Dermatophytic onychia: Effectiveness of rapid immunochromatographic diagnostic testing directly on samples compared to culture

Abstract

BackgroundUntil now, definite diagnosis of dermatophytic onychia has been made by taking a nail sample and placing it in culture. The result is usually obtained only after 2 to 3weeks. More recently, diagnosis within a few minutes after sampling has become possible thanks to an immunochromatography technique developed in Japan and now available in France: the Diafactory Tinea Unguium® test strip (Biosynex, France). MethodsOver a 12-month period, 80nail samples from 80patients giving rise to a positive fungal culture were included in the study. For each patient, part of the removed nail was stored at room temperature and an immunochromatographic test was retrospectively performed according to the supplier's instructions. A small fragment of nail (≥ 1mg) was mixed with a few drops of reagent in a tube for 1min and the test strip was then placed in the tube with the result being visible to the naked eye (control strip, positivity strip) after incubation for a few minutes. ResultsCompared with the culture method used for 51 isolated dermatophytes (42 Trichophyton rubrum, 9 Trichophyton interdigitale), the sensitivity of the rapid test was 96.07% (49/51). For the 29other fungal cultures (10Fusarium sp., 3Scytalidium sp., 3Scopulariopsis brevicaulis,3Aspergillus sp., 1Alternaria sp., 3Candida albicans, 1Candida parapsilosis, 1Trichosporons sp., 1Rhodotorula sp., and 3Corynebacterium sp.), the specificity was 75.86% (22/29). False positives were mainly due to the genera Fusarium and Scopulariopsis (6 of 7false positives), which were the likely cause of onychomycosis. DiscussionThis rapid test could be useful in limiting excessive clinical diagnosis of dermatophyte onychomycosis. The rapid test has several advantages: ease of application, speed of results, and good performance, which, together, could improve diagnostic certainty during the actual consultation, thus limiting prolonged unnecessary prescriptions of antifungal treatments, while waiting for the laboratory culture results (3weeks for a negative result).