Indian Journal of Pathology and Microbiology
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LETTER TO EDITOR  
Year : 2012  |  Volume : 55  |  Issue : 4  |  Page : 606-607
A rare but diagnostic fungal microorganism in cervical Pap smears


1 Department of Pathology, Uludag University Medical Faculty, Bursa, Turkey
2 Department of Microbiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey

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Date of Web Publication4-Mar-2013
 

How to cite this article:
Ozgun G, Borsa BA. A rare but diagnostic fungal microorganism in cervical Pap smears. Indian J Pathol Microbiol 2012;55:606-7

How to cite this URL:
Ozgun G, Borsa BA. A rare but diagnostic fungal microorganism in cervical Pap smears. Indian J Pathol Microbiol [serial online] 2012 [cited 2014 Nov 28];55:606-7. Available from: http://www.ijpmonline.org/text.asp?2012/55/4/606/107854


Sir,

The Papanicolaou (Pap) smear has been in use for more than half a century to screen women for the precursors of cancer of the uterine cervix. Although diagnosing specific infections is not the primary function of the  Pap smear More Details and not mandatory in the current Bethesda System terminology, it is common practice to do so. [1]

The genus Fusarium is a common soil saprophyte and an important plant pathogen. Fusarium spp. also have the ability to adhere to prosthetic material (contact lenses, catheters), and to produce proteases and collagenases. The organism causes a broad spectrum of human disease, including mycotoxicosis and infections which can be locally invasive or disseminated. [2] In comparison to other sites of infection, the presence of Fusarium macroconidia in Pap smears is uncommon.

The specimen was a Pap smear from a 33-year-old female patient, G0P0, who had a persistent white vaginal discharge and discomfort for 2 months, which continued under empiric antifungal (Clotrimazol, Miconazol nitrate) therapy, and had lost 8 kgs in weight. On examination, mild cervical erosion was observed. The Pap smear showed well-preserved squamous epithelial and endocervical cells with minimal inflammation, with a cluster of crescentic to sickle-shaped, pink- orange macroconidia of Fusarium spp. [Figure 1], which were unbranched and multiseptate [Figure 2] and 30-40 × 3-8 μm.
Figure 1: Crescentic to sickle-shaped macroconidia of Fusarium species seen among the squamous epithelial cells. (Papanicolaou stain, ×400)

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Figure 2: Macroconidia of Fusarium showing transverse septa formation. (Papanicolaou stain, ×400)

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More than 50 species of Fusarium have been identified, including plant and animal pathogens, and a number cause a broad spectrum of infections in humans, including superficial, locally invasive and disseminated infections. The clinical form of Fusarium infection depends largely on the immune status of the host and the method of entry of the infection. Among immunocompetent hosts, keratitis and onychomycosis are the most common infections. Fusariosis in the immunocompromised population is typically invasive and disseminated. [2]

Fusarium species typically produce macroconidia and microconidia from slender phialides and chlamydospores, but it is the morphology of the macroconidia, hyaline, multicelled, fusiform-to-sickle shaped, with elongated apical ends, which is the diagnostic feature for the identification of Fusarium, but distinguishing the specific species of Fusarium requires molecular methods. [3] The macroconidia of Fusarium resemble of Aspergillus spp.; the filaments are hyaline and septate. They can be differentiating their typical branch at acute or right angles. Fusarium can be distinguished from Acremonium by its curved, multicellular macroconidia. [2]

The other four cases of Fusarium in Pap smears were published in 2003 and 2005. [4],[5] The symptoms in two patients were similar to our patient with a thick, white vaginal discharge, while two other cases had no vaginal discharge or discomfort. Fusarium isolated from culture of one symptomatic patient was identified as Fusarium oxyporum on the basis of typical colonial and microscopic morphology, but as in our case, Fusarium could not be isolated from the other. The two asymptomatic patients were lost to follow-up.

 
   References Top

1.Fitzhugh VA, Heller DS. Significance of a diagnosis of microorganisms on pap smear. J Low Genit Tract Dis 2008;12:40-51.  Back to cited text no. 1
[PUBMED]    
2.Dignani MC, Anaissie E. Human fusariosis. Clin Microbiol Infect 2004;10 (Suppl 1):67-75.  Back to cited text no. 2
[PUBMED]    
3.Azor M, Gene J, Cano J, Manikandan P, Venkatapathy N, Guarro J. Less-frequent Fusarium species of clinical interest: Correlation between morphological and molecular identification and antifungal susceptibility. J Clin Microbiol 2009;47:1463-8.  Back to cited text no. 3
    
4.Sarwar SF, Lorusso GD. Fusarium macroconidia in Pap smears. Diagn Cytopathol 2005;32:217-8.  Back to cited text no. 4
[PUBMED]    
5.Buch AC, Chandrakala SR, Savio J. Incidental detection of macroconidia of Fusarium in cervical smear. Indian J Pathol Microbiol 2005;48:418-20.  Back to cited text no. 5
    

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Correspondence Address:
Gonca Ozgun
Department of Pathology, Uludag University Medical Faculty, Gorukle, Nilufer, Bursa
Turkey
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DOI: 10.4103/0377-4929.107854

PMID: 23455828

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