{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:51:18Z","timestamp":1790718678007,"version":"4.1.0"},"reference-count":10,"publisher":"MDPI AG","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11]]},"abstract":"\n Background<\/jats:title>\n Diagnosis of onychomycosis using the periodic acid\u2013Schiff (PAS) test for sensitive identification of hyphae and fungal culture for identification of species has become the mainstay for many clinical practices. With the advent of polymerase chain reaction (PCR) testing, physicians can identify a fungal toenail infection quickly with the added benefit of species identification. We compared PAS testing with multiplex PCR testing from a clinical perspective.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A total of 209 patients with clinically diagnosed onychomycosis were recruited. A high-resolution picture was taken of the affected hallux nail, and the nail was graded using the Onychomycosis Severity Index. A proximal sample of the affected toenail and subungual debris were obtained and split into two equal samples. One sample was sent for multiplex PCR testing and the other for PAS testing. The results were analyzed and compared.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Six patients were excluded due to insufficient sample size for PCR testing. Of the remaining 203 patients, 109 (53.7%) tested positive with PAS, 77 (37.9%) tested positive with PCR. Forty-one patients tested positive with PAS but negative with PCR, and nine tested positive with PCR but negative with PAS.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Physicians should continue the practice of using PAS biopsy staining for confirmation of a fungal toenail infection before using oral antifungal therapy. Because multiplex PCR allows species identification, some physicians may elect to perform both tests.<\/jats:p>\n <\/jats:sec>","DOI":"10.7547\/18-048","type":"journal-article","created":{"date-parts":[[2020,12,10]],"date-time":"2020-12-10T14:03:45Z","timestamp":1607609025000},"source":"Crossref","is-referenced-by-count":1,"title":["Commercial Multiplex Polymerase Chain Reaction versus Periodic Acid\u2013Schiff Testing for the Diagnosis of Onychomycosis"],"prefix":"10.3390","volume":"110","author":[{"given":"Bryan","family":"Caldwell","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Uchmanowicz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill S.","family":"Kawalec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Petrofski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl","family":"Kurzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"i8750-7315-110-6-Article_2-b01","series-title":"J Am Acad Dermatol","doi-asserted-by":"publisher","first-page":"S2","DOI":"10.1016\/S0190-9622(96)90061-4","article-title":"Onychomycosis: a significant medical disorder","volume":"35","author":"Scher","year":"1996","unstructured":"Scher\n RK:\n \n \n Onychomycosis: a significant medical disorder.\n\t\t\t\t\tJ Am Acad Dermatol35: S2,\n\t\t\t\t\t1996.\n\t\t\t\t878430210.1016\/S0190-9622(96)90061-4"},{"key":"i8750-7315-110-6-Article_2-b02","series-title":"Geriatr Gerontol Int","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1111\/ggi.12496","article-title":"Epidemiological study of onychomycosis in older adults with onychodystrophy","volume":"16","author":"Cozzani","year":"2016","unstructured":"Cozzani\n E\n \n \n Agnoletti\n A\n \n \n Speziari\n S\n \n :\n\t\t\t\t\t\n Epidemiological study of onychomycosis in older adults with onychodystrophy.\n\t\t\t\t\tGeriatr Gerontol Int16: 486,\n\t\t\t\t\t2016.\n\t\t\t\t25981058http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000373611800011&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1111\/ggi.12496"},{"key":"i8750-7315-110-6-Article_2-b03","series-title":"Arch Dermatol","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.1001\/archdermatol.2011.267","article-title":"A new classification system for grading the severity of onychomycosis: Onychomycosis Severity Index","volume":"147","author":"Carney","year":"2011","unstructured":"Carney\n C\n \n \n Tosti\n A\n \n \n Daniel\n R\n \n :\n\t\t\t\t\t\n A new classification system for grading the severity of onychomycosis: Onychomycosis Severity Index.\n\t\t\t\t\tArch Dermatol147: 1277,\n\t\t\t\t\t2011.\n\t\t\t\t22106113http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000297226000006&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1001\/archdermatol.2011.267"},{"key":"i8750-7315-110-6-Article_2-b04","series-title":"J Am Acad Dermatol","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","unstructured":"Weinberg\n JM\n \n \n Koestenblatt\n EK\n \n \n Tutrone\n WD\n \n :\n\t\t\t\t\t\n Comparison of diagnostic methods in the evaluation of onychomycosis.\n\t\t\t\t\tJ Am Acad Dermatol49: 193,\n\t\t\t\t\t2003.\n\t\t\t\t10.1067\/S0190-9622(03)01480-412894064"},{"key":"i8750-7315-110-6-Article_2-b05","series-title":"Eur J Dermatol","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1684\/ejd.2010.1152","article-title":"Direct detection and differentiation of causative fungi of onychomycosis by multiplex polymerase chain reaction-based assay","volume":"21","author":"Li","year":"2011","unstructured":"Li\n X\n \n \n Wei\n T\n \n \n Wang\n H\n \n :\n\t\t\t\t\t\n Direct detection and differentiation of causative fungi of onychomycosis by multiplex polymerase chain reaction-based assay.\n\t\t\t\t\tEur J Dermatol21: 37,\n\t\t\t\t\t2011.\n\t\t\t\thttp:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000289677500006&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f32124501910.1684\/ejd.2010.1152"},{"key":"i8750-7315-110-6-Article_2-b06","series-title":"Br J Dermatol","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1111\/j.1365-2133.2010.09852.x","article-title":"Polymerase chain reaction in the diagnosis of onychomycosis: a large, single-institute study","volume":"163","author":"Litz","year":"2010","unstructured":"Litz\n CE\n \n \n Cavagnolo\n RZ:\n \n \n Polymerase chain reaction in the diagnosis of onychomycosis: a large, single-institute study.\n\t\t\t\t\tBr J Dermatol163: 511,\n\t\t\t\t\t2010.\n\t\t\t\thttp:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000281135800013&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1111\/j.1365-2133.2010.09852.x"},{"key":"i8750-7315-110-6-Article_2-b07","series-title":"JAPMA","first-page":"280","article-title":"Onychomycosis infections: do polymerase chain reaction and culture reports agree?","volume":"107","author":"Gupta","year":"2017","unstructured":"Gupta\n AK\n \n \n Nakrieko\n K:\n \n \n Onychomycosis infections: do polymerase chain reaction and culture reports agree?\n JAPMA\n 107\n : \n 280,\n\t\t\t\t\t2017."},{"key":"i8750-7315-110-6-Article_2-b08","series-title":"Mycoses","doi-asserted-by":"publisher","first-page":"e539","DOI":"10.1111\/j.1439-0507.2010.01977.x","article-title":"Incubation of fungal cultures: how long is long enough?","volume":"54","author":"Bosshard","year":"2011","unstructured":"Bosshard\n PP:\n \n \n Incubation of fungal cultures: how long is long enough?\n Mycoses\n 54\n : \n e539,\n\t\t\t\t\t2011.\n\t\t\t\thttp:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000294878900130&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1111\/j.1439-0507.2010.01977.x"},{"key":"i8750-7315-110-6-Article_2-b09","series-title":"Nucleic Acids Res","first-page":"1","article-title":"Multiplex pyrosequencing","volume":"30","author":"Pourmand","year":"2002","unstructured":"Pourmand\n N\n \n \n Elahi\n E\n \n \n Davis\n RW\n \n :\n\t\t\t\t\t\n Multiplex pyrosequencing.\n\t\t\t\t\tNucleic Acids Res30: 1,\n\t\t\t\t\t2002."},{"key":"i8750-7315-110-6-Article_2-b10","series-title":"J Am Acad Dermatol","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1067\/mjd.2000.107754","article-title":"A large-scale North American study of fungal isolates from nails: the frequency of onychomycosis fungal distribution, and antifungal susceptibility patterns","volume":"43","author":"Ghannoum","year":"2000","unstructured":"Ghannoum\n MA\n \n \n Hajjeh\n RA\n \n \n Scher\n R\n \n :\n\t\t\t\t\t\n A large-scale North American study of fungal isolates from nails: the frequency of onychomycosis fungal distribution, and antifungal susceptibility patterns.\n\t\t\t\t\tJ Am Acad Dermatol43: 641,\n\t\t\t\t\t2000.\n\t\t\t\t1100462010.1067\/mjd.2000.107754"}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"link":[{"URL":"https:\/\/japmaonline.org\/view\/journals\/apms\/110\/6\/i8750-7315-110-6-article_2.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/meridian.allenpress.com\/japma\/article-pdf\/doi\/10.7547\/18-048\/2679521\/i8750-7315-110-6-article_2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/110\/6\/i8750-7315-110-6-article_2.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/110\/6\/i8750-7315-110-6-article_2.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:18:04Z","timestamp":1783505884000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/110\/6\/18048"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11]]},"references-count":10,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.7547\/18-048","relation":{},"ISSN":["8750-7315"],"issn-type":[{"value":"8750-7315","type":"print"}],"subject":[],"published":{"date-parts":[[2020,11]]}}}