PDF(Pubmed)
Abstract：
Onychomycosis is an under-recognized healthcare burden. Despite the risk of misdiagnosis, confirmatory laboratory testing is under-utilized. Histopathologic examination with polymerase chain reaction (PCR) is currently the most effective diagnostic method; it offers direct detection and identification of a fungal invasion. In this retrospective cohort study, we assessed confirmatory testing results, with matching clinical diagnoses, in 96,293 nail specimens submitted during a 9-month period from 2022 to 2023. Toenail specimens were examined using fungal culture, histopathology and/or PCR. Clinical diagnoses were identified using the International Classification of Diseases 10th Revision codes. For clinically diagnosed onychomycosis patients, the overall positivity rate was 59.4%; a similar positivity rate (59.5%) was found in patients with clinically diagnosed non-fungal nail dystrophy. Performing a histopathologic examination with PCR was more likely to provide pathogen identification results than using fungal culture. Male patients had a higher rate of onychomycosis overall; however, female patients had more non-dermatophyte mold onychomycosis caused by Aspergillus. Clinically diagnosed onychomycosis patients with a co-diagnosis of tinea pedis were more likely to test positive for onychomycosis by PCR (odds ratio [OR]: 4.2; 95% confidence interval [CI]: 2.7-6.4), histopathology (OR: 2.5; 95% CI: 2.0-3.1) and fungal culture (OR: 3.2; 95% CI: 1.5-6.6). Our results support the use of confirmatory laboratory testing when there is a clinical diagnosis of onychomycosis.
摘要：
甲癣是一个认识不足的医疗负担。尽管存在误诊的风险,验证性实验室测试未得到充分利用。用聚合酶链反应（PCR）进行组织病理学检查是目前最有效的诊断方法；它可以直接检测和鉴定真菌的侵袭。在这项回顾性队列研究中，我们评估了验证性测试结果，有匹配的临床诊断，在2022年至2023年的9个月期间提交的96,293个指甲标本中。使用真菌培养检查趾甲标本，组织病理学和/或PCR。临床诊断使用国际疾病分类第10版代码进行鉴定。对于临床诊断为甲癣的患者，总阳性率为59.4%;在临床诊断为非真菌性指甲营养不良的患者中发现了相似的阳性率(59.5%).与使用真菌培养物相比，使用PCR进行组织病理学检查更有可能提供病原体鉴定结果。男性患者的甲癣总体发病率较高；然而，女性患者较多的是曲霉菌引起的非皮肤癣霉菌甲癣。临床诊断为足癣的甲癣患者更有可能通过PCR检测甲癣阳性（比值比[OR]：4.2;95％置信区间[CI]：2.7-6.4），组织病理学（OR：2.5;95％CI：2.0-3.1）和真菌培养（OR：3.2;95％CI：1.5-6.6）。我们的结果支持在临床诊断甲癣时使用确证性实验室测试。
