When is onychomycosis onychomycosis? A cross-sectional study of fungi in normal-appearing nails
Bibliographic record
Abstract
BACKGROUND: The presence of fungal organisms in healthy-looking toenails has previously been reported in individuals with a known dermatophyte infection and in those with onycholysis, but has not been extensively studied in individuals who do not present with foot pathology. OBJECTIVES: To determine the prevalence of fungal organisms in the toenails and on the soles of normal-appearing feet. METHODS: Adults who visited a dermatology clinic between June 2012 and February 2013 for concerns unrelated to fungal infection of the nails and feet participated in this study. Participants' feet were clinically examined, and skin and nail samples were collected and sent for potassium hydroxide (KOH) light microscopy and culture. RESULTS: Five hundred and eighty-five individuals with normal-appearing feet and toenails participated in this study. Fungal organisms were detected in 9·2%, 3·9% and 3·1% of participants' toenails by KOH, culture, and a combination of KOH and culture, respectively, while fungal organisms were present on the soles of the feet of 7·0%, 2·9% and 1·4% of participants by KOH, culture and both these methods combined, respectively. A significant association between the presence of fungal organisms in toenails and on the soles of the feet was found (P < 0·01). CONCLUSIONS: The presence of fungal organisms in the nail, even in the absence of clinical signs, may be termed 'subclinical' onychomycosis. The normal-appearing nail plate may act as a reservoir for infectious dermatophyte and nondermatophyte organisms. When left unimpeded by the host's immune system, these organisms are inclined to proliferate to produce clinically apparent disease.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".