微生物培养联合 PCR 检测在甲真菌病诊断中的应用：121 例患者的描述性分析。

Microbiological culture combined with PCR for the diagnosis of onychomycosis: Descriptive analysis of 121 patients.

机构信息

Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.

Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.

出版信息

Mycoses. 2023 Dec;66(12):1045-1049. doi: 10.1111/myc.13648. Epub 2023 Aug 13.

DOI:10.1111/myc.13648

PMID:37574461

Abstract

BACKGROUND

Onychomycosis is the most common nail pathology, involving various pathogens such as dermatophytes, moulds and yeasts.

OBJECTIVE

The objective of this study was to observe the prevalence of onychomycosis, analyse the most appropriate diagnostic test, and assess the distribution of pathogens based on age, sex, quarter of the year, duration of symptoms and previous treatment.

METHODS

Retrospectively, mycological culture and PCR data and results were collected from 121 patients.

RESULTS

Of the 121 samples, 57% (69/121) tested positive when both microbiological study techniques were combined. The prevalence of onychomycosis was higher when PCR was performed (52.1%) compared to microbiological culture (33.1%). Among the 81 samples negative by microbiological culture, 31 were positive by PCR. Similarly, of the 58 samples negative by PCR, eight were positive by microbiological culture. Diagnostic accuracy data (with 95% confidence intervals) for PCR, using microbiological culture as the gold standard, were as follows: sensitivity of 0.8, specificity of 0.62, positive predictive value of 0.51 and negative predictive value of 0.86. The most frequently identified pathogen was Trichophyton rubrum, and the hallux nail plate was the most commonly affected location. However, no statistically significant associations were found between sex, age, quarter of the year and affected area with culture and PCR results.

CONCLUSION

Combining microbiological culture and PCR can increase the detection rate of onychomycosis and help avoid false-negative results.

摘要

背景

甲真菌病是最常见的指甲病理，涉及各种病原体，如皮肤癣菌、霉菌和酵母。

目的

本研究旨在观察甲真菌病的流行情况，分析最合适的诊断检测方法，并根据年龄、性别、季度、症状持续时间和既往治疗评估病原体的分布。

方法

回顾性收集了 121 例患者的真菌培养和 PCR 数据和结果。

结果

在 121 个样本中，当两种微生物研究技术结合使用时，有 57%（69/121）呈阳性。与微生物培养（33.1%）相比，PCR 时甲真菌病的患病率更高（52.1%）。在 81 个微生物培养阴性的样本中，有 31 个通过 PCR 呈阳性。同样，在 58 个 PCR 阴性的样本中，有 8 个通过微生物培养呈阳性。以微生物培养为金标准，PCR 的诊断准确性数据（95%置信区间）如下：灵敏度为 0.8，特异性为 0.62，阳性预测值为 0.51，阴性预测值为 0.86。最常鉴定的病原体是红色毛癣菌，大脚趾指甲板是最常受影响的部位。然而，在培养和 PCR 结果方面，性别、年龄、季度和受影响区域之间未发现统计学显著关联。