title: Invasive fungal infection in Ramathibodi Hospital: a ten-year autopsy review.
abstract: OBJECTIVE
  Determine the clinicopathological findings in autopsy cases with invasive fungal infection.
  
  
  METHODS
  The autopsy and medical records with invasive fungal infection in Ramathibodi Hospital between January 1997 and December 2006 were analyzed. The criterions for the diagnosis of invasive fungal infection were the evidence of fungal elements from histopathological section. The age, gender underlying predisposing risk factors for the disease, clinical manifestations, extent of systemic organ involvement documented morphologically at autopsy, and fungal culture were analyzed
  
  
  RESULTS
  There were 155 autopsy cases (73 male, 82 female; mean age 45.3 years, range 3 months to 87 years) with the diagnosis of invasive fungal infection. The common clinical presentations were fever (55.5%), and dyspnea (26.5%). The invasive fungal infection was associated with hematologic malignancy in 31%. The common mycoses were aspergillosis and candidiasis, which were observed in 88 and 80 cases, respectively. There were 32 cases (20.6%) of mixed fungal infection. Cultures from autopsy materials were positive for fungus in 80 cases out of 99 cases (80.8%). The most frequent site of fungal infection was in the lungs (74.8%), followed by gastrointestinal tract (28.4%), and brain (26.5%). Invasive fungal infection was diagnosed intravitally in 63.9% of total cases.
  
  
  CONCLUSIONS
  A diagnosis of invasive fungal infection requires a high index of suspicion, especially in immunocompromised patients who presented with prolonged fever Clinical specimens must be sent for histopathology and fungal culture for a definite diagnosis and an appropriate management. Therefore, the physician should inform the laboratory if invasive fungal infection is suspected because special media are necessary for the best recovery of fungi. In addition, the present study underscores the significance of autopsy as a diagnostic method and means of medical quality control.
authors.affiliation: Division of Anatomical Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. Noppadol_l@hotmail.com
authors.forename: Noppadol
authors.initials: N
authors.lastname: Larbcharoensub
authors.forename: Sahaphume
authors.initials: S
authors.lastname: Srisuma
authors.forename: Thanat
authors.initials: T
authors.lastname: Ngernprasertsri
authors.forename: Rangsima
authors.initials: R
authors.lastname: Aroonroch
authors.forename: Piriyaporn
authors.initials: P
authors.lastname: Chongtrakool
authors.forename: Pitak
authors.initials: P
authors.lastname: Santanirand
authors.forename: Thamrong
authors.initials: T
authors.lastname: Chirachariyavej
authors.forename: Vorachai
authors.initials: V
authors.lastname: Sirikulchayanonta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001228:Aspergillosis / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology; D001344:Autopsy; D002102:Cadaver; D002177:Candidiasis / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D013785:Thailand; D013997:Time Factors