Granuloma inguinale and HIV: a unique presentation and novel treatment regimen.

phytosis complex." 2,3 A bacterial and fungal culture may thus be necessary to identify all nail and foot pathogens. A clue that a patient has a significant bacterial infection is green discoloration of the nail, as in our patient. Unfortunately, because of the faster growth rate of bacteria, isolation of fungi is often not possible. The inability to isolate a fungus because of bacterial overgrowth may also suggest a clinically significant bacterial infection. Because about half of toenail fungal cultures fail to isolate a mycotic pathogen, an associated bacterial infection in onychomycosis should be considered in such cases. 4 REFERENCES 1. Summerbell RC, Kane J, Krajden S. Onychomycosis, tinea pedis and tinea manuum caused by non-dermatophytic filamentous fungi. Mycoses 1989;32:609-19. 2. Leyden JJ, Kligman AM. Interdigital athlete's foot: the interaction of dermatophytes and resident bacteria. Arch Dermatol 1978;114:1466-72. 3. Leyden JJ. Progression of interdigital infections from simplex to complex. J Am Acad Dermatol 1993;28(Suppl):S7-11. 4. Kemna ME, Elewski BE. A U.S. epidemiologic survey of superficial fungal diseases. J Am Acad Dermatol 1996;35:539-42.