Thread by @pathologeek_

Pathology Report for Fungal Infections #tweetorial

1/9 Histopathological diagnosis of an invasive fungal infection should be PRIMARILY DESCRIPTIVE and must include:
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📌 The order can vary but try to include them all.
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2/9 🍄 The fungal elements you find and their amount:

- Hyphae: Are they Pigmented or non-pigmented, septation and branching (acute angle, right angle or both)

- Yeasts: Their size, form and budding

- Pseudohyphae

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3/9
🍄 Invasion of the tissues and vessels

🍄 The host’s reaction to the infection (inflammation, necrosis, or hemorrhage)

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4/9 🍄 A comment stating which fungi are most frequently associated with the observed morphology as well as other possible fungi and parasites for use in a differential diagnosis

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5/9 🍄 A statement in the comments regarding the importance of correlating clinical-epidemiologic features and results of cultures or other laboratory tests

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6/9 ⚠️ Avoid terminology like "compatible with [ specific fungi ] ” This can limit differential diagnosis and treatment because you can’t ascertain the genus and species. Instead, focus on the description and potential suspects.

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7/9 For example:
❌ "compatible with Aspergillus"
✅ "Hyaline, septate, branching fungal hyphae with morphology shared by Aspergillus, Fusarium and Scedosporium, and other hyalohyphomycetes, identification by culture or molecular methods is recommended. "
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8/9 Hyalohyphomycetes are a diverse group with similar tissue forms, but treatments vary tremendously. Namely, Scedosporium apiospermum does not respond to Amphotericin B, but Aspergillus does. So, by stating that it’s Aspergillus, one may have misdirected the treatment.

9/9 Pathologists and clinicians must be cautious of the limitations and pitfalls of morphological diagnosis and be mindful of the tests needed to make organism-specific diagnoses.

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