Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA 30322, USA.
Clin Microbiol Rev. 2011 Apr;24(2):247-80. doi: 10.1128/CMR.00053-10.
Fungal infections are becoming more frequent because of expansion of at-risk populations and the use of treatment modalities that permit longer survival of these patients. Because histopathologic examination of tissues detects fungal invasion of tissues and vessels as well as the host reaction to the fungus, it is and will remain an important tool to define the diagnostic significance of positive culture isolates or results from PCR testing. However, there are very few instances where the morphological characteristics of fungi are specific. Therefore, histopathologic diagnosis should be primarily descriptive of the fungus and should include the presence or absence of tissue invasion and the host reaction to the infection. The pathology report should also include a comment stating the most frequent fungi associated with that morphology as well as other possible fungi and parasites that should be considered in the differential diagnosis. Alternate techniques have been used to determine the specific agent present in the histopathologic specimen, including immunohistochemistry, in situ hybridization, and PCR. In addition, techniques such as laser microdissection will be useful to detect the now more frequently recognized dual fungal infections and the local environment in which this phenomenon occurs.
由于高危人群的扩大以及治疗方式的应用，使这些患者的生存时间延长，真菌感染变得更加频繁。由于组织的组织病理学检查可检测到真菌对组织和血管的侵袭以及宿主对真菌的反应，因此它一直是定义阳性培养分离物或 PCR 检测结果的诊断意义的重要工具。但是，真菌的形态特征很少具有特异性。因此，组织病理学诊断主要应描述真菌，并应包括组织侵袭的存在与否以及宿主对感染的反应。病理报告还应包括一条注释，说明与该形态相关的最常见真菌以及在鉴别诊断中应考虑的其他可能的真菌和寄生虫。已经使用了替代技术来确定组织病理学标本中存在的特定病原体，包括免疫组织化学，原位杂交和 PCR。此外，激光显微切割等技术将有助于检测现在更频繁出现的双重真菌感染以及发生这种现象的局部环境。
