Comparative analysis in diagnosis by real-time polymerase chain reaction versus direct microscopy, culture, and histology in fungal infections of the nails, scalp, and skin.

BACKGROUND: The diagnosis of superficial fungal infections is the subject of intensive research in many countries around the world. The diagnostic methods used are diverse, including both conventional and innovative techniques. METHODS: This study evaluates the sensitivity, specificity, and efficacy of the real-time polymerase chain reaction (PCR) methodology and compares them with those of the conventional methods - direct microscopic, cultural, and histological examinations of materials from hair, skin, and nails - in order to demonstrate the benefits and significance of real-time PCR for the diagnosis of dermatophytic infections. RESULTS: The values obtained for the sensitivity, specificity, and efficacy of direct microscopic, cultural, histological, and real-time PCR studies are as follows: 63.71, 88.89, and 72.96% (P < 0.001); 58.06, 100, and 73.47% (P < 0.001); 85.96, 100, and 90.70% (P < 0.001); 88.52, 100, and 92.63% (P < 0.001). CONCLUSION: The use of real-time PCR in the diagnosis of dermatophytic infections is a relatively new approach in mycology and is subject to testing and experience from its use. The results are promising, but the method has not yet established itself as a new gold standard in the diagnosis of superficial fungal infections caused by dermatophytes, though its application would be very useful in identifying isolates without conidiogenesis or absence of growth.

In search of dermatophytes - frequency and etiology of fungal infections in patients with and without diabetes mellitus.

INTRODUCTION: Onychomycosis is a frequent nail disorder, accounting for up to 50% of all nail problems. Treatment of onychomycosis is expensive and requires a long time of antifungal medications. Consequently, a proper and faster diagnosis is necessary. Especially for those patients with diabetes mellitus, where onychomycosis is among the most significant predictors of foot ulcer and possible severe complications.

Tinea barbae profunda caused by Trichophyton rubrum - an autoinoculation from a primary Tinea pedis.

Tinea barbae profunda is a rare mycotic infection of the beard, caused by dermatophytic fungi. Patients with suppressed immune systems and severe comorbidities, such as diabetes mellitus, are more prone to this disease, but it could also be seen in agricultural workers and stockbreeders. The most frequent etiological agents of this infection are the zoophilic dermatophytes. But in rare cases, an infection with anthropophilic dermatophytes as Trichophyton rubrum can be observed.We present a case of a 55-year-old patient with insulin-dependent diabetes mellitus and tinea barbae profunda, caused by Trichophyton rubrum, as a consequence of autoinoculation from concomitant Tinea pedis. The patient was treated with oral antibiotics before admission to the clinic, but with no effect due to incorrect diagnosis and lack of mycological laboratory investigations. A satisfactory therapeutic outcome was achieved after a two-month course with antimycotic medications.