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Harel F, Robert-Gangneux F, Gangneux JP, Guegan H. Monocentric evaluation of the Novaplex dermatophyte multiplex qPCR assay in the diagnosis of dermatophytoses. J Clin Microbiol 2024:e0089424. [PMID: 39324812 DOI: 10.1128/jcm.00894-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 09/05/2024] [Indexed: 09/27/2024] Open
Abstract
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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Affiliation(s)
- Florian Harel
- CHU Rennes, Laboratoire de parasitologie-mycologie, European ECMM Excellence Center in Medical Mycology, Centre National de Référence pour les mycoses et antifongiques-Laboratoire associé Aspergilloses chroniques, Rennes, France
| | - Florence Robert-Gangneux
- CHU Rennes, Laboratoire de parasitologie-mycologie, European ECMM Excellence Center in Medical Mycology, Centre National de Référence pour les mycoses et antifongiques-Laboratoire associé Aspergilloses chroniques, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, Irset (Institut de recherche en santé, environnement et travail), Rennes, France
| | - Jean-Pierre Gangneux
- CHU Rennes, Laboratoire de parasitologie-mycologie, European ECMM Excellence Center in Medical Mycology, Centre National de Référence pour les mycoses et antifongiques-Laboratoire associé Aspergilloses chroniques, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, Irset (Institut de recherche en santé, environnement et travail), Rennes, France
| | - Hélène Guegan
- CHU Rennes, Laboratoire de parasitologie-mycologie, European ECMM Excellence Center in Medical Mycology, Centre National de Référence pour les mycoses et antifongiques-Laboratoire associé Aspergilloses chroniques, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, Irset (Institut de recherche en santé, environnement et travail), Rennes, France
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Evrard S, Minon C, Lamtiri Laarif M, De Backer B, Paridaens H, Hayette MP, Frère J, Senterre JM, Minon JM. New Diagnostic Strategy for Onychomycosis: First-Line Utilization of DermaGenius ® PCR and Calcofluor Microscopy Combined with Selective Culturing. J Fungi (Basel) 2024; 10:515. [PMID: 39194841 DOI: 10.3390/jof10080515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/05/2024] [Accepted: 07/17/2024] [Indexed: 08/29/2024] Open
Abstract
Onychomycosis (OM) is a widespread infection requiring prolonged treatment with potential side effects. Diagnostic certainty is therefore essential before initiating antifungal therapy. Molecular biology has already shown benefits in reducing the time to diagnosis, providing technical ease, and increasing sensitivity for the respective species that molecular tests can detect. Nevertheless, causative agents are numerous, and culture remains essential, particularly for detecting non-dermatophytes mold infections. This study compared the performance of three different diagnostic strategies: conventional culture technique, the multiplex DermaGenius® 2.0 PCR (DG), and a mixed PCR/culture algorithm guided by the result of direct examination with calcofluor (DEC). The mixed algorithm (MA) prioritizes DG PCR and DEC as the primary diagnostic tools, supplemented by selective sample inoculation when mycelial elements are visualized in DEC and when DG PCR fails to detect any fungus or identifies a fungus with morphology differing from that observed in DEC (filamentous fungi versus yeasts). With only 13% of samples requiring inoculation, MA emerged as the most effective strategy, demonstrating significantly higher sensitivity (98.18%; p < 0.001) compared to single-method approaches (78.18% for DG PCR alone and 74.55% for culture alone) while maintaining a specificity comparable to DG PCR (100%). This new approach saves time in result delivery, requires fewer human resources, and increases diagnostic accuracy to better meet the needs of clinicians.
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Affiliation(s)
- Séverine Evrard
- Laboratory Medicine Department, Centre Hospitalier Régional de la Citadelle, 4000 Liege, Belgium
| | - Caroline Minon
- Laboratory Medicine Department, Centre Hospitalier Régional de la Citadelle, 4000 Liege, Belgium
| | - Mouhsine Lamtiri Laarif
- Laboratory Medicine Department, Centre Hospitalier Régional de la Citadelle, 4000 Liege, Belgium
| | - Benjamin De Backer
- Laboratory Medicine Department, Centre Hospitalier Régional de la Citadelle, 4000 Liege, Belgium
| | - Henry Paridaens
- Laboratory Medicine Department, Centre Hospitalier Régional de la Citadelle, 4000 Liege, Belgium
| | - Marie-Pierre Hayette
- Department of Clinical Microbiology, Centre Hospitalier Universitaire du Sart-Tilman, 4000 Liege, Belgium
| | - Julie Frère
- Pediatrics Department, Centre Hospitalier Régional de la Citadelle, 4000 Liege, Belgium
| | - Jean-Marc Senterre
- Laboratory Medicine Department, Centre Hospitalier Régional de la Citadelle, 4000 Liege, Belgium
| | - Jean-Marc Minon
- Laboratory Medicine Department, Centre Hospitalier Régional de la Citadelle, 4000 Liege, Belgium
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Kenjar AR, Mohan Raj JR, Girisha BS, Karunasagar I. Diagnostic ability of Peptidase S8 gene in the Arthrodermataceae causing dermatophytoses: A metadata analysis. PLoS One 2024; 19:e0306829. [PMID: 38980893 PMCID: PMC11232979 DOI: 10.1371/journal.pone.0306829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/24/2024] [Indexed: 07/11/2024] Open
Abstract
An unambiguous identification of dermatophytes causing dermatophytoses is necessary for accurate clinical diagnosis and epidemiological implications. In the current taxonomy of the Arthrodermataceae, the etiological agents of dermatophytoses consist of seven genera and members of the genera Trichophyton are the most prevalent etiological agents at present. The genera Trichophyton consists of 16 species that are grouped as clades, but the species borderlines are not clearly delimited. The aim of the present study was to determine the discriminative power of subtilisin gene variants (SUB1-SUB12) in family Arthrodermataceae, particularly in Trichophyton. Partial and complete reads from 288 subtilisin gene sequences of 12 species were retrieved and a stringent filtering following two different approaches for analysis (probability of correct identification (PCI) and gene gap analysis) conducted to determine the uniqueness of the subtilisin gene subtypes. SUB1 with mean PCI value of 60% was the most suitable subtilisin subtype for specific detection of T.rubrum complex, however this subtype is not reported in members of T. mentagrophytes complex which is one of the most prevalent etiological agent at present. Hence, SUB7 with 40% PCI value was selected for testing its discriminative power in Trichophyton species. SUB7 specific PCR based detection of dermatophytes was tested for sensitivity and specificity. Sequences of SUB7 from 42 isolates and comparison with the ITS region showed that differences within the subtilisin gene can further be used to differentiate members of the T. mentagrophytes complex. Further, subtilisin cannot be used for the differentiation of T. benhamiae complex since all SUB subtypes show low PCI scores. Studies on the efficiency and limitations of the subtilisin gene as a diagnostic tool are currently limited. Our study provides information that will guide researchers in considering this gene for identifying dermatophytes causing dermatophytoses in human and animals.
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Affiliation(s)
- Apoorva R. Kenjar
- Nitte (deemed to be University), Nitte University Centre for Science Education and Research, Mangaluru, Karnataka, India
| | - Juliet Roshini Mohan Raj
- Nitte (deemed to be University), Nitte University Centre for Science Education and Research, Mangaluru, Karnataka, India
| | | | - Indrani Karunasagar
- Nitte (deemed to be University), Nitte University Centre for Science Education and Research, Mangaluru, Karnataka, India
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Mehlhorn C, Uhrlaß S, Klonowski E, Krüger C, Paasch U, Simon JC, Nenoff P. [Conventional and molecular diagnostics in onychomycosis-part 2 : Molecular identification of causative dermatophytes by polymerase chain reaction and sequence analysis of the internal transcribed spacer region of ribosomal DNA]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:238-252. [PMID: 38095686 DOI: 10.1007/s00105-023-05265-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 02/24/2024]
Abstract
Dermatophyte identification using traditional methods such as optics-based direct fluorescence microscopy and culture is nowadays supplemented by molecular biological methods. The validity of dermatophyte DNA detection with direct uniplex-polymerase chain reaction-enzyme immunoassay (PCR-EIA) in nail samples was proven by sequence analysis of the ribosomal internal transcribed spacer (ITS) region. A total of 108 dermatophytes, isolated from patients with onychomycosis, were positive for Trichophyton rubrum (TR) and Trichophyton interdigitale (TI) in culture and/or uniplex-PCR-EIA. Conventional methods for dermatophyte identification were complemented by direct uniplex-PCR-EIA and sequence analysis of the ribosomal ITS region (18S rRNA, ITS1, 5.8S rRNA, ITS2, 28S rRNA). Of 108 patients (average age 62, median age 73), 56 showed cultural growth with 31 of them being identified as TR and 23 as TI. There was high agreement with the sequence analysis. Surprisingly, the pathogen of a single nail sample was identified as T. quinckeanum (formerly T. mentagrophytes sensu stricto), a rare zoophilic dermatophyte in Germany. A single TI strain turned out to be a misidentified T. tonsurans based on the sequence analysis. In all, 34 of the 52 specimens lacking cultural growth were detected by PCR as TR, and 18 specimens could be identified as TI. The results of dermatophyte identification of culture-negative nail samples were also in agreement with the results of sequence analysis. Molecular biological methods are well applicable, and they show high reliability for direct dermatophyte identification in nail samples without prior cultivation. Especially for nail samples without cultural growth, PCR-based dermatophyte identification was highly specific and sensitive.
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Affiliation(s)
- Carolin Mehlhorn
- Haut- und Laborarzt/Allergologie, Andrologie, Tätigkeitsschwerpunkt: Tropen- und Reisedermatologie (DDA), labopart - Medizinische Laboratorien, Labor Leipzig-Mölbis, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland
| | - Silke Uhrlaß
- Haut- und Laborarzt/Allergologie, Andrologie, Tätigkeitsschwerpunkt: Tropen- und Reisedermatologie (DDA), labopart - Medizinische Laboratorien, Labor Leipzig-Mölbis, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland
| | - Esther Klonowski
- Haut- und Laborarzt/Allergologie, Andrologie, Tätigkeitsschwerpunkt: Tropen- und Reisedermatologie (DDA), labopart - Medizinische Laboratorien, Labor Leipzig-Mölbis, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland
| | - Constanze Krüger
- Haut- und Laborarzt/Allergologie, Andrologie, Tätigkeitsschwerpunkt: Tropen- und Reisedermatologie (DDA), labopart - Medizinische Laboratorien, Labor Leipzig-Mölbis, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland
| | - Uwe Paasch
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR und Medizinische Fakultät der Universität Leipzig, Leipzig, Deutschland
| | - Jan C Simon
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR und Medizinische Fakultät der Universität Leipzig, Leipzig, Deutschland
| | - Pietro Nenoff
- Haut- und Laborarzt/Allergologie, Andrologie, Tätigkeitsschwerpunkt: Tropen- und Reisedermatologie (DDA), labopart - Medizinische Laboratorien, Labor Leipzig-Mölbis, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland.
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Anton A, Plinet M, Peyret T, Cazaudarré T, Pesant S, Rouquet Y, Tricoteaux MA, Bernier M, Bayette J, Fournier R, Marguerettaz M, Rolland P, Bayol T, Abbaoui N, Berry A, Iriart X, Cassaing S, Chauvin P, Bernard E, Fabre R, François JM. Rapid and Accurate Diagnosis of Dermatophyte Infections Using the DendrisCHIP ® Technology. Diagnostics (Basel) 2023; 13:3430. [PMID: 37998565 PMCID: PMC10670032 DOI: 10.3390/diagnostics13223430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
Dermatophytosis is a superficial fungal infection with an ever-increasing number of patients. Culture-based mycology remains the most commonly used diagnosis, but it takes around four weeks to identify the causative agent. Therefore, routine clinical laboratories need rapid, high throughput, and accurate species-specific analytical methods for diagnosis and therapeutic management. Based on these requirements, we investigated the feasibility of DendrisCHIP® technology as an innovative molecular diagnostic method for the identification of a subset of 13 pathogens potentially responsible for dermatophytosis infections in clinical samples. This technology is based on DNA microarray, which potentially enables the detection and discrimination of several germs in a single sample. A major originality of DendrisCHIP® technology is the use of a decision algorithm for probability presence or absence of pathogens based on machine learning methods. In this study, the diagnosis of dermatophyte infection was carried out on more than 284 isolates by conventional microbial culture and DendrisCHIP®DP, which correspond to the DendrisCHIP® carrying oligoprobes of the targeted pathogens implicated in dermatophytosis. While convergence ranging from 75 to 86% depending on the sampling procedure was obtained with both methods, the DendrisCHIP®DP proved to identify more isolates with pathogens that escaped the culture method. These results were confirmed at 86% by a third method, which was either a specific RT-PCR or genome sequencing. In addition, diagnostic results with DendrisCHIP®DP can be obtained within a day. This faster and more accurate identification of fungal pathogens with DendrisCHIP®DP enables the clinician to quickly and successfully implement appropriate antifungal treatment to prevent the spread and elimination of dermatophyte infection. Taken together, these results demonstrate that this technology is a very promising method for routine diagnosis of dermatophytosis.
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Affiliation(s)
- Aurore Anton
- Dendris SAS, 335 Rue du Chêne Vert, 31670 Labège, France; (M.P.); (T.P.); (T.C.); (S.P.); (E.B.); (R.F.); (J.-M.F.)
| | - Mathilde Plinet
- Dendris SAS, 335 Rue du Chêne Vert, 31670 Labège, France; (M.P.); (T.P.); (T.C.); (S.P.); (E.B.); (R.F.); (J.-M.F.)
| | - Thomas Peyret
- Dendris SAS, 335 Rue du Chêne Vert, 31670 Labège, France; (M.P.); (T.P.); (T.C.); (S.P.); (E.B.); (R.F.); (J.-M.F.)
| | - Thomas Cazaudarré
- Dendris SAS, 335 Rue du Chêne Vert, 31670 Labège, France; (M.P.); (T.P.); (T.C.); (S.P.); (E.B.); (R.F.); (J.-M.F.)
| | - Stéphanie Pesant
- Dendris SAS, 335 Rue du Chêne Vert, 31670 Labège, France; (M.P.); (T.P.); (T.C.); (S.P.); (E.B.); (R.F.); (J.-M.F.)
| | - Yannick Rouquet
- Laboratoire Inovie-CBM, 31000 Toulouse, France; (Y.R.); (M.-A.T.); (M.B.)
| | | | - Matthieu Bernier
- Laboratoire Inovie-CBM, 31000 Toulouse, France; (Y.R.); (M.-A.T.); (M.B.)
| | - Jérémy Bayette
- Laboratoire Inovie-Labosud, 34070 Montpellier, France; (J.B.); (R.F.); (M.M.); (P.R.); (T.B.); (N.A.)
| | - Remi Fournier
- Laboratoire Inovie-Labosud, 34070 Montpellier, France; (J.B.); (R.F.); (M.M.); (P.R.); (T.B.); (N.A.)
| | - Mélanie Marguerettaz
- Laboratoire Inovie-Labosud, 34070 Montpellier, France; (J.B.); (R.F.); (M.M.); (P.R.); (T.B.); (N.A.)
| | - Pierre Rolland
- Laboratoire Inovie-Labosud, 34070 Montpellier, France; (J.B.); (R.F.); (M.M.); (P.R.); (T.B.); (N.A.)
| | - Thibaud Bayol
- Laboratoire Inovie-Labosud, 34070 Montpellier, France; (J.B.); (R.F.); (M.M.); (P.R.); (T.B.); (N.A.)
| | - Nadia Abbaoui
- Laboratoire Inovie-Labosud, 34070 Montpellier, France; (J.B.); (R.F.); (M.M.); (P.R.); (T.B.); (N.A.)
| | - Antoine Berry
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire Purpan de Toulouse, Institut Fédératif de biologie (IFB), 31300 Toulouse, France; (A.B.); (X.I.); (S.C.); (P.C.)
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), Hôpital Purpan, 31024 Toulouse, France
| | - Xavier Iriart
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire Purpan de Toulouse, Institut Fédératif de biologie (IFB), 31300 Toulouse, France; (A.B.); (X.I.); (S.C.); (P.C.)
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), Hôpital Purpan, 31024 Toulouse, France
| | - Sophie Cassaing
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire Purpan de Toulouse, Institut Fédératif de biologie (IFB), 31300 Toulouse, France; (A.B.); (X.I.); (S.C.); (P.C.)
| | - Pamela Chauvin
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire Purpan de Toulouse, Institut Fédératif de biologie (IFB), 31300 Toulouse, France; (A.B.); (X.I.); (S.C.); (P.C.)
| | - Elodie Bernard
- Dendris SAS, 335 Rue du Chêne Vert, 31670 Labège, France; (M.P.); (T.P.); (T.C.); (S.P.); (E.B.); (R.F.); (J.-M.F.)
| | - Richard Fabre
- Dendris SAS, 335 Rue du Chêne Vert, 31670 Labège, France; (M.P.); (T.P.); (T.C.); (S.P.); (E.B.); (R.F.); (J.-M.F.)
| | - Jean-Marie François
- Dendris SAS, 335 Rue du Chêne Vert, 31670 Labège, France; (M.P.); (T.P.); (T.C.); (S.P.); (E.B.); (R.F.); (J.-M.F.)
- Toulouse Biotechnology Institute (TBI), Université de Toulouse, Institut National des Sciences (INSA), 135 Avenue de Rangueil, 31077 Toulouse, France
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Trovato L, Calvo M, Domina M, De Pasquale R, Scalia G, Oliveri S. Multiplex real-time PCR for skin fungal infections: The diagnostic reliability in a one-year non-interventional study. Med Mycol 2023; 61:myad092. [PMID: 37740445 DOI: 10.1093/mmy/myad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/03/2023] [Accepted: 09/20/2023] [Indexed: 09/24/2023] Open
Abstract
The skin fungal infection diagnostic workflow currently includes microscopic and culture-based methods as the gold standard. Recent published data described the possible limitations of these conventional techniques documenting the possibility of reducing response time intervals. The present study reports an evaluation of the DermaGenius® (DG) multiplex kit (PathoNostics) for rapid C. albicans and dermatophytes identification directly from skin samples. The investigations involved 90 specimens that underwent DNA extraction and amplification simultaneously to microscopic and culture methods. According to current guidelines, we defined a dermatophytic skin infection as the simultaneous presence of clinical evidence of skin lesions and positive results for dermatophyte elements from microscopy and/or cultures. The collected data remarked on the advantages of the molecular assay, especially in terms of sensitivity and rapidity. A statistical evaluation analysed a comparison between conventional and innovative diagnostic methods. The sensitivity, specificity, positive predictive value, and negative predictive value of DG-PCR in the cutaneous dermatophytosis were, respectively, 94.7%, 78.8%, 88.5%, and 89.6%. Based on our experience, the molecular technique could represent a diagnostic confirmation in the case of previous antifungal treatment, little biological material available, or urgent clinical conditions.
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Affiliation(s)
- Laura Trovato
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
- U.O.C. Laboratory Analysis Unit, A.O.U. "Policlinico-San Marco", Catania, Italy
| | - Maddalena Calvo
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
- U.O.C. Laboratory Analysis Unit, A.O.U. "Policlinico-San Marco", Catania, Italy
| | - Maria Domina
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Rocco De Pasquale
- Department of General Surgery and Surgical-Medical Specialites, Unit of Dermatology, University of Catania, Catania, Italy
| | - Guido Scalia
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
- U.O.C. Laboratory Analysis Unit, A.O.U. "Policlinico-San Marco", Catania, Italy
| | - Salvatore Oliveri
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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Pospischil I, Reinhardt C, Bontems O, Salamin K, Fratti M, Blanchard G, Chang YT, Wagner H, Hermann P, Monod M, Hoetzenecker W, Guenova E. Identification of Dermatophyte and Non-Dermatophyte Agents in Onychomycosis by PCR and DNA Sequencing—A Retrospective Comparison of Diagnostic Tools. J Fungi (Basel) 2022; 8:jof8101019. [PMID: 36294584 PMCID: PMC9605175 DOI: 10.3390/jof8101019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/14/2022] [Accepted: 09/21/2022] [Indexed: 12/02/2022] Open
Abstract
Rapid and reliable fungal identification is crucial to delineate infectious diseases, and to establish appropriate treatment for onychomycosis. Compared to conventional diagnostic methods, molecular techniques are faster and feature higher accuracy in fungal identification. However, in current clinical practice, molecular mycology is not widely available, and its practical applicability is still under discussion. This study summarizes the results of 16,094 consecutive nail specimens with clinical suspicion of onychomycosis. We performed PCR/sequencing on all primary nail specimens for which conventional mycological diagnostics remained inconclusive. In specimens with a positive direct microscopy but negative or contaminated culture, molecular mycology proved superior and specified a fungal agent in 65% (587/898). In 75% (443/587), the identified pathogen was a dermatophyte. Positive cultures for dermatophytes, yeasts and non-dermatophyte molds (NDMs) were concordant with primary-specimen-DNA PCR/sequencing in 83% (10/12), 34% (22/65) and 45% (76/169), respectively. Among NDMs, agreement was high for Fusarium spp. (32/40; 80%), but low for Penicillium spp. (5/25; 20%) and Alternaria spp. (1/20; 5%). This study underlines the improvement in diagnostic yield by fungal primary-specimen-DNA PCR/sequencing in the event of a negative or contaminated culture, as well as its significance for the diagnosis of dermatophyte and non-dermatophyte onychomycosis. Molecular mycology methods like PCR and DNA sequencing should complement conventional diagnostics in cases of equivocal findings, suspected NDM onychomycosis or treatment-resistant nail pathologies.
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Affiliation(s)
- Isabella Pospischil
- Department of Dermatology, Kepler University Hospital, Johannes Kepler University Linz, 4020 Linz, Austria
- Correspondence: (I.P.); (W.H.); (E.G.)
| | - Charlotte Reinhardt
- Department of Dermatology, Kepler University Hospital, Johannes Kepler University Linz, 4020 Linz, Austria
- Department of Dermatology, Lausanne University Hospital (CHUV) and the Faculty of Biology and Medicine, University of Lausanne, 1007 Lausanne, Switzerland
| | - Olympia Bontems
- Department of Dermatology, Lausanne University Hospital (CHUV) and the Faculty of Biology and Medicine, University of Lausanne, 1007 Lausanne, Switzerland
| | - Karine Salamin
- Department of Dermatology, Lausanne University Hospital (CHUV) and the Faculty of Biology and Medicine, University of Lausanne, 1007 Lausanne, Switzerland
| | - Marina Fratti
- Department of Dermatology, Lausanne University Hospital (CHUV) and the Faculty of Biology and Medicine, University of Lausanne, 1007 Lausanne, Switzerland
| | - Gabriela Blanchard
- Department of Dermatology, Lausanne University Hospital (CHUV) and the Faculty of Biology and Medicine, University of Lausanne, 1007 Lausanne, Switzerland
| | - Yun-Tsan Chang
- Department of Dermatology, Lausanne University Hospital (CHUV) and the Faculty of Biology and Medicine, University of Lausanne, 1007 Lausanne, Switzerland
| | - Helga Wagner
- Center for Clinical Studies (CCS Linz), Johannes Kepler University Linz, 4020 Linz, Austria
- Institute of Applied Statistics, Johannes Kepler University Linz, 4020 Linz, Austria
| | - Philipp Hermann
- Center for Clinical Studies (CCS Linz), Johannes Kepler University Linz, 4020 Linz, Austria
| | - Michel Monod
- Department of Dermatology, Lausanne University Hospital (CHUV) and the Faculty of Biology and Medicine, University of Lausanne, 1007 Lausanne, Switzerland
| | - Wolfram Hoetzenecker
- Department of Dermatology, Kepler University Hospital, Johannes Kepler University Linz, 4020 Linz, Austria
- Correspondence: (I.P.); (W.H.); (E.G.)
| | - Emmanuella Guenova
- Department of Dermatology, Lausanne University Hospital (CHUV) and the Faculty of Biology and Medicine, University of Lausanne, 1007 Lausanne, Switzerland
- Department of Dermatology, University Hospital Zurich and the University of Zurich, 8091 Zurich, Switzerland
- Department of Dermatology, Hospital 12 de Octubre, Medical School, University Complutense, 28040 Madrid, Spain
- Correspondence: (I.P.); (W.H.); (E.G.)
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8
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Trovato L, Domina M, Calvo M, De Pasquale R, Scalia G, Oliveri S. Use of Real Time Multiplex PCR for the diagnosis of dermatophytes onychomycosis in patients with empirical antifungal treatments. J Infect Public Health 2022; 15:539-544. [DOI: 10.1016/j.jiph.2022.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/12/2022] [Accepted: 03/31/2022] [Indexed: 12/22/2022] Open
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9
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Lim SS, Ohn J, Mun JH. Diagnosis of Onychomycosis: From Conventional Techniques and Dermoscopy to Artificial Intelligence. Front Med (Lausanne) 2021; 8:637216. [PMID: 33937282 PMCID: PMC8081953 DOI: 10.3389/fmed.2021.637216] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/19/2021] [Indexed: 12/17/2022] Open
Abstract
Onychomycosis is a common fungal nail infection. Accurate diagnosis is critical as onychomycosis is transmissible between humans and impacts patients' quality of life. Combining clinical examination with mycological testing ensures accurate diagnosis. Conventional diagnostic techniques, including potassium hydroxide testing, fungal culture and histopathology of nail clippings, detect fungal species within nails. New diagnostic tools have been developed recently which either improve detection of onychomycosis clinically, including dermoscopy, reflectance confocal microscopy and artificial intelligence, or mycologically, such as molecular assays. Dermoscopy is cost-effective and non-invasive, allowing clinicians to discern microscopic features of onychomycosis and fungal melanonychia. Reflectance confocal microscopy enables clinicians to observe bright filamentous septate hyphae at near histologic resolution by the bedside. Artificial intelligence may prompt patients to seek further assessment for nails that are suspicious for onychomycosis. This review evaluates the current landscape of diagnostic techniques for onychomycosis.
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Affiliation(s)
| | - Jungyoon Ohn
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea.,Institute of Human-Environment Interface Biology, Seoul National University, Seoul, South Korea
| | - Je-Ho Mun
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea.,Institute of Human-Environment Interface Biology, Seoul National University, Seoul, South Korea
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10
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Krammer S, Krammer C, Vladimirova G, Salzer S, Ruini C, Sattler E, French LE, Hartmann D. Ex vivo Confocal Laser Scanning Microscopy: A Potential New Diagnostic Imaging Tool in Onychomycosis Comparable With Gold Standard Techniques. Front Med (Lausanne) 2020; 7:586648. [PMID: 33240908 PMCID: PMC7677524 DOI: 10.3389/fmed.2020.586648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/12/2020] [Indexed: 12/15/2022] Open
Abstract
Ex vivo confocal laser scanning microscopy (CLSM) is an innovative imaging tool that enables real-time examination of specimens and may be used in evaluating fungal infections. We aimed to assess the applicability of ex vivo CLSM in the diagnosis of onychomycosis by comparing results to those obtained by histopathology, potassium hydroxide (KOH) examination, and fungal culture. In this prospective study, 57 patients with the clinical diagnosis of distal nail fungal infection were examined and compared using all four of the above-mentioned diagnostic tools in terms of sensitivity, positive and negative predictive value. Ex vivo CLSM showed the highest sensitivity, followed by KOH examination, histopathology and fungal culture. Regarding positive and negative predictive values, ex vivo CLSM was superior and showed even higher sensitivity than the combined gold standard comprised of KOH examination, fungal culture or histopathology.
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Affiliation(s)
- Sebastian Krammer
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Christian Krammer
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Gabriela Vladimirova
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Suzanna Salzer
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Cristel Ruini
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Elke Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Lars E French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
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11
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Gupta A, Stec N, Summerbell R, Shear N, Piguet V, Tosti A, Piraccini B. Onychomycosis: a review. J Eur Acad Dermatol Venereol 2020; 34:1972-1990. [DOI: 10.1111/jdv.16394] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/25/2020] [Indexed: 01/25/2023]
Affiliation(s)
- A.K. Gupta
- Division of Dermatology Department of Medicine University of Toronto Toronto ON Canada
- Mediprobe Research Inc. London ON Canada
| | - N. Stec
- Mediprobe Research Inc. London ON Canada
| | - R.C. Summerbell
- Sporometrics Toronto ON Canada
- Dalla Lana School of Public Health University of Toronto Toronto ON Canada
| | - N.H. Shear
- Division of Dermatology Department of Medicine University of Toronto Toronto ON Canada
- Division of Dermatology Sunnybrook Health Sciences Centre Toronto ON Canada
| | - V. Piguet
- Division of Dermatology Department of Medicine University of Toronto Toronto ON Canada
- Division of Dermatology Women's College Hospital Toronto ON Canada
| | - A. Tosti
- Department of Dermatology and Cutaneous Surgery Leonard Miller School of Medicine University of Miami Miami FL USA
| | - B.M. Piraccini
- Dermatology Unit Department of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna Italy
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12
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Gnat S, Łagowski D, Nowakiewicz A. Major challenges and perspectives in the diagnostics and treatment of dermatophyte infections. J Appl Microbiol 2020; 129:212-232. [PMID: 32048417 DOI: 10.1111/jam.14611] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/07/2020] [Accepted: 02/07/2020] [Indexed: 12/20/2022]
Abstract
Dermatophytes are the aetiological factors of a majority of superficial fungal infections. What distinguishes them from other pathogenic filamentous fungi is their unique ability to degrade keratin. The remarkable ability of this group of fungi to survive in different ecosystems results from their morphological and ecological diversity as well as high adaptability to changing environmental conditions. Paradoxically, despite the progress in medicine, the prevalence of dermatophyte infections is increasing from year to year. At the beginning of the third millennium, practical diagnostic and therapeutic options are still very limited. This review focuses on understanding the major problems in this aspect of dermatophyte infections and indicates future strategies and perspectives for novel approaches to identification and drugs for elimination of dermatophytes. Particular importance is placed on development of a strategy for a diagnostic pathway and implementation of rapid and reliable diagnostics methods designed by international teams. Furthermore, among compounds that currently arouse great interest, representatives of terpenoids, alkaloids, saponins, flavonoids and essential oils deserve attention. Many of these compounds are undergoing clinical trials as potential antifungal agents, and future research should focus on attempts at determination of the applicability of tested substances. Finally, the advantages and disadvantages in implementation of new diagnostic paths and medicinal substances for routine use are indicated.
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Affiliation(s)
- S Gnat
- Faculty of Veterinary Medicine, Institute of Biological Bases of Animal Diseases, Sub-Department of Veterinary Microbiology, University of Life Sciences, Lublin, Poland
| | - D Łagowski
- Faculty of Veterinary Medicine, Institute of Biological Bases of Animal Diseases, Sub-Department of Veterinary Microbiology, University of Life Sciences, Lublin, Poland
| | - A Nowakiewicz
- Faculty of Veterinary Medicine, Institute of Biological Bases of Animal Diseases, Sub-Department of Veterinary Microbiology, University of Life Sciences, Lublin, Poland
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13
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Begum J, Mir NA, Lingaraju MC, Buyamayum B, Dev K. Recent advances in the diagnosis of dermatophytosis. J Basic Microbiol 2020; 60:293-303. [PMID: 32003043 DOI: 10.1002/jobm.201900675] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/10/2020] [Accepted: 01/18/2020] [Indexed: 11/09/2022]
Abstract
Dermatophytosis is a disease of global significance caused by pathogenic keratinolytic fungi called dermatophytes in both animals and humans. The recent taxonomy of dermatophytes classifies them into six pathogenic genera, namely Microsporum, Trichophyton, Epidermophyton, Nannizzia, Lophophyton and Arthroderma. It is because of the delayed diagnostic nature and low accuracy of dermatophyte detection by conventional methods that paved the path for the evolution of molecular diagnostic techniques, which provide the accurate and rapid diagnosis of dermatophytosis for an appropriate, timely antifungal therapy that prevents the nonspecific over-the-counter self-medication. This review focuses on the importance of rapid and accurate diagnosis of dermatophytosis, limitations of conventional methods, selection of targets in diagnosis, and factors affecting sensitivity and specificity of various molecular diagnostic technologies in the diagnosis of dermatophytosis. Generally, all the molecular techniques have a significant edge over the conventional methods of culture and microscopy in the dermatophytosis diagnosis. However, in mycology laboratory, the suitability of any molecular diagnostic technique in the diagnosis of dermatophytosis is driven by the requirement of time, economy, complexity, the range of species spectrum detected and the scale of diagnostic output required. Thus, various choices involved in the pursuit of a diagnosis of dermatophytosis are determined by the available conditions and the facilities in the laboratory.
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Affiliation(s)
- Jubeda Begum
- Department of Veterinary Microbiology, College of Veterinary and Animal Sciences, GBPUAT, Pantnagar, India
| | - Nasir A Mir
- AN & FT Division, ICAR-Central Avian Research Institute, Bareilly, India
| | - Madhu C Lingaraju
- Division of Pharmacology & Toxicology, ICAR-Indian Veterinary Research Institute, Bareilly, India
| | - Bidyarani Buyamayum
- Department of Microbiology, Jawaharlal Nehru Institute of Medical Science, Porompat, Manipur, India
| | - Kapil Dev
- AN & FT Division, ICAR-Central Avian Research Institute, Bareilly, India
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14
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Gill P, Kaur S, Gupta A. Arbitrarily primed polymerase chain reaction-based identification of dystrophic onychomycosis. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2020. [DOI: 10.4103/amhs.amhs_31_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Koo SH, Teoh YL, Koh WL, Ochi H, Tan SK, Sim DMF, Jiang B, Tan AL, Tan TY, Lim SPR. Development and validation of a real-time multiplex PCR assay for the detection of dermatophytes and Fusarium spp. J Med Microbiol 2019; 68:1641-1648. [PMID: 31526456 DOI: 10.1099/jmm.0.001082] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction: Onychomycosis is a debilitating, difficult-to-treat nail fungal infection with increasing prevalence worldwide. The main etiological agents are dermatophytes, which are common causative pathogens in superficial fungal mycoses. Conventional detection methods such as fungal culture have low sensitivity and specificity and are time-consuming.Aim: The main objective of this study was to design, develop and validate a real-time probe-based multiplex qPCR assay for the detection of dermatophytes and Fusarium species.Methodology: The performance characteristics of the qPCR assays were evaluated. The multiplex qPCR assays targeted four genes (assay 1: pan-dermatophytes/Fusarium spp.; assay 2: Trichophyton rubrum/Microsporum spp.). Analytical validation was accomplished using 150 fungal isolates and clinical validation was done on 204 nail specimens. The performance parameters were compared against the gold standard (fungal culture) and expanded gold standard (culture in conjunction with sequencing).Results: Both the single-plex and multiplex qPCR assays performed well especially when compared against the expanded gold standard. Among the 204 tested nail specimens, the culture method showed that 125 (61.3 %) were infected with at least one organism, of which 40 yielded positive results for dermatophytes and Fusarium spp. These target organisms detected include 20 dermatophytes and 22 Fusarium spp. The developed qPCR assays demonstrated excellent limit of detection, efficiency, coefficient of determination, analytical and clinical sensitivity and specificity.Conclusion: The multiplex qPCR assays were reliable for the diagnosis of onychomycosis, with shorter turn-around time as compared to culture method. This aids in the planning of treatment strategies to achieve optimal therapeutic outcome.
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Affiliation(s)
- Seok Hwee Koo
- Clinical Trials and Research Unit, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Yee Leng Teoh
- Department of Dermatology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Wei Liang Koh
- Department of Dermatology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Harumi Ochi
- Department of Dermatology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Sher Kye Tan
- School of Chemical and Life Sciences, Singapore Polytechnic, 500 Dover Road, Singapore 139651, Singapore
| | - Diana Miao Fang Sim
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Boran Jiang
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Ai Ling Tan
- Department of Microbiology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Su Ping Regina Lim
- Department of Dermatology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
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16
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[Genome detection of dermatophytes : Current findings from the external quality assessment test]. Hautarzt 2019; 70:627-637. [PMID: 31165909 DOI: 10.1007/s00105-019-4435-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In addition to morphological diagnostics, molecular methods have become available for the diagnosis of suspected dermatophytoses. Since March 2016, INSTAND e. V., in cooperation with the National Reference Laboratory for Dermatophytes, has provided an external quality assessment (EQA) test for the genome detection of dermatophytes twice a year. More than half of the participants used commercial kits for the analysis of the samples. All kits with a high level of accuracy correctly determined the presence of Trichophyton rubrum or no dermatophytes. In species diagnostics beyond Trichophyton rubrum there are large differences between the kits. These are examined in more detail based on clinical studies and the results of the EQA test.
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17
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Hayette MP, Seidel L, Adjetey C, Darfouf R, Wéry M, Boreux R, Sacheli R, Melin P, Arrese J. Clinical evaluation of the DermaGenius® Nail real-time PCR assay for the detection of dermatophytes and Candida albicans in nails. Med Mycol 2019; 57:277-283. [PMID: 29762721 DOI: 10.1093/mmy/myy020] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/24/2018] [Accepted: 04/10/2018] [Indexed: 12/29/2022] Open
Abstract
Onychomycosis represents one of the most frequent mycoses in the world. Causative agents are mainly dermatophytes, but yeasts and nondermatophyte moulds can also be involved. Conventional diagnostic methods include direct microscopy (or histology) and culturing. However, molecular methods are becoming increasingly popular in this field. The DermaGenius® (DG) Nail multiplex assay (PathoNostics, The Netherlands) is a new commercial real-time polymerase chain reaction (PCR) kit, which can detect Trichophyton rubrum, Trichophyton interdigitale and Candida albicans directly in nails. The present study is a retrospective evaluation of the kit applied to 138 finger and toenail clippings in comparison to histology and culture methods. The sensitivity and specificity of the PCR assay are 80% (76/95) and 74.4% (32/43), respectively, when histology and culture are used as reference to define onychomycosis. DG performance is not different from histology combined with culture (P = .11) but the best diagnostic efficacy (88.4%, 122/138) is obtained by the combination of histology and DG. In conclusion, this study emphasizes the clinical usefulness of the DG in diagnostics. The high specificity of this test guarantees a better identification compared to culture that can lead to dermatophyte misidentifications. It is a reliable PCR assay that shortens the time to diagnosis and can unmask the presence of nongrowing fungal pathogens in nails.
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Affiliation(s)
- Marie-Pierre Hayette
- Department of Clinical Microbiology, Center for Interdisciplinary Research on Medicines (CIRM), University Hospital of Liège, Belgium.,National Reference Center for Mycosis, University Hospital of Liège, Belgium
| | - Laurence Seidel
- Department of Biostatistics, University Hospital of Liège, Belgium
| | - Caroline Adjetey
- Department of Clinical Microbiology, Center for Interdisciplinary Research on Medicines (CIRM), University Hospital of Liège, Belgium
| | - Rajae Darfouf
- Department of Clinical Microbiology, Center for Interdisciplinary Research on Medicines (CIRM), University Hospital of Liège, Belgium.,National Reference Center for Mycosis, University Hospital of Liège, Belgium
| | - Marie Wéry
- Department of Clinical Microbiology, Center for Interdisciplinary Research on Medicines (CIRM), University Hospital of Liège, Belgium
| | - Raphaël Boreux
- Department of Clinical Microbiology, Center for Interdisciplinary Research on Medicines (CIRM), University Hospital of Liège, Belgium
| | - Rosalie Sacheli
- Department of Clinical Microbiology, Center for Interdisciplinary Research on Medicines (CIRM), University Hospital of Liège, Belgium.,National Reference Center for Mycosis, University Hospital of Liège, Belgium
| | - Pierrette Melin
- Department of Clinical Microbiology, Center for Interdisciplinary Research on Medicines (CIRM), University Hospital of Liège, Belgium
| | - Jorge Arrese
- Department of Dermatopathology, University Hospital of Liège, Belgium
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18
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Lipner SR, Scher RK. Onychomycosis. J Am Acad Dermatol 2019; 80:835-851. [DOI: 10.1016/j.jaad.2018.03.062] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/05/2018] [Accepted: 03/06/2018] [Indexed: 02/03/2023]
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19
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Gupta AK, Mays RR, Versteeg SG, Shear NH, Piguet V. Update on current approaches to diagnosis and treatment of onychomycosis. Expert Rev Anti Infect Ther 2018; 16:929-938. [DOI: 10.1080/14787210.2018.1544891] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Aditya K. Gupta
- Mediprobe Research Inc., London, Canada
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, Canada
| | | | | | - Neil H. Shear
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, Canada
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, Canada
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
- Division of Dermatology, Women’s College Hospital, Toronto, Canada
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20
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Sherman S, Goshen M, Treigerman O, Ben-Zion K, Carp MJ, Maisler N, Ehrenreich IB, Kimchi A, Lifshitz S, Smollan G, Davidovici B, David M, Hodak E, Segal R. Evaluation of multiplex real-time PCR for identifying dermatophytes in clinical samples-A multicentre study. Mycoses 2017; 61:119-126. [PMID: 29024067 DOI: 10.1111/myc.12713] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/26/2017] [Accepted: 10/06/2017] [Indexed: 11/28/2022]
Abstract
The gold-standard method for dermatophyte identification involves direct microscopy and culture, which have inherent shortcomings. Only few molecular methods have been standardised for routine clinical work. This study aimed to develop and test a platform for identifying the most common dermatophytes in Israel using multiplex real-time polymerase chain reaction (RT-PCR). Specific primers were designed for the multiplex system (LightCycler 480) according to known cultures and validated by reference isolates. The dermatophyte detection rate was compared to smear and culture in 223 clinical samples obtained from a tertiary medical centre. Inconsistencies between methods were evaluated by sequencing. The RT-PCR was further evaluated in 200 community-based samples obtained from a health maintenance organisation and 103 military-personnel-based samples analysed at a central laboratory. In hospital-based clinical samples, complete concordance between methods was observed in 190 samples (85%; Kappa = 0.69). In most cases of non-concordance, sequencing was consistent with RT-PCR results. RT-PCR correctly identified all smear- and culture-positive cases in community and military-personnel samples. The results were available within 4 hours. The multiplex RT-PCR platform is a rapid and efficient method for identifying dermatophyte species in clinical samples and may serve as a first step in the diagnostic algorithm of superficial fungal infections.
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Affiliation(s)
- Shany Sherman
- Department of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | | | - Orit Treigerman
- Microbiology Laboratory, Meuhedet Health Services, Lod, Israel
| | | | | | | | | | - Aviva Kimchi
- Mycological Laboratory, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Sara Lifshitz
- Mycological Laboratory, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Gill Smollan
- Clinical Microbiology Laboratory, Sheba Medical Center, Tel Hashomer, Israel
| | - Batya Davidovici
- Department of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael David
- Department of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emmilia Hodak
- Department of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rina Segal
- Department of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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21
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Gupta AK, Versteeg SG, Shear NH. Onychomycosis in the 21st Century: An Update on Diagnosis, Epidemiology, and Treatment. J Cutan Med Surg 2017. [PMID: 28639462 DOI: 10.1177/1203475417716362] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Onychomycosis accounts for 50% of all nail disease cases and is commonly caused by dermatophytes. Diabetes, human immunodeficiency virus, immunosuppression, obesity, smoking, and advancing age are predisposing factors of this fungal infection. Potassium hydroxide and culture are considered the current standard for diagnosing onychomycosis, revealing both fungal viability and species identification. Other diagnostic tests currently available include periodic acid-Schiff staining, polymerase chain reaction techniques, and fluorescent staining. Across 6 recently published epidemiology studies, the global prevalence of onychomycosis was estimated to be 5.5%, falling within the range of previously reported estimates (2%-8%). Newly approved onychomycosis treatments include efinaconazole, tavaborole, and laser therapy with lasers only approved to temporarily increase the amount of clear nail. Additional onychomycosis treatments being investigated include iontophoresis and photodynamic therapy with small open-label studies reported thus far. Preventative strategies, to help decrease recurrence and reinfection rates, include sanitisation of footwear and prophylactic topical antifungal agents.
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Affiliation(s)
- Aditya K Gupta
- 1 Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada.,2 Mediprobe Research, Inc, London, Ontario, Canada
| | | | - Neil H Shear
- 3 Department of Medicine (Dermatology, Clinical Pharmacology and Toxicology) and Department of Pharmacology, Sunnybrook and Women's College Health Science Centre and the University of Toronto, Toronto, Ontario, Canada
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22
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Kizny Gordon A, McIver C, Kim M, Murrell DF, Taylor P. Clinical application of a molecular assay for the detection of dermatophytosis and a novel non-invasive sampling technique. Pathology 2016; 48:720-726. [PMID: 27780596 DOI: 10.1016/j.pathol.2016.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 08/23/2016] [Accepted: 08/28/2016] [Indexed: 11/30/2022]
Abstract
The dermatophytoses are the most common superficial fungal infections worldwide. Clinical diagnosis is not reliable as there are many differentials, and laboratory diagnosis is required to gain access to treatment in more severe disease. Traditional diagnostic methods are limited by suboptimal sensitivity, specificity and prolonged turnaround times. Molecular methods are being used increasingly in the diagnostic algorithm in the clinical microbiology laboratory. The aim of this study was to evaluate a real-time polymerase chain reaction (RT-PCR) targeting the chitin synthase 1 gene (CHS1) of dermatophytes for analytical specificity, and to assess its clinical application by comparing it to the current methods of microscopy and culture. We also assessed a novel non-invasive sample collection technique involving adhesive tape impressions of suspected lesions. The PCR was highly specific, being able to discern between cultures of dermatophytes and other microorganisms. It also proved to be more sensitive than traditional methods at detecting dermatophytes in clinical samples. Similar sensitivities were seen on the samples assessed by the adhesive tape technique. An internal control system allowed for the detection of inhibition in certain culture and clinical specimens. This rapid and cost-effective technique could be incorporated into the initial diagnostic algorithm for dermatophytosis in Australian laboratories.
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Affiliation(s)
- Alice Kizny Gordon
- Department of Microbiology, South Eastern Area Laboratory Services, St George Hospital, Sydney, Australia.
| | - Christopher McIver
- Department of Microbiology, South Eastern Area Laboratory Services, St George Hospital, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Minhee Kim
- Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Dermatology, St George Hospital, Sydney, NSW, Australia
| | - Dedee F Murrell
- Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Dermatology, St George Hospital, Sydney, NSW, Australia
| | - Peter Taylor
- Department of Microbiology, South Eastern Area Laboratory Services, St George Hospital, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
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23
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Reappraisal of Conventional Diagnosis for Dermatophytes. Mycopathologia 2016; 182:169-180. [PMID: 27718160 DOI: 10.1007/s11046-016-0071-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/17/2016] [Indexed: 10/20/2022]
Abstract
Dermatophytoses include a wide variety of diseases involving glabrous skin, nails and hair. These superficial infections are a common cause of consultation in dermatology. In many cases, their diagnosis is not clinically obvious, and mycological analysis therefore is required. Direct microscopic examination of the samples using clearing agents provides a quick response to the clinician and is usually combined with cultures on specific media, which must be used to overcome the growth of contaminating moulds that may hamper the recovery of dermatophytes. Accurate identification of the causative agent (i.e. at the species level), currently based on morphological criteria, is necessary not only to initiate an appropriate treatment but also for setting prophylactic measures. However, conventional methods often lack sensitivity and species identification may require up to 4 weeks if subcultures are needed. Histological analysis, which is considered the "gold standard" for the diagnosis of onychomycoses, is seldom performed, and as direct examination, it does not allow precise identification of the pathogen. Nevertheless, a particular attention to the quality of clinical specimens is warranted. Moreover, the sensitivity of direct examination may be greatly enhanced by the use of fluorochromes such as calcofluor white. Likewise, sensitivity of the cultures could be enhanced by the use of culture media containing antifungal deactivators. With the generalization of molecular identification by gene sequencing or MALDI-TOF mass spectrometry, the contribution of historical biochemical or physiological tests to species identification of atypical isolates is now limited. Nevertheless, despite the recent availability of several PCR-based kits and an extensive literature on molecular methods allowing the detection of fungal DNA or both detection and direct identification of the main dermatophyte species, the biological diagnosis of dermatophytosis in 2016 still relies on both direct examination and cultures of appropriate clinical specimens.
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Verrier J, Monod M. Diagnosis of Dermatophytosis Using Molecular Biology. Mycopathologia 2016; 182:193-202. [PMID: 27480761 DOI: 10.1007/s11046-016-0038-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/07/2016] [Indexed: 10/21/2022]
Abstract
Identification of fungi in dermatological samples using PCR is reliable and provides significantly improved results in comparison with cultures. It is possible to identify the infectious agent when negative results are obtained from cultures. In addition, identification of the infectious agent can be obtained in 1 day. Conventional and real-time PCR methods used for direct fungus identification in collected samples vary by DNA extraction methods, targeted DNA and primers, and the way of analysing the PCR products. The choice of a unique method in a laboratory is complicated because the results expected from skin and hair sample analysis are different from those expected in cases of onychomycosis. In skin and hair samples, one dermatophyte among about a dozen possible species has to be identified. In onychomycosis, the infectious agents are mainly Trichophyton rubrum and, to a lesser extent, Trichophyton interdigitale, but also moulds insensitive to oral treatments used for dermatophytes, which renders fungal identification mandatory. The benefits obtained with the use of PCR methods for routine analysis of dermatological samples have to be put in balance with the relative importance of getting a result in a short time, the price of molecular biology reagents and equipment, and especially the time spent conducting laboratory manipulations.
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Affiliation(s)
- Julie Verrier
- Groupe d'Etude des Interactions Hôte-Pathogène (GEIHP), Institut de Biologie en Santé (PBH-IRIS), CHU Angers, Université d'Angers, 4 rue Larrey, 49933, Angers, France
| | - Michel Monod
- Laboratoire de Mycologie, Service de Dermatologie, Centre Hospitalier Universitaire Vaudois, BT403, 1011, Lausanne, Switzerland.
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Wiegand C, Bauer A, Brasch J, Nenoff P, Schaller M, Mayser P, Hipler UC, Elsner P. Are the classic diagnostic methods in mycology still state of the art? J Dtsch Dermatol Ges 2016; 14:490-4. [PMID: 27119470 DOI: 10.1111/ddg.12980] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The diagnostic workup of cutaneous fungal infections is traditionally based on microscopic KOH preparations as well as culturing of the causative organism from sample material. Another possible option is the detection of fungal elements by dermatohistology. If performed correctly, these methods are generally suitable for the diagnosis of mycoses. However, the advent of personalized medicine and the tasks arising therefrom require new procedures marked by simplicity, specificity, and swiftness. The additional use of DNA-based molecular techniques further enhances sensitivity and diagnostic specificity, and reduces the diagnostic interval to 24-48 hours, compared to weeks required for conventional mycological methods. Given the steady evolution in the field of personalized medicine, simple analytical PCR-based systems are conceivable, which allow for instant diagnosis of dermatophytes in the dermatology office (point-of-care tests).
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Affiliation(s)
| | - Andrea Bauer
- Department of Dermatology, University Hospital Dresden, Dresden, Germany
| | - Jochen Brasch
- Department of Dermatology, University Hospital Kiel, Kiel, Germany
| | - Pietro Nenoff
- Laboratory for Medical Microbiology, Rötha/OT Mölbis, Germany
| | - Martin Schaller
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Peter Mayser
- Department of Dermatology and Allergology, University Hospital Giessen, Giessen, Germany
| | | | - Peter Elsner
- Department of Dermatology, University Hospital, Jena, Germany
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Wiegand C, Bauer A, Brasch J, Nenoff P, Schaller M, Mayser P, Hipler UC, Elsner P. Sind die klassischen Methoden zur mykologischen Diagnostik noch „State-of-the-Art“? J Dtsch Dermatol Ges 2016; 14:490-4. [DOI: 10.1111/ddg.12980_g] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie; Universitätsklinikum Carl Gustav Carus; Dresden
| | | | - Pietro Nenoff
- Labor für medizinische Mikrobiologie; Rötha/OT Mölbis
| | | | - Peter Mayser
- Klinik für Dermatologie und Allergologie; Universitätsklinikum Gießen
| | | | - Peter Elsner
- Klinik für Hautkrankheiten; Universitätsklinikum Jena
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Petinataud D, Berger S, Ferdynus C, Debourgogne A, Contet-Audonneau N, Machouart M. Optimising the diagnostic strategy for onychomycosis from sample collection to FUNGAL identification evaluation of a diagnostic kit for real-time PCR. Mycoses 2016; 59:304-11. [DOI: 10.1111/myc.12471] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/19/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Dimitri Petinataud
- Structure de Parasitologie-Mycologie; Département de Microbiologie; Centre Hospitalo-Universitaire de Nancy (CHU-Nancy); Hôpitaux de Brabois; Vandœuvre-les-Nancy France
| | - Sibel Berger
- Plateforme de génomique microbienne; Département de Microbiologie; CHU-Nancy; Hôpitaux de Brabois; Vandœuvre-les-Nancy France
| | - Cyril Ferdynus
- Service de Biostatistiques; CHU Félix Guyon; la Réunion; Centre de Méthodologie et de Gestion des données: Unité de Soutien Méthodologique; CHU La Réunion-Site du CHFG Route de Bellepierre; Saint Denis Cedex France
| | - Anne Debourgogne
- Structure de Parasitologie-Mycologie; Département de Microbiologie; Centre Hospitalo-Universitaire de Nancy (CHU-Nancy); Hôpitaux de Brabois; Vandœuvre-les-Nancy France
| | - Nelly Contet-Audonneau
- Structure de Parasitologie-Mycologie; Département de Microbiologie; Centre Hospitalo-Universitaire de Nancy (CHU-Nancy); Hôpitaux de Brabois; Vandœuvre-les-Nancy France
| | - Marie Machouart
- Structure de Parasitologie-Mycologie; Département de Microbiologie; Centre Hospitalo-Universitaire de Nancy (CHU-Nancy); Hôpitaux de Brabois; Vandœuvre-les-Nancy France
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28
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Wang HY, Kim H, Choi E, Lee H. Performance of the Real Fungus-ID kit based on multiplex RT-PCR assay for the rapid detection and identification of Trichophyton
spp. and Microsporum
spp. in clinical specimens with suspected dermatophyte infection. J Appl Microbiol 2015; 120:234-47. [DOI: 10.1111/jam.12993] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 10/16/2015] [Accepted: 10/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- H.-Y. Wang
- Wonju Eco Environmental Technology Center; M&D, Inc.; Wonju Korea
| | - H. Kim
- Department of Biomedical Laboratory Science; College of Health Sciences; Yonsei University; Wonju Korea
| | - E.H. Choi
- Department of Dermatology; Yonsei University Wonju College of Medicine; Wonju Korea
| | - H. Lee
- Department of Biomedical Laboratory Science; College of Health Sciences; Yonsei University; Wonju Korea
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Geddes JMH, Croll D, Caza M, Stoynov N, Foster LJ, Kronstad JW. Secretome profiling of Cryptococcus neoformans reveals regulation of a subset of virulence-associated proteins and potential biomarkers by protein kinase A. BMC Microbiol 2015; 15:206. [PMID: 26453029 PMCID: PMC4600298 DOI: 10.1186/s12866-015-0532-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 09/25/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The pathogenic yeast Cryptococcus neoformans causes life-threatening meningoencephalitis in individuals suffering from HIV/AIDS. The cyclic-AMP/protein kinase A (PKA) signal transduction pathway regulates the production of extracellular virulence factors in C. neoformans, but the influence of the pathway on the secretome has not been investigated. In this study, we performed quantitative proteomics using galactose-inducible and glucose-repressible expression of the PKA1 gene encoding the catalytic subunit of PKA to identify regulated proteins in the secretome. METHODS The proteins in the supernatants of cultures of C. neoformans were precipitated and identified using liquid chromatography-coupled tandem mass spectrometry. We also employed multiple reaction monitoring in a targeted approach to identify fungal proteins in samples from macrophages after phagocytosis of C. neoformans cells, as well as from the blood and bronchoalveolar fluid of infected mice. RESULTS We identified 61 secreted proteins and found that changes in PKA1 expression influenced the extracellular abundance of five proteins, including the Cig1 and Aph1 proteins with known roles in virulence. We also observed a change in the secretome profile upon induction of Pka1 from proteins primarily involved in catabolic and metabolic processes to an expanded set that included proteins for translational regulation and the response to stress. We further characterized the secretome data using enrichment analysis and by predicting conventional versus non-conventional secretion. Targeted proteomics of the Pka1-regulated proteins allowed us to identify the secreted proteins in lysates of phagocytic cells containing C. neoformans, and in samples from infected mice. This analysis also revealed that modulation of PKA1 expression influences the intracellular survival of cryptococcal cells upon phagocytosis. CONCLUSIONS Overall, we found that the cAMP/PKA pathway regulates specific components of the secretome including proteins that affect the virulence of C. neoformans. The detection of secreted cryptococcal proteins from infected phagocytic cells and tissue samples suggests their potential utility as biomarkers of infection. The proteomics data are available via ProteomeXchange with identifiers PXD002731 and PASS00736.
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Affiliation(s)
- Jennifer M H Geddes
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada.
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada.
| | - Daniel Croll
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada.
| | - Mélissa Caza
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada.
| | - Nikolay Stoynov
- Centre for High-Throughput Biology, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada.
| | - Leonard J Foster
- Centre for High-Throughput Biology, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada.
| | - James W Kronstad
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada.
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada.
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Nenoff P, Krüger C, Schaller J, Ginter-Hanselmayer G, Schulte-Beerbühl R, Tietz HJ. Mycology - an update part 2: dermatomycoses: clinical picture and diagnostics. J Dtsch Dermatol Ges 2015; 12:749-77. [PMID: 25176455 DOI: 10.1111/ddg.12420] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/19/2014] [Indexed: 11/28/2022]
Abstract
Most fungal infections of the skin are caused by dermatophytes, both in Germany and globally. Tinea pedis is the most frequent fungal infection in Western industrial countries. Tinea pedis frequently leads to tinea unguium, while in the elderly, both may then spread causing tinea corporis. A variety of body sites may be affected, including tinea glutealis, tinea faciei and tinea capitis. The latter rarely occurs in adults, but is the most frequent fungal infection in childhood. Following antifungal treatment of tinea unguium and also tinea capitis a dermatophytid or hyperergic reaction to dermatophyte antigens may occur. Yeast infections affect the mucous membranes both of the gastro-intestinal system and the genital tract as candidiasis mostly due to Candida albicans. Cutaneous candidiasis affects predominantely the intertriginous regions such as groins and the inframammary area, but also the intertriginous space of fingers and toes. In contrast, pityriasis versicolor is a superficial epidermal fungal infection primarily on the the trunk. Mold infections are rare in dermatology; they play a role nearly exclusively in nondermatophyte-mold (NDM) onychomycosis. The diagnosis of dermatomycoses comprises the microscopic detection of fungi using the potassium hydroxide preparation or alternatively the fluorescence optical Blankophor preparation together with culture. The histological fungal detection with PAS staining possesses a high sensitivity, and it should play a more important role in particular for diagnosis of onychomycosis. Molecular biological methods, based on the amplification of fungal DNA with use of specific primers for the distinct causative agents are on the rise. With PCR, such as dermatophyte-PCR-ELISA, fungi can be detected directly in clinical material in a highly specific and sensitive manner without prior culture. Today, molecular methods, such as Matrix Assisted Laser Desorption/Ionization Time-Of-Flight Mass Spectrometry (MALDI TOF MS) as culture confirmation assay, complete the conventional mycological diagnostics.
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Affiliation(s)
- Pietro Nenoff
- Laboratory for Medical Microbiology, Mölbis, Germany
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31
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Xanthomegnin detection does not discriminate between Trichophyton rubrum and T. mentagrophytes complexes. J Microbiol Methods 2015; 111:122-6. [DOI: 10.1016/j.mimet.2015.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/18/2015] [Accepted: 02/19/2015] [Indexed: 12/16/2022]
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Järv H. Onychomycosis caused by Onychocola canadensis: the first report in Estonia and lessons to learn. Mycoses 2015; 58:113-7. [PMID: 25591072 DOI: 10.1111/myc.12281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 11/09/2014] [Accepted: 11/17/2014] [Indexed: 11/30/2022]
Abstract
We report the first case of onychomycosis caused by Onychocola canadensis in Estonia. We believe that the number of nail infections caused by this fungus is underestimated due to the current diagnostic algorithm of non-dermatophytic onychomycosis. The need to define categories and criteria for 'proven' and 'probable' non-dermatophyte mold infections to promote more extensive studies in the future is also discussed.
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Affiliation(s)
- Helle Järv
- Department of Botany, University of Tartu, Institute of Ecology and Earth Sciences, Tartu, Estonia; Department of Microbiology, Tartu University Hospitals, United Laboratories, Tartu, Estonia
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33
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Evaluation of a commercial PCR test for the diagnosis of dermatophyte nail infections. J Med Microbiol 2015; 64:25-31. [DOI: 10.1099/jmm.0.079962-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
Onychomycosis is a frequent cause of nail infections due to dermatophytes. Molds and yeast may also be responsible of these pathologies. Antifungal treatments are frequently given without a mycological diagnosis, partly because of the requisite time for obtaining the biological results. The mycological diagnosis requires a direct microscopic examination and a culture in order to accurately identify the fungal genus and species. Nevertheless, this conventional diagnosis is often time consuming due to the delay of fungal cultures and presents disadvantages that make it not sufficient enough to give a precise and confident response to the clinicians. Therefore additional tests have been developed to help distinguish onychomycosis from other nail disorders. Among them, molecular biology techniques offer modern and rapid tools to improve traditional microbiological diagnosis. In this review, we first present the conventional diagnosis methods for onychomycosis and then we describe the main molecular biology tools and the currently available commercial kits that allow a rapid detection of the pathology.
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Dubljanin E, Calovski IC, Vujcic I, Dzamic A, Arendrup M, Petersen R, Jensen R. Clinical evaluation of aT. rubrum-specific polymerase chain reaction and pandermatophyte polymerase chain reaction in the diagnosis of suspected onychomycosis in 183 Serbian patients. Br J Dermatol 2014; 171:1593-5. [PMID: 24909835 DOI: 10.1111/bjd.13168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E. Dubljanin
- Institute of Microbiology and Immunology; Faculty of Medicine; University of Belgrade; Belgrade Serbia
| | - I. Colovic Calovski
- Institute of Microbiology and Immunology; Faculty of Medicine; University of Belgrade; Belgrade Serbia
| | - I. Vujcic
- Institute of Epidemiology; Faculty of Medicine; University of Belgrade; Belgrade Serbia
| | - A. Dzamic
- Institute of Microbiology and Immunology; Faculty of Medicine; University of Belgrade; Belgrade Serbia
| | - M.C. Arendrup
- Unit of Parasitology and Mycology; Statens Serum Institut; Copenhagen Denmark
| | - R.F. Petersen
- Microbiological Diagnostics and Virology; Statens Serum Institut; Copenhagen Denmark
| | - R.H. Jensen
- Unit of Parasitology and Mycology; Statens Serum Institut; Copenhagen Denmark
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36
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Nenoff P, Krüger C, Schaller J, Ginter-Hanselmayer G, Schulte-Beerbühl R, Tietz HJ. Mykologie - ein Update Teil 2: Dermatomykosen: Klinisches Bild und Diagnostik. J Dtsch Dermatol Ges 2014. [DOI: 10.1111/ddg.12420_suppl] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Pietro Nenoff
- Labor für medizinische Mikrobiologie, Mölbis, Deutschland
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