Human Hands and Fingernails

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Fingernails affected by onychomycosis


Description of Niche

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Physical Conditions?

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Influence by Adjacent Communities (if any)

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Conditions under which the environment changes

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Microbes Present

Microbe Genera Found Underneath the Fingernails
Bacteria Fungus Yeast
Pseudomonas Trichophyton Candida
Staphylococcus Epidermophyton Rhodotorula
Acinetobacter Acremonium
Enterobacter Aspergillus
Klebsiella Scopulariopsis
Aeromonas Cladosporium
Serratia
There are many species within these genera that can be located within the fingernails, such as Staphylococcus Epidermis and Aeureas or Candida Albicans, Parapsilosis, and Instaniae. These are a select few of the many microbes that can survive on human hands and nails.

Bacteria

Fingernails are increasingly becoming a major concern in many health related issues because of the capability to harbour many varieties of microorganisms. In healthcare related occupations fingernail etiquitte is becoming a strict practice as the bacteria in the nails of healthcare providers can exacerbate a patient's existing medical conditions. This issue is of even greater concern for individuals who have artifical nails. Artifical nails have a greater affinity of harbouring microorganisms than natural nails and have been identified as a major cause of transmitting infections to medical patients. In 1998, a research study was instigated to compare the bacteria found in the nails of various medical staff such as nurses, technicians, and other personel. The study showed that out of all the nails collected (ie. polished nails, natural nails, and artifical nails), artifical nails proved to harbour the most gram-negative rods before and after washing them. Artificial nails have since been scrutinized as having contributed to many hospital acquired infections. In particular, outbreaks of Pseudomonas Aruguinosa have been attributed to two nurses with long, artifical nails and have caused either serious infections or death multiple infants. Also, the Serratia Marcescens bacteria have been involved in the postoperative infections of several cardiac surgery patients.

Fungi and Yeasts

The hands and fingernails are often affected by fungal and yeast infections, such as those caused by species of Trichophyton and Candida. In particular onychomycosis (nail infection) is the most common disease associated with the hands and feet, effectuating at least 50% of all fingernail infections. Onychomycosis is caused by dermatophytes (infectious fungi or yeast) invading the nailbed, which are also causes ringworms and tinea such as athletes foot. Most cases of onychomycosis is characterized by mild inflamations, resuling in the nail bed becoming cornified and losing its normal contour. Another form of onychomycosis results in the destrcution of the nail plate and is often visible by a whitish yellow discoloration. Onychomycosis can also occur on the external nail plate, caused by an invasion of Acremonium and Aspergillus, which infect the superficial layers of the nail resulting in white patches on the nail. Onychomycosis is increasingly viewed as a major medical concern as these infections can lead to secondary infections as well as being transferred to other bodily areas and other people. Fungi and yeasts are also a major concern for individuals with artifical nails. Artifical nails weaken the natrual and can also cause the natural nail to lift from its base which can expose the fingers to bacteria and fungi that can grow between the nail and artifical nail. These condition substatially increase the risk of onychomycosis and other related diseases. Thus, as mentioned before short cut, natural nails are the best for fingernail health care.

Microbial Interactions

The main mechanism through which microbes interact with each other under the fingernails are through a biofilm. Biofilms are communites of surface attatching microbes that collaborate with each other to perform various tasks that contribute to the community. Often in nature biofilms consists of multiple species of microbes that require interspecies communication. Quorum Sensing is one such method of communicating between cells and species. Quorum sesing is a type of chemcial signal that is produced by a community of microbes promoting genetic regulation and cellular changes to bind to e surface and each other. In the fingernails, Candida Albicans and Staphylococcus Aureus co-exist in a mixed-biofilm and often cause simultaneous infections. Because they live together in a biofilm it makes it much more difficult to treat infections with antibiotics and antifungals. The resistance is most likely attributed to the biofilm as antibiotic/fungal resistance profiles are often changed in mixed infections. This also makes the microbes capable of persisting many of the conditions hands are exposed to, which is probably why most related infections continue even after washing hands with antimicrobial soap. For example, one experiment introduced a species of Candida into a mixed-species biofilm composed of both yeast and bacteria. The Candida were observed bridging to adjacent colonies and altering its community structure after an acid supression therapy. The altered biofilm proved to be able to persist in highly acidic environments, surviving in a pH less than three. This implies that biofilms are major mechanisms for protecting microbial communities and are of particular intrest for medical concerns as they are indicative of persitance of infections in the human body.

Current Research

‘Super’ bacteria live on sheets, fingernails: study [1]

On June 6, 2005, U.S. researchers reported that MRSA (methicillin-resistant Staphylococcus aureus ) is commonly found on computer keyboard covers and under fingernails which causes rashes and infections. MRSA has resistance to almost everything besides an antibiotic called vancomycin. Vancomycin binds the end of D-ala D-ala which blocks transpeptidation of bacteria to inhibit its growth. Although Staphylococcus aureus is usually harmless and found on skin, it can sometimes cause necrotizing fasciitis or “flesh-eating” disease in hospitals. A study at Northwestern Memorial Hospital in Chicago shows that computer keyboard can contaminate the fingers of a doctor or a nurse, and then further transfer the bacteria to patients thus causing deadly infections.

Onychomycosis due to artificial nails [2]

Although the use of artificial nails is a popular trend nowadays, several bacterial and fungal infections such as Onychomycosis have been found in patients who use artificial nails. Onychomycosis is a fungal infection of the nail which causes 50% of all nail diseases and affects 18% of the general population. Due to the use of artificial nails, Onychomycosis is found to be very common in nail changes. The researchers performed KOH examination and fungal culture to detect the fungal infection from the distal part of the nail and from the proximal nail fold. The results show that both KOH and culture were significantly better in the samples from the distal part of the nail compared to the samples from the proximal nail fold. The study demonstrates that the use of artificial nails can lead to increasing chance of transmitting bacteria. People should avoid using artificial nails especially for health care personnel and food industry workers.

Ultraviolet C inactivation of dermatophytes: implications for treatment of Onychomycosis [3]

In this study, researchers were trying to find an alternative treatment besides antifungals to treat Onychomycosis. The major purpose of the study is to test whether ultraviolet C is able to sterilize a novel ex vivo model of nail infection. Infected human toenail clippings were irradiated with ultraviolet C (254 mm) at a radiant exposure of 36-864 J cm(-2). The results show that ultraviolet C successfully inactivated Trichophyton rubrum and its resistance to ultraviolet C did not increase after five cycles of inactivation in vitro. The radiant exposure might vary depends on the thickness of the vivo culture. Ultraviolet C irradiation might become an alternative treatment for Onychomycosis in the future after researchers find a way to prevent mutations caused by ultraviolet irradiation.

Fast and sensitive detection of Trichophyton rubrum DNA from the nail samples of patients with Onychomycosis by a double-round polymerase chain reaction-based assay [4]

Trichophyton rubrum is one of the pathogens that can be isolated from patients who have Onychomycosis. Using traditional culture-based method to isolate Trichophyton rubrum is a time-consuming process and usually leads to false detection. The study shows it is possible to detect Trichophyton rubrum in fingernail samples using double-round polymerase chain reaction-based assay which is used for DNA detection. The isolated Trichophyton rubrum DNA was amplified using actin gene and internal transcribed spacer 1 in double-round polymerase chain reaction (PCR). The combined detections shows positive results in patients undergo fungal infections. The results suggest PCR is a fast, sensitive and accurate method for fungal detection.

Yale University Experiment [5]

Dr. David Katz of Yale University, the United States, did an experiment with his students to test out the bacteria grow under fingernail. They took swab from under fingernails from different students and let the bacteria to grow. Dr. Katz also took another swab after they wash their hands. After 3 days of growing time, they found out short painted nails have least of bacteria growth. On the other hand, long unpainted nails have most of growth. The reason is because of shorter fingernails are easier to clean. The nail polish is constituted of phthalates, toluene, and formaldehyde which are toxic thus minimizing bacterial growth. The technique of hand washing is also important for limiting bacteria under fingernail. Washing hand properly can kill most of the bacteria under fingernails.

References

1. 'Super' bacteria live on sheets, fingernails: study

2. Onychomycosis due to artificial nails. Shemer A, Trau H, Davidovici B, Grunwald MH, Amichai B. J Eur Acad Dermatol Venereol. 2008 Mar 18

3. Ultraviolet C inactivation of dermatophytes: implications for treatment of Onychomycosis. Dai T, Tegos GP, Rolz-Cruz G, Cumbie WE, Hamblin MR. Br J Dermatol. 2008 Jun;158(6):1239-46. Epub 2008 Apr 10.

4. Fast and sensitive detection of Trichophyton rubrum DNA from the nail samples of patients with Onychomycosis by a double-round polymerase chain reaction-based assay. Gupta AK, Zaman M, Singh J. Br J Dermatol. 2007 Oct;157(4):698-703. Epub 2007 Aug 21.

5. Yale Experiment



Edited by [Chao-Lin Chen], students of Rachel Larsen