Uncommon Fungi Isolated from Diabetic Patients Toenails With or Without Visible Onychomycoses Marisela Gonza ´lez-Avila • Juan Vicente Go ´mez-Go ´mez • Alejandra Paula Espinosa Texis • Jose ´ Luis Imbert-Palafox • Marco Antonio Becerril-Flores • Jose ´ Luis Blasco Received: 4 October 2010 / Accepted: 22 March 2011 Ó Springer Science+Business Media B.V. 2011 Abstract Kodamaea ohmeri and Prototheca wick- erhamii are rare pathogens for humans, and even more rare as cause of onychomycosis. This work reports the second case of onychomycosis by K. ohmeri and the fourth of onycoprotothecosis; it was made in public health institutions in the Hidalgo State, Mexico, studying 261 diabetic patients during 2005 and 2006. Kodamaea ohmeri was isolated from toenails of a 51-year-old female patient, and P. wickerhamii from three female patients of 48, 49, and 61 years old, respectively, all of them with type 2 diabetes mellitus (DM 2). Identifications were done by standard microbiological methods and a commercial system. Only one patient infected with P. wickerhamii showed mixed infection with dermatophytes. Out of the total studied DM 2 patients, 1.15% presented onycoproto- thecosis and 0.38% onychomycosis by K. ohmeri, high percentages if it is considered that few cases have been reported of K. ohmeri and P. wickerhamii as onycho- mycosis causal agents. Keywords Prototheca wickerhamii Á Kodamaea ohmeri Á Onychomycoses Á Diabetic patient Á Yeast-like Introduction Diabetic patients may present with complications involving all systems of the body [1]. Diabetic foot represents a major risk for foot amputation [2]; fungal nail infection can contribute to the severity of diabetic foot [3]. Fungal infection in toenails may be a major cause of morbility in feet of diabetic patients, and the presence of mycotic nail may result in infection to the adjacent nail or skin injury and provide a reservoir of pathogen fungi [4]. Causal agents responsible for onychomy- coses can be dermatophytes, yeasts, and molds; the agents most frequently isolated from toenails are der- matophytes in both diabetic and non-diabetic patients [1]. In contrast, Dogra et al. [5] reported yeasts were M. Gonza ´lez-Avila Á J. L. Blasco (&) Biotechnology Area, Universidad Polite ´cnica de Pachuca, Carretera Pachuca-Ciudad Sahagu ´n Km. 20, Ex Hacienda de Santa Ba ´rbara, Zempoala, Hidalgo 43830, Mexico e-mail: jlblascoc@yahoo.com.mx J. V. Go ´mez-Go ´mez Á J. L. Imbert-Palafox Á M. A. Becerril-Flores A ´ rea Acade ´mica de Medicina, Instituto de Ciencias de la Salud, Universidad Auto ´noma del Estado de Hidalgo, Carretera Actopan-Tilcuautla, Ex Hacienda de la Concepcio ´n s/n, Hidalgo 42160, Mexico A. P. Espinosa Texis Centro de Investigaciones Microbiolo ´gicas, Instituto de Ciencias, Beneme ´rita Universidad Auto ´noma de Puebla, Ciudad Universitaria, Puebla 72570, Mexico M. Gonza ´lez-Avila Centro de Investigacio ´n y Asistencia en Tecnologı ´a y Disen ˜o de Jalisco A. C., Av. Normalistas N°. 800, Colinas de la Normal, Guadalajara, Jalisco 44270, Mexico 123 Mycopathologia DOI 10.1007/s11046-011-9417-7