Modified PAS stain: A new diagnostic method for onychomycosis

Hajar, Tamar; Fernández‐Martínez, Ramón; Moreno‐Coutiño, Gabriela; Mercado, Elsa Vásquez del; Arenas, Roberto

doi:10.1016/j.riam.2014.10.002

Cited by 9 publications

(9 citation statements)

References 12 publications

(19 reference statements)

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“…The main etiological agents are Trichophyton, Epidermophyton , and Candida fungi 6, 7. Onychomycosis is an emerging global health problem, as it represents 50% of nail disorders1, 8, 9 and affects 2–9% of the world population 2, 10. This pathological condition affects quality of life, with loss of the patient self-esteem and may result in physical, occupational, and social limitations 2, 11, 12…”

Section: Introductionmentioning

confidence: 99%

“…Existing therapies for onychomycosis are only partially effective, and recurrence and consequent fungal resistance are common when combined with poor medication compliance 21, 22, 23, 24, 25. Furthermore, oral antifungal drugs are associated with undesirable side effects, such as hepatotoxicity 8, 10, 19. Therefore, new alternatives to prevent, diagnose, and treat onychomycosis are of utmost importance 26 .…”

Section: Introductionmentioning

confidence: 99%

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In vitro antifungal activity of organic compounds derived from amino alcohols against onychomycosis

Caneschi

Almeida

Martins

et al. 2017

Brazilian Journal of Microbiology

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Onychomycosis is a fungal infection of the nail caused by high densities of filamentous fungi and yeasts. Treatment for this illness is long-term, and recurrences are frequently detected. This study evaluated in vitro antifungal activities of 12 organic compounds derived from amino alcohols against standard fungal strains, such as Trichophyton rubrum CCT 5507 URM 1666, Trichophyton mentagrophytes ATCC 11481, and Candida albicans ATCC 10231. The antifungal compounds were synthesized from p-hydroxybenzaldehyde (4a–4f) and p-hydroxybenzoic acid (9a–9f). Minimum inhibitory concentrations and minimum fungicidal concentrations were determined according to Clinical and Laboratory Standards Institute protocols M38-A2, M27-A3, and M27-S4. The amine series 4b–4e, mainly 4c and 4e compounds, were effective against filamentous fungi and yeast (MIC from 7.8 to 312 μg/mL). On the other hand, the amide series (9a–9f) did not present inhibitory effect against fungi, except amide 9c, which demonstrated activity only against C. albicans. This allowed us to infer that the presence of amine group and intermediate carbon number (8C–11C) in its aliphatic side chain seems to be important for antifungal activity. Although these compounds present cytotoxic activity on macrophages J774, our results suggest that these aromatic compounds might constitute potential as leader molecules in the development of more effective and less toxic analogs that could have considerable implications for future therapies of onychomycosis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

In vitro antifungal activity of organic compounds derived from amino alcohols against onychomycosis

Caneschi

Almeida

Martins

et al. 2017

Brazilian Journal of Microbiology

View full text Add to dashboard Cite

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“…[15][16][17] For example, Jung et al 18 performed a diagnostic method comparison and found that the combination of FC and PAS (94.1%) was significantly (P < 0.001) more sensitive than that of KOH and FC (72.1%). Refinements have also been tried; for instance, Hajar et al 19 tried advanced testing, such as improving the PAS stain method to refine its sensitivity and specificity.…”

Section: Discussionmentioning

confidence: 99%

Liquid chromatography–tandem mass spectrometry is effective for analysis of ergosterol in fungal‐infected nails

Yang

2019

Clin Exp Dermatol

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Summary Background Identification of onychomycosis is mainly based on clinical diagnosis with auxiliary diagnostic methods such as potassium hydroxide (KOH) microscopy, periodic acid–Schiff staining or fungal culture. However, each method is limited by its sensitivity and specificity. Aim To develop a new test method using the common fungal end product, ergosterol, and investigate if it can be used as a new diagnostic tool. Methods We collected consecutive data from 20 participants with nail problems. Following clinical diagnosis, samples were taken for KOH microscopy and for mass spectrometry (MS) to check for the presence of ergosterol. Results Of the 20 cases collected, 7 were positive for fungal infection by MS. Four of these were already suspected to have onychomycosis, whereas one of the remaining three subjects was presumed to have dry nail and the other two to have onycholysis. The MS test seemed to be better at detecting combinations of nail conditions. Conversely, of the five patients clinically diagnosed as having onychomycosis, four had a positive MS result, whereas the fifth had negative results on both KOH and MS. Two other participants had a positive KOH test and were also found to have positive MS results. Conclusion Detection of the presence of ergosterol by MS seems to be a useful tool for confirming onychomycosis. However, further studies are needed to verify the sensitivity and specificity of this MS method.

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“…A recently published meta‐analysis has evaluated the utility of direct microscopic examination, culture, and histological examination for the diagnosis of onychomycosis . In the included studies of this meta‐analysis and similar studies, the positivity rates of these diagnostic methods have shown wide ranges (Table ). This rate was ranged from 23 to 77% for KOH, from 10 to 68% for culture, and from 38 to 80% for PAS.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, another center may have a greater skill for direct microscopy, so they get a higher positivity rate for direct microscopy, as in the study of Hajar et al . (59% for direct microscopy and 18% for culture) …”

Section: Discussionmentioning

confidence: 99%

Diagnostic values of KOH examination, histological examination, and culture for onychomycosis: a latent class analysis

et al. 2018

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Background In the absence of a real gold standard, comparative studies are still done on diagnostic methods for onychomycosis. There are only a few attempts using latent class analysis to determine the value of polymerase chain reaction in comparison to conventional methods. We aimed to determine the value of histological examination in such a way for the diagnosis of onychomycosis.Methods Potassium hydroxide mount (KOH), culture and histological examination with periodic acid-Schiff (PAS), and Gomori's methenamine silver (GMS) stains were done in 106 patients having clinically suspected toenail onychomycosis.Results KOH was positive in 74% of the patients; culture in 14%; PAS in 30%; and GMS in 66%. According to the results of the latent class analysis, culture and PAS were highly specific but poorly sensitive; KOH, highly sensitive but poorly specific; and GMS, both highly sensitive and specific.Conclusions Based on these results, we have proposed KOH as a screening test and GMS as a confirmatory test for the diagnosis of onychomycosis in our own practice.However, since positivity rates of different diagnostic methods vary widely in different centers, it is more suitable that every center should determine their own diagnostic strategy by evaluating their own results with latent class analysis.

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Modified PAS stain: A new diagnostic method for onychomycosis

Cited by 9 publications

References 12 publications

In vitro antifungal activity of organic compounds derived from amino alcohols against onychomycosis

In vitro antifungal activity of organic compounds derived from amino alcohols against onychomycosis

Liquid chromatography–tandem mass spectrometry is effective for analysis of ergosterol in fungal‐infected nails

Diagnostic values of KOH examination, histological examination, and culture for onychomycosis: a latent class analysis

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