The Use of Immunohistochemistry to Improve Sensitivity and Specificity in the Diagnosis of Systemic Mycoses in Patients With Haematological Malignancies

Abstract

The original histomorphological diagnoses in a series of 34 mycotic lesions from 23 patients with haematological malignancies were re‐evaluated by immunohistochemistry. A panel of antibodies was used to identify the agents of aspergillosis, candidosis, fusariosis, scedosporiosis (pseudallescheriosis), and zygomycosis. Apart from improving the diagnosis of aspergillosis, candidosis, and zygomycosis, the application of immunohistochemistry also disclosed three lesions of aspergillosis which had been overlooked during the original screening. It is concluded that the use of immunohistochemistry for the diagnosis of common opportunistic mycoses will not only increase diagnostic specificity, but will also reveal more tissue infections than the conventional histomorphological examination of traditionally stained sections. © 1997 by John Wiley & Sons, Ltd.

Scrotal granulomatous aspergillosis in a dromedary camel (Camelus dromedarius)

“…Although culture isolation remains the gold standard for the identification of fungi involved in human and animal infections [11], many cases are not cultured because a fungal etiology is not suspected when biological samples are sent to the laboratory [5, 6]. Even when submitted, cultures often fail to isolate the fungus responsible of the infection [8].…”

Usefulness of molecular biology performed with formaldehyde-fixed paraffin embedded tissue for the diagnosis of combined pulmonary invasive mucormycosis and aspergillosis in an immunocompromised patient

“…The distinction between aspergillosis and scedosporiosis, between aspergillosis and fusariosis and certain mucormycosis, such as those caused by Cunninghamella from tissue sections may be difficult or impossible [31,35,36]. Other potential pitfalls are more easily eliminated [37,38].…”

The use of MUC5B antibody in identifying the fungal type of fungal sinusitis

“…This is especially the case for Aspergillus spp and Mucorales. Another confounding factor is the presence of sparse or atypical fungal elements [3].…”

“…To meet the increasing demands for the detection and identification of fungi within tissues, a number of immunohistochemical studies have focused on the search for immunoreagents for the specific identification of fungi in tissues. An important limitation on the widespread application of such immunohistochemical tests lies in the fact that sensitive and specific reagents are usually derived from multiple heterologously absorbed polyclonal antisera, which are not commercially available [3]. The increasing commercial availability of fungal-specific immunoreagents will likely aid the clinician in selecting an appropriate therapeutic strategy.…”