@entity1292 caused by nondermatophytic molds may differ in treatment from tinea unguium. Confirmed diagnosis of @entity1292 classically requires more than one laboratory analysis to show consistency of fungal outgrowth. Walshe and English in 1966 proposed to extract sufficient diagnostic information from a single @entity1 consultation by counting the number of nail fragments positive for inoculum of the suspected fungus. Twenty fragments were plated per @entity1 , and each case in which five or more fragments grew the same mold was considered an infection by that mold, provided that compatible filaments were also seen invading the nail tissue by direct microscopy. This widely used and often recommended method has never been validated. Therefore, the validity of substituting any technique based on inoculum counting for conventional follow-up study in the diagnosis of @entity1292 was investigated. Sampling of 473 @entity1 was performed repeatedly. Nail specimens were examined by direct microscopy, and 15 pieces were plated on standard growth media. After 3 weeks, outgrowing dermatophytes were recorded, and pieces growing any nondermatophyte mold were counted. @entity1 returned on two to eight additional occasions over a 1- to 3-year period for similar examinations. @entity6313 was etiologically classified based on long-term study. @entity1292 was definitively established for 86 @entity1 . Counts of nondermatophyte molds in initial examinations were analyzed to determine if they successfully predicted both true cases of @entity1292 and cases of insignificant mold contamination. There was a strong positive statistical association between mold colony counts and true @entity1292 . Logistic regression analysis, however, determined that even the highest counts predicted true cases of @entity1292 only 89.7% of the time. The counting criterion suggested by Walshe and English was correct only 23.2% of the time. @entity281 were especially likely to be correctly predicted by inoculum counting. Inoculum counting could be used to indicate a need for repeat studies in cases of false-negative results from laboratory direct microscopy. Inoculum counting cannot serve as a valid substitute for follow-up study in the diagnosis of @entity1292 . It may, nonetheless, provide useful information both to the physician and to the laboratory, and it may be especially valuable when the @entity1 does not present for follow-up sampling.

Utility of inoculum counting (Walshe and English criteria) in clinical diagnosis of XXXX caused by nondermatophytic filamentous fungi.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity1292 :: ('MESH:D009894', 'Disease') :: ['opportunistic onychomycosis', 'Opportunistic onychomycosis'] @entity6313 :: ('MESH:D014009', 'Disease') :: ['Onychomycosis'] @entity281 :: ('MESH:D007239', 'Disease') :: ['Acremonium infections']
@entity6313 :: (MESH:D014009,Disease) :: ['onychomycosis']
