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Related Concept Videos

Skin Diseases and Disorders01:23

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Sputum studies are a critical part of diagnosing and treating numerous respiratory conditions. These studies involve obtaining sputum samples for analysis to identify pathogenic organisms and assess the presence of abnormal cells indicative of malignant conditions. This lesson will delve into three fundamental sputum studies: Gram Stain, Cytology, and Acid-fast Smear and Culture.
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Author Spotlight: Advancing Pathogen Detection and Disease Assessment in Real-Time Using M-ROSE
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Preliminary Experience in Post-COVID-19 Mycoses: A Pathologist's Perspective.

Vaishali Walke1, Erukkambattu Jayashankar1, Ujjawal Khurana1

  • 1Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, IND.

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|November 21, 2022
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Summary

This study analyzed tissue reactions in COVID-19-associated mucormycosis, revealing characteristic fungal hyphae and diverse tissue damage patterns like necrosis and angioinvasion. Findings highlight how the post-COVID microenvironment promotes destructive fungal infections.

Keywords:
angioinvasionaspergillosiscovid-associated mucormycosisinvasive fungal infectiontissue necrosis

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Area of Science:

  • Pathology
  • Mycology
  • Infectious Diseases

Background:

  • Coronavirus disease (COVID-19) has led to an increased incidence of opportunistic fungal infections, particularly mucormycosis, due to comorbidities and the use of steroids and antibiotics.
  • Understanding the tissue reaction patterns in COVID-19-associated mucormycosis is crucial for comprehending the pathogenesis of these sequelae.

Purpose of the Study:

  • To analyze the diverse tissue reaction patterns in surgical debridement specimens of COVID-19-associated mucormycosis.
  • To utilize routine and special histochemical stains for detailed morphological analysis.
  • To elucidate the pathogenesis of COVID-19 sequelae related to fungal infections.

Main Methods:

  • A retrospective observational study was conducted on 45 surgical debridement specimens from patients with COVID-associated mucormycosis.
  • Histopathological analysis employed routine hematoxylin and eosin (H&E) stain alongside special stains: periodic acid-Schiff (PAS), Grocott-Gomori's methenamine silver (GMS), Masson trichrome (MT), and Prussian blue (PB).
  • Demographic, clinical, radiological, and microbiological data were collected and correlated with histomorphological findings.

Main Results:

  • All specimens (45/45) showed mucormycosis characterized by broad, aseptate, ribbon-like fungal hyphae with right-angle branching.
  • Six cases (6/45) also exhibited features of Aspergillosis, with thin, narrow septate hyphae branching at acute angles.
  • Predominant histological tissue reaction patterns included extensive tissue necrosis (100%), vascular proliferation (82%), angioinvasion (58%), giant cell reaction (53%), and fibrin thrombi (47%).

Conclusions:

  • Post-COVID-19 mucormycosis involves alterations in the local tissue microenvironment that favor fungal colonization and lead to destructive reactions.
  • Observed reactions include angioinvasion, angiodestruction, necrosis, necrotizing granulomas, suppurative inflammation, and iron pigment deposition.
  • The spectrum of morphological changes observed reflects the host's immune status during the post-COVID-19 period.