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Oral Biofilm Sampling for Microbiome Analysis in Healthy Children
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Onychomycosis: a simpler in-office technique for sampling specimens.

Avner Shemer1, Batya Davidovici, Marcelo H Grunwald

  • 1Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Israel.

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|September 25, 2012
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Summary

Optimal fungal sampling for toenail onychomycosis involves collecting material from both the distal nail bed and the underside of the nail plate. This combined approach significantly improves diagnostic accuracy for accurate treatment.

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Area of Science:

  • Dermatology
  • Mycology
  • Medical Diagnostics

Background:

  • Accurate diagnosis of onychomycosis (fungal nail infection) is critical for effective treatment.
  • Current specimen collection methods vary, impacting diagnostic yield.
  • Distal and lateral subungual onychomycosis (DLSO) is a common form requiring precise sampling.

Purpose of the Study:

  • To determine the optimal technique for fungal specimen collection in onychomycosis.
  • To compare diagnostic accuracy between different sampling sites and methods.

Main Methods:

  • 106 patients with confirmed DLSO underwent repeat sampling.
  • Specimens were collected from the distal nail bed and the distal underside of the nail plate.
  • Samples were analyzed using potassium hydroxide (KOH) testing and fungal culture.

Main Results:

  • KOH testing yielded higher positive results from the distal nail bed (79.2%) compared to the nail plate underside (56.6%).
  • Fungal cultures were more frequently positive from the distal nail bed (87.7%) than the nail plate underside (71.7%).
  • Combining both collection sites resulted in 86.8% positive KOH tests and 94.3% positive cultures.

Conclusions:

  • The study recommends collecting specimens from both the distal nail bed and the distal underside of the nail plate for suspected DLSO.
  • This dual-site collection strategy enhances the detection rate of fungal elements.
  • Improved specimen collection is vital for accurate onychomycosis diagnosis and treatment initiation.