皮肤镜检查与微生物培养和聚合酶链反应诊断甲真菌病的诊断准确性：一项横断面研究。

Diagnostic Accuracy of Dermatoscopy Versus Microbiological Culture and Polymerase Chain Reaction in the Diagnosis of Onychomycosis: A Cross-Sectional Study.

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. 2024 Sep;67(9):e13799. doi: 10.1111/myc.13799.

DOI:10.1111/myc.13799

PMID:39289823

Abstract

BACKGROUND

Several clinical signs in dermatoscopy are very characteristic of onychomycosis and can be a quick complement for the diagnosis of onychomycosis.

OBJECTIVES

The aim of this study was to evaluate the diagnostic accuracy of dermatoscopy compared to microbiological culture and polymerase chain reaction (PCR), as well as the clinical signs associated with onychomycosis.

METHODS

The clinical signs of 125 patients were assessed cross-sectionally using dermatoscopy, and a positive or negative result was assigned. A sample was then taken for PCR and microbiological culture.

RESULTS

Of the 125 patients, 69.6% (87/125) had positive results when both laboratory tests were combined. When they were not combined, the prevalence was lower at 48% (60/125) with PCR and at 43.2% (54/125) with culture. Furthermore, 76.8% (96/125) were classified as positive with dermatoscopy with a sensitivity of 1, a specificity of 0.76, positive predictive value of 0.91 and negative predictive value of 1 (with 95% confidence intervals). Of the 96 dermatoscopy-positive samples, 36 were negative with PCR (p < 0.001), 42 were negative with culture (p < 0.001) and nine were negative when both tests were combined (p < 0.001). Clinical signs that were significantly associated with the presence of onychomycosis were subungual hyperkeratosis (dermatoscopy: p = 0.004, odds ratio (OR) = 2.438; PCR + microbiological culture: p = 0.004, OR = 3.221), subungual detritus (p = 0.033, OR = 3.01, only with dermatoscopy) and dermatophytoma (dermatoscopy: p = 0.049, OR = 3.02; PCR + microbiological culture: p = 0.022, OR = 2.40).

CONCLUSIONS

The results suggest that dermatoscopy is a good tool for the diagnosis of onychomycosis but should be used as a complementary test or for screening patients to be sampled for laboratory testing. The combination of the three tests can lead to a reduction of false-positive and false-negative clinical and laboratory results. This allows for early diagnosis and specific treatment based on test results.

摘要

背景

在皮肤镜检查中有几个临床特征对甲真菌病非常有特点，可以快速补充甲真菌病的诊断。

目的

本研究旨在评估皮肤镜检查与微生物培养和聚合酶链反应（PCR）相比的诊断准确性，以及与甲真菌病相关的临床特征。

方法

采用皮肤镜检查对 125 例患者的临床特征进行横断面评估，并给出阳性或阴性结果。然后采集样本进行 PCR 和微生物培养。

结果

在 125 例患者中，当两种实验室检查联合使用时，69.6%（87/125）的患者结果为阳性。当不联合使用时，PCR 的患病率较低为 48%（60/125），培养的患病率为 43.2%（54/125）。此外，皮肤镜检查的阳性率为 76.8%（96/125），其敏感性为 1，特异性为 0.76，阳性预测值为 0.91，阴性预测值为 1（置信区间为 95%）。在 96 例皮肤镜检查阳性的样本中，有 36 例 PCR 结果为阴性（p<0.001），42 例培养结果为阴性（p<0.001），9 例两种检查联合结果为阴性（p<0.001）。与甲真菌病存在显著相关的临床特征是甲下过度角化（皮肤镜检查：p=0.004，优势比（OR）=2.438；PCR+微生物培养：p=0.004，OR=3.221）、甲下碎屑（p=0.033，OR=3.01，仅皮肤镜检查）和甲真菌瘤（皮肤镜检查：p=0.049，OR=3.02；PCR+微生物培养：p=0.022，OR=2.40）。