DIAGNOSTIC MANAGEMENT OF PATIENTS WITH ONYCHOMYCOSES

Area of Science:

• Mycology and Infectious Diseases
• Molecular Diagnostics
• Dermatology

Background:

• Onychomycosis is a prevalent fungal nail infection causing nail plate discoloration and thickening.
• Current gold standard diagnostic methods, microscopy and fungal culture, have limitations including long turnaround times and high costs.
• Polymerase chain reaction (PCR) offers a promising alternative for rapid and accurate detection of fungal DNA.

Purpose of the Study:

• To optimize diagnostic strategies for onychomycosis by evaluating PCR, epiluminescent diagnostics, and therapeutic agents.
• To enhance the timely diagnosis and treatment of fungal nail infections.

Main Methods:

• Observation of 343 patients undergoing inpatient and outpatient treatment for fungal nail lesions.
• Mycological examination including microscopy and fungal culture of nail fragments.
• Polymerase chain reaction (PCR) using specific and panfungal primers, and epiluminescence surface microscopy.

Main Results:

• PCR demonstrated higher sensitivity (91.9%) and diagnostic accuracy (90.3%) compared to microscopy (75.9% sensitivity, 76.3% accuracy) and culture (44.3% sensitivity, 47.3% accuracy).
• While microscopy showed higher specificity (83.3%) than PCR (71.4%), PCR's superior sensitivity allows for increased detection of onychomycosis cases.
• The study highlights the potential of molecular methods like PCR to improve the detection rates of fungal nail infections.

Conclusions:

• An integrated management algorithm combining PCR diagnostics, epiluminescent methods, and targeted antifungal and nail-restoring therapies is proposed.
• This comprehensive approach facilitates timely diagnosis and effective treatment, leading to improved nail plate structure.