Abstract
Conventional cytopathology examination of respiratory samples can aid in identifying Aspergillus but with poor sensitivity, so this study aimed to assess the potential of the liquid-based cytopathology test (LCT) for improving the identification of Aspergillus in respiratory samples following Papanicolaou’s or Special staining with Grocott’s methenamine silver or periodic acid-Schiff staining. Paired bronchial brushing samples (n = 54) and sputum samples (n = 117) from 171 patients with pulmonary aspergillosis were prepared as slides using either conventional cytopathology or SurePath LCT. LCT slides were generally superior to conventional slides, showing smaller cell monolayer surface area, clearer background and more distinct stereoscopic cytological features. For Papanicolaou’s staining, LCT-prepared slides allowed a higher positive rate of Aspergillus identification than conventional slides for bronchial brushing samples (59.25% vs. 20.37%, P < 0.05) and sputum samples (29.05% vs. 8.55%, P < 0.05). Similarly, Special staining of LCT-prepared slides showed a higher positive rate of Aspergillus identification for bronchial brushing samples (83.33% vs. 57.41%, P < 0.05) and sputum samples (43.59% vs. 19.66%, P < 0.05). This preliminary study suggests that LCT may be better than conventional slide preparation for identifying Aspergillus in respiratory samples from patients with pulmonary aspergillosis.
Highlights
Aspergillus is a ubiquitous fungus that causes a variety of clinical syndromes by interacting with the host[1, 2]
Direct mycological examination under the microscope plays a central role in the diagnosis of pulmonary aspergillosis: cytopathological detection of Aspergillus in respiratory tract samples is essential for accurate diagnosis based on follow-up culture or histology examinations[6, 7]
We found that liquid-based cytopathological test (LCT) allowed significantly better pathogen detection in both types of samples, suggesting that this method may help improve timely and accurate diagnosis of pulmonary aspergillosis
Summary
Aspergillus is a ubiquitous fungus that causes a variety of clinical syndromes by interacting with the host[1, 2]. Despite significant progress in understanding the pathogenesis of pulmonary aspergillosis and the availability of new fungicidal agents, as many as 30% of patients with IPA die from the disease around the world, and the mortality rate may be even higher among patients in critical care units[3, 4] Such high mortality reflects the severity of comorbidities as well as delays in diagnosis, which in turn delay treatment initiation and compromise prognosis[5]. The present study aimed to compare LCT and conventional slide preparation techniques for identifying Aspergillus following Papanicolaou’s or Special staining of respiratory samples from patients with pulmonary aspergillosis
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