Office practice-based confirmation of XXXX : a US nationwide prospective survey.

@entity1 @entity281 @entity6313
BACKGROUND: @entity6313 is sufficiently prevalent to be seen and treated by primary care physicians. The diagnosis of @entity6313 is most often confirmed from nail specimens by microscopy and fungal culture done at a central laboratory; these are relatively expensive tests with a turnaround time of a month or more. This study was conducted (1) to evaluate the use of in-office dermatophyte test medium (DTM) culture, and (2) to determine the epidemiology of @entity6313 in a large, nationwide sample of @entity1 who were not @entity1 in a clinical trial. METHODS: A nationwide sample of primary care physicians and podiatrists enrolled 670 @entity1 with clinical signs of @entity6313 . Dermatophyte test medium cultures were performed in the office and the results were compared with fungal cultures performed by a central laboratory. RESULTS: Central laboratory fungal cultures were positive in 44% (n = 297) of @entity1 and DTM cultures in 51% (n = 345). Dermatophytes accounted for 93% of the confirmed infections and nondermatophyte molds the rest. In the 617 @entity1 with paired dermatophyte test medium and laboratory fungal culture results, the 2 tests were in agreement (both positive or both negative) in 68% of cases (kappa, 0.37; asymptotic SE, 0.04; 95% confidence interval, 0.299-0.441). CONCLUSIONS: A DTM culture is a relatively rapid, easy, and inexpensive method to confirm @entity281 in @entity1 with signs of @entity6313 in the primary care setting. Because the available drugs for treating @entity6313 are effective against all dermatophyte species, the confirmation of dermatophyte infection, without further identification of genus and species, is sufficient evidence to begin treatment.
