Practical Diagnostic Approach to the Presence of Hyphae in Neuropathology Specimens With Three Illustrative Cases

Abstract Objectives Early and accurate diagnosis remains crucial in the therapeutic management of invasive central nervous system fungal infections. Different molds have intrinsic resistance to antifungal agents; thus, morphologic differentiation is helpful to clinicians. Methods Using three example...

Full description

Saved in:

Bibliographic Details
Published in:	American journal of clinical pathology Vol. 149; no. 2; pp. 98 - 104
Main Authors:	Chavez, Jesus A, Brat, Daniel J, Hunter, Steven B, Velazquez Vega, Jose, Guarner, Jeannette
Format:	Journal Article
Language:	English
Published:	US Oxford University Press 29-01-2018
Subjects:	Adult Aged Antifungal agents Aspergillosis - diagnosis Aspergillosis - microbiology Aspergillosis - pathology Aspergillus fumigatus - isolation & purification Central nervous system Central Nervous System Fungal Infections - diagnosis Central Nervous System Fungal Infections - microbiology Central Nervous System Fungal Infections - pathology Diabetes mellitus Diagnosis, Differential Differential diagnosis Genera Humans Hyphae Hyphae - classification Infectious diseases Male Medical diagnosis Middle Aged Mold Mucormycosis - diagnosis Mucormycosis - microbiology Mucormycosis - pathology Neuropathology Neutropenia Outbreaks Saccharomycetales - isolation & purification Species Septate Histopathology Hypha Hyphae Pauciseptated Dematiaceous Mold Septated
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Abstract Objectives Early and accurate diagnosis remains crucial in the therapeutic management of invasive central nervous system fungal infections. Different molds have intrinsic resistance to antifungal agents; thus, morphologic differentiation is helpful to clinicians. Methods Using three examples, we present a guide on how to approach neuropathology specimens where hyphae are identified on initial histologic examination. Results Hyphae can be classified into three basic groups: hyaline pauciseptated, hyaline septated, and pigmented or dematiaceous. The hyaline pauciseptated group includes the order of the Mucorales (previously Zygomyces) and is frequent in patients with decompensated diabetes and severe neutropenia. Aspergillus species constitutes the most frequently isolated mold in the hyaline septated group. However, other invasive hyaline septated molds include Fusarium species, which is frequently resistant to multiple antifungals, and Candida species Last, dematiaceous molds, although infrequent, can be found in neuropathology specimens, as happened during the outbreak of Exserohilum associated with manufacturing practices in a compound pharmacy. Conclusions Categorizing hyphae into the three groups described allows pathologists to provide information that is useful for infectious disease treatment with an inclusive differential diagnosis of diverse fungal genera that share the same morphological features.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Review-3 content type line 23 ObjectType-Feature-5 ObjectType-Article-4 ObjectType-Report-1
ISSN:	0002-9173 1943-7722
DOI:	10.1093/ajcp/aqx144