APMA News - November/December 2019 - 20

SPECIAL CORPORATE SECTION

Editor's Note: The following (on pages 20 and 21) is promotional information furnished by the companies featured.

BakoDX: Best Practice to Collect Nail Specimens
While the distal nail may appear dystrophic enough on many patients, experts advise
not submitting specimens containing only the
distal nail plate, when possible.
Javan Bass, DPM, of Metro Foot and Ankle Centers in Lithonia, GA, noted the distal
nail plate frequently contains contaminants
that may obscure identification of pathogenic fungi. He recommended scraping the ventral surface of the nail plate and the nail
bed for viable hyphae to result in the highest sensitivity.
"If I have to decide between sending the distal nail plate and
the proximal nail plate, I will send the proximal nail plate, even
if it appears less than optimal," said Dr. Bass. "The proximal nail
is the more important specimen that I will want to send to the
laboratory for diagnostic testing."

Diagnostic testing gives
you the answers you need
for optimal patient care.
Because the infective organism lives within the nail bed,
and the nail plate is a bit more resistant, fungus dies out as the
nail grows distally.
"The nail plate is so dense that the fungus doesn't thrive in
the distal portion because it can't digest the keratin as readily," said Wayne L. Bakotic, DO, chief medical officer at Bako
Diagnostics.
So if the sample is taken from the distal end, there is a good
chance it may not show any fungal hyphae.
For better diagnostic results, first swab the nail plate with
alcohol. Then trim the distal nail all the way back to the hyponychium and discard. Then sample the proximal nail using a
curette. This proximal nail sample will result in the highest diagnostic yield.

Increase Sensitivity of
Specimen Submissions
Diagnostic testing gives you the answers you need for optimal patient care. To attain the highest sensitivity from your nail
specimen submissions:
20 APMA News November/December 2019

1. Ensure your practice submits adequate tissue for evaluation
Recommendations:
DNA (PCR) testing-3 mm
Anatomic Pathology testing-3 mm
DNA (PCR) plus Anatomic
Pathology testing-6 mm
2. Ensure the specimen is submitted appropriately
For DNA (PCR) testing, always submit the specimen
dry (without fixative).
For PAS/GMS testing, the sample may be submitted
dry or in formalin.

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Not all nail dystrophy is onychomycosis. So, in addition to
determining the genus and species with DNA (PCR), adding
Anatomic Pathology has the benefit of assessing the patient's
sample for non-infectious etiologies of nail dystrophy, including trauma, neoplastic processes, psoriasis, or other inflammatory etiologies.
If you have questions or would like to speak to one of
BakoDx's dermatopathologists, call 855-422-5628.
To download your complimentary Optimal Nail Specimen
Collection Technique Guide for complete steps and best practice tips, visit www.bakodx.com/APMAnailguide. n

BakoDx expert clinical consultants created a step-by-step
illustrated guide that can be used to train staﬀ and provides
clinicians with optimal nail specimen collection technique.
To download the complimentary guide, visit bakodx.com/
APMAnailguide.

http://www.bakodx.com/APMAnailguide https://bakodx.com/learning-center/nailguide/?utm_medium=301&utm_source=APMA https://bakodx.com/learning-center/nailguide/?utm_medium=301&utm_source=APMA

APMA News - November/December 2019

Table of Contents for the Digital Edition of APMA News - November/December 2019