RESUMEN
BACKGROUND: Ultrasonic humidifier lung is a rare form of hypersensitivity pneumonitis (HP), and its clinical and radiological features are unclear. This study examined the clinical and radiological characteristics of humidifier lung. METHODS: Data from 18 patients with humidifier lung (mean age, 67.3 years) diagnosed during October 2012 through April 2018 were retrospectively reviewed. We compared clinical, laboratory, and CT findings and bronchoalveolar lavage fluid (BALF) characteristics of these patients with those of 19 patients with summer-type HP (mean age, 57.4 years). RESULTS: Cough and dyspnea were the most common symptoms. White blood cell count and serum C-reactive protein titers were higher for humidifier lung than for summer-type HP. Serum levels of Krebs von den Lungen-6 and surfactant protein D were significantly lower for humidifier lung than for summer-type HP. The most common chest CT findings in humidifier lung were ground-glass opacities (88.9%) and mosaic attenuation (50.0%). Centrilobular ground glass nodules were less common in humidifier lung than in summer-type HP (27.8% vs 63.1%; P = 0.043). Peribronchovascular or subpleural nonsegmental consolidation was more frequent in humidifier lung than in summer-type HP (44.4% vs 5.3%; P = 0.013). Lymphocyte fractions in BALF specimens were significantly lower for humidifier lung than for summer-type HP (37.3% vs 69.0%; P < 0.001). Neutrophil fractions were higher for humidifier lung, but the difference was not significant (22.1% vs 8.1%; P = 0.153). The CD4/8 ratio was higher for humidifier lung than for summer-type HP (1.7 vs 0.8; P = 0.003). CONCLUSIONS: The clinical and radiological characteristics of humidifier lung differ from those of summer-type HP.
Asunto(s)
Alveolitis Alérgica Extrínseca/diagnóstico , Tomografía Computarizada por Rayos X , Tricosporonosis/diagnóstico , Anciano , Alveolitis Alérgica Extrínseca/diagnóstico por imagen , Biomarcadores/análisis , Biomarcadores/sangre , Recuento de Células Sanguíneas , Líquido del Lavado Bronquioalveolar/citología , Proteína C-Reactiva , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tricosporonosis/diagnóstico por imagenRESUMEN
NATIONALE: Trichosporon species are widely distributed in nature and are emerging opportunistic human pathogens. Trichosporon infections are associated with superficial cutaneous involvement in immunocompetent individuals to severe systemic disease in immunocompromised patients. Until now, there is no report in infective endocarditis by Trichosporon mucoides confirmed by molecular diagnostics PATIENT CONCERNS:: A 66-year-old man presented with a fever that had occurred for a period of 6 months. He had undergone aortic valve replacement 10 years prior. Transthoracic echocardiography showed vegetations on the prosthetic aortic valve and native mitral valve. T mucoides was detected in the cultures of blood and vegetations. DIAGNOSIS: DNA sequencing using D/D2 region of rRNA and internal transcribed spacer were performed. INTERVENTIONS: Infections were successfully controlled with valve replacement and voriconazole plus liposomal amphotericin B therapy. OUTCOMES: There has been no sign of recurrence for 18-months after treatment completion. LESSONS: This is the first reported case of infective endocarditis due to T mucoides. Clinicians should consider Trichosporon species as causative agents of endocarditis in patients who have undergone cardiac surgery.
Asunto(s)
Endocarditis/microbiología , Implantación de Prótesis de Válvulas Cardíacas , Infecciones Relacionadas con Prótesis/microbiología , Trichosporon/aislamiento & purificación , Tricosporonosis/microbiología , Anciano , Antifúngicos/uso terapéutico , Terapia Combinada , Endocarditis/diagnóstico por imagen , Endocarditis/terapia , Humanos , Masculino , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/terapia , Reoperación , Tricosporonosis/diagnóstico por imagen , Tricosporonosis/terapiaAsunto(s)
Antifúngicos/administración & dosificación , Itraconazol/administración & dosificación , Tejido Subcutáneo/microbiología , Trichosporon/aislamiento & purificación , Tricosporonosis/tratamiento farmacológico , Ultrasonografía Intervencional/métodos , Administración Oral , Femenino , Humanos , Persona de Mediana Edad , Tejido Subcutáneo/diagnóstico por imagen , Tejido Subcutáneo/efectos de los fármacos , Resultado del Tratamiento , Tricosporonosis/diagnóstico por imagenRESUMEN
Pacemaker-related fungal endocarditis is an uncommon and unexpected complication. It is associated with high mortality rates. Due to nonspecific clinical symptoms, negative blood culture and delays in obtaining appropriate imaging studies; late diagnosis is common with fungal endocarditis. Hereby we are reporting a rare case of pacemaker lead endocarditis due to Trichosporon species. In literature we did not find any case of pacemaker-related endocarditis due to Trichosporon species.