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Modified PAS stain: A new diagnostic method for onychomycosis.

Tamar Hajar1, Ramon Fernández-Martínez2, Gabriela Moreno-Coutiño2

  • 1Dermatology Resident, General Hospital "Dr. Manuel Gea González", Clazada de Tlalpan 4800, Sección XVI, CP 14080 México City, Mexico.

Revista Iberoamericana De Micologia
|March 31, 2015
PubMed
Summary

A new diagnostic method for onychomycosis, modified PAS stain (M-PAS), shows high sensitivity and can diagnose cases missed by traditional KOH/CB and culture methods. This rapid, inexpensive technique improves onychomycosis diagnosis accuracy.

Keywords:
DiagnosisDiagnósticoMicologíaMycologyOnicomicosisOnychomycosis

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Area of Science:

  • Medical Mycology
  • Diagnostic Pathology
  • Dermatology

Background:

  • Onychomycosis is the most prevalent nail disorder, accounting for approximately 50% of all nail conditions.
  • Accurate diagnosis is crucial for effective treatment, yet current methods lack sufficient specificity and sensitivity.
  • There is a need for improved diagnostic tools to ensure timely and correct management of onychomycosis.

Purpose of the Study:

  • To develop and evaluate a novel diagnostic method for onychomycosis.
  • To compare the diagnostic performance of the new method against established techniques like KOH/chlorazol black (KOH/CB) and fungal culture.
  • To assess the sensitivity, specificity, and predictive values of the new diagnostic approach.

Main Methods:

  • A total of 192 samples from patients with suspected onychomycosis were analyzed.
  • Samples were subjected to modified PAS stain (M-PAS), KOH/chlorazol black (KOH/CB) staining, and fungal culture.
  • Statistical analysis was performed to calculate sensitivity, specificity, and predictive values.

Main Results:

  • Fungal structures indicative of onychomycosis were detected in 152 out of 192 samples (79.2%).
  • Modified PAS stain (M-PAS) identified fungal elements in 94% of positive cases and detected 25.6% of cases missed by KOH/CB and culture.
  • M-PAS demonstrated 92.5% sensitivity and 55.55% specificity, with a negative predictive value of 81.6%.

Conclusions:

  • The modified PAS stain (M-PAS) procedure, when combined with KOH/CB and nail clipping biopsy, offers a highly sensitive diagnostic approach for onychomycosis.
  • This method is rapid, cost-effective, and easily implementable in most healthcare settings.
  • M-PAS significantly improves the diagnosis of onychomycosis by identifying cases that yield false negatives with conventional KOH/CB and culture methods.