Internal Medicine

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