RESUMO
BACKGROUND: Tenosynovitis is an uncommon manifestation of disseminated infection with Coccidioides fungal species. Most experts treat this infection with combined surgical debridement and antifungal medication. The aim of our study was to examine the outcomes of patients with coccidioidal tenosynovitis of the hand and wrist. METHODS: We retrospectively searched for the records of patients with coccidioidal tenosynovitis of the hand and wrist at our institution. between 1987 and 2013. We also conducted a review of the literature from 1950 to 2014 to identify additional cases. RESULTS: We identified 9 cases of coccidioidal tenosynovitis of the hand and wrist at our institution, along with 5 other cases found in a review of the literature. The relapse rate was high overall (50%) and was higher after discontinuation of antifungal therapy (71%) in both immunocompromised and immunocompetent patients. Results of serologic testing were not predictive of relapse. CONCLUSIONS: A treatment strategy for coccidioidal tenosynovitis should focus on long-term administration of antifungal agents.
Assuntos
Coccidioides/isolamento & purificação , Coccidioidomicose/diagnóstico , Coccidioidomicose/patologia , Mãos/patologia , Tenossinovite/diagnóstico , Tenossinovite/patologia , Punho/patologia , Adulto , Idoso , Antifúngicos/uso terapêutico , Coccidioidomicose/tratamento farmacológico , Coccidioidomicose/cirurgia , Desbridamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tenossinovite/tratamento farmacológico , Tenossinovite/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: We examined the epidemiology, clinical manifestations, histopathology, management, and outcomes of gastrointestinal basidiobolomycosis, an uncommon manifestation of infection caused by the fungus Basidiobolus ranarum. METHODS: In this retrospective observational cohort study, cases of gastrointestinal basidiobolomycosis in the United States were identified by reviewing medical records from Mayo Clinic Hospital (Phoenix, AZ) and contacting local infectious diseases specialists, pathologists, gastroenterologists, the Arizona Department of Health Services, health departments of adjacent states, the Armed Forces Institute of Pathology, and the US Centers for Disease Control and Prevention. A comprehensive literature review identified additional cases worldwide. RESULTS: Of 44 patients (mean age, 37 years [range, 2-81 years]) with gastrointestinal basidiobolomycosis, most were from the United States (19 patients [43%], of whom 17 [89%] were from Arizona) or Saudi Arabia (11 [25%]). Most (28 [64%]) were previously healthy. Common chronic medical conditions among 15 patients (34%) were diabetes mellitus (8 patients [18%]) and gastric disorders (7 [16%]). Common findings were abdominal pain (37 patients [84%]) and a palpable abdominal mass (19 [43%]). Intraabdominal malignancy was the leading provisional diagnosis (19 patients [43%]). The large bowel was involved in 36 (82%), the small intestine in 16 (36%), and the liver or gallbladder in 13 (30%). Characteristic histopathologic findings were observed in 43 (98%). Eight patients (18%) died. Combined surgical intervention and antifungal therapy was the preferred treatment. CONCLUSIONS: Gastrointestinal basidiobolomycosis is an emerging invasive fungal infection in desert regions of the US Southwest. Clinical findings mimic malignancy and inflammatory bowel disease. Surgical excision and prolonged antifungal therapy are associated with favorable outcomes.
Assuntos
Entomophthorales/isolamento & purificação , Gastroenteropatias/epidemiologia , Gastroenteropatias/microbiologia , Zigomicose/epidemiologia , Zigomicose/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Arizona/epidemiologia , Criança , Pré-Escolar , Doenças Transmissíveis Emergentes/diagnóstico , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/microbiologia , Doenças Transmissíveis Emergentes/terapia , Clima Desértico , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Gastroenteropatias/diagnóstico , Gastroenteropatias/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem , Zigomicose/diagnóstico , Zigomicose/terapiaRESUMO
Community-acquired pneumonia (CAP) often results in severe illness and death. In large, geographically defined areas where Coccidioides spp. are endemic, coccidioidomycosis is a recognized cause of CAP, but its frequency has not been studied extensively. To determine the frequency of patients with coccidioidomycosis, we conducted a prospective evaluation of 59 patients with CAP in the Phoenix, Arizona, area. Of 35 for whom paired coccidioidal serologic testing was performed, 6 (17%) had evidence of acute coccidioidomycosis. Coccidioidal pneumonia was more likely than noncoccidioidal CAP to produce rash. The following were not found to be risk factors or reliable predictors of infection: demographic features, underlying medical conditions, duration of time spent in disease-endemic areas, occupational and recreational activities, initial laboratory studies, and chest radiography findings. Coccidioidomycosis is a common cause of CAP in our patient population. In the absence of distinguishing clinical features, coccidioidal pneumonia can be identified only with appropriate laboratory studies.
Assuntos
Coccidioides , Coccidioidomicose , Infecções Comunitárias Adquiridas , Pneumopatias Fúngicas , Pneumonia , Adulto , Idoso , Idoso de 80 Anos ou mais , Arizona/epidemiologia , Coccidioides/imunologia , Coccidioides/isolamento & purificação , Coccidioides/patogenicidade , Coccidioidomicose/diagnóstico , Coccidioidomicose/epidemiologia , Coccidioidomicose/microbiologia , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Doenças Endêmicas , Feminino , Humanos , Incidência , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/epidemiologia , Pneumopatias Fúngicas/microbiologia , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico , Pneumonia/epidemiologia , Pneumonia/microbiologia , Fatores de RiscoAssuntos
Colite Ulcerativa/diagnóstico , Colonoscopia/efeitos adversos , Infecções por Fusobacterium/etiologia , Abscesso Hepático Piogênico/etiologia , Biópsia/efeitos adversos , Diagnóstico Diferencial , Drenagem , Infecções por Fusobacterium/diagnóstico por imagem , Infecções por Fusobacterium/cirurgia , Fusobacterium nucleatum/isolamento & purificação , Humanos , Abscesso Hepático Piogênico/diagnóstico por imagem , Abscesso Hepático Piogênico/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: An endemic fungal infection of the desert southwestern United States, coccidioidomycosis is generally a self-limited illness in healthy persons. Immunosuppressed persons who contract coccidioidomycosis, however, are at increased risk for disseminated infection. METHODS: We conducted a retrospective review of patients with coccidioidomycosis and hematologic malignancy or bone marrow disease. RESULTS: Fifty-five patients were identified. The most common underlying malignancies were non-Hodgkin lymphoma and chronic lymphocytic leukemia. Extrathoracic (or disseminated) infection was observed in 12 patients (22%). Fifteen patients (27%) died with active coccidioidomycosis. Treatment of the hematologic disease with corticosteroids or antineoplastic chemotherapy increased the risk of death. CONCLUSION: To date, this is the largest case series of patients with hematologic malignancy and coccidioidomycosis. In persons with hematologic malignancy, coccidioidomycosis can be a severe illness with a high risk for disseminated infection and death.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Coccidioidomicose/etiologia , Neoplasias Hematológicas/tratamento farmacológico , Imunossupressores/efeitos adversos , Corticosteroides/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças da Medula Óssea/tratamento farmacológico , Coccidioidomicose/tratamento farmacológico , Feminino , Humanos , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Linfoma não Hodgkin/tratamento farmacológico , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , Infecções Oportunistas/etiologia , Estudos Retrospectivos , Fatores de Risco , Sudoeste dos Estados Unidos , Resultado do TratamentoRESUMO
We report on a patient with an abdominal wall abscess that developed after an inguinal hernia repair that utilized synthetic mesh. Mycobacterium goodii, a recently recognized, rapidly growing mycobacterium related to M. smegmatis, was isolated both from the abdominal wall aspirate and from surgically drained material. Infection resolved following thorough debridement, mesh removal, and prolonged antimicrobial therapy. This case report extends our understanding of the spectrum of M. goodii infection.