Fungal Infections

Fungal infections of the larynx are very rare, but may be expected to arise, though not exclusively, in immuno-compromised patients. Mycotic infections tend to occur as a result of the dissemination of the fungi, especially from the bronchopulmonary foci. An important exception is laryngeal candidiasis, which usually occurs as a result of direct spread from the oral cavity [280]. Different types of mycotic infections have been reported, such as laryngeal histoplasmosis [302, 319], cryptococcosis [171, 236], coccidioidomycosis [41], blastomycosis [89, 307], candidiasis [280], paracoccidioidomycosis [317] and aspergillosis [272, 310]. The histological features are similar for each of these infections and range from granulomatous lesions related to histoplasma and cryptoccocus, to abscess formation in blastomycosis and aspergillosis [291]. Pronounced epithelial hyper-plasia with prominent ortho-parakeratosis or pseudo-epitheliomatous hyperplasia in laryngeal blastomycosis, candidiasis and aspergillosis may mimic the squamous cell and verrucous cell carcinoma [272, 280, 307]. The identification of the causal agents by special silver, PAS or mucicarmine stains of the biopsy specimens and/or cultures of microorganisms are crucial for successful treatment.

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