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Fungus in histopathology

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Fungus in histopathology

  1. 1. Fungus in Histopathology
  2. 2. Advantages • Speed, low cost • Presumptive identification of the infecting fungus • Demonstrating tissue reaction. • Only way to diagnose- L. loboi or Rhinosporidium seeberi
  3. 3. Special Stains TISSUE STAINING METHODS FUNGI Skin and Subcutaneous Tissue KOH , Giemsa, GMS Dermatophytes, Sporothrix,Zygomycetes Nasal Smear Biopsy H and E, GMS Rhinosporidiosis Muscle H and E, GMS Zygomycetes( very rare) Bone Marrow Giemsa, GMS Histoplasma Lung H & E, Giemsa, GMS and PAS Aspergillus, C.Neoformans Lymph Node H & E, Giemsa , GMS and PAS Aspergillus, C.Neoformans Mucin stains (Mayer’s mucicarmine and Alcian blue)-C. neoformans,Blastomyces dermatitidis and R. seeberi
  4. 4. Major forms • Yeast cells • Hyphae • Pseudohyphae, • Arthroconidia, • Chlamydoconidia • Spherules.
  5. 5. TRUE PATHOGENS Cutaneous infective agents Subcutaneous infective agents Epidermophyton species Microsporum species Trichophyton species Actinomadura madurae Cladosporium Madurella grisea Phialophora Sporothrix schenckii Systemic infective agents Blastomyces dermatitidis Coccidioides immitis Histoplasma capsulatum Paracoccidioides brasiliensis
  6. 6. OPPORTUNISTIC PATHOGENS • Absidia corymbifera • Aspergillus fumigatus • Candida albicans • Crytococcus neoformans • Pneumocystis carinii • Rhizomucor pusillus • Rhizopus oryzae (R.arrhizus)
  7. 7. Case 1 • A 42 year old female • Chronic asthma ( Inhaled corticosteroids) • c/o- Productive cough (brown mucous, blood tinged) • O/E- Mild Fever • Chest X ray- Lobar Infiltrate (Clusters of grapes) • CBC- Mildly elevated WBC count - Markedly elevated eosinophil count
  8. 8. Diagnosis • Aspergillosis Fumigatus (90%) • Other Species- A.terreus, A.flavus
  9. 9. Case 2 • 52 year old male • C/o – Cough and fever since 1 week a/w fatigue, headaches, joint pains at night . • No history of pulmonary diseases or smoking • Travel history to Phoenix 3 weeks ago • O/E- Mild fever, wheezing in upper left chest • X ray chest- Hilar adenopathy • CBC- Normal TLC with eosinophilia • KOH- Numerous spherules
  10. 10. Differential Diagnosis • Blastomycosis • Coccidomycosis ( C. immitis) • Histoplasmosis
  11. 11. Case 3 • 68 year old male • C/O- Dysphagia , retrosternal pain since 2 days, was on treatment for UTI • O/E- Normal • On Endoscopy- Thick , curdy white patches on esophageal wall
  12. 12. Diagnosis Candida Albicans
  13. 13. Case 4 • 32 year old male • K/C/O- Retroviral disease • C/O- fever, headache x 3 days • A/w- Confusion, forgetfullness • O/E – Moderate grade fever, cranial nerves normal • Minimal nuchal rigidity, hyperreflexic • CSF- high TLC , lymphocyte predominant • India Ink - Positive
  14. 14. Diagnosis • Cryptococcus Neoformis
  15. 15. CASE 5 • 29 year old female • C/o cough , worsening since weeks, low grade fever • H/0 smoking half pack a day • K/C/O- RVD • O/E- Normal • Anticubital veins- Needle Track • Lungs- Decreased breath sounds, ronchi • Chest Xray- Ground glass appearance
  16. 16. Diagnosis • Pneumocystis Carinii
  17. 17. CASE 6 • 27 year old male • Newly diagnosed HIV (CD 4 count- 7 cells/mm3) • C/O- fever with chills, night sweats, myalgia, dry cough, loss of weight x 25 days • O/E- 2 - 3 mm hyperpigmented papules and dermal basophilic spherules 2 - 4 microns • Has been treated for Pneumonia
  18. 18. Diagnosis • Histoplasma
  19. 19. Case 7 • 60 year old farmer • c/o – Nasal obstruction, epistaxsis since one year . • No comorbid conditions • H/O Chronic smoking , occasional ethanolic • O/E- Mass noticed in left nostril, reddish in color, strawberry like in appearence
  20. 20. • Diagnosis Rhinosporidium seebri
  21. 21. CASE 8 • A 70-year-old male • C/O- Bad breath and pus discharge from upper left region of jaw since one month. • K/C/O - Diabetes mellitus • Three months came to Emergency Department in an unconscious state- Diabetic ketoacidosis with renal failure
  22. 22. Diagnosis Mucormycosis
  23. 23. Artefacts • Tissue components such as Russell bodies, calcified bodies, elastic fibres and small blood vessels . • Silver precipitates- collagen, fibrin, elastin , neutrophils, cytolytic debris.
  24. 24. • The KOH preparation – unstained fungal elements in skin, hair and nails • Specimens- sputum and vaginal • Calcofluor white • Combination of the two. • India ink preparation - C. neoformans in CSF
  25. 25. Newer Techniques • Immunohistochemistry. • In Situ Hybridization • In Situ Polymerase Chain Reaction • Fluorescent in situ hybridization (FISH)
  26. 26. REFERENCES • Robbins and Cotran , South Asia Edition, Volume I &II • Andersons 6 th Edition • Case Files Microbiology , Lange
  27. 27. THANK YOU

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