1. Usefulness of molecular biology performed with formaldehyde-fixed paraffin embedded tissue for the diagnosis of combined pulmonary invasive mucormycosis and aspergillosis in an immunocompromised patient
- Author
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Véronique Hofman, Michele Baumann, Nicolas Venissac, Dea Garcia-Hermoso, Paul Hofman, Martine Gari-Toussaint, Bernard Padovani, Abdelmajid Dhouibi, Catherine Butori, Gieri Cathomas, Laboratory of Clinical and Experimental Pathology, Louis Pasteur Hospital, Human Biobank, Department of Radiology, Laboratory of Mycology, Archet II Hospital, Centre National de Référence Mycologie et Antifongiques-Mycologie Moléculaire (CNRMA), Institut Pasteur [Paris], Laboratory for Molecular and Infectious Disease Pathology, Cantonal Institute for Pathology, Department of Thoracic Surgery, and Institut Pasteur [Paris] (IP)
- Subjects
Male ,MESH: Fatal Outcome ,Pathology ,Tissue Fixation ,MESH: Paraffin Embedding ,Case Report ,MESH: Formaldehyde ,Aspergillosis ,Polymerase Chain Reaction ,MESH: Kidney Transplantation ,Aspergillus fumigatus ,Fatal Outcome ,0302 clinical medicine ,MESH: Rhizopus ,MESH: Immunocompromised Host ,MESH: Fixatives ,Lung ,MESH: Aged ,Invasive Pulmonary Aspergillosis ,0303 health sciences ,Paraffin Embedding ,biology ,General Medicine ,MESH: Predictive Value of Tests ,3. Good health ,MESH: Staining and Labeling ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,MESH: Immunosuppressive Agents ,MESH: Aspergillus fumigatus ,MESH: Tomography, X-Ray Computed ,Bronchoalveolar Lavage Fluid ,Immunosuppressive Agents ,Rhizopus ,medicine.drug ,lcsh:RB1-214 ,Mucorales ,MESH: Pneumonia ,MESH: Invasive Pulmonary Aspergillosis ,Rhizopus microsporus ,medicine.medical_specialty ,Histology ,Pathology and Forensic Medicine ,Fixatives ,Immunocompromised Host ,Necrosis ,03 medical and health sciences ,Predictive Value of Tests ,Formaldehyde ,medicine ,lcsh:Pathology ,Humans ,Mucormycosis ,MESH: Lung ,MESH: Mucormycosis ,Aged ,MESH: Necrosis ,Voriconazole ,MESH: Humans ,Staining and Labeling ,MESH: Bronchoalveolar Lavage Fluid ,030306 microbiology ,MESH: Polymerase Chain Reaction ,Pneumonia ,biology.organism_classification ,medicine.disease ,Kidney Transplantation ,MESH: Male ,MESH: Tissue Fixation ,Tomography, X-Ray Computed ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
Immunocompromised patients who develop invasive filamentous mycotic infections can be efficiently treated if rapid identification of the causative fungus is obtained. We report a case of fatal necrotic pneumonia caused by combined pulmonary invasive mucormycosis and aspergillosis in a 66 year-old renal transplant recipient. Aspergillus was first identified during the course of the disease by cytological examination and culture (A. fumigatus) of bronchoalveolar fluid. Hyphae of Mucorales (Rhizopus microsporus) were subsequently identified by culture of a tissue specimen taken from the left inferior pulmonary lobe, which was surgically resected two days before the patient died. Histological analysis of the lung parenchyma showed the association of two different filamentous mycoses for which the morphological features were evocative of aspergillosis and mucormycosis. However, the definitive identification of the associative infection was made by polymerase chain reaction (PCR) performed on deparaffinized tissue sections using specific primers for aspergillosis and mucormycosis. This case demonstrates that discrepancies between histological, cytological and mycological analyses can occur in cases of combined mycotic infection. In this regard, it shows that PCR on selected paraffin blocks is a very powerful method for making or confirming the association of different filamentous mycoses and that this method should be made available to pathology laboratories.
- Published
- 2010
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