Epidemiological and clinical features of onychomycosis caused by Fusarium spp. in a reference center from Bogotá, Colombia, 2001-2010
DOI:
https://doi.org/10.29176/2590843X.264Keywords:
Onychomycosis, molds, Fusarium, epidemiologyAbstract
Introduction:Fusarium spp. is one of the etiological agents of onychomycosis by non dermatophytic molds most frequently isolated worldwide. However, the available information on the subject is limited and sometimes contradictory, probably due to the small number of reported cases. The aim of the study was to describe the epidemiological and clinical features of a group of patients with confirmed onychomycosis due to Fusarium spp. in a referral center from Bogotá, Colombia.
Methods: A cross-sectional descriptive study type was conducted on patients with confirmed diagnosis of onychomycosis by Fusarium spp. who consulted between January 1st, 2001, and December 31st, 2010, to describe its epidemiological and clinical features.
Results: We confirmed 95 cases of onychomycosis by Fusarium spp. in 72 women (76 %) and 23 men (24 %), with an average age of 40 years. Eight (8.4 %) had vascular insufficiency, six (6.3 %) hypothyroidism, and two (2.1 %) diabetes. The most frequent clinical presentations were distal and lateral subungual onychomycosis in 71 patients (74.7 %) and total dystrophic onychomycosis in 10 patients (10.5 %). One case of mixed infection with Neoscytalidium dimidiatum was observed.
Conclusion: The most common clinical presentation of onychomycosis by Fusarium spp. is the distal and lateral subungual, with leukonychia or yellow decoloration, which may be indistinguishable from onychomycosis caused by dermatophyte or other molds. No relationship was found with risk factors that may predispose to infection.
Author Biographies
Camilo Andrés Morales
Médico dermatólogo, Oficina de Docencia e Investigación, Centro Dermatológico Federico Lleras Acosta, E.S.E., Bogotá, D.C., Colombia; instructor, Facultad de Medicina, Universidad CES, Medellín, Colombia
Andrea Solórzano
Médica, residente de tercer año de Dermatología, Facultad de Medicina, Universidad CES, Medellín, Colombia; Centro Dermatológico Federico Lleras Acosta, E.S.E., Bogotá, D.C., Colombia
Aída Paola Rojas
Médica epidemióloga, Oficina de Docencia e Investigación, Centro Dermatológico Federico Lleras Acosta, E.S.E., Bogotá, D.C., Colombia; instructora, Facultad de Medicina, Universidad CES, Medellín, Colombia
References
1. Baran R, Tosti A, Piraccini B. Uncommon clinical patterns of Fusarium nail infection: Report of three cases. Br J Dermatol. 1997;136:424-7.
2. Hay RJ. Fusarium infections of the skin. Curr Opin Infect Dis. 2007;20:115-7.
3. Moreno G, Arenas R. Other fungi causing onychomycosis. Clin Dermatol. 2010;28:160-3.
4. Ellis DH, Watson A, Marley J, Williams T. Non-dermatophytes in onychomycosis of the toenails. Br J Dermatol. 1997;136:490-3.
5. English MP. Nails and fungi. Br J Dermatol. 1976;94:697-701.
6. van der Straten MR, Balkis MM, Ghannoum MA. The role of nondermatophyte molds in onychomycosis: Diagnosis and treatment. Dermatol Ther. 2002;15:89-98.
7. Zuluaga A, Tabares A, Arango M, Robledo M, Restrepo A, Lotero M. Importancia creciente de los géneros Fusarium y Scytalidium como agentes de onicomicosis. Rev Asoc Colom Dermatol. 2001;9:593-9.
8. Schechtman RC. Nondermatophytic filamentous fungi infection in South America -Reality or misdiagnosis? Dermatol Clin. 2008;26:271-83.
9. García-Martos P, Domínguez I, Marín P, Linares M, Mir J, Calap J. Onicomicosis por hongos filamentosos no dermatofitos en Cadiz. Enferm Infecc Microbiol Clin. 2000;18:319-24.
10. Gentles J, Evans E. Infection of the feet and nails with Hendersonula toruloidea. Med Mycol. 1970;8:72-5.
11. Campbell C, Mulder J. Skin and nail infection by Scytalidium hyalinum sp. nov. Med Mycol. 1977;15:161-6.
12. Restrepo A, Arango M, Vélez H, Uribe L. The isolation of Botryodiplodia theobromae from a nail lesion. Med Mycol. 1976;14:1-4.
13. López-Jodra O, Torres-Rodríguez JM. Especies fúngicas poco comunes responsables de onicomicosis. Rev Iberoam Micol. 1999;16:11-5.
14. Gugnani HC. Nondermatophytic filamentous keratinophilic fungi and their role in human infection. Rev Iberoam Micol. 2000;17:109-14.
15. Guilhermetti E, Takahachi G, Shinobu CS, Svidzinski TI. Fusarium spp. as agents of onychomycosis in immunocompetent hosts. Int J Dermatol. 2007;46:822-6.
16. Hattori N, Shirai A, Sugiura Y, Li W, Yokoyama K, Misawa Y, et al. Onychomycosis caused by Fusarium proliferatum. Br J Dermatol. 2005;153:647-9.
17. Weitzman I. Saprophytic molds as agents of cutaneous and subcutaneous infection in the immunocompromised host. Arch Dermatol. 1986;122:1161-8.
18. Gianni C, Cerri A, Crosti C. Non-dermatophytic onychomycosis. An understimated entity? A study of 51 cases. Mycoses. 2000;43:29-33.
19. Garcés EG, Orozco MO, Bautista GR, Valencia H. Fusarium oxysporum el hongo que nos falta conocer. Acta Biol Colomb. 2001;6:7-25.
20. Castro-López N, Casas C, Sopó L, Rojas A, Del Portillo P, Cepero MC, et al. Fusarium species detected in onychomycosis in Colombia. Mycoses. 2009;52:350-6.
21. Avendaño C, Arbeláez G, Rondón G. Control biológico del marchitamiento vascular causado por Fusarium oxysporum f. sp. phaseoli en fríjol Phaseolus vulgaris L., mediante la acción combinada de Entrophospora colombiana, Trichoderma sp. y Pseudomonas fluorescens. Agron Colomb. 2006;24:62-7.
22. Pérez E, Posada F, González M. Patogenicidad de un aislamiento de Fusarium sp. encontrado infectando la broca del café Hypothenemus hampei. Rev Colom Entomol. 1996;22:105-11.
23. Gómez-Franco J, Navarro-Restrepo B, Restrepo-Botero S, SalazarParra D. Factores de riesgo en adquisición y/o transmisión de onicomicosis por Trichophyton Rubrum, Fusarium spp. y Scytalidium dimidiatum. CIB Medellín 1993-1995. CES Med. 1996;10:17-24.
24. Negroni R, Arechavala A, Bohnvel P. Hongos miceliales no dermatofitos en onicodistrofias. Experiencia de un centro médico privado en Buenos Aires. Dermatol Argent. 2008;14:118-23.
25. Oyeka C, Gugnani H. Keratin degradation by Scytalidium species and Fusarium solani. Mycoses. 1998;41:73-6.
26. Vélez H. Onicomicosis por hongos saprofitos: informe de 49 casos. Iatreia. 1988;1:91-7.
27. Escobar ML, Carmona-Fonseca J. Onicomicosis por hongos ambientales no dermatofíticos. Rev Iberoam Micol. 2003;20:6-10.
28. Zuluaga A, de Bedout C, Tabares A, Cano LE, Restrepo A, Arango M, et al. Comportamiento de los agentes etiológicos de las onicomicosis en un laboratorio de micologia de referencia (Medellín 1994-2003). Med Cutan Iber Lat Am. 2005;33:251-6.
29. Mendoza N, Palacios C, Cardona N, Gómez LM. Onicomicosis: afección común de difícil tratamiento. Rev Asoc Colom Dermatol. 2012;20:149-58.
30. Ranawaka RR, de Silva N, Ragunathan RW. Onychomycosis caused by Fusarium sp in Sri Lanka: Prevalence, clinical features and response to itraconazole pulse therapy in six cases. J Dermatol Treat. 2008;19:308-12.
31. Bonifaz A, Cruz-Aguilar P, Ponce RM. Onychomycosis by molds. Report of 78 cases. Eur J Dermatol. 2007;17:70-2.
32. Gupta AK, Baran R, Summerbell RC. Fusarium infections of the skin. Curr Opin Infect Dis. 2000;13:121.
33. Piraccini BM, Tosti A. White superficial onychomycosis: Epidemiological, clinical, and pathological study of 79 patients. Arch Dermatol. 2004;140:696-701.
34. Rush-Munro F, Black H, Dingley JM. Onychomycosis caused by Fusarium Oxysporum. Aust J Derm. 1971;12:18-29.
35. Salas-Campos I, Hernández-Chavarría F. Fusarium como agente etiológico de onicomicosis: informe de tres casos y revisión de la literatura. Rev Costarric Cienc Méd. 2005;26:53-9.
36. Zaias N. Superficial white onychomycosis. Med Mycol. 1966;5:99.
37. Ministerio de Salud de Colombia. Normas científicas, técnicas y administrativas para la investigación en salud. Resolución Nº 008430 de 1993. Fecha de consulta: 16 de mayo de 2011. Disponible en: http://www.urosario.edu.co/urosario_files/a2/a24fb07af561-4fcc-b611-affff4374bb7.pdf.
38. World Medical Association. Declaration of Helsinki: Ethical principles for medical research involving human subjects; 2008. Fecha de consulta: 16 de mayo de 2011. Disponible en: http://www.wma.net/en/30publications/10policies/b3.
39. Relloso S, Arechavala A, Guelfand L, Maldonado I, Walker L, Agorio I, et al. Onicomicosis: estudio clínico, epidemiológico y micológico multicéntrico. Revista Iberoam Micol. 2012;29:157-63.
40. Gupta A, Elewski B. Nondermatophyte causes of onychomycosis and superficial mycoses. Current Top Med Mycol. 1996;7:87-97.
41. Godoy P, Nunes F, Silva V, Tomimori-Yamashita J, Zaror L, Fischman O. Onychomycosis caused by Fusarium solani and Fusarium oxysporum in São Paulo, Brazil. Mycopathologia. 2004;157:287-90.
42. Hwang SM, Suh MK, Ha GY. Onychomycosis due to nondermatophytic molds. Ann Dermatol. 2012;24:175-80.
43. Romano C, Papini M, Ghilardi A, Gianni C. Onychomycosis in children: A survey of 46 cases. Mycoses. 2005;48:430-7.
44. Boutati EI, Anaissie EJ. Fusarium, a significant emerging pathogen in patients with hematologic malignancy: Ten years’ experience at a cancer center and implications for management. Blood. 1997;90:999-1008.
45. Hidalgo I, Garaguso GM, Galimberti G, Galimberti R, Kowalczuk A. Fusariosis diseminada en síndrome linfoproliferativo. Presentación de dos casos. Dermatol Argent. 2008;14:191-5.
46. Nucci M, Anaissie E. Cutaneous infection by Fusarium species in healthy and immunocompromised hosts: Implications for diagnosis and management. Clin Infect Dis. 2002;35:909-20.
47. Bader M, Jafri AK, Krueger T, Kumar V. Fusarium osteomyelitis of the foot in a patient with diabetes mellitus. Scan J infect Dis. 2003;35:895-7.
48. Tosti A, Piraccini BM, Lorenzi S. Onychomycosis caused by nondermatophytic molds: Clinical features and response to treatment of 59 cases. J Am Acad Dermatol. 2000;42:217-24.
49. Kacalak-Rzepka A, Maleszka R, Turek-Urasinska K, Kempinska A, Rałajczak-Stefanska V, Rozewicka M. Investigations concerning agents influencing the development of onychomycosis caused by Scopulariopsis brevicaulis. Mikol Lek. 2004;11:283-90.
50. Gupta AK, Jain HC, Lynde CW, Watteel GN, Summerbell RC. Prevalence and epidemiology of unsuspected onychomycosis in patients visiting dermatologists’ offices in Ontario, Canada: A multicenter survey of 2001 patients. Int J Dermatol. 1997;36:783-7.
51. Andre J, Achten G. Onychomycosis. Int J Dermatol. 1987;26:481-90.
52. Ramani R, Srinivas C, Ramani A, Kumari T, Shivananda P. Molds in onychomycosis. Int J Dermatol. 1993;32:877-8.
53. Ritchie EB, Pinkerton ME. Fusarium Oxysporum infection of thenail: Report of cases. AMA Arch Derm. 1959;79:705-8.
54. Asbati M, Bell Smythe A, Cavallera E. Onicomicosis por hongos no dematofitos: estudio retrospectivo en 4 años. Rev Soc Ven Microbiol. 2002;22:147-52.
55. Di Salvo A, Fickling A. A case of nondermatophytic toe onychomycosis caused by Fusarium oxysporum. Arch Dermatol. 1980;116:699-700.
56. Cavallera E, Asbati M. Onicomicosis por hongos filamentosos no dermatofitos. Dermatol Venez. 2006;44:4-10.
57. Torres-Rodríguez JM, Sellart-Altisent M. Celulitis y onicomicosis proximal de ambos ortejos mayores producida por Fusarium solani. Rev Iberoam Micol. 2006;23:241-4.
58. Álvarez MI, González LA, Castro LA. Onychomycosis in Cali, Colombia. Mycopathologia. 2004;158:181-6.
59. Pérez JE, Cárdenas C, Hoyos AM. Características clínicas, epidemiológicas y microbiológicas de la onicomicosis en un laboratorio de referencia, Manizales (Caldas), 2009. Infect. 2012;15:168-76.
2. Hay RJ. Fusarium infections of the skin. Curr Opin Infect Dis. 2007;20:115-7.
3. Moreno G, Arenas R. Other fungi causing onychomycosis. Clin Dermatol. 2010;28:160-3.
4. Ellis DH, Watson A, Marley J, Williams T. Non-dermatophytes in onychomycosis of the toenails. Br J Dermatol. 1997;136:490-3.
5. English MP. Nails and fungi. Br J Dermatol. 1976;94:697-701.
6. van der Straten MR, Balkis MM, Ghannoum MA. The role of nondermatophyte molds in onychomycosis: Diagnosis and treatment. Dermatol Ther. 2002;15:89-98.
7. Zuluaga A, Tabares A, Arango M, Robledo M, Restrepo A, Lotero M. Importancia creciente de los géneros Fusarium y Scytalidium como agentes de onicomicosis. Rev Asoc Colom Dermatol. 2001;9:593-9.
8. Schechtman RC. Nondermatophytic filamentous fungi infection in South America -Reality or misdiagnosis? Dermatol Clin. 2008;26:271-83.
9. García-Martos P, Domínguez I, Marín P, Linares M, Mir J, Calap J. Onicomicosis por hongos filamentosos no dermatofitos en Cadiz. Enferm Infecc Microbiol Clin. 2000;18:319-24.
10. Gentles J, Evans E. Infection of the feet and nails with Hendersonula toruloidea. Med Mycol. 1970;8:72-5.
11. Campbell C, Mulder J. Skin and nail infection by Scytalidium hyalinum sp. nov. Med Mycol. 1977;15:161-6.
12. Restrepo A, Arango M, Vélez H, Uribe L. The isolation of Botryodiplodia theobromae from a nail lesion. Med Mycol. 1976;14:1-4.
13. López-Jodra O, Torres-Rodríguez JM. Especies fúngicas poco comunes responsables de onicomicosis. Rev Iberoam Micol. 1999;16:11-5.
14. Gugnani HC. Nondermatophytic filamentous keratinophilic fungi and their role in human infection. Rev Iberoam Micol. 2000;17:109-14.
15. Guilhermetti E, Takahachi G, Shinobu CS, Svidzinski TI. Fusarium spp. as agents of onychomycosis in immunocompetent hosts. Int J Dermatol. 2007;46:822-6.
16. Hattori N, Shirai A, Sugiura Y, Li W, Yokoyama K, Misawa Y, et al. Onychomycosis caused by Fusarium proliferatum. Br J Dermatol. 2005;153:647-9.
17. Weitzman I. Saprophytic molds as agents of cutaneous and subcutaneous infection in the immunocompromised host. Arch Dermatol. 1986;122:1161-8.
18. Gianni C, Cerri A, Crosti C. Non-dermatophytic onychomycosis. An understimated entity? A study of 51 cases. Mycoses. 2000;43:29-33.
19. Garcés EG, Orozco MO, Bautista GR, Valencia H. Fusarium oxysporum el hongo que nos falta conocer. Acta Biol Colomb. 2001;6:7-25.
20. Castro-López N, Casas C, Sopó L, Rojas A, Del Portillo P, Cepero MC, et al. Fusarium species detected in onychomycosis in Colombia. Mycoses. 2009;52:350-6.
21. Avendaño C, Arbeláez G, Rondón G. Control biológico del marchitamiento vascular causado por Fusarium oxysporum f. sp. phaseoli en fríjol Phaseolus vulgaris L., mediante la acción combinada de Entrophospora colombiana, Trichoderma sp. y Pseudomonas fluorescens. Agron Colomb. 2006;24:62-7.
22. Pérez E, Posada F, González M. Patogenicidad de un aislamiento de Fusarium sp. encontrado infectando la broca del café Hypothenemus hampei. Rev Colom Entomol. 1996;22:105-11.
23. Gómez-Franco J, Navarro-Restrepo B, Restrepo-Botero S, SalazarParra D. Factores de riesgo en adquisición y/o transmisión de onicomicosis por Trichophyton Rubrum, Fusarium spp. y Scytalidium dimidiatum. CIB Medellín 1993-1995. CES Med. 1996;10:17-24.
24. Negroni R, Arechavala A, Bohnvel P. Hongos miceliales no dermatofitos en onicodistrofias. Experiencia de un centro médico privado en Buenos Aires. Dermatol Argent. 2008;14:118-23.
25. Oyeka C, Gugnani H. Keratin degradation by Scytalidium species and Fusarium solani. Mycoses. 1998;41:73-6.
26. Vélez H. Onicomicosis por hongos saprofitos: informe de 49 casos. Iatreia. 1988;1:91-7.
27. Escobar ML, Carmona-Fonseca J. Onicomicosis por hongos ambientales no dermatofíticos. Rev Iberoam Micol. 2003;20:6-10.
28. Zuluaga A, de Bedout C, Tabares A, Cano LE, Restrepo A, Arango M, et al. Comportamiento de los agentes etiológicos de las onicomicosis en un laboratorio de micologia de referencia (Medellín 1994-2003). Med Cutan Iber Lat Am. 2005;33:251-6.
29. Mendoza N, Palacios C, Cardona N, Gómez LM. Onicomicosis: afección común de difícil tratamiento. Rev Asoc Colom Dermatol. 2012;20:149-58.
30. Ranawaka RR, de Silva N, Ragunathan RW. Onychomycosis caused by Fusarium sp in Sri Lanka: Prevalence, clinical features and response to itraconazole pulse therapy in six cases. J Dermatol Treat. 2008;19:308-12.
31. Bonifaz A, Cruz-Aguilar P, Ponce RM. Onychomycosis by molds. Report of 78 cases. Eur J Dermatol. 2007;17:70-2.
32. Gupta AK, Baran R, Summerbell RC. Fusarium infections of the skin. Curr Opin Infect Dis. 2000;13:121.
33. Piraccini BM, Tosti A. White superficial onychomycosis: Epidemiological, clinical, and pathological study of 79 patients. Arch Dermatol. 2004;140:696-701.
34. Rush-Munro F, Black H, Dingley JM. Onychomycosis caused by Fusarium Oxysporum. Aust J Derm. 1971;12:18-29.
35. Salas-Campos I, Hernández-Chavarría F. Fusarium como agente etiológico de onicomicosis: informe de tres casos y revisión de la literatura. Rev Costarric Cienc Méd. 2005;26:53-9.
36. Zaias N. Superficial white onychomycosis. Med Mycol. 1966;5:99.
37. Ministerio de Salud de Colombia. Normas científicas, técnicas y administrativas para la investigación en salud. Resolución Nº 008430 de 1993. Fecha de consulta: 16 de mayo de 2011. Disponible en: http://www.urosario.edu.co/urosario_files/a2/a24fb07af561-4fcc-b611-affff4374bb7.pdf.
38. World Medical Association. Declaration of Helsinki: Ethical principles for medical research involving human subjects; 2008. Fecha de consulta: 16 de mayo de 2011. Disponible en: http://www.wma.net/en/30publications/10policies/b3.
39. Relloso S, Arechavala A, Guelfand L, Maldonado I, Walker L, Agorio I, et al. Onicomicosis: estudio clínico, epidemiológico y micológico multicéntrico. Revista Iberoam Micol. 2012;29:157-63.
40. Gupta A, Elewski B. Nondermatophyte causes of onychomycosis and superficial mycoses. Current Top Med Mycol. 1996;7:87-97.
41. Godoy P, Nunes F, Silva V, Tomimori-Yamashita J, Zaror L, Fischman O. Onychomycosis caused by Fusarium solani and Fusarium oxysporum in São Paulo, Brazil. Mycopathologia. 2004;157:287-90.
42. Hwang SM, Suh MK, Ha GY. Onychomycosis due to nondermatophytic molds. Ann Dermatol. 2012;24:175-80.
43. Romano C, Papini M, Ghilardi A, Gianni C. Onychomycosis in children: A survey of 46 cases. Mycoses. 2005;48:430-7.
44. Boutati EI, Anaissie EJ. Fusarium, a significant emerging pathogen in patients with hematologic malignancy: Ten years’ experience at a cancer center and implications for management. Blood. 1997;90:999-1008.
45. Hidalgo I, Garaguso GM, Galimberti G, Galimberti R, Kowalczuk A. Fusariosis diseminada en síndrome linfoproliferativo. Presentación de dos casos. Dermatol Argent. 2008;14:191-5.
46. Nucci M, Anaissie E. Cutaneous infection by Fusarium species in healthy and immunocompromised hosts: Implications for diagnosis and management. Clin Infect Dis. 2002;35:909-20.
47. Bader M, Jafri AK, Krueger T, Kumar V. Fusarium osteomyelitis of the foot in a patient with diabetes mellitus. Scan J infect Dis. 2003;35:895-7.
48. Tosti A, Piraccini BM, Lorenzi S. Onychomycosis caused by nondermatophytic molds: Clinical features and response to treatment of 59 cases. J Am Acad Dermatol. 2000;42:217-24.
49. Kacalak-Rzepka A, Maleszka R, Turek-Urasinska K, Kempinska A, Rałajczak-Stefanska V, Rozewicka M. Investigations concerning agents influencing the development of onychomycosis caused by Scopulariopsis brevicaulis. Mikol Lek. 2004;11:283-90.
50. Gupta AK, Jain HC, Lynde CW, Watteel GN, Summerbell RC. Prevalence and epidemiology of unsuspected onychomycosis in patients visiting dermatologists’ offices in Ontario, Canada: A multicenter survey of 2001 patients. Int J Dermatol. 1997;36:783-7.
51. Andre J, Achten G. Onychomycosis. Int J Dermatol. 1987;26:481-90.
52. Ramani R, Srinivas C, Ramani A, Kumari T, Shivananda P. Molds in onychomycosis. Int J Dermatol. 1993;32:877-8.
53. Ritchie EB, Pinkerton ME. Fusarium Oxysporum infection of thenail: Report of cases. AMA Arch Derm. 1959;79:705-8.
54. Asbati M, Bell Smythe A, Cavallera E. Onicomicosis por hongos no dematofitos: estudio retrospectivo en 4 años. Rev Soc Ven Microbiol. 2002;22:147-52.
55. Di Salvo A, Fickling A. A case of nondermatophytic toe onychomycosis caused by Fusarium oxysporum. Arch Dermatol. 1980;116:699-700.
56. Cavallera E, Asbati M. Onicomicosis por hongos filamentosos no dermatofitos. Dermatol Venez. 2006;44:4-10.
57. Torres-Rodríguez JM, Sellart-Altisent M. Celulitis y onicomicosis proximal de ambos ortejos mayores producida por Fusarium solani. Rev Iberoam Micol. 2006;23:241-4.
58. Álvarez MI, González LA, Castro LA. Onychomycosis in Cali, Colombia. Mycopathologia. 2004;158:181-6.
59. Pérez JE, Cárdenas C, Hoyos AM. Características clínicas, epidemiológicas y microbiológicas de la onicomicosis en un laboratorio de referencia, Manizales (Caldas), 2009. Infect. 2012;15:168-76.
How to Cite
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Morales CA, Solórzano A, Rojas AP. Epidemiological and clinical features of onychomycosis caused by Fusarium spp. in a reference center from Bogotá, Colombia, 2001-2010. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 2013 Jan. 1 [cited 2024 Jun. 30];21(1):21-8. Available from: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/264
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How to Cite
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Morales CA, Solórzano A, Rojas AP. Epidemiological and clinical features of onychomycosis caused by Fusarium spp. in a reference center from Bogotá, Colombia, 2001-2010. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 2013 Jan. 1 [cited 2024 Jun. 30];21(1):21-8. Available from: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/264
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