Panfungal PCR on formalin fixed paraffin embedded tissue – to proceed or not proceed?

Sparks, Rebecca; Halliday, Catriona; Chen, Sharon C‐A

doi:10.1016/j.pathol.2022.12.145

Cited by 5 publications

(9 citation statements)

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“…In view of this, in the absence of routine fungal culture, proceeding with further molecular investigations on tissue blocks in which histopathology analysis demonstrated the presence of fungal elements will go a long way to influence drug options while providing data on emerging or rare species causing human infections. 19 , 20 This is extremely important in the Ghanaian clinical setting particularly considering the critical role of histopathology in aiding diagnosis and in most instances the commonly available means of diagnosis. 4 Despite the common use of molecular methods on formalin-fixed-paraffin-embedded to aid species-level identification in many clinical mycology laboratories, the methodology or procedures of available assays are not extensively standardized and not available in many African settings.…”

Section: Discussionmentioning

confidence: 99%

A diverse spectrum of mycoses histologically diagnosed in Ghana: Insights from a 10-year retrospective study

Ocansey,

Erskine,

Okine

et al. 2024

Medical Mycology

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In Ghana, most laboratory diagnosis of severe mycoses are based on histopathology findings due to inadequate availability of serology, culture, and molecular tests. The aim of this study was to evaluate the spectrum of mycoses diagnosed in Ghana. We retrospectively reviewed reports from 2012 to 2021 from three major pathology laboratories in Ghana to identify reports indicating the presence of fungal elements and diagnosis of a mycosis, then extracted demographic, clinical history, site of infection, stain (s) used and diagnosed mycosis details. Over the 10-year period, 107 cases were found. No apparent increasing and decreasing trend of the number of cases per year or in a period was observed. The age range of affected patients were from 4 to 86 years. Special stains for fungi were only used in 22 of 107 (20.6%) of cases. The most frequently affected site was the sino-nasal area (34%). Mycosis type was determined for 58 (54.2%) cases, comprising aspergillosis (21), candidiasis (14), dermatophytosis (6), mucormycosis (3), two cases each of chromoblastomycosis, histoplasmosis, eumycetoma, entomophthoromycosis, sporotrichosis and Malassezia infection and a single case each of cryptococcosis and deep onychomycosis. Of the 53 (49.5%) cases with presumptive diagnosis data, only seven (13.2%) had a pre-biopsy suspicion of mycosis. There is a wide spectrum of mycoses in Ghana, including endemic mycoses not previously reported. Improving use of special fungal stains could increase yield and mycoses identification. Laboratory diagnostic capacity needs enhancement to complement histopathology investigations with serology, culture, and molecular methods.

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Section: Discussionmentioning

confidence: 99%

A diverse spectrum of mycoses histologically diagnosed in Ghana: Insights from a 10-year retrospective study

Ocansey,

Erskine,

Okine

et al. 2024

Medical Mycology

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“…Other techniques such as culture may be limited by their slow growth time that takes up to 4 or more weeks, and the histopathological yield may be lower (79%), probably due to their wide interobserver variability and difficult distinction of conidia 10 . Molecular assays such as amplification and sequencing of ITS2 and D2 region of 28S ribosomal RNA from clinical specimens are now available with sensitivity and specificity of 97% and 98%, respectively, and in cases where fresh tissue is not available, and histopathology demonstrates non‐specific structures with preliminarily negative cultures, paraffin‐embedded Panfungal PCR can be useful and quickly tool to guide early diagnosis and therapy 11 …”

Section: Discussionmentioning

confidence: 99%

Histoplasma capsulatum tenosynovitis: An unusual presentation in a kidney transplant recipient

Alza‐Arcila,

Ramírez‐Sánchez,

Diaz‐Sanabria

2024

Transplant Infectious Dis

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Histoplasmosis is an expected endemic mycosis in solid organ transplant recipients and occurs as a primary infection, reactivation, or, rarely, acquired from an infected allograft. Reactivation is favored by maintenance immunosuppression or anti‐rejection therapy, which facilitates the appearance of disseminated forms as well as unusual presentations. We present the case of a 66‐year‐old woman with isolated tenosynovitis due to Histoplasma capsulatum 25 years after a kidney transplant.

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“…Polymerase chain reaction and next-generation sequencing (NGS) techniques can be leveraged to identify emerging fungal pathogens from lung tissue, bronchial lavage samples, and blood. PCR offers excellent specificity, but the sensitivity in tissue samples varies widely (64–97%), largely depending on the specimen type (body fluid, fresh tissue, or formalin-fixed paraffin-embedded tissue) and site of sampling (sterile or nonsterile) [56,59 ▪▪ ]. A panfungal PCR that detects fungi through the amplification of the internal transcriber region (ITS) or 18s ribosomal RNA gene, followed by DNA sequencing, is commercially available for the molecular diagnosis of the organisms included in this review.…”

Section: Diagnosismentioning

confidence: 99%

“…A panfungal PCR that detects fungi through the amplification of the internal transcriber region (ITS) or 18s ribosomal RNA gene, followed by DNA sequencing, is commercially available for the molecular diagnosis of the organisms included in this review. Its sensitivity is highest with fresh tissue and when a large sample is available [59 ▪▪ ]. Its use is cost-effective when fungal structures are seen on histopathology but cultures are negative; accordingly, the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORTC-MSGERC) do not support its use when histopathology does not show yeasts or hyphae [60].…”

Section: Diagnosismentioning

confidence: 99%

Lung infections due to emerging fungal pathogens

Machiavello Roman,

Pischel,

Azar

2024

Current Opinion in Pulmonary Medicine

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Purpose of review This review highlights the epidemiology, pathogenesis and clinical management of pulmonary infections caused by emerging fungal organisms. Recent findings Emerging fungal infections have arisen as a result of population and environmental changes. An enlarging pool of immunocompromised hosts on triazole antifungal prophylaxis has led to an increased incidence of non-Aspergillus molds, such as Fusarium, Scedosporium and Lomentospora spp. Advances in diagnostic capabilities led to the identification of the Emergomyces genus and non-dermatitidis Blastomyces species, which have a significant disease burden in Africa and the Middle East. Climate change has contributed to changing the distribution of previously confined endemic mycoses, like coccidioidomycosis and talaromycosis. These emerging organisms pose important diagnostic and therapeutic challenges. Summary Newly recognized pathogenic fungi and established endemic mycoses with expanding geographic boundaries have become important agents of pulmonary disease. There is a dearth of clinical evidence on the appropriate management of these infections.

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Panfungal PCR on formalin fixed paraffin embedded tissue – to proceed or not proceed?

Cited by 5 publications

References 0 publications

A diverse spectrum of mycoses histologically diagnosed in Ghana: Insights from a 10-year retrospective study

A diverse spectrum of mycoses histologically diagnosed in Ghana: Insights from a 10-year retrospective study

Histoplasma capsulatum tenosynovitis: An unusual presentation in a kidney transplant recipient

Lung infections due to emerging fungal pathogens

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