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• W2979945203 abstract "To the Editor: Potassium hydroxide (KOH) preparation is a widely used method for diagnosing cutaneous dermatophyte infections. However, KOH has widely variable sensitivity and specificity based on user experience and performance.1Yadav S. Saxena A. Capoor M. Ramesh V. Comparison of direct microscopic methods using potassium hydroxide, periodic acid Schiff, and calcofluor white with culture in the diagnosis of onychomycosis.Indian J Dermatol Venereol Leprol. 2013; 79: 242-243Crossref PubMed Scopus (7) Google Scholar Calcofluor white (CFW) is a fluorescent blue dye commonly used in microbiology laboratories for fungal identification. It binds to the chitin in the fungal cell wall and brightly fluoresces on exposure to ultraviolet (UV) light (Fig 1). Although considered a superior method for dermatophyte detection, bedside use of this technique is limited by the increased cost and complexity associated with fluorescence microscopes.2Goenka C. Lewis W. Chevres-Fernández L.R. et al.Mobile phone-based UV fluorescence microscopy for the identification of fungal pathogens.Lasers Surg Med. 2019; 51: 201-207Crossref PubMed Scopus (10) Google Scholar Our study presents a new method for bedside identification of dermatophyte infections by using a modified version of KOH microscopy: using the fluorescent compound CFW and an inexpensive and easily available handheld 395-nm light-emitting diode flashlight (TaoTronics model TT-FL001, TaoTronics, Sunvalley Group, Shenzhen, China) as an effective means of detection. This study was approved by the Johns Hopkins Medicine institutional review board. After performing skin scrapings of a clinically apparent dermatophyte infection and a control, samples were prepared by addition of either 1% CFW solution (Sigma-Aldrich) or 20% KOH and allowed to sit for 3 to 5 minutes. The samples were examined in the traditional manner and then with stage-light off and tangential illumination from a handheld UV light source (Fig 2). To compare these methods, a series of 30 images were captured displaying the following: 5 positive KOH preparations, 5 negative KOH preparations, 5 positive calcofluor preparations with 4′,6-diamidino-2-phenylindole (DAPI) fluorescence, 5 negative calcofluor preparations with DAPI fluorescence, 5 positive calcofluor preparations with a handheld UV flashlight, and 5 negative calcofluor preparations with a handheld UV flashlight. DAPI illumination is traditionally used with CFW and was therefore used as a control for the UV flashlight. These images were randomized and incorporated into an online Qualtrics survey and distributed to attending physicians and residents at the Johns Hopkins Department of Dermatology. Of the 20 individuals who completed the survey, 40% were resident physicians and 60% attending physicians. Our cohort correctly classified the KOH preparation 90.5% of the time. In contrast, the CFW illuminated with DAPI fluorescence and the CFW illuminated with the UV flashlight were both correctly classified 99% of the time. Additionally, our cohort determined if the images were positive or negative for fungal elements significantly faster for images using CFW versus KOH, regardless of the method of illuminated (mean time 7.7 seconds vs 16.8 seconds, P < .05, paired samples t test). Our study identifies a more efficient and accurate method for bedside cutaneous dermatophyte identification using CFW compared with that of traditional KOH microscopy. Although exposure to the eyes should be limited, the use of a UV light-emitting diode flashlight, which is typically in the 395-nm range, is unlikely to result in significant ocular damage.3Tosini G. Ferguson I. Tsubota K. Effects of blue light on the circadian system and eye physiology.Mol Vis. 2016; 22: 61-72PubMed Google Scholar Clinicians can mitigate such risk with the use of UV safety goggles, which filter out light <400 nm. Although this study is limited by its small size, a nationwide follow-up study has been initiated to assess the effectiveness and use of this detection technique and to compare our approach with the use of other dyes that may enhance KOH microscopy." @default.
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• W2979945203 date "2020-04-01" @default.
• W2979945203 modified "2023-09-26" @default.
• W2979945203 title "Rapid detection of fungal elements using calcofluor white and handheld ultraviolet illumination" @default.
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• W2979945203 doi "https://doi.org/10.1016/j.jaad.2019.10.012" @default.
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