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Morphological spectrum of fungal infections: a retrospective study

Muniyappa Usha, H B Rakshitha, Jasuja Avnika, Asok Aneesha, Reginald Sharon.

Abstract
Background: Over the past few years, major advances in health care have led to an unwelcome increase in the number of life-threatening infections due to true pathogenic and opportunistic fungi. The population at risk includes transplant recipients, cancer patients, and other individuals receiving immunosuppressive treatments. Various diagnostic modalities are used to diagnose fungal infections. These include KOH preparation, culture, histopathology, antigen and antibody assay, metabolite detection, and polymerase chain reaction methods. Histopathologic examination permits rapid, presumptive identification of fungal infections. Also, histopathologic examination reveals many significant prognostic evidences such as host tissue reaction, extent of invasion by fungi, and also tissue response to treatment, which cannot be assessed by any other methods. One or combination of these methods can be employed to know the etiologic agent and so determining therapy.

Objective: To detect the type of fungal infections and their distribution according to age, sex, and organ in histopathologic specimens.

Materials and Methods: This was a retrospective study carried out in the department of pathology for a period of 4 years from January 2011 to January 2015. All the histopathologic specimens diagnosed to have fungal infections during this study period were included in this study.

Result: During the study period, of 15,501 total histopathologic specimens, 33 with fungal infections were received, accounting for 0.08% of total histopathologic specimens. Of these, 76% were males, 24% were females with male preponderance. The most common type of fungal infection was mucormycosis (19) followed by candidiasis (5), others were zygomycosis (2), pigmented fungosis (2), and one case each of rhinosporidiasis, cryptococcosis, and aspergillosis were found. The most common site of infection was maxillary sinus.

Conclusion: Histopathologic examination can offer prompt provisional identification of infectious fungal organisms and remains the only available reliable means to identify certain pathogens. However, significant morphological overlap in fungal organisms, a desire to provide unequivocal fungal categorization owing to pressure from clinical colleagues, and idiosyncratic language in surgical pathology reporting contribute to errors.

Key words: Histopathology, fungal organisms, special stains, culture



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