• International Journal of Technology (IJTech)
  • Vol 12, No 2 (2021)

Touch Biopsy: A Simple and Rapid Method for the Diagnosis of Systemic Mycoses with Skin Dissemination in HIV-Infected Patients

Touch Biopsy: A Simple and Rapid Method for the Diagnosis of Systemic Mycoses with Skin Dissemination in HIV-Infected Patients

Title: Touch Biopsy: A Simple and Rapid Method for the Diagnosis of Systemic Mycoses with Skin Dissemination in HIV-Infected Patients
Retno Wahyuningsih, Robiatul Adawiyah, Aida SD Hoemardani, Ridhawati Sjam, Evy Yunihastuti, Darma Imran, Eliza Miranda, Samsuridjal Djauzi, Mulyati Tugiran, Ariananda Hariadi, Sem Samuel Surja

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Cite this article as:
Wahyuningsih, R., Adawiyah, R., Hoemardani, A.S., Sjam, R., Yunihastuti, E., Imran, D., Miranda, E., Djauzi, S., Tugiran, M., Hariadi, A., Surja, S.S., 2021. Touch Biopsy: A Simple and Rapid Method for the Diagnosis of Systemic Mycoses with Skin Dissemination in HIV-Infected Patients. International Journal of Technology. Volume 12(2), pp. 243-251

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Retno Wahyuningsih 1. Department of Parasitology, Faculty of Medicine Universitas Indonesia, Salemba Raya Street No.6, Jakarta 10430, Indonesia 2. Department of Parasitology, School of Medicine, Indonesian Christian Un
Robiatul Adawiyah Department of Parasitology, Faculty of Medicine Universitas Indonesia, Salemba Raya Street No.6, Jakarta 10430, Indonesia
Aida SD Hoemardani Indonesia Dharmais Cancer Hospital, S. Parman Street Kav. 84-86, Jakarta 11420, Indonesia
Ridhawati Sjam Department of Parasitology, Faculty of Medicine Universitas Indonesia, Salemba Raya Street No.6, Jakarta 10430, Indonesia
Evy Yunihastuti Department of Internal Medicine Faculty of Medicine, Universitas Indonesia/ Cipto Mangunkusumo Hospital, Salemba raya street No.6, Jakarta 10430, Indonesia
Darma Imran Department of Neurology, Faculty of Medicine, Universitas Indonesia/ Cipto Mangunkusumo Hospital, Salemba Raya Street No.6, Jakarta 10430, Indonesia
Eliza Miranda Department of Dermato-Venereology, Faculty of Medicine, Universitas Indonesia/ Cipto Mangunkusumo Hospital, Salemba Raya Street No.6, Jakarta 10430, Indonesia
Samsuridjal Djauzi Department of Internal Medicine Faculty of Medicine, Universitas Indonesia/ Cipto Mangunkusumo Hospital, Salemba raya street No.6, Jakarta 10430, Indonesia
Mulyati Tugiran Department of Parasitology, Faculty of Medicine Universitas Indonesia, Salemba Raya Street No.6, Jakarta 10430, Indonesia
Ariananda Hariadi Department of Parasitology, Faculty of Medicine Universitas Indonesia, Salemba Raya Street No.6, Jakarta 10430, Indonesia
Sem Samuel Surja Department of Parasitology, School of Medicine and Health Sciences, Universitas Katolik Indonesia Atma Jaya, Jl. Pluit Raya No. 2, Jakarta Utara 14440, Indonesia
Email to Corresponding Author

Abstract
Touch Biopsy: A Simple and Rapid Method for the Diagnosis of Systemic Mycoses with Skin Dissemination in HIV-Infected Patients

Systemic fungal infection can disseminate to the skin and require prompt treatment, making early diagnosis very important. This study describes the use of a simple, quick touch biopsy method for the diagnosis of invasive mycoses in patients with AIDS with cutaneous manifestations. We identified fungal infections in 24 of the 29 investigated patients. Histoplasma capsulatum, Cryptococcus neoformans, Talaromyces artroroseus, Aspergillus flavus, Candida tropicalis, and Malassezia sp. were visualized directly in samples obtained from cutaneous lesions and confirmed by culture and molecular examination. The results suggested that touch biopsy is a simple, rapid method for the diagnosis of systemic mycoses with skin dissemination. It can be performed using simple tools and provides quick results, allowing for early intervention with appropriate antifungal therapy.

Cutaneous dissemination; Rapid diagnosis; Systemic fungal infection

Introduction

Fungi are known to be one of the types of microorganisms responsible for fatal opportunistic infections in HIV-infected patients (Lortholary et al., 1999; Vanittanakom et al., 2006; Bicanic et al., 2008). The dissemination of systemic fungal infections to the skin is common in HIV-infected patients, and laboratory investigations are required to establish timely diagnosis (Lortholary et al., 1999; Dhar et al., 2006; Dinato et al., 2006).

Systemic fungal infection is very difficult to diagnose because the fungus infects internal organs and  thus biopsy is required to obtain clinical materials for laboratoryinvestigations (Azar and Hage, 2017; Sanguinetti et al., 2019). Dissemination to the skin is a blessing in disguise because the collection of clinical materials becomes much easier.

In our laboratory, sample collection for cutaneous mycoses is generally completed using skin scraping for microscopic wet slide analysis and culture. However, this approach has several limitations. For example, fungi such as Histoplasma do not occur in superficial skin scales but in leucocytes, which may not be observable in KOH preservation (Kauffman, 2007), although KOH is very good in plasma electrolysis (Saksono et al., 2012). Culturing is a diagnostic effort that is always carried out in mycological investigations. Culturing can be used to isolate the causative fungi, but unfortunately, this method is time-consuming. Meanwhile, patients with systemic mycoses require immediate diagnosis so that the right drug can be given promptly.

      Infections with HIV are currently distributed throughout Indonesia (Ministry of Health Republic Indonesia, 2018). Left untreated, this infection will develop into AIDS, which is susceptible to various opportunistic infections, including fungal infections. Indonesia is an archipelago with a wide variety of health facilities. Fully equipped laboratories are available only in big cities; therefore, a simple method is needed for use in areas with limited laboratory settings. Technological innovation is very important for the next generation (Berawi, 2015). In this paper, we describe a method that we call touch biopsy to obtain samples for the diagnosis of systemic mycoses with cutaneous dissemination in individuals with HIV infections. This method is relatively simple in that it can be used even in remote areas with limited laboratory equipment. The touch biopsy method was used to take samples from the skin, which were then examined using conventional methods (e.g., KOH slide testing and culturing). The fungi that grew on the cultures were morphologically identified and then confirmed on a molecular level using the PCR method.

Conclusion

    Touch biopsy is a simple, rapid method of diagnosing systemic mycosis with cutaneous dissemination. This method provides fast results, allowing for immediate anti-fungal treatment.

Acknowledgement

    RW received a research grant from Dana Ilmu Pengetahuan Indonesia/ Lembaga Pengelolaan Dana Pendidikan (DIPI/LPDP) with contract number MR/P017622/1, year 2017–2020.

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