Evaluate the accuracy of CFW fluorescent staining for the diagnosis of suspected onychomycosis

Abstract

Abstract:

Objective Evaluate the positive rate,accuracy and efficiency of CFW (Calcofluor white) fluorescent staining for the diagnosis of suspected onychomycosis.Methods Outpatients suspected to have onychomycosis were recruited.Each patient was subjected to three methods (CFW fluorescent staining,KOH microscopy and fungal culture) together to confirm the diagnosis.Then we compared the positive rates and the statistically significant differences across the three methods.Moreover,the images under KOH and CFW were also compared. Results One hundred patients with 100 affected nails were recruited.Among them,the positive rates of the CFW,KOH,and culture were 64%,63%,and 31%,respectively.According to the McNemar test,CFW had a higher percentage of positive rate than culture testing (P<0.01),but it was not statistically significant different from KOH (P>0.05).Compared with KOH,the preparation and examination time were faster and easier,and the fungal structures under CFW were clearer,more obvious,and more easily detected. Conclusions CFW fluorescent staining was a simple,fast,convenient,accurate,and time-efficient method.It could potentially increase the accuracy and efficiency of the diagnosis of onychomycosis and help to avoid misdiagnosis.

Key words: onychomycosis, CFW fluorescent staining, KOH microscopy, fungal culture

CLC Number:

R756.4

YUE Xue-ping, SHI Xiu-yan, CHEN Wei, WAN Zhe, LI Ruo-yu, WANG Ai-ping, LI Qing. Evaluate the accuracy of CFW fluorescent staining for the diagnosis of suspected onychomycosis[J]. Chinese Journal of Mycology, 2018, 13(1): 8-10,45.

References

[1] Ghannoum M,Isham N.Fungal nail infections (onychomycosis):a never-ending story[J].Plos Pathogens,2014,10(6):206-211.
[2] Jung MY,Shim JH,Lee JH,et al.Comparison of diagnostic methods for onychomycosis,and proposal of a diagnostic algorithm[J].Clin Exp Dermatol,2015,40(5):479-484.
[3] Spiliopoulou A,Bartzavali C,Jelastopulu E,et al.Evaluation of a commercial PCR test for the diagnosis of dermatophyte nail infections[J].J Med Microbiol,2015,64(Pt 1):25-31.
[4] Soltani M,Khosravi AR,Shokri H,et al.A study of onychomycosis in patients attending a dermatology center in Tehran,Iran[J].2015,25(2):e81-87.
[5] Relloso S,Arechavala A,Guelfand L,et al.Onychomycosis:multicentre epidemiological,clinical and mycological study[J].Rev Iberoam Micol,2012,29(3):157-163.
[6] Haghani I,Shokohi T,Hajheidari Z,et al.Comparison of diagnostic methods in the evaluation of onychomycosis[J].Mycopathologia,2013,175(3-4):315-321.
[7] Bonifaz A,Rios-Yuil JM,Arenas R,et al.Comparison of direct microscopy,culture and calcofluor white for the diagnosis of onychomycosis[J].Rev Iberoam Micol,2013,30(2):109-111.
[8] Weinberg JM,Koestenblatt EK,Tutrone WD,et al.Comparison of diagnostic methods in the evaluation of onychomycosis[J].J Am Acad Dermatol,2003,49(2):193-197.
[9] Gupta AK,Zaman M,Singh J.Diagnosis of Trichophyton rubrum from onychomycotic nail samples using polymerase chain reaction and calcofluor white microscopy[J].J Am Podiatr Med Assoc,2008,98(3):224-228.
[10] Joseph J,Murthy S,Garg P,et al.Use of different stains for microscopic evaluation of corneal scrapings for diagnosis of microsporidial keratitis[J].J Clin Microbiol,2006,44(2):583-585.
[11] Zhang W,Yang H,Jiang L,et al.Use of potassium hydroxide,Giemsa and calcofluor white staining techniques in the microscopic evaluation of corneal scrapings for diagnosis of fungal keratitis[J].J Int Med Res,2010,38(6):1961-1967.
[12] Haldane DJ,Robart E.A comparison of calcofluor white,potassium hydroxide,and culture for the laboratory diagnosis of superficial fungal infection[J].Diagn Microbiol Infect Dis,1990,13(4):337-339.

[1]	WANG Ling, JING Dong-yun, WANG Xue-jun, LIU Jun, CAO Yue-qing. Efficacy of long pulsed Nd:YAG 1064nm laser for the treatment of distal lateral subungual onychomycosis and effect on the ultrastructural changes of fungi [J]. Chinese Journal of Mycology, 2020, 15(5): 268-273.
[2]	XIONG Ying, CHEN Ting, CHAI Bao, ZENG Fei-peng, SUN Wen-wen, WU Bo. In vitro evaluation of inhibitory effect and mechanism of various lasers on Trichophyton rubrum under different energies [J]. Chinese Journal of Mycology, 2019, 14(5): 292-296.
[3]	CAO Yan-yun, SUN Ying-fei, XU Yang, KONG Wei, XU Shun-ming. Clinical observation of long-pulsed 1064nm laser combined with ketoconazole ointment in the treatment of onychomycosis [J]. Chinese Journal of Mycology, 2019, 14(3): 154-158.
[4]	Shang Yuan-yuan, Yu Nan, Dong Ling-di, Li Sha-sha, Liu Yu-xi. Clinical significance of plasma (1-3)-β-D glucan for diagnosis of invasive fungal infection [J]. Chinese Journal of Mycology, 2018, 13(3): 168-172.
[5]	SONG Na-na, ZHOU Xiao-wei, LI Xiao-fang, LIU Wei-da. The current therapeutics and research progress of topical antifungal agents [J]. Chinese Journal of Mycology, 2018, 13(3): 184-187.
[6]	WANG Ruo-jun, LI Ruo-yu, WANG Ai-ping. Progess of topical antifungal agents for the treatment of onychomycosis [J]. Chinese Journal of Mycology, 2018, 13(2): 114-119.
[7]	ZANG Xiao-hui, YAO Zhi-yuan. Research progress in grading the severity of onychomycosis [J]. Chinese Journal of Mycology, 2017, 12(3): 168-170,179.
[8]	LU Xiang-ting, Arun Karki, HUANG Xin, ZHAO Jing-jun. Advances on the mechanism of laser therapy for onychomycosis [J]. Chinese Journal of Mycology, 2017, 12(3): 171-174.
[9]	XIE Jun, JIN Qin, WU Dan. Recurrent genital 45 cases of vaginal Candida disease clinical treatment experience [J]. Chinese Journal of Mycology, 2017, 12(3): 152-155.
[10]	WANG Han, CHEN Hui. Onychomycosis caused by Trichophyton violaceum in a child and review of literatures [J]. Chinese Journal of Mycology, 2016, 11(5): 292-293.
[11]	HUANG He, LI Jin, LIU Juan, ZHANG Jia-an, XU Yang, WU Di, LUO Dan, ZHOU Bing-rong. Efficacy and safety of superpulse-mode fractional carbon-dioxide laser combined with 1% luliconazole in the treatment of onychomycosis [J]. Chinese Journal of Mycology, 2016, 11(5): 298-303,297.
[12]	WANG You-wei, LUO Cai-hui, LI Hong-xia, YANG Yang, ZHAO Wei, LIU Chun-jiang. An analysis of isolates of pathogenic fungi from 47766 suspected skin mycosis outpatients [J]. Chinese Journal of Mycology, 2016, 11(1): 37-40.
[13]	GUO Yan-yang, WU Zhuo-yan, GAO Ji-xin, ZHAO Di, LIAO Wen-jun, WANG Sheng-chun. A case of generalized superficial mycosis with SLE [J]. Chinese Journal of Mycology, 2015, 10(6): 368-370.
[14]	WANG Ai-ping, YU Jin, WAN Zhe, LI Fu-qiu, ZENG Jing-si, LIU Wei-da, ZHANG Qiang-qing, HAO Fei, RAN Yu-ping, XI Li-yan, LAI Wei, LI Ruo-yu. Multi-center epidemiological survey of pathogenic fungi of onychomycosis in China [J]. Chinese Journal of Mycology, 2015, 10(4): 197-202.
[15]	QIU Meng, ZOU Xian-biao. The apprehension of British association of dermatologists' guidelines for the management of onychomycosis 2014 [J]. Chinese Journal of Mycology, 2015, 10(3): 171-174.