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Reflectance Confocal Microscopy in the Diagnosis of Onychomycosis: A Systematic Review

Accurately diagnosing onychomycosis is vital, as therapy is time-consuming and accompanied by multiple adverse effects. Reflectance confocal microscopy (RCM), in contrast to traditional mycological testing, is a noninvasive, point-of-care tool that can rapidly identify fungal lesions. This systemati...

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Autores principales: Lim, Sophie Soyeon, Kim, Bo Ri, Mun, Je-Ho
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9783243/
https://www.ncbi.nlm.nih.gov/pubmed/36547605
http://dx.doi.org/10.3390/jof8121272
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author Lim, Sophie Soyeon
Kim, Bo Ri
Mun, Je-Ho
author_facet Lim, Sophie Soyeon
Kim, Bo Ri
Mun, Je-Ho
author_sort Lim, Sophie Soyeon
collection PubMed
description Accurately diagnosing onychomycosis is vital, as therapy is time-consuming and accompanied by multiple adverse effects. Reflectance confocal microscopy (RCM), in contrast to traditional mycological testing, is a noninvasive, point-of-care tool that can rapidly identify fungal lesions. This systematic review aims to understand the utility of RCM in evaluating onychomycosis and follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search of four databases was conducted. A total of five articles—three prospective cohort studies and two case reports—which reported RCM findings in nails clinically suspicious for onychomycosis were analyzed. Fungal hyphae or spores were visualized on RCM in 67 (81.7%) of the 82 mycologically confirmed cases of onychomycosis. Terms used to describe hyphae included bright, linear, lengthy, thready-like, branching and filamentous. Spores were described as bright, roundish structures with high reflection. The three cohort studies demonstrated RCM had a sensitivity of 52.9–91.7, a specificity of 57.58–90.2%, a positive predictive value of 61.1–88.6% and a negative predictive value of 68.0–90.5%. In conclusion, existing studies demonstrate how RCM can assist the diagnosis of onychomycosis at the bedside. Larger studies incorporating multiple testing modalities to confirm the diagnosis of onychomycosis are warranted to further explore the diagnostic utility of RCM.
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spelling pubmed-97832432022-12-24 Reflectance Confocal Microscopy in the Diagnosis of Onychomycosis: A Systematic Review Lim, Sophie Soyeon Kim, Bo Ri Mun, Je-Ho J Fungi (Basel) Review Accurately diagnosing onychomycosis is vital, as therapy is time-consuming and accompanied by multiple adverse effects. Reflectance confocal microscopy (RCM), in contrast to traditional mycological testing, is a noninvasive, point-of-care tool that can rapidly identify fungal lesions. This systematic review aims to understand the utility of RCM in evaluating onychomycosis and follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search of four databases was conducted. A total of five articles—three prospective cohort studies and two case reports—which reported RCM findings in nails clinically suspicious for onychomycosis were analyzed. Fungal hyphae or spores were visualized on RCM in 67 (81.7%) of the 82 mycologically confirmed cases of onychomycosis. Terms used to describe hyphae included bright, linear, lengthy, thready-like, branching and filamentous. Spores were described as bright, roundish structures with high reflection. The three cohort studies demonstrated RCM had a sensitivity of 52.9–91.7, a specificity of 57.58–90.2%, a positive predictive value of 61.1–88.6% and a negative predictive value of 68.0–90.5%. In conclusion, existing studies demonstrate how RCM can assist the diagnosis of onychomycosis at the bedside. Larger studies incorporating multiple testing modalities to confirm the diagnosis of onychomycosis are warranted to further explore the diagnostic utility of RCM. MDPI 2022-12-02 /pmc/articles/PMC9783243/ /pubmed/36547605 http://dx.doi.org/10.3390/jof8121272 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Lim, Sophie Soyeon
Kim, Bo Ri
Mun, Je-Ho
Reflectance Confocal Microscopy in the Diagnosis of Onychomycosis: A Systematic Review
title Reflectance Confocal Microscopy in the Diagnosis of Onychomycosis: A Systematic Review
title_full Reflectance Confocal Microscopy in the Diagnosis of Onychomycosis: A Systematic Review
title_fullStr Reflectance Confocal Microscopy in the Diagnosis of Onychomycosis: A Systematic Review
title_full_unstemmed Reflectance Confocal Microscopy in the Diagnosis of Onychomycosis: A Systematic Review
title_short Reflectance Confocal Microscopy in the Diagnosis of Onychomycosis: A Systematic Review
title_sort reflectance confocal microscopy in the diagnosis of onychomycosis: a systematic review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9783243/
https://www.ncbi.nlm.nih.gov/pubmed/36547605
http://dx.doi.org/10.3390/jof8121272
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