RESUMO
INTRODUCTION: Systemic endemic mycoses are prevalent in specific geographical areas of the world and are responsible for high rates of morbidity and mortality in these populations, and in immigrants and travelers returning from endemic regions. The most common fungal infections that can affect the lungs of immunocompetent patients include histoplasmosis, coccidioidomycosis, paracoccidioidomycosis, blastomycosis, sporotrichosis, aspergillosis, and cryptococcosis. Diagnosis and management of these diseases remain challenging, especially in non-endemic areas due to the lack of experience. Therefore, recognition of the various radiologic manifestations of pulmonary fungal infections associated with patients' clinical and epidemiologic history is imperative for narrowing the differential diagnosis. Areas covered: This review discusses the clinical and radiological findings of the main endemic fungal diseases affecting the lungs in immunocompetent patients. Specific topics discussed are their etiology, epidemiology, pathogenesis, clinical manifestations, methods of diagnosis, pathology and main imaging findings, especially in computed tomography. Expert commentary: Imaging plays an important role in the diagnosis and management of pulmonary fungal infection and may reveal useful signs. Although definitive diagnosis cannot be made based on imaging features alone, the use of a combination of epidemiologic, clinical and imaging findings may permit the formulation of an adequate differential diagnosis.
Assuntos
Imunocompetência , Pneumopatias Fúngicas/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Aspergilose/diagnóstico por imagem , Blastomicose/diagnóstico por imagem , Coccidioidomicose/diagnóstico por imagem , Criptococose/diagnóstico por imagem , Doenças Endêmicas , Feminino , Histoplasmose/diagnóstico por imagem , Humanos , Pulmão/patologia , Pneumopatias Fúngicas/epidemiologia , Pneumopatias Fúngicas/patologia , Masculino , Esporotricose/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Sporotrichosis in children is rare, and its osteoarticular form is very unusual. Disseminated forms are described mostly in immunocompromised patients. We report a case of a 5-year-old immunocompetent boy with multiple suppurated cutaneous lesions that progressed to polyarthritis of the hands and feet. Radiographic imaging demonstrated multifocal lytic lesions. Sporotrichosis was diagnosed through biopsy and culture. This article describes the radiographic appearance of a rare manifestation of this disease. In areas of high prevalence, the diagnosis of sporotrichosis should be taken into account, even in immunocompetent patients, when dactylitis with lytic lesions is present.
Assuntos
Doenças Ósseas Infecciosas/diagnóstico por imagem , Doenças Ósseas Infecciosas/microbiologia , Sporothrix/isolamento & purificação , Esporotricose/diagnóstico por imagem , Esporotricose/microbiologia , Doenças Ósseas Infecciosas/imunologia , Pré-Escolar , Diagnóstico Diferencial , Humanos , Imunocompetência/imunologia , Masculino , Radiografia , Doenças Raras/diagnóstico por imagem , Doenças Raras/imunologia , Doenças Raras/microbiologia , Esporotricose/imunologiaRESUMO
Sporotrichosis is an uncommon mycosis of dogs caused by Sporothrix schenckii. This report details the diagnosis and treatment of intranasal sporotrichosis in a dog presented for a loss of smell, sneezing, and nasal congestion. Following 6 months of itraconazole treatment, a computed tomography scan showed a complete resolution of previously identified abnormalities.
Assuntos
Antifúngicos/uso terapêutico , Doenças do Cão/tratamento farmacológico , Itraconazol/uso terapêutico , Esporotricose/veterinária , Animais , Doenças do Cão/diagnóstico por imagem , Cães , Feminino , Sporothrix/patogenicidade , Esporotricose/diagnóstico por imagem , Esporotricose/tratamento farmacológico , Tomografia Computadorizada por Raios X/veterinária , Resultado do TratamentoAssuntos
Antifúngicos/uso terapêutico , Calafrios , Febre , Itraconazol/uso terapêutico , Esporotricose/tratamento farmacológico , Calafrios/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Febre/diagnóstico por imagem , Humanos , Pulmão/diagnóstico por imagem , Pessoa de Meia-Idade , Radiografia , Esporotricose/diagnóstico por imagemRESUMO
Summary A case of mucocutaneous sporotrichosis presenting as mycotic pansinusitis with polyposis with intracranial and intraorbital extension in a patient from Punjab, India is described. The patient had nasal discharge, sneezing and nasal obstruction for 12 years, had undergone repeated surgeries (for endoscopic clearance) but had recurrence. Computerized tomography (CT) and magnetic resonance imaging (MRI) findings revealed pansinusitis. A definitive diagnosis of sporotrichosis was established by culture of Sporothrix schenckii, verification of its dimorphic character and a positive pathogenicity test. The patient was successfully treated with potassium iodide and itraconazole.
Assuntos
Doenças dos Seios Paranasais/microbiologia , Sporothrix/isolamento & purificação , Esporotricose/microbiologia , Adulto , Animais , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Feminino , Humanos , Itraconazol/administração & dosagem , Itraconazol/uso terapêutico , Imageamento por Ressonância Magnética , Camundongos , Doenças dos Seios Paranasais/diagnóstico por imagem , Doenças dos Seios Paranasais/tratamento farmacológico , Iodeto de Potássio/administração & dosagem , Iodeto de Potássio/uso terapêutico , Sporothrix/patogenicidade , Esporotricose/diagnóstico por imagem , Esporotricose/tratamento farmacológico , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Ten cats with sporotrichosis were examined clinically and pathologically. They were in very poor general condition, and had widespread ulcerated cutaneous lesions and respiratory signs. Gross internal abnormalities were found only in the lungs and lymph nodes. Histologically, an inflammatory infiltrate and yeast-like structures were observed in the skin, lungs, liver and lymph nodes. The spleen was congested and contained fungal elements. No microscopical changes were observed in the pancreas, kidneys and heart. Sporothix schenckii was isolated from all the skin samples and nasal swabs obtained in vivo, and from all the samples of lung, liver, spleen, lymph nodes, heart and kidney taken postmortem.
Assuntos
Doenças do Gato/microbiologia , Doenças do Gato/patologia , Esporotricose/patologia , Esporotricose/veterinária , Animais , Brasil , Doenças do Gato/diagnóstico por imagem , Doenças do Gato/tratamento farmacológico , Gatos , Feminino , Itraconazol/uso terapêutico , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Pulmão/patologia , Masculino , Radiografia , Esporotricose/diagnóstico por imagem , Esporotricose/tratamento farmacológicoAssuntos
Artrite Infecciosa/diagnóstico , Esporotricose/diagnóstico , Artralgia , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/patologia , Artrite Infecciosa/fisiopatologia , Mãos/diagnóstico por imagem , Mãos/patologia , Humanos , Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Osteoartrite , Radiografia , Sporothrix , Esporotricose/diagnóstico por imagem , Esporotricose/patologia , Esporotricose/fisiopatologiaRESUMO
The small number of patients suffering from pulmonary involvement with Sporothrix schenckii has prevented prospective controlled studies that could determine the optimal therapy for this chronic infection. The clinician's ability to determine the best medical treatment for chronic cavitary pulmonary sporotrichosis is also tempered by the limited use of newer azole antifungal agents in this disorder as well as the relative lack of efficacy reported with older therapies. We present a 50-year-old male with primary pulmonary sporotrichosis whose chronic cavitary disease responded to oral itraconazole.
Assuntos
Antifúngicos/administração & dosagem , Itraconazol/administração & dosagem , Pneumopatias Fúngicas/tratamento farmacológico , Esporotricose/tratamento farmacológico , Administração Oral , Anticorpos Antifúngicos/isolamento & purificação , Doença Crônica , Humanos , Pneumopatias Fúngicas/diagnóstico por imagem , Pneumopatias Fúngicas/imunologia , Masculino , Pessoa de Meia-Idade , Sporothrix/imunologia , Esporotricose/diagnóstico por imagem , Esporotricose/imunologia , Tomografia Computadorizada por Raios XRESUMO
A 27-year-old man, who had been shoveling gravel in southern Texas for 3 years, had a history of papules and nodules in the left lateral wall of the abdomen. The lesions increased in number and severity with spread to other regions of the body. A punch biopsy of the right arm lesion revealed intracellular, round and cigar shaped budding yeast. The cultures grew Sporotrichum schenkii. Three-phase bone imaging and a Ga-67 scan defined the extent of the disease including involvement of the right tibia, left second metacarpal, and the left wrist joints, the latter two of which were not apparent on clinical examination.
Assuntos
Osso e Ossos/diagnóstico por imagem , Osteomielite/diagnóstico por imagem , Esporotricose/diagnóstico por imagem , Adulto , Radioisótopos de Gálio , Humanos , Artropatias/diagnóstico por imagem , Artropatias/microbiologia , Masculino , Osteomielite/microbiologia , Cintilografia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/microbiologiaAssuntos
Hemoptise/etiologia , Pneumopatias Fúngicas/diagnóstico , Esporotricose/diagnóstico , Adulto , Biópsia , Diagnóstico Diferencial , Humanos , Pneumopatias Fúngicas/diagnóstico por imagem , Pneumopatias Fúngicas/patologia , Masculino , Esporotricose/diagnóstico por imagem , Esporotricose/patologia , Escarro/microbiologia , Tomografia Computadorizada por Raios XAssuntos
Doenças Ósseas/diagnóstico por imagem , Esporotricose/diagnóstico por imagem , Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Doenças Ósseas/parasitologia , Humanos , Masculino , Pele/parasitologia , Sporothrix/isolamento & purificação , Tíbia/parasitologiaRESUMO
A case of articular sporotrichosis occurring in the wrist and ankle of a 39-year-old man is reported. Review of the literature on this disorder confirms the diagnostic difficulties presented by this usually chronic, progressive, fungal arthritis. The diagnosis of this entity should be considered in the evaluation of any patient presenting with a progressive destructive arthritic process. The pathological and radiological features of a typical case are discussed and the mechanisms of infection and type of individual affected by this disease are described.
Assuntos
Artrite Infecciosa/diagnóstico por imagem , Esporotricose/diagnóstico por imagem , Adulto , Humanos , Masculino , RadiografiaRESUMO
Sporothrix schenckii produces an insidious debilitating illness in humans. The lungs are seldom involved and pleural involvement is distinctly unusual, with only four patients described in the literature. We have described a patient with both parenchymal lung disease and pleural effusion. The characteristics of the pleural fluid were unlike those previously reported, and suggest that the coexistence of a parenchymal Sporothrix infiltrate may alter the nature of the pleural fluid to mimic an empyema rather than a self-limited hypersensitivity reaction.
Assuntos
Empiema/etiologia , Pneumopatias Fúngicas/complicações , Esporotricose/complicações , Empiema/diagnóstico por imagem , Humanos , Cetoconazol/uso terapêutico , Pneumopatias Fúngicas/diagnóstico por imagem , Pneumopatias Fúngicas/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Iodeto de Potássio/uso terapêutico , Radiografia , Esporotricose/diagnóstico por imagem , Esporotricose/tratamento farmacológicoRESUMO
Pulmonary sporotrichosis is an uncommon condition that may mimic tuberculosis. We present a patient who, years after antifungal therapy, presented with massive pulmonary hemorrhage. Although such life-threatening hemoptysis caused by sporotrichosis is rare, the possibility of this complication of progressive disease should influence decisions regarding medical and surgical treatment of patients with extensive cavitary involvement.