal-title":"J. Appl. Microbiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"941","DOI":"10.2144\/000113244","article-title":"A quantitative approach to detect and overcome PCR inhibition in ancient DNA extracts","volume":"47","author":"Debruyne","year":"2009","journal-title":"BioTechniques"}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/7\/8\/623\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:38:18Z","timestamp":1760164698000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/7\/8\/623"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,31]]},"references-count":23,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["jof7080623"],"URL":"https:\/\/doi.org\/10.3390\/jof7080623","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,31]]}}}