Fourteenth Annual Grant Winners 2013-2014
Bacterial Diversity of Fungal Toenails Through PCR and Culture Techniques
Harold Laubach, Ph.D. (HPD-MED)
Faculty and Students
Paul Greenman, DPM (HPD-MED)
Nick Garett, B.S. (HPD-OST)
Nail disease is common. Seven percent of all diabetic hospitalizations involve a nail infection and many end with amputation. Patients suffer from pain, ulceration, and embarrassment due to nail disease. Medicare reimburses for treatment of diseased nails. Patients spend millions of over the counter dollars to self-diagnose and treat these conditions. Approximately 50% of nail problems are fungal. The diagnosis is confirmed with a positive laboratory test for the presence of fungus. Treatment of a fungal nail is often expensive, painful, and unsuccessful. Surgery, dangerous oral medications, topical antifungals, laser therapies and benign neglect offer poor results. Clinicians have learned that current microbial analysis (culture) often does not provide a clear picture of the clinically significant offending organisms. DNA analysis is not just for crime scenes anymore. Molecular (DNA) diagnostics, targeting the genome of microorganisms, have shown that there are often more and different pathogens causing nail disease than what we currently identify via cultivation in lab. There is a paucity of studies comparing traditional lab tests with molecular diagnostics. Clinicians treating these conditions have performed molecular testing of the nails and have been surprised to find clinically significant numbers of bacterial organisms in their samples (see picture appendices 1-2). Nail fungus treatments may be failing because what we have identified as a fungal nail is actually a mixed bacterial and fungal infection (polymicrobial onychopathy). This study will test 25-50 individuals seeking treatment for suspected fungal nail disease (onychomycosis). Practicing physicians will obtain nail specimens for standard laboratory and DNA analysis. In addition to basic statistical evaluation, the results will be catalogued and documented to illustrate the findings and justify further study. If clinicians can target the polymicrobial nature of these maladies correctly, cost and morbidity may be reduced significantly.