Mucormycosis laboratory findings
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]
Overview
When a clinician suspects invasive mucormycosis infection, an early diagnostic procedure performed within 16 days from the onset of symptom and early initiation of antifungal therapy will lead to successful management of this highly fatal disease.[1] Biopsy with H&E staining of the specimen and PCR may confirm the diagnosis in suspected cases.
Findings on Hemotoxylin and Eosin (H&E) sections[2]
- Subcutaneous lesions show aseptate hyphae immersed in an intense acute inflammatory exudate of neutrophils, eosinophils and fibrosis.
- Focal collections of epithelioid and Langhans multinucleated giant cells are also observed.
- Mucor spp. typically are rapid growing, producing globose sporangia on sporangiophores that are either solitary or branched.
- The sporangia contain the entire columella and spores that are mucus bound.
- The sporangial wall collapses irregularly, if at all.
- Rhizoids and stolons are absent. These features distinguish the Mucor spp. from the other producers of globose sporangia.
Findings on PCR analysis
- Detection of fungal DNA from biopsy specimens allows rapid identification of the causative organism of mucormycosis.[3]
- Mucorales quantitative PCR not only confirm the mucormycosis diagnosis when other mycological arguments were present but could also anticipate this diagnosis.[4]
- Quantification of DNA loads may also be a useful adjunct to treatment monitoring.
References
- ↑ Jeong SJ, Lee JU, Song YG, Lee KH, Lee MJ (2015). “Delaying diagnostic procedure significantly increases mortality in patients with invasive mucormycosis”. Mycoses. 58 (12): 746–52. doi:10.1111/myc.12428. PMID 26565066.
- ↑ Ribes JA, Vanover-Sams CL, Baker DJ (2000). “Zygomycetes in human disease”. Clin. Microbiol. Rev. 13 (2): 236–301. PMC 100153. PMID 10756000.
- ↑ Rickerts V, Just-Nübling G, Konrad F, Kern J, Lambrecht E, Böhme A, Jacobi V, Bialek R (2006). “Diagnosis of invasive aspergillosis and mucormycosis in immunocompromised patients by seminested PCR assay of tissue samples”. Eur. J. Clin. Microbiol. Infect. Dis. 25 (1): 8–13. doi:10.1007/s10096-005-0078-7. PMID 16416267.
- ↑ Millon L, Herbrecht R, Grenouillet F, Morio F, Alanio A, Letscher-Bru V, Cassaing S, Chouaki T, Kauffmann-Lacroix C, Poirier P, Toubas D, Augereau O, Rocchi S, Garcia-Hermoso D, Bretagne S (2016). “Early diagnosis and monitoring of mucormycosis by detection of circulating DNA in serum: retrospective analysis of 44 cases collected through the French Surveillance Network of Invasive Fungal Infections (RESSIF)”. Clin. Microbiol. Infect. 22 (9): 810.e1–810.e8. doi:10.1016/j.cmi.2015.12.006. PMID 26706615.
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