Parasitology
Vinyl adhesive tape also effective for direct microscopy diagnosis of chromomycosis, lobomycosis, and paracoccidioidomycosis

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Abstract

Among the existing techniques for direct microscopy diagnosis in mycology, vinyl adhesive tape (VAT) preparations have proved their usefulness for Malassezia spp., Candida spp., and dermatophyte superficial infections. The collection and identification of fungal agents can be performed easily by the VAT technique, as demonstrated in this work, for the setting of some deep-seated cutaneous mycoses, where infectious agents can be observed in the horny layer of the epidermis in transepidermal elimination events. Preliminary results obtained in a series of 19 cases (chromomycosis, 12; lobomycosis, 5; paracoccidioidomycosis, 2) yielded positive results in 17 (89.47%). Failures for proper microscopic diagnosis detection happened in just 2 cases, 1 for chromomycosis and 1 for paracoccidioidomycosis. These results, although encouraging, were obtained from a relatively small patient population sample. Thus, the authors recommend further tests using this direct microscopy technique in a larger number of patients to validate these preliminary results and to explore its sensitivity in cases of small lesions.

Introduction

Stripping keratin layer's fragments from cutaneous or mucocutaneous surfaces by a vinyl adhesive tape (VAT)—the so-called Scotch® test—has largely been used over time for diagnostic purposes, especially in dermatology. These applications encompass situations as diverse as the searching for superficial infection/infestation agents, including fungi (Porto, 1953, Barnetson and Milne, 1973, Milne and Barnetson, 1974, Rogers et al., 2000, Miranda and Silva, 2003), fungi and corynebacteria (Padilha-Gonçalves, 1996), cutaneous flora (Keddie et al., 1961), and Enterobius vermicularis ova (Graham, 1941), as well as to simply removing a melanin-loaded cornea for better visualization of underlying epidermal layers during dermatoscopy (Argenziano et al., 2001). Since the first report on the usefulness of VAT for diagnosis of tinea versicolor (Porto, 1953), further experiments expanded the application of this technique to Candida spp. and dermatophyte infections. In these cases, the technique was proven efficacious only when clearing agents, such as the potassium hydroxide (KOH) solution with or without dimethyl sulfoxide (DMSO), were added to VAT mounts, as previously demonstrated by various researchers (Barnetson and Milne, 1973, Milne and Barnetson, 1974, Rogers et al., 2000, Miranda and Silva, 2003). The latter researchers (Miranda and Silva, 2003) recently demonstrated, how such a VAT-based technique lead to an exceptionally high-sensitivity level for diagnosis of superficial Malassezia spp., Candida spp., and dermatophyte skin infections. It was then hypothesized that this technique could also work in the setting of some deep-seated mycoses, in which transepidermal elimination of infectious organisms (TEIO) is known to take place.

This article presents the preliminary results observed with the use of VAT for diagnosis of chromomycosis (CM), lobomycosis (LM), and paracoccidioidomycosis (PM).

Section snippets

Patients and methods

The study was carried out from August 2000 to June 2004 and included all attended patients on and others referred to the Laboratory of Mycology of the Dermatology Service, Centro de Ciências da Saúde da Universidade Federal do Pará, and Hospital da Fundação Santa Casa de Misericórdia do Pará, Belém, Pará, Brazil. In all cases, the patients were clinically suspected of having cutaneous and/or mucocutaneous lesions of CM, LM, or PM. The thin, clear, 19-mm-wide Tapefix Adere® adhesive tape

Results

Twenty-three patients were included in the study. From them, lesions were sampled consisting of overall erythematous and violaceous papulonodular, en plaque, or verrucous ones, in some cases with ulcerated areas. A diagnosis of deep-seated mycosis was confirmed for 19 patients (17 men and 2 women; age range 37–74 years, mean 56.15 years), from whom clinical and laboratory data are summarized in Table 1. They comprised 12 cases of CM, 5 cases of LM, and 2 cases of PM. Of these cases, 17 (89.47%)

Discussion

TEIO has long been observed in dermatopathology. In the setting of deep-seated cutaneous mycoses, some research papers and textbooks refer to TEIO occurrence in CM (Goette and Robertson, 1984, Woo and Rasmussen, 1985), LM (Gadelha and Bandeira, 1983), and PM (Uribe et al., 1987), as well as in other infectious conditions. In fact, TEIO images are occasionally seen when one examines histopathologic sections stained by either hematoxylin-eosin (H-E, Fig. 4A) or period acid Schiff (PAS, Fig. 4B).

Acknowledgments

The authors thank Luiz de Miranda and Mauro A. C. de M. Rodrigues for the critical review of the manuscript and Carlos A. M. Silva for the assistance in photomicrographs.

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