Abstract
Background: Pulmonary mucormycosis, a relatively rare but severe pulmonary fungal disease with a high mortality rate, is difficult to diagnose in immunocompromised patients. Conventional cytopathology (CCP) examination of respiratory samples can help detect Mucorales, but its diagnostic sensitivity is poor. The aim of this study was to assess the first application of liquid-based cytopathology test (LCT) to detect Mucorales.Methods: A total of 33 pairs of bronchial brushing samples from 27 patients diagnosed as pulmonary mucormycosis by fiberoptic bronchoscopy biopsy were prepared as slides using both CCP and LCT. LCT and CCP used the same cytology brush to obtain samples at the same site during the same time as the fiberoptic bronchoscopy biopsy. All samples were stained with Papanicolaou, GMS and PAS. CCP and LCT slides were evaluated from the rate of positive detection, 8 cytomorphological features and 7 background features.Results: LCT-prepared slides showed a higher positive rate of Mucorales detection than CCP-prepared slides for Papanicolaou’s staining [28/33 (84.85%) vs. 15/33 (45.45%), p = 0.001] and for “special staining” with GMS and PAS [29/33 (87.88%) vs. 18/33 (54.55%), p = 0.003]. Clearer smear background and more distinct stereoscopic cytopathological features were observed in LCT. Messy yarn-like necrosis observed in conventionally prepared 75.76% (25/33) samples was cytomorphological suggestive for the diagnosis of mucormycosis.Conclusion: This retrospective study suggests that LCT may be better than CCP to detect Mucorales in bronchial brushing samples from patients with pulmonary mucormycosis.
Highlights
Mucorales, a widespread filamentous order of fungi in the environment, can cause rare but severe infection in immunocompromised patients with hematological malignant disease, uncontrolled diabetes mellitus, trauma, organ transplants, allogeneic stem cell transplantation, renal disease, septicemia, burns, malnutrition, etc. (Roden et al, 2005; Nasa et al, 2017)
A total of 33 pairs of bronchial brushing samples from 27 patients diagnosed as pulmonary mucormycosis by fiberoptic bronchoscopy biopsy were prepared as slides using both Conventional cytopathology (CCP) and liquid-based cytopathology test (LCT)
LCT-prepared slides showed a higher positive rate of Mucorales detection than CCP-prepared slides for Papanicolaou’s staining [28/33 (84.85%) vs. 15/33 (45.45%), p = 0.001] and for “special staining” with Gomori’s methenamine silver (GMS) and periodic acid-Schiff (PAS) [29/33 (87.88%) vs. 18/33 (54.55%), p = 0.003]
Summary
A widespread filamentous order of fungi in the environment, can cause rare but severe infection in immunocompromised patients with hematological malignant disease, uncontrolled diabetes mellitus, trauma, organ transplants, allogeneic stem cell transplantation, renal disease, septicemia, burns, malnutrition, etc. (Roden et al, 2005; Nasa et al, 2017). Pulmonary mucormycosis is the second most common presentation (Lin et al, 2017), representing up to 80% of the mortality rate due to delay diagnosis and inadequate treatment (Tedder et al, 1994). Laboratory methods for diagnosing mucormycosis include conventional fungal culture, histopathologic examination, cytology, serology, and molecular-based diagnosis. A relatively rare but severe pulmonary fungal disease with a high mortality rate, is difficult to diagnose in immunocompromised patients. Conventional cytopathology (CCP) examination of respiratory samples can help detect Mucorales, but its diagnostic sensitivity is poor. The results showed that LCT had a higher positive rate of Mucorales detection than CCP samples. Similar results demonstrated that LCT-prepared slides showed a higher positive rate of Aspergillus detection in bronchial brushing samples (83.33 vs 57.41%, P < 0.05) (Shen et al, 2017). We reviewed the histology biopsy from the same site and found that the number of Mucorales was initially small
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
