2017
DEC 1-3
HistopathologicalSPEAKERdiagnosis CONFERENCE,OF Professor Arunaloke Chakrabarti MMTN Head, Department of Medical Microbiology AT Postgraduate InstituteCOPYRIGHT of Medical Education and Research Chandigarh, India Co-chair, ISHAM Asia Fungal Working Group PRESENTED
Presented at MMTN Vietnam Conference 1–3 December 2017, Ho Chi Minh City, Vietnam Histopathological diagnosis
2017
DEC Arunaloke Chakrabarti1-3 Professor & Head Center for Advanced Research in Medical Mycology & WHO Collaborating Center Department of MedicalSPEAKER Microbiology Postgraduate Institute of CONFERENCE,MedicalOF Education & Research Chandigarh – 160012, India MMTN AT COPYRIGHT
PRESENTED Need of histopathological diagnosis
• Fungi are ubiquitous & saprophytic 2017 DEC • Usual laboratory contaminant 1-3
• Infection versus colonization - a frequent problem
SPEAKER • Rapid & cost-effective meansCONFERENCE, of providingOF a presumptive or definitive diagnosis of an invasive fungal infection MMTN AT • Help in knowing the load,COPYRIGHT tissue reaction, extent & invasion
• Difficulty – to get samples from deep tissue PRESENTED • Advances in diagnostic radiology & patient support (platelet transfusions) have improved collection of tissue biopsy specimens Learning histopathological diagnosis 2017 • Learn tissue reaction to fungi DEC 1-3 • Commonly performed H & E stain in histopathology will help you to observe tissue reaction SPEAKER • Difficult to identify fungi on H & CONFERENCE,E (exceptOF Histoplasma , Mucor etc.)
• On H&E, all fungi show pinkMMTN cytoplasm, blue nuclei & no colouration of AT the wall. You may see unstainedCOPYRIGHT area in the position of fungi
• Go ahead performing PAS, GMS PRESENTED • Other specific stains – Alcian blue, Mucicarmine, Fontana Masson etc.
• Need training…. Other challenges • Morphological characters of fungi are specific in few occasions 2017 • Histopathology report - description fungus & the presence or DEC absence of tissue invasion & the host reaction1-3 to the infection • Other possible fungi with same morphology to be considered in the differential diagnosis SPEAKER CONFERENCE,OF
MMTN AT Aspergillosis FusariosisCOPYRIGHT Scedosporiosis Phaeohyphomycosis
• Alternate techniques - immunohistochemistry, in situ hybridization,PRESENTED & PCR • Laser micro-dissection - detect dual fungal infections & the local environment in which this phenomenon occurs 2017
DEC Tissue reaction depends on 1-3
• Host immunity SPEAKER CONFERENCE,OF
• Class of fungal pathogenMMTN AT COPYRIGHT
PRESENTED 2017
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Superficial infectionsSPEAKER CONFERENCE,OF
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PRESENTED Superficial Candida infection
• Low level tissue destruction & inflammation compared2017 to dermatophytes DEC 1-3 • Pathogenic (vs. commensal) correlates with pro-inflammatory
response & depends on fungal burdenSPEAKER CONFERENCE,OF • Steps – colonization, adhesion, invasion, damage MMTN • Cell wall (mannan, glucan,AT chitin, protein) triggers host immune COPYRIGHT response (cytokines, antimicrobial molecule & attraction of immune effector cells) PRESENTED • But it is not best interest of commensal Candida, as host response would cause elimination 2017
DEC 1-3
SPEAKER CONFERENCE,OF
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PRESENTED Chronic mucocutaneous candidiasis
2017
DEC • Disease occurs in autoimmune polyendocrinopathy1-3 candidiasis ectodermal dystrophy syndrome (APECED), hypoparathyroidism,
Addison disease or Hyper IgE syndromeSPEAKER CONFERENCE,OF • CMC can occur in defective pathogen recognition pathway MMTN • Low level of inflammationAT COPYRIGHT
PRESENTED Dermatophyte 2017 infection DEC 1-3
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• Though dermatophytes MMTNalone have minimal capacity to damage AT host, consistently high levelCOPYRIGHT of host tissue destruction observed in dermatophytosis PRESENTED • However, for long-term survival - tissue reaction required (tinea unguium – localized in nail & avoid host immune cells) Malassezia infection 2017 DEC 1-3 • Host secretion of β- endorphins increase the production of SPEAKER CONFERENCE,OF Malssezia MMTN phospholipases AT disrupt epithelial COPYRIGHT barrier & provoke inflammation PRESENTED
Hube et al. J Mycol Med 2015; 25: e44 Tissue reaction in subcutaneous & systemic fungal infections
Tissue reactions Fungi can be suspected 2017 Acute pyogenic or suppurative Candida, Aspergillus DEC Suppurative with angio-invasion Aspergillus, Mucorales 1-3 Mixed suppurative inflammation Blastomyces, Coccidioides Mixed suppurative & granulomatous Blastomyces, Coccidioides, Talaromyces, Paracoccidioides, Sporothrix, PhaeohyphomycetesSPEAKER CONFERENCE,OF Predominantly granulomatous Cryptococcus, Histoplasma, Coccidioides
Granulomatous with various degreeMMTN of Cryptococcus, Rhinosporidium, Chronic or fibrosis AT sub-acute aspergillosis Nodules having vascular necrosis,COPYRIGHTlympho- Histoplasma histiocytic vasculitis, rare granuloma Granuloma with necrosis & calcification Histoplasma, Coccidioides PRESENTED Predominant fibrosis with granuloma, Entomophthorales mixed eosinophilic inflammation Diffuse alveolar damage (ARDS) Blastomyces, Histoplasma, Aspergillus Tissue reaction
• Non-invasive colonization of pre-existing cavity – fungal ball 2017 (paranasal sinus & pulmonary cavities) DEC • Allergic, mucin-producing, non-invasive 1-3fungal disease –ABPA, AFRS
• No reaction, gelatinous (Cryptococcus) SPEAKER • Predominantly neutrophilic inflammatoryCONFERENCE,OF response
Mild neutropenia – localizedMMTN lesion (neutrophilic exudate) AT Severe neutropenia – disseminatedCOPYRIGHT (coagulative necrosis) • Granuloma vs. diffuse macrophage infiltration PRESENTED • Mixed granulomatous & purulent inflammation (mixture of epithelioid macrophages & neutrophils) Mixed granulomatous & purulent inflammation
• Localized controlled infection – granuloma predominates,2017 organism scanty (chronic granulomatous FRS) DEC 1-3 • Fulminant infection – predominance of neutrophils, organism readily seen (dimorphic infection in AIDS) SPEAKER CONFERENCE,OF • Mixed purulent & granulomatous inflammation (sporotrichosis, chromoblastomycosis) MMTN AT COPYRIGHT
PRESENTED Fungal ball
2017
DEC 1-3
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MMTN AT . Usually unilateral COPYRIGHT . Involves the maxillary sinus . Well defined, high attenuation mass PRESENTED . Occasional flocculent Ca . Reactive sclerosis of sinus wall . No invasion 2017
DEC 1-3
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PRESENTED Aspergilloma 2017 DEC 1-3
• Fungus ball composed of Aspergillus hyphae & cellular debris SPEAKER within a pulmonary cavity CONFERENCE,OF
• Preexisting pulmonary cavitiesMMTN that have become colonized with AT Aspergillus spp. COPYRIGHT
• Fungal ball is single, cavity stable over months PRESENTED • Patient has few symptoms (mild cough only) and little evidence of systemic inflammation Allergic fungal rhinosinusitis •Type I hypersensitivity
•Nasal polyposis 2017
•Characteristic CT findings DEC •Allergic mucin without mucosal invasion 1-3 •Positive fungal culture of sinus content Bent & Kuhn, Otolaryngol Head Neck Surg, 1994; 111: 580-8
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DEC 1-3 Gelatinous inflammation SPEAKER CONFERENCE,OF
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Acute pyogenic SPEAKER CONFERENCE,OF
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PAS 2017
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PRESENTED CANDIDA
2017
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SPEAKER TRICHOSPORONOSIS CONFERENCE,OF ASPERGILLUS
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PRESENTED Acute coccidioidal pneumonia 2017
DEC 1-3
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Mixed purulent & granulomatousSPEAKER CONFERENCE,OF
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PRESENTED Rhinosporidiosis
2017
DEC 1-3
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PRESENTED Lobomycosis
2017
DEC 1-3
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PRESENTED Chromoblastomycosis
2017
DEC 1-3
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PRESENTED Granuloma of chromoblastomycosis 2017
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PRESENTED Mycetoma
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DEC 1-3 Granulomatous pathology SPEAKER CONFERENCE,OF
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PRESENTED Granulomatous Invasive
2017 Granulomas with few fungal hyphae chronicDEC inflammatory infiltrate 1-3
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PRESENTED Coccidioidal nodule 2017
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PRESENTED Interaction of Aspergillus with host
2017
DEC
1-3 Frequency of aspergillosis
Acute IA ABPA SPEAKERAllergic sinusitis Subacute IA CONFERENCE,OF aspergillosis Tracheobronchitis AspergillomaMMTN AT Chronic cavitary COPYRIGHT Chronic fibrosing Frequency of Frequency
PRESENTED
Immune dysfunction Normal Immune hyperactivity immune function www.aspergillus.org.uk 2017
DEC 1-3
SPEAKER Acute invasive aspergillosisCONFERENCE,OF
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PRESENTED Clinical phenotypes of chronic aspergillosis 2017
DEC
Single/simple 1-3 aspergilloma
Subacute Invasive aspergillosis Aspergillus (SAIA) or chronic necrotizing SPEAKER nodule(s) pulmonary aspergillosis (CNPA) CONFERENCE,OF
ChronicMMTNcavitary pulmonary aspergillosis (CCPA) AT COPYRIGHT
Chronic fibrosing pulmonary aspergillosis PRESENTED (CFPA)
Denning et al. Eur Respir J 2016; 47: 45 Chronic pulmonary aspergillosis
2017
DEC 1-3
SPEAKER Aspergilloma CONFERENCE,OF CCPA CFPA MMTN AT COPYRIGHT
PRESENTED
Aspergillus nodule Sub-acute invasive aspergillosis 2017
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SPEAKER Aspergilloma CONFERENCE,OF
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SPEAKER Chronic necrotizing pulmonaryCONFERENCE,OF aspergillosis
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PM-22189 2017
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DEC 1-3 Allergic aspergillosis
SPEAKER - allergic fungal rhinosinusitisCONFERENCE,OF
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Pneumocystosis SPEAKER CONFERENCE,OF
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PRESENTED Wt-856g 2017
DEC 1-3
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PM-22153 2017
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PM-22153 2017
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