Abstract
Ex vivo confocal laser scanning microscopy (CLSM) is an innovative imaging tool that enables real-time examination of specimens and may be used in evaluating fungal infections. We aimed to assess the applicability of ex vivo CLSM in the diagnosis of onychomycosis by comparing results to those obtained by histopathology, potassium hydroxide (KOH) examination, and fungal culture. In this prospective study, 57 patients with the clinical diagnosis of distal nail fungal infection were examined and compared using all four of the above-mentioned diagnostic tools in terms of sensitivity, positive and negative predictive value. Ex vivo CLSM showed the highest sensitivity, followed by KOH examination, histopathology and fungal culture. Regarding positive and negative predictive values, ex vivo CLSM was superior and showed even higher sensitivity than the combined gold standard comprised of KOH examination, fungal culture or histopathology.
Highlights
Onychomycosis is a ubiquitous disease with a worldwide prevalence of 5.5% [1]
We examined nails clinically suspicious of onychomycosis with ex vivo confocal laser scanning microscopy (CLSM) and compared the results with three different, wellestablished examination methods, KOH examination, fungal culture, and histopathological examination using periodic acidSchiff (PAS) staining
We evaluated the feasibility of the ex vivo CLSM as a method for daily use in the diagnosis of onychomycosis in comparison to the current diagnostic approaches
Summary
Onychomycosis is a ubiquitous disease with a worldwide prevalence of 5.5% [1]. Onychomycosis may serve as an entry site for other infectious diseases, such as erysipelas. Topical therapeutic approaches are seldom successful and systemic therapy is often necessary. Positive diagnostic proof is required in order to justify systemic therapies, including itraconazole, terbinafine, fluconazole or griseofulvin, since these may rarely be accompanied by side effects such as elevation of liver enzymes, some of which may be serious [5]. Current diagnostic approaches include potassium hydroxide (KOH) examination, fungal culture, histological examination, and polymerase chain reaction (PCR) examination, which all have been shown to be successful in diagnosing mycotic infections. As a new promising method of rapid diagnosis of fungal infection, the confocal laser scanning microscopy (CLSM) seems to show promising results
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