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Onychomycosis Laboratory Diagnosis: Review

  • Fungal Infections of Skin and Subcutaneous Tissue (A Bonifaz, Section Editor)
  • Published:
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Abstract

Purpose of Review

Onychomycosis is a growing global health problem. Proper diagnosis is important in order to avoid the risks of unnecessary treatments. This review summarizes the laboratory techniques currently available for the diagnosis of onychomycosis with the advantages and disadvantages of each test.

Recent Findings

Research is underway to prove the clinical utility of other diagnostic techniques such as PAS-stained nail biopsies and molecular tests as viable alternatives for the diagnosis of onychomycosis with promissory results.

Summary

Dermoscopy can be helpful to differentiate onychomycosis from traumatic onycholysis or true melanonychia; however, a definitive diagnosis requires the demonstration of the presence of the fungi. The combination of direct microscopy using potassium hydroxide and fungal culture is the gold standard for the diagnosis of onychomycosis; however, other alternatives, such as calcofluor white under fluorescence, PAS-stained nail biopsies, and molecular techniques have proven to be excellent methods with their advantages and limitations.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance.

  1. Asz-Sigall D, Tosti A, Arenas R. Tinea Uunguium: Ddiagnosis and Ttreatment in Ppractice. Mycopathologia. 2017;182:95–100.

    Article  CAS  PubMed  Google Scholar 

  2. • Bonifaz A, Rios-Yuil JM, Arenas R, Araiza J, Fernández R, Mercadillo-Pérez P, et al. Comparison of direct microscopy, culture and calcofluor white for the diagnosis of onychomycosis. Rev. Iberoam Micol. 2013;30:109–11. Study highlighting the usefulness of CW

    Article  PubMed  Google Scholar 

  3. • Rios-Yuil JM, Bonifaz A, Arenas R, Araiza J, Fernández R, Mercadillo-Pérez P, et al. Mycological studies of nail samples obtained by curettage vs. vertical perforation of the nail plate. J Eur Acad Dermatol Venereol. 2013;27:1189–90. Study comparing nail sampling techniques

    Article  CAS  PubMed  Google Scholar 

  4. Kaur R, Kashyap B, Bhalla P. Onychomycosis – Eepidemiology, Ddiagnosis and Mmanagement. Indian J Med Microbiol. 2008;26:108–16.

    Article  CAS  PubMed  Google Scholar 

  5. •• Velasquez-Agudelo V, Cardona-Arias JA. Meta-analysis of the utility of culture, biopsy, and direct KOH examination for the diagnosis of onychomycosis. BMC Infect Dis. 2017;17:166. Meta-analysis showing PAS-staining is a very good alternative for the diagnosis of onychomycosis

    Article  PubMed  PubMed Central  Google Scholar 

  6. • Jung MY, Shim JH, Lee JH, Lee JH, Yang JM, Lee DY, et al. Comparison of diagnostic methods for onychomycosis, and proposal of a diagnostic algorithm. Clin Exp Dermatol. 2015;40:479–84. Proposes a diagnostic algorithm for onychomycosis

    Article  CAS  PubMed  Google Scholar 

  7. Ohn J, Choe YS, Park J, Mun JH. Dermoscopic patterns of fungal melanonychia: Aa comparative study with other causes of melanonychia. J Am Acad Dermatol. 2017;76:488–93.

    Article  PubMed  Google Scholar 

  8. Bet DL, Reis AL, Di Chiacchio N, Belda JW. Dermoscopy and Oonychomycosis: guided nail abrasion for mycological samples. An Bras Dermatol. 2015;90:904–6.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Blake N, Zhu J, Hernandez G, Juliano PJ. A Rretrospective Rreview of Ddiagnostic Ttesting for Oonychomycosis of the Ffoot. J Am Podiatr Med Assoc. 2015;105:503–8.

    Article  PubMed  Google Scholar 

  10. Jeelani S, Ahmed QM, Lanker AM, Hassan I, Jeelani N, Fazili T. Histopathological examination of nail clippings using PAS staining (HPE-PAS): gold standard in diagnosis of Oonychomycosis. Mycoses. 2015;58:27–32.

    Article  CAS  PubMed  Google Scholar 

  11. Bombace F, Iovene MR, Galdiero M, Martora F, Nicoletti GF, D'’Andrea M, et al. Non-dermatophytic onychomycosis diagnostic criteria: an unresolved question. Mycoses. 2016;59:558–65.

    Article  PubMed  Google Scholar 

  12. Gomez-Moyano E, Erchiga VC, Martínez Pilar L, Godoy Diaz DJ. [Which is the role of cultures in the diagnosis of onychomycosis?]. Rev. Iberoam Micol. 2015;32:129–30.

    Article  Google Scholar 

  13. Ovrén E, Berglund L, Nordlind K, Rollman O. Dermatophytosis: fluorostaining enhances speed and sensitivity in direct microscopy of skin, nail and hair specimens from dermatology outpatients. Mycoses. 2016;59:436–41.

    Article  PubMed  Google Scholar 

  14. •• Stephen S, Tosti A, Rubin AI. Diagnostic applications of nail clippings. Dermatol Clin. 2015;33:289–301. Highlights the applications and correct technique for obtaining nail clippings

    Article  CAS  PubMed  Google Scholar 

  15. Hajar T, Fernández-Martínez R, Moreno-Coutiño G, Vásquez Del Mercado E, Arenas R. Modified PAS stain: Aa new diagnostic method for onychomycosis. Rev. Iberoam Micol. 2016;33:34–7.

    Article  PubMed  Google Scholar 

  16. Watanabe S, Ishida K. Molecular Ddiagnostic Ttechniques for Oonychomycosis: Vvalidity and Ppotential Aapplication. Am J Clin Dermatol. 2017;18:281–6.

    Article  PubMed  Google Scholar 

  17. •• Verrier J, Monod M. Diagnosis of Ddermatophytosis Uusing Mmolecular Bbiology. Mycopathologia. 2017;182:193–202. Comprehensive review of molecular diagnostic methods

    Article  CAS  PubMed  Google Scholar 

  18. Kotrotsiou T, Chatzimichaloglou A, Nasr A, Spandou E, Patsatsi A, Sotiriadis D, et al. A comparative study of three extraction protocols of DNA from nails: Ppotential use in the diagnosis of onychomycoses. Mycoses. 2017;60:183–7.

    Article  CAS  PubMed  Google Scholar 

  19. Spiliopoulou A, Bartzavali C, Jelastopulu E, Anastassiou ED, Christofidou M. Evaluation of a commercial PCR test for the diagnosis of dermatophyte nail infections. J Med Microbiol. 2015;64(Pt 1):25–31.

    Article  CAS  PubMed  Google Scholar 

  20. Feng X, Ling B, Yang X, Liao W, Pan W, Yao Z. Molecular Iidentification of Ccandida Sspecies Iisolated from Oonychomycosis in Shanghai, China. Mycopathologia. 2015;180(5–6):365–71.

    Article  CAS  PubMed  Google Scholar 

  21. Petinataud D, Berger S, Ferdynus C, Debourgogne A, Contet-Audonneau N, Machouart M. Optimising the diagnostic strategy for onychomycosis from sample collection to FUNGAL identification evaluation of a diagnostic kit for real-time PCR. Mycoses. 2016;59:304–11.

    Article  CAS  PubMed  Google Scholar 

  22. Gong J, Ran M, Wang X, Wan Z, Li R. Development and Eevaluation of a Nnovel Rreal-Ttime PCR for Ppan-Ddermatophyte Ddetection in Nnail Sspecimens. Mycopathologia. 2016;181:51–7.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Jose Manuel Rios-Yuil.

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The author declares that he has no competing interests.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Fungal Infections of Skin and Subcutaneous Tissue

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Rios-Yuil, J.M. Onychomycosis Laboratory Diagnosis: Review. Curr Fungal Infect Rep 11, 92–97 (2017). https://doi.org/10.1007/s12281-017-0285-6

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  • DOI: https://doi.org/10.1007/s12281-017-0285-6

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