Comparison of direct smear, culture and histology for the diagnosis of onychomycosis

SUMMARY A sensitive and efficient diagnostic strategy is needed to confirm the clinical suspicion of onychomycosis. The purpose of this study was to compare the sensitivity of three most commonly used diagnostic methods for onychomycosis. Nail specimens of 96 patients with clinically suspected onych...

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Bibliographic Details
Published in:Australasian journal of dermatology 2007-02, Vol.48 (1), p.18-21
Main Authors: Karimzadegan-Nia, Motahareh, Mir-Amin-Mohammadi, Akram, Bouzari, Navid, Firooz, Alireza
Format: Article
Language:English
Subjects:
Biological and medical sciences
Culture Techniques
Dermatology
dermatophyte
Female
Foot Dermatoses - diagnosis
Foot Dermatoses - microbiology
Foot Dermatoses - pathology
Hand Dermatoses - diagnosis
Hand Dermatoses - microbiology
Hand Dermatoses - pathology
Histological Techniques
Human mycoses
Humans
Infectious diseases
Male
Medical sciences
Mycoses
Mycoses of the skin
nail
Onychomycosis - diagnosis
Onychomycosis - microbiology
Onychomycosis - pathology
Predictive Value of Tests
sensitivity
Sensitivity and Specificity
specificity
Specimen Handling
yeast
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Summary:SUMMARY A sensitive and efficient diagnostic strategy is needed to confirm the clinical suspicion of onychomycosis. The purpose of this study was to compare the sensitivity of three most commonly used diagnostic methods for onychomycosis. Nail specimens of 96 patients with clinically suspected onychomycosis were evaluated using potassium hydroxide smear, culture and histology. A positive result of any of these tests was considered confirmatory for fungal infection and the sensitivity of each test as well as various combinations of them was calculated. The diagnosis of onychomycosis was confirmed in 47 patients (48.9%). Histology was the most sensitive single test for the diagnosis of onychomycosis, although its sensitivity (80.8%) was not statistically different from smear (76.5%). Both histology and smear were significantly more sensitive than culture (53.2%). The most sensitive combination of tests, smear plus histology, was 97.8% sensitive with 98% negative predictive value. In conclusion, direct smear combined with histological examination is the most sensitive diagnostic approach for onychomycosis.
ISSN:0004-8380
1440-0960
DOI:10.1111/j.1440-0960.2007.00320.x