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

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

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

Intestinal tuberculosis is a secondary infection from swallowing of infected sputum of pulmonary tuberculosis patient. The diagnosis is usually difficult there are no specific radiological signs and false negatives are often found in biopsy material obtained by colonoscopy since the process is mainly submucous. A lesion which is visualized on colonoscopic examination is rather confusing in that one will find a firm tumor mass occupying the lumen of the bowel which is most suggestive of carcinoma. We experienced a case of intestinal tuberculosis presenting a ulcerofungating mass occupying the lumen of the ascending colon, confirmed by colonoscopc biopsy in a 36-year-old man. He received anti-tuberculosis medication far 18months. The mass initially found totally disappeared as shown by a follow-up colonoscopy.
Adult ; Biopsy ; Coinfection ; Colon, Ascending ; Colonoscopy ; Deglutition ; Diagnosis ; Follow-Up Studies ; Humans ; Sputum ; Tuberculosis* ; Tuberculosis, Pulmonary

BACKGROUND: It has been known that the polymerase chain reaction(PCR) test of clinical specimens including blood, sputum, urine, and cerebrospinal fluid collected from patients with systemic fungal infection is a highly sensitive diagnostic method. Recently, the PCR test was applied to the diagnosis of onychomycosis. OBJECTIVE: This study was aimed to explore whether the PCR test would be a more sensitive diagnostic tool than the KOH smear, fungus culture and KONCPA(KOH+Nail Clipping+ PAS(periodic acid-Schiff) stain) test in diagnosing the onychomycosis. METHODS: Using 50 nail samples from 50 patients with onychomycosis, the result of the PCR test was compared with those of the KOH smear, fungus culture and KONCPA test. RESULTS: The results were as follows: 1. The positive rates for detecting the causative fungi from the KOH smear, fungus culture, KONCPA test and PCR test were 64.0%, 46.0%, 90.0%, and 100.0% respectively. 2. The fungus culture identified the causative fungi from 23 samples, of which 21(91.2%) were T. rubrum, 1(4.4%) Candida sp. and 1(4.4%) C. albicans. KONCPA test yielded higher positivity by detecting the pathogenic fungi in 45 samples: dermatophytes 35(77.8%), mixed infections of dermatophytes and Candida sp. 6(13.3%), molds 2(4.4%) and unclassified 2(4.4%). The PCR test yielded the highest positivity by detecting the pathogenic fungi in all samples ; T. rubrum 44(88.0%) and unclassified 6(12.0%). 3. Compared with the results of fungus culture and KONCPA test, that of PCR test showed some differences. The case of Candida sp. in fungus culture was identified as T. rubrum in PCR ; the case of C. albicans in fungus culture as unclassified in the PCR. Five cases of mixed infection and 2 cases of mold infection in the KONCPA test were diagnosed as T. rubrum infection in the PCR test. CONCLUSION: The PCR test is useful in diagnosing the onychomycosis because of its highest positive rate in detecting the causative fungi compared with fungus culture and the KONCPA test. Furthermore, a more accurate diagnostic method such as the PCR test will be necessary in case Candida sp. or mold is cultured from the infected nail specimen.
Arthrodermataceae ; Candida ; Cerebrospinal Fluid ; Coinfection ; Diagnosis ; Fungi* ; Humans ; Onychomycosis* ; Polymerase Chain Reaction* ; Sputum

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

BACKGROUND: PCR-based reverse blot hybridization assay (PCR-REBA) has high sensitivity and specificity, can be performed directly on nail samples, is relatively cheaper than other molecular biologic methods, and is useful for diagnosing onychomycosis. OBJECTIVE: This study aims to compare the diagnostic efficacy of fungal culture and REBA Fungus-ID® which is a commercial PCR-REBA-based kit used for onychomycosis diagnosis. METHODS: Fifty nail samples were collected from 50 patients diagnosed with onychomycosis via direct microscopic examination using KOH preparation, and subjected to fungal culture and REBA Fungus-ID® test. RESULTS: The sensitivity of conventional fungal culture and REBA Fungus-ID® was 56% and 100%, respectively. In REBA Fungus-ID®, 43 of 50 samples were found to be infected with Trichophyton rubrum. Four of the remaining 7 samples were identified as infected with Trichophyton spp., one with Trichophyton mentagrophytes, and two revealed a panfungal DNA sequence. In fungal culture, 28 of 50 samples showed growth, of which 18 samples were identified as T. rubrum, 3 as Rhodotorula mucilaginosa, 3 as Cladosporium spp., 1 as Cyphellophora europaea, 1 as Penicillium cvjetkovicii, 1 as Lachnum soppittii, and 1 as non-dermatophytic mold. REBA Fungus-ID® and fungal culture were identical in 20 cases (40%). The non-dermatophytic fungi identified in fungal culture were considered contaminants. CONCLUSION: Nail specimens can be used directly for REBA Fungus-ID®, which has a high sensitivity for onychomycosis diagnosis. Therefore, it can be considered useful for diagnosis and identification of the causative organism in mixed infections like onychomycosis.
Base Sequence ; Cladosporium ; Coinfection ; Diagnosis* ; Fungi ; Humans ; Onychomycosis* ; Penicillium ; Polymerase Chain Reaction ; Rhodotorula ; Sensitivity and Specificity ; Trichophyton

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