BACKGROUND: It has been reported that KONCPA(KOH+Nail clipping+PAS reaction) test might be a useful complementary method with a high positive rate and an exellent view for making the diagnosis of onychomycosis. OBJECTIVE: KONCPA test, Onyehomycosis This study was aimed to know whether KONCPA test would increase the diagnostic sensitivity of onychomycosis, and agree with the findings of fungus culture and whether KONCPA finding would be of help in diagnosing the causative fungi even in case that KOH smear and fungus culture fail to identify the causative fungi. METHODS: Using 95 onychomycotic nail samples obtained from 87 patients, the KONCPA findings were compared with those of KOH smear and fungus culture. RESULTS: The results were as follows ; 1. The positive rates for dtecting the causative fungi from KOH srnear, fungus culture and KONCPA test were 779%, 45.3% and 95.8% respectively. The time required for KONCPA test, showing the highest positive rate, was only about 2 to 3 hours. 2. The fungus culture identified the causative fungi from 43 samples, of which dermatophytes were found in 31 samples(72.1%), Candida spp. in 5 samples(11.6%) and molds in 7 samples(16. 3%). KOH smear revealed the causative fungi in 63 samples : dermatophytes 56(88.9%), Candida spp. 4(6.3%) and molds 3(4.8%). KONCPA yielded the highest positivity by detecting the pathogenic fungi in 86 samples(95.8%): dermatophytes 60(69.8%), Candida spp. 8(9.3%), molds 10 (11.6%) and mixed infections 8(9.3%). 3. Compared with the results of fungus culture, 3 groups of fungi showed morphologic differences on KONCPA test: dermatophyte showing septated long and thin hyphae and a few arthrospores, Candida sp. showing blastospores and/or grape-like clusters of regular spores and pseudohyphae, and mold showing irregular hyphae with variable width and aggregates of irregular spores. 4. Of the 52 samples which were negative in fungus culture, 33(63.5%) showed findings of dermatophyte, 2(3.8% ) of Candida sp., 2(3.8% ) of mold and the remaining 11 samples(21.2% ) were negative on KOH smear, Of these 52 samples, KONCPA diagnosed 34(65.4%) to be dermatophytes, 6(11.5%) Candida syp., 6(11.5%) molds, 1(1.9%) mixed infection and 2 samples(3.8%) to be negative. CONCLUSION: KONCPA test is useful in the diagnosis of onychomycosis because of its higher positive rate in detecting the causative fungi compared with fungus culture or KOH smear. It is also a timesaving and simple procedure Furthermore, in case that KOH smear and fungus culture fail to identify the causative fungi, it is possible to make a presumptive diagnosis by the findings of KONCPA test.
Arthrodermataceae ; Candida ; Coinfection ; Diagnosis ; Fungi ; Humans ; Hyphae ; Onychomycosis* ; Spores

BACKGROUND: Onychomycosis is one of the most common nail disorders, but dermatologists have experienced poor efficacy ol therapy because of incorrect diagnosis. It has been reported that histopathologic evaluation of the nail plate by nail clipping might be a useful supportive method for identification of causative fungi showing higher detection rates. OBJECTIVE: This study was aimed to determine whether histopathologic examination support for identification of causative fungi and whether it increased. The diagnostic sensitivity of onychomycosis even in cases that those fungus culture fail to identify the causative fungi, and to clarify the relative frequency of causative fungi in onychomycosis. METHODS: Histopathologic findings of 218 onychomycotic nail samples, proven by KOH smear, were analyzed and compared with the results of fungus culture. RESULTS: The results were as follows; 1. Histopathologic examination showed higher positive rate (73.9%) than that of fungus culture (35.8%) in identifying the etiologic fungi. 2. The 3 groups of causative fungi confirmed by fungus culture showed morphologically distinguishable characteristics in histopathologic examination: Dermatophytes showed septated long, thin and regular hyphae with or without arthrospores, while Candida sp. showed blastospores, grape-like clusters of regular spores and pseudohyphae. Mold exhibited irregular hyphae with variable width and aggregates of irregular spores. Mixed infections showed the characteristic findings of the corresponding groups at the different sites of the nail samples. 3. Frequency of the causative fungi by fungus culture was 88.5% of dermatophytes, 5.1% of Candida sp. and 6.4% of mold. In histopathologic examination, the frequency was considered as 80.7% of dermatophytes,8.1% of Candida sp.,6.2% of mold and 1.9% of mixed infection. 4. In 42 of 59 samples of T. rubrum and 3 of 10 samples of T. mentagrophytes, hyphae were observed on the ventral and dorsal layer of the nail plate, respectively. In histopathologic sections, 88 of 130 samples of dermatophytes showed fungal element on the ventral layer of the nail plate and all 13 samples of Candida sp. on the subungal keratin layer and ventral layer of the nail plate. CONCLUSION: Histopathologic examination in onychomycosis is considered to be simple, useful supportive method in studying the classification and distribution of causative fungi of onychomycosis and might be included in the routine laboratory tests for making the presumptive diagnosis of causative fungi of onychomycosis. Moreover, we can determine the site of involvement of the fungi in the nail, so we can get useful informations about mixed infections or contaminations
Arthrodermataceae ; Candida ; Classification ; Coinfection ; Diagnosis ; Fungi* ; Hyphae ; Onychomycosis* ; Spores

Upper airway tuberculosis usually develops as a secondary infection from pulmonary tuberculosis, and primary upper airway tuberculosis, especially in nasopharynx, is a rare disease. The appropriate treatment for nasopharyngeal tuberculosis has been difficult because of complicated initial diagnosis and suspicion. Physicians should consider various granulomatous diseases in differential diagnosis. However, upper airway tuberculosis can be highly contagious, like pulmonary tuberculosis; therefore, early diagnosis and proper management are important. We recently experienced the successful early diagnosis and treatment of two cases of nasopharyngeal tuberculosis and report these cases with a review of the literature.
Coinfection ; Diagnosis ; Diagnosis, Differential ; Early Diagnosis ; Nasopharynx* ; Rare Diseases ; Tuberculosis* ; Tuberculosis, Pulmonary

COVID-19/diagnosis* ; Coinfection/diagnosis* ; Female ; HIV Infections/diagnosis* ; Humans ; Middle Aged ; Severity of Illness Index

Actinomyces ; growth & development ; Coinfection ; Humans ; Maxillary Sinus ; Maxillary Sinusitis ; diagnosis ; microbiology

For the sake of simplicity, it is as well to divide nail pathogens into dermatophytes (moulds) and yeasts. Most dermatophyte infections of nails, some over 80% are caused by Trichophyton rubrum (T. rubrum), with Trichophyton mentagrophytes (T. mentagrophytes) found in around 10% of cases. Occasionally there are mixed or pure infections with yeast mostly Candida albicans. Rarely nondermatophytic fungi such as Scopolariopsis, Aspergillus, Scytalidium and Fusarium species are found to be causative agents in onychomycosis. Importance of accurate diagnosis of onychomycosis has been increasing because more than half of the patients with nail disorders are non-onychomycotic. Direct smear with KOH is the most simple and valuable laboratory test which will takes about 20 to 30 minutes. the positive rate of direct smear is relatively high (40~60%), but permanent keeping of the positive microscopic findings is not possible. Fungus culture is the most essential laboratory test for identifying the species of the causative fungi even though the positive rate is low (20~50%) and takes 3 to 4 week to have the result. Histopathologic test is a non-invasive diagnostic method with high positive rate (70~90%). The test is very helpful for confirming the mixed infection of the onychomycosis. KONCPA test abbreviated by "melting with KOH of the nail clippings and PAS staining" is a new diagnostic method. Though the test requires some skill and equipments, the positive rate is high (70~90%) and permanent keeping of the positive findings is possible.
Arthrodermataceae ; Aspergillus ; Candida albicans ; Coinfection ; Diagnosis ; Fungi ; Fusarium ; Humans ; Onychomycosis* ; Trichophyton ; Yeasts

PURPOSE: To report a case of corneal ulcer caused by Leclercia adecarboxylata in an immunocompetent patient. CASE SUMMARY: A previously healthy 43-year-old female presented with right ocular pain and was referred to our clinic under the impression of corneal abrasion and secondary infection. The patient was treated at a local clinic for 3 days using artificial tears, therapeutic contact lens, topical antibiotics, and anti-inflammatory eye drops but showed no improvement. Gram staining, bacterial and fungal cultures and antibiotic sensitivity test were performed from a corneal scrape. The cultures revealed growth of Leclercia adecarboxylata. The patient was treated with moxifloxacin and ofloxacin eye drops. After 2 weeks of treatment, the infection resolved without remaining scars. CONCLUSIONS: Reportedly, Leclercia adecarboxylata affects humans only as an opportunistic pathogen or part of polymicrobial infections. However, in the present case, Leclercia adecarboxylata was isolated as a single pathogen in an immunocompetent patient which is the first clinical report of this microorganism found in an ocular sample. Therefore, if antibiotic-susceptible gram-negative bacilli are found in opthalmologic samples, the above bacteria should be considerd in the diagnosis.
Adult ; Anti-Bacterial Agents ; Bacteria ; Cicatrix ; Coinfection ; Corneal Ulcer* ; Diagnosis ; Enterobacteriaceae* ; Female ; Humans ; Ofloxacin ; Ophthalmic Solutions

BACKGROUND: Onychomycosis is one of the most common nail disorders, and it is necessary of mycologic confirmation to treat correctly. It has been reported that histopathologic evaluation and polymerase chain reaction (PCR) of the nail plate by nail clipping might be a useful supportive method for identification of causative fungi showing higher detection rates. Objective: This study was designed to compare diagnostic efficacy of KOH preparation, fungal culture, histopathologic examination and PCR in onychomycosis. METHODS: Using 60 nail samples from 60 patients with clinically suspected onychomycosis, KOH preparation and fungal culture with nail and subungual tissue was performed. And histopathologic examination with PAS staining and PCR with DNA extracted from paraffin block was performed. RESULTS: The results are summarized as follows: 1. The positive rates of conventional KOH preparation, fungal culture, histopathologic examination and PCR were 87.5%, 8.9%, 87.5% and 83.9%. 2. In histopathologic examination, fungi were distinguished as 3 groups based on Kim and Cho's classification (1997): dermatophytes, Candida sp. and non-dermatophytic mold (NDM). Fifteen of 49 samples are dermatophytes, 1 is Candida sp., and 7 are NDM, 8 are dermatophytes and Candida sp. mixed infections, 18 are dermatophytes and NDM mixed infections. 3. In PCR, 1 of 47 samples is Trichophyton rubrum, 4 are Candida sp. and 39 samples are NDM. CONCLUSION: Histopathologic examination in onychomycosis is considered to be an useful supportive method in diagnosis and identification of causative fungi in onychomycosis.
Arthrodermataceae ; Candida ; Classification ; Coinfection ; Diagnosis* ; DNA ; Fungi ; Humans ; Onychomycosis* ; Paraffin ; Polymerase Chain Reaction* ; Trichophyton

BACKGROUND: Condyloma acuminatum is a sexually transmitted disease (STD) associated with the human papillomavirus (HPV). Although it is a relatively common disease, there has been no epidemiological and clinical study of condyloma acuminatum performed in Korea since 1978. OBJECTIVE: We aimed to evaluate the clinical features of condyloma acuminatum in Korean patients, to identify the genotypes of HPV, as well as determine factors associated with recurrence of condyloma acuminatum. METHODS: We studied 80 patients (60 men and 20 women) diagnosed with condyloma acuminatum. We analyzed age, sex, duration of the disease, number and locations of lesions, underlying diseases and co-infection with STDs, treatment modalities, and number of relapses. Additionally, 26 patients were analyzed for HPV subtypes. We also evaluated factors affecting recurrence of condyloma. RESULTS: Mean age at the time of diagnosis was 36.9±17.7 years and mean duration of disease was 7.2±16.5 months. The most common sites of involvement were found to be the penile shaft in men and the labia majora in women. We observed that 28 patients showed relapse with a mean duration of 1.5±4.5 months. HPV genotyping revealed that type 6, 11, and 44 genotypes that are associated with a low risk of malignancy were detected in 76.9% of cases, and type 16, 18, 51, 52, and 66 genotypes associated with a high risk of malignancy were detected in 15.3% cases. A significant relationship was observed between the recurrence rates of condyloma acuminatum and the rates of co-infection with STDs and the number of lesions. CONCLUSION: We report a recent epidemiological and clinical review analyzing genotypes of HPV in Korean patients presenting with condyloma acuminatum.
Clinical Study ; Coinfection ; Diagnosis ; Female ; Genotype* ; Humans* ; Korea ; Male ; Recurrence ; Sexually Transmitted Diseases

BACKGROUNDS: Sexually transmitted disease is class 3 major communicable disease group in Korea, and nationwide surveillance is required to control it. It is necessary to investigate the trends and current characteristics of STDs for effective control. METHODS: We analysed the laboratory data of those who visited a health center in Seoul for venereal disease examination and had abnormal results from Jan 1, 1991 to Dec 31, 1994. Venereal disease examination was composed of serum VDRL(quantitative), Gram staining and culture of urine or urethral discharge. RESULTS: There were 1196 male cases(97.6%) among the total 1226 cases. Mean age was 31.1+/-8.4, and the most common age group was 25-34 yr-old(60.8%). Diagnosis was as follows : syphilis 48 cases(3.9%), gonorrhea 388 cases(31.6%), Nongonoccocal urethritis 773 cases(63.1%), others 10 cases(0.8%), mixed infection of syphilis and gonorrhea 2 cases(0.2 %), mixed infection of syphilis and NGU 5 cases(0.4%). The proportion of PPNG among gonorrhea was as follows : 1991 48.1%, 1992 38.0%, 1993 32.9%, 1994 58.8%. The fraction of NGU among whole urethritis patients increased year by year, 1991 68.0%, 1992 69.4%, 1993 73.3%, 1994 55.3%. There were more WBCs on Gram staining of gonorrhea cases than NGU cases(p<0.01). CONCLUSIONS: The STD patients among beneficiaries of a health center were mainly young male. Common diagnosis was as follows, NGU, gonorrhea, syphilis. The proportion of PPNG among gonorrhea decreased initially, then increased in 1994, and the fraction of NGU among whole urethritis cases increased initially, then increased in 1994.
Coinfection ; Communicable Diseases ; Diagnosis ; Gonorrhea ; Humans ; Korea ; Male ; Seoul* ; Sexually Transmitted Diseases* ; Syphilis ; Urethritis