100 An Introduction to Medical Mycology 



cocci (which are occasionally present) and perhaps some of the ordinary 

 saprophytes of the skin may cause the condition. This is purely speculative. 

 We have reported 23 cases of multiple fungous infections with 12 different 

 combinations of pathogenic fungi. Although some difficulty was encountered 

 in deciding the role of the pathogenic species isolated from diseased tissue, 

 in nine cases it was decided that the fungi present were in symbiosis. Mul- 

 tiple fungous disease is probably not uncommon. In the majority of cases 

 infection of the nail is also caused by T. gypseum or T. purpureum. 

 Achorion schoenleini and several other fungi are occasionally found. Cases 

 of infection due to M. albicans are discussed in the section on moniliasis 

 ( pp. 145 ff . ) . While the toenails are usually infected secondarily to an 

 interdigital infection of the feet, the fingernails may or may not be in- 

 volved after infection in another site. In some instances the evidence 

 points to a primary infection of the fingernails due to poor hygiene during 

 a manicure. In many instances the method of infection is unknown. Hodges 

 estimated that in the Southern states the prevalence of tinea unguium is 

 1 to 500 of the population. Incidence is at least as great in New York. 



The disorder is rarely seen in children. The most vulnerable age period 

 seems to be from the sixteenth to the twenty-fifth year. Primarv infections 

 usually appear during these most active years. The manifestations of the 

 disease in later years, while common, may usually be placed in the category 

 of flare-up, or exacerbation. 



The disorder is seen much more in males than in females. This may 

 be due in part to more particular hygiene on the part of women or to 

 the greater chance of contamination of men due to their greater interest 

 in athletics and to their congregating in camps, clubs and gymnasiums, 

 with the common use of locker rooms, shower baths and other facilities. 

 There must be still another reason why many wives who were exposed 

 prior to the knowledge of the contagiousness of the condition failed to 

 become infected. It seems that men are more vulnerable. There was 

 an apparent increase in the incidence of disabling dermatophytosis among 

 the members of the armed forces in World War II over incidence in the same 

 age group in civilian life. This is not unexpected, despite improved meth- 

 ods of therapy, for the troops walk in bare feet over floors bound to be 

 infected, there is common use of bathrooms, hygiene is poor during combat 

 service and trauma and sweating after long marches are conducive. 



The disease is more prevalent in the summer. We observe fewer cases 

 in New York in the winter than in the summer, and the character of the 

 disease varies considerably with the season. In summer, exceedingly 

 acute involvement occurs more often, and there is generally more in- 

 flammation. 



