Dermatophyte fungi: Infections, Diagnosis and Treatment

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Diagnostic techniques
In accordance with progression in mycological diagnostic approaches, today there are two diagnostic categories including traditional and advanced molecular diagnostic tools available. Accuracy, availability, rapidity, sensitivity, specificity and cost effectiveness are important items for diagnostic procedures. Nevertheless, routine traditional diagnostic tools are not able to warrant adequate sensitivity and specificity (62).
Traditional diagnostic techniques
Traditional mycological diagnostics involve specimen direct microscopy, Wood’s lamp test, fungal culture medium, and biopsy. (2, 5, 63, 64).
Specimen direct microscopy
Direct microscopic observation of fungi in clinical samples is obviously a cheap and short-time diagnostic method. Clinical specimen must be prepared by scalpel, moving to a clean glass slide with a drop of 10%-20% KOH. Mild heat may help to increase the lytic activity of KOH on fungal α-(1,3) and α-(1,4) cross linkages in cell wall glucan polymers to have a clear and transparent vision of dermatophyte fungal elements including filamentous, septate, and branched hyphae with or without conidia among the specimen (1-3, 8, 9, 17, 65).
Providing suitable samples is an important part of direct microscopy. Accuracy in isolation of scale from peripheral border of suspected lesion, obtaining infected hair shafts or hair follicles, scraping from infected nails are the primary procedures for preparing valuable samples to have a successful observation to confirm the presence or absence of dermatophyte fungi. According to previous studies, sensitivity and the specificity of direct KOH microscopy are ~65% and >45% (1, 2, 8, 17, 66, 67).

Wood’s lamp test
Wood’s lamp tool is a limited diagnostic...

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...are not available or may be expensive. Thus, direct KOH microscopy is an acceptable diagnostic method yet. Simultaneous application of direct microscopy and culture are used as a best choice in some countries worldwide.
We purpose that, the use of direct microscopy, culture medium and molecular diagnostics simultaneously is the best choice until now. In addition, by detection of fungal elements via direct microscopy and molecular diagnostic approaches, pharmacotherapy must be started and the respond of culture medium is a confirmation test for an accurate diagnosis.
Although different types of antifungal drugs are available today; we believe that topical pharmacotherapy is the first choice. Negative respond to topical treatment, may be a good evidence for administering systematic antifungal drugs.
Conflict of interest
The authors declare no conflict of interests.

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