Shanghai Skin Disease Hospital, Anhui Medical University, Shanghai, China.
Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China.
Mycoses. 2022 Oct;65(10):969-975. doi: 10.1111/myc.13494. Epub 2022 Jul 25.
The successful diagnosis of dermatomycosis depends on specimen collection. Dermatomycosis is sampled mainly for scales, but there is a lack of research on specimens of blister fluid.
To explore whether blister fluid can diagnose dermatomycosis and compare blister fluid and scale specimens for dermatomycosis diagnosis.
From April to July 2021, we prospectively gathered 34 patients who needed to meet all inclusion criteria simultaneously and collected their blister fluid and scales as specimens. The two samples were tested by fluorescent stain microscopy, fungal culture and PCR, and the diagnosis results were compared.
The blister fluid sample's sensitivity, specificity and accuracy were 90%, 100% and 94.1%, respectively, whereas the scales sample were 60%, 100% and 76.5%, respectively. The positive likelihood ratios were >10 for both blister fluid and scales specimen, and the negative likelihood ratios were not <0.1. On the Youden's index, the blister fluid specimen was 90%, and the scales specimen was 60%. As for the diagnostic odds ratio, both of them were >1. By fungal culture, we detected 14 cases of fungi in blister fluid and eight in scales. On PCR, 22 cases of fungi in blister fluid and ten in scales were identified.
This study demonstrated that a sample of blister fluid had better sensitivity, accuracy and Youden's index in diagnosing dermatomycosis with blister fluid. Collection of blister fluid might compensate for the inadequacy of collecting only scales specimens for mycological testing.
真菌病的成功诊断取决于标本的采集。真菌病主要采集鳞屑标本，但疱液标本的研究较少。
探讨疱液是否能诊断真菌病，并比较疱液和鳞屑标本在真菌病诊断中的价值。
2021 年 4 月至 7 月，我们前瞻性地收集了 34 例同时符合所有纳入标准的患者，采集其疱液和鳞屑标本作为检测样本。分别采用荧光染色显微镜检查、真菌培养和 PCR 对两种样本进行检测，并比较诊断结果。
疱液样本的敏感性、特异性和准确性分别为 90%、100%和 94.1%，而鳞屑样本分别为 60%、100%和 76.5%。疱液和鳞屑标本的阳性似然比均>10，阴性似然比均<0.1。在约登指数方面，疱液标本为 90%，鳞屑标本为 60%。对于诊断比值比，两者均>1。通过真菌培养，我们在疱液中检测到 14 例真菌，在鳞屑中检测到 8 例真菌。通过 PCR，在疱液中鉴定出 22 例真菌，在鳞屑中鉴定出 10 例真菌。
本研究表明，疱液标本在诊断真菌病方面具有更好的敏感性、准确性和约登指数。采集疱液可以弥补仅采集鳞屑标本进行真菌学检测的不足。
