When to Consider the Possibility of a Fungal Infection: An Overview of Clinical Diagnosis and Laboratory Approaches.

Fungal infections are an important and increasingly prevalent cause of disease in certain patient populations. These infections can occur both in immune-compromised and immune-competent individuals. Because the number of patients who are immunocompromised is steadily growing, it is vital for clinicians to consider fungal disease in the differential diagnosis of these patients. This article reviews the epidemiology and approach to diagnosis of a variety of fungal infections.

Pulmonary Parenchymal Lymphoma Diagnosed by Bronchoscopic Cryoprobe Lung Biopsy.

A 51-year-old man presented with progressively worsening lung infiltrates and respiratory failure. Extensive investigations including bronchoscopy with bronchoalveolar lavage and conventional transbronchial forceps biopsies failed to establish the diagnosis. After transfer to our institution, he underwent repeat bronchoscopy with transbronchial cryobiopsy, which provided large, high-quality biopsy specimens establishing the diagnosis of parenchymal diffuse large B-cell lymphoma.

Acute renal failure associated with albendazole therapy in a patient with trichinosis.

A 72-year-old Caucasian woman presented with a 3-week history of confusion, cramping abdominal pain, nausea, vomiting, diarrhoea, fatigue and dehydration. By history, she reported consumption of raw pork and bacon that was salted and cured in brine, but not boiled or cooked. Laboratory testing was significant for an absolute eosinophil count of 3.09×10(9)/L. She was found to have a positive Trichinella serology by ELISA testing. Based on history of raw pork consumption, symptoms, peripheral eosinophilia and positive serology, a diagnosis of trichinosis was made. Treatment was started with oral albendazole. Following initiation of therapy, the patient developed acute kidney injury presumably secondary to albendazole. Therapy was discontinued. Her serum creatinine returned to baseline over the following days. The decision was made to proceed with observation alone, as she did not tolerate treatment. At the 3-week follow-up, her gastrointestinal symptoms had improved and her eosinophilia had resolved.

Predicting 1-year mortality rate for patients admitted with an acute exacerbation of chronic obstructive pulmonary disease to an intensive care unit: an opportunity for palliative care.

The objective of this study was to develop a model to aid clinicians in better predicting 1-year mortality rate for patients with an acute exacerbation of chronic obstructive pulmonary disease admitted to the medical intensive care unit (ICU) with the goal of earlier initiation of palliative care and end-of-life communications in this patient population. This retrospective cohort study included patients from a medical ICU from April 1, 1995, to November 30, 2009. Data collected from the Acute Physiology and Chronic Health Evaluation III database included demographic characteristics; severity of illness scores; noninvasive and invasive mechanical ventilation time; ICU and hospital length of stay; and ICU, hospital, and 1-year mortality. Statistically significant univariate variables for 1-year mortality were entered into a multivariate model, and the independent variables were used to generate a scoring system to predict 1-year mortality rate. At 1-year follow-up, 295 of 591 patients died (50%). Age and hospital length of stay were identified as independent determinants of mortality at 1 year by using multivariate analysis, and the predictive model developed had an area under the operating curve of 0.68. Bootstrap analysis with 1000 iterations validated the model, age, and hospital length of stay, entered the model 100% of the time (area under the operating curve=0.687; 95% CI, 0.686-0.688). A simple model using age and hospital length of stay may be informative for providers willing to identify patients with chronic obstructive pulmonary disease with high 1-year mortality rate who may benefit from end-of-life communications and from palliative care.