0521779407-16 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18
Occupational Pulmonary Disease Onychomycosis – Tinea Unguium 1083
➣generally progressive
➣poor prognostic factors
long duration of exposure/symptoms
high severity of exposure
short latency to symptoms
high degree of impairment
greater severity of radiographic findings
➣cigarette smoking+asbestos exposure increases risk of bron-
chogenic carcinoma multiplicatively
➣TB more common with silicosis and worsens prognosis
■Hypersensitivity pneumonitis:
➣variable; can resolve
➣poor prognostic factors
long duration of exposure/symptoms
high severity of exposure
high degree of impairment (low FVC, TLC, DLCO)
fibrotic changes on imaging
ONYCHOMYCOSIS – TINEA UNGUIUM
BONI E. ELEWSKI, MD and JEFFREY P. CALLEN, MD
history & physical
History
■Toenail – Tinea pedis, athletic activities
■Fingernail – Tinea manuum
Signs & Symptoms
■Thick, dystrophic toenail or fingernail
■Toenails more common than fingernails
■May be painful in 40–50% of patients
tests
Laboratory
■KOH tests – hyphae in subungual debris
■Fungal culture – growth of dermatophyte – about 60% are culture
positive
■Trichophyton rubrummost common pathogen
■Nail biopsy/clippings
■PAS stain may reveal fungal hyphae
■No Blood tests