[Pulmonary paecilomycosis: Diagnosis and treatment].

AIM: To represent the advances of Russia and Uzbekistan in studying the problem of paecilomycosis. The goal of the investigation was to develop the diagnosis and treatment of pulmonary paecilomycosis (PP). SUBJECTS AND METHODS: Two hundred and twenty-five people, including 200 patients with bronchopulmonary infection with fungi of the Paecilomyces genus and 25 clinically healthy individuals (a control group), were examined. Clinico-anamnestic, laboratory diagnostic, mycological, and immunological studies were conducted; a lymphocyte antigen-binding test was used for differential diagnosis. Paecilomyces infection was diagnosed by microscopically examining the morphology of the fungi in the pathological material (blood, sputum) and by isolating the cultured fungi in the media (Sabouraud's and Czapek's ones). The severe complication of PP - atypical paecilomycosis-associated myocarditis (APAM) - was studied in 112 patients with helminthiasis-complicated paecilomycosis. These patients underwent using the conventional echocardiography. RESULTS: Bronchopulmonary paecilomycosis resulting from primary and secondary infection with fungi of the Paecilomyces genus was clinically manifested as chronic obstructive bronchitis (11.5%), recurrent pneumonia (13.5%), exogenous allergic alveolitis (37%), and asthma (26%) complicated by helminthiasis (12%). Iodine deficiency promotes the prevalence of paecilomycosis and echinococcosis favors Paecilomycosis infection; moreover, the helminth capsule itself serves as a nutrient medium for the development of the mycelial form of the fungus. APAM is a severe complication of PP. Almost 50% of the patients with PP presented with carditis. The patients with APAM occasionally experienced fear and the most severe intermittent pain. The latter first occurred in the chest.and irradiated to the axilla, left hand, and its fingertips, paralyzing the arm. In some patients, the pain manifested itself in both arms with abdominal irradiation, by being accompanied by faints. Current analgesics (meloxicam, tizanidine, nimesulide, morphine, promedole) in combination with fluconazole provided a temporary positive effect. CONCLUSION: Further investigations that must also include neurologists and anesthetists are required to work out effective pain relief regimens for APAM in patients with PP.

[Cardiac involvement in adults with echinococcosis].

Experiments have established that the first target for echinococcus is the liver and lung and that for pathogenic fungi and protozoa is the heart. Adult patients with hepatic hydatid disease complicated by paecilomycosis have been found to have atypical paecilomycosis-associated myocarditis, the treatment of which was developed by the authors, by using antibiotics, fungicides, and homeopathic remedies.

[Transformation of the fungus Paecilomyces variotii and the causes of host cell lysis at the boundary with a fungal mycelium-containing Echinococcus capsule].

Experiments were carried out on animal species. The experiments used 30-day chicks, 80 rats, and 70 rabbits. Three hundred and twenty-nine patients with echinococcus complicated by paecilomycosis were meticulously examined. The fungi of the genus Paecilomyces undergo two transformation directions: the saprotrophic mycelial form of the fungus Paecilomyces variotii transforms to the tissue parasitic one as a globular form of spherules that transforms to the mycelial form in larval Echinococcus infection because the cyst capsule is a favorable environment for growth of fungal mycelia. The growth and aggressiveness of larval Echinococcus in the human lung are associated with the fact that fungal mycelial fibrous tunic contains Paecilomyces that have been first used to isolate active hyaluronidase that lyses host cells. Pulmonary echinococcosis complicated by the tissue form of paecilomycosis can be complicated by the mycelial form of the fungus of the genus Paecilomyces, by afflicting the nails and skin of patients, which requires particular treatment after surgery for hydatid disease. The chicks that had been brooded in an incubator and grown under special conditions to rule out fungal infection were first contaminated with the fungal mycelium labeled with methionine, sodium sulfate, sodium phosphate, or iodine. Each chick received 0.5 g of the labeled fungal mycelium. Regardless of the contamination mode, all the chicks from 3 groups were infected with Paecilomyces; the spherules exhibited labeled isotopes. Thus, it has been first conclusively proven that the diagnosis of paecilomycosis based on the blood detection of fungal globular spherules is valid and easy-to-use in any health care facility.

[Amino acid exchange in paeci lomycosis-complicated echinococcosis].

The authors have detected atypical paecilomycosis-associated myocarditis with impaired amino acid exchange and pain syndrome for the first time. At first, pain occurs in the chest and radiates into the axilla, to the left arm to the finger tips, by paralyzing the arm. In some patients, pain manifests itself in both arms with radiation to the belly, by accompanying by fainting. The skin is wet, cold; the pulse is frequent and of poor volume and difficult-to-count. Heart pain spreads into the armpit and down the arm, by making the fingers numb. Attempts to use current analgesics (movalis, sirdalud, nimesil, morphine) in combination with fungicides (diflucan, mycosist, orungal) have failed to yield positive results. The homeopathic drug Latrodectus mactans, prepared from caracurt venom, in combination with the authors' designed diet and other homeopathic agents have relieved pain syndrome and normalized amino acid exchange, which offered possibilities for successful surgical treatment for echinococcosis with later recovery.