Abstract：
Invasive fungal infections including invasive pulmonary aspergillosis (IPA) generally have a poor prognosis, because the fungi spread throughout various organs. Therefore, it is important to accurately identify the fungal species for treatment. In this article, we present the results of pathological and molecular morphological analyses that were performed to elucidate the cause of respiratory failure in a patient who died despite suspicion of IPA and treatment with micafungin (MCFG). Pathological analysis revealed the existence of cystic and linear fungi in lung tissue. The fungi were identified as Aspergillus fumigatus (A. fumigatus) by partial sequencing of genomic DNA. Correlative light microscopy and electron microscopy (CLEM) analysis confirmed that fungi observed with light microscopy can also be observed with scanning electron microscopy (SEM) using formalin-fixed paraffin-embedded tissue sections. SEM revealed an atypical ultrastructure of the fungi including inhomogeneous widths, rough surfaces, and numerous cyst-like structures of various sizes. The fungi showed several morphological changes of cultured A. fumigatus treated with MCFG that were previously reported. Our results indicate that integrated analysis of ultrastructural observation by SEM and DNA sequencing may be an effective tool for analyzing fungi that are difficult to identify by conventional pathological analysis.
摘要：
侵袭性真菌感染，包括侵袭性肺曲霉病（IPA）通常预后不良，因为真菌遍布各个器官。因此,重要的是要准确地识别真菌物种进行治疗。在这篇文章中,我们提供了病理和分子形态学分析的结果,这些结果是为了阐明1例尽管怀疑有IPA并接受米卡芬净(MCFG)治疗而死亡的患者的呼吸衰竭原因.病理分析显示肺组织中存在囊性和线性真菌。真菌被鉴定为烟曲霉（A.烟曲霉）通过基因组DNA的部分测序。相关的光学显微镜和电子显微镜（CLEM）分析证实，使用福尔马林固定的石蜡包埋的组织切片，用扫描电子显微镜（SEM）也可以观察到用光学显微镜观察到的真菌。SEM显示真菌的非典型超微结构，包括不均匀的宽度，粗糙表面,和许多不同大小的囊肿样结构。真菌显示了先前报道的用MCFG处理的培养的烟曲霉的几种形态变化。我们的结果表明，通过SEM和DNA测序对超微结构观察进行综合分析可能是分析难以通过常规病理分析鉴定的真菌的有效工具。
