c.i.-fluorescent-brightening-agent-28 and potassium-hydroxide

Onychomycosis is a fungal nail infection caused primarily by dermatophytes. Several other nail disorders, including psoriasis, can simulate onychomycosis. Accurate diagnosis is therefore vital for the ongoing treatment and management of onychomycosis and to avoid misdiagnosis and treatment delay, which can be both lengthy and costly. Often, a combination of histologic and laboratory techniques is used to obtain an accurate diagnosis. The potential diagnostic challenges associated with the differential diagnosis of onychomycosis caused by dermatophytes and the most common techniques used to confirm the diagnosis are discussed.

Topics: Benzenesulfonates; Biopsy; Diagnosis, Differential; Fluorescent Dyes; Humans; Hydroxides; Microbiological Techniques; Mycology; Nails; Onychomycosis; Periodic Acid-Schiff Reaction; Polymerase Chain Reaction; Potassium Compounds; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization

Coccidioidomycosis is a regionally common fungal infection, primarily affecting the lung. While in the majority of cases the tempo of the disease allows for a more leisurely diagnostic plan, including multiple serologic tests and culture of respiratory secretions, occasionally, patients will present with rapidly progressive, life-threatening pulmonary illness, in whom there is an urgent need for rapid diagnosis. Evaluation of respiratory secretions including expectorated sputum as well as bronchial washings are frequently available or obtained for diagnosing pulmonary infiltrates. We compared the sensitivity of the Papanicolaou stain with 10% potassium hydroxide digestion (10% KOH) and with calcofluor white (cw). The Papanicolaou test performed the best and should be used in the evaluation of suspected patients with coccidioidomycosis.

Topics: Benzenesulfonates; Blood Gas Analysis; Bronchoalveolar Lavage Fluid; Coccidioides; Coccidioidomycosis; Contrast Media; Humans; Hydroxides; Potassium Compounds; Prospective Studies; Respiratory Tract Infections; Sensitivity and Specificity; Sputum; Time Factors; Vaginal Smears

The incidence of fungal keratitis demonstrates significant geographic and climatic variation. We report on the characteristics of the potassium hydroxide/calcofluor white (KOH-CFW) preparation observed at a tertiary center in Northern California, a region with a low incidence of fungal keratitis.. Culture-proven cases of microbial keratitis during a 5-year period were retrospectively reviewed. The sensitivity, specificity, and posttest probabilities were determined for the KOH-CFW assay. These results were compared with documented clinical impression and values reported in the literature.. Three hundred three of 368 episodes of microbial keratitis during the study period documented the results of a fungal culture, KOH-CFW assay, and a clinical impression. Twenty-one (6.9%) of these cultures were positive for fungal organisms. The sensitivity and specificity of the KOH-CFW test were 29% and 93%, respectively. Clinicians' initial clinical impression based solely on patients' history and examination, without the aid of any histopathologic or biochemical test results, demonstrated a sensitivity and specificity of 33% and 89%, respectively.. The observed sensitivity and specificity of the KOH-CFW preparation are significantly lower than many previously reported values. In regions with low incidence of fungal keratitis, the KOH-CFW preparation may have diagnostic performance similar to that of the clinical impression formed only on the basis of history and physical examination.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Benzenesulfonates; California; Child; Child, Preschool; Cornea; Eye Infections, Fungal; Female; Fluorescent Dyes; Follow-Up Studies; Fungi; Humans; Hydroxides; Incidence; Indicators and Reagents; Infant; Infant, Newborn; Keratitis; Male; Microscopy, Fluorescence; Middle Aged; Potassium Compounds; Reproducibility of Results; Retrospective Studies; Young Adult

To assess the sensitivity of potassium hydroxide and calcofluor white (KOH+CFW) mount in the diagnosis of Pythium keratitis and concordance among microbiologists.. Three microbiologists evaluated the microscopic images of KOH + CFW mounts of confirmed cases of Pythium and fungal keratitis seen between January 2019 and February 2021. The filaments were compared using specific differentiating features. The sensitivity and specificity of KOH + CFW in diagnosing Pythium infection were evaluated along with concordance among the microbiologists.. Sixty consecutive cases with confirmed growth of fungus or Pythium insidiosum (n = 29) were evaluated. The sensitivity of KOH + CFW in the correct identification of Pythium filaments ranged from 79.3% to 96.5% among three microbiologists. There was good interobserver (k = 0.76-0.90) and intraobserver (k = 0.70-0.97) agreements among three microbiologists. The differentiating findings (P < 0.0001) suggestive of Pythium filaments were the absence of septae in 23 (79.3%) and collapsed walls in 22 (75.9%) cases.. KOH + CFW has good sensitivity and specificity in the diagnosis of Pythium keratitis with good interobserver and intraobserver concordance.

Topics: Benzenesulfonates; Coloring Agents; Cornea; Eye Infections, Fungal; Fungi; Humans; Hydroxides; Keratitis; Potassium Compounds; Pythium

Topics: Benzenesulfonates; Coloring Agents; Humans; Hydroxides; Keratitis; Potassium Compounds; Pythium

Topics: Benzenesulfonates; Coloring Agents; Humans; Hydroxides; Keratitis; Potassium Compounds; Pythium

Vulvovaginal candidiasis (VVC) is a common vaginitis in females. The commonly used diagnostic method, 10% potassium hydroxide (KOH) smear microscopy, makes it not very easy to recognize fungi.. Vaginal secretions were collected from clinically suspected VVC patients and divided into four groups and examined using KOH, CFW (Calcofluor White), FB 85(fluorescent brightener 85), and culture. The data were statistically analyzed.. In total, 110 patients with suspected VVC were recruited. The positive rates of KOH, CFW, FB 85, and the culture method were 68.2%, 64.5%, 61.8%, and 77%, respectively. According to the McNemar test, there was no statistically significant difference between the KOH, CFW, and the FB 85 methods (p > 0.05). However, CFW had a shorter diagnosis time than the KOH method and had a statistically significant difference (p < 0.001). Moreover, CFW has the highest sensitivity, specificity, and accuracy. In morphological recognition, it was easier to recognize fungal structures with CFW and FB 85 than with the KOH.. The fluorescent method is a good method for the diagnosis of VVC. And the fungi can be found more quickly. Similar to CFW, FB 85 is also a potential good fluorescent reagent for the diagnosis of VVC and has potential value for application in clinical fungal infection diseases.

Topics: Adult; Benzenesulfonates; Candida albicans; Candida glabrata; Candida tropicalis; Candidiasis, Vulvovaginal; Female; Fluorescent Dyes; Humans; Hydroxides; Image Processing, Computer-Assisted; Microscopy, Fluorescence; Potassium Compounds; Sensitivity and Specificity; Time Factors

To evaluate the efficacy of trypan blue in direct microscopic examination of corneal scrapings in the diagnosis of non-viral microbial keratitis.. In a prospective, interventional, masked study, 82 consecutive patients were investigated. Direct microscopic examination of the corneal scrapings involved three smears stained with potassium hydroxide with calcofluor white (KOH + CFW), Gram stain (not analyzed), and trypan blue stain and culture for bacteria, fungus, and Acanthamoeba. While KOH + CFW stained slides were examined under a fluorescence microscope, trypan blue-stained slides were examined by two microbiologists (masked to KOH + CFW and culture results) under normal light microscopy. Thirty samples were reexamined for interobserver and intraobserver variability.. Out of 82 samples, fungal/fungus-like elements were seen in 48 (58.5%) in KOH + CFW and 38 (46.3%) in trypan blue stain. One microsporidial case, detected in KOH + CFW was negative in trypan blue stain (culture not done). Fungal growth was positive in 23 out of 81 (28.3%) cases cultured, single bacterial species in 18 (22.2%), Pythium insidiosum in three, mixed bacteria and fungus/Pythium in 7 (8.6%), Acanthamoeba in none and 30 (37.0%) samples were sterile. With culture as gold standard, the respective sensitivity (84.9%, 75.7%) and specificity (90.9%, 68.2%) of KOH + CFW stain and trypan blue stain were comparable (p = 0.16, P = 0.06). The interobserver linear weighted kappa score between the two microbiologists was 1.00 while it was 0.86 for intraobserver agreement.. Trypan blue stain, an easily available dye to ophthalmologists, is highly efficacious in the diagnosis of fungal keratitis.

Topics: Benzenesulfonates; Cornea; Humans; Hydroxides; Keratitis; Microscopy, Fluorescence; Potassium Compounds; Prospective Studies; Trypan Blue

The diagnosis of superficial mycosis such as dermatophytosis is often done clinically. However, in difficult cases, a rapid test with high sensitivity and specificity helps in the immediate confirmation and administration of treatment.. The efficacy, rapidity of detection, and cost-effectiveness of KOH preparation, calcofluor white (CW) stain, and Chicago sky blue (CSB) stain in the identification of fungal elements were assessed in patients with dermatophytoses attending the dermatology clinic of a tertiary care hospital. All three tests were performed on each sample collected from 73 patients according to standard procedure. The slides were examined after 5 and 30 minutes in × 10 and × 40 magnifications. The sensitivity and specificity of CW and CSB at 5 and 30 minutes were calculated using KOH preparation as the standard test.. CSB stain showed highest positivity (94.5%) within 5 minutes when compared to KOH (75.3%) and CW (83.5%). After 30 minutes, positivity increased in KOH (84.9%) and CW stains (89%), but it remained the same in CSB stain. Both CW and CSB stains when compared to 10% KOH are equally sensitive (100%), but CW was more specific (72.7%), particularly at 30 minutes. When cost of performing tests on 100 specimens is considered, KOH, CW, and CSB stains cost Rs 5, 100, and 15, respectively.. CSB stain is a better stain for rapid diagnosis of dermatophytoses because of ease of performance, rapidity of detection, better appreciation of morphology of fungal elements, and cost effectiveness.

Topics: Adolescent; Adult; Aged; Benzenesulfonates; Child; Child, Preschool; Coloring Agents; Cost-Benefit Analysis; Female; Humans; Hydroxides; Male; Microscopy; Middle Aged; Potassium Compounds; Predictive Value of Tests; Staining and Labeling; Time Factors; Tinea; Trypan Blue; Young Adult

The aim of this study was to develop a quick and economical method for the diagnosis of fungal keratitis. Corneal scrapings were obtained from consecutive patients (n = 165) with clinically suspected fungal keratitis and were used for culture and to prepare two smears. Potassium hydroxide stain followed by calcofluor white stain was added to one smear and Giemsa stain followed by calcofluor white stain was added to the second. In comparison with the fungal culture results, the sensitivity of potassium hydroxide wet mounts was 81.0% and following the addition of calcofluor white was 96.6% in diagnosing fungal keratitis, whereas sensitivity using Giemsa stain was 39.7% and following the addition of calcofluor white was 98.3%. The Giemsa stain detected 23 cases of bacterial infection, of which six cases were mixed fungal and bacterial infections. Giemsa stain followed by calcofluor white was considered to be the better method for diagnosing fungal keratitis due to its high sensitivity combined with its ability to identify bacterial or mixed infections.

Topics: Azure Stains; Benzenesulfonates; Cornea; Eye Infections, Fungal; Humans; Hydroxides; Keratitis; Microscopy; Potassium Compounds; Staining and Labeling

Fluorescent whiteners, such as Blankophor and Calcofluor white, bind to chitin and cellulose, and fluoresce when exposed to UV light. Detection of fungal elements from skin and nail samples was faster and more accurate using Blankophor compared with potassium hydroxide preparations and Calcofluor (sensitivity and specificity 100% and 86% vs. 83-90% and 84-88%, or 80% and 84%, respectively). Visibility was improved, and the procedures were simple, inexpensive and rapid, all of which are important considerations in a busy diagnostic laboratory.

Topics: Benzenesulfonates; Fluorescence; Fungi; Humans; Hydroxides; Mycoses; Nails; Potassium Compounds; Sensitivity and Specificity; Skin; Stilbenes

Retrospective evaluation of potassium hydroxide plus calcofluor white (KOH+CFW), Gram, Giemsa, and modified Ziehl-Neelsen (1% H(2)SO(4), cold) stains for the detection of microsporidia in corneal scrapings from 30 patients showed KOH+CFW and acid-fast stains to be most efficient (29/30 [96.7%] and 28/30 [93.3%], respectively) in the diagnosis of microsporidial keratitis.

Topics: Benzenesulfonates; Cornea; Eye Infections, Parasitic; Humans; Hydroxides; Keratitis; Microsporidia; Microsporidiosis; Potassium Compounds; Specimen Handling; Staining and Labeling

Onychomycosis is a common problem seen in clinical practice. Given the differential diagnosis of dystrophic nails, it is helpful to obtain a definitive diagnosis of dermatophyte infection before the initiation of antifungal therapy. Potassium hydroxide (KOH) preparation and fungal culture, which are typically used in the diagnosis of these infections, often yield false-negative results. Recent reports have suggested that nail plate biopsy using periodic acid-Schiff (PAS) (Bx/PAS) stain may be a very sensitive technique for the diagnosis of onychomycosis.. The purpose of this study was to compare KOH preparation, culture, Bx/PAS stain, and calcofluor white (CW) stain in the diagnosis of onychomycosis and to determine their sensitivity and specificity.. We evaluated 105 patients with suspected onychomycosis using 4 diagnostic methods: KOH preparation, culture, Bx/PAS, and CW stain. CW stain binds to cellulose and chitin, and fluoresces when exposed to UV radiation. It is a highly sensitive and specific technique for the detection of dermatophytes. To determine the clinical usefulness and performance characteristics of each test, CW was chosen as the gold standard for statistical analysis.. Of the patients, 93 had at least 1 of the 4 diagnostic methods positive for the presence of organisms. The following were calculated for each test: sensitivity; specificity; positive predictive value; and negative predictive value. The sensitivities of each of the techniques were as follows: KOH 80%; Bx/PAS 92%; and culture 59%. Both KOH and Bx/PAS methods were more sensitive than culture (P =.00002). Bx/PAS was also more sensitive than KOH (P =.03). The specificities were as follows: KOH 72%; Bx/PAS 72%; and culture 82%. The positive predictive value calculated for the different techniques were: KOH 88%; Bx/PAS 89.7%; and culture 90%. In terms of negative predictive value, the results were: KOH 58%; Bx/PAS 77%; and culture 43%.. Bx/PAS is the most sensitive method for the diagnosis of onychomycosis. It is also superior to the other methods in its negative predictive value. It is indicated if other methods are negative and clinical suspicion is high, and potentially is the single method of choice for the evaluation of onychomycosis.

Topics: Arthrodermataceae; Benzenesulfonates; Culture Media; Diagnosis, Differential; Fluorescent Dyes; Foot Dermatoses; Humans; Hydroxides; Onychomycosis; Periodic Acid-Schiff Reaction; Potassium Compounds; Sensitivity and Specificity; Specimen Handling

Calcofluor and ink-potassium hydroxide preparations identified Fusarium solani, Aspergillus fumigatus, and Candida albicans, the three most common ocular fungal pathogens, in scrapings, biopsy specimens, and tissue sections of corneal mycotic infections in rabbits. These stains also identified fungal organisms in specimens from four human patients with keratomycoses. Neither procedure requires more than a few minutes to perform or extensive training or experience to interpret. The specimen stained with calcofluor can be examined immediately, but may not identify all fungi. The more sensitive ink-potassium hydroxide preparation should be examined after 18 to 24 hours, and is less likely to provide false-positive results than the calcofluor method.

Topics: Animals; Benzenesulfonates; Contrast Media; Eye Diseases; Hydroxides; Ink; Keratitis; Mycoses; Potassium; Potassium Compounds; Rabbits