PAS stain based histological classification and severity grading of toenail onychomycosis

2019 ◽  
Vol 58 (4) ◽  
pp. 453-459
Author(s):  
Xingpei Hao ◽  
Joon Yim ◽  
David Freedman ◽  
Sarwat Siddiqui ◽  
David Levine ◽  
...  
Keyword(s):  
Potassium Hydroxide ◽  
Detection Rate ◽  
World Wide ◽  
Response To Treatment ◽  
Fungal Culture ◽  
Histological Classification ◽  
Depth Level ◽  
Severity Grading ◽  
Severe Infections ◽  
Common World

Abstract Onychomycosis is a common world-wide health issue. Accurate detection is essential for treatment. Multiple studies have shown that PAS-stain based histological visualization of fungal elements is superior to either direct microscopy with 20% potassium hydroxide, or fungal culture. However, PAS stain based histological classification and severity grading of onychomycosis are lacking in the literature. Here we reported a fungal detection rate of 47.87% based on an analysis of 13,805 toenails processed for H&E and PAS stains over a three year period. Based on the analysis of fungal density, distribution and infiltrating depth level in 858 PAS-positive toenails, we created a novel PAS stain based histological classification system to classify onychomycosis as occult onychomycosis (OO), focal or diffuse subungual onychomycosis (FSO or DSO), focal or diffuse plate onychomycosis (FPO or DPO), focal or diffuse subungual and plate onychomycosis (FSPO or DSPO) and superficial onychomycosis (SO). The severities of OO, FSO and FPO were graded as mild, DSO and DPO as moderate, FSPO and DSPO as severe infections, which revealed that more than 75% PAS positive toenails were severe infections. Evaluation of 97 paired toenails biopsied pre- and post-treatment from 47 patients demonstrated that the severity of infection was significantly reduced from severe to mild and moderate levels. These data indicate that the current histological classification evaluates not only the severity of the fungal infection but also the response to treatment. We further propose a guideline for treatment of onychomycosis based on the histological classification and severity.

Clinical Study of various Nail Disorders presenting to Dermatology Outpatient Department

2017 ◽  
Vol 2 (3) ◽  
pp. 125-129
Author(s):  
Praveen K Rathore ◽  
Sapna Goyal ◽  
Anuj Kumar ◽  
Parul Garg
Keyword(s):  
Clinical Study ◽  
Potassium Hydroxide ◽  
Outpatient Department ◽  
Fungal Culture ◽  
Nail Bed ◽  
Nail Psoriasis ◽  
Medical College ◽  
Gram Staining ◽  
Nail Discoloration ◽  
Pachyonychia Congenita

ABSTRACT Aims and objectives To study the clinical spectrum of nail disorders including congenital, developmental, infectious, neoplastic, degenerative, dermatological, and systemic diseases affecting the nail unit. Materials and methods A total of 100 consecutive cases of nail disorders reporting to the dermatology outpatient department in Rohilkhand Medical College & Hospital were examined. Complete dermatological, systemic, hematological examinations, Gram staining, scraping for fungus, nail clipping for potassium hydroxide mount, fungal culture, biopsy from nail bed were undertaken in doubtful cases. Observations and results Among 100 cases, the most common was onychomycosis — 28 cases, followed by nail psoriasis — 13 cases, pitting — 10 cases, paronychia — 9 cases, trachyonychia — 5 cases, onycholysis — 4 cases, clubbing — 3 cases, koilonychia — 3 cases, ingrow toenail — 3 cases, pterygium — 3 cases, onychogryphosis — 2 cases, subungual wart — 2 cases, half and half nail — 2 cases, anonychia — 2 cases, longitudinal grooves — 2 cases, clubbing with resorption of fingers — 2 cases, onychomadesis — 1 case, nail discoloration — 1 case, melanonychia — 1 case, pachyonychia congenita — 1 case, beau's line — 1 case, racket nail — 1 case, transverse groove — 1 case. Conclusion Among examined cases, onychomycosis was most common followed by another nail disorders. How to cite this article Garg P, Kumar A, Rathore PK, Goyal S. Clinical Study of various Nail Disorders presenting to Dermatology Outpatient Department. Int J Adv Integ Med Sci 2017;2(3):125-129.

Dermatophyte test medium culture versus mycology laboratory analysis for suspected onychomycosis. A study of 100 cases in a geriatric population

2000 ◽  
Vol 90 (9) ◽  
pp. 450-459 ◽  
Author(s):  
WP Scherer ◽  
K Kinmon
Keyword(s):  
Potassium Hydroxide ◽  
Geriatric Patients ◽  
The United States ◽  
Laboratory Analysis ◽  
Fungal Culture ◽  
Test Medium ◽  
Presumptive Diagnosis ◽  
Geriatric Population ◽  
Mycology Laboratory ◽  
Medium Culture

Onychomycosis is the most frequently encountered condition in podiatric practice in the United States. A variety of modalities are available to confirm the presumptive diagnosis of onychomycosis. This study was conducted to compare the results of in-office dermatophyte test medium cultures with those of mycology laboratory analysis for 100 cases of suspected onychomycosis in a geriatric population. The results demonstrated that 20% of the patients had dermatophyte involvement, 56% had saprophyte involvement, and 19% had yeast involvement. Only 50% of positive dermatophyte test medium cultures correlated with a positive microscopic fungal culture for dermatophytes. Given these results, it is questionable whether in-office dermatophyte test medium cultures should be routinely used in geriatric patients for the diagnosis of onychomycosis. The authors believe mycology laboratory testing with fluorescent potassium hydroxide preparations and microscopic fungal cultures to be superior to in-office dermatophyte test medium cultures for the diagnosis of onychomycosis in geriatric patients.

Utility of Histopathologic Analysis in the Evaluation of Onychomycosis

2005 ◽  
Vol 95 (3) ◽  
pp. 258-263 ◽  
Author(s):  
Jeffrey M. Weinberg ◽  
Evelyn K. Koestenblatt ◽  
Maureen B. Jennings
Keyword(s):  
Potassium Hydroxide ◽  
Periodic Acid ◽  
False Negative ◽  
Nail Plate ◽  
Fungal Culture ◽  
Periodic Acid Schiff ◽  
Negative Results ◽  
False Negative Results ◽  
Histopathologic Analysis ◽  
Dermatophyte Infection

Onychomycosis is a common problem seen in clinical practice. Given the differential diagnosis of dystrophic nails, it is helpful to obtain a definitive diagnosis of dermatophyte infection before initiation of antifungal therapy. Potassium hydroxide preparation and fungal culture, which are typically used in the diagnosis of these infections, often yield false-negative results. Recent studies have suggested that nail plate biopsy with periodic acid–Schiff stain may be a very sensitive technique for the diagnosis of onychomycosis. In this article, we review the literature on the utility of histopathologic analysis in the evaluation of onychomycosis. Many of these studies indicate that biopsy with periodic acid–Schiff is the most sensitive method for diagnosing onychomycosis. We propose that histopathologic examination is indicated if the results of other methods are negative and clinical suspicion is high; therefore, it is a useful complementary technique in the diagnosis of onychomycosis. (J Am Podiatr Med Assoc 95(3): 258–263, 2005)

Efinaconazole Topical Solution, 10%

2015 ◽  
Vol 105 (5) ◽  
pp. 407-411 ◽  
Author(s):  
Bryan Markinson ◽  
Bryan Caldwell
Keyword(s):  
Potassium Hydroxide ◽  
Tinea Pedis ◽  
Fungal Culture ◽  
Cure Rate ◽  
Double Blind ◽  
Once Daily ◽  
Complete Cure ◽  
Topical Solution ◽  
Cure Rates ◽  
To Receive

Background We sought to evaluate the efficacy of efinaconazole topical solution, 10%, in patients with onychomycosis and coexisting tinea pedis. Methods We analyzed 1,655 patients, aged 18 to 70 years, randomized (3:1) to receive efinaconazole topical solution, 10%, or vehicle from two identical multicenter, double-blind, vehicle-controlled 48-week studies evaluating safety and efficacy. The primary end point was complete cure rate (0% clinical involvement of the target toenail and negative potassium hydroxide examination and fungal culture findings) at week 52. Three groups were compared: patients with onychomycosis and coexisting interdigital tinea pedis on-study (treated or left untreated) and those with no coexisting tinea pedis. Results Treatment with efinaconazole topical solution, 10%, was significantly more effective than vehicle use irrespective of the coexistence of tinea pedis or its treatment. Overall, 352 patients with onychomycosis (21.3%) had coexisting interdigital tinea pedis, with 215 of these patients (61.1%) receiving investigator-approved topical antifungal agents for their tinea pedis in addition to their randomized onychomycosis treatment. At week 52, efinaconazole complete cure rates of 29.4% were reported in patients with onychomycosis when coexisting tinea pedis was treated compared with 16.1% when coexisting tinea pedis was not treated. Both cure rates were significant compared with vehicle (P = .003 and .045, respectively), and in the latter subgroup, no patients treated with vehicle achieved a complete cure. Conclusions Treatment of coexisting tinea pedis in patients with onychomycosis enhances the efficacy of once-daily topical treatment with efinaconazole topical solution, 10%.

The Diagnosis of Onychomycosis in a Geriatric Population

2001 ◽  
Vol 91 (9) ◽  
pp. 456-464 ◽  
Author(s):  
William P. Scherer ◽  
Jon P. McCreary ◽  
Walter W. Hayes
Keyword(s):  
Private Practice ◽  
Potassium Hydroxide ◽  
Fungal Growth ◽  
South Florida ◽  
Fungal Culture ◽  
Geriatric Population ◽  
Men And Women ◽  
Fungal Organisms ◽  
Dermatophyte Infection ◽  
Mycology Laboratory

An investigative study was performed to determine the diagnosis of onychomycosis in a South Florida geriatric population. In this study, 450 cases of suspected onychomycosis involving men and women 65 years of age and older from a private practice office and two nursing home settings were used. Samples were taken from the hallux toenail and sent to a mycology laboratory for fluorescent potassium hydroxide (KOH) preparation and microscopic examination of a fungal culture. Of the 450 cases studied, 46.4% of the patients had a single fungal organism cultured, 30.4% had a mixed fungal infection cultured, and 23.1% had no fungal growth. Saprophytes were found in 59.9% of the 526 total fungal organisms cultured while dermatophytes were found in only 23.8%. The results of this investigation demonstrate that there may be a shift from isolated dermatophyte infection to mixed saprophyte infections in a geriatric population with onychomycosis. (J Am Podiatr Med Assoc 91(9): 456-464, 2001)

scholarly journals Laparoscopic Radical Prostatectomy in Albania. Initial Experience in 25 Patients

2018 ◽  
Vol 2 (2) ◽  
Author(s):  
Astrit Mustafaj ◽  
Evisa Zhapa ◽  
Francesco Saverio Grossi
Keyword(s):  
Radical Prostatectomy ◽  
World Wide ◽  
Laparoscopic Radical Prostatectomy ◽  
Pathological Examination ◽  
Initial Experience ◽  
Regional Lymph Nodes ◽  
Positive Surgical Margins ◽  
Robotic Assisted ◽  
Oncologic Results ◽  
Common World

Background: Laparoscopic or robotic assisted prostatectomy has become common world wide. However, to our knowledge, laparoscopic radical prostatectomy has not been reported in Albania. Objective: To analyze the early perioperative and oncologic results obtained with the extraperitoneal laparoscopic prostatectomy (ELRP). Patients and Method: A retrospective study of all the patients operated at Salus Hospital Tirana, Albania. All data were collected and evaluated retrospectively on the basis of thorough clinical and pathological examination. For data management and statistical analysis, all variables pre-, intra- and perioperative data were collected in a spreadsheet. Results: In the 4-year period ( outline the period), 25 patients underwent the ELRP procedure. The average age of patients was 65 year-old and the PSA of 17.5 ng/dl. The total surgery time was 168 minutes on average. Only one patient was transfused after surgery, and limfocele was present in 2 patients. No other complications occured. Pathological examination revealed pT2 and pT3 cancers in 72% (18/25) and 25% (6/25) of patients, respectively. One patient had regional lymph nodes infiltration. The incidence of positive surgical margins and biochemical relapse rate was 16 % (4/25) and 32 % (8/25), respectively.  Conclusion: The ELRP technique is safe and effective procedure in the treatment of prostate cancer, with low morbidity.

scholarly journals NASAL POLYPS

2018 ◽  
Vol 25 (09) ◽  
pp. 1417-1420
Author(s):  
Waseem Ahmad ◽  
Muhammad Iqbal ◽  
Gohar Amin
Keyword(s):  
Aspergillus Flavus ◽  
Potassium Hydroxide ◽  
Nasal Polyps ◽  
Nasal Polyposis ◽  
Fungal Culture ◽  
Aspergillus Fumigates ◽  
Reactive Hyperplasia ◽  
Taste Sense ◽  
Study Setting

Background: Nasal polyposis is a provocative situation of indefinite etiology thatinvolve nasal as well as sinus mucous membrane. Quality of life of a person can damage by nasalimpediment due to these nasal polyps. Further, it can cause of persistent postnasal drainage,hyposmia, sinusitis, taste sense change even bony demolition. It shows that inflammationreason a reactive hyperplasia of intra-nasal mucosal membrane resulted in the polyp formation.Objectives: To discover the kind of fungus concerned in nasal polyps fungal. Study Design:Descriptive study. Setting: ENT department of Sir Ganga Ram Hospital Lahore. Period: 1stJanuary 2017 to 30th June 2017. Materials and Methods: In microbiology department, thesecollected samples were processed to check the involvement of fungal. Out of all, 118 caseswere included in this study which culture was positive. Increase for microscopic assessment,mycological culture to determine the involvement of fungal and fungus kind, these sampleswere processed for diagnosis by potassium hydroxide (KOH). By using seaboard dextroseagar at 25ºC and 37ºC the fungal culture was done. Periodically it was identified through culturecharacteristics & microscopy if growth was present. Results: In this study, 118 culture positivesamples were included. In 82 cases Aspergillus Spp. was observed among positive specimens;In 32 samples Aspergillus flavus was observed while in 10 samples Aspergillus fumigates wasfound and species was not cleared in 40 samples. The fungal element was isolated in 36samples but genus was not determined. Conclusion: In fungal nasal polyposis, AspergillusSpp. is very general pathogen and we observed in our study that Aspergillus flavus is verycommon agent.

scholarly journals The Role of Pro-Adrenomedullin as a Marker of Severe Bacterial Infection in Children: A Review

Reports ◽  
2019 ◽  
Vol 2 (3) ◽  
pp. 17
Author(s):  
Silvia Garazzino ◽  
Elena Altieri ◽  
Marco Denina
Keyword(s):  
Paediatric Population ◽  
Positive Outcome ◽  
Essential Elements ◽  
Response To Treatment ◽  
Medical Progress ◽  
Reactive Protein ◽  
Risk Of Progression ◽  
Patients At Risk ◽  
Paediatric Age ◽  
Severe Infections

Sepsis is still related to high mortality and hospitalization rates in the paediatric population despite medical progress. Prompt recognition of sepsis and consequent initiation of an appropriate treatment are essential elements in securing a positive outcome in adults and children. In such scenario, various biomarkers have been studied to support the clinician in the diagnosis of severe infections, in the identification of patients at risk of progression towards sepsis as well as in the evaluation of the response to treatment. In children, the performance of C-reactive protein and procalcitonin has been largely investigated, whereas data on newer biomarkers of sepsis are scant. The aim of the present review is to summarise the available data on the use of pro-adrenomedullin in the paediatric age.

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