Aragón-Sánchez Javier, López-Valverde María E, Víquez-Molina Gerardo, Milagro-Beamonte Ana, Torres-Sopena Luis
La Paloma Hospital, Las Palmas de Gran Canaria, Spain.
Juan Ramón Jimenez Hospital, Huelva, Spain.
Int J Low Extrem Wounds. 2023 Jun;22(2):321-327. doi: 10.1177/15347346211009409. Epub 2021 Apr 23.
This study aimed to determine the prevalence of onychomycosis and interdigital tinea pedis in a cohort of Spanish patients with diabetes in whom onychomycosis was clinically suspected (n = 101). Samples from a first toenail scraping and the fourth toe clefts were subjected to potassium hydroxide direct vision and incubated in Sabouraud and dermatophyte test medium. Fifty-eight samples were also analyzed by a pathologist using periodic acid-Schiff staining and Calcofluor white direct fluorescence microscopy. Onychomycosis was only confirmed in 41 patients (40.6%). The most frequent aetiological agent was , isolated in 10 patients (36%), followed by in 7 patients (25%). Tests on the fourth toe cleft samples were only positive in 11 patients (10.9%), and in all cases, onychomycosis was also diagnosed. Neuroischemic foot was the only significant variable associated with onychomycosis in the univariate analysis ( < .01). A positive result for mycosis in the fourth toe cleft was found in 11 cases (10.9%) and was associated with a history of myocardial infarction (< .01; odds ratio [OR]: 84.2, confidence interval [CI]: 6.8-1036.4) and neuroischemic foot (< .01; OR: 13.7, CI: 12.6-71.6) in the multivariate model. In conclusion, the prevalence of onychomycosis and tinea pedis in patients with diabetes in whom onychomycosis was clinically suspected was 40.6% and 10.9%, respectively. In addition, onychomycosis was not always associated with tinea pedis. These results show that clinical diagnosis has low accuracy in people with diabetes mellitus, and that diagnosis should not be based on clinical toenail characteristics alone.
本研究旨在确定一组临床疑似甲真菌病的西班牙糖尿病患者（n = 101）中甲真菌病和足趾间足癣的患病率。采集首个趾甲刮屑样本和第四趾间的样本，进行氢氧化钾直接镜检，并在沙氏培养基和皮肤癣菌测试培养基中培养。58个样本还由病理学家使用过碘酸希夫染色和荧光增白剂直接荧光显微镜进行分析。仅41例患者（40.6%）确诊为甲真菌病。最常见的病原体是 ，10例患者（36%）分离出该菌，其次是 ，7例患者（25%）分离出该菌。第四趾间样本检测仅11例患者（10.9%）呈阳性，且所有病例均诊断为甲真菌病。单因素分析中，神经缺血性足是与甲真菌病相关的唯一显著变量（P <.01）。多因素模型中，第四趾间真菌病检测阳性11例（10.9%），与心肌梗死病史相关（P <.01；比值比[OR]：84.2，置信区间[CI]：6.8 - 1036.4），与神经缺血性足相关（P <.01；OR：13.7，CI：12.6 - 71.6）。总之，临床疑似甲真菌病的糖尿病患者中甲真菌病和足癣的患病率分别为40.6%和10.9%。此外，甲真菌病并不总是与足癣相关。这些结果表明，糖尿病患者的临床诊断准确性较低，诊断不应仅基于临床趾甲特征。
