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BackgroundOnychomycosis is a chronic nail disorder commonly seen by healthcare providers; toenail involvement in particular presents a treatment challenge.ObjectiveTo provide an updated estimate on the prevalence of toenail onychomycosis.MethodsWe conducted a literature search using PubMed, Embase and Web of Science. Studies reporting mycology‐confirmed diagnoses were included and stratified into (a) populations‐based studies, and studies that included (b) clinically un‐suspected and (c) clinically suspected patients.ResultsA total of 108 studies were included. Based on studies that examined clinically un‐suspected patients (i.e., with or without clinical features suggestive of onychomycosis), the pooled prevalence rate of toenail onychomycosis caused by dermatophytes was 4% (95% CI: 3–5) among the general population; special populations with a heightened risk include knee osteoarthritis patients (RR: 14.6 [95% CI: 13.0–16.5]), chronic venous disease patients (RR: 5.6 [95% CI: 3.7–8.1]), renal transplant patients (RR: 4.7 [95% CI: 3.3–6.5]), geriatric patients (RR: 4.7 [95% CI: 4.4–4.9]), HIV‐positive patients (RR: 3.7 [95% CI: 2.9–4.7]), lupus erythematosus patients (RR: 3.1 [95% CI: 1.2–6.3]), diabetic patients (RR: 2.8 [95% CI: 2.4–3.3]) and hemodialysis patients (RR: 2.8 [95% CI: 1.9–4.0]). The prevalence of onychomycosis in clinically suspected patients was significantly higher likely due to sampling bias. A high degree of variability was found in a limited number of population‐based studies indicating that certain pockets of the population may be more predisposed to onychomycosis. The diagnosis of non‐dermatophyte mould onychomycosis requires repeat sampling to rule out contaminants or commensal organisms; a significant difference was found between studies that performed single sampling versus repeat sampling. The advent of PCR diagnosis results in improved detection rates for dermatophytes compared to culture.ConclusionOnychomycosis is an underrecognized healthcare burden. Further population‐based studies using standardized PCR methods are warranted.
BackgroundOnychomycosis is a chronic nail disorder commonly seen by healthcare providers; toenail involvement in particular presents a treatment challenge.ObjectiveTo provide an updated estimate on the prevalence of toenail onychomycosis.MethodsWe conducted a literature search using PubMed, Embase and Web of Science. Studies reporting mycology‐confirmed diagnoses were included and stratified into (a) populations‐based studies, and studies that included (b) clinically un‐suspected and (c) clinically suspected patients.ResultsA total of 108 studies were included. Based on studies that examined clinically un‐suspected patients (i.e., with or without clinical features suggestive of onychomycosis), the pooled prevalence rate of toenail onychomycosis caused by dermatophytes was 4% (95% CI: 3–5) among the general population; special populations with a heightened risk include knee osteoarthritis patients (RR: 14.6 [95% CI: 13.0–16.5]), chronic venous disease patients (RR: 5.6 [95% CI: 3.7–8.1]), renal transplant patients (RR: 4.7 [95% CI: 3.3–6.5]), geriatric patients (RR: 4.7 [95% CI: 4.4–4.9]), HIV‐positive patients (RR: 3.7 [95% CI: 2.9–4.7]), lupus erythematosus patients (RR: 3.1 [95% CI: 1.2–6.3]), diabetic patients (RR: 2.8 [95% CI: 2.4–3.3]) and hemodialysis patients (RR: 2.8 [95% CI: 1.9–4.0]). The prevalence of onychomycosis in clinically suspected patients was significantly higher likely due to sampling bias. A high degree of variability was found in a limited number of population‐based studies indicating that certain pockets of the population may be more predisposed to onychomycosis. The diagnosis of non‐dermatophyte mould onychomycosis requires repeat sampling to rule out contaminants or commensal organisms; a significant difference was found between studies that performed single sampling versus repeat sampling. The advent of PCR diagnosis results in improved detection rates for dermatophytes compared to culture.ConclusionOnychomycosis is an underrecognized healthcare burden. Further population‐based studies using standardized PCR methods are warranted.
Superficial fungal infections caused by dermatophytes are a prevalent global health concern. Rapid and accurate diagnosis of these pathogens through molecular tools would offer a substantial advantage for early detection and effective treatment. The conventional fungal culture presents inherent limitations, including extended result delivery delay and variable sensitivity. This study aimed to evaluate the performance of the multiplex real-time PCR Novaplex dermatophyte assay (Seegene) in comparison to traditional mycological methods including direct examination and culture. A total of 312 nail, skin, and scalp samples collected from patients with suspected superficial fungal infections for mycological diagnosis were retrospectively subjected to the Novaplex dermatophyte assay. Overall, 170 (54.6%) and 186 (59.6%) samples tested positive for dermatophyte culture and dermatophyte PCR, respectively. The concordance between PCR and culture for dermatophyte detection was 87.2%. There were 158 culture-positive/PCR-positive samples, 12 culture-positive/PCR-negative samples, and 28 culture-negative/PCR-positive samples. The sensitivity of PCR against culture varied according to the dermatophyte target, ranging from 90.5% ( Trichophyton mentagrophytes/interdigitale/benhamiae ), 91.2% ( Trichophyton rubrum ), to 100% ( Microsporum spp. and Trichophyton tonsurans ). When considering the final diagnosis using composite criteria, the sensitivity and specificity for the diagnosis of dermatophytosis were 92.9% and 96.6% for PCR, 86.7% and 100% for culture, and 95.4% and 92.2% for direct examination and culture combined, respectively. The Seegene Novaplex dermatophyte assay is an easy-to-use automated one-step extraction-PCR system that offers satisfactory performance for routine diagnosis of dermatophytoses in clinical laboratories, particularly in non-specialized centers. However, it cannot fully replace conventional mycology due to its inability to detect mold infections and to identify dermatophytes at the species level.
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