scholarly journals Comparative evaluation of KOH mount, fungal culture and PAS staining in onychomycosis

Author(s):  
Venkateswaramma Begari ◽  
Prathyusha Pathakumari ◽  
Anant A. Takalkar

<p class="abstract"><strong>Background:</strong> Onychomycosis is a common ailment associated with significant physical and psychological morbidity. Increased prevalence in the recent years has attributed to enhanced longitivity, co morbid conditions like diabetes, avid spots participation and emergence of HIV. The objective of the study was to evaluate KOH mount, fungal culture and PAS staining of affected nail plate in diagnosis of onychomycosis.</p><p class="abstract"><strong>Methods:</strong> The present study was carried out in OPD of Dermatology, PESIMSR, Kuppam, Andhra Pradesh during the period of October 2010 to October 2012 including all patients showing classical clinical features of onychomycosis.<strong></strong></p><p class="abstract"><strong>Results:</strong> Majority of patients were from 21-40 years age group i.e. 46%. 56% of finger nails were commonly involved than 36% toe nails. DLSO is the most common clinical variant accounting for 80%. Most common isolated species as <em>Trichophyton rubrum </em>(31.6%) followed by <em>T. mentagrophytes</em> and <em>Aspergillus niger</em> 15.8% each. The sensitivity of KOH (81.82%), PAS (84.56%) and culture 57%. Both PAS and KOH were more sensitive than culture (p&lt;0.001). PAS was also more sensitive than KOH. The specificity of KOH 92.86%, culture 92.86% and PAS 57.14%.</p><p class="abstract"><strong>Conclusions:</strong> Fungal culture though is the gold standard for the identification of pathogens but it takes minimum 2-3 weeks. Histopathological examination of nail clippings with PAS stain is simple, highly sensitive screening test.</p>

2005 ◽  
Vol 95 (3) ◽  
pp. 258-263 ◽  
Author(s):  
Jeffrey M. Weinberg ◽  
Evelyn K. Koestenblatt ◽  
Maureen B. Jennings

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)


2018 ◽  
Vol 46 ◽  
pp. 5
Author(s):  
Saulo Romero Felix Gonçalves ◽  
Órion Pedro Da Silva ◽  
Mariana Lumack do Monte Barretto ◽  
Rômulo Freitas Francelino Dias ◽  
Raylson Pereira De Oliveira ◽  
...  

Background: Cryptococcosis is an important zoonotic disease that occurs worldwide. The disease is caused by a soilborne opportunistic fungus of the genus Cryptococcus, which can also be found in the feces of birds, especially pigeons. In Brazil, the geographical distribution of the agent is fairly defined, with the species C. gattii predominantly found in thenorth-eastern states. Diagnosis is based on the clinical history, physical examination findings, and results of complementary testing, such as cytopathological and histopathological examinations. This report aims to describe the clinical and anatomopathological findings in a case of systemic cryptococcosis in a dog.Case: A 4-year-old female Miniature Schnauzer was referred for necropsy. For 3 months prior to death, the dog had displayed generalized alopecia, pruritus, and severe weight loss, Initially, a private veterinarian had suspected leishmaniasis. Gross examination was performed and samples for cytopathology, histopathology, and fungal culture were obtained. Themacroscopic examination revealed generalized alopecia, congested mucosa, cachexia, hyperemia of the brain, and multiple white nodules measuring 0.5 cm to 4 cm in the lungs and the kidneys. None of the other organs showed significant lesions. Cytopathological examination of the nodules revealed a highly cellular sample, with a severe chronic inflammatory response, characterized by multinucleated giant cells and round-to-elliptical, yeast-shaped structures (5-10 μm), suggestive ofCryptococcus organisms. Histopathological examination of the lungs, kidneys, and brain revealed a severe diffuse chronic inflammatory process, with lymphocytic infiltration and multinucleated giant cells; countless yeast-shaped, round-to-ovoid structures (similar in appearance to “soap bubbles”) that were negative in hematoxylin-eosin stain were also present.Grocott’s methenamine silver stain was then applied, which positively stained the organism capsules black, confirming Cryptococcus. For mycological diagnosis, samples from the lungs nodules were cultured on Sabouraud’s dextrose agar supplemented with chloramphenicol 0.4% and incubated for 7 days at 25-30ºC. Abundant small, smooth, irregular-sized,cream-colored colonies were obtained, and a mycological smear, stained by India ink, was performed.Discussion: Considered an uncommon disease, canine cryptococcosis can be misdiagnosed. Clinical findings, such as alopecia, lymphadenopathy, and cutaneous nodules that may be ulcerated, are commonly seen in these patients due to the hematogenous spread of the organism. In the case described, the dog’s owner was contacted and asked to provide epidemiological information. The owner reported that the dog had lived in an apartment, with little access to the street; however, pigeons were frequently observed on the balcony, along with pigeon feces in the dog feeder. The presence of pigeon feces is a risk factor for the development and spread of the fungus, which may be problematic to public health. Cytopathological examination is a simple, quick diagnostic tool with good sensitivity for some infectious agents. Mycological culture can provide results due to the characteristic of the Cryptococcus sp., since the encapsulated yeast produces a mucous-like colony. Cryptococcosis has a relevant role in public health, so a precise diagnosis is imperative. Its diagnosis is based upon culture, cytology and serological tools. When the animal does not survive to the ilness, the association between necropsyfindings and histopathological examinations is essencial.Keywords: canine, diagnostic, yeast, anatomopathology.


2021 ◽  
Vol 15 (02) ◽  
pp. 306-309
Author(s):  
Risa Miliawati Nurul Hidayah ◽  
Andini Dwikenia Anjani ◽  
Lies Marlysa Ramali ◽  
Oki Suwarsa ◽  
Hendra Gunawan

Exfoliative dermatitis (ED) or erythroderma is defined as diffuse erythema and scaling of the skin involving more than 90% of the total body skin surface, which can be caused by variety of systemic and cutaneous diseases, such as infection, including dermatophytosis. Dermatophytosis is a superficial fungal infection of keratinized tissue caused by dermatophytes. There are only few case reports of ED due to dermatophytosis in literature. A 39-year-old male present with history of diffuse erythematous macules and scales almost on entire body due to dermatophytosis was reported. The diagnosis of dermatophytosis was confirmed by direct microscopic examination, fungal culture, and histopathological examination. Patient was treated with 2% ketoconazole shampoo and two pulses of 1-week of 200 mg itraconazole twice a day for each month. Clinical improvement was showed on the 7th day of observation characterized by decreasing of erythematous macules and scales. Mycological and clinical improvements were obtained on the 29th day of observation. The etiology of ED should be determined in order to give an appropiate treatment.


Author(s):  
Rashmi Kandukuri ◽  
Suresh Phatak

Background: Computed Tomography plays a major diagnostic role in patients with inflammatory sinonasal diseases and determines the mode of management by displaying the complex osteomeatal anatomy, determining anatomical variations, extent of disease and characterizing various inflammatory sinonasal diseases. Purpose of the study was to assess the role of CT in evaluation of inflammatory sinonasal diseases by evaluating the sensitivity and specificity of CT in diagnosis of various inflammatory Sinonasal diseases.Methods: In this hospital based prospective study 122 patients with symptomatic inflammatory sinonasal diseases were evaluated by 16 slice MDCT. CT diagnosis is correlated with final diagnosis obtained from findings of nasal endoscopy/Functional Endoscopic Sinus Surgery, histopathological examination and fungal culture. Statistical analysis was done by descriptive and inferential statistics using Test statistics (sensitivity, specificity, PPV, NPV and accuracy) and Z test for single proportions (Z value >1.96 is considered significant). Software used in the analysis was SPSS 17.0 version and graph pad prism 6.0 version and p <0.05 is considered as level of significance.Results: On correlating CT diagnosis with final diagnosis, Chronic Sinusitis had 98.41% sensitivity and 96.61% specificity, fungal sinusitis had 66.67% sensitivity and specificity 99.14%, polyps had sensitivity of 94.59% and specificity of 97.6%, the rest of the inflammatory conditions had sensitivity 93.7 % and 99% specificity. P value in all instances was <0.05, i.e. <0.0001, indicating the significance of the findings.Conclusions: CT is the diagnostic modality of choice in evaluation of various inflammatory pathologies and associated complications thereby planning the further management of the patient.


2021 ◽  
pp. 72-76
Author(s):  
Nam Gyoung Ha ◽  
Kyung Duck Park ◽  
Yong Jun Bang ◽  
Jae Bok Jun ◽  
Jong Soo Choi ◽  
...  

Purpureocillium lilacinum is a saprophytic fungus with a ubiquitous environmental distribution, and it can be detected in soil samples and decaying materials worldwide. It has been reported as an emerging pathogen in both immunocompromised and immunocompetent patients, showing various cutaneous presentations. Herein, we report a case of a patient with a localized cutaneous P. lilacinum infection, which resembles the skin lesions of psoriasis. A 72-year-old female was presented with a peripherally spreading, well-demarcated, asymptomatic, scaly, erythematous patch on her forehead for several months. Histopathological examination showed pinkish septated fungal elements and mixed inflammatory and granulomatous infiltrates in the dermis. Furthermore, a fungal culture on potato dextrose agar showed gray, velvety colonies with light yellow background after being subcultured. Phialides with chains of oval conidia were observed on lactophenol cotton blue staining. The ITS region of rRNA gene sequence obtained from the colony was identical to that of Purpureocillium lilacinum. The lesion was resolved with oral itraconazole (200 mg/day) after four months of treatment.


Author(s):  
Sarita Kumari Nayak ◽  
P. Bala Murali Krishna ◽  
N. Lakshmi

Background: Onychomycosis is one of the most common fungal nail infections caused by Dermatophytes, Non-Dermatophytic Molds (NDM) and Yeast. Though it is not life-threatening, can cause pain, discomfort, and disfigurement. It decreases the nail growth rate. Objectives: This study was carried out to document the clinico-mycological pattern and antifungal susceptibility pattern of onychomycosis.Methods: The study group included 130 consecutive patients with suspected fungal nail infections, attending Dermatology outpatient department of King George Hospital, Visakhapatnam, Andhra Pradesh during November 2012 to August 2014. The nail clippings of the patients were collected and subjected to KOH mounts for direct microscopy and fungal culture and antifungal susceptibility tests.Results: Onychomycosis was common among males (66.92%) than females (33.08%) with highest incidence was in age group 31-40 years (41.37%). Finger or toenails were exclusively involved in 32.18% and 55.18% patients respectively while these were involved concurrently in the rest of the 12.65% patients. Distal and lateral subungual onychomycosis seen in 64.36% of the patients was the most common clinical type. KOH and culture positivity were recorded in 56.92% and 48.46% cases respectively. Dermatophytes (50.58%) were predominant isolate followed by NDM (27.58%) and yeast (21.84%). Clotrimazole and ketoconazole were most effective antifungals against dermatophytes. For NDM, itraconazole, nystatin and amphotericin B and for yeast fluconazole and itraconazole were effective.Conclusions: The present study gives an insight about the aetiological agents causing onychomycosis and their anti-fungal susceptibility pattern in this region. Thus, it can help in taking adequate control measures to prevent it.


2021 ◽  
Vol 28 (5) ◽  
pp. 4016-4030
Author(s):  
Katarzyna Steinhof-Radwańska ◽  
Andrzej Lorek ◽  
Michał Holecki ◽  
Anna Barczyk-Gutkowska ◽  
Anna Grażyńska ◽  
...  

Background: The multifocality and multicentrality of breast cancer (MFMCC) are the significant aspects that determine a specialist’s choice between applying breast-conserving therapy (BCT) or performing a mastectomy. This study aimed to assess the usefulness of mammography (MG), contrast-enhanced spectral mammography (CESM), and magnetic resonance imaging (MRI) in women diagnosed with breast cancer before qualifying for surgical intervention to visualize other (additional) cancer foci. Methods: The study included 60 breast cancer cases out of 630 patients initially who underwent surgery due to breast cancer from January 2015 to April 2019. MG, CESM, and MRI were compared with each other in terms of the presence of MFMCC and assessed for compliance with the postoperative histopathological examination (HP). Results: Histopathological examination confirmed the presence of MFMCC in 33/60 (55%) patients. The sensitivity of MG in detecting MFMCC was 50%, and its specificity was 95.83%. For CESM, the sensitivity was 85.29%, and the specificity was 96.15%. For MRI, all the above-mentioned parameters were higher as follows: sensitivity—91.18%; specificity—92.31%. Conclusions: In patients with MFMCC, both CESM and MRI are highly sensitive in the detection of additional cancer foci. Both CESM and MRI change the extent of surgical intervention in every fourth patient.


2012 ◽  
Vol 140 (11-12) ◽  
pp. 728-731 ◽  
Author(s):  
Vesna Kopitovic ◽  
Dragan Budakov ◽  
Aleksandra Trninic-Pjevic ◽  
Sonja Pop-Trajkovic ◽  
Srdjan Djurdjevic ◽  
...  

Introduction. Hysteroscopy is one of the oldest endoscopic procedures which uses the cervix for introducing a telescope to place a camera into the uterine cavity. Objective The aim of the study was to present our experiences with this procedure during the long-term work starting from the time when hysteroscopic method of treatment was first introduced at this Clinic until today. Methods. This prospective study involved 2000 female patients referred to the Clinic for Gynecology and Obstetrics in Novi Sad from January 2005 till January 2011 for diagnostic and operative hysteroscopy. The following parameters were analyzed: the presence of minor and major pathology of the endometrium, type of anesthesia, technique of operative work, instruments and energy used during hysteroscopy and complications. Results. Seventy-eight percent of all procedures were done under intravenous anesthesia. The most common operative procedure was polypectomy and the most complicated one was myomectomy. By histopathological examination of hysteroscopic biopsy specimens four endometrial carcinomas were revealed. The combination of mechanical instrument and bipolar energy were used in most of the cases, while the percentage of complications was extremely low. Conclusion. Hysteroscopy is a safe, highly sensitive, precise diagnostic and operative endoscopic procedure. Our experiences and dilemmas open a field for discussion and offer salutations to everyday problems. The introduction of this procedure into out-patients conditions has contributed to the efficiency of the treatment of vaginal pathological processes, thus enabling that the method has become available to all gynecologists. This fact requires further study and new results.


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Mingrui Zhang ◽  
Lanxiang Jiang ◽  
Fuqiu Li ◽  
Yangchun Xu ◽  
Sha Lv ◽  
...  

Abstract Background Dermatophytosis is a fungal infectious disease caused by dermatophytes, which produce protease and keratinase to digest keratin, leading to the colonization, invasion, and infection of the stratum corneum of the skin, hair shafts, and nails. Trichophyton interdigitale belongs to Trichophyton mentagrophytes complex, which is the common pathogen causing dermatophytosis. Fungal keratitis, also called keratomycosis, is an infectious disease of cornea. Case presentation Here, we report a case of simultaneous dermatophytosis and keratomycosis caused by Trichophyton interdigitale. A 67-year-old man presented with extensive erythema all over the body since 4 years ago, fungal infection of left eye for 2 years, and loss of vision in the eye. These symptoms had become aggravated in the last month. Dermatological examinations showed extensive erythematous plaques with clear borders and scales, scattered red papules with ulceration, and scabs throughout the body. Onychomycosis was observed on the nails of left hand, conjunctival infection with secretion and loss of vision were noted in left eye. Hyaline septate hyphae were observed under direct microscopic examination, fungal culture and internal transcribed spacer sequencing revealed T. interdigitale. Histopathological examination suggested infectious granuloma. A diagnosis of dermatophytosis and keratomycosis caused by T. interdigitale with loss of vision in left eye was made. The patient was treated with luliconazole cream (two applications per day) and itraconazole (100 mg, BID, PO). Complete clinical remission was achieved after 1 month. Subsequently, the patient underwent left eye enucleation in the ophthalmology department. Conclusions In the present study, we reported a case of simultaneous dermatophytosis and keratomycosis caused by T. interdigitale, and reviewed the literature on corneal infection caused by Trichophyton. A total of 10 articles with 45 patients were published between 1973 and 2018. The pathogen of 27 patient were identified to species level. There were T. schoenleinii (17), T. mentagrophytes (4), T. verrucosum (3), T. rubrum (1), T. erinacei (1), and T. interdigitale (1). Five patients had corneal trauma, one had contact lens use history. Direct microscopic examination, fungal culture, and analysis of physiological characteristics were the main methods of identification. Early diagnosis and prompt treatment may help improve the management and outcomes.


2019 ◽  
Vol 57 (1) ◽  
pp. 139-146 ◽  
Author(s):  
Claudia Cafarchia ◽  
Romina Paradies ◽  
Luciana A. Figueredo ◽  
Roberta Iatta ◽  
Salvatore Desantis ◽  
...  

With the aim of evaluating the presence of Fusarium spp. in sea turtles with and without lesions and assessing the risk factors favoring colonization and/or infection, 74 loggerhead sea turtles ( Caretta caretta) admitted to rescue and rehabilitation clinics in Italy were analyzed. The study compared 31 individuals with no apparent macroscopic lesions and 43 individuals with macroscopic lesions. Shell and skin samples were analyzed using Calcofluor white with 10% potassium hydroxide, standard histopathological examination, and fungal cultures. Fusarium spp. were isolated more frequently from animals with superficial lesions (39%) than from those with no macroscopic lesions (16%). Isolates from animals with superficial lesions were Fusarium solani species complex (FSSC) lineages haplotypes 9, 12, and 27 (unnamed lineages), FSSC-2 ( Fusarium keratoplasticum), Fusarium oxysporum (27%), and Fusarium brachygibbosum (3%). In contrast, only F. solani haplotypes 9 and 12 were isolated from animals with no macroscopic lesions. The presence of lesions was identified as a risk factor for the occurrence of Fusarium spp. Of the 74 animals, only 7 (9.5%) scored positive on microscopic examination with Calcofluor, and histological examination of those 7 animals revealed necrosis, inflammatory cells, and fungal hyphae in the carapace and skin. The results of this study suggest that fusariosis should be included in the differential diagnosis of shell and skin lesions in sea turtles. Direct examination using Calcofluor and potassium hydroxide was not useful to diagnose the infection. Histopathological examination and fungal culture should be performed to ensure correct treatment and infection control.


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