Cytodiagnosis of Dimorphic Fungi with Disseminated Infection in a HIV Positive Patient – A Diagnostic Dilemma
Science Journal of Clinical Medicine
Volume 4, Issue 4-1, July 2015, Pages: 19-22
Received: May 15, 2015;
Accepted: May 16, 2015;
Published: Aug. 3, 2015
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Chitresh Yadav, Department of pathology, faculty JSS Medical College & hospital, constituent of JSS University, Mysore, India
Nandini N. M., Department of pathology, faculty JSS Medical College & hospital, constituent of JSS University, Mysore, India
Shruti M. K., Department of pathology, faculty JSS Medical College & hospital, constituent of JSS University, Mysore, India
Sowmya G. S., Department of Microbiology, faculty JSS Medical College & hospital, constituent of JSS University, Mysore, India
M. R. Shivaprakash, Medical mycology division, Post Graduate Institute of Medical Education and Research, Chandigarh, India
G. V. Manjunath, Department of pathology, faculty JSS Medical College & hospital, constituent of JSS University, Mysore, India
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Systemic mycosis caused by fungi (or dimorphic fungi) such as Histoplasma, emmonsia, candida & penicillium has emerged as an important opportunistic fungal infection in immunocompromised patient in South- East Asia. Several cases of opportunistic fungal infection has been reported but cytological diagnosis of disseminated (dimorphic) fungal infection has been reported in very few cases. Cytological diagnosis of these infections depending on the morphological characteristics has always been a challenge to practising cytologists. A case of rare disseminated fungal infection reported in a 45 year old seropositive male who is noncompliant on ART presented with ulcer over palate, fever, weight loss, occasional per rectal bleeding. On examination having bilateral cervical lymphadenopathy and hepatomegaly. On investigation- anaemia, high ESR, deranged liver function test, CD4 count 16/cumm, USG showed hepatomegaly, underwent FNAC cervical lymphnodes and guided FNAC of liver, which showed these organisms, but no pathogens were found with classical microbiological procedure. Patient was treated with itraconazole and amphotericine and showed improvement. This case illustrate the utility of FNAC in early diagnosis & management of rare infection & it also highlight the combined role of molecular technique and FNAC as an interdisciplinary approach for management of patient.
Dimorphic Fungal Infection, FNAC Lymph Node, Seropositive
To cite this article
Nandini N. M.,
Shruti M. K.,
Sowmya G. S.,
M. R. Shivaprakash,
G. V. Manjunath,
Cytodiagnosis of Dimorphic Fungi with Disseminated Infection in a HIV Positive Patient – A Diagnostic Dilemma, Science Journal of Clinical Medicine. Special Issue: Latest Different Concepts of Gynaecology.
Vol. 4, No. 4-1,
2015, pp. 19-22.
Sunita singh, Sonia chhabra, Ruchi goyal et.al. Cytodiagnosis of histoplasma case report from two patient with variable clinical presentation. Diagnostic Cytopathology. 09/2011; DOI: 10.1002/dc.21803.
Manoj harnalika, Vidya kharkar, Uday khopkar. Disseminated cutaneous histoplasmosis in an immunocompetent adult. Indian journalof dermatology. 2012; 57(3); 206-209; DOI: 10.4103/0019-514.96194.
Chakrabarti A, Shivaprakash M R. Microbiology of systemic fungal infections. J Postgrad Med 2005;51, Suppl S1:16-20.
Groll AH, Shah PM, Mentzel C,Schneider M, Just-Nuebling G, Huebner K. Trends in the postmortem epidemiology of fungal infections at a University hospital. J Infect 1996; 33:23-32. [PUBMED].
Vogesar M, Hass A, Aust D, Ruckdeschel G. Postmortem analysis of invasive aspergillosis in a tertiary care hospital. Eur J Clin Microbiol Inf Dis 1997;16:1-6.
Pfaller MA, Diekema DJ. Role of sentinel surveillance of candidemia: Trends in species distribution and antifungal susceptibility. J Clin Microbiol 2002;40:3551-7.
Ribaud P, Chastang C, Latge JP, et al . Outcome and prognostic factors of invasive aspergillosis after allogenic bone marrow transplantation. Clin Infect Dis 1999;28:322-30.
Denning DW. Invasive aspergillosis. Clin Infect Dis 1998;26:781-805.
Moore RD, Chaisson RE. Natural history of opportunistic disease in an HIV infected urban clinical cohort. Ann Intern Med 1996;124:633-42.
Grant AD, Djomand G, DeCock KM. Natural history and spectrum of disease in adults with HIV/AIDS in Africa. AIDS 1997;11:S43-54.
Supparatpinyo K, Khamwan C, Baosoung V, Nelson KE, Sirisanthana T. Disseminated Penicillium marneffei infection in southeast Asia. Lancet 1994;344:110-3.
Mills, Stacey E: Sternberg's Diagnostic Surgical Pathology, 5th Edition. 2010; page no 962-963.
Koss, Leopold G, Melamed, Myron R: Koss' Diagnostic Cytology and Its Histopathologic Bases, 5th Edition. 2006; page no 1194.
Sankha koley, Rjesh kumar mandal, Kalyan khan et.al. Disseminated Cutaneous Histoplasmosis, an Initial Manifestation of HIV, Diagnosed with Fine Needle Aspiration Cytology. Indian J Dermatol. 2014 Mar-Apr; 59(2): 182–185.
Gupta N, Arora SK, Rajwanshi A, Nijhawan R, Srinivasan R. Histoplasmosis: Cytodiagnosis and review of literature with special emphasis on differential diagnosis on cytomorphology. Cytopathology 2010;21:240-4.
Nancy A. Rihana, Manasa Kandula, Ana Velez et.al. Histoplasmosis presenting as granulomatous hepatitis: case report and review of the literature. Hindawi publishing corporation. Vol 2014; Article ID 879535; 4 pages; DOI: org10.1155/2014/879535.
Yanyu Sun, Tawfiq Bbhuiya, Tarun Wasil et.al. Fine needle aspiration of pulmonary adiaspiromycosis-A case report. Acta cytol. 2007; 51; 217-221.