Histopathological diagnosis of onychomycosis by periodic acid-Schiff-stained nail clippings
Histopathological diagnosis of onychomycosis by periodic acid-Schiff-stained nail clippings
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DOI：
10.1046/j.1365-2133.2003.05029.x
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发表时间：
2003-04-01
影响因子：
10.3
通讯作者：
Szeimies, RM
中科院分区：
文献类型：
--
作者：
Reisberger, EM;Abels, C;Szeimies, RM
背景 目前诊断指甲真菌感染的实验室方法是氢氧化钾（KOH）刮擦技术和真菌培养。然而，由于真菌培养需要较长的潜伏期，并且据报道使用这些方法观察到的假阴性结果率约为30%，因此迫切需要一种快速且高度特异性的甲真菌病诊断筛查试验。目的在一项前瞻性研究中，将使用培养基和KOH制剂的传统真菌学诊断与通过过碘酸希夫（PAS）染色的指甲剪进行的甲真菌病组织病理学诊断进行比较。获取了 350 名疑似患有甲真菌病的患者的 387 个指甲，并制备了 KOH 染色剂以及两种真菌培养物（含有和不含放线菌酮的 Kimmig 琼脂）。此外，对同一标本进行组织病理学检查（PAS染色）。结果培养基和KOH制剂分别显示100例和156例甲癣，而组织学检查为182例。组织学检查阳性结果率明显较高（P < 0.05）。考虑到三种方法中至少一种给出的阳性结果总数（总计 = 438），发现组织学评估对真菌感染的成功识别率最高（41.6%）。结论 PAS 染色的指甲剪的组织病理学评估非常快速且易于执行，并且将增加诊断甲真菌病的频率，高于仅通过培养和 KOH 制剂所达到的诊断频率。然而，由于仅通过这项调查无法获得有关真菌活力和准确识别特定病原体的信息，因此真菌学培养仍然是真菌学诊断无可争议的“金标准”。
Background The current laboratory methods for diagnosing fungal infections of the nails are the potassium hydroxide (KOH) scraping technique and fungal culture. However, due to the long incubation period required for fungal culture and the reported rate of approximately 30% false negative results observed when using these methods, a quick and highly specific screening test for diagnosing onychomycosis is urgently needed.Objectives In a prospective study, to compare the traditional mycological diagnostics using culture medium and KOH preparation with the histopathological diagnosis of onychomycosis by periodic acid-Schiff (PAS)-stained nail clippings.Methods Material from 387 nails of 350 patients suspected of having onychomycosis was obtained and a KOH stain as well as two fungal cultures (Kimmig agar with and without cycloheximide) were prepared. In addition, the same specimen was histopathologically examined (PAS stain).Results Culture medium and KOH preparation respectively revealed 100 and 156 cases of onychomycosis, as compared with 182 cases by histological examination. Histological examination gave a significantly higher rate of positive results (P < 0.05). Considering the total number of positive results given by at least one of the three methods (total = 438), histological evaluation was found to give the highest rate of successful recognition of mycotic infection (41.6%).Conclusions The histopathological evaluation of PAS-stained nail clippings is very quick and easy to perform, and will increase the frequency of diagnosing onychomycotic disease above that achieved by culture and KOH preparation alone. However, because information concerning the vitality of the fungi and accurate identification of the specific pathogen is not available through this investigation alone, mycological culture continues to remain the indisputable 'gold standard' of mycological diagnostics.