Clinical and mycological diagnostic aspects of onychomycoses and dermatomycoses

Clayton, Yvonne M.

doi:10.1111/j.1365-2230.1992.tb00276.x

Cited by 123 publications

(86 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Clayton et al, 17 analisaram em seu estudo 2.113 unhas, sendo que 11% das referentes a pés e 19% a mãos apresentaram resultados positivos ao EMD e negativos à cultura. Culturas falso-positivas podem também ocorrer secundárias à contaminação do meio de crescimento.…”

Section: Discussionunclassified

Avaliação dos métodos diagnósticos para onicomicose

Zanardi

Nunes

Pacheco

et al. 2008

An. Bras. Dermatol.

View full text Add to dashboard Cite

Resumo: FUNDAMENTOS -As onicomicoses são infecções fúngicas responsáveis por 15 a 40% das doenças ungueais. Apesar do pleno conhecimento de seus agentes etiológicos e do surgimento de inúmeros medicamentos antifúngicos, mantêm-se as dificuldades para se estabelecer diagnóstico correto. OBJETIVOS -Comparar o exame micológico direto, o histopatológico e a cultura dos pacientes com suspeita de onicomicose e verificar a sensibilidade e especificidade de cada método. MÉTODO -Foram selecionados 40 pacientes com suspeita clínica de onicomicose e avaliados os três métodos diagnósticos. Calculou-se para cada exame: sensibilidade, especificidade e valores preditivos, positivo e negativo. RESULTADOS -O exame micológico direto foi positivo em 29 pacientes (72,5%), o histopatológico em 14 (35%), a cultura em 22 (55%). As especificidades foram: exame micológico direto 78,6%, histopatológi-co 92,9% e cultura 100%. As especificidades não apresentaram diferença significativa (p > 0,05). Na análise dos valores preditivos positivo e negativo, a cultura e o exame micológico direto obtiveram maior eficácia, respectivamente. CONCLUSÕES -O exame micológico direto foi o mais confiável para seu resultado negativo. A cultura mostrou-se específica quando positiva. Quanto à biópsia, não se mostrou sensível e apresentou especificidade equivalente à dos outros exames.

show abstract

Section: Discussionunclassified

Avaliação dos métodos diagnósticos para onicomicose

Zanardi

Nunes

Pacheco

et al. 2008

An. Bras. Dermatol.

View full text Add to dashboard Cite

show abstract

“…It is always possible with mold infection, as with dermatophytosis, to sample fortuitously a portion of the lesion that is suboptimal for laboratory investigation, whether the area sampled contains effete inoculum, or whether it is marginal and is not yet heavily colonized. The laboratory study of dermatophytosis is constantly rendered difficult by the failure of truepositive samples to contain living inoculum in 15 to 25% of cases (4,6,7,13,32,34). In light of such possibilities, it may be unrealistic to expect low mold inoculum counts to be as readily interpretable as high counts are.…”

Section: Vol 39 2001 Diagnosis Of Nondermatophyte Mold Onychomycosimentioning

confidence: 99%

Utility of Inoculum Counting (Walshe and English Criteria) in Clinical Diagnosis of Onychomycosis Caused by Nondermatophytic Filamentous Fungi

et al. 2001

View full text Add to dashboard Cite

Opportunistic onychomycosis caused by nondermatophytic molds may differ in treatment from tinea unguium. Confirmed diagnosis of opportunistic onychomycosis classically requires more than one laboratory analysis to show consistency of fungal outgrowth. Walshe and English in 1966 proposed to extract sufficient diagnostic information from a single patient consultation by counting the number of nail fragments positive for inoculum of the suspected fungus. Twenty fragments were plated per patient, and each case in which five or more fragments grew the same mold was considered an infection by that mold, provided that compatible filaments were also seen invading the nail tissue by direct microscopy. This widely used and often recommended method has never been validated. Therefore, the validity of substituting any technique based on inoculum counting for conventional follow-up study in the diagnosis of opportunistic onychomycosis was investigated. Sampling of 473 patients was performed repeatedly. Nail specimens were examined by direct microscopy, and 15 pieces were plated on standard growth media. After 3 weeks, outgrowing dermatophytes were recorded, and pieces growing any nondermatophyte mold were counted. Patients returned on two to eight additional occasions over a 1-to 3-year period for similar examinations. Onychomycosis was etiologically classified based on long-term study. Opportunistic onychomycosis was definitively established for 86 patients. Counts of nondermatophyte molds in initial examinations were analyzed to determine if they successfully predicted both true cases of opportunistic onychomycosis and cases of insignificant mold contamination. There was a strong positive statistical association between mold colony counts and true opportunistic onychomycosis. Logistic regression analysis, however, determined that even the highest counts predicted true cases of opportunistic onychomycosis only 89.7% of the time. The counting criterion suggested by Walshe and English was correct only 23.2% of the time. Acremonium infections were especially likely to be correctly predicted by inoculum counting. Inoculum counting could be used to indicate a need for repeat studies in cases of false-negative results from laboratory direct microscopy. Inoculum counting cannot serve as a valid substitute for follow-up study in the diagnosis of opportunistic onychomycosis. It may, nonetheless, provide useful information both to the physician and to the laboratory, and it may be especially valuable when the patient does not present for follow-up sampling.

show abstract

“…General clinical manifestations of Candida nail infections include total dystrophic onychomycosis (seen mostly in chronic mucocutaneous candidiasis), proximal and lateral nail dystrophy (secondary to chronic paronychia), and distal and lateral nail dystrophy (associated with onycholysis and peripheral vascular disease) (111,251). Further clinical manifestations are hyperkeratosis of the nail plate with distortion of the normal curvature and distal erosion, chronic proximal paronychia with irregular transverse grooves and ridges and discoloration of the lateral margin, and isolated distal and lateral onycholysis (48,100). Clinical observations specific to reports of C. parapsilosis nail infections are associated with distal nail disease, in contrast to the case for C. albicans which is more prominent in proximal subungal onychomycosis or total dystrophic onychomycosis (182,251,301).…”

Section: Onychomycosismentioning

confidence: 99%

Candida parapsilosis, an Emerging Fungal Pathogen

2008

View full text Add to dashboard Cite

SUMMARY Candida parapsilosis is an emerging major human pathogen that has dramatically increased in significance and prevalence over the past 2 decades, such that C. parapsilosis is now one of the leading causes of invasive candidal disease. Individuals at the highest risk for severe infection include neonates and patients in intensive care units. C. parapsilosis infections are especially associated with hyperalimentation solutions, prosthetic devices, and indwelling catheters, as well as the nosocomial spread of disease through the hands of health care workers. Factors involved in disease pathogenesis include the secretion of hydrolytic enzymes, adhesion to prosthetics, and biofilm formation. New molecular genetic tools are providing additional and much-needed information regarding C. parapsilosis virulence. The emerging information will provide a deeper understanding of C. parapsilosis pathogenesis and facilitate the development of new therapeutic approaches for treating C. parapsilosis infections.

show abstract

Clinical and mycological diagnostic aspects of onychomycoses and dermatomycoses

Cited by 123 publications

References 18 publications

Avaliação dos métodos diagnósticos para onicomicose

Avaliação dos métodos diagnósticos para onicomicose

Utility of Inoculum Counting (Walshe and English Criteria) in Clinical Diagnosis of Onychomycosis Caused by Nondermatophytic Filamentous Fungi

Candida parapsilosis, an Emerging Fungal Pathogen

Contact Info

Product

Resources

About