Cycloheximide-resistant Aspergillus candidus onychomycosis: an unusual case
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Introduction: Onychomycosis is a chronic, superficial fungal infection that affects the nails and is most frequently caused by dermatophytes. Onychomycosis due to Aspergillus spp. (A.) is rare. A. flavus, A. niger, and A. fumigatus are the most implicated of these non-dermatophyte molds. A. candidus is a very unusual opportunistic pathogen of the nails. Only a few cases have been previously published internationally, but neither was cycloheximide-resistant. Case presentation: Here we report the first case of onychomycosis caused by cycloheximide-resistant A. candidus in a 63-year-old diabetic man. The diagnosis was made on the basis of a positive direct examination and pure cultures growing on Sabouraud's agar with chloramphenicol and cycloheximide on all inocula in three consecutive toenail samplings at one-week intervals. Conclusion: Such clinical cases are important to be presented by medical mycology teams in order to maintain vigilance regarding the epidemiological trends, which evolve constantly.
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The reviewers have highlighted major concerns with the work presented. Please ensure that you address their comments. Having received reviewer comments, it is clear the work requires additional experimental work. There are some concerns that have been raised, some are fairly minor, and in addition to the reviewers comments I would like to emphasize these two issues: - No molecular tools have been used to speciate. This is a routine technique (PCR) which should confirm or reveal what species it definitely is. - The claim for 'resistance' to CHX is not substantiated well. Different suppliers of turnkey media and different papers use different levels of CHX - this should at least be quoted. Please quote the level of drug to make any sense of the claim 'resistance'. However, what you actually say in the paper is that the isolate grows …
The reviewers have highlighted major concerns with the work presented. Please ensure that you address their comments. Having received reviewer comments, it is clear the work requires additional experimental work. There are some concerns that have been raised, some are fairly minor, and in addition to the reviewers comments I would like to emphasize these two issues: - No molecular tools have been used to speciate. This is a routine technique (PCR) which should confirm or reveal what species it definitely is. - The claim for 'resistance' to CHX is not substantiated well. Different suppliers of turnkey media and different papers use different levels of CHX - this should at least be quoted. Please quote the level of drug to make any sense of the claim 'resistance'. However, what you actually say in the paper is that the isolate grows more slowly with CHX present - Further experimental work is necessary for this and to carry out MIC testing on the isolate
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Comments to Author
This manuscript by Nachate et al, Manuscript ID; ACMI-D-23-00082, entitled "Cycloheximide-resistant Aspergillus candidus onychomycosis: an unusual case" presents a case of Cycloheximide-resistant Aspergillus candidus onychomycosis. The addressed subject is interesting and within the journal's scope, but this manuscript contains some major points. The work is interesting and brings a case of cycloheximide-resistant Aspergillus candidus onychomycosis. However, the study needs the contribution of more current references and the methodology used to identify fungi is very fragile. Currently, we know that reliable identification at the species level requires the input of molecular techniques and the authors used only morphological analysis to do so, which generates a great bias in the identification, …
Comments to Author
This manuscript by Nachate et al, Manuscript ID; ACMI-D-23-00082, entitled "Cycloheximide-resistant Aspergillus candidus onychomycosis: an unusual case" presents a case of Cycloheximide-resistant Aspergillus candidus onychomycosis. The addressed subject is interesting and within the journal's scope, but this manuscript contains some major points. The work is interesting and brings a case of cycloheximide-resistant Aspergillus candidus onychomycosis. However, the study needs the contribution of more current references and the methodology used to identify fungi is very fragile. Currently, we know that reliable identification at the species level requires the input of molecular techniques and the authors used only morphological analysis to do so, which generates a great bias in the identification, interpretation and discussion of the results. It is recommended to add these items to improve the manuscript. * All the manuscript has been italicized, please correct them. * Genus and species names must be in italics. * These species must be confirm by molecular methods such as PCR for beta tubulin, and Then sequencing for confirming this species. * Did you deposit the sequence in GenBank? please add the obtained accession number to the manuscript. * It is recommended to add a review of the literature about Aspergillus candidus onychomycosis. * Line 105: Please correct "{16]" to "[16]".
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
-
Comments to Author
Dear authors: The manuscript has been read in details and here are my comments: - Please make the introduction and discussion sections briefer and eliminate frequently brought up topics like the microscopic and macroscopic properties of the fungus. - Follow journal referencing guidelines (correct it in line 105 {16]). - lines 81, 148 and 256: Specify the right time of incubation for observing the fungus' mature colonies on SCC medium. (5 or10 days ?) - Line 160: I suggest using the term "uncommon" rather than "emerging" because Aspergillus candidus onychomycosis has been previously recorded.
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do …
Comments to Author
Dear authors: The manuscript has been read in details and here are my comments: - Please make the introduction and discussion sections briefer and eliminate frequently brought up topics like the microscopic and macroscopic properties of the fungus. - Follow journal referencing guidelines (correct it in line 105 {16]). - lines 81, 148 and 256: Specify the right time of incubation for observing the fungus' mature colonies on SCC medium. (5 or10 days ?) - Line 160: I suggest using the term "uncommon" rather than "emerging" because Aspergillus candidus onychomycosis has been previously recorded.
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
-
Comments to Author
This is an interesting case study. The presentation was succinct and informative. The importance of sharing case studies like this for epidemiological surveillance cannot be over stated. Especially for medical mycologists specializing in characterizing immune responses to pathogens, particularly molds with strong antifungal resistance that is often seen in Aspergilli. As more opportunistic pathogens emerge, it becomes increasingly important to report key findings like those presented in this case study. Additionally, the treatment choice and outcome discussed here is critical information to take away from this case study, considering how difficult it can be to treat antifungal resistant mold infections.
Please rate the quality of the presentation and structure of the manuscript
Very…
Comments to Author
This is an interesting case study. The presentation was succinct and informative. The importance of sharing case studies like this for epidemiological surveillance cannot be over stated. Especially for medical mycologists specializing in characterizing immune responses to pathogens, particularly molds with strong antifungal resistance that is often seen in Aspergilli. As more opportunistic pathogens emerge, it becomes increasingly important to report key findings like those presented in this case study. Additionally, the treatment choice and outcome discussed here is critical information to take away from this case study, considering how difficult it can be to treat antifungal resistant mold infections.
Please rate the quality of the presentation and structure of the manuscript
Very good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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