Sophisticated Test Facilitates Quicker Diagnosis And Treatment Of Fungal Nail Infections

The emergence of a molecular genetic test to identify fungal pathogens in nail tissue may take the guesswork out of treating fungal infections, allowing doctors to begin targeted therapy within days.

Bako Integrated Physician Solutions added molecular genetic testing to its laboratory-testing arsenal with the PCR Assay in 2015. The PCR Assay can accurately identify the genetic material of pathologic fungi within two days, according to the company. Traditional cultures often take up to four weeks before getting results.

The PCR Assay detects the genetic material of dermatophytes, saprophytes and/or yeasts, and is twice as sensitive as cultures in identifying dermatophytes, notes the company. Bako asserts that such specificity means doctors no longer have to rely on guesswork when determining which medications to use on patients.

Peter Brieloff, DPM, FACFAS, started using the PCR Assay shortly after the test became available.

“(The) PCR Assay appeals to me because of the very specific and quick results that are achieved with this testing, which then makes it easier for me to begin appropriate treatment,” says Dr. Brieloff, the President and founder of the Maryland-based Brieloff Foot Centers.

Dr. Brieloff, a Fellow of the American College of Foot and Ankle Orthopedics and Medicine, points to several cases in which the PCR Assay clarified the course of action necessary for a patient.

“I have had patients who (were) placed on oral antifungal medication in the past (with) no results,” says Dr. Brieloff. “I then performed the appropriate PCR testing and discovered that either the patient did not have any organisms growing which would cause the nails to have this condition, or that the patient had a condition that would not be responsive to oral therapy.”

Like Dr. Brieloff, Daniel Waldman, DPM, FACFAS, has been using the PCR Assay since the test first became available. Dr. Waldman, the owner and Medical Director of the North Carolina-based Blue Ridge Foot Centers, also points to quick, reliable and valid results as the qualities of the PCR Assay that appeal to him.

“Typical fungal cultures are not often reliable because of high false negative results,” says Dr. Waldman, a member of the Council for Nail Disorders.

Dr. Waldman describes one case of a 40-year-old patient who had been using over-the-counter remedies for many years to help resolve her toenail fungus.

“Her dermatologist ordered DTM (dermatophyte test media) but it was negative. The dermatologist still felt the diagnosis of onychomycosis was clinically accurate so he placed her on oral Lamisil,” says Dr. Waldman. “Months later, her nails still showed no improvement. She came to my office and I ordered PCR Assay of her worst looking toenails.”

Dr. Waldman says one of the nails tested positive for Candida albicans and the other nail was negative. He prescribed itraconazole along with in-office debridement of her toenails.

According to Dr. Waldman, the patient was relieved to not only have better looking toenails but an accurate diagnosis as well. “The PCR analysis confirmed yeast infection and with the added benefit of periodic acid-Schiff (PAS) reaction/Grocott-Gomori’s methenamine silver (GMS) stain, I was able to make the diagnosis of acrodermatitis continua, a form of psoriasis that affects mainly nail units,” maintains Dr. Waldman.

Ms. Garthwait is a freelance writer who lives in Downingtown, Pa.