Turkderm-Turk Arch Dermatol Venereol. 2014; 48(1): 21-25 | DOI: 10.4274/turkderm.36034

Comparison of The Efficacy and Cost Effectiveness of Five Different Diagnostic Methods in Onychomycosis

Faruk Erkan¹, Seval Doðruk Kaçar¹, Pýnar Özuðuz¹, Gülþah Aþýk², Çiðdem Tokyol³, Þemsettin Karaca^4
1Afyon Kocatepe University School Of Medicine Department Of Dermatology
²Afyon Kocatepe University School Of Medicine Department Of Microbiology
³Afyon Kocatepe University School Of Medicine Department Of Medical Pathology
⁴Izmir Katip Celebi University School Of Medicine Department Of Dermatology

Background and Design: We aimed to compare diagnostic value and cost efficacy of the diagnostic tests in patients with clinical findings that suggest onychomycosis as well as assess the factors that effect these diagnostic tests.
Material and Method: The efficiency and cost effectiveness of 5 diagnostic methods in 61 patients. Besides the clinical picture, at least one of the tests should be positive for diagnosis of onychomycosis. Factors possible to effect test results such as demographical data, accompanying systemic diseases, tinea pedis and tinea manum, previous antifungal treatment are recorded.
Results: Fifty patients out of 61 diagnosed as onychomycosis by positivity of at least one of the five methods. The success rate of diagnostic methods out of 50 patients were as followed: KOH standart microscopy 34 (68%), 24 hours KOH microscopy 40 (80%), fungal culture 24 (48%), histopathology with PAS 34 (68%) and with GMS 32 (64%). When cost effectiveness is considered 24 hours KOH microscopy testing is the most efficient and the cheapest whereas histopathological tests were the most expensive.
Conclusion: 24 hours KOH testing is relatively fast, efficient and cost-effective complementary method that does not depend on another clinician or a laboratory, thus could be preferred more frequently in dermatology practices.

Keywords: Onychomycosis, direct KOH microscopy, 24 hour KOH testing, fungal culture, PAS stain, GMS stain

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Onikomikoz Tanýsýnda Kullanýlan 5 Farklý Yöntemin Etkinlik ve Maliyet Karþýlaþtýrmasý

Faruk Erkan¹, Seval Doðruk Kaçar¹, Pýnar Özuðuz¹, Gülþah Aþýk², Çiðdem Tokyol³, Þemsettin Karaca^4
1Afyon Kocatepe Üniversitesi Týp Fakültesi Deri Ve Zührevi Hastalýklarý Anabilim Dalý
²Afyon Kocatepe Üniversitesi Týp Fakültesi Mikrobiyoloji Anabilim Dalý
³Afyon Kocatepe Üniversitesi Týp Fakültesi Týbbi Patoloji Anabilim Dalý
⁴Ýzmir Katip Çelebi Üniversitesi Týp Fakültesi Deri Ve Zührevi Hastalýklarý Anabilim Dalý

Giriþ ve Amaç: Bu çalýþmada kliniðimize onikomikoz düþündüren klinik bulgularla baþvuran hastalarda taný testlerinin taný koyma etkinlik ve maliyet etkinlik karþýlaþtýrmasý, taný yöntemlerini etkileyen faktörlerin belirlenmesi hedeflenmiþtir.
Gereç ve Yöntem: 61 hastada 5 taný yöntemi uygulanarak testlerin etkinlik ve maliyeti deðerlendirildi. Klinik görünümle birlikte beþ taný yönteminden en az birisi pozitif olan hastalar onikomikoz tanýsý aldý. Ayrýca hastalarýn demografik verileri yanýnda eþlik eden hastalýklar, tinea pedis ve tinea manum varlýðý, önceki antifungal tedavileri gibi test sonuçlarýný etkileyebilecek diðer faktörler kaydedildi.
Bulgular: Çalýþmaya alýnan 61 hastanýn 50’si (%82) beþ taný yönteminden en az biri pozitif saptanarak onikomikoz tanýsý aldý. Taný yöntemlerinin baþarýsý 50 olgu için sýrasýyla deðerlendirildiðinde; standart KOH inceleme 34’üne (%68), 24 saatlik KOH inceleme 40 ’ýna (%80), kültür 50 olgudan 24’üne (%48), histopatolojik incelemelerden PAS boyama 34’üne (%68), GMS ise 32’sine (%64) doðru taný koyabilmiþtir. Maliyet iliþkisine göre incelendiðinde en ucuz test 24 saatlik inceleme iken en pahalýsý histopatolojik incelemeler (PAS-GMS)’dir.
Sonuç: 24 saatlik KOH inceleme dermatoloji pratiðinde farklý bir klinisyen ve laboratuvara ihtiyaç duymadan nispeten hýzlý, etkili ve ucuz bir tamamlayýcý yöntem olarak daha sýk tercih edilebilir.

Anahtar Kelimeler: Onikomikoz, direkt KOH mikroskopi, 24 saatlik KOH inceleme, mantar kültürü, PAS boyama, GMS boyama

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