ABSTRACT
Background: onychomycosis is a common nail disorder, affects approximately 5% of the population worldwide and represents 50% of onychopathies and about 30% of mycotic cutaneous infections. Onychomycosis requires administration of antifungal agents for long periods. Several nail disorders may mimic to onychomycosis clinically. Therefore sensitive, quick and inexpensive test is essential for screening nail specimens. In our labs we commonly diagnose onychomycosis using potassium hydroxide [KOH] preparation and culture. These tests are either time-consuming or require specially trained personnel. A recently developed polymerase chain reaction [PCR] assay has the potential to provide a quick and inexpensive method for diagnosis of onychomycosis. We studied all these different methods in the diagnosis of onychomycosis with special concern on tinea unguium diagnosis
Aim: the aims of this study were to compare KOH preparation, calcofluor white stain [CFW], culture and PCR in the diagnosis of onychomycosis and to determine their sensitivity, specificity, positive predictive value and negative predictive value
Methods: nail specimens were collected from patients clinically suspected of onychomycosis. Nail specimens were examined by KOH 20%, CFW microscopic examination, cultured on Sabouraud's dextrose agar [SDA] containing chloramphenicol, SDA containing cyclohexamide and chloramphenicol and dermatophytes test media [DTM] and lastly nail specimen were subjected to DNA extraction and PCR which was carried out using pan-fungal, pan-dermatophyte, Trichophyton rubrum specific primers
Results: of the 76 patients, 54 had at least I of the 4 diagnostic methods positive for the presence of organisms. Culture was positive only in 46 [46.9%] of nail samples. The most common isolated organisms were Candida albicans [3 6. 9%] followed by T. rub rum [I 7.4%]. Using culture as gold test, sensitivity of KOH, CFW and PCR was 85%, 100%, and 100% respectively while specificity of KOH, culture and PCR was 69%, 67%, and 63% respectively. Conclusion: the application of PCR technology directly to the clinical specimens will allow early and accurate diagnosis of onychomycosis
ABSTRACT
Background and objectives: Fungal infections of the eye constitute a group of difficult clinical problems for both the ophthalmologist and infectious disease practitioner. Despite the uncommon occurrence of ocular fungal disease, the threat of blindness from conditions such as fungal keratitis or endophthalmitis makes it a serious problem. The incidence of ocular fungal infections has increased over the last few years. This study was conducted to estimate the rate of ocular fungal infections, identify the fungal species causing ocular mycoses, and find out the epidemiological features of mycotic eye infections in patients admitted to the Ophthalmic Center, Mansoura University, Egypt
Methods: Fifty four patients [50 with clinically suspected fungal keratitis and 4 with endophthalmitis] were included in this study. Samples were collected by ophthalmologist and subjected to direct examination with potassium hydroxide [KOH] 10% and culture on Sabouraud's dextrose agar [SDA] without actidion. Experimental fungal keratitis was induced in mice to compare different methods of diagnosis of fungal keratitis
Results: Out of 54 samples collected, four showed fungal growth on SDA from patients with keratitis, while no fungi were isolated from suspected cases of fungal endophthalmitis. Two isolates were Candida albicans and two isolates were Aspergillus fumigatus. Fungal keratitis was more common among female patients in the age group 21-50 years old from rural areas. Contact lens wear, corneal trauma, topical steroid use, and systemic disease [diabetes mellitus] were the most common risk factors for fungal keratitis in our patients. Comparison of different methods of diagnosis of fungal keratitis induced in mice revealed that polymerase chain reaction [PCR] and histopathological examination were the best methods [sensitivity, specificty, and accuracy 100%] followed by Calcofluor White stain [CFW], culture on SDA without actidion, and finally KOH 10% wet mount [86, 100, 93%], [74, 100, 87%], and [54, 100, 78%] respectively
Conclusion: It is important to know the exact aetiology of fungal eye infections to institute appropriate therapy in time. Laboratory confirmation should be undertaken and fungal infection should be ruled out before prescribing corticosteroids and antibiotics. PCR and histopathological examination are cosidered the most sensitive, specific, and accurate method for diagnosing fungal keratitis
ABSTRACT
Bloodstream infections [BSI] due to Candida species are important complications in immunocompromised patients. This study presents data on species distribution and antifungal susceptibility profiles of Candida bloodstream isolates obtained from Mansoura University Hospitals [MUH] over a 2-year period. All the bloodstream isolates were identified to species level by CHROMagar Candida cornmeal-Tween 80 agar, and API 20C [bioMerieux, France]. Susceptibility to triazole antifungal drugs were determined by M 27A2 [broth microdilution method] of the Clinical and Laboratory Standards Institute [CLSI]. C. albicans was the predominant species, followed by C. parapsilosis, C. tropicalis, C. glabrata, C. krusei and C. dubliensis . All C. dubliensis, C. tropicalis and C. glabrata isolates were susceptible to triazoles. Resistance to fluconazole was observed in 3.8% [1/13] of C. albicans isolates, 50% [2/4] of C. glabrata isolates and 100% [4/4] of C. krusei isolates. Resistance to voriconazole was observed in 4 isolates [12.1%]. Our findings show that C. albicans is the most common cause of Candida-related BSI, followed by C. parapsilosis, and that the rates of resistance to triazole antifungals are low among bloodstream Candida isolates in MUH