Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Onychomycosis (OM) can be identified by its appearance. However, other conditions and infections can cause problems in the nails that look like onychomycosis. OM must be confirmed by laboratory tests before beginning treatment, because treatment is long, expensive, and does have some risks.
A sample of the nail can be examined under a microscope to detect fungi. See Anatomy of the Nail for information on the parts of the nail.
The nails must be clipped and cleaned with an alcohol swab to remove bacteria and dirt so the fungal structures can be more easily visualized with a microscope.
If the doctor suspects distal lateral subungual onychomycosis (DLSO), a sample (specimen) should be taken from the nail bed to be examined. The sample should be taken from a site closest to the cuticle, where the concentration of fungi is the greatest.
If proximal subungual onychomycosis (PSO) is suspected, the sample is taken from the underlying nail bed close to the lunula.
A piece of the nail surface is taken for examination if white superficial onychomycosis (WSO) is suspected.
To detect candidal onychomycosis, the doctor should take a sample from the affected nail bed edges closest to the cuticle and sides of the nail.
In the laboratory, the sample may be treated with a solution made from 20% potassium hydroxide (KOH) in dimethyl sulfoxide (DMSO) to help rule out or more easily verify the presence of fungi by reducing debris and human tissue in the sample. The specimen may also be treated with dyes (a process called staining) to make it easier to see the fungal structure through the microscope that help identify the precise species of the pathogen.
If fungi are present in the infected nail, they can be seen through a microscope, but the exact type (species) cannot be determined by simply looking through a microscope. To identify what exactly is causing onychomycosis, a
fungal culturing is used. Using a fungal culture to identify the particular fungus is important because regular therapy may not work on nondermatophyte molds.
The infected nail is scraped or clipped.
The scrapings or clippings are crushed and put into containers. Any fungus in the samples can grow in the laboratory in these special containers. This is true for most molds and yeast also.
The species of pathogen (usually a fungus) can be identified from the cultures grown in the lab by technicians trained to recognize the microscopic structures that are identifiers of the fungal species.