Importance of Fungal Histopathology in Immunocompromised Pediatric Patients: It's Not Just "Aspergillus" Anymore.

Abstract

In a study published last month in the American Journal of Clinical Pathology , Dekio et al1 reported on the performance and clinical impact of histologic examination of surgical pathology tissues for fungi from immunocompromised pediatric patients at risk for invasive fungal infections (IFIs). IFIs are associated with high morbidity and mortality in immunocompromised pediatric patients.2–4 Thus, rapid and accurate laboratory diagnosis is of the utmost importance.5,6 This is one of few reports of histologic examination in pediatric immunocompromised patients, and the results of this study emphasize the important diagnostic role of histology in providing clinically actionable information. The purpose of histologic examination of tissue for fungi is twofold: (1) to alert clinicians to the presence of fungi and (2) to guide clinicians in the choice of antifungal therapy through provision of an inclusive but targeted differential diagnosis. This study highlights these points while also underscoring the importance of communication among pathologists, microbiologists, and clinicians in the care of immunocompromised pediatric patients. In the study by Dekio et al,1 two surgical pathologists and one clinical microbiologist retrospectively reviewed histologic slides from 47 pediatric patients with IFI collected over an 11-year period. The aims of their study were to evaluate the predictive accuracy of histologic examination and to investigate the impact of histologic results on clinical decision making. Correlation between histologic appearance and culture was available for 27 patients, while the impact of histologic results on clinical decision making was evaluable in 36 patients for whom medical records were accessible. Several important findings resulted from this study. First, the authors demonstrated that histology correlated with culture for all cases in which growth was obtained. Concordance in their study was broadly defined as the following: yeast on histology with yeast in culture, septate hyphae …