title: Invasive fungal disease in university hospital: a PCR-based study of autopsy cases.
abstract: Invasive fungal disease (IFD) has high mortality rate, especially in the growing population of immunocompromised patients. In spite of introduction of novel diagnostic approaches, the intravital recognition of IFD is challenging. Autopsy studies remain a key tool for assessment of epidemiology of visceral mycoses. We aimed to determine species distribution and trends of IFD over the last 10 years in unselected autopsy series from a large university hospital. Forty-five cases of visceral mycoses, confirmed by histopathology and panfungal PCR, were found in 587 consecutive autopsies. Major underlying diseases were diabetes mellitus (20%), hematologic malignancies (15.6%) and systemic lupus erythematosus (15.6%). There was a high risk for disseminated IFD in immunocompromised patients stayed in the hospital over 1 month with a fever longer than 3 weeks. The most common fungi were Aspergillus spp. (58%), Candida spp. (16%), Mucorales (14%) and Fusarium spp. (10%). We found significant increase in Aspergillus flavus (P = 0.04) and Mucorales (P < 0.01) infections over the last 5 years. Concordance rate between histopathology and panfungal PCR was 89.5% to the genus level. All 6 cases of fusariomycosis were misinterpreted as aspergillosis by histology alone. The precise species identification, necessary for targeted antifungal treatment, was rendered only by the molecular technique. Panfungal PCR showed high performance on formalin-fixed paraffin-embedded specimens, providing important epidemiological data in retrospective autopsy series. Rapid detection of fungi by panfungal PCR assay has high potential for intravital diagnostics of IFD in surgical and biopsy specimens.
authors.affiliation: Department of Pathology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society Bangkok, Thailand.
authors.forename: Komkrit
authors.initials: K
authors.lastname: Ruangritchankul
authors.affiliation: Department of Microbiology, Faculty of Medicine, Chulalongkorn University Bangkok, Thailand.
authors.forename: Ariya
authors.initials: A
authors.lastname: Chindamporn
authors.affiliation: Interdisciplinary Program of Medical Microbiology, Graduate School, Chulalongkorn University Bangkok, Thailand.
authors.forename: Navaporn
authors.initials: N
authors.lastname: Worasilchai
authors.affiliation: Department of Pathology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society Bangkok, Thailand.
authors.forename: Ubon
authors.initials: U
authors.lastname: Poumsuk
authors.affiliation: Department of Pathology, Faculty of Medicine, Chulalongkorn University Bangkok, Thailand.
authors.forename: Somboon
authors.initials: S
authors.lastname: Keelawat
authors.affiliation: Department of Pathology, Faculty of Medicine, Chulalongkorn University Bangkok, Thailand.
authors.forename: Andrey
authors.initials: A
authors.lastname: Bychkov
mesh_terms: D000293:Adolescent; D000328:Adult; D001344:Autopsy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology*; D016133:Polymerase Chain Reaction / Q000379:methods; D012189:Retrospective Studies; D013785:Thailand / Q000453:epidemiology
keywords: FFPE; Invasive fungal disease; autopsy; panfungal PCR
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