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Mycological Examination

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European Handbook of Dermatological Treatments

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Abstract

Mycological examination is the diagnostic procedure necessary to confirm a fungal disease. The diagnosis of a fungal infection is considered simple from a clinical point of view, but the report of unusual presentations, misdiagnosed or sometimes neglected, has increased worldwide causing extensive and long-standing disease. The mycological test is also necessary to document the complete cure response to treatment, as clinical recovery is often followed by a relapse if the fungus has not been completely eliminated from the skin (mycological cure).

General immunosuppressive treatment for inflammatory chronic diseases and acquired immune depression syndrome is frequently complicated with fungal superinfections, both from common strain and rare or opportunistic fungal species, such as cryptococcosis, histoplasmosis, sporotrichosis, blastomycosis, and aspergillosis. In the immunocompetent patient, dermatophytes are the main fungal infection, being the primary pathogen. Clinical presentation has also changed with time, from the classic ringworm appearance (tinea) to more veiled eczematous undefined patches, simulating more frequent diseases, such as atopic or contact eczema, seborrheic dermatitis, impetigo, rosacea, and lupus erythematosus. A general common attitude to prescribe combination treatments and/or corticosteroid topics before confirming the diagnosis (“ex adjuvantibus”) is one of the possible causes of further dermatophyte pathomorphosis and misdiagnosis, named tinea incognita or tinea atypica.

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References

  • Afshar P, Larijani LV, Rouhanizadeh H. A comparison of conventional rapid methods in diagnosis of superficial and cutaneous mycoses based on KOH, Chicago sky blue 6B and calcofluor white stains. Iran J Microbiol. 2018;10(6):433–40.

    PubMed  PubMed Central  Google Scholar 

  • Al-Janabi AAHS, Al-Tememi NN, Al-Shammari RA, Al-Assadi AHA. Suitability of hair type for dermatophytes perforation and differential diagnosis of T. mentagrophytes from T. verrucosum. Mycoses. 2016;59:247–52.

    Article  PubMed  Google Scholar 

  • Alshawa K, Beretti JL, Lacroix C, Feuilhade M, Dauphin B, Quesne G, et al. Successful identification of clinical dermatophyte and Neoscytalidium species by matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol. 2012;50(7):2277–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ansar A, Farshchian M, Nazeri H, Ghiasian SA. Clinico-epidemiological and mycological aspects of tinea incognito in Iran: a 16-year study. Med Mycol J. 2011;52(1):25–32.

    Article  PubMed  Google Scholar 

  • Atzori L, Pau M, Aste N, Aste N. Dermatophyte infections mimicking other skin diseases: a 154-person case survey of tinea atypica in the district of Cagliari (Italy). Int J Dermatol. 2012;51(4):410–5.

    Article  PubMed  Google Scholar 

  • Atzori L, Pau M, Aste N. Tinea atypica. G Ital Dermatol Venereol. 2013;148(6):593–601.

    CAS  PubMed  Google Scholar 

  • Bahuguna S, Kushwaha RK. Hair perforation by keratinophilic fungi. Mycoses. 1989;32(7):340–3.

    Article  CAS  PubMed  Google Scholar 

  • Bašková L, Buchta V. Laboratory diagnostics of invasive fungal infections: an overview with emphasis on molecular approach. Folia Microbiol. 2012;57(5):421–30.

    Article  Google Scholar 

  • Bejdák P, Lengerová M, Paloušová D, Volfová P, Kocmanová I, Mayer J, Ráčil Z. Detection and identification of filamentous fungi causing mycoses using molecular genetic methods. Klin Mikrobiol Infekc Lek. 2012;18(4):109–14.

    PubMed  Google Scholar 

  • Bhat YJ, Keen A, Hassan I, Latif I, Bashir S. Can dermoscopy serve as a diagnostic tool in dermatophytosis? A pilot study. Indian Dermatol Online J. 2019;10:530–5.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bonifaz A, Rios-Yuil JM, Arenas R, et al. Comparison of direct microscopy, culture and calcofluor white for the diagnosis of onychomycosis. Rev Iberoam Micol. 2013;30(2):109–11.

    Article  PubMed  Google Scholar 

  • Bugli F, Cacaci M, Martini C, Torelli R, Posteraro B, Sanguinetti M, Paroni SF. Human monoclonal antibody-based therapy in the treatment of invasive candidiasis. Clin Dev Immunol. 2013;2013:403121.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cassagne C, Normand AC, L’Ollivier C, Ranque S, Piarroux R. Performance of MALDI-TOF MS plat-forms for fungal identification. Mycoses. 2016;59(11):678–90.

    Article  PubMed  Google Scholar 

  • Friedman D, Friedman PC, Gill M. Reflectance confocal microscopy: an effective diagnostic tool for dermatophytic infections. Cutis. 2015;95(2):93–7.

    PubMed  Google Scholar 

  • Gong J, Ran M, Wang X, Wan Z, Li R. Development and evaluation of a novel real-time PCR for pan-dermatophyte detection in nail specimens. Mycopathologia. 2016;181(1–2):51–7.

    Article  CAS  PubMed  Google Scholar 

  • Grigoriu D, Delacretaz J, Borelli D. Medical mycology. Toronto, ON: Hans Huber Publishers; 1987.

    Google Scholar 

  • Hui D, Xue-Cheng S, Xu A-E. Evaluation of reflectance confocal microscopy in dermatophytosis. Mycoses. 2013;56(2):130–3.

    Article  PubMed  Google Scholar 

  • Isa R, Amaya B, Pimentel M, Arenas R, Tosti A, Cruz A. Dermoscopy in tinea capitis: a prospective study on 43 patients. Med Cutan Iber Lat Am. 2014;42:18–22.

    Google Scholar 

  • Ive FA, Marks R. Tinea incognito. Br Med J. 1968;3(5611):149–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Karimzadegan-Nia M, Mir-Amin-Mohammadi A, Bouzari N, Firooz A. Comparison of direct smear, culture and histology for the diagnosis of onychomycosis. Aust J Dermatol. 2007;48(1):18–21.

    Article  Google Scholar 

  • Kourkoumpetis TK, Fuchs BB, Coleman JJ, Desalermos A, Mylonakis E. Polymerase chain reaction-based assays for the diagnosis of invasive fungal infections. Clin Infect Dis. 2012;54(9):1322–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lawry MA, Haneke E, Strobeck K, Martin S, Zimmer B, Romano PS. Methods for diagnosing onychomycosis: a comparative study and review of the literature. Arch Dermatol. 2000;136(9):1112–6.

    Article  CAS  PubMed  Google Scholar 

  • Liu D, Cloe S, Baird R, Pedersen J. Application of PCR to the identification of dermatophyte fungi. Med Microbiol. 2000;49:493–7.

    Article  CAS  Google Scholar 

  • Marcos JY, Pincus DH. Fungal diagnostics: review of commercially available methods. Methods Mol Biol. 2013;968:25–54.

    Article  CAS  PubMed  Google Scholar 

  • Margarot J, Devèz P. La lumière de Wood en dermatologie. Ann Derm Syph. 1929;10:581.

    Google Scholar 

  • Nenoff P, Erhard M, Simon JC, Muylowa GK, Herrmann J, Rataj W, Gräser Y. MALDI-TOF mass spectrometry – a rapid method for the identification of dermatophyte species. Med Mycol. 2013;51(1):17–24.

    Article  CAS  PubMed  Google Scholar 

  • Nenoff P, Verma SB, Vasani R, et al. The current Indian epidemic of superficial dermatophytosis due to Trichophyton mentagrophytes-a molecular study. Mycoses. 2019;62(4):336–56.

    Article  CAS  PubMed  Google Scholar 

  • Panasiti V, Borroni RG, Devirgiliis V, Rossi M, Fabbrizio L, Masciangelo R, Bottoni U, Calvieri S. Comparison of diagnostic methods in the diagnosis of dermatomycoses and onychomycoses. Mycoses. 2006;49:26–9.

    Article  CAS  PubMed  Google Scholar 

  • Piraccini BM, Balestri R, Starace M, Rech G. Nail digital dermoscopy (onychoscopy) in the diagnosis of onychomycosis. J Eur Acad Dermatol Venereol. 2013;27:509–13.

    Article  CAS  PubMed  Google Scholar 

  • Romano C, Maritati E, Gianni C. Tinea incognito in Italy: a 15-year survey. Mycoses. 2006;49(5):383–7.

    Article  CAS  PubMed  Google Scholar 

  • Seyfarth F, Wiegand C, Erhard M, Gräser Y, Elsner P, Hipler UC. Identification of yeast isolated from dermatological patients by MALDI-TOF mass spectrometry. Mycoses. 2012;55(3):276–80.

    Article  CAS  PubMed  Google Scholar 

  • Shenoy MM, Teerthanath S, Karnaker VK, Girisha BS, Krishna Prasad MS, Pinto J. Comparison of potassium hydroxide mount and mycological culture with histopathologic examination using periodic acid-Schiff staining of the nail clippings in the diagnosis of onychomycosis. Indian J Dermatol Venereol Leprol. 2008;74(3):226–9.

    Article  PubMed  Google Scholar 

  • Skerlev M, Miklić P. The changing face of microsporum spp infections. Clin Dermatol. 2010;28(2):146–50.

    Article  PubMed  Google Scholar 

  • Theel ES, Hall L, Mandrekar J, Wengenack NL. Dermatophyte identification using matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol. 2011;49(12):4067–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Tsunemi Y, Hiruma M. Clinical study of Dermatophyte Test Strip, an immunochromatographic method, to detect tinea unguium dermatophytes. J Dermatol. 2016;43:1–7.

    Article  Google Scholar 

  • Veasey JV, Meneses OMS, da Silva FO. Reflectance confocal microscopy of tinea capitis: comparing images with results of dermoscopy and mycological exams. Int J Dermatol. 2019;58:849–51.

    Article  PubMed  Google Scholar 

  • Verma SB. Emergence of recalcitrant dermatophytosis in India. Lancet Infect Dis. 2018;18(7):718–9.

    Article  PubMed  Google Scholar 

  • Weitzman I, Summerbell RC. The dermatophytes. Clin Microbiol Rev. 1995;8(2):240–59.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wolfson JS, Waldron MA, Sierra LS. Blinded comparison of a direct immunofluorescent monoclonal antibody staining method and a Giemsa staining method for identification of Pneumocystis carinii in induced sputum and bronchoalveolar lavage specimens of patients infected with human immunodeficiency virus. J Clin Microbiol. 1990;28(9):2136–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Zisova LG, Dobrev HP, Tchernev G, et al. Tinea atypica: report of nine cases. Wien Med Wochenschr. 2013;163(23–24):549–55.

    Article  PubMed  Google Scholar 

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Acknowledgment

The authors are grateful to Barry Mark Wheaton for the kind revision of the English text.

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Authors and Affiliations

  1. Department of Dermatology, University of Cagliari, Cagliari, Italy

    Laura Atzori, Laura Pizzatti, Monica Pau & Nicola Aste

  2. Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy

    Laura Atzori & Laura Pizzatti

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  1. Laura Atzori
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  2. Laura Pizzatti
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  3. Monica Pau
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  4. Nicola Aste
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Correspondence to Laura Atzori .

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Editors and Affiliations

  1. Andreas Syggros Hospital, Athens State University, Athens, Greece

    Andreas D. Katsambas

  2. Research Center CSRMR, Marconi University, Rome, Roma, Italy

    Torello M. Lotti

  3. Andreas Syggros Hospital, Athens State University, Athens, Greece

    Clio Dessinioti

  4. Dermatoloy Unit, Livorno Hospital, Livorno, Italy

    Angelo Massimiliano D'Erme

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Atzori, L., Pizzatti, L., Pau, M., Aste, N. (2023). Mycological Examination. In: Katsambas, A.D., Lotti, T.M., Dessinioti, C., D'Erme, A.M. (eds) European Handbook of Dermatological Treatments. Springer, Cham. https://doi.org/10.1007/978-3-031-15130-9_123

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  • DOI: https://doi.org/10.1007/978-3-031-15130-9_123

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  • Online ISBN: 978-3-031-15130-9

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