KOH Microscopy: A Rapid Diagnostic Tool for Fungal Infections

Potassium hydroxide (KOH) microscopy is a direct wet mount technique that uses alkaline digestion to clear keratinized debris and epithelial cells while preserving fungal elements for visual identification. This article provides laboratory students, technicians, researchers, and diagnostic professionals with a practical protocol for preparing and interpreting KOH mounts, guidance on when this method is appropriate, and clear criteria for escalating cases that require culture, molecular testing, or histopathology. The KOH preparation remains a first-line diagnostic tool because it is inexpensive, rapid, and requires only basic microscopy equipment, making it particularly valuable in resource-limited settings.

Clinical Applications and Diagnostic Context

KOH microscopy is used to detect fungal elements in skin scrapings, hair pluckings, nail clippings, corneal scrapings, tissue biopsies, swabs, and pus. The technique is most commonly applied to superficial dermatophyte infections of the skin, hair, and nails, where it can provide a same-day diagnosis. Dermatophytes are fungi that require keratin for growth and cause infections spread through direct contact with infected people, animals, soil, or contaminated objects. A diagnosis can often be made from history, physical examination, and KOH microscopy, with culture or histologic examination reserved for cases where the clinical picture is unclear or treatment has failed.

The diagnostic performance of KOH microscopy varies by specimen type and clinical context. In a study of microbial keratitis in Nepal, smear microscopy using KOH, Gram stain, and calcofluor white achieved the highest sensitivity of all tested methods at 90.7 percent, with KOH alone showing 85.3 percent sensitivity for detecting fungal keratitis. This performance exceeded that of fungal culture, which had 75.7 percent sensitivity in the same cohort. The authors recommended that clinicians in low-resource settings perform corneal scrapes for microscopy using KOH and Gram staining. For invasive aspergillosis, KOH microscopy of bronchoalveolar lavage fluid showed 90.7 percent sensitivity and 77.1 percent specificity in a prospective observational study, though the galactomannan enzyme immunoassay at a higher optical density cutoff was significantly superior to KOH for this specific diagnosis.

For mucormycosis, KOH mount examination using conventional light microscopy has been emphasized as a rapid and reliable diagnostic tool in resource-limited settings, particularly during outbreaks when early diagnosis and targeted therapy are critical. One evaluation of KOH preparation for suspected mucormycosis reported 67 percent sensitivity, 87 percent specificity, 76 percent positive predictive value, and 81 percent negative predictive value when compared with fungal culture as the gold standard. The authors noted that interpretation of KOH smears requires experience and that prompt diagnosis is crucial because treatment initiation is time-critical due to rapid infection progression.

Principle of the KOH Wet Mount

The KOH wet mount works on a simple chemical principle. Potassium hydroxide dissolves keratin, which is the structural protein that makes up the outer layer of skin, hair, and nails. When a clinical specimen containing keratinized material is mixed with KOH solution, the keratin is digested and the sample becomes transparent. Fungal elements, including hyphae, yeast cells, and spores, are not digested by KOH at the concentrations and exposure times used in routine diagnostics. This differential digestion allows fungal structures to remain visible against a cleared background.

The concentration of KOH and the incubation time must be adjusted based on the specimen type. Skin scrapings contain relatively thin layers of keratin and may clear within 5 to 15 minutes. Nail clippings are densely keratinized and may require 30 to 60 minutes or longer, sometimes with gentle heating to accelerate clearing. Hair specimens require intermediate clearing times. Some laboratories use KOH concentrations of 10 to 20 percent for skin and hair, while concentrations of 20 to 40 percent may be used for nail material. The choice of concentration involves a tradeoff between speed of clearing and preservation of fungal morphology. Higher concentrations clear faster but can over-digest delicate fungal structures if left too long.

The addition of dimethyl sulfoxide (DMSO) to the KOH solution can accelerate clearing without heating, which is useful for nail specimens. Some formulations also include a dye such as calcofluor white, which binds to chitin in fungal cell walls and fluoresces when viewed under ultraviolet light. Calcofluor white staining requires a fluorescence microscope and increases sensitivity but adds cost and complexity. Trypan blue has also been evaluated as a conventional and fluorescent dye for KOH testing of superficial mycoses, offering an alternative for laboratories without fluorescence capability.

Step-by-Step KOH Preparation Protocol

Specimen Collection

Proper collection is the most important determinant of KOH mount quality. Collect skin scrapings from the active border of the lesion, which is where viable fungal elements are most concentrated. Use a sterile scalpel blade or glass slide edge to scrape outward from the lesion margin. For hair infections, pluck hairs from the affected area, including the roots, and select broken or distorted hairs. For nail infections, clip the affected nail and scrape debris from beneath the nail plate. Collect corneal scrapings using a sterile spatula or blade under topical anesthesia, performed by trained personnel. For tissue biopsies, swabs, and pus, collect the specimen into a sterile container and transport it to the laboratory promptly.

Label each specimen with the patient identifier, collection date, and anatomic site. Record the clinical indication and any prior antifungal therapy, because recent treatment can reduce the number of visible fungal elements and lead to false negative results.

Slide Preparation

Place the collected specimen on a clean glass slide. Add one to two drops of KOH solution at the appropriate concentration for the specimen type. Add a coverslip and gently press to spread the specimen and remove air bubbles. For thick specimens such as nail clippings, use a scalpel blade to fragment the material into thin pieces before adding KOH. This increases the surface area exposed to the digesting solution and reduces clearing time.

Clearing and Incubation

Allow the slide to sit at room temperature for the appropriate clearing time. Skin scrapings typically clear within 5 to 15 minutes. Hair specimens may require 10 to 20 minutes. Nail clippings may require 30 to 60 minutes or longer. Gentle heating can accelerate clearing, but overheating can cause the KOH to crystallize or damage fungal morphology. If heating is used, pass the slide briefly through a flame or place it on a warming plate, then allow it to cool before examination. Do not boil the specimen.

Microscopic Examination

Examine the cleared preparation under low power (100x total magnification) to scan for fungal elements, then switch to high power (400x total magnification) to confirm morphologic details. Reduce the condenser aperture or close the iris diaphragm to increase contrast, because fungal hyphae are refractile and may be difficult to see with full illumination. Scan multiple fields across the entire coverslip area before reporting a negative result. A minimum of 10 to 20 fields should be examined under high power.

Reporting Results

Report the presence or absence of fungal elements and describe the morphology observed. Include the type of structure seen, such as septate hyphae, nonseptate hyphae, yeast cells, or spores. Note whether the morphology is consistent with a dermatophyte, yeast, or mold. Report the specimen type and the clearing time used. A negative result should be reported as no fungal elements seen, with a note that this does not exclude fungal infection if clinical suspicion remains high.

Interpretation of Fungal Morphology

Septate Hyphae

Septate hyphae are branching filamentous structures divided by cross-walls called septa. They are the characteristic finding in dermatophyte infections of skin, hair, and nails. Dermatophyte hyphae appear as long, branching, refractile filaments with regular septation. They may fragment into chains of arthroconidia in older or treated lesions. The presence of septate hyphae in a skin scraping from a patient with an annular scaly lesion supports a diagnosis of tinea corporis or tinea cruris. In nail specimens, septate hyphae confirm onychomycosis and justify the expense and duration of antifungal therapy.

Nonseptate Hyphae

Nonseptate or sparsely septate hyphae are broad, ribbon-like filaments with irregular branching and few or no cross-walls. This morphology is characteristic of mucormycetes, the fungi that cause mucormycosis. In a KOH mount of tissue, pus, or swab material from a patient with suspected mucormycosis, the presence of broad, nonseptate hyphae is an urgent finding that requires immediate clinical notification. Mucormycosis progresses rapidly and has a high mortality rate, so early diagnosis and prompt initiation of targeted therapy are critical. KOH microscopy can provide this diagnosis in minutes using conventional light microscopy, making it especially valuable in resource-limited settings.

Yeast Cells

Yeast cells appear as round or oval budding structures, sometimes with pseudohyphae, which are elongated yeast cells that remain attached after budding. This morphology is consistent with Candida species or Malassezia species. In skin scrapings from patients with intertrigo or diaper rash, budding yeast cells with pseudohyphae support a diagnosis of cutaneous candidiasis. In vaginal discharge specimens, the presence of budding yeast supports a diagnosis of vulvovaginal candidiasis. The KOH preparation is particularly useful for vaginal specimens because it clears epithelial cells and mucus, making yeast cells easier to identify than in a saline wet mount.

Mixed Morphology

Some specimens may show more than one type of fungal element. Mixed infections can occur, particularly in immunocompromised patients or in specimens from patients with prolonged or recurrent infections. When mixed morphology is observed, report all structures seen and recommend culture for definitive identification. Mixed infections may require combination antifungal therapy, so accurate reporting of all morphologic types is clinically important.

At a Glance: KOH Microscopy Decision Table

Quality Controls and Assurance

Positive and Negative Controls

Each batch of KOH solution should be tested with a known positive specimen to confirm that the reagent is working properly. A laboratory can maintain a stock of preserved fungal specimens or use commercially available control slides. The positive control should show clearly visible fungal elements after the expected clearing time. A negative control using a specimen known to be free of fungi confirms that the KOH solution is not producing artifacts that could be mistaken for fungal elements.

Reagent Quality

KOH solutions should be prepared fresh or stored according to the manufacturer instructions. Concentrated KOH can absorb carbon dioxide from the air and form potassium carbonate, which reduces its effectiveness. Check the expiration date on commercial reagents and discard solutions that show precipitation or discoloration. Record the preparation date and lot number for each batch of KOH solution used.

Microscope Maintenance

The microscope used for KOH examination should be cleaned and calibrated regularly. Check that the light source is functioning and that the condenser and objectives are free of debris. Record any maintenance or repair work in the laboratory log. A poorly maintained microscope can cause false negative results because fungal elements may be missed under suboptimal illumination.

Technician Competency

Interpretation of KOH smears requires experience. New laboratory staff should be trained using a set of known positive and negative specimens before they are allowed to report patient results independently. Regular competency assessments should be conducted, and technicians should participate in continuing education on fungal morphology. The accuracy of KOH interpretation improves with practice, and laboratories should track individual technician performance against culture results to identify interpretation errors.

Comparison with Alternative Diagnostic Methods

Fungal Culture

Fungal culture is the traditional gold standard for diagnosing fungal infections and provides definitive identification of the infecting species. However, culture requires 1 to 4 weeks for growth and identification, which delays diagnosis and treatment. In the Nepal keratitis study, culture had lower sensitivity than smear microscopy, detecting only 75.7 percent of fungal keratitis cases compared with 90.7 percent for smear microscopy. Culture is also more expensive and requires specialized media and incubation conditions. KOH microscopy provides a same-day result that can guide initial therapy while culture is pending.

Molecular Testing

Polymerase chain reaction (PCR) testing has largely replaced KOH microscopy and culture in some laboratories for diagnosing dermatophyte and onychomycosis infections. PCR offers higher predictive value than KOH microscopy and culture for diagnosing or ruling out fungal infection and provides results faster than culture. However, PCR requires specialized equipment, reagents, and training that may not be available in all settings. KOH microscopy and culture should be reserved for cases of therapy failure and suspected false negative PCR testing. When there is doubt about the clinical diagnosis, PCR testing should be performed with sufficient clinical information to enable the microbiologist to determine whether the test is appropriate.

Histopathology

Periodic acid-Schiff (PAS) staining of biopsy specimens can detect fungal elements in tissue and is useful when KOH microscopy is negative but clinical suspicion remains high. Histopathology requires an invasive biopsy procedure and several days for tissue processing and staining. It provides information about tissue invasion and host response that KOH microscopy cannot. Reflectance confocal microscopy is a non-invasive imaging technology that can provide real-time dermatologic diagnoses, and fungal infections appear as bright, linear, branching, filamentous structures at the level of the stratum corneum. However, this technology requires specialized equipment and training and is not widely available.

Fluorescent Staining

Calcofluor white and other fluorescent stains bind to chitin in fungal cell walls and increase the sensitivity of direct microscopy. Fluorescent staining requires a fluorescence microscope, which adds cost and complexity. Studies have compared fluorescent staining with KOH wet mount for diagnosing nail infections, with fluorescent methods generally showing higher sensitivity. Trypan blue has been evaluated as both a conventional and fluorescent dye for KOH testing, offering a potential alternative for laboratories seeking increased sensitivity without the expense of calcofluor white.

Common Failure Patterns and Troubleshooting

False Negative Results

The most common cause of a false negative KOH result is inadequate specimen collection. Scrapings taken from the center of a lesion may contain only dead keratin with no viable fungi. Scrapings that are too thin may contain too few fungal elements to find. Scrapings that are too thick may not clear adequately, obscuring fungal elements. Collect specimens from the active border of the lesion and prepare multiple slides if the specimen is large.

Inadequate clearing time is another common cause of false negatives. If the specimen is not fully cleared, keratin debris can obscure fungal elements. If the specimen is over-cleared, delicate fungal structures may be digested. Adjust the clearing time based on the specimen type and check the slide periodically during clearing.

Recent antifungal therapy can reduce the number of visible fungal elements and cause false negative results. Record any prior treatment and interpret negative results with caution in patients who have used antifungal agents within the past several weeks.

False Positive Results

Artifacts can be mistaken for fungal elements. Air bubbles can appear as refractile circles that may be confused with yeast cells. Cell borders and elastic fibers can appear as linear structures that may be confused with hyphae. Potassium hydroxide crystals can form if the solution is too concentrated or the slide is overheated. Distinguish artifacts from true fungal elements by their regular morphology, consistent width, and characteristic branching patterns. True hyphae have parallel walls and regular septation, while artifacts are more irregular.

Poor Clearing

Nail specimens are the most difficult to clear because of their dense keratin content. Fragment the nail into thin pieces before adding KOH and allow adequate clearing time. Gentle heating can accelerate clearing, but do not boil the specimen. Some laboratories use higher KOH concentrations for nail specimens, up to 40 percent, to achieve adequate clearing.

Contamination

Contamination of the KOH solution or the slide can introduce fungal elements that are not from the patient. Use clean slides and coverslips, and store KOH solution in a sealed container. If contamination is suspected, prepare a fresh KOH solution and repeat the examination.

Biosafety and Laboratory Practices

KOH microscopy involves handling clinical specimens that may contain infectious agents. Follow standard laboratory biosafety practices, including the use of gloves, laboratory coats, and eye protection when collecting and processing specimens. Work in a biosafety cabinet when handling specimens that may generate aerosols, such as those from respiratory sources. The World Health Organization Laboratory Biosafety Manual provides guidance on risk assessment and the selection of appropriate biosafety levels and practices for handling clinical specimens.

Dispose of used slides, coverslips, and specimen containers in appropriate sharps and biohazard waste containers. Decontaminate work surfaces with an appropriate disinfectant after processing specimens. Do not eat, drink, or apply cosmetics in the laboratory. Wash hands thoroughly after handling specimens and before leaving the laboratory.

The World Health Organization Laboratory Quality Management System Handbook emphasizes the importance of standard operating procedures, documentation, and quality control in ensuring reliable laboratory results. Each laboratory should have written procedures for KOH preparation, including specimen collection, reagent preparation, clearing times, examination protocols, and reporting. Records should be maintained for reagent preparation, quality control testing, and technician competency assessments.

Records and Documentation

Maintain a laboratory log for each KOH examination that includes the patient identifier, specimen type, collection date, clinical indication, KOH concentration used, clearing time, examination findings, and the name of the technician who performed the examination. Record the morphology observed, including the type of fungal elements seen and their quantity. Record any comments about specimen quality or limitations of the examination.

Track quality control results, including positive and negative control results for each batch of KOH solution. Record reagent preparation dates, lot numbers, and expiration dates. Document any equipment maintenance or repair work. Review quality control records regularly to identify trends that may indicate problems with reagents, equipment, or technician performance.

Compare KOH results with culture results when both are performed to monitor the diagnostic accuracy of the KOH method. Track the rate of false negative and false positive results and investigate any significant deviations from expected performance. This information can guide decisions about when to recommend culture or molecular testing in addition to KOH microscopy.

Limitations of KOH Microscopy

KOH microscopy cannot identify the specific fungal species causing an infection. Dermatophyte species, molds, and yeasts have overlapping morphologic features, and definitive identification requires culture or molecular testing. Species identification is important for selecting appropriate therapy, particularly for infections that do not respond to first-line treatment.

KOH microscopy has limited sensitivity for some types of fungal infections. Fungal elements may be present in low numbers, particularly in early infections or in patients who have received prior antifungal therapy. A negative KOH result does not exclude fungal infection, and culture or molecular testing should be considered when clinical suspicion remains high.

The sensitivity of KOH microscopy depends on the skill and experience of the technician. Inexperienced technicians may miss fungal elements or misinterpret artifacts. The study of mucormycosis diagnosis noted that interpretation of KOH smears requires experience, and the sensitivity of the method was 67 percent when compared with culture. Laboratories should invest in training and competency assessment to maximize the diagnostic yield of KOH microscopy.

KOH microscopy provides no information about the viability of the fungi or their susceptibility to antifungal agents. Culture is required for antifungal susceptibility testing, which is important for infections that do not respond to empiric therapy.

Professional Escalation Criteria

Urgent Findings

Certain KOH findings require immediate clinical notification. The presence of broad, nonseptate hyphae in tissue, swab, or pus specimens suggests mucormycosis, a rapidly progressive infection with high mortality. Notify the requesting clinician immediately so that targeted therapy can be initiated without delay. The presence of fungal elements in corneal scrapings indicates fungal keratitis, which requires urgent ophthalmology referral and treatment to prevent vision loss.

Non-Urgent Escalation

A positive KOH result with septate hyphae in skin, hair, or nail specimens confirms a superficial fungal infection and supports the initiation of antifungal therapy. If the infection does not respond to appropriate therapy, recommend culture or molecular testing to identify the species and guide treatment. A negative KOH result in a patient with high clinical suspicion for fungal infection should prompt consideration of culture, molecular testing, or histopathology.

Quality Escalation

If quality control results indicate a problem with the KOH solution, microscope, or technician performance, escalate the issue to the laboratory supervisor. Suspend patient testing until the problem is resolved and repeat any patient results that may have been affected. Document the investigation and corrective actions taken.

Frequently Asked Questions

What is the difference between KOH microscopy and fungal culture?

KOH microscopy is a direct examination that provides results within minutes by clearing keratinized tissue and allowing visual identification of fungal elements. Fungal culture involves inoculating the specimen onto growth media and incubating for 1 to 4 weeks to grow and identify the specific fungal species. KOH microscopy is faster and less expensive but cannot identify the species, while culture provides definitive identification but delays diagnosis.

How long should a KOH slide be incubated before examination?

The incubation time depends on the specimen type. Skin scrapings typically clear within 5 to 15 minutes, hair specimens within 10 to 20 minutes, and nail clippings within 30 to 60 minutes or longer. Gentle heating can accelerate clearing, but the slide should not be boiled. Check the slide periodically during clearing and examine it when the background is transparent enough to see fungal elements clearly.

Can KOH microscopy detect all types of fungal infections?

KOH microscopy can detect fungal elements in skin, hair, nails, corneal scrapings, tissue, swabs, and pus. It is most sensitive for superficial dermatophyte infections and is also useful for detecting yeast infections and mucormycosis. However, sensitivity is limited for some infections, and a negative KOH result does not exclude fungal infection. Culture, molecular testing, or histopathology may be needed when clinical suspicion remains high.

What does a positive KOH result mean?

A positive KOH result means that fungal elements were visualized in the specimen. The morphology of the fungal elements provides clues about the type of infection. Septate hyphae suggest a dermatophyte infection, broad nonseptate hyphae suggest mucormycosis, and budding yeast cells suggest candidiasis. A positive KOH result supports the diagnosis of fungal infection and justifies the initiation of antifungal therapy.

What does a negative KOH result mean?

A negative KOH result means that no fungal elements were visualized in the specimen. This may indicate that the patient does not have a fungal infection, but it can also occur if the specimen was collected improperly, if the clearing time was inadequate, if the patient has used antifungal therapy recently, or if the fungal elements are present in low numbers. A negative KOH result should be interpreted with caution when clinical suspicion for fungal infection is high.

How can I improve the sensitivity of KOH microscopy?

Collect specimens from the active border of the lesion, where fungal elements are most concentrated. Use the appropriate KOH concentration and clearing time for the specimen type. Examine multiple fields across the entire coverslip area before reporting a negative result. Reduce the condenser aperture to increase contrast. Consider using fluorescent staining with calcofluor white or trypan blue if available, as these methods increase sensitivity.

When should I recommend culture or molecular testing instead of KOH microscopy?

Recommend culture or molecular testing when the KOH result is negative but clinical suspicion for fungal infection remains high, when the infection does not respond to empiric antifungal therapy, when species identification is needed to guide treatment, or when the patient is immunocompromised and at risk for invasive fungal infection. Some laboratories use PCR testing as the primary diagnostic method for dermatophyte and onychomycosis infections, reserving KOH microscopy and culture for cases of therapy failure or suspected false negative PCR results.

What safety precautions should I follow when performing KOH microscopy?

Wear gloves, a laboratory coat, and eye protection when collecting and processing specimens. Work in a biosafety cabinet when handling specimens that may generate aerosols. Dispose of used slides, coverslips, and specimen containers in appropriate sharps and biohazard waste containers. Decontaminate work surfaces after processing specimens. Do not eat, drink, or apply cosmetics in the laboratory. Wash hands thoroughly after handling specimens.

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References and Further Reading

• Laboratory Quality Management System Handbook. World Health Organization.
• Laboratory Biosafety Manual. World Health Organization.
• Assay Guidance Manual. National Center for Advancing Translational Sciences.
• Bioanalytical Method Validation Guidance. U.S. Food and Drug Administration.
• NCBI Literature Resources. National Center for Biotechnology Information.
• Applications of Reflectance Confocal Microscopy in the Diagnosis of Fungal Infections: A Systematic Review.. Journal of fungi (Basel, Switzerland), 2022.
• Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)(1).. Autophagy, 2021.
• Dermatophyte infections.. American family physician, 2003.
• Diagnosis of Fungal Keratitis in Low-Income Countries: Evaluation of Smear Microscopy, Culture, and In Vivo Confocal Microscopy in Nepal.. Journal of fungi (Basel, Switzerland), 2022.
• [Diagnosis of suspected superficial fungal infections].. Nederlands tijdschrift voor geneeskunde, 2022.
• Relevance of Conventional Microscopy in the Diagnosis of Mucormycosis during COVID-19 Pandemic.. Journal of microscopy and ultrastructure, 2023.
• Comparative host-coronavirus protein interaction networks reveal pan-viral disease mechanisms.. Science (New York, N.Y.), 2020.
• Structural mechanism of angiogenin activation by the ribosome.. Nature, 2024.
• Role of Sanger Sequencing in the Early Diagnosis of Infective Endophthalmitis: Experience From a Pilot Study.. 2025.
• Knowledge, Attitudes, and Practices of Primary Care Physicians Regarding Vaginal Discharge Management in Alahsa, Saudi Arabia.. 2025.
• A Prospective Observational Study on the Evaluation of the Galactomannan Test in the Diagnosis of Invasive Aspergillosis.. 2025.
• Spatiotemporal analysis of cell division during symbiotic root nodule development in the model legume Medicago truncatula.. 2026.
• Radiologic Characterization of Invasive Fungal Infections of the Paranasal Sinuses and Skull Base: A Prospective Analysis.. 2026.
• Evaluation of Sensitivity and Specificity of Direct Microscopical Examination of Suspected Mucor Mycosis Samples by Potassium Hydroxide (KOH) during Covid-19 Pandemic Era. Advances in Infectious Diseases, 2022.
• A review of factors that affect contact angle and implications for flotation practice.. Advances in Colloid and Interface Science, 2009.
• Improved microwave-assisted saponification to reduce the variability of MOAH determination in edible oils.. Analytica Chimica Acta, 2024.
• Enhanced adsorption of phenolic compounds, commonly encountered in olive mill wastewaters, on olive husk derived activated carbons.. Bioresource Technology, 2008.
• Service evaluation of radiographer-led vetting and protocoling of Computed Tomography (CT) scan requests in a Singapore public healthcare institution.. Radiography, 2022.
• Experiences and Factors that Influence Potassium Hydroxide Examination by Microscopists.. Medical Mycology Journal, 2016.
• Comparison between clinical judgement, direct microscopy and fungal culture in the diagnosis of superficial fungal infections. Journal of Clinical Dermatology, 2009.
• Comparison of KOH mount & fungal culture in the diagnosis of onychomycosis. Pakistan Journal of Medical and Health Sciences, 2012.
• Experience of the diagnosis and treatment of fungal keratitis in 29 cases. International Journal of Ophthalmology, 2008.
• The Role of Trypan Blue as a Conventional and Fluorescent Dye for the Diagnosis of Superficial Mycoses by Potassium Hydroxide (KOH) Testing. Mycopathologia, 2023.
• Clinical evaluation of rapid diagnosis of fungal keratitis by the combination of corneal scraping with laser scanning confocal microscopy. Chinese Journal of Experimental Ophthalmology, 2013.
• Fluorescent staining method vs KOH wet mount method in the diagnosis of finger (toe) nail infection. Chinese Journal of Microecology, 2022.

This article is educational and does not replace validated laboratory procedures, institutional biosafety review, manufacturer instructions, or professional interpretation.