Invasive Fungal Infection in Ramathibodi Hospital: A Ten-Year Autopsy Review
Noppadol Larbcharoensub MD*, Sahaphume Srisuma MD*, Thanat Ngernprasertsri MD*, Rangsima Aroonroch MD*, Piriyaporn Chongtrakool PhD**, Pitak Santanirand PhD**, Thamrong Chirachariyavej MD, PhD***, Vorachai Sirikulchayanonta MD*
Affiliation : * Division of Anatomical Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok ** Division of Microbiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok *** Division of Forensic Pathology, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok
Objective : Determine the clinicopathological findings in autopsy cases with invasive fungal infection.
Materials and 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 involve-
ment 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.
Conclusion : 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.
Keywords : Invasive fungal infection, Mycoses, Aspergillosis, Candidiasis, Autopsy
