[1433] Pulmonary Granulomatous Infections: Comparison of the Yield of Cultures and Histologic Examination in 88 Cases from 10 Institutions.

Sanjay Mukhopadhyay, Carol Farver, Laszlo T Vaszar, Owen Dempsey, Helmut Popper, Haresh Mani, Vera L Capelozzi, Junya Fukuoka, Keith Kerr, E Handan Zeren, Venkatesh Iyer, Tomonori Tanaka, Ivy Narde, Angheliki Nomikos, Derya Gumurdulu, Sudheer Arava, Dani S Zander, Henry D Tazelaar. SUNY Upstate Medical University, Syracuse, NY; Cleveland Clinic, OH; Mayo Clinic, Scottsdale, AZ; Aberdeen Univ Med School, United Kingdom; Med Univ of Graz, Austria; Penn State Hershey Med Ctr, Hershey, PA; Univ of São Paulo, Brazil; Toyama Univ Hosp, Japan; Çukurova Univ, Adana, Turkey; AIIMS, New Delhi, India

Background: Histology and cultures are the main methods for detecting organisms in pulmonary granulomas. However, the relative yield of these two methods is not well defined. The aim of this study was to compare the yield of histology with that of cultures for the detection of various organisms in pulmonary granulomas.
Design: Cases of pulmonary granulomatous inflammation from 10 institutions (4 US, 6 non-US) in 7 countries were retrospectively reviewed and classified as infections if an organism was identified by histology or cultures, or if serology was strongly suggestive. In cases where culture results were available, the yield of cultures was compared to that of histology.
Results: Organisms were identified in 125/500 pulmonary granulomas. Results of cultures were available in 88 cases, including cultures of biopsied lung tissue in 35 and of other respiratory tract specimens in 53. Mycobacteria were detected by cultures in 47 cases and histologically in 22. In contrast, only 7 fungi were detected on cultures whereas 31 were detected by histology.

Comparison of Yield of Cultures and Histology for Detecting Organisms in Pulmonary Granulomatous Infections
OrganismTotal casesCulture data availableCultures pos, Histology negCultures neg, Histology posBoth pos
Histoplasma18130130
Coccidioides1311065
Cryptococcus64031
Pneumocystis22020
Aspergillus42110
Paracoccidioides6**0000
Fungus, unknown type20000
M. tuberculosis2828171*10
Non-tubercular mycobacteria2121151*5
Mycobacteria, unknown type235050
2 organisms22002
ALL ORGANISMS12588333223
*identified by PCR of fresh biopsy tissue; **diagnosed serologically


Conclusions: In pulmonary granulomas, cultures are more likely to detect mycobacteria than histology, whereas the reverse is true for fungi. Although Coccidioides, Cryptococcus and Aspergillus may grow in cultures from pulmonary granulomas, Histoplasma and Pneumocystis are highly unlikely to do so; their detection, therefore, mostly depends on histologic examination.
Category: Infections

Wednesday, March 2, 2011 1:00 PM

Poster Session VI # 233, Wednesday Afternoon

 

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