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Dematiaceous fungal infections: clinical and pathologic conundrums
Emily Mae Hartsough1, Ruth K Foreman2, Maria Martinez-Lage2
1Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA ehartsough@mgh.harvard.edu.
Abstract:
Dematiaceous fungi are defined by pigment within their cell walls. They are increasingly recognised human pathogens, causing a wide range of clinical presentations, from localised subcutaneous infections to disseminated disease in rare cases. We report our institutional experience with diagnosis of dematiaceous fungal infections from 2005 to 2022 and highlight four instructive cases that clinically and pathologically mimicked other diseases for which the diagnosis was confirmed by fungal culture (one case) or supported by PCR with 28S rRNA and internal transcribed spacer primers (three cases). Two patients were immunocompromised and two had presumed exposure to the organism. In each highlighted case, fungal infection was not clinically suspected, and the pathologist was critical in making the diagnosis and ensuring appropriate clinical management, which was supplemented by fungal stains and novel molecular methods.
Insights
Dematiaceous fungi, pigmented molds, can cause diverse infections. Pathologists play a key role in diagnosing these challenging cases, often mimicking other conditions, using culture and molecular methods.
Area of Science:
- Medical Mycology
- Diagnostic Pathology
Background:
- Dematiaceous fungi are characterized by pigment in their cell walls.
- These fungi are emerging as significant human pathogens.
- They present with a spectrum of clinical manifestations, from localized to disseminated disease.
Purpose of the Study:
- To review institutional experience in diagnosing dematiaceous fungal infections.
- To highlight challenging cases where diagnosis was critical.
- To emphasize the role of pathology and molecular methods in diagnosis.
Main Methods:
- Retrospective review of institutional diagnostic experience (2005-2022).
- Analysis of four instructive cases mimicking other diseases.
- Diagnostic confirmation using fungal culture and PCR (28S rRNA, ITS primers).
- Utilization of fungal stains and molecular techniques.
Main Results:
- Four cases of dematiaceous fungal infections are presented.
- These infections were initially not clinically suspected.
- Diagnosis was confirmed by culture in one case and supported by PCR in three cases.
- Pathological examination was crucial for diagnosis.
Conclusions:
- Dematiaceous fungal infections can present atypically, mimicking other conditions.
- Pathologists are vital for accurate diagnosis of these infections.
- Fungal culture, stains, and molecular methods are essential for diagnosis and management.
