What is the best method to detect dermatophytes from clinical specimens?

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Hi everyone

I would like to hear your opinion on your method to detect dermatophytes from clinical specimens. What method do you use?
In my practice I normally get a fragment of the affected nail and send it to a clinical lab to perform an mycological exam to determine the presence of dermatophytes.
But recently a colleague of mine told me of a system that he uses called Intray ™ DM ...after a quick internet search I found that the InTray DM is an enriched dermatophyte medium used in the detection of dermatophytes from clinical specimens. The InTray DM medium is formulated to produce a red color in the presence of growing dermatophytes. When incubated at room temperature, the color change will usually appear within one to 14 days after inoculation.
Moreover, the medium is formulated to produce distinctive colony growth with typical identifying characteristics both macro and microscopically.
The medium inhibits most gram-positive bacteria, gram-negative bacteria, yeast and saprophytic fungi.
Does anyone already used this system ?
Does it really work our is the Laboratory exam better?

I would like to hear your opinion on this!

Cheers
André

 

I have used InTray DM for a couple of years now with consistently acceptable results. Its cost-effective, simple to use and accurate. I prefer this to referral of contaminated samples for laboratory mycology culture, which here in the Republic of Ireland, must be through the patient's own family doctor. Give it a trial yourself.

 

I agree, it is easy to use but is difficult to determine the exact genus, although treatment is similar for each. I believe the laboratory tests to be superior but more expensive. It is also available from several suppliers in the UK.

As to sending tests off, I had a lady in yesterday who was told to take her own samples and place them in the clear pot for the lab! Obviously it came back negative, so no GP involvement wanted! This is no necessarily the wrong result, but that she had taken the samples without instruction and a clear pot!!

Angie

 

Thanks Mr C.W.Kerans and AngieR

I contacted a company from the UK that sells this system , I will try it to see if it really is efficient.
In Portugal the laboratory test does not require a prescription, however the price is expencive for many patients especially if they do not have health insurance.

Kind Regars :drinks
André

 

I used to use the InTray, but became suspicious of the amount of `positive` results; i.e. Every sample. So I contacted my local microbiology lab to ask their opinion. They very kindly offered me an afternoon of free CPD

I took along specimens in a couple of Intrays and, under the guidance and supervision of the pathologist there, looked for dermatophytes through a microscope. Fascinating stuff. One (which i was fairly certain was not fungus, but changed to red in the Intray) showed no dermatophyte presence. Neither did the same cultured sample 4 weeks later identify any colony growth. Hence my decision to stop using the InTray.

Ok, so the lab charge £30 per microscopy and culture, but i find that patients dont mind paying if the results provide a diagnosis so that prescription of suitable meds are more likely to be met with approval by their GP.

Cheers,
Bel

 

Hi Belinda,

Very interesting comments, something to consider.

I have had about 70/30 positives but am currently out of In-Trays and was going to order more, but may consider the call to the microbiology lab instead.

Thanks

Angela

 

Hi Angela,

I think it`s a good idea to keep a professional relationship going with our local labs, you never know when you are going to need their expertise. I really enjoyed my afternoon there, you can see work in progress and ask them important questions like; how much of a specimen they require, gain tips on obtaining the best sample, transportation, etc.

Cheers,
Bel