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 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.

journal_name

Am J Clin Pathol

authors

Chavez JA,Brat DJ,Hunter SB,Velazquez Vega J,Guarner J

doi

10.1093/ajcp/aqx144

subject

Has Abstract

pub_date

2018-01-29 00:00:00

pages

98-104

issue

2

eissn

0002-9173

issn

1943-7722

pii

4818415

journal_volume

149

pub_type

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