Correlation of culture with histopathology in fungal burn wound colonization and infection

Schofield, Christina; Murray, Clinton K.; Horvath, Edward E.; Cancio, Leopoldo C.; Kim, Seung H.; Wolf, Steven E.; Hospenthal, Duane R.

doi:10.1016/j.burns.2006.08.040

Cited by 93 publications

(54 citation statements)

References 9 publications

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“…Bronchoalveolar lavage and cerebrospinal fluid specimens can also be used for detection of fungal antigens. Retrospective studies that correlate culture results with histopathology and cytology showed that the overall accuracy for microscopic morphological techniques can vary from 20 to 80% (140,143,158). The lowest correlation has been reported for invasive septate molds (158).…”

Section: Histochemical Stainingmentioning

confidence: 99%

“…The misclassifications with greater potential for adverse consequences occurred when there were few, folded, fragmented, and/or necrotic fungal elements in the specimen and the structures could not be adequately categorized as septate versus pauciseptate hyaline molds. Therefore, clinicians need to be aware that misclassifications in histopathologic examination occur in at least 20% of cases, and pathologists need to give as much information as possible without overextending their diagnostic capabilities (140,143).…”

Section: Histochemical Stainingmentioning

confidence: 99%

“…Infections with more than one fungus have been reported in burn and immunosuppressed patients (70,143). Even though histopathology might be expected to be an adequate method to identify these double infections, the morphological diversity may be subtle and not appreciated.…”

Section: Histochemical Stainingmentioning

confidence: 99%

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Histopathologic Diagnosis of Fungal Infections in the 21st Century

2011

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SUMMARY Fungal infections are becoming more frequent because of expansion of at-risk populations and the use of treatment modalities that permit longer survival of these patients. Because histopathologic examination of tissues detects fungal invasion of tissues and vessels as well as the host reaction to the fungus, it is and will remain an important tool to define the diagnostic significance of positive culture isolates or results from PCR testing. However, there are very few instances where the morphological characteristics of fungi are specific. Therefore, histopathologic diagnosis should be primarily descriptive of the fungus and should include the presence or absence of tissue invasion and the host reaction to the infection. The pathology report should also include a comment stating the most frequent fungi associated with that morphology as well as other possible fungi and parasites that should be considered in the differential diagnosis. Alternate techniques have been used to determine the specific agent present in the histopathologic specimen, including immunohistochemistry, in situ hybridization, and PCR. In addition, techniques such as laser microdissection will be useful to detect the now more frequently recognized dual fungal infections and the local environment in which this phenomenon occurs.

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Section: Histochemical Stainingmentioning

confidence: 99%

Section: Histochemical Stainingmentioning

confidence: 99%

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Histopathologic Diagnosis of Fungal Infections in the 21st Century

2011

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“…Debridement, skin grafting and improved infection management and control have led to better outcomes in burn patient management [8] [9]. In some situations, fungal infections may develop later if proper wound management is not implemented [10] [11]. Infections with anaerobes are much likely in the event of electrical burns [12].…”

Section: Introductionmentioning

confidence: 99%

The Burns Menace: Antibiotics for the Fight against Burns Bacterial Infection, a Systemic Review

Agbenorku¹,

Amankwa²,

Agbenorku³

et al. 2016

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Burn wound infection delays wound healing, leading to varying degrees of morbidity and mortality. Various antibiotics are administered to burn patients in burn wound management. The emergence of antibiotic resistance is a menace that costs families and the country. This review seeks to expound on infections related to burn wounds, common bacteria of burn wound infections and choice of antibiotics in burns treatment. Words such as burns, wound infection, burns injury and antibiotics were put into the Google search engine. Only articles related to the subject of burns, burn wound infection and antibiotics were used to write the review. Articles obtained included case reports on burns, research articles, review articles, short notes, briefs, literatures and other articles relating to burns. We found that the choice of antibiotics in the management of burns is an issue of major concern due to the evolution of pathogens causing these infections. The challenge of antibiotic resistance still persists in burns wound management. The commonly used topical antimicrobials included silver sulphadiazine, silver nitrate solution, silver impregnated dressings and mafenide acetate. Mafenide acetate has a wide antibacterial activity and also acts against the usual wound pathogens that were identified:Pseudomonas aeruginosa and Staphylococcus aureus. The role of antibiotic resistance is of major concern. Antibiotics must be administered after culture evidence in order to reduce the chance of increasing evolution of resistant strains of bacteria.

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“…Current diagnosis often depends on histopathologic appearance and culture, which can lead to delays in accurate diagnosis due to low sensitivity and specificity of these methods (15)(16)(17)(18)(19)(20). Increasingly, PCR-based methods have been evaluated for use in IFI identification, with improved sensitivity and specificity relative to standard culture techniques (21).…”

mentioning

confidence: 99%

Combat-Related Pythium aphanidermatum Invasive Wound Infection: Case Report and Discussion of Utility of Molecular Diagnostics

et al. 2015

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hWe describe a 22-year-old soldier with 19% total body surface area burns, polytrauma, and sequence-and culture-confirmed Pythium aphanidermatum wound infection. Antemortem histopathology suggested disseminated Pythium infection, including brain involvement; however, postmortem PCR revealed Cunninghamella elegans, Lichtheimia corymbifera, and Saksenaea vasiformis coinfection. The utility of molecular diagnostics in invasive fungal infections is discussed. CASE REPORT In August 2013, a 22-year-old U.S. soldier was injured by an improvised explosive device (IED) while on foot patrol in Bamyan Province, central Afghanistan, which propelled him into a nearby stream. He sustained 19% total body surface area (TBSA) partial-and full-thickness burns, including superficial burns to the penis and multiple skin and soft tissue injuries. These injuries extended from the distal right medial thigh to the right midcalf and from the left gluteus to the left thigh, involving portions of the scrotum. Open fractures of the right tibia/fibula and left proximal femur were noted in addition to comminuted, minimally displaced fractures of the left pelvic girdle complicated by intra-and retroperitoneal hematomas. Soft tissue wounds from IED fragments without bony injury were observed in the left posterior upper arm. He was evacuated to Craig Joint Theater Hospital (CJTH) in Bagram in north-central Afghanistan.Upon arrival at CJTH, he received a massive transfusion of packed red blood cells (PRBC; 18 units within the first 24 h from injury), fresh frozen plasma (20 units), platelets (3 units apheresis platelets), and cryoprecipitate (20 units) and underwent irrigation and debridement of all soft tissue wounds with external fixation of the right tibia/fibula and left femoral fractures. The minimally displaced fractures of the left pelvic girdle were treated nonoperatively. The patient was medically evacuated to Landstuhl Regional Medical Center (LRMC) in Germany. Despite serial irrigation and debridement of each of these injuries (except the pelvic girdle injuries) over the next 48 h, progressive wound infection in the proximal open left femur fracture necessitated a left hip disarticulation on day 4 after injury (PDOI 4). Intraoperative cultures of the left lower extremity (the site was not further specified) revealed 2 isolates of multidrug-resistant (MDR) Escherichia coli. A prior fungal culture from the left lower extremity (PDOI 2) grew three separate molds (Aspergillus species, Geotrichum species, and Alternaria species) and an unspecified yeast, whereas a fungal culture from this site on PDOI 4 became overgrown with bacteria and could not be further evaluated. No additional operative cultures were obtained at LRMC. To minimize fecal contamination of the left hip wound, an open laparotomy was performed, with placement of a diverting colostomy and evacuation of a retroperitoneal hematoma.On PDOI 12, the patient was transferred to the Burn Intensive Care Unit at San Antonio Military Medical Center (SAMMC) for continued treatment. He ...

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Correlation of culture with histopathology in fungal burn wound colonization and infection

Cited by 93 publications

References 9 publications

Histopathologic Diagnosis of Fungal Infections in the 21st Century

Histopathologic Diagnosis of Fungal Infections in the 21st Century

The Burns Menace: Antibiotics for the Fight against Burns Bacterial Infection, a Systemic Review

Combat-Related Pythium aphanidermatum Invasive Wound Infection: Case Report and Discussion of Utility of Molecular Diagnostics

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