scholarly journals Bullous Tinea Pedis – Misdiagnosed for Long Time

2017 ◽  
Vol 6 (1) ◽  
pp. 28-30
Author(s):  
Md Mahabubur Rahaman ◽  
MA Wahab ◽  
Md Rezaul Kader ◽  
Md Rahmat Ullah Siddique ◽  
Saha Bijoy Kumar ◽  
...  
Keyword(s):  
Fungal Infection ◽  
Potassium Hydroxide ◽  
Tinea Pedis ◽  
Periodic Acid ◽  
Trichophyton Mentagrophytes ◽  
Laboratory Examination ◽  
Periodic Acid Schiff ◽  
Oral Steroids ◽  
Long Time ◽  
Oral Terbinafine

Fungal infection is very common in Dermatological practice in Bangladesh. Most of the cases can be diagnosed clinically and simple laboratory examination. But here we present a case of recurrent bullous tinea pedis that had been misdiagnosed for a long time and treated with oral steroids. Initially, direct microscopy of potassium hydroxide preparations was negative and culture did not reveal any fungal organism. In a biopsy taken simultaneously from the edge of a bulla and stained with periodic acid-Schiff, septate mycelia were clearly visible. Trichophyton mentagrophytes was later identified in repeated cultures. The patient was treated with oral Terbinafine 250 mg daily for 2 months cured completely. CBMJ 2017 January: Vol. 06 No. 01 P: 28-30

Onychomycosis: An Updated Review

2020 ◽  
Vol 14 (1) ◽  
pp. 32-45
Author(s):  
Alexander K.C. Leung ◽  
Joseph M. Lam ◽  
Kin F. Leong ◽  
Kam L. Hon ◽  
Benjamin Barankin ◽  
...  
Keyword(s):  
Fungal Infection ◽  
Therapeutic Option ◽  
English Literature ◽  
Periodic Acid ◽  
Nail Plate ◽  
Clinical Manifestations ◽  
Trichophyton Mentagrophytes ◽  
Treatment Modalities ◽  
Fungal Culture ◽  
Periodic Acid Schiff

Background : Onychomycosis is a common fungal infection of the nail. Objective: The study aimed to provide an update on the evaluation, diagnosis, and treatment of onychomycosis. Methods: A PubMed search was completed in Clinical Queries using the key term “onychomycosis”. The search was conducted in May 2019. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews published within the past 20 years. The search was restricted to English literature. Patents were searched using the key term “onychomycosis” in www.freepatentsonline.com. Results : Onychomycosis is a fungal infection of the nail unit. Approximately 90% of toenail and 75% of fingernail onychomycosis are caused by dermatophytes, notably Trichophyton mentagrophytes and Trichophyton rubrum. Clinical manifestations include discoloration of the nail, subungual hyperkeratosis, onycholysis, and onychauxis. The diagnosis can be confirmed by direct microscopic examination with a potassium hydroxide wet-mount preparation, histopathologic examination of the trimmed affected nail plate with a periodic-acid-Schiff stain, fungal culture, or polymerase chain reaction assays. Laboratory confirmation of onychomycosis before beginning a treatment regimen should be considered. Currently, oral terbinafine is the treatment of choice, followed by oral itraconazole. In general, topical monotherapy can be considered for mild to moderate onychomycosis and is a therapeutic option when oral antifungal agents are contraindicated or cannot be tolerated. Recent patents related to the management of onychomycosis are also discussed. Conclusion: Oral antifungal therapies are effective, but significant adverse effects limit their use. Although topical antifungal therapies have minimal adverse events, they are less effective than oral antifungal therapies, due to poor nail penetration. Therefore, there is a need for exploring more effective and/or alternative treatment modalities for the treatment of onychomycosis which are safer and more effective.

Onychomycosis and Tinea Pedis in the Feet of Patients With Diabetes

2021 ◽  
pp. 153473462110094
Author(s):  
Javier Aragón-Sánchez ◽  
María E. López-Valverde ◽  
Gerardo Víquez-Molina ◽  
Ana Milagro-Beamonte ◽  
Luis Torres-Sopena
Keyword(s):  
Potassium Hydroxide ◽  
Tinea Pedis ◽  
Periodic Acid ◽  
Univariate Analysis ◽  
Significant Variable ◽  
Calcofluor White ◽  
Periodic Acid Schiff ◽  
Patients With Diabetes ◽  
History Of ◽  
Direct Fluorescence

This study aimed to determine the prevalence of onychomycosis and interdigital tinea pedis in a cohort of Spanish patients with diabetes in whom onychomycosis was clinically suspected (n = 101). Samples from a first toenail scraping and the fourth toe clefts were subjected to potassium hydroxide direct vision and incubated in Sabouraud and dermatophyte test medium. Fifty-eight samples were also analyzed by a pathologist using periodic acid-Schiff staining and Calcofluor white direct fluorescence microscopy. Onychomycosis was only confirmed in 41 patients (40.6%). The most frequent aetiological agent was Trichophyton rubrum, isolated in 10 patients (36%), followed by Candida parapsilosis in 7 patients (25%). Tests on the fourth toe cleft samples were only positive in 11 patients (10.9%), and in all cases, onychomycosis was also diagnosed. Neuroischemic foot was the only significant variable associated with onychomycosis in the univariate analysis ( P < .01). A positive result for mycosis in the fourth toe cleft was found in 11 cases (10.9%) and was associated with a history of myocardial infarction ( P< .01; odds ratio [OR]: 84.2, confidence interval [CI]: 6.8-1036.4) and neuroischemic foot ( P< .01; OR: 13.7, CI: 12.6-71.6) in the multivariate model. In conclusion, the prevalence of onychomycosis and tinea pedis in patients with diabetes in whom onychomycosis was clinically suspected was 40.6% and 10.9%, respectively. In addition, onychomycosis was not always associated with tinea pedis. These results show that clinical diagnosis has low accuracy in people with diabetes mellitus, and that diagnosis should not be based on clinical toenail characteristics alone.

scholarly journals Ability of Hydroxypropyl Chitosan Nail Lacquer To Protect against Dermatophyte Nail Infection

2014 ◽  
Vol 59 (4) ◽  
pp. 1844-1848 ◽  
Author(s):  
M. A. Ghannoum ◽  
L. Long ◽  
N. Isham ◽  
A. Bulgheroni ◽  
M. Setaro ◽  
...  
Keyword(s):  
Untreated Control ◽  
Periodic Acid ◽  
Control Sample ◽  
Trichophyton Mentagrophytes ◽  
Periodic Acid Schiff ◽  
Sample Mean ◽  
Content Type ◽  
Model Following ◽  
Nail Lacquer ◽  
Nail Infection

ABSTRACTThe development of a topical agent that would strengthen the nail, improve the natural barrier, and provide better drug penetration to the nail bed is needed. In this study, we examined the effects of a hydroxypropyl chitosan (HPCH)-based nail solution using a bovine hoof model. Following application of the nail solution, changes in the hardness of the hoof samples were measured using the Vickers method. Tensile and flexural strengths were tested by stretching or punching the samples, respectively. The ultrastructure was examined using scanning electron microscopy (SEM), and samples stained with periodic acid-Schiff (PAS) stain were used to determine the fungal penetration depth. The comparators included 40% urea and 70% isopropyl alcohol solutions. The HPCH nail solution increased hoof sample hardness in comparison to the untreated control sample (mean, 22.3 versus 19.4 Vickers pyramid number [HV]). Similarly, the HPCH solution increased the tensile strength (mean, 33.07 versus 28.42 MPa) and flexural strength (mean, 183.79 versus 181.20 MPa) compared to the untreated control. In contrast, the comparators had adverse effects on hardness and strength. SEM showed that the HPCH solution reduced the area of sample crumbling following abrasion compared to the untreated control (7,418 versus 17,843 pixels), and the PAS-stained images showed that the HPCH solution reduced penetration of the dermatophyte hyphae (e.g., penetration byTrichophyton mentagrophyteswas <25 μm at day 9 versus 275 μm in the untreated control). Unlike chemicals normally used in cosmetic treatments, repeated application of the HPCH nail solution may help prevent the establishment of new or recurring fungal nail infection.

scholarly journals The role of histopathology in the diagnosis of dermatophytoses / Značaj patohistološkog nalaza u dijagnostici dermatofitoza

2010 ◽  
Vol 2 (2) ◽  
pp. 45-53 ◽  
Author(s):  
Đorđi Gocev ◽  
Katerina Damevska
Keyword(s):  
Fungal Infection ◽  
Periodic Acid ◽  
False Negative ◽  
Histopathological Analysis ◽  
Unexpected Finding ◽  
Skin Infections ◽  
Specific Staining ◽  
Periodic Acid Schiff ◽  
Skin Reactions ◽  
Pas Staining

Abstract Histopathological analysis is not a routine procedure for diagnosing fungal skin infections. In the histopathological specimens, fungi are visible only when using special stain such as periodic acid-Schiff (PAS). However, histopathological analysis may not be performed in small laboratories. Histopathological characteristics of fungal skin infections are not specific. In all skin biopsy cases, obtained without clinical suspicion of fungal infection, the knowledge of certain, most frequent histopathological reaction patterns, as well as specific histopathological indicators (a diagnostic histopathological “clue”), of certain superficial mycoses e.g., dermatophytoses, may raise a suspicion of fungal infection and warrant a fungal-specific staining. A retrospective analysis of all PAS-stained sections was carried out. All PAS-positive biopsy specimens were assessed for clinical features, histopathological patterns of skin reactions, and presence of histopathological indicators. Our results have shown that out of the total of 361 PAS-stained sections, fungal hyphae were identified in 12 (3.3%) specimens. In 5 (1.4%) cases, the diagnosis of fungal infection was suspected on clinical grounds, while in 7 (1.9%) cases detection of fungi was an unexpected finding. The most frequent type of histopathological pattern was spongiotic, and the most frequent histopathological indicator was the presence of neutrophils within the epidermis. Our results confirm that dermatophytoses may present with clinical and histological non-specific findings. PAS staining represents a relatively cheap and simple fungal-specific staining. It has been suggested that it not only confirms that the selected material is actually invaded, but also reduces the number of false-negative direct reports, where fungi are cultured from a microscopically negative specimen. Apart from a small percentage of positive findings, our results justify the need for routine PAS staining of all clinically and histologically non-specific inflammatory skin conditions.

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)

scholarly journals A histochemical method for the identification of 9-O-acyl sialic acid. An investigation of bovine submaxillary gland and intestinal mucins.

1978 ◽  
Vol 26 (3) ◽  
pp. 187-192 ◽  
Author(s):  
P E Reid ◽  
C F Culling ◽  
W L Dunn
Keyword(s):  
Sialic Acid ◽  
Potassium Hydroxide ◽  
Periodic Acid ◽  
Periodate Oxidation ◽  
Submaxillary Gland ◽  
Sialic Acids ◽  
Histochemical Method ◽  
Periodic Acid Schiff ◽  
Oxidation Step ◽  
Intestinal Mucins

Prolongation of the initial periodate oxidation step of the periodate-borohydride technique/potassium hydroxide/periodic acid-Schiff and periodic acid-Thionin Schiff/potassium hydroxide/periodic acid-Schiff sequences produced little or no change in the diagnostic staining for the potassium hydroxide/periodic acid-Schiff effect, exhibited by the colonic epithelial mucins of man and rat and the Brunner's gland mucin of rabbits. In contrast, there was a gradual, but clear decrease in the intensity of such staining of bovine submaxillary gland mucins. It was concluded that, in the intestinal mucins studied the potassium hydroxide/periodic acid-Schiff effect was due to sialic acids bearing O-acyl substitutents at positions C7 and/or C8 whereas in bovine submaxillary gland mucin the potassium hydroxide/periodic acid-Schiff effect is probably due, at least in part, to the presence of 9-O-acyl sialic acids. This investigation has led to the development of a technique which can be used to identify 9-O-acyl sialic acids.

scholarly journals A new histochemical method for the identification and visualization of both side chain acylated and nonacylated sialic acids.

1976 ◽  
Vol 24 (12) ◽  
pp. 1225-1230 ◽  
Author(s):  
C F Culling ◽  
P E Reid ◽  
W L Dunn
Keyword(s):  
Potassium Hydroxide ◽  
Periodic Acid ◽  
Sialic Acids ◽  
Histochemical Method ◽  
Side Chain ◽  
Parotid Glands ◽  
Periodic Acid Schiff ◽  
Mucin Histochemistry ◽  
Single Section ◽  
General Field

A new histochemical method is described for the differentiation of mucins that utilizes two different Schiff reagents and allows single section identification of side chain O-acylated, and nonacylated, sialic acids in contrasting colors. In the event of mucins containing only one type of sialic acid, it may allow their specific identification (e.g., C7 or C8 side chain O-acylated). It has been shown to be useful in the identification of some metastases from adenocarcinomas of colon (where the primary is potassium hydroxide/periodic acid-Schiff positive) and should prove of great value in the investigation of diseases of the gastrointestinal tract and particularly those of the colon. It should also be valuable in the general field of epithelial mucin histochemistry, particularly for those mucins of the salivary and parotid glands, etc.

scholarly journals Adrenal involvement in Histoplasmosis

2019 ◽  
Vol 9 (1) ◽  
pp. 1502-1504
Author(s):  
Nisha Sharma ◽  
Ram Chandra Adhikari
Keyword(s):  
Adrenal Gland ◽  
Fungal Infection ◽  
Adrenal Mass ◽  
Histoplasma Capsulatum ◽  
Periodic Acid ◽  
Excisional Biopsy ◽  
Left Adrenal Gland ◽  
Periodic Acid Schiff ◽  
Saprophytic Fungus ◽  
Methenamine Silver

Histoplasmosis is a fungal infection caused by a dimorphic, saprophytic fungus Histoplasma capsulatum with primary predilection for the lungs and disseminated infections occurring rarely. Our case illustrates the case of disseminated adrenal histoplasmosis in an immunocompromised 42-year-old diabetic man. Radiological diagnosis suggested bilateral malignant adrenal mass, most likely metastasis. FNAC yielded blood only. Excisional biopsy from left adrenal gland, Hematoxylin & Eosin staining along with special stains as Periodic Acid Schiff and Grocott’s Methenamine Silver were performed to yield the concluding diagnosis of histoplasmosis.

Sign in / Sign up

Export Citation Format

Share Document