Pulmonary cytology in paracoccidioidomycosis

Paracoccidioidomycosis caused by the fungus Paracoccidioides brasiliensis is a common endemic deep mycosis in Brazil and other Latin American countries; the lungs are frequently involved with suppurative and granulomatous inflammation. With the aim of using pulmonary cytology as a diagnostic tool in paracoccidioidomycosis, the cytologic findings in 127 sputa, 4 bronchial washings and 2 bronchial aspirates from 45 patients with the mycosis were reviewed. Smears from all samples were stained by the Shorr and Leishmann techniques. Cell-block preparations stained with hematoxylin and eosin and by the Gomori-Grocott method were available from 115 samples. Most samples (55%) were purulent, 30% were hemorrhagic and 17% were mucous. Polymorphonuclear neutrophils, macrophages and multinucleated giant cells were observed in all cases. P. brasiliensis was identified in samples from 95.5% of the patients, more frequently in the cell-block preparations (93%) than in the smears (57.7%), probably as the consequence of the application of the Gomori-Grocott stain to the former. Epithelioid cells were present in 62.2% and squamous metaplasia of the respiratory epithelium in 51.1% of cases. Cytology of pulmonary samples proved to be a useful diagnostic method for the detection of lung involvement by paracoccidioidomycosis in humans. The accuracy of the method increased with the number of samples examined from each patient.