Role of fine-needle aspiration cytology in early diagnosis of fungal infections

Background: Fine-needle aspiration (FNA) is an important tool for the diagnosis of infectious diseases. In this study, we assessed the efficacy of FNA cytology in early diagnosis of fungal infections. Methods: This was a retrospective study from January 2016 to August 2018. Electronic archives were searched for FNAs from superficial and deep lesions obtained from various sites with the diagnosis of fungal infection. Each case was evaluated for underlying predisposing conditions, FNA source, radiologic findings, culture, and serology results. Results: A total of 15 cases were identified from the following sites: lung (eight), cervical lymph nodes (four), soft tissue (two), and retroperitoneal lymph node (one). Predisposing conditions were found in 11 patients: HIV (five), malignancy (three), and post-transplant (three). Imaging impression was mostly malignancy vs infection. In all 15 cases, the diagnosis of fungal infection was done by FNA cytology. The presumptive genus specific diagnoses based on yeast morphology was given in 12 cases (five Histoplasma, four Cryptococcus, and three Coccidioides). The diagnosis of fungal infection was provided within 24 h in nine cases, four during onsite evaluation. Microbial cultures were confirmatory in seven cases, and five cases exhibited negative cultures with positive serology. Out of the 15 patients, 14 were discharged in fair condition, and one died with complications of heart graft failure. Conclusion: FNA is a rapid and reliable method for early diagnosis of fungal infections, allowing a prompt and appropriate management, especially in immunocompromised patients. When onsite evaluation indicates infectious process, cultures can be timely done.