title: Onychomycosis associated with Onychocola canadensis: ten case reports and a review of the literature.
abstract: BACKGROUND
  Onychocola canadensis is a nondermatophyte mold associated with onychomycosis particularly in temperate climates (eg, Canada, New Zealand, and France). The slow growth rate of O canadensis and lack of resemblance to any other known nail-infecting fungus may have delayed its discovery. We are aware of 23 mycologically confirmed cases of O canadensis in the literature.
  
  
  OBJECTIVE
  We describe 10 previously unreported Canadian patients, specimens from whom grew O canadensis. We also review the literature on infections associated with this organism.
  
  
  METHODS
  Cases of O canadensis onychomycosis were diagnosed on the basis of (1) the finding of compatible filaments on direct microscopy of nail and (2) consistent culture from repeated specimens. All patients from whom O canadensis was isolated were followed up, but those in whom outgrowth was not consistent were not accepted as having "authentic" infections.
  
  
  RESULTS
  In 10 patients O canadensis was found to be associated with distal lateral subungual onychomycosis (6 patients), white superficial onychomycosis (1 patient), and as an insignificant contaminant in the nails of 3 patients. Less commonly the organism may cause tinea manuum or tinea pedis interdigitalis. O canadensis appears to be more frequent in the elderly, especially females. It is not unusual for a patient with onychomycosis caused by O canadensis to be a gardener or farmer, suggesting that the infectious inoculum may originate from the soil. The optimal therapy for onychomycosis caused by this organism remains unclear.
  
  
  CONCLUSIONS
  O canadensis may be the etiologic agent of distal and lateral subungual or white superficial onychomycosis; however, it may sometimes be present in an abnormal-appearing nail as an insignificant finding, not acting as a pathogen.
authors.affiliation: Department of Medicine, Sunnybrook Health Science Center and the University of Toronto, Ontario, Canada. agupta@execulink.com
authors.forename: A K
authors.initials: AK
authors.lastname: Gupta
authors.forename: C B
authors.initials: CB
authors.lastname: Horgan-Bell
authors.forename: R C
authors.initials: RC
authors.lastname: Summerbell
mesh_terms: D000368:Aged; D005260:Female; D005533:Foot Dermatoses / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D014009:Onychomycosis / Q000453:epidemiology / Q000382:microbiology*