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Jabrodini A, Sohrabizdeh M, Aboutalebian S, Hashemi SB, Zomorodian K, Alirezaie A, Rasti Jahromi M, Shamsdin SN, Motamedi M. Molecular strategy for the direct detection and identification of the most common fungal community in cerumen specimens by multiplex PCR. J Med Microbiol 2023; 72. [PMID: 37624031 DOI: 10.1099/jmm.0.001746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
Introduction. Otomycosis is a superficial fungal infection that is responsible for approximately 9-27 % of otitis externa. However, fungal communities in otomycosis are varied, but Aspergillus spp. and Candida spp. are the most common causes of this infection.Hypothesis Statement. The multiplex PCR assay is postulated to be able to directly detect more than one fungal genus in cerumen specimens.Aim. This study aimed to develop and evaluate the role of the multiplex PCR assay in detecting the most common genus of fungi that cause otomycosis directly from the cerumen specimens.Methodology. To detect Candida and Aspergillus/Penicillium genera, three pairs of primers, including pan-fungal, pan-Candida, and pan-Aspergillus/Penicillium, were used in a multiplex PCR. In order to evaluate the performance and reproducibility of the multiplex PCR. the cerumen of 140 patients suspected of otomycosis were investigated.Results. Pan-Candida and pan-Aspergillus/Penicillium primers were designed to amplify the ITS1-5.8S-ITS2 region and the β-tubulin gene, respectively. In the multiplex PCR assay, 64 (47.40 %) and 118 (87.40 %) specimens were positive with pan-Candida and pan-Aspergillus/Penicillium primers, respectively. Double amplicon bands of Candida and Aspergillus were obtained in 51 (37.77 %) specimens. In the culture method, yeast (n=18, 13.33 %) and mould (n=117, 86.66 %) were isolated from 135 cerumen specimens. The sensitivity, specificity, and positive and negative predictive values of the multiplex PCR assays using culture method results as the gold standard were determined to be 94, 33, 97, and 22 %, respectively.Conclusion. In our study, multiplex PCR assays enabled simultaneous detection of two common genera of the causative agent of otomycosis in a cerumen specimen. Regarding the high sensitivity of the first step of the multiplex PCR assay, this assay may be used for the direct detection of Candida and Aspergillus genera in other clinical specimens.
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Affiliation(s)
- Ahmad Jabrodini
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Sohrabizdeh
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shima Aboutalebian
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Basir Hashemi
- Otolaryngology Research Center, Department of Otolaryngology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamiar Zomorodian
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arefeh Alirezaie
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mona Rasti Jahromi
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyedeh Neda Shamsdin
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marjan Motamedi
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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2
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Codreanu SI, Ciurea CN. Candida spp. DNA Extraction in the Age of Molecular Diagnosis. Microorganisms 2023; 11:microorganisms11040818. [PMID: 37110241 PMCID: PMC10143247 DOI: 10.3390/microorganisms11040818] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
The standard procedure for the detection of candidemia is blood culture, a method that might require 3-5 days for a positive result. Compared with culturing, molecular diagnosis techniques can provide faster diagnosis. The current paper aimed to present the main strengths and constraints of current molecular techniques for Candida spp. DNA extraction, analyzing their efficiency from a time, price, and ease of usage point of view. A comprehensive search was conducted using the PubMed NIH database for peer-reviewed full-text articles published before October 2022. The studies provided adequate data on the diagnosis of the infection with the Candida spp. DNA extraction is a relevant step in yielding pure qualitative DNA to be amplified in molecular diagnostic techniques. The most used fungal DNA extraction strategies are: mechanical (bead beating, ultrasonication, steel-bullet beating), enzymatic (proteinase K, lysozyme, lyticase), and chemical extraction (formic acid, liquid nitrogen, ammonium chloride). More clinical studies are needed to formulate adequate guidelines for fungal DNA extraction as the current paper highlighted discrepancies in the reported outcome.
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Affiliation(s)
- Smaranda Ioana Codreanu
- Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, 38 Gheorghe Marinescu Street, 540139 Târgu Mures, Romania
| | - Cristina Nicoleta Ciurea
- Department of Microbiology, Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, 38 Gheorghe Marinescu Street, 540139 Târgu Mures, Romania
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3
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Jiang W, Hu D, Xu Y, Chen Y, Zhu X, Han Z, Ye X, Li X. Loop-mediated isothermal amplification-microfluidic chip for the detection of Trichophyton infection. Front Microbiol 2022; 13:1031388. [PMID: 36312927 PMCID: PMC9606667 DOI: 10.3389/fmicb.2022.1031388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022] Open
Abstract
Trichophyton is the most pathogenic type of fungal skin infection. It often invades and grows in a keratin-rich matrix, and lesions include human skin, hair, and fingernails (toenails). We designed LAMP primers for Trichophyton and developed a LAMP-Microfluidic chip detection system for Trichophyton. This system detects six common species of Trichophyton in the genus Trichophyton, including Trichophyton rubrum, Trichophyton mentagrophyte, Trichophyton violaceum, Trichophyton tonsurans, Trichophyton verrucosum, and Trichophyton schoenleinii. The specificity reached 100%, and the sensitivity could reach about 1 × 102 copies/μl. The entire detection process can be completed within 60 min and does not cross-react with other dermatophytes. The established LAMP-Microfluidic chip detection system has the advantages of simple operation, high specificity, and high sensitivity, and has the potential for clinical application.
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Affiliation(s)
- Weiwei Jiang
- Department of Dermatology, 72nd Group Army Hospital of PLA, Huzhou, Zhejiang, China
| | - Dongying Hu
- Department of Dermatology, 72nd Group Army Hospital of PLA, Huzhou, Zhejiang, China
| | - Yanyan Xu
- Affiliated Hospital of Hebei University of Engineering, Handan, Hebei, China
| | - Yang Chen
- Department of Dermatology, 72nd Group Army Hospital of PLA, Huzhou, Zhejiang, China
| | - Xiaoyang Zhu
- Department of Dermatology, 72nd Group Army Hospital of PLA, Huzhou, Zhejiang, China
| | - Zhao Han
- Affiliated Hospital of Hebei University of Engineering, Handan, Hebei, China
- *Correspondence: Zhao Han,
| | - Xin Ye
- Department of Laboratory Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Xin Ye,
| | - Xiaojing Li
- Affiliated Hospital of Hebei University of Engineering, Handan, Hebei, China
- Xiaojing Li,
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4
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Falotico JM, Lipner SR. Updated Perspectives on the Diagnosis and Management of Onychomycosis. Clin Cosmet Investig Dermatol 2022; 15:1933-1957. [PMID: 36133401 PMCID: PMC9484770 DOI: 10.2147/ccid.s362635] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/08/2022] [Indexed: 12/02/2022]
Abstract
Onychomycosis is the most common nail disease encountered in clinical practice and can cause pain, difficulty with ambulation, and psycho-social problems. A thorough history and physical examination, including dermoscopy, should be performed for each patient presenting with nail findings suggestive of onychomycosis. Several approaches are available for definitive diagnostic testing, including potassium hydroxide and microscopy, fungal culture, histopathology, polymerase chain reaction, or a combination of techniques. Confirmatory testing should be performed for each patient prior to initiating any antifungal therapies. There are several different therapeutic options available, including oral and topical medications as well as device-based treatments. Oral antifungals are generally recommended for moderate to severe onychomycosis and have higher cure rates, while topical antifungals are recommended for mild to moderate disease and have more favorable safety profiles. Oral terbinafine, itraconazole, and griseofulvin and topical ciclopirox 8% nail lacquer, efinaconazole 10% solution, and tavaborole 5% solution are approved by the Food and Drug Administration for treatment of onychomycosis in the United States and amorolfine 5% nail lacquer is approved in Europe. Laser treatment is approved in the United States for temporary increases in clear nail, but clinical results are suboptimal. Oral fluconazole is not approved in the United States for onychomycosis treatment, but is frequently used off-label with good efficacy. Several novel oral, topical, and over-the-counter therapies are currently under investigation. Physicians should consider the disease severity, infecting pathogen, medication safety, efficacy and cost, and patient age, comorbidities, medication history, and likelihood of compliance when determining management plans. Onychomycosis is a chronic disease with high recurrence rates and patients should be counseled on an appropriate plan to minimize recurrence risk following effective antifungal therapy.
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Affiliation(s)
- Julianne M Falotico
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Shari R Lipner
- Weill Cornell Medicine, Department of Dermatology, New York, NY, USA
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5
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Motamedi M, Amini A, Yazdanpanah S, Mahmoodi M, Khodadadi H, Zalpoor H. Evaluation of different DNA extraction methods based on steel-bullet beating for molecular diagnosis of onychomycosis. J Clin Lab Anal 2022; 36:e24657. [PMID: 35989493 PMCID: PMC9550968 DOI: 10.1002/jcla.24657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Considering increased trends toward molecular methods for detection/identification of fungi causing onychomycosis, the aim of this study is comparison three DNA extraction methods based on steel-bullet beating to extract DNA from nail. METHODS Ex -vivo onychomycosis model was developed using bovine hoof with Candida albicans and Aspergillus flavus. For two models, total DNA was extracted using the three different methods. In method 1, the extraction and purification were performed by steel-bullet beating and phenol chloroform protocol, respectively. In method 2, a freezing step were applied before beating. The purification step in method 3 was carried out using a commercial kit, although DNA extraction was done similarly to method 1 in that approach. To evaluate the efficacy of each method, the extracted genomic DNA was amplified with Polymerase Chain Reaction (PCR) using Internal Transcribed Spacer (ITS) regions. Moreover, 50 nail samples were evaluated for onychomycosis using direct microscopy examination as well as PCR in order to evaluate the diagnostic efficiency of the optimal DNA extraction method. RESULTS Regarding the desirable quality of the extracted DNA, cost effectiveness, and simplicity, method 1 could be used to extract DNA effectively. Additionally, the obtained data showed that PCR had a higher detection rate of fungal agents in the nail samples than direct microscopic examination. CONCLUSIONS This study demonstrated that the mechanical disruption of the cell wall by steel-bullet beating is a useful and practical method to improve the quantity and quality of fungal DNA thorough the extraction process.
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Affiliation(s)
- Marjan Motamedi
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical
- Science, Shiraz, Iran
| | - Abdulbaqi Amini
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical
- Science, Shiraz, Iran
| | - Somayeh Yazdanpanah
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical
- Science, Shiraz, Iran
| | - Mozhgan Mahmoodi
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical
- Science, Shiraz, Iran
| | - Hossein Khodadadi
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical
- Science, Shiraz, Iran
| | - Hamidreza Zalpoor
- Neuroscience Research Center, Shiraz University of Medical Siences, Shiraz, Iran
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6
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Gupta AK, Hall DC, Cooper EA, Ghannoum MA. Diagnosing Onychomycosis: What’s New? J Fungi (Basel) 2022; 8:jof8050464. [PMID: 35628720 PMCID: PMC9146047 DOI: 10.3390/jof8050464] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 02/05/2023] Open
Abstract
An overview of the long-established methods of diagnosing onychomycosis (potassium hydroxide testing, fungal culture, and histopathological examination) is provided followed by an outline of other diagnostic methods currently in use or under development. These methods generally use one of two diagnostic techniques: visual identification of infection (fungal elements or onychomycosis signs) or organism identification (typing of fungal genus/species). Visual diagnosis (dermoscopy, optical coherence tomography, confocal microscopy, UV fluorescence excitation) provides clinical evidence of infection, but may be limited by lack of organism information when treatment decisions are needed. The organism identification methods (lateral flow techniques, polymerase chain reaction, MALDI-TOF mass spectroscopy and Raman spectroscopy) seek to provide faster and more reliable identification than standard fungal culture methods. Additionally, artificial intelligence methods are being applied to assist with visual identification, with good success. Despite being considered the ‘gold standard’ for diagnosis, clinicians are generally well aware that the established methods have many limitations for diagnosis. The new techniques seek to augment established methods, but also have advantages and disadvantages relative to their diagnostic use. It remains to be seen which of the newer methods will become more widely used for diagnosis of onychomycosis. Clinicians need to be aware of the limitations of diagnostic utility calculations as well, and look beyond the numbers to assess which techniques will provide the best options for patient assessment and management.
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Affiliation(s)
- Aditya K. Gupta
- Department of Medicine, Division of Dermatology, University of Toronto School of Medicine, Toronto, ON M5S 3H2, Canada
- Mediprobe Research Inc., London, ON N5X 2P1, Canada; (D.C.H.); (E.A.C.)
- Correspondence: ; Tel.: +1-519-851-9715; Fax: +1-519-657-4233
| | - Deanna C. Hall
- Mediprobe Research Inc., London, ON N5X 2P1, Canada; (D.C.H.); (E.A.C.)
| | | | - Mahmoud A. Ghannoum
- Center for Medical Mycology, Department of Dermatology, Case Western Reserve University, Cleveland, OH 44106, USA;
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
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7
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Fuhr R, Cook D, Ridden J, Nield K, Leigh E, Cook J, Davies‐Strickleton H, Dobmeyer J. Results from Phase 1/2 trial of BB2603, a terbinafine‐based topical nano‐formulation, in onychomycosis and tinea pedis. Mycoses 2022; 65:661-669. [DOI: 10.1111/myc.13448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/17/2022] [Accepted: 04/21/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - David Cook
- Blueberry Therapeutics Limited Macclesfield SK10 4TG UK
| | - John Ridden
- Blueberry Therapeutics Limited Macclesfield SK10 4TG UK
| | - Kerry Nield
- Blueberry Therapeutics Limited Macclesfield SK10 4TG UK
| | - Emma Leigh
- Blueberry Therapeutics Limited Macclesfield SK10 4TG UK
| | - Julie Cook
- Blueberry Therapeutics Limited Macclesfield SK10 4TG UK
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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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Evaluation of the Multiplex Real-Time PCR DermaGenius ® Assay for the Detection of Dermatophytes in Hair Samples from Senegal. J Fungi (Basel) 2021; 8:jof8010011. [PMID: 35049951 PMCID: PMC8781194 DOI: 10.3390/jof8010011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 12/11/2022] Open
Abstract
For the successful treatment of dermatophytoses, especially tinea capitis, there is a need for accurate and rapid diagnostic methods. A lot of recent literature has focused on the detection of dermatophytes directly on sample material such as nails, hair and skin scrapings. Molecular tools offer the ability to rapidly diagnose dermatophytosis within 48 h. This study aimed to compare the results of a commercial real-time PCR (real-time PCR) assay DermaGenius®(DG) 2.0 complete multiplex kit with those of conventional diagnostic methods (direct microscopy and culture). A total of 129 hair samples were collected in Dakar (Senegal) from patients suspected of dermatophytosis. DG was applied for the molecular detection of Candida albicans, Trichophyton rubrum/soudanense, T. interdigitale, T. tonsurans, T. mentagrophytes, T. violaceum, Microsporum canis, M. audouinii, Epidermophyton floccosum, T. benhamiae and T. verrucosum. Dermatophytes species and C. albicans were differentiated by melting curve analysis. The sensitivity and specificity of the PCR assay were 89.3% and 75.3%, respectively. DG PCR was significantly more sensitive than culture (p < 0.001). DG PCR is fast and robust to contamination. In this paper, the main questions discussed were the replacement of culture by a broad-spectrum fungal real-time PCR and the implementation of DG PCR into a routine laboratory in Senegal.
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10
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Trave I, Cozzani E, Canepa P, Verdiani S, Parodi A. Real-life applicability of the Euroarray Dermatomycosis Kit in the diagnosis of onychomycosis. Mycoses 2021; 65:317-322. [PMID: 34843133 DOI: 10.1111/myc.13405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Traditionally, KOH microscopy and fungal culture are the two preferred tests as gold standard for diagnosis of onychomycosis. Recently, other diagnostic methods have been developed to improve the microbiological diagnosis. The EUROArray dermatomycosis kit is a PCR-based microarray test system for the detection and direct identification of species that are most frequently involved in skin and nail infections. OBJECTIVES Our primary aim was to evaluate the real-life applicability of the EUROArray dermatomycosis kit in the diagnosis of onychomycoses. In addition, we compared the etiology of onychomycoses found in our patients with those described in the literature. PATIENTS/METHODS We prospectively studied consecutive 100 patients with suspected onychomycoses. Samples of suspect toenails were taken as part of routine medical management. Nail specimens were evaluated by means of 3 diagnostic methods: KOH preparation, culture and EUROArray dermatomycosis kit. RESULTS Onychomycosis was diagnosed in 47/100 patients who proved positive on at least one reference diagnostic test and in 49/100 patients who proved positive on PCR. The combination of microscopy and PCR had better sensitivity than microscopy (p=0.0397), fungal culture (p=0.0061) and PCR alone (p=0 .0117). Molds were more frequently positive in culture than in PCR (p=0.033). Dermatophytes proved positive more frequent than molds and yeasts in both culture and PCR; in particular, Trichophyton interdigitale was the most frequent pathogen. CONCLUSIONS In conclusion, introducing EUROArray dermatomycosis kit into the diagnostic algorithm of onychomycosis increases the sensitivity of direct microscopy and yields more rapid results than culture.
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Affiliation(s)
- I Trave
- Section of Dermatology - Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
| | - E Cozzani
- Section of Dermatology - Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
| | - P Canepa
- Section of Dermatology - Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
| | - S Verdiani
- Section of Dermatology - Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
| | - A Parodi
- Section of Dermatology - Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
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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: 4] [Impact Index Per Article: 1.3] [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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12
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Mareschal A, Scherer E, Lihoreau T, Bellanger AP, Millon L, Aubin F. Diagnosis of toenail onychomycosis by an immunochromatographic dermatophytes test strip. J Eur Acad Dermatol Venereol 2021; 35:e367-e369. [PMID: 33465839 DOI: 10.1111/jdv.17128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/17/2020] [Accepted: 01/14/2021] [Indexed: 11/30/2022]
Affiliation(s)
- A Mareschal
- Department of Dermatology, CHU Besançon, Besançon, France
| | - E Scherer
- Department of Parasitology-Mycology, CHU Besançon, Besançon, France
| | - T Lihoreau
- Inserm CIC 1431, CHU Besançon, Besançon, France
| | - A-P Bellanger
- Department of Parasitology-Mycology, CHU Besançon, Besançon, France
| | - L Millon
- Department of Parasitology-Mycology, CHU Besançon, Besançon, France
| | - F Aubin
- Department of Dermatology, CHU Besançon, Besançon, France.,Inserm UMR 1098 RIGHT, Université de Franche Comté, Besançon, France
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Seo JW, Kim JY, Kim DH, Oh JJ, Kim YJ, Kim GH. Selection and characterization of toxic Aspergillus spore-specific DNA aptamer using spore-SELEX. RSC Adv 2021; 11:2608-2615. [PMID: 35424249 PMCID: PMC8693783 DOI: 10.1039/d0ra09571k] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/28/2020] [Indexed: 11/30/2022] Open
Abstract
As airborne spores of toxic Aspergillus species cause mild symptoms to invasive fungal infections, their indoor concentration should be controlled through real-time management. Aptamer-based biosensors could provide economical and simple solutions for point-of-care. In this study, we isolated aptamers binding to the spores of three representative toxic Aspergillus species (A. fumigatus, A. flavus, and A. niger) for the first time, using cell-SELEX (systematic evolution of ligands through exponential enrichment). Among the aptamer candidates, Asp-3 showed a broad and high binding affinity for the Aspergillus spores. Considering the low binding affinity with proteinase-treated spores, we speculated that the Asp-3 binding sites could be possibly associated with cell surface proteins. The high Asp-3 specificity was confirmed by comparing the binding affinity between the Aspergillus target species and other common indoor fungal species. Moreover, we also established quantitative linear relationships between Asp-3 and the spore concentration of each Aspergillus species. Therefore, the selected Asp-3 aptamer, conjugated with detection sensors, could be an effective biorecognition element for the spores of three toxic Aspergillus species.
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Affiliation(s)
- Jin-Woo Seo
- Division of Environmental Science & Ecological Engineering, College of Life Sciences & Biotechnology, Korea University 145, Anam-ro, Seongbuk-gu Seoul 02841 Korea +82 2 3290 9753 +82 2 3290 3014
| | - Jee Young Kim
- Division of Environmental Science & Ecological Engineering, College of Life Sciences & Biotechnology, Korea University 145, Anam-ro, Seongbuk-gu Seoul 02841 Korea +82 2 3290 9753 +82 2 3290 3014
| | - Da Hee Kim
- Division of Environmental Science & Ecological Engineering, College of Life Sciences & Biotechnology, Korea University 145, Anam-ro, Seongbuk-gu Seoul 02841 Korea +82 2 3290 9753 +82 2 3290 3014
| | - Jeong-Joo Oh
- Division of Environmental Science & Ecological Engineering, College of Life Sciences & Biotechnology, Korea University 145, Anam-ro, Seongbuk-gu Seoul 02841 Korea +82 2 3290 9753 +82 2 3290 3014
| | - Young Jun Kim
- Life Science and Biotechnology Department, Underwood Division, Underwood International College, Yonsei University Seoul 03722 Korea
| | - Gyu-Hyeok Kim
- Division of Environmental Science & Ecological Engineering, College of Life Sciences & Biotechnology, Korea University 145, Anam-ro, Seongbuk-gu Seoul 02841 Korea +82 2 3290 9753 +82 2 3290 3014
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Colosi IA, Cognet O, Colosi HA, Sabou M, Costache C. Dermatophytes and Dermatophytosis in Cluj-Napoca, Romania-A 4-Year Cross-Sectional Study. J Fungi (Basel) 2020; 6:E154. [PMID: 32872110 PMCID: PMC7558200 DOI: 10.3390/jof6030154] [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: 07/28/2020] [Revised: 08/23/2020] [Accepted: 08/27/2020] [Indexed: 12/28/2022] Open
Abstract
Dermatophytes are filamentous keratinophilic fungi which affect nails, skin, and hair. Their variable distribution in the world justifies local epidemiological studies. During recent decades, few studies have been published regarding the epidemiology and etiology of dermatophytosis in Romania. The aim of this study was to identify the dermatophytes isolated from superficial fungal infections. To the best of our knowledge, this is the first such study conducted in the area of North-Western Romania. Over the past four years, samples collected from outpatients with suggestive lesions for dermatophytoses (nails, skin, hair), who addressed several private practice dermatologists from Cluj-Napoca, Romania, were sent to a specialized laboratory and examined by microscopy and culture. A total of 350 samples from 322 patients were examined. One hundred samples (28.6%) collected from 90 patients (27.9%) were positive by direct microscopy and/or culture. Among the 63 positive cultures (18%), 44 dermatophytes (69.8%), 2 molds (3.2%), and 17 yeasts (27%) were isolated. The main dermatophyte species identified were Trichophyton rubrum (mostly from onychomycosis) and Microsporum canis (from tinea capitis and tinea corporis in children). Yeasts (Candida species) were isolated from nails, especially from women.
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Affiliation(s)
- Ioana Alina Colosi
- Department of Microbiology, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (I.A.C.); (C.C.)
- Department of Laboratory Medicine, Regina Maria Private Health Network, Unirea Medical Center, 400117 Cluj-Napoca, Romania
| | - Odile Cognet
- Parasitology-Mycology Laboratory, Grenoble Alpes University Hospital, 38043 Grenoble CEDEX 9, France;
| | - Horațiu Alexandru Colosi
- Division of Medical Informatics and Biostatistics, Department of Medical Education, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Marcela Sabou
- Dynamique des Interactions Hôte-Pathogène UR 7292, Université de Strasbourg, F-67000 Strasbourg, France;
| | - Carmen Costache
- Department of Microbiology, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (I.A.C.); (C.C.)
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15
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Pakshir K, Farazmand F, Ghasemi F, Mirhendi H, Zomorodian K, Kharazi M, Alborzi Pour R, Golestani H, Motamedi M. Translation elongation factor 1-alpha gene as a marker for diagnosing of candidal onychomycosis. Curr Med Mycol 2020; 6:15-21. [PMID: 32420503 PMCID: PMC7217255 DOI: 10.18502/cmm.6.1.2503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose: Culture-based identification methods have been the gold standard for the diagnosis of candidal onychomycosis. Molecular technologies, such as polymerase chain reaction (PCR) assays, can provide an alternative for the rapid detection of Candida species. The present study was conducted to investigate a pan-Candida PCR assay based on the translation elongation factor 1-alpha (TEF-1α) gene for the detection of the most prevalent pathogenic Candida species. Materials and Methods: For the purpose of the study, an optimized pan-Candida PCR primer pair was designed, and the target was amplified and sequenced. The analytical and clinical diagnostic performance of the designed primers was tested using 17 reference strains, 137 nail scrapings suspected of onychomycosis, and 10 healthy nail specimens. Results: The use of the universal pan-Candida primers designed on TEF-1α gene resulted in the successful amplification of a 270-base pair fragment in all Candida species tested, except for C. glabrata, and reacted neither with other fungi nor with E. coli. The sequence difference count matrix showed poor insertion/deletion differences (0-2 nt) among Candida species. Among 137 nail specimens, 35% (n=48), 30.7% (n=42), and 40.1% (n=55) of the samples were found to be positive by direct microscopy, culture, and pan-Candida PCR, respectively. Conclusion: Based on the findings, the PCR-based detection targeting the DNA TEF-1α gene is a rapid and simple procedure for the diagnosis of candidal onychomycosis directly from nail sample.
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Affiliation(s)
- Keyvan Pakshir
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Basic Sciences in Infectious Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Forough Farazmand
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farnoush Ghasemi
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Mirhendi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kamiar Zomorodian
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Basic Sciences in Infectious Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahboobeh Kharazi
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hajar Golestani
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marjan Motamedi
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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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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Walser M, Bosshard P. Development and evaluation of a pan‐dermatophyte polymerase chain reaction with species‐level identification using sloppy molecular beacon probes. Br J Dermatol 2019; 180:1489-1497. [DOI: 10.1111/bjd.17512] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- M. Walser
- Institute of Molecular Life Sciences University of Zurich Winterthurerstr. 190 CH‐8057 Zurich Switzerland
| | - P.P. Bosshard
- Department of Dermatology University Hospital Zurich Gloriastrasse 31 CH‐8091 Zurich Switzerland
- Faculty of Medicine University of Zurich Gloriastrasse 31 CH‐8091 Zurich Switzerland
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18
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19
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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: 24] [Impact Index Per Article: 4.8] [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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20
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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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21
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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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22
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De Bruyne S, Speeckaert R, Boelens J, Hayette MP, Speeckaert M, Delanghe J. Infrared spectroscopy as a novel tool to diagnose onychomycosis. Br J Dermatol 2018; 180:637-646. [PMID: 30216405 DOI: 10.1111/bjd.17199] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The determination of causative organisms of onychomycosis is still not optimal. There remains a need for a cheap, fast and easy-to-perform diagnostic tool with a high capacity to distinguish between organisms. OBJECTIVES To determine whether attenuated total-reflectance Fourier transform infrared (ATR-FTIR) spectroscopy can detect and differentiate causative agents in culture-based, ex vivo nail and in vivo nail models. METHODS A methodological study was conducted. Both the ex vivo nail model and in vivo pilot study were carried out in an academic university hospital. RESULTS Analysis of cultured fungi revealed spectral differences for dermatophytes (1692-1606 and 1044-1004 cm-1 ) and nondermatophytes and yeasts (973-937 cm-1 ), confirmed by dendrograms showing an excellent separation between samples from different genera or species. Exploration of dermatophytes, nondermatophytes and yeasts growing on ex vivo nails exposed prominent differences from 1200 to 900 cm-1 . Prediction models resulted in a 96·9% accurate classification of uninfected nails and nails infected with dermatophytes, nondermatophytes and yeasts. Overall correct classification rates of 91·0%, 97·7% and 98·6% were obtained for discrimination between dermatophyte, nondermatophyte and yeast genera or species, respectively. Spectra of in vivo infected and uninfected nails also revealed distinct spectral differences (3000-2811 cm-1 , 1043-950 cm-1 and 1676-1553 cm-1 ), illustrated by two main clusters (uninfected vs. infected) on a dendrogram. CONCLUSIONS Our data suggest that ATR-FTIR spectroscopy may be a promising, fast and accurate method to determine onychomycosis, including identification of the causative organism, bypassing the need for lengthy fungal cultures.
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Affiliation(s)
- S De Bruyne
- Department of Laboratory Medicine, Ghent University, Ghent, Belgium.,Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium
| | - R Speeckaert
- Department of Dermatology, Ghent University, Ghent, Belgium
| | - J Boelens
- Department of Laboratory Medicine, Ghent University, Ghent, Belgium.,Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium
| | - M-P Hayette
- Department of Clinical Microbiology, CHU Sart-Tilman, Liège, Belgium
| | - M Speeckaert
- Department of Nephrology, Ghent University, Ghent, Belgium
| | - J Delanghe
- Department of Laboratory Medicine, Ghent University, Ghent, Belgium.,Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium
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23
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Karaman BF, Açıkalın A, Ünal İ, Aksungur VL. Diagnostic values of KOH examination, histological examination, and culture for onychomycosis: a latent class analysis. Int J Dermatol 2018; 58:319-324. [DOI: 10.1111/ijd.14255] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 06/22/2018] [Accepted: 08/31/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Arbil Açıkalın
- Department of Pathology; Faculty of Medicine; Çukurova University; Adana Turkey
| | - İlker Ünal
- Department of Biostatistics; Faculty of Medicine; Çukurova University; Adana Turkey
| | - Varol L. Aksungur
- Department of Dermatology; Faculty of Medicine; Çukurova University; Adana Turkey
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24
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Gnat S, Łagowski D, Nowakiewicz A, Trościańczyk A, Zięba P. Infection ofTrichophyton verrucosumin cattle breeders, Poland: A 40-year retrospective study on the genomic variability of strains. Mycoses 2018; 61:681-690. [DOI: 10.1111/myc.12791] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/12/2018] [Accepted: 05/08/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Sebastian Gnat
- Faculty of Veterinary Medicine; Sub-Department of Veterinary Microbiology; Institute of Biological Bases of Animal Diseases; University of Life Sciences; Lublin Poland
| | - Dominik Łagowski
- Faculty of Veterinary Medicine; Sub-Department of Veterinary Microbiology; Institute of Biological Bases of Animal Diseases; University of Life Sciences; Lublin Poland
| | - Aneta Nowakiewicz
- Faculty of Veterinary Medicine; Sub-Department of Veterinary Microbiology; Institute of Biological Bases of Animal Diseases; University of Life Sciences; Lublin Poland
| | - Aleksandra Trościańczyk
- Faculty of Veterinary Medicine; Sub-Department of Veterinary Microbiology; Institute of Biological Bases of Animal Diseases; University of Life Sciences; Lublin Poland
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25
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Bao F, Fan Y, Sun L, Yu Y, Wang Z, Pan Q, Yu C, Liu H, Zhang F. Comparison of fungal fluorescent staining and ITS rDNA PCR-based sequencing with conventional methods for the diagnosis of onychomycosis. J Eur Acad Dermatol Venereol 2018; 32:1017-1021. [PMID: 29405481 PMCID: PMC6001524 DOI: 10.1111/jdv.14843] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/22/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The current gold standard for diagnosing onychomycosis is direct microscopic examination and culturing. Fungal culture is a time-consuming procedure, while direct microscopy of potassium hydroxide (KOH) mounts suffers from low sensitivity. More rapid and sensitive methods for the diagnosis of onychomycosis are in high demand. OBJECTIVE To establish an effective method for the diagnosis of onychomycosis by assessing the efficacies of fungal fluorescent staining and internal transcribed spacer (ITS) ribosomal DNA (rDNA) polymerase chain reaction (PCR)-based sequencing. METHODS A total of 204 clinical specimens from patients with suspected onychomycosis were analysed. The gold standard for a true positive sample was positive by KOH, culturing or both methods. All specimens were also tested by fungal fluorescent staining and ITS rDNA PCR-based sequencing. We compared the detection, sensitivity and specificity for these two methods with conventional methods. RESULTS In total, 126 (62%) and 102 (50%) were detected by fluorescent staining and PCR-based sequencing, respectively. According to the conventional diagnostic standard, the sensitivity of fluorescent staining and PCR-based sequencing was 97% and 78%, respectively, and specificities of 89% and 90%, respectively. Use of fluorescence enhanced the sensitivity of direct examination by 12% compared with KOH. PCR-based sequencing increased the sensitivity by 6% compared with culturing. CONCLUSIONS Fluorescence microscopy has a higher sensitivity for the detection of fungi in nail specimens compared with KOH and can be used as a rapid screening tool. PCR-based sequencing was faster and more sensitive compared with culture and when used in conjunction with fluorescence microscopy resulted in higher efficiency.
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Affiliation(s)
- F Bao
- Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, China.,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Y Fan
- Department of Toxicological and Functional Test, Shandong Centers for Disease Control and Prevention, Jinan, Shandong, China
| | - L Sun
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Y Yu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Z Wang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Q Pan
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - C Yu
- Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, China.,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China
| | - H Liu
- Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, China.,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - F Zhang
- Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, China.,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China.,Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China
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26
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Gupta AK, Versteeg SG, Shear NH. Confirmatory Testing Prior to Initiating Onychomycosis Therapy Is Cost-Effective. J Cutan Med Surg 2017; 22:129-141. [DOI: 10.1177/1203475417733461] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Onychomycosis can be investigated by sampling. Information gleaned includes nail bed involvement, nail plate penetration, fungal viability, and species identification. Testing samples can confirm a diagnosis. While diagnostic testing is considered useful in directing therapy, a substantial number of clinicians do not confirm diagnosis prior to treatment. Objectives: The aim of this study is to quantify the benefit of confirmatory testing prior to treating toenail onychomycosis. Methods: The cost of mycological cure (negative potassium hydroxide and negative culture) and the cost-effectiveness of confirmatory testing were determined using the average cost of potassium hydroxide (KOH), culture, periodic acid–Schiff (PAS), efinaconazole, ciclopirox, terbinafine, and itraconazole. Costs were obtained through literature searches, public domain websites, and telephone surveys to local pharmacies and laboratories. To represent the potential risks of prescribing onychomycosis treatment, the costs associated with liver monitoring, potential life-threatening adverse events, and drug-drug interactions were obtained through public domain websites, published studies, and product inserts. Results: PAS was determined to be the most sensitive confirmatory test and KOH the least expensive. The overall cost of an incorrect diagnosis (no confirmatory test used) ranged between $350 and $1175 CAD per patient for treatment of 3 infected toenails. Comparatively, performing confirmatory testing prior to treatment decreases the overall cost to $320 to $930, depending on the therapy, physician, and test. Conclusions: It is preferred to diagnose onychomycosis prior to treatment. Furthermore, there are cost savings when confirmatory testing is performed before initiating treatment with both topical and oral antifungals in Canada.
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Affiliation(s)
- Aditya K. Gupta
- Department of Medicine, University of Toronto School of Medicine, Toronto, ON, Canada
- Mediprobe Research, London, ON, Canada
| | | | - Neil H. Shear
- 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, ON, Canada
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27
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Motamedi M, Mirhendi H, Zomorodian K, Khodadadi H, Kharazi M, Ghasemi Z, Shidfar MR, Makimura K. Clinical evaluation of β-tubulin real-time PCR for rapid diagnosis of dermatophytosis, a comparison with mycological methods. Mycoses 2017; 60:692-696. [DOI: 10.1111/myc.12648] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/25/2017] [Accepted: 05/29/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Marjan Motamedi
- Department of Medical Parasitology and Mycology; School of Medicine; Shiraz University of Medical Sciences; Shiraz Iran
- Department of Medical Parasitology and Mycology; School of Public Health; National Institute of Health Research; Tehran University of Medical Sciences; Tehran Iran
| | - Hossein Mirhendi
- Department of Medical Parasitology and Mycology; School of Medicine; Isfahan University of Medical Sciences; Isfahan Iran
| | - Kamiar Zomorodian
- Department of Medical Parasitology and Mycology; School of Medicine; Shiraz University of Medical Sciences; Shiraz Iran
| | - Hossein Khodadadi
- Department of Medical Parasitology and Mycology; School of Medicine; Shiraz University of Medical Sciences; Shiraz Iran
| | - Mahboobeh Kharazi
- Department of Medical Parasitology and Mycology; International Campus; Tehran University of Medical Sciences; Tehran Iran
| | - Zeinab Ghasemi
- Department of Medical Parasitology and Mycology; School of Public Health; National Institute of Health Research; Tehran University of Medical Sciences; Tehran Iran
| | - Mohammad Reza Shidfar
- Department of Medical Parasitology and Mycology; School of Public Health; National Institute of Health Research; Tehran University of Medical Sciences; Tehran Iran
| | - Koichi Makimura
- Laboratory of Space and Environmental Medicine; Graduate School of Medicine; Teikyo University; Tokyo Japan
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28
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29
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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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Gnat S, Nowakiewicz A, Ziółkowska G, Trościańczyk A, Majer-Dziedzic B, Zięba P. Evaluation of growth conditions and DNA extraction techniques used in the molecular analysis of dermatophytes. J Appl Microbiol 2017; 122:1368-1379. [DOI: 10.1111/jam.13427] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/13/2017] [Accepted: 02/20/2017] [Indexed: 11/28/2022]
Affiliation(s)
- S. Gnat
- Sub-Department of Veterinary Microbiology; Institute of Biological Bases of Animal Diseases; Faculty of Veterinary Medicine; University of Life Sciences; Lublin Poland
| | - A. Nowakiewicz
- Sub-Department of Veterinary Microbiology; Institute of Biological Bases of Animal Diseases; Faculty of Veterinary Medicine; University of Life Sciences; Lublin Poland
| | - G. Ziółkowska
- Sub-Department of Veterinary Microbiology; Institute of Biological Bases of Animal Diseases; Faculty of Veterinary Medicine; University of Life Sciences; Lublin Poland
| | - A. Trościańczyk
- Sub-Department of Veterinary Microbiology; Institute of Biological Bases of Animal Diseases; Faculty of Veterinary Medicine; University of Life Sciences; Lublin Poland
| | - B. Majer-Dziedzic
- Sub-Department of Veterinary Microbiology; Institute of Biological Bases of Animal Diseases; Faculty of Veterinary Medicine; University of Life Sciences; Lublin Poland
| | - P. Zięba
- State Veterinary Laboratory; Lublin Poland
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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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