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Infektionen an Finger- und Zehennägeln durch Pilze und Bakterien

Infections of finger and toe nails due to fungi and bacteria

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Zusammenfassung

Infektionen der Finger- und Zehennägel werden am häufigsten durch Pilze verursacht, an erster Stelle durch Dermatophyten. Erreger der Tinea unguium sind in der Regel anthropophile Dermatophyten. Trichophyton rubrum ist in Deutschland und weltweit bei der Onychomykose nach wie vor der wichtigste Erreger. Hefepilze werden jedoch viel häufiger als vermutet bei Nagelpilzinfektionen – sowohl der Paronychie als auch einer Onychomykose – isoliert. Es handelt sich entweder um eine saprophytäre Besiedlung der Nägel oder – gar nicht selten – auch um eine akute oder chronische Infektion des Nagelapparates. Wichtigste Erreger sind Candida parapsilosis und Candida guilliermondii, erst auf dem dritten Rang folgt Candida albicans. Onychomykosen durch Schimmelpilze oder sog. „non-dermatophyte molds“ (NDM) werden zunehmend nachgewiesen. Es handelt sich dabei teilweise um als sog. „emerging pathogen“ angesehene Erreger, an erster Stelle Fusarium-Arten, aber auch um seltene Schimmelpilze wie Onychocola canadensis. Bakterielle Infektionen der Nägel werden durch Gram-negative Bakterien, an erster Stelle Pseudomonas aeruginosa (erkennbar an der grünlich schwarzen Verfärbung der Nägel), aber auch durch Klebsiella spp. und durch Gram-positive Bakterien, z. B. Staphylococcus aureus, verursacht. Die Behandlung der Onychomykose erfolgt mit lokalen Antimykotika (Amorolfin, Ciclopirox), bei Befall von mehr als 50 % der Nagelplatte bzw. bei Befall von mehr als 3 von 10 Nägeln systemisch mit Terbinafin (bei Dermatophyteninfektionen), Fluconazol (bei Hefepilzinfektionen) oder alternativ mit Itraconazol. Bei bakteriellen Infektionen kommen antiseptische (Octenidin), im Einzelfall auch antibiotische (Nadifloxacin, Gentamicin) Wirkstoffe zur Anwendung. Systemisch wird bei Pseudomonas-Infektionen des Nagelapparates mit Ciprofloxacin oder bei anderen Erregern entsprechend Antibiogramm zielgerichtet mit Antibiotika behandelt.

Abstract

Infections of the finger and the toe nails are most frequently caused by fungi, primarily dermatophytes. Causative agents of tinea unguium are mostly anthropophilic dermatophytes. Both in Germany, and worldwide, Trichophyton rubrum represents the main important causative agent of onychomycoses. Yeasts are isolated from fungal nail infections, both paronychia and onychomycosis far more often than generally expected. This can represent either saprophytic colonization as well as acute or chronic infection of the nail organ. The main yeasts causing nail infections are Candida parapsilosis, and Candida guilliermondii; Candida albicans is only in third place. Onychomycosis due to molds, or so called non-dermatophyte molds (NDM), are being increasingly detected. Molds as cause of an onychomycosis are considered as emerging pathogens. Fusarium species are the most common cause of NDM onychomycosis; however, rare molds like Onychocola canadensis may be found. Bacterial infections of the nails are caused by gram negative bacteria, usually Pseudomonas aeruginosa (recognizable because of green or black coloration of the nails) but also Klebsiella spp. and gram positive bacteria like Staphylococcus aureus. Treatment of onychomycosis includes application of topical antifungal agents (amorolfine, ciclopirox). If more than 50 % of the nail plate is affected or if more than three out of ten nails are affected by the fungal infection, oral treatment using terbinafine (in case of dermatophyte infection), fluconazole (for yeast infections), or alternatively itraconazole are recommended. Bacterial infections are treated topically with antiseptic agents (octenidine), and in some cases with topical antibiotics (nadifloxacin, gentamicin). Pseudomonas infections of the nail organ are treated by ciprofloxacin; other bacteria are treated according to the results of culture and sensitivity testing.

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Danksagung

Die exzellenten makroskopischen Fotografien der Pilzkulturen verdanken wir dem Leipziger Fotografen Uwe Schoßig.

Einhaltung ethischer Richtlinien

Interessenkonflikt. P. Nenoff, U. Paasch und W. Handrick geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Haut- und Laborarzt/Allergologie, Andrologie, Labor für medizinische Mikrobiologie, Straße des Friedens 8, 04579, Mölbis, Deutschland

    P. Nenoff

  2. Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR, Medizinische Fakultät der Universität Leipzig, Leipzig, Deutschland

    U. Paasch

  3. Institut für Medizinische Diagnostik Oderland, Frankfurt (Oder), Deutschland

    W. Handrick

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Nenoff, P., Paasch, U. & Handrick, W. Infektionen an Finger- und Zehennägeln durch Pilze und Bakterien. Hautarzt 65, 337–348 (2014). https://doi.org/10.1007/s00105-013-2704-0

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