The aim of this study was to evaluate a new commercial
multiplex-based PCR which allows the detection and differentiation of the most relevant human pathogen fungi see more causing dermatomycoses in Europe. The accuracy and reproducibility of this application were verified in a clinical performance assessment in comparison to direct microscopy and culture using DNA isolates from 253 clinical samples. Sensitivity, specificity, positive predictive value and negative predictive value of 87.3%, 94.3%, 87.3% and 94.3%, respectively, were calculated for dermatophytes when confirmed by direct microscopy, culture or both. The corresponding values for Candida spp. were 62.7%, 93.5%, 77.8%, and 87.4%, respectively. Furthermore, in comparison to culture, the multiplex PCR was able to detect additional 38 Trichophytum rubrum and 12 Trichophytum interdigitale infections. These results
were confirmed by independent PCR analysis. From DNA isolation to diagnosis the multiparameter diagnostic kit gives rise to a 1-day workflow, enables fast clarification of disease aetiology and, thus, contributes to specific therapy selection. The latter is particularly important in light of growing resistance to antimycotics. Dermatomycoses are worldwide the most frequent diseases with a prevalence of 15–26% and a high number of unreported cases.[1-3] Due to demographic and socio-economic changes in the population as well as comorbidities and related drug therapies, an increasing incidence of dermatophytoses and changes in the spectrum of isolated strains have been observed.[2, 3] The causative CP-868596 agents of superficial mycoses are mainly dermatophytes, yeast and to a lesser extend non-dermatophyte moulds. Depending on the clinical pattern and the geographical area different pathogens are dominating. Microsporum canis is the most frequent fungus which causes tinea capitis in Central Europe. Trichophyton rubrum is
most prevalent in onychomycoses with approximately 60–90% in toenail and 50% in fingernail infections followed by Trichophytum interdigitale (former T. mentagrophytes var. interdigitale)[5, 6] and Epidermophyton floccosum. Up to 6% of all onychomycoses are caused by non-dermatophyte selleck compound moulds such as Scopulariopsis brevicaulis or Aspergillus spp., and yeast, predominant Candida spp., are frequently observed especially in fingernail infections.[8-10] Currently, the identification of these pathogens is almost based on morphological features examined by microscopy or by microbial cultivation in combination with metabolic tests. The success of these conventional laboratory procedures requires long-term expertise due to technical challenges as well as interspecific morphological similarity and growth variability of these organisms. Therefore, diagnostic sensitivities of 50–80% have been reported with high interlaboratory variability.