Histopathological Periodic Acid–Schiff Stains of Nail Clippings as a Second-Line Diagnostic Tool in Onychomycosis

Mayer, Eliza; Izhak, Ofer Ben; Bergman, Reuven

doi:10.1097/dad.0b013e318234cc49

Cited by 30 publications

(14 citation statements)

References 10 publications

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“…Mayer et al . in their study included 100 consecutive cases in which direct microscopy and fungal cultures from suspected onychomycosis were negative on one occasion or more. They concluded that as a second‐line diagnostic tool, PAS stain of nail clippings increases markedly the diagnostic yield of onychomycosis over and above direct microscopy and culture.…”

Section: Discussionmentioning

confidence: 99%

Histopathological examination of nail clippings using PAS staining (HPE‐PAS): gold standard in diagnosis of Onychomycosis

Jeelani

Ahmed

Lanker

et al. 2014

Mycoses

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Onychomycosis is fungal infection of one or more of the nail units. However, because fungi cause only about half of all nail dystrophies, the use of appropriate diagnostic techniques is important to ensure correct diagnosis and treatment. Aim of the present study was to compare direct microscopy, culture and HPE-PAS for diagnosis of onychomycosis by evaluating their sensitivity and various other relevant statistical parameters. A prospective, hospital-based, cross-sectional study was conducted on 216 patients with a high degree of clinical suspicion of onychomycosis. Nail specimens were evaluated using three diagnostic methods, i.e. direct microscopy using 20% Potassium hydroxide (KOH) & 40% Di-methyl-suphoxide (DMSO), culture and histopathological examination using PAS stain (HPE-PAS). Of 216 patients direct microscopy was positive in 138 (63.9%), culture in 147 (68%) and HPE-PAS in 164 patients (76%). One hundred and seventy-nine patients fitted into the criteria set for confirmed diagnosis of onychomycosis. Using this as a denominator; direct microscopy, culture and HPE-PAS had sensitivities of 77.1%, 70% and 91.6% respectively. Also, HPE-PAS showed the highest sensitivity of 94.7% in 19 cases with prediagnostic antimycotic treatment compared to direct microscopy (42.1%) or culture (57.9%). HPE-PAS shows high sensitivity for diagnosis of onychomycosis and can be considered as a gold standard in the diagnosis of onychomycosis.

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Section: Discussionmentioning

confidence: 99%

Histopathological examination of nail clippings using PAS staining (HPE‐PAS): gold standard in diagnosis of Onychomycosis

Jeelani

Ahmed

Lanker

et al. 2014

Mycoses

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“…The majority of nail clipping studies fix the specimens in formalin [1–8, 10,17], some apply substances for softening of the nail plate, like chitin-softening solution [1,10] and Tween solution [5]. Several articles mentioned using traditional routine histologic examination for nail processing [1,2,3,7,10], few studies applied what seemed to be a diverse microscopic processing only with a series of ethanol [4,6], and a few did not use any microscopic processing at all after fixing with formalin and before paraffin embedding [5,8]. One study obtained good histologic preparations without using a fixative and immersed nail fragments in a solution of liquid hand soap and distilled water followed by a process in a routine overnight cycle [16], and in only two reports the samples examined were immediately wrapped in paraffin without using a fixative liquid [9,17].…”

Section: Discussionmentioning

confidence: 99%

“…Nail plate microscopic analysis in PAS stained slides, also known simply as nail clipping, is an established test used in the diagnosis of onychomycosis [1–7], and in one study it proved to have a role in discovering clinically unapparent nail fungal infection [8]. Its application in evaluating causes of onychodystrophy other than fungal infection is reported to a very small extent, though [2,9,10].…”

Section: Introductionmentioning

confidence: 99%

Microscopic examination of normal nail clippings

Werner

Antunes

2013

Dermatol Pract Concept

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Background:Nail clipping analysis for diagnosing causes of onychodystrophy other than onychomycosis is investigated to a very small extent. In order to achieve acceptance as a diagnostic method for any kind of nail abnormalities, normal microscopic parameters have to be established first. In most reported cases, nail plates were fixed in formalin with processing of the specimens with routine automated histotechnique.Methodology:Fifteen pairs of normal nails were studied. One nail fragment was placed in a container with formalin, and the other was kept dry in a proper receptacle. Fixed specimens were submitted to standard automated tissue processing (formalin group) and dry specimens were directly embedded in paraffin (dry group). Several microscopic parameters were analyzed.Results:Nail plate thickness ranged from 0.25 to 0.50 mm (mean 0.36 mm) and subungual region from 0 to 0.31 mm (mean 0.11 mm). Forty-one percent of cases presented onychokaryosis, and hypereosinophilic nuclear shadows were detected in 63%, statistically more frequent in the dry group (p=0.002). Parakeratosis was present in 86% of nails varying from 1 to 13 layers (mean 5.6). None of the nails presented fungi, neutrophils, and blood or serum collections. Bacteria were seen in 60% of specimens. Both groups yielded adequate microscopic preparations for analysis with no statistical difference in the dryness or hardness of specimens or difficulty in cutting the paraffin blocks (p=1).Conclusion:These microscopic findings of a normal population can be used as parameters for evaluating any cause of onychodystrophy. The dry method is faster and cheaper and yields adequate slide preparations for microscopic analysis of nail clippings.

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“…Aslında onikomikoz tanısı için klinik şüphe yanında en az bir laboratuvar testinin pozitif olması önerilir 2 . Klasik olarak tanıda, direkt mikroskopik inceleme ve kültür tanı yöntemleri kullanılırken son yıllarda histopatolojik inceleme tamamlayıcı bir yöntem olarak yerini almıştır 3,4 . Bunların dışında immunfloresan boyamalar, in vivo konfokal mikroskopi, polimeraz zincir reaksiyonu (PCR) gibi moleküler teknikler ve enzim analiz yöntemleri tanı için kullanılmaktadır [5][6][7] .…”

Section: Introductionunclassified

“…Bunların dışında immunfloresan boyamalar, in vivo konfokal mikroskopi, polimeraz zincir reaksiyonu (PCR) gibi moleküler teknikler ve enzim analiz yöntemleri tanı için kullanılmaktadır [5][6][7] . Onikomikozda tanı yöntemlerinin etkinliğini değerlendiren çeşitli çalışmalar mevcuttur 2,4,[8][9][10][11][12][13][14][15][16] . Altın standart olarak değerlendirilen tanı yöntemi, çalışmalarda farklılık göstermektedir.…”

Section: Introductionunclassified

Onikomikoz Tanısında Kullanılan 5 Farklı Yöntemin Etkinlik ve Maliyet Karşılaştırması

Erkan¹,

Kaçar²,

Özuğuz³

et al. 2014

TURKDERM

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ÖzetGiriş ve Amaç: Bu çalışmada kliniğimize onikomikoz düşündüren klinik bulgularla başvuran hastalarda tanı testlerinin, tanı koyma etkinlik ve maliyet etkinlik karşılaştırması, tanı yöntemlerini etkileyen faktörlerin belirlenmesi hedeflenmiştir. Gereç ve Yöntem: Altmış bir hastada 5 tanı yöntemi uygulanarak testlerin etkinlik ve maliyeti değerlendirildi. Klinik görünümle birlikte beş tanı yönteminden en az birisi pozitif olan hastalar onikomikoz tanısı aldı. Ayrıca hastaların demografik verileri yanında eşlik eden hastalıklar, tinea pedis ve tinea manum varlığı, önceki antifungal tedavileri gibi test sonuçlarını etkileyebilecek diğer faktörler kaydedildi. Bulgular: Çalışmaya alınan 61 hastanın 50'si (%82) beş tanı yönteminden en az biri pozitif saptanarak onikomikoz tanısı aldı. Tanı yöntemlerinin başarısı 50 olgu için sırasıyla değerlendirildiğinde; standart potasyum hidroksit (KOH) inceleme 34'üne (%68), 24 saatlik KOH inceleme 40'ına (%80), kültür 50 olgudan 24'üne (%48), histopatolojik incelemelerden periodic acid-Schiff (PAS) boyama 34'üne (%68), ''Grocott'un metenamin'' gümüş boyası (GMS) ise 32'sine (%64) doğru tanı koyabilmiştir. Maliyet ilişkisine göre incelendiğinde en ucuz test 24 saatlik inceleme iken en pahalısı histopatolojik incelemeler (PAS-GMS)'dir. Sonuç: Yirmi dört saatlik KOH inceleme dermatoloji pratiğinde farklı bir klinisyen ve laboratuvara ihtiyaç duymadan nispeten hızlı, etkili ve ucuz bir tamamlayıcı yöntem olarak daha sık tercih edilebilir. (Türk derm 2014; 48: 21-5) Anah tar Ke li me ler: Onikomikoz, direkt KOH mikroskopi, 24 saatlik KOH inceleme, mantar kültürü, PAS boyama, GMS boyama Sum maryBackground and Design: We aimed to compare the diagnostic value and cost-effectiveness of the diagnostic tests in patients with clinical findings suggesting onychomycosis as well as to assess the factors that affect these diagnostic tests. Material and Method:We evaluated the efficiency and cost-effectiveness of 5 diagnostic methods in 61 patients. Patients with at least one positive test, in addition to the the clinical picture, received the diagnosis of onychomycosis. Besides demographical features, we recorded factors such as presence of accompanying systemic diseases, tinea pedis and tinea manum, and previous antifungal treatment which may affect test results. Results: Fifty patients out of 61 were diagnosed as having onychomycosis by positivity of at least one of the five methods. The success rate of the diagnostic methods in 50 patients was as follows: standard potassium hydroxide (KOH) microscopy in 34 (68%) patients, 24-hour KOH microscopy in 40 (80%), fungal culture in 24 (48%), periodic acid-Schiff (PAS) staining in 34 (68%) and Grocott's methenamine silver staining (GMS) in 32 (64%) patients. When cost-effectiveness was considered, 24-hour KOH microscopy testing was the most efficient and the cheapest whereas histopathological tests were the most expensive methods. Conclusion: Twenty-four-hours KOH testing is relatively fast, efficient and cost-effective complementary method that do...

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Histopathological Periodic Acid–Schiff Stains of Nail Clippings as a Second-Line Diagnostic Tool in Onychomycosis

Cited by 30 publications

References 10 publications

Histopathological examination of nail clippings using PAS staining (HPE‐PAS): gold standard in diagnosis of Onychomycosis

Histopathological examination of nail clippings using PAS staining (HPE‐PAS): gold standard in diagnosis of Onychomycosis

Microscopic examination of normal nail clippings

Onikomikoz Tanısında Kullanılan 5 Farklı Yöntemin Etkinlik ve Maliyet Karşılaştırması

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