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'''Fungi''' are [[microorganisms]] that are occasionally seen by pathologists.
[[Image:Pulmonary aspergillosis.jpg|thumb|right|280px|Fungi (aspergillus). [[H&E stain]].]]
'''Fungi''' (singular '''fungus''') are [[microorganisms]] that are occasionally seen by pathologists.


=Overview=
=Overview=
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*[[Mucor]].
*[[Mucor]].
*[[Aspergillus]].
*[[Aspergillus]].
===Sign out===
*The gold standard for determining the microorganisms is culture.
*As anatomical pathologists are approximately 80% accurate (when measured against culture), it is important to state something like ''correlation with culture is recommended''.<ref name=pmid19228642>{{Cite journal  | last1 = Sangoi | first1 = AR. | last2 = Rogers | first2 = WM. | last3 = Longacre | first3 = TA. | last4 = Montoya | first4 = JG. | last5 = Baron | first5 = EJ. | last6 = Banaei | first6 = N. | title = Challenges and pitfalls of morphologic identification of fungal infections in histologic and cytologic specimens: a ten-year retrospective review at a single institution. | journal = Am J Clin Pathol | volume = 131 | issue = 3 | pages = 364-75 | month = Mar | year = 2009 | doi = 10.1309/AJCP99OOOZSNISCZ | PMID = 19228642 }}</ref>


==Summary table==
==Summary table==
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| ? Immunosuppression
| ? Immunosuppression
| <ref name=Ref_APBR682>{{Ref APBR|682}}</ref>
| <ref name=Ref_APBR682>{{Ref APBR|682}}</ref>
| [http://commons.wikimedia.org/w/index.php?title=File:Pulmonary_aspergillosis.jpg Aspergillus (WC)], [http://commons.wikimedia.org/wiki/File:Pulmonary_aspergillosis_cytology.jpg Aspergillus cytology (WC)]
| [[Image:Pulmonary_aspergillosis.jpg|thumb|center|150px| Aspergillus. (WC)]]
|-
|-
| Zygomycota ([[zygomycosis]]);<br>''more specific''<br>Mucorales (mucormycosis)
| Zygomycota ([[zygomycosis]]);<br>''more specific''<br>Mucorales (mucormycosis)
Line 47: Line 52:
| Diabetes, immunodeficient
| Diabetes, immunodeficient
| <ref name=Ref_APBR682>{{Ref APBR|682}}</ref>
| <ref name=Ref_APBR682>{{Ref APBR|682}}</ref>
| [http://granuloma.homestead.com/ZygoHE_02.jpg Mucormycosis (homestead.com)], [http://commons.wikimedia.org/wiki/File:Zygomycosis.jpg Zygomycosis (WC)]
| [[Image:Zygomycosis.jpg |thumb|center|150px| Zygomycosis. (WC)]]
|-
|-
| Coccidioides, usually C. immitis<br>(coccidioidomycosis)
| Coccidioides, usually C. immitis<br>(coccidioidomycosis)
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| Immunodeficient
| Immunodeficient
| <ref name=Ref_APBR682>{{Ref APBR|682}}</ref>
| <ref name=Ref_APBR682>{{Ref APBR|682}}</ref>
| [http://pathmicro.med.sc.edu/mycology/cocc3.jpg Coccidioidomycosis (med.sc.edu)] [http://commons.wikimedia.org/wiki/File:Coccidioides_immitis_on_Sabouraud%27s_medium.jpg C. immitis (WC)] [http://www.webpathology.com/image.asp?case=374&n=3 (webpathology.com)]
| [http://pathmicro.med.sc.edu/mycology/cocc3.jpg Coccidioidomycosis (med.sc.edu)] [[Image:Coccidioides_immitis_on_Sabouraud%27s_medium.jpg |thumb|center|150px|C. immitis (WC)]]  
|-
|-
| Histoplasma ([[histoplasmosis]])
| Histoplasma ([[histoplasmosis]])
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| Source: soil with bird droppings
| Source: soil with bird droppings
| <ref name=Ref_APBR682>{{Ref APBR|682}}</ref>
| <ref name=Ref_APBR682>{{Ref APBR|682}}</ref>
| [http://commons.wikimedia.org/wiki/File:Histoplasma_pas-d.jpg Histoplasmosis (WC)]
| [[Image:Histoplasma_pas-d.jpg|thumb|center|150px| Histoplasmosis. (WC)]]
|-
|-
| Blastomyces ([[blastomycosis]])
| Blastomyces ([[blastomycosis]])
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| Habitat: Northeast America, Africa
| Habitat: Northeast America, Africa
| <ref name=Ref_APBR682>{{Ref APBR|682}}</ref><ref>[http://pathmicro.med.sc.edu/mycology/mycology-6.htm http://pathmicro.med.sc.edu/mycology/mycology-6.htm]</ref>
| <ref name=Ref_APBR682>{{Ref APBR|682}}</ref><ref>[http://pathmicro.med.sc.edu/mycology/mycology-6.htm http://pathmicro.med.sc.edu/mycology/mycology-6.htm]</ref>
| [http://pathmicro.med.sc.edu/mycology/blast1.jpg Blastomyces]
| [[Image:Blastomycosis_cropped.JPG | thumb|center|150px|Blastomyces. (WC)]]
|-
|-
| Paracoccidioides ([[paracoccidioidomycosis]])
| Paracoccidioides ([[paracoccidioidomycosis]])
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| Clinical???
| Clinical???
| <ref name=Ref_APBR682>{{Ref APBR|682}}</ref>
| <ref name=Ref_APBR682>{{Ref APBR|682}}</ref>
| [http://commons.wikimedia.org/wiki/File:Paracoccidioides_brasiliensis_01.jpg P. brasiliensis (WC)].
| [[Image:Paracoccidioides_brasiliensis_01.jpg |thumb|center|150px|P. brasiliensis (WC)]]
|-
|-
| Pneumocystis jirovecii ([[pneumocystis carinii pneumonia]]; abbrev. PCP)
| Pneumocystis jirovecii ([[pneumocystis carinii pneumonia]]; abbrev. PCP)
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| [[HIV]]/AIDS associated
| [[HIV]]/AIDS associated
| <ref name=Ref_APBR684>{{Ref APBR|684}}</ref>
| <ref name=Ref_APBR684>{{Ref APBR|684}}</ref>
| [http://commons.wikimedia.org/wiki/File:Pneumocystosis_carinii_of_lung_in_AIDS_959_lores.jpg PCP (WC)]
| [[Image:Pneumocystosis_carinii_of_lung_in_AIDS_959_lores.jpg|thumb|center|150px| PCP. (WC)]]
|-
|-
| Cryptococcus ([[cryptococcosis]])
| Cryptococcus ([[cryptococcosis]])
Line 107: Line 112:
| HIV/AIDS associated, most common CNS fungus
| HIV/AIDS associated, most common CNS fungus
| <ref name=Ref_APBR682>{{Ref APBR|682}}</ref>
| <ref name=Ref_APBR682>{{Ref APBR|682}}</ref>
| [http://commons.wikimedia.org/wiki/File:Cryptococcosis_of_lung_in_patient_with_AIDS_Methenamine_silver_stain_963_lores.jpg Crytococcosis - methenamine silver (WC)], [http://commons.wikimedia.org/wiki/File:Cryptococcosis_of_lung_in_patient_with_AIDS._Mucicarmine_stain_962_lores.jpg Crytococcosis - mucicarmine (WC)].
| [[Image:Cryptococcosis_of_lung_in_patient_with_AIDS._Mucicarmine_stain_962_lores.jpg |thumb|center|150px| Crytococcosis - mucicarmine (WC)]]
|}
|}
Notes:
Notes:
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*** Have a "central dot".<ref name=pathquiz_1>URL: [http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/A6I001-PQ01-M.htm http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/A6I001-PQ01-M.htm]. Accessed on: 19 October 2010</ref>  
*** Have a "central dot".<ref name=pathquiz_1>URL: [http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/A6I001-PQ01-M.htm http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/A6I001-PQ01-M.htm]. Accessed on: 19 October 2010</ref>  


Images:
====Images====
*[http://commons.wikimedia.org/wiki/File:Histoplasma_pas-d.jpg Histoplasmosis - PASD (WC)].
<gallery>
Image:Histoplasma in granuloma pas-d.jpg | Histoplasmosis - granuloma - [[PASD stain]]. (WC)
Image:Histoplasma_pas-d.jpg | Histoplasmosis - [[PASD stain]]. (WC)
Image:Histoplasma_pas-d_small.jpg | Histoplasmosis - cropped - PASD stain. (WC)
Image:Histoplasma_in_granuloma_gms.jpg | Histoplasmosis - [[GMS stain]]. (WC)
</gallery>
www:
*[http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/PQ-Images/A6I001-3.gif The "central dot" of Histoplasma (ouhsc.edu)].<ref name=pathquiz_1/>
*[http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/PQ-Images/A6I001-3.gif The "central dot" of Histoplasma (ouhsc.edu)].<ref name=pathquiz_1/>
*[http://commons.wikimedia.org/wiki/File:Histoplasma_in_granuloma_gms.jpg Histoplasma - GMS (WC)].
*[http://path.upmc.edu/cases/case693.html Histoplasmosis - several images (upmc.edu)].
*[http://path.upmc.edu/cases/case693.html Histoplasmosis - several images (upmc.edu)].


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**Usu. from soil.
**Usu. from soil.
*Typical locations: lung, oral cavity.<ref name=Ref_WMSP3>{{Ref WMSP|3}}</ref>  
*Typical locations: lung, oral cavity.<ref name=Ref_WMSP3>{{Ref WMSP|3}}</ref>  
*+/-Immunodeficiency.<ref name=pmid23824371>{{Cite journal  | last1 = Nguyen | first1 = C. | last2 = Barker | first2 = BM. | last3 = Hoover | first3 = S. | last4 = Nix | first4 = DE. | last5 = Ampel | first5 = NM. | last6 = Frelinger | first6 = JA. | last7 = Orbach | first7 = MJ. | last8 = Galgiani | first8 = JN. | title = Recent advances in our understanding of the environmental, epidemiological, immunological, and clinical dimensions of coccidioidomycosis. | journal = Clin Microbiol Rev | volume = 26 | issue = 3 | pages = 505-25 | month = Jul | year = 2013 | doi = 10.1128/CMR.00005-13 | PMID = 23824371 }}</ref>
*Predominantly southwest USA and Mexico.<ref name=pmid23068145>{{Cite journal  | last1 = Welsh | first1 = O. | last2 = Vera-Cabrera | first2 = L. | last3 = Rendon | first3 = A. | last4 = Gonzalez | first4 = G. | last5 = Bonifaz | first5 = A. | title = Coccidioidomycosis. | journal = Clin Dermatol | volume = 30 | issue = 6 | pages = 573-91 | month =  | year =  | doi = 10.1016/j.clindermatol.2012.01.003 | PMID = 23068145 }}</ref>


===Microscopic===
===Microscopic===
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*Spherules may be described as a "bag of marbles".
*Spherules may be described as a "bag of marbles".


Images:
====Images====
*www:
<gallery>
**[http://library.med.utah.edu/WebPath/jpeg2/AIDS092.jpg Coccidioides (med.utah.edu)].<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/pufrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/pufrm.html]. Accessed on: 4 December 2011.</ref>
Image:Coccidioidomycosis - intermed mag.jpg |  Coccidioidomycosis - intermed. mag. (WC)
**[http://path.upmc.edu/cases/case516.html Coccidioidomycosis (upmc.edu)].
Image:Coccidioidomycosis - high mag.jpg | Coccidioidomycosis - high mag. (WC)
*WC:
Image:Coccidioidomycosis_-_very_high_mag.jpg | Coccidioidomycosis - very high mag. (WC)
**[http://commons.wikimedia.org/wiki/File:Coccidioidomycosis_-_very_high_mag.jpg Coccidioidomycosis - very high mag. (WC)].
Image:Coccidioidomycosis_-_2_-_gms_-_very_high_mag.jpg | Coccidioidomycosis - GMS - very high mag. (WC)
**[http://commons.wikimedia.org/wiki/File:Coccidioidomycosis_-_2_-_gms_-_very_high_mag.jpg Coccidioidomycosis - GMS - very high mag. (WC)].
Image:Mature_spherule_with_endospores_of_Coccidioides_immitis_PHIL_480_lores.jpg | Coccidioides. (WC)
**[http://commons.wikimedia.org/wiki/File:Mature_spherule_with_endospores_of_Coccidioides_immitis_PHIL_480_lores.jpg Coccidioides (WC)].
</gallery>
www:
*[http://library.med.utah.edu/WebPath/jpeg2/AIDS092.jpg Coccidioides (med.utah.edu)].<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/pufrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/pufrm.html]. Accessed on: 4 December 2011.</ref>
*[http://path.upmc.edu/cases/case516.html Coccidioidomycosis (upmc.edu)].


==Pneumocystis pneumonia==
==Pneumocystis pneumonia==
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**Approximately 7-8 μm in size.
**Approximately 7-8 μm in size.


Images:
DDx:
*[http://commons.wikimedia.org/wiki/File:Pneumocystosis_carinii_of_lung_in_AIDS_959_lores.jpg The frothy casts of PCP (WC)].
*[[Pulmonary alveolar proteinosis]].
 
====Images====
<gallery>
Image:Pneumocystosis_carinii_of_lung_in_AIDS_959_lores.jpg | The frothy casts of PCP. (WC)
</gallery>
www:
*[http://commons.wikimedia.org/w/index.php?title=Special%3ASearch&search=Pneumocystis+carinii&go=Go Several images of PCP (WC)].
*[http://commons.wikimedia.org/w/index.php?title=Special%3ASearch&search=Pneumocystis+carinii&go=Go Several images of PCP (WC)].


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*May be confused with corpora amylacea in the CNS, esp. as they (like cryptococci) stain for methenamine silver, Alcian blue, and PAS.<ref>URL: [http://flylib.com/books/en/2.953.1.17/1/ http://flylib.com/books/en/2.953.1.17/1/]. Accessed on: 15 December 2010.</ref>
*May be confused with corpora amylacea in the CNS, esp. as they (like cryptococci) stain for methenamine silver, Alcian blue, and PAS.<ref>URL: [http://flylib.com/books/en/2.953.1.17/1/ http://flylib.com/books/en/2.953.1.17/1/]. Accessed on: 15 December 2010.</ref>


Images:
====Images====
*[[WC]]:
<gallery>
**[http://commons.wikimedia.org/wiki/File:Cryptococcosis_of_lung_in_patient_with_AIDS._Mucicarmine_stain_962_lores.jpg Micrograph of crytococcosis - mucicarmine stain (WC)].
Image:Cryptococcus.jpg | Cryptococcosis - cytology - [[Field stain]]. (WC)
**[http://commons.wikimedia.org/wiki/File:Cryptococcosis_of_lung_in_patient_with_AIDS_Methenamine_silver_stain_963_lores.jpg Micrograph of crytococcosis - methenamine silver stain (WC)].
Image:Cryptococcosis_of_lung_in_patient_with_AIDS._Mucicarmine_stain_962_lores.jpg | Crytococcosis - mucicarmine stain. (WC)
*www:
Image:Cryptococcosis_of_lung_in_patient_with_AIDS_Methenamine_silver_stain_963_lores.jpg | Crytococcosis - methenamine silver stain. (WC)
**[http://path.upmc.edu/cases/case89/micro.html Cryptococcosis (upmc.edu)].
</gallery>
**[http://path.upmc.edu/cases/case396.html Cryptococcosis - case 2 (upmc.edu)].
www:
*[http://path.upmc.edu/cases/case89/micro.html Cryptococcosis (upmc.edu)].
*[http://path.upmc.edu/cases/case396.html Cryptococcosis - case 2 (upmc.edu)].


==Cryptosporidiosis==
==Cryptosporidiosis==
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**Bluish staining of brush border '''key feature''' - low power.
**Bluish staining of brush border '''key feature''' - low power.


Images:
====Images====
*[[WC]]:
<gallery>
**[http://commons.wikimedia.org/wiki/File:Cryptosporidiosis_-_very_high_mag.jpg Cryptosporidiosis - very high mag. (WC)].
Image:Cryptosporidiosis_-_very_high_mag.jpg | Cryptosporidiosis - very high mag. (WC)
**[http://commons.wikimedia.org/wiki/File:Cryptosporidiosis_-_very_high_mag_-_cropped.jpg Cryptosporidosis - very high mag. - cropped (WC)].
Image:Cryptosporidiosis_-_very_high_mag_-_cropped.jpg | Cryptosporidosis - very high mag. - cropped (WC)
*www:
</gallery>
**[http://www.tulane.edu/~wiser/protozoology/notes/images/cp_path.gif Schematic picture of cryptosporidium & bowel (tulane.edu)].
www:
**[http://www.brown.edu/Courses/Digital_Path/systemic_path/GI/cryptosporidiosis.html Micrograph of cryptosporidiosis (brown.edu)].
*[http://www.tulane.edu/~wiser/protozoology/notes/images/cp_path.gif Schematic picture of cryptosporidium & bowel (tulane.edu)].
*[http://www.brown.edu/Courses/Digital_Path/systemic_path/GI/cryptosporidiosis.html Micrograph of cryptosporidiosis (brown.edu)].


Notes:
Notes:
Line 253: Line 277:
*Yeast forms.
*Yeast forms.
*Locations: oral cavity, vagina.
*Locations: oral cavity, vagina.
===Gross===
Esophageal candidiasis:
*"Sticky": do not wash-off from the mucosa with water irrigation.<ref>URL: [https://www.ncbi.nlm.nih.gov/books/NBK537268/ https://www.ncbi.nlm.nih.gov/books/NBK537268/]. Accessed on: 2022 June 22.</ref>


===Microscopic===
===Microscopic===
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*''Dimorphic'' - seen in two forms:
*''Dimorphic'' - seen in two forms:
**Pseudohyphae<ref name=Ref_WMSP3>{{Ref WMSP|3}}</ref>  - collections of many ''C. albicans'' cells in a branching pattern.
**Pseudohyphae<ref name=Ref_WMSP3>{{Ref WMSP|3}}</ref>  - collections of many ''C. albicans'' cells in a branching pattern.
**Yeast form - single cells, 10 to 12 micrometres in diameter, gram positive.<ref>[http://pathmicro.med.sc.edu/mycology/mycology-3.htm http://pathmicro.med.sc.edu/mycology/mycology-3.htm]</ref>
**Yeast form - single cells, 10 to 12 micrometres in diameter.{{fact}}


Notes:
Notes:
*May be described as "sticks and stones".
*May be described as "sticks and stones".


*Images:
====Images====
**[http://pathmicro.med.sc.edu/mycology/candi4.jpg Candida (pseudohyphae) - methenamine silver (med.sc.edu)].
www:
**[http://commons.wikimedia.org/wiki/File:Candida_pap_1.jpg Candida on Pap test (WC)].
*[http://pathmicro.med.sc.edu/mycology/candi4.jpg Candida (pseudohyphae) - methenamine silver (med.sc.edu)].
<gallery>
Image:Candida_pap_1.jpg | Candida on Pap test. (WC)
File:Candidiasis (5494228352).jpg | Candidiasis. (WC/Yale Rosen)
File:Candidiasis - PAS (5493634827).jpg | Candidiasis: PAS stain. (WC/Yale Rosen)
File:Candidiasis - GMS (5493634393).jpg | Candidiasis: Pseudohyphae + Budding yeast. (WC/Yale Rosen)
</gallery>


===Stains===
===Stains===
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*PAS +ve.
*PAS +ve.
*Methenamine silver +ve.
*Methenamine silver +ve.
*[[Gram stain|Gram]] +ve.<ref name=pmid20711156>{{Cite journal  | last1 = Salerno | first1 = C. | last2 = Pascale | first2 = M. | last3 = Contaldo | first3 = M. | last4 = Esposito | first4 = V. | last5 = Busciolano | first5 = M. | last6 = Milillo | first6 = L. | last7 = Guida | first7 = A. | last8 = Petruzzi | first8 = M. | last9 = Serpico | first9 = R. | title = Candida-associated denture stomatitis. | journal = Med Oral Patol Oral Cir Bucal | volume = 16 | issue = 2 | pages = e139-43 | month = Mar | year = 2011 | doi =  | PMID = 20711156 }}</ref>


==Blastomycosis==
==Blastomycosis==
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*[[Cryptosporidiosis]].
*[[Cryptosporidiosis]].


Images:
====Images====
*[http://commons.wikimedia.org/wiki/File:Blastomycosis_cropped.JPG Blastomycosis (wikimedia.org)].
<gallery>
Image:Blastomycosis_cropped.JPG | Blastomycosis. (WC)
</gallery>
www:
*[http://www.pathguy.com/lectures/blastomycosis.jpg Blastomycosis - budding (pathguy.com)].
*[http://www.pathguy.com/lectures/blastomycosis.jpg Blastomycosis - budding (pathguy.com)].
*[http://www.lahey.org/Medical/InfectiousDiseases/ID_Blastomycosis.asp Blastomycosis - with broad budding (lahey.org)].
*[http://www.lahey.org/Medical/InfectiousDiseases/ID_Blastomycosis.asp Blastomycosis - with broad budding (lahey.org)].
 
*[http://pathmicro.med.sc.edu/mycology/blast1.jpg Blastomyces (med.sc.edu)].
==Mucormycosis==
==Mucormycosis==
===General===
===General===
Line 309: Line 347:
*[[Aspergillosis]].
*[[Aspergillosis]].


Images:
====Images====
*[http://commons.wikimedia.org/wiki/File:Zygomycosis.jpg Zygomycosis - cytology (WC)].
<gallery>
Image:Zygomycosis.jpg | Zygomycosis - [[cytology]]. (WC)
</gallery>
www:
*[http://granuloma.homestead.com/ZygoHE_02.jpg Mucormycosis (homestead.com)].
*[http://granuloma.homestead.com/ZygoHE_02.jpg Mucormycosis (homestead.com)].
*[http://path.upmc.edu/cases/case181.html Mucormycosis - several images (upmc.edu)].
*[http://path.upmc.edu/cases/case181.html Mucormycosis - several images (upmc.edu)].


==Aspergillosis==
==Aspergillosis==
===General===
{{Main|Aspergillosis}}
*Due to ''Aspergillus''.
*Fungus.
*Associated with immunosuppression/immunodeficiency. (???)
 
===Microscopic===
Features:
*Hyphae that branching with 45 degrees angle - '''key feature'''.<ref name=Ref_APBR682>{{Ref APBR|682}}</ref>
**Uniform width - typically ~3-5 μm.
*Septated - often difficult to see.
*Fruiting heads when aerobic - uncommon.
 
DDx:
*Scedosporium prolificans.<ref>URL: [http://path.upmc.edu/cases/case290.html http://path.upmc.edu/cases/case290.html]. Accessed on: 14 January 2012.</ref>
*[[Mucormycosis]].
 
Images:
*[[WC]]:
**[http://commons.wikimedia.org/w/index.php?title=File:Pulmonary_aspergillosis.jpg Aspergillus (WC)].
**[http://commons.wikimedia.org/wiki/File:Pulmonary_aspergillosis_cytology.jpg Aspergillus - cytology (WC)].
**[http://commons.wikimedia.org/wiki/File:Aspergillus_-_high_mag.jpg Aspergillus with fruiting head - high mag. (WC)].
**[http://commons.wikimedia.org/wiki/File:Aspergillus_-_add_-_very_high_mag.jpg Aspergillus with fruiting head - very high mag. (WC)].
*www:
**[http://www.ispub.com/journal/the-internet-journal-of-otorhinolaryngology/volume-6-number-1/maxillary-sinus-mycetoma-due-to-aspergillus-niger.article-g03.fs.jpg Aspergillosis - fruiting head (ispub.com)].<ref>URL: [http://www.ispub.com/journal/the-internet-journal-of-otorhinolaryngology/volume-6-number-1/maxillary-sinus-mycetoma-due-to-aspergillus-niger.html http://www.ispub.com/journal/the-internet-journal-of-otorhinolaryngology/volume-6-number-1/maxillary-sinus-mycetoma-due-to-aspergillus-niger.html]. Accessed on: 27 February 2012.</ref>
 
===Stains===
*PAS-D +ve.


==Microsporidiosis==
==Microsporidiosis==
Michael
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