{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T05:00:36Z","timestamp":1785128436760,"version":"3.55.0"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Onychomycosis requires laboratory confirmation before prolonged oral antifungal therapy is initiated. Periodic acid\u2013Schiff (PAS) staining is highly sensitive for the histopathologic diagnosis of onychomycosis but increases cost and turnaround time. This study evaluated the diagnostic accuracy of fluorescence microscopy of routine hematoxylin\u2013eosin (H&amp;amp;E)-stained nail sections compared with PAS-stained nail sections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A diagnostic accuracy study was performed using archived nail clipping slides from patients evaluated between 2019 and 2023. Fluorescence microscopy of H&amp;amp;E-stained nail clippings served as the index test, while PAS-stained nail clippings served as the reference standard. Slides were randomly selected from de-identified records and independently assessed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 84 slides were included, comprising 42 PAS-positive onychomycosis slides and 42 PAS-negative non-onychomycosis slides. Fluorescence microscopy showed a sensitivity of 80.95% (95% confidence interval [CI], 65.88\u201391.40%) and a specificity of 97.62% (95% CI, 87.43\u201399.94%). The PPV and NPV were 97.14% (95% CI, 85.08\u201399.93%) and 83.67% (95% CI, 70.34\u201392.68%), respectively. False-negative results were primarily associated with sparse fungal elements and yeast forms lacking pseudohyphae, while the single false-positive result was associated with fluorescent plasma globules and neutrophils.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Fluorescence microscopy of H&amp;amp;E-stained nail sections exhibits high specificity and may serve as a rapid, lower-cost adjunctive diagnostic method for confirming onychomycosis, particularly in resource-limited settings where fluorescence microscopy is available.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1900267","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T04:26:02Z","timestamp":1785126362000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic accuracy of fluorescence microscopy of hematoxylin\u2013eosin-stained nail sections for onychomycosis"],"prefix":"10.3389","volume":"13","author":[{"given":"Erickah Mary Therese R.","family":"Dy-Calayag","sequence":"first","affiliation":[{"name":"Department of Dermatology, Philippine General Hospital","place":["Manila, Philippines"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudine Yap","family":"Silva","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Philippine General Hospital","place":["Manila, Philippines"]},{"name":"College of Medicine, University of the Philippines Manila","place":["Manila, Philippines"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"32","DOI":"10.2174\/1872213X13666191026090713","article-title":"Onychomycosis: an updated review","volume":"14","author":"Leung","year":"2020","journal-title":"Recent Patents Inflamm Allergy Drug Discov"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"559","DOI":"10.3390\/jof9050559","article-title":"Onychomycosis: old and new","volume":"9","author":"Maskan-Bermudez","year":"2023","journal-title":"J Fungi (Basel)."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"71","DOI":"10.3314\/jjmm.46.71","article-title":"Mycology in the Philippines, revisited","volume":"46","author":"Handog","year":"2005","journal-title":"Nippon Ishinkin Gakkai Zasshi"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1186\/s12879-017-2258-3","article-title":"Meta-analysis of the utility of culture, biopsy, and direct KOH examination for the diagnosis of onychomycosis","volume":"17","author":"Velasquez-Agudelo","year":"2017","journal-title":"BMC Infect Dis"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"464","DOI":"10.3390\/jof8050464","article-title":"Diagnosing onychomycosis: what's new?","volume":"8","author":"Gupta","year":"2022","journal-title":"J Fungi (Basel)"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"637216","DOI":"10.3389\/fmed.2021.637216","article-title":"Diagnosis of onychomycosis: from conventional techniques and Dermoscopy to artificial intelligence","volume":"8","author":"Lim","year":"2021","journal-title":"Front Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"226","DOI":"10.4103\/0378-6323.39584","article-title":"Comparison of potassium hydroxide mount and mycological culture with histopathologic examination using periodic acid-Schiff staining of the nail clippings in the diagnosis of onychomycosis","volume":"74","author":"Shenoy","year":"2008","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1067\/S0190-9622(03)01480-4","article-title":"Comparison of diagnostic methods in the evaluation of onychomycosis","volume":"49","author":"Weinberg","year":"2003","journal-title":"J Am Acad Dermatol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"11314","DOI":"10.3389\/bjbs.2023.11314","article-title":"Dermatopathology and the diagnosis of fungal infections","volume":"80","author":"Howell","year":"2023","journal-title":"Br J Biomed Sci"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1067\/mjd.2002.120623","article-title":"Medical pearl: fluorescence microscopy of hematoxylin-eosin-stained sections","volume":"47","author":"Elston","year":"2002","journal-title":"J Am Acad Dermatol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1093\/ajcp\/79.2.231","article-title":"Fungal autofluorescence with ultraviolet 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superficial and deep fungal infections","volume":"1","author":"Elston","year":"2001","journal-title":"BMC Microbiol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1111\/j.1553-2712.1996.tb03538.x","article-title":"Statistical methodology: I. Incorporating the prevalence of disease into the sample size calculation for sensitivity and specificity","volume":"3","author":"Buderer","year":"1996","journal-title":"Acad Emerg Med"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1900267\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T04:26:02Z","timestamp":1785126362000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1900267\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,27]]},"references-count":16,"alternative-id":["10.3389\/fmed.2026.1900267"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1900267","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,27]]},"article-number":"1900267"}}