AUTHOR=Krammer Sebastian , Krammer Christian , Vladimirova Gabriela , Salzer Suzanna , Ruini Cristel , Sattler Elke , French Lars E. , Hartmann Daniela 

TITLE=Ex vivo Confocal Laser Scanning Microscopy: A Potential New Diagnostic Imaging Tool in Onychomycosis Comparable With Gold Standard Techniques

JOURNAL=Frontiers in Medicine

VOLUME=7

YEAR=2020

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2020.586648

DOI=10.3389/fmed.2020.586648

ISSN=2296-858X

ABSTRACT=<p><italic>Ex vivo</italic> confocal laser scanning microscopy (CLSM) is an innovative imaging tool that enables real-time examination of specimens and may be used in evaluating fungal infections. We aimed to assess the applicability of <italic>ex vivo</italic> CLSM in the diagnosis of onychomycosis by comparing results to those obtained by histopathology, potassium hydroxide (KOH) examination, and fungal culture. In this prospective study, 57 patients with the clinical diagnosis of distal nail fungal infection were examined and compared using all four of the above-mentioned diagnostic tools in terms of sensitivity, positive and negative predictive value. <italic>Ex vivo</italic> CLSM showed the highest sensitivity, followed by KOH examination, histopathology and fungal culture. Regarding positive and negative predictive values, <italic>ex vivo</italic> CLSM was superior and showed even higher sensitivity than the combined gold standard comprised of KOH examination, fungal culture or histopathology.</p>