BACKGROUND Onychomycosis or nail fungal infection is the most common nail disease.
Despite the wide range of studies on this condition, it remains difficult to
establish the correct diagnosis and effective treatment. OBJECTIVES To evaluate the efficacy of classical laboratory methods for the diagnosis
of onychomycosis, and the in vitro susceptibility of the its main
etiological agent to antifungals used in routine. METHODS Nail samples of 100 patients with clinically suspected feet onychomycosis
were collected to confirm the diagnosis by direct mycological examination
and fungal culture. In vitro antifungal susceptibility testing was performed
against strains of the main dermatophyte isolated by microdilution,
according to the standardized protocol (M38-A2 - CLSI) RESULTS Clinical diagnosis of onychomycosis was confirmed by laboratory analysis in
59% of patients. Of these, 54.2% were positive only in direct mycological
examination, 44.1% in direct mycological examination and culture, and one
case (1.7%) was positive only in culture, resulting in weak agreement
between these tests (Kappa = 0.385; p <0.001) High minimum inhibitory
concentration values of fluconazole and itraconazole were observed in 66.7%
and 25.0% of isolates of T. rubrum tested. Additionally,
high MIC values of terbinafine and ciclopirox was detected in only one
isolate, and this was one of the strains in which in vitro activity of
itraconazole and fluconazole has not been proven. CONCLUSIONS Poor agreement was observed between direct mycological examination and
culture for the diagnosis of onychomycosis, with direct mycological
examination being significantly more sensitive. Except for fluconazole, the
other three antifungals tested showed good in vitro activity against
clinical isolates of T. rubrum.