Confocal laser scanning microscopy as a new valuable tool in the diagnosis of onychomycosis – comparison of six diagnostic methods

Onychomycosis is common and can mimic several different nail disorders. Accurate diagnosis is essential to choose the optimum antifungal therapy. The aim of this study was to evaluate the use of confocal laser scanning microscopy (CLSM) and optical coherence tomography (OCT) as new non‐invasive diagnostic tools in onychomycosis and to compare them with the established techniques. In a prospective trial, 50 patients with suspected onychomycosis and 10 controls were examined by CLSM and OCT. Parallel KOH preparation, culture, PAS‐staining and PCR were performed. PCR showed the highest sensitivity, followed by CLSM, PAS and KOH preparation. OCT offered the second best sensitivity but displayed the lowest specificity. CLSM and KOH preparation showed a high specificity and CLSM offered the best positive predictive value, similar to KOH preparation and OCT. Fungal culture showed the lowest sensitivity and the worst negative predictive value, yet culture and PCR are the only techniques able to identify genus and species. In summary, CLSM was comparable to PAS staining and superior to KOH preparation. Due to the low specificity we assess OCT not as appropriate. In the differentiation of species PCR outplays the fungal culture in terms of time and sensitivity.     

Fungi Causing Superficial Cutaneous Mycoses in the District of Cracow Part One: The Incidence of Dermatophytes

Summary: From January 1^st 1972 to December 31^st 1981 5363 patients living in Cracow and its environs were examined mycologically. Those patients were suspected of superficial cutaneous mycoses and were referred to the department of Mycology of the Institute of Microbiology (Medical Academy of Cracow). A total of 8545 samples were examined. 36% of the patients were males and 64% were females. Part one of the paper presents the spectrum of dermatophytes isolated from different regions of the skin, the nails and hair. In general, dermatophytes were cultured from 23% of the specimens. T. rubrum outnumbered T. mentagrophytes (13.7% and 8.87% respectively). Other species and genera of dermatophytes such as T. tonsurans, T. violaceum, T. verrucosum, E. floccosum and M. gypseum were found only sporadically. Dermatophytes were found most often in samples taken from the toe nails (39.6%) and the skin of the feet (38.9%), both in male patients. They were found extremely rarely in samples taken from the scalp and the beard (5.8%). Many authors have pointed out that it is important to review the mycological flora of human skin in certain areas of the world from time to time because this flora changes (2, 6, 10, 13). Zusammenfassung: Vom 1. Januar 1972 bis 31. Dezember 1981 wurden 5363 Patienten aus Krakau und dessen Umgebung mykologisch untersucht. Diese boten klinischen Anhalt für oberflächliche Mykosen der Haut Sie wurden an die Abteilung für Mykologie des Institutes für Mikrobiologie (Medizinische Akademie Krakau) überwiesen. Insgesamt wurden 8545 Proben untersucht 36% der Untersuchten waren Männer, 64% Frauen. Teil 1 der Arbeit bringt das Dermatophytenspektrum, welches aus verschiedenen Bereichen - der Haut, den Nägeln und den Haaren - isoliert wurde. Insgesamt wurden aus 23% der Proben Dermatophyten gezüchtet. T. rubrum übertraf T. mentagrophytes (Nachweis in 13,7 bzw. 8,87% der Fälle). Andere Dermatophytenarten und -gattungen wie T. tonsurans, T. violaceum, T. verrucosum, E. floccosum und M. gypseum wurden nur sporadisch nachgewiesen. Dermatophyten wurden am häufigsten aus Zehennägeln und Fußhaut bei Männern nachgewiesen (in 39,6 bzw. 38,9% der Fälle), am seltensten aus Proben der Kopf- und Bartregion.     

What's new in diagnosis and therapy of dermatomycoses in childhood

Mycotic infections in childhood are caused in the majority of cases by dermatophytes. If an oral treatment is indicated, itraconazole and terbinafine are superior to griseofulvin and are nowadays drugs of first choice although an official registration for treatment of children is missing in Germany. Yeasts in infections of childhood are the causative organisms in Pityrosporum-folliculitis and act as an important co-factor in diaper dermatitis.     

Clinical evaluation of a novel commercial multiplex‐based PCR diagnostic test for differential diagnosis of dermatomycoses

Dermatomycoses are very common worldwide with increasing prevalence. An accurate and rapid detection of fungi is most important for the choice of antimycotics and the success of treatment. The aim of this study was to evaluate a new commercial multiplex‐based PCR which allows the detection and differentiation of the most relevant human pathogen fungi causing dermatomycoses in Europe. The accuracy and reproducibility of this application were verified in a clinical performance assessment in comparison to direct microscopy and culture using DNA isolates from 253 clinical samples. Sensitivity, specificity, positive predictive value and negative predictive value of 87.3%, 94.3%, 87.3% and 94.3%, respectively, were calculated for dermatophytes when confirmed by direct microscopy, culture or both. The corresponding values for Candida spp. were 62.7%, 93.5%, 77.8%, and 87.4%, respectively. Furthermore, in comparison to culture, the multiplex PCR was able to detect additional 38 Trichophytum rubrum and 12 Trichophytum interdigitale infections. These results were confirmed by independent PCR analysis. From DNA isolation to diagnosis the multiparameter diagnostic kit gives rise to a 1‐day workflow, enables fast clarification of disease aetiology and, thus, contributes to specific therapy selection. The latter is particularly important in light of growing resistance to antimycotics.     

乳腺疾病术前影像学评估价值探讨

目的：比较彩色多普勒超声、钼靶和MRI在乳腺良恶性疾病诊断中的作用。方法：以术后病理结果为金标准,比较术前3种检查方法的诊断准确性。结果：共计465例乳腺疾病患者接受检查,其中乳腺恶性病变339例,乳腺良性病变126例。乳腺癌彩超、钼靶和MRI的灵敏度分别为88.3%、85.3%和92.3%,特异度分别为88.6%、90.4%和91.7%,诊断符合率分别为88.5%、89.5%和92.0%,其中MRI的各项诊断指标均为最高,对≤2cm的乳腺癌,钼靶的特异度最高（96.2%）,但对于〈45岁的年轻女性的致密性乳腺内的病变诊断,具有较低灵敏度。对乳腺炎性病变和导管瘤,钼靶及彩超较MRI诊断率高（66.6%,66.7%）。结论：彩色多普勒超声和钼靶及MRI 3种乳腺影像诊断方法对乳腺病变的诊断均有各自优势,联合三种检查方法可对术前乳腺病变有更高的诊断价值。     

Pilot study: optical coherence tomography as a non‐invasive diagnostic perspective for real time visualisation of onychomycosis

The objective of this study was to compare optical coherence tomography (OCT) with conventional techniques such as KOH‐preparation, culture and histology in the identification of the fungal elements in the nail. A total of 18 patients were examined; 10 with clinically evident onychomycosis in toe nails, two with psoriatic nail lesions, one with nail affection caused by lichen planus and five healthy controls. Serial in vivo OCT analyses of onychomycosis was performed prior to KOH‐preparation, culture and punch biopsy of the nail plate for consecutive histology. Fungal elements were detected non‐invasively in vivo using OCT in all 10 patients with histologically proven onychomycosis. Fungal elements were detectable as highly scattering elongated structures inside the nail plate, in the middle of the areas of homogeneous decrease in signal intensity. KOH‐preparations and culture did reveal a positive result in 5/6 out of 10 patients. In patients with psoriasis, lichen planus as well as in the healthy controls, no fungal infection could be detected by either method used. OCT is a reliable, easy to use, non‐invasive and non‐destructive method to visualise fungal elements in vivo in onychomycosis, even in cases of false negative KOH‐preparation and culture. Furthermore, OCT offers the opportunity to screen several areas of the same nail plate and to detect fungal elements during local or systemic therapy.     

Comparison of various serological and direct methods for the diagnosis of BLV infection in cattle

The sensitivities of several serological and direct methods for the detection of bovine leukemia virus (BLV) infection in cattle have been critically compared. Among the serological methods, the radioimmunoassay (RIA) using the BLV glycoprotein (gp) was found to be more sensitive than the RIA using the internal virion antigen (p25) and the immunodiffusion test using the virion gp antigen. The differences in sensitivity between these tests were particularly evident with sera of cattle in early stages of infection. The sensitivities of the syncytia induction assay and the competitive RIA for the direct demonstration of BLV infection in cattle are comparable. Following natural infection, antibodies to the gp antigen in most cattle were detected by the RIA several months before infectious BLV became detectable by the SIA in the blood lymphocytes. It is concluded that the most accurate, sensitive, and rapid method for the detection of BLV infection in cattle is the RIA using the virion gp antigen. The data presented confirm that BLV infection as well as the antibody responses of naturally infected cattle to the BLV p25 and gp antigens are persistent.     

Clinical evaluation of miconazole tincture in skin mycoses

Seventy-five out-patients (age limits 4–67 years, median age 28) with fungal infections of the skin were instructed to apply miconazole 2 % alcoholic solution to their lesions twice daily for a maximum of six weeks (fortnightly control examinations). Of the 63 patients (12 drop-outs), 55 were cured within the six treatment weeks; 24 of them were already cured by the end of the second week. The treatment seemed to be effective against all pathogens.

Zusammenfassung

Fünfundsiebzig ambulante Patienten (Alter 4-67 Jahre, Medianwert 28) mit Dermatomykosen wurden gebeten, eine 2 %-ige Miconazollösung in Alkohol zweimal täglich in ihre Läsionen einzureiben. Die Behandlungsdauer betrug sechs Wochen, und die Patienten wurden jede zweite Woche kontrolliert. Von 63 Patienten (12 beendeten die Studie frühzeitig) heilten 55 innerhalb der sechs Behandlungswochen ab; 24 von ihnen, mehr als ein Drittel, waren schon am Ende der zweiten Woche geheilt. Die Behandlung war gegen alle pathogenen Keime wirksam.     

Sulconazole in the therapy of dermatomycoses in Nigeria

Summary. A 1% cream of sulconazole nitrate, an imidazole derivative, was used to treat 38 patients with diverse clinical types of dermatomycoses, including 16 cases of pityriasis versicolor, 14 of dermatophytosis (tinea pedis, tinea cruris, tinea corporis), two of balanoposthitis due to Candida albicans , another two of candidosis of the groin, one each of groin and foot infection due to Trichosporon beigelii and one case each of lesions of the hand and trunk caused by Pétriellidium boydii and Scytalidium hyalinum respectively. A complete cure was achieved in 91% of patients, with resolution of the lesions in the majority within 2–4 weeks. There were only two relapses. Sulconazole is recommended as an effective drug for topical treatment of superficial fungal infections of the skin.
Zusammenfassung. Sulconazolnitrat wurde als 1%ige Creme zur topischen Therapie an 38 Dermatomykose-Patienten eingesetzt. Darunter waren 16 Fälle von Pityriasis versicolor, 14 Dermatophytosen (Tinea pedis, Tinea cruris, Tinea corporis), 2 Fälle von Balanoposthitis bedingt durch Candida albicans , 2 Candidosen der Leistenbeuge, 2 Trichosporon beigelii -Infektionen je an Leistenbeuge und Fuß und je eine Infektion durch Petriellidium boydii und Scytalidium hyalinum an Hand und Stamm. Bei 91% der Patienten wurde vollständige Heilung erzielt, in der Mehrzahl der Patienten bereits nach 2 bis 4 Wochen. Zwei Rückfälle wurden beobachtet. Sulconazol wird als wirksames Therapeutikum für die topische Behandlung oberflächlicher Pilzinfektionen auf der Haut empfohlen.     

Clotrimazole in treatment of dermatomycoses and vaginitis

62 patients with dermatomycoses and 39 patients suffering from vaginitis were treated with topical application (1 %) of clotrimazole (Canesten) cream and vaginal tablets (100 mg) respectively. A majority of the patients (44) of dermatophytoses were completely cured in 3 to 6 weeks and all cases (11) of cutaneous candidiasis in 1 to 2 weeks. 14 cases of Candida vaginitis were cured in 2 weeks and 24 patients with nonspecific vaginitis responded well to the treatment showing definite clinical improvement. No untoward reactions were noticed in these patients.

Zusammenfassung

62 Patienten mit einer Dermatomykose und 39 Patientinnen die an einer Vaginitis erkrankt waren, wurden lokal mit einer 1 %igen Clotrimazol-Creme (Canesten) beziehungsweise mit Vaginaltabletten (100 mg) behandelt.
44 Patienten mit einer Dermatophyteninfektion heilten vollständig innerhalb von 3 bis 4 Wochen und 11 Candidosen der Haut in 1 bis 2 Wochen ab. Eine zweiwöchige Therapie bei 14 Patientinnen rnit einer Vaginalmykose führte zur Abheilung der Pilzinfektion. In 24 Fällen einer bakteriellen Vaginitis z am es unter der Clotrimazol-Behandlung zur Beshwerdefreiheit.     

An Evaluation of two Years of Clinical Experience with Ketoconazole: Die Auswertung der klinischen Erfahrungen mit Ketoconazol über zwei Jahre

Summary: In an open trial, ketoconazole, a new imidazole derivative with broad-spectrum antifungal activity for oral use, was evaluated in 160 patients with superficial and systemic mycotic infections. The therapeutic efficacy of various daily and total dosages of ketoconazole are discussed. Ketoconazole was well tolerated by the patients. Laboratory values changed rarely and transiently. The clinical and mycological studies proved that ketoconazole is a highly effective drug for the systemic therapy of mycotic infections. Zusammenfassung: In einer offenen Studie wurde Ketoconazol, ein neues, oral wirksames Imidazol-Breitband-Antimykotikum an 160 Patienten geprüft, die an oberflächlichen oder systemischen Mykosen litten. Die therapeutische Wirksamkeit derverschiedenen täglichen und gesamten Dosen wurde diskutiert. Die Verträglichkeit des Ketoconazol war sehr gut. Die Laborwerte zeigten nur selten und vorübergehend Abweichungen. Klinische und mykologische Untersuchungen haben bewiesen, daß das Ketoconazol ein hochwirksames Mittel in der systemischen Behandlung der mykotischen Infektionen ist.     

The change of dermatophyte spectrum in dermatomycoses

The spectrum of dermatophytes out of mycotic skin lesions had changed in last 70 years. Before the Second World War in Germany Microsporum audouinii and Epidermophyton floccosum held the first position, since the fifties of last century Trichophyton rubrum is the most frequently isolated dermatophyte accounting for 80-90% of the strains, followed by T. mentagrophytes. This development is typical for Central and North Europe and is connected with the increase in the incidence of tinea pedis. In contrast to this, in Southern Europe and in Arab countries zoophilic dermatophytes, such as M. canis and T. verrucosum, are the most frequently isolated dermatophytes. An analysis of the frequency and distribution of tinea pedis in different occupations and the route of infection is also reported. The epidemiologic findings are contrary to the assumption that patients are genetically predisposed to T. rubrum infection in a dominant autosomal pattern.     

Analyse des Dermatophytenvorkommens und der von Dermatophyten hervorgerufenen Hautinfektionen in der Slowakischen Sozialistischen Republik (SSR) im Zeitraum von 15 Jahren (1969 -1983)/Analysis of the Incidence of Dermatophytes and Dermatomycoses in the Slovak Socialist Republic (SSR) During a Period of 15 Years (1969–1983)

Zusammenfassung: In der Arbeit wird das Vorkommen von dermatophytischen Infektionen und ihrer Erreger auf dem Gebiet der SSR während des 15jährigen Zeitraumes in den Jahren 1969 — 1983 analysiert. Es wird besonders auf die steigende Morbidität durch T. rubrum-Infektionen aufmerksam gemacht. Der Favus wurde auf dem Gebiet der SSR eradiziert, das Vorkommen der Mikrosporie ist minimal und die Inzidenz der Trichophytie sinkt bedeutungsvoll.
Summary: A report is given on the incidence of dermatophytoses and their causative fungi in the Slovak Socialist Republic during a period of 15 years (1969–1983). The results show a remarkable increase of Trichophyton rubrum infections. Favus has disappeared from the territory of the SSR. Tinea capitis by Microsporum species (microsporia) has become a rare event The incidence of Trichophyton infections of animal origin has markedly decreased.     

Results of the first dermatomycoses quality control study in Germany

For the first time in the history of German mycology, a multicenter study for identification of dermatophytes, yeasts and molds was conducted under the auspices of the German Speaking Mycological Society and the German Dermatological Society. A total of 1,008 dermatological offices and dermatology hospitals as well as 106 institutes of microbiology participated in this voluntary quality control trial. They were requested to identify four pathogens: Trichophyton tonsurans, Trichophyton mentagrophytes, Aspergillus niger, and Candida glabrata. T. tonsurans was correctly determined by 749 participants (67.2%), T. mentagrophytes by 974 (87.4%), A. niger by 922 (82.8%) and C. glabrata by 973 (87.3%). Four pathogens were identified at the species level by 591 investigators (53.1%). Three species were correctly identified by 310 investigators (27.8%), two by 143 (12.8%) and 0-1 by 70 (6.3%). The first dermatomycological quality control study in Germany may therefore be considered a success. Further trials will be carried out, initially at intervals of one year.     

Onychomycosis in psoriatic patients – rationalization of systemic treatment

Nail changes in patients with psoriasis have been reported with varying prevalence. Onychomycosis has been reported in up to 47% of the psoriasis patients. The purpose of this study was to determine the prevalence of nail abnormalities, onychomycosis in psoriasis and response to itraconazole treatment. We evaluated 312 patients suffering from psoriasis for nail changes and onychomycosis. Patients having laboratory confirmation of onychomycosis were treated with three courses of itraconazole (400 mg day^?1 for 1 week). Of 312 patients with psoriasis, 67 (21.5%) patients had nail changes, 23 (34%) of them suffered from onychomycosis. Complete cure (clinical and mycological) was achieved in 30% of the patients with onychomycosis. The response to treatment of onychomycosis with itraconazole in psoriasis patients was found to be lower than in the general population. Considering the low response to onychomycosis systemic therapy in psoriatic patients and the potential side‐effects of the treatment, the rationality of this treatment is questionable.     

Evaluation of diagnostic methods in kidney cancer]

Different methods for the renal cancer diagnosis: roentgenological, vasographic, radioisotopic, cytological, immunological and others are assessed comparatively. Among the routine roentgenological methods excretory and infusion urography, retropneumoperitoneum associated with tomography and excretory urography, retrograde pyelography proved to be effective. Kidney scanning with neohydrine is a simple and safe technic of examination. Selective arteriography is the most effective method for recognizing renal cancer, however in 7.2% of patients the response was negative. Cytological and immunological methods are of a secondary value. The scheme of examining patients suspected of renal cancer is recommended.     

Current methods in diagnosis of the kidney tuberculosis

Conventional and updated medical technologies of detecting M. tuberculosis (MT) and tuberculosis antibodies (TAB) were compared. It is shown that molecular-biological and immunological methods can be used only in rapid diagnosis and screening. They should be followed by further examinations as urine MT makers and blood TAB are not criteria for final diagnosis of renal tuberculosis. Routine microbiological methods are most precise in the above diagnosis. Diagnosis of initial forms of renal tuberculosis is still unsolved problem. Low professional skills of outpatient service urologists in the field of urogenital tuberculosis explain late detection of urinary tuberculosis.     

Quantitative diagnostic methods in osteoporosis: A review

During the last two decades there have been major advances in the understanding of pathophysiology and in the diagnosis of osteoporosis. There are now, in addition to standard radiographs, a number of different diagnostic modalities available to doctors for the quantitative assessment of bone mass. These methodologies are having an increasingly important role, not only in the clinical diagnosis, but also in the monitoring of patients with osteoporosis. As the population ages there will be an increasing demand for these services, and radiologists need to be aware of the strength and limitations of the different modalities available.