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Fungal Pathology Report
Hi Dr.
I have a question about the preliminary report we have received regarding my husbands nodules. Nothing has grown on the slides yet - but it has only been 2 weeks. Report says Necrotizing granulomas with many yeast form fungal organisms. Possible dx is crpto, candida, blastomyces, or coccidio. Nodules were non-calcified. Kinyoun, congo red, and mucicarmine stains all neg. If the fungal cells are dead and nothing grows on the samples, will we ever be able to determine what exactly caused this? All seem to be pointing to cryto, but wouldnt that have caused a positive onthe mucicarmine stain? Thanks for any help!
I have a question about the preliminary report we have received regarding my husbands nodules. Nothing has grown on the slides yet - but it has only been 2 weeks. Report says Necrotizing granulomas with many yeast form fungal organisms. Possible dx is crpto, candida, blastomyces, or coccidio. Nodules were non-calcified. Kinyoun, congo red, and mucicarmine stains all neg. If the fungal cells are dead and nothing grows on the samples, will we ever be able to determine what exactly caused this? All seem to be pointing to cryto, but wouldnt that have caused a positive onthe mucicarmine stain? Thanks for any help!
Hi,
You are correct that some fungal diseases do occur in patients with a suppressed immune system.
Fungus balls however, persist not because the immune system is down, but simply because locally damaged spaces (partly by the fungi itself or due to underlying lung disease) represents areas where they may grow unabated. The immune system is still intact - but without an intact lining, the fungi will form a ball.
Fungal infections in immunosuppressed patients generally present like bacterial diseases with symptoms like fever, cough, and difficulty breathing.
You are correct that some fungal diseases do occur in patients with a suppressed immune system.
Fungus balls however, persist not because the immune system is down, but simply because locally damaged spaces (partly by the fungi itself or due to underlying lung disease) represents areas where they may grow unabated. The immune system is still intact - but without an intact lining, the fungi will form a ball.
Fungal infections in immunosuppressed patients generally present like bacterial diseases with symptoms like fever, cough, and difficulty breathing.
Thank you for the info!
The entire wedge was removed containing all nodules, so hopefully something will grow! It is felt that this was the only area affected. We are to proceed with Infectious Disease dr. to confirm. I will ask about bloodwork.
By any chance, would being in an active phase of Epstein Barr, and therefore reduced immune protection, be a possiblity as to why this fungus was able to grow in the lung at all? Other than that, husband is young (47) healthy, and had no symptoms other than this incidental finding on an xray. Just wondering - but thanks for answering my other questions!
The entire wedge was removed containing all nodules, so hopefully something will grow! It is felt that this was the only area affected. We are to proceed with Infectious Disease dr. to confirm. I will ask about bloodwork.
By any chance, would being in an active phase of Epstein Barr, and therefore reduced immune protection, be a possiblity as to why this fungus was able to grow in the lung at all? Other than that, husband is young (47) healthy, and had no symptoms other than this incidental finding on an xray. Just wondering - but thanks for answering my other questions!
Hi,
Another means of determining what the causative organism is the presence of antibodies in the blood. This may be available for blastomyces, coccidio, and crypto. Candida is pretty common - so this is not likely evaluable by this method.
You are correct that the mucicarmine should turn red for crypto . However, negative results of stains raise doubts as to whether it became negative because it really did not accept the stain or it became negative because the specimen wasn't adequate. Aside from the staining procedure - a more powerful test is the culture which would involve growing the fungi. If the stain isn 't good because of scarcity of sample - the cultures may likewise turn negative.
Best discuss things with your doctor.
Another means of determining what the causative organism is the presence of antibodies in the blood. This may be available for blastomyces, coccidio, and crypto. Candida is pretty common - so this is not likely evaluable by this method.
You are correct that the mucicarmine should turn red for crypto . However, negative results of stains raise doubts as to whether it became negative because it really did not accept the stain or it became negative because the specimen wasn't adequate. Aside from the staining procedure - a more powerful test is the culture which would involve growing the fungi. If the stain isn 't good because of scarcity of sample - the cultures may likewise turn negative.
Best discuss things with your doctor.
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