Liu K, Howell D N, Perfect J R, Schell W A
Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA.
Am J Clin Pathol. 1998 Jan;109(1):45-54. doi: 10.1093/ajcp/109.1.45.
Nontraditional human pathogenic fungi, including Fusarium, Paecilomyces, and Acremonium species, have been increasingly documented as agents of infection in immunocompromised patients and, occasionally, in normal hosts. Although definitive identification of these fungi requires culture, they often can be identified provisionally in tissue sections by a combination of histologic features, including hyaline septate hyphae and characteristic reproductive structures known as phialides and phialoconidia. These morphologic characteristics, although familiar to mycologists, are easily overlooked by histopathologists; as a result, Fusarium species and Paecilomyces lilacinus are frequently misidentified in tissue sections as Aspergillus or Candida species. We identified 19 culture-proved cases of infection with species of Fusarium, Paecilomyces, or Acremonium; retrospectively reviewed histologic specimens stained by routine hematoxylin and eosin, Gomori methenamine silver, and/or periodic acid-Schiff stains; and delineated morphologic criteria that will help pathologists make a preliminary identification of these fungi by histopathology. Adventitious sporulation was found in 9 of 9 infections caused by Paecilomyces species, 7 of 10 infections caused by Fusarium species, and in the single case of infection caused by Acremonium strictum. Histologic recognition of these morphologies may help clinicians select appropriate initial antifungal treatment and manage the infection.
非传统人类致病真菌，包括镰刀菌属、拟青霉属和枝顶孢属菌种，越来越多地被记录为免疫功能低下患者以及偶尔在正常宿主中的感染病原体。尽管这些真菌的确诊需要培养，但通过组织学特征的组合，包括透明有隔菌丝以及称为瓶梗和瓶梗分生孢子的特征性繁殖结构，通常可以在组织切片中进行初步鉴定。这些形态学特征，虽然真菌学家很熟悉，但很容易被组织病理学家忽视；因此，镰刀菌属菌种和淡紫拟青霉在组织切片中经常被误诊为曲霉属或念珠菌属菌种。我们确定了19例经培养证实的镰刀菌属、拟青霉属或枝顶孢属菌种感染病例；回顾性地检查了用常规苏木精和伊红、Gomori六胺银和/或过碘酸希夫染色法染色的组织学标本；并描述了有助于病理学家通过组织病理学对这些真菌进行初步鉴定的形态学标准。在9例拟青霉属菌种引起的感染中有9例、10例镰刀菌属菌种引起的感染中有7例以及在1例由紧密枝顶孢引起的感染中发现了偶然形成的孢子。对这些形态的组织学识别可能有助于临床医生选择合适的初始抗真菌治疗并控制感染。
