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Histopathology Diagnosis of Filamentous Fungi

  • Clinical Pathology (C Sundaram, Section Editor)
  • Published:
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Abstract

Purpose of Review

Invasive fungal diseases (IFDs) are challenging to treat and early diagnosis is important. No single laboratory test is ideal. A proven diagnosis of IFD requires a microbiological and/or histopathological demonstration of fungi. Histopathology examination is rapid and cost effective but lacks specificity for the diagnosis of filamentous fungi. Ancillary techniques can enhance accuracy.

Recent Findings

Diagnosis on histopathology is based on the diagnosis of the mould and the tissue reaction. The filamentous fungi can be classified as hyaline septate, hyaline pauci-septate and pigmented (dematiaceous). The tissue reaction helps in differentiating from colonization/contamination and depends on the immune status of the host. Histopathology provides a rapid, though presumptive, diagnosis and may be the only means of diagnosis when culture studies are not available or negative. The morphology diagnosis is aided by histochemistry with periodic acid-Schiff, Gomori methenamine silver and Masson Fontana stains. The tissue response may be allergic mucin or mycetoma, abscess/granuloma, infarct/haemorrhage or angioinvasion/perineural invasion. The low fungal burden, artefacts in morphology due to distortion of hyphae during processing, masking of pathogens by the tissue reaction and lack of immune response in immunosuppressed hosts pose problems in diagnosis. Histopathology alone cannot differentiate the genera from the species, which is important for treatment decisions as antifungal susceptibility varies. Ancillary techniques like immuno histochemistry, polymerase chain reaction, in situ hybridization and laser capture can enhance the diagnostic accuracy to species level, but require rigorous quality control.

Summary

Histopathology is a standardized technique, available in most laboratories that can provide a rapid though presumptive diagnosis of IFD. Despite the limitations, it is a cost-effective means of providing early diagnosis when cultures are not available. Application of ancillary techniques to histopathology should be considered for improving accuracy of diagnosis.

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  1. Department of Pathology and Laboratory Medicine, Basavatarakam Indo-American Cancer Hospital & Research Institute, Telangana State, 500034, Hyderabad, India

    Sundaram Challa

  2. Department of Pathology, Aware Gleneagles Global Hospital, Hyderabad, Telangana State, India, 500035

    Radha Sistla

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Challa, S., Sistla, R. Histopathology Diagnosis of Filamentous Fungi. Curr Fungal Infect Rep 16, 17–32 (2022). https://doi.org/10.1007/s12281-021-00428-4

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