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Invasive fungal disease in university hospital: a PCR-based study of autopsy cases
Komkrit Ruangritchankul1, Ariya Chindamporn2, Navaporn Worasilchai3
1Department of Pathology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society Bangkok, Thailand.
Abstract:
Invasive fungal disease (IFD) has high mortality rate, especially in the growing population of immunocompromised patients. In spite of introduction of novel diagnostic approaches, the intravital recognition of IFD is challenging. Autopsy studies remain a key tool for assessment of epidemiology of visceral mycoses. We aimed to determine species distribution and trends of IFD over the last 10 years in unselected autopsy series from a large university hospital. Forty-five cases of visceral mycoses, confirmed by histopathology and panfungal PCR, were found in 587 consecutive autopsies. Major underlying diseases were diabetes mellitus (20%), hematologic malignancies (15.6%) and systemic lupus erythematosus (15.6%). There was a high risk for disseminated IFD in immunocompromised patients stayed in the hospital over 1 month with a fever longer than 3 weeks. The most common fungi were Aspergillus spp. (58%), Candida spp. (16%), Mucorales (14%) and Fusarium spp. (10%). We found significant increase in Aspergillus flavus (P = 0.04) and Mucorales (P < 0.01) infections over the last 5 years. Concordance rate between histopathology and panfungal PCR was 89.5% to the genus level. All 6 cases of fusariomycosis were misinterpreted as aspergillosis by histology alone. The precise species identification, necessary for targeted antifungal treatment, was rendered only by the molecular technique. Panfungal PCR showed high performance on formalin-fixed paraffin-embedded specimens, providing important epidemiological data in retrospective autopsy series. Rapid detection of fungi by panfungal PCR assay has high potential for intravital diagnostics of IFD in surgical and biopsy specimens.
Insights
Invasive fungal disease (IFD) diagnosis is challenging. Panfungal PCR in autopsy studies revealed increasing Aspergillus flavus and Mucorales infections, improving species identification for targeted antifungal therapy.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Molecular Diagnostics
Background:
- Invasive fungal disease (IFD) presents a significant mortality risk, particularly in immunocompromised individuals.
- Accurate and timely diagnosis of IFD remains a clinical challenge, despite advancements in diagnostic methods.
- Autopsy studies are crucial for understanding the epidemiology of visceral mycoses.
Purpose of the Study:
- To investigate the species distribution and temporal trends of IFD over a decade using autopsy data.
- To evaluate the diagnostic performance of panfungal PCR compared to histopathology in identifying fungal pathogens.
- To assess the utility of molecular techniques for epidemiological surveillance of IFD.
Main Methods:
- Analysis of 45 cases of visceral mycoses from 587 consecutive autopsies over 10 years.
- Confirmation of fungal infections using histopathology and panfungal PCR on formalin-fixed paraffin-embedded specimens.
- Statistical analysis to identify trends in fungal species distribution and correlations with patient characteristics.
Main Results:
- Aspergillus spp. (58%), Candida spp. (16%), Mucorales (14%), and Fusarium spp. (10%) were the most common fungi identified.
- A significant increase in Aspergillus flavus (P = 0.04) and Mucorales (P < 0.01) infections was observed in the last five years.
- Panfungal PCR demonstrated high concordance (89.5%) with histopathology at the genus level and accurately identified Fusarium spp., often misdiagnosed as Aspergillus by histology alone.
Conclusions:
- Autopsy-based molecular diagnostics, like panfungal PCR, provide valuable epidemiological data on IFD.
- Panfungal PCR offers precise species identification crucial for guiding targeted antifungal treatment, surpassing limitations of traditional histology.
- The findings highlight the increasing prevalence of specific fungal pathogens and underscore the potential of rapid molecular assays for both retrospective and prospective IFD diagnostics.
