ABSTRACT
Infections caused by uncommon and resistant pathogens in unusual sites have been increasingly reported in medical literature. We describe four cases of rare cytological findings and clinical impact for patients. In the first case, Aspergillus sp and Pneumocystis jirovecii were observed in the bronchoalveolar lavage of a patient with severe systemic lupus. In the second and third cases, we describe the presence of Trichomonas sp and Strongyloides sp larvae in samples of pleural and peritoneal fluid, respectively. The fourth report is about a patient with a wrist subcutaneous nodule whose synovial aspiration and cytology revealed the presence of brown septate hyphae. The early identification of the infectious agent in the cytological examination was essential for the introduction and/or re-adaptation of therapy in the four cases described. Patients in this report were immunocompromised with severe comorbidities, conditions often associated with unfavorable clinical outcomes.
Subject(s)
Communicable Diseases/diagnosis , Cytodiagnosis/methods , Animals , Ascitic Fluid/parasitology , Aspergillus/isolation & purification , Bronchoalveolar Lavage Fluid/microbiology , Fatal Outcome , Female , Humans , Male , Middle Aged , Pleural Effusion/parasitology , Pneumocystis carinii/isolation & purification , Strongyloides/isolation & purification , Strongyloidiasis/diagnosis , Trichomonas/isolation & purification , Trichomonas Infections/diagnosisABSTRACT
Infections caused by uncommon and resistant pathogens in unusual sites have been increasingly reported in medical literature. We describe four cases of rare cytological findings and clinical impact for patients. In the first case, Aspergillus sp and Pneumocystis jirovecii were observed in the bronchoalveolar lavage of a patient with severe systemic lupus. In the second and third cases, we describe the presence of Trichomonas sp and Strongyloides sp larvae in samples of pleural and peritoneal fluid, respectively. The fourth report is about a patient with a wrist subcutaneous nodule whose synovial aspiration and cytology revealed the presence of brown septate hyphae. The early identification of the infectious agent in the cytological examination was essential for the introduction and/or re-adaptation of therapy in the four cases described. Patients in this report were immunocompromised with severe comorbidities, conditions often associated with unfavorable clinical outcomes.
Subject(s)
Humans , Animals , Male , Female , Middle Aged , Communicable Diseases/diagnosis , Cytodiagnosis/methods , Pleural Effusion/parasitology , Aspergillus/isolation & purification , Strongyloides/isolation & purification , Strongyloidiasis/diagnosis , Trichomonas/isolation & purification , Trichomonas Infections/diagnosis , Ascitic Fluid/parasitology , Bronchoalveolar Lavage Fluid/microbiology , Fatal Outcome , Pneumocystis carinii/isolation & purificationABSTRACT
BACKGROUND: Toxoplasmosis is one of the most common human zoonosis, and is generally benign in most of the individuals. Pulmonary involvement is common in immunocompromised subjects, but very rare in immunocompetents and there are scarce reports of tomographic findings in the literature. The aim of the study is to describe three immunocompetent patients diagnosed with acute pulmonary toxoplasmosis and their respective thoracic tomographic findings. Acute toxoplasmosis was diagnosed according to the results of serological tests suggestive of recent primary infection and the absence of an alternative etiology. CASE PRESENTATION: From 2009 to 2013, three patients were diagnosed with acute respiratory failure secondary to acute toxoplasmosis. The patients were two female and one male, and were 38, 56 and 36 years old. Similarly they presented a two-week febrile illness and progressive dyspnea before admission. Laboratory tests demonstrated lymphocytosis, slight changes in liver enzymes and high inflammatory markers. Tomographic findings were bilateral smooth septal and peribronchovascular thickening (100%), ground-glass opacities (100%), atelectasis (33%), random nodules (33%), lymph node enlargement (33%) and pleural effusion (66%). All the patients improved their symptoms after treatment, and complete resolution of tomographic findings were found in the followup. CONCLUSION: These cases provide a unique description of the presentation and evolution of pulmonary tomographic manifestations of toxoplasmosis in immunocompetent patients. Toxoplasma pneumonia manifests with fever, dyspnea and a non-productive cough that may result in respiratory failure. In animal models, changes were described as interstitial pneumonitis with focal infiltrates of neutrophils that can finally evolve into a pattern of diffuse alveolar damage with focal necrosis. The tomographic findings are characterized as ground glass opacities, smooth septal and marked peribronchovascular thickening; and may mimic pulmonary congestion, lymphangitis, atypical pneumonia and pneumocystosis. This is the largest series of CT findings of acute toxoplasmosis in immunocompetent hosts, and the diagnosis should be considered as patients that present with acute respiratory failure in the context of a subacute febrile illness with bilateral and diffuse interstitial infiltrates with marked peribronchovascular thickening. If promptly treated, pulmonary toxoplasmosis can result in complete clinical and radiological recovery in immunocompetent hosts.
Subject(s)
Immunocompetence , Lung Diseases/diagnostic imaging , Toxoplasmosis/diagnostic imaging , Adult , Female , Humans , Lung Diseases/parasitology , Lymph Nodes/diagnostic imaging , Male , Middle Aged , Multiple Pulmonary Nodules/diagnostic imaging , Multiple Pulmonary Nodules/parasitology , Pleural Effusion/diagnostic imaging , Pleural Effusion/parasitology , Tomography, X-Ray ComputedABSTRACT
Sparganosis in humans is an incidental infection and is known to be associated with eating insufficiently cooked meat of frogs and snakes or drinking unboiled stream water. Although it can involve various internal organs, pulmonary and pleural involvement due to sparganum is rare. Because we recently experienced two cases involving lung parenchyma and pleura that were misdiagnosed as bacterial pneumonia and lung cancer, we herein intend to present them in detail.
Subject(s)
Lung Diseases, Parasitic/diagnosis , Pleural Effusion/parasitology , Sparganosis/diagnosis , Biopsy , Diagnosis, Differential , Enzyme-Linked Immunosorbent Assay , Humans , Lung Diseases, Parasitic/parasitology , Lung Neoplasms/diagnosis , Male , Middle Aged , Pleural Effusion/diagnosis , Pneumonia, Bacterial/diagnosis , Tomography, X-Ray ComputedABSTRACT
Sparganosis in humans is an incidental infection and is known to be associated with eating insufficiently cooked meat of frogs and snakes or drinking unboiled stream water. Although it can involve various internal organs, pulmonary and pleural involvement due to sparganum is rare. Because we recently experienced two cases involving lung parenchyma and pleura that were misdiagnosed as bacterial pneumonia and lung cancer, we herein intend to present them in detail.
Subject(s)
Humans , Male , Middle Aged , Lung Diseases, Parasitic/diagnosis , Pleural Effusion/parasitology , Sparganosis/diagnosis , Biopsy , Diagnosis, Differential , Enzyme-Linked Immunosorbent Assay , Lung Diseases, Parasitic/parasitology , Lung Neoplasms/diagnosis , Pleural Effusion/diagnosis , Pneumonia, Bacterial/diagnosis , Tomography, X-Ray ComputedABSTRACT
The presence of numerous trypomastigote forms of Trypanosoma cruzi in the pleural fluid of a patient with AIDS from Santiago del Estero, Agentina, was detected. Chagas disease is endemic in some countries of Latin America. To our knowledge, the finding of trypomastigote forms of T. cruzi in the pleural fluid has not yet been described in the literature.
Se detectó la presencia de numerosos tripomastigotes de Trypanosoma cruzi en el líquido pleural de un paciente con SIDA proveniente de Santiago del Estero, Argentina. La enfermedad de Chagas es endémica en algunos países de América Latina. Según nuestro conocimiento el hallazgo de tripomastigotes de T. cruzi en el líquido pleural no ha sido previamente descrito en la literatura médica.
Subject(s)
Humans , Male , Middle Aged , AIDS-Related Opportunistic Infections/parasitology , Chagas Disease/diagnosis , Pleural Effusion/parasitology , Trypanosoma cruzi/isolation & purification , Fatal OutcomeABSTRACT
The presence of numerous trypomastigote forms of Trypanosoma cruzi in the pleural fluid of a patient with AIDS from Santiago del Estero, Argentina, was detected. Chagas disease is endemic in some countries of Latin America. To our knowledge, the finding of trypomastigote forms of T. cruzi in the pleural fluid has not yet been described in the literature.
Subject(s)
AIDS-Related Opportunistic Infections/parasitology , Chagas Disease/diagnosis , Pleural Effusion/parasitology , Trypanosoma cruzi/isolation & purification , Fatal Outcome , Humans , Male , Middle AgedABSTRACT
Paragonimiasis is a zoonosis affecting wild and domestic animals and human beings, caused by species of trematodes of the genus Paragonimus. Humans become infected after ingestion of raw or poorly cooked fresh water crustaceans. The aim of the present work is the description of a case of a 3-years old child, coming from Guárico State in Venezuela with a year of residence in the seashore of the Provincia Manabí in Ecuador, where he ate crabs in "ceviche". During hospitalization, he presented respiratory distress, hepatomegaly and nodules in the back. The thorax cat scan showed heavy infiltrate in both pulmonary bases and pleural compromise. Based on clinic, radiological images, an eosinophilia of 47% (Eosinophils absolute count (EAC) 6.682/mm3) and the antecedent of raw crabs ingestion, pulmonary paragonimiasis was diagnosed. Paragonimus eggs were not found in sputum and feces. ELISA with crude Paragonimus antigen was positive and Western blot revealed recognition of specific molecules. After treatment for three days with Praziquantel at a daily dose of 25 mg/kg body weight divided into three intakes, the sintomatology disappeared and radiological images and number of eosinophils diminished considerably.