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1.
Neumol. pediátr. (En línea) ; 14(2): 81-85, jul. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1014999

RESUMO

At present, there is no specific treatment for primary ciliary dyskinesia, nor controlled and randomized clinical trials to determine how the management and monitoring of these patients should be considered. The therapeutic options are extrapolated from other diseases, such as cystic fibrosis, or non-cystic fibrosis bronchiectasis. However, the implementation of specific groups of experts, both in the USA (PDC-foundation) and in Europe (BESTCILIA or BEAT-PD), are helping to increase knowledge of the disease, opening research channels and seeking new treatments. Until we have therapies capable of correcting the basic defect of the disease, the pillars of treatment are the daily cleansing of the airways and aggressive antibiotherapy against respiratory infections. Multidisciplinary care in specialized centers where pulmonary function is monitored and the infection is prevented and treated will improve, as in cystic fibrosis, the results of patients.


En la actualidad no existe un tratamiento específico para la discinesia ciliar primaria, ni se cuenta con ensayos clínicos controlados y randomizados que permitan determinar cómo debe plantearse el manejo y seguimiento de estos pacientes. Las opciones terapéuticas son extrapoladas de otras enfermedades, como la fibrosis quística, o las bronquiectasias no fibrosis quística. Sin embargo, la puesta en marcha de grupos específicos de expertos, tanto en USA (PDC-foundation) como en Europa (BESTCILIA o BEAT-PD), están permitiendo incrementar el conocimiento de la enfermedad, abriendo vías de investigación y buscando nuevos tratamientos. Hasta contar con terapias capaces de corregir el defecto básico de la enfermedad, los pilares del tratamiento son la limpieza diaria de las vías aéreas y la antibioterapia agresiva frente a las infecciones respiratorias. La atención multidisciplinar en centros especializados donde se monitorice la función pulmonar y se prevengan y traten las infecciones mejorará, como en la fibrosis quística, los resultados de los pacientes.


Assuntos
Humanos , Síndrome de Kartagener/diagnóstico , Síndrome de Kartagener/fisiopatologia , Síndrome de Kartagener/genética , Síndrome de Kartagener/terapia , Infecções Respiratórias/tratamento farmacológico , Seguimentos , Pneumopatias/fisiopatologia , Pneumopatias/terapia , Pneumopatias Fúngicas
2.
Can Assoc Radiol J ; 70(3): 273-281, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31104862

RESUMO

Histoplasmosis is primarily a pulmonary fungal infection with a vast array of radiological manifestations, which can mimic a number of thoracic diseases. This article reviews various presentations of histoplasmosis on chest imaging.


Assuntos
Histoplasmose/diagnóstico por imagem , Pneumopatias Fúngicas/diagnóstico por imagem , Radiografia Torácica/métodos , Diagnóstico Diferencial , Humanos , Pulmão/diagnóstico por imagem
4.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(5): 431-435, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31104657

RESUMO

OBJECTIVE: To study the clinical features of children with bronchial asthma complicated by pulmonary fungal infection and the risk factors for pulmonary fungal infection. METHODS: A retrospective analysis was performed for the clinical data of 150 children with bronchial asthma who were admitted from January 2015 to June 2018. Among these children, 75 had pulmonary fungal infection (fungal infection group) and 75 did not have such infection (control group). The distribution of pathogenic fungi, clinical symptoms/signs and treatment outcome were recorded for the fungal infection group. The multivariate logistic regression analysis was used to investigate the risk factors for pulmonary fungal infection. RESULTS: A total of 69 pathogenic fungi were detected in 75 children in the fungal infection group, among which Candida albicans had the highest detection rate of 61%. Major clinical symptoms were cough (93%), persistent high fever (56%), wheezing (49%) and dyspnea (48%). Major signs were dry and moist rales (43%) and moist rales (29%). Parts of children had hepatosplenomegaly. Among the 75 children in the fungal infection group, 39 were markedly improved, 26 were improved, 7 had no response, and 3 experienced aggravation and then died. Age <3 years, comorbidities of nasosinusitis and/or allergic rhinitis, asthma attacks of >3 times during hospitalization, intravenous administration of glucocorticoids, non-rational use of antibiotics, mechanical ventilation and prolonged hospital stay were independent risk factors for pulmonary fungal infection in children with asthma (OR=4.865, 3.241, 2.255, 3.725, 3.568, 1.549, 3.808; P<0.05). CONCLUSIONS: Pulmonary fungal infection should be considered for asthmatic children with cough, persistent high fever, obvious dry and moist rales and hepatosplenomegaly. The asthmatic children with an age of <3 years, comorbidities of nasosinusitis and/or allergic rhinitis, asthma attacks of >3 times during hospitalization, intravenous administration of glucocorticoids, non-rational use of antibiotics, mechanical ventilation or prolonged hospital stay have a higher risk for secondary pulmonary fungal infection.


Assuntos
Asma , Pneumopatias Fúngicas , Rinite Alérgica , Criança , Humanos , Estudos Retrospectivos , Fatores de Risco
5.
Medicine (Baltimore) ; 98(17): e15264, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027078

RESUMO

RATIONALE: Histoplasmosis occurs most commonly in Northern and Central America and Southeast Asia. Increased international travel in Japan has led to a few annual reports of imported histoplasmosis. Healed sites of histoplasmosis lung infection may remain as nodules and are often accompanied by calcification. Previous studies in endemic areas supported the hypothesis that new infection/reinfection, rather than reactivation, is the main etiology of symptomatic histoplasmosis. No previous reports have presented clinical evidence of reactivation. PATIENT CONCERNS: An 83-year-old Japanese man was hospitalized with general fatigue and high fever. He had been treated with prednisolone at 13 mg/d for 7 years because of an eczematous skin disease. He had a history of travel to Los Angeles, Egypt, and Malaysia 10 to 15 years prior to admission. Five years earlier, computed tomography (CT) identified a solitary calcified nodule in the left lingual lung segment. The nodule size remained unchanged throughout a 5-year observation period. Upon admission, his respiratory condition remained stable while breathing room air. CT revealed small, randomly distributed nodular shadows in the bilateral lungs, in addition to the solitary nodule. DIAGNOSIS: Disseminated histoplasmosis, based on fungal staining and cultures of autopsy specimens. INTERVENTIONS: The patient's fever continued despite several days of treatment with meropenem, minocycline, and micafungin. Although he refused bone marrow aspiration, isoniazid, rifampicin, ethambutol, and prednisolone were administered for a tentative diagnosis of miliary tuberculosis. OUTCOMES: His fever persisted, and a laboratory examination indicated severe thrombocytopenia with disseminated intravascular coagulation. He died on day 43 postadmission. During autopsy, the fungal burden was noted to be higher in the calcified nodule than in the disseminated nodules of the lung, suggesting a pathogenesis involving endogenous reactivation of the nodule and subsequent hematogenous and lymphatic spread. LESSONS: Physicians should consider histoplasmosis in patients with calcified nodules because the infection may reactivate during long-term corticosteroid therapy.


Assuntos
Histoplasmose/patologia , Pneumopatias Fúngicas/patologia , Idoso de 80 Anos ou mais , Calcinose , Eczema/complicações , Eczema/tratamento farmacológico , Glucocorticoides/uso terapêutico , Histoplasmose/complicações , Humanos , Hospedeiro Imunocomprometido , Japão , Pneumopatias Fúngicas/complicações , Masculino , Tomografia Computadorizada por Raios X
6.
Transplant Proc ; 51(2): 561-564, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30879590

RESUMO

BACKGROUND: In transplant recipients, due to the use of immunosuppressive therapy, it is occasionally difficult to distinguish between an infection and malignancy, especially in the case of a lung lesion. Here, we report a case of isolated pulmonary cryptococcosis after kidney transplantation that was difficult to distinguish from a lung tumor. CASE REPORT: A 52-year-old man underwent a kidney transplant from his mother when he was 44 years old. Immunosuppression was maintained with tacrolimus, methylprednisolone, and mycophenolate mofetil. His post-transplant course was uneventful and serum creatinine levels were maintained. Five years post-transplantation, a non-contrast computed tomography (CT) examination revealed a nodule measuring 3 mm in diameter in the middle lobe of the right lung. The nodule gradually increased to 12 mm in 2 years. Positron emission tomography/CT examination showed a maximum standardized uptake value of 0.5 for the nodule. Biochemical examination revealed no elevation in total leucocyte count and C-reactive protein levels. However, tumor markers were elevated: serum carcinoembryonic antigen, 5.9 ng/mL; pro-gastrin-releasing peptide, 84.6 pg/mL. Furthermore, the serum cryptococcus antigen was negative. Therefore, thoracoscopic partial lung resection was performed. Pathologically, a number of spherical fungi from the necrotic substance of the tumor were confirmed positive by periodic acid-Schiff and Grocott-Gomori staining. The patient was therefore diagnosed with pulmonary cryptococcosis. Two years later, the patient is alive and has shown no evidence of recurrence. CONCLUSIONS: In lung nodules after kidney transplantation, even if serum cryptococcus antigen is not identified, it is necessary to keep in mind the possibility of pulmonary cryptococcosis.


Assuntos
Criptococose/imunologia , Hospedeiro Imunocomprometido , Transplante de Rim/efeitos adversos , Pneumopatias Fúngicas/imunologia , Humanos , Imunossupressão/efeitos adversos , Pneumopatias Fúngicas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Masculino , Pessoa de Meia-Idade
7.
Med Mycol ; 57(Supplement_2): S110-S117, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30816974

RESUMO

Fungal asthma broadly encompasses the presence of fungal sensitization or fungal allergy in patients with asthma. The clinical presentation of fungal asthma can vary from fungal-sensitized asthma at one end to allergic bronchopulmonary mycosis at the other end of the spectrum. Here we present five cases that illustrate some of the most challenging aspects of the diagnosis and management of fungal asthma. The cases are aimed at elucidating complex clinical presentations in fungal asthma such as allergic bronchopulmonary mycosis presenting with normal immunoglobulin E (IgE) values, the role of several different fungi in causing allergic mycosis, newer treatments like omalizumab (and mepolizumab), and a complication of long-standing allergic bronchopulmonary aspergillosis, namely, chronic pulmonary aspergillosis.


Assuntos
Asma/etiologia , Gerenciamento Clínico , Pneumopatias Fúngicas/complicações , Antifúngicos/uso terapêutico , Asma/diagnóstico , Testes Diagnósticos de Rotina/métodos , Humanos , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/tratamento farmacológico
8.
PLoS Pathog ; 15(3): e1007627, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30897162

RESUMO

Cryptococcus neoformans is a leading cause of invasive fungal infections among immunocompromised patients. However, the cellular constituents of the innate immune response that promote clearance versus progression of infection upon respiratory acquisition of C. neoformans remain poorly defined. In this study, we found that during acute C. neoformans infection, CCR2+ Ly6Chi inflammatory monocytes (IM) rapidly infiltrate the lungs and mediate fungal trafficking to lung-draining lymph nodes. Interestingly, this influx of IM is detrimental to the host, since ablating IM or impairing their recruitment to the lungs improves murine survival and reduces fungal proliferation and dissemination. Using a novel conditional gene deletion strategy, we determined that MHC class II expression by IM did not mediate their deleterious impact on the host. Furthermore, although ablation of IM reduced the number of lymphocytes, innate lymphoid cells, and eosinophils in the lungs, the effects of IM were not dependent on these cells. We ascertained that IM in the lungs upregulated transcripts associated with alternatively activated (M2) macrophages in response to C. neoformans, consistent with the model that IM assume a cellular phenotype that is permissive for fungal growth. We also determined that conditional knockout of the prototypical M2 marker arginase 1 in IM and deletion of the M2-associated transcription factor STAT6 were not sufficient to reverse the harmful effects of IM. Overall, our findings indicate that C. neoformans can subvert the fungicidal potential of IM to enable the progression of infection through a mechanism that is not dependent on lymphocyte priming, eosinophil recruitment, or downstream M2 macrophage polarization pathways. These results give us new insight into the plasticity of IM function during fungal infections and the level of control that C. neoformans can exert on host immune responses.


Assuntos
Criptococose/imunologia , Monócitos/fisiologia , Receptores CCR2/metabolismo , Animais , Criptococose/patologia , Cryptococcus neoformans/metabolismo , Cryptococcus neoformans/patogenicidade , Modelos Animais de Doenças , Interações Hospedeiro-Patógeno/imunologia , Imunidade Inata/imunologia , Imunidade Inata/fisiologia , Infecção , Inflamação/imunologia , Inflamação/microbiologia , Pulmão/patologia , Pneumopatias Fúngicas/fisiopatologia , Macrófagos , Camundongos , Camundongos Endogâmicos C57BL , Monócitos/imunologia , Monócitos/microbiologia , Receptores CCR2/genética
9.
Microb Pathog ; 129: 168-175, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30742949

RESUMO

In this present study, for the first time, we evaluated the cystic fibrosis (CF) patients for the Scedosporium species and their antifungal susceptibility against eight antifungal agents. During one-year period, 90 Sputum samples were collected from Iranian CF patients. All samples were evaluated by direct microscopic examination, culture onto four different media including Malt extract agar, Inhibitory mold agar, Brain Heart Infusion and Scedo-Select III. The mold isolated fungi were identified by PCR-Sequencing of ITS and ß-tubulin genes. In-vitro antifungal susceptibility was performed according to the Clinical & Laboratory Standards Institute (CLSI) M38-A2 guidelines. Out of 90 CF patients, 47 (52.2%) were male. The age of the patients ranged from 1 to 34 years (median of 15.84 ±â€¯7.41 years). Overall, 3 (3.3%) cases were positive for Scedosporium spp. of which two isolates were characterized as Scedosporium boydii and one isolate as S. ellipsoideum. Among Aspergillus genus, A. flavus (29.4%) was the most prevalent species followed by A. tubingensis (24.7%), A. niger (17.0%) and A. fumigatus (14.5%). The minimum effective concentration ranges of micafungin, anidulafungin, and caspofungin were 0.008-0.031 µg/mL, 0.0625-0.25 µg/mL, and 0.0625-0.25 µg/mL, respectively. All isolates of Scedosporium species showed high minimum inhibitory concentration to the triazoles tested, except voriconazole. Our results showed that A. flavus and Scedosporium species are the most prevalent molds isolated from CF patient populations in Iran. Our findings have also showed that Scedo-Select III can be used as a reliable culture media for isolation of Scedosporium spp. in clinical samples.


Assuntos
Fibrose Cística/complicações , Pneumopatias Fúngicas/epidemiologia , Pneumopatias Fúngicas/microbiologia , Scedosporium/isolamento & purificação , Adolescente , Adulto , Antifúngicos/farmacologia , Criança , Pré-Escolar , Análise por Conglomerados , DNA Fúngico/química , DNA Fúngico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Feminino , Humanos , Lactente , Irã (Geográfico)/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Técnicas Microbiológicas , Microscopia , Filogenia , Prevalência , Estudos Prospectivos , Scedosporium/classificação , Scedosporium/genética , Análise de Sequência de DNA , Tubulina (Proteína)/genética , Adulto Jovem
10.
J Mycol Med ; 29(1): 80-83, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30553628

RESUMO

Pulmonary mucormycosis is a rare opportunistic infection caused by Mucormycosis. This fungal infection is uncommon in immunocompetent individuals. Because of its various clinical and imaging manifestations, it is a diagnostic challenge to distinguish pulmonary mucormycosis from other pulmonary diseases, such as carcinoma. Herein, we report a case of pulmonary mucormycosis presenting as Pancoast syndrome and bone destruction of ribs. A 46-year-old Chinese woman was admitted due to pain in chest, right neck and arm for four months and hoarseness for one week. The pre-admission diagnosis via chest CT was pulmonary carcinoma. The subsequent bronchoalveolar lavage fluid analysis and bronchoscopic biopsy were negative for malignant cells, except chronic inflammation. Imaging-guided percutaneous biopsies were carried out after admission and the final pathological diagnosis was pulmonary mucormycosis. Although the patient was started on oral posaconazole of 400mg bid, the disease condition continued to deteriorate. She finally died of respiratory failure.


Assuntos
Osso e Ossos/patologia , Pneumopatias Fúngicas/diagnóstico , Mucormicose/diagnóstico , Síndrome de Pancoast/diagnóstico , Antifúngicos/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Imunocompetência , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Pneumopatias Fúngicas/tratamento farmacológico , Neoplasias Pulmonares/diagnóstico , Pessoa de Meia-Idade , Mucormicose/tratamento farmacológico , Infecções Oportunistas/diagnóstico , Síndrome de Pancoast/tratamento farmacológico , Tomografia Computadorizada por Raios X
11.
Autops. Case Rep ; 8(4): e2018065, Oct.-Dec. 2018. ilus
Artigo em Inglês | LILACS | ID: biblio-986613

RESUMO

Histoplasmosis is a mycosis caused by the dimorphic fungus, Histoplasma capsulatum, which is transmitted via dust and aerosols. Lung involvement is the most common, with a varied clinical presentation. Although it is not the only source of infection, H. capsulatum is frequently found in bat guano, which is the reason why it is highly prevalent among caving practitioners. The solitary histoplasmoma of the lung is an unusual and chronic manifestation of this entity, which mimics, or at least is frequently misconstrued, as a malignancy. Almost invariably, the diagnosis of this type of histoplasmosis presentation is achieved after lung biopsy. The authors present the case of a young woman who sought medical care because of chest pain. The diagnostic work-up revealed the presence of a pulmonary nodule. She was submitted to a thoracotomy and wedge pulmonary resection. The histologic analysis rendered the diagnosis of histoplasmoma. Thisreport aims to call attention to this diagnosis as the differential diagnosis of a pulmonary nodule.


Assuntos
Humanos , Feminino , Adulto , Histoplasmose/diagnóstico , Pneumopatias Fúngicas/diagnóstico , Diagnóstico Diferencial , Doença Granulomatosa Crônica , Histoplasmose/patologia , Pneumopatias Fúngicas/patologia
12.
Rev Inst Med Trop Sao Paulo ; 61: e2, 2018 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-30570075

RESUMO

Although colony-forming unit (CFU) counting is widely used to quantify fungal load in tissue from animal experimentally infected with Paracoccidioides brasiliensis, several technical disadvantages have been described. Here we developed highly accurate quantitative PCR (qPCR) assays to determine the relative P brasiliensis load in lungs from infected mice. SYBR Green- and TaqMan-based assays using primers and probe for the 43-kDa glycoprotein (gp43) gene detected as little as 270 gene copies (about 2 fg of DNA) per reaction. Although qPCR assays cannot distinguish between living and dead yeasts, we found a highly positive linear correlation between CFU and qPCR.


Assuntos
Pneumopatias Fúngicas/microbiologia , Pulmão/microbiologia , Paracoccidioides , Paracoccidioidomicose/microbiologia , Animais , Contagem de Colônia Microbiana , Modelos Animais de Doenças , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Reação em Cadeia da Polimerase em Tempo Real , Reprodutibilidade dos Testes , Células-Tronco
13.
Clin Lab ; 64(11)2018 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-30549981

RESUMO

Background: Cryptococcal pneumonia is an uncommon lesion in immune-competent adults. Histological evidence of Cryptococcus neoformans is a gold criterion for diagnosis. Here we report a case firstly misdiagnosed as tuberculosis from a lung biopsy. Methods: Chest computed tomography (CT) scan and CT-guided puncture were performed for diagnosis and blood tests explored for the latent etiology. Results: Chest CT scan images showed multiple nodules in the left peripheral lower lobe. Histopathology demonstrated multiple granulomatous inflammatory response lacking evidence of Cryptococcus neoformans, acid-fast staining was negative, serum cryptococcal antigen was positive. Conclusions: Serum cryptococcal antigen has high specificity in cryptococcal pneumonia.


Assuntos
Antígenos de Fungos/sangue , Criptococose/diagnóstico , Cryptococcus neoformans/imunologia , Pneumopatias Fúngicas/diagnóstico , Tuberculose Pulmonar/diagnóstico , Adulto , Biópsia , Criptococose/sangue , Criptococose/microbiologia , Cryptococcus neoformans/fisiologia , Erros de Diagnóstico , Humanos , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Pulmão/patologia , Pneumopatias Fúngicas/sangue , Pneumopatias Fúngicas/microbiologia , Masculino , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/patologia
14.
Rev. Fac. Cienc. Méd. Univ. Cuenca ; 36(2): 55-63, Noviembre 2018. ilus
Artigo em Espanhol | LILACS | ID: biblio-998699

RESUMO

La micosis pulmonar mixta es una entidad muy poco común, aún más en pacientes sin inmunodepresión, a continuación, se exponen los hallazgos epidemiológicos y clínicos que explican la masiva invasión micótica en un estado inmune normal. Resumen del Caso: Se trata de una paciente femenina, adulta, sin antecedentes médicos de importancia, que debuta con cuadro de insuficiencia respiratoria aguda y hemoptisis, la evidencia imagenológica y microbiológica permitió el diagnóstico de aspergilosis pulmonar angio-invasiva coexistente con candidiasis pulmonar; se empleó terapia anti fúngica solucionando así la infección. Conclusión: Una micosis pulmonar mixta depende de la exposición de la fuente de infección y puede coexistir en inmunocompetencia gracias a la acción exfoliativa de los patógenos y los sustratos que el huésped produzca.


Mixed pulmonary mycosis is a very rare entity, even more so in patients without immunosuppression, then the epidemiological and clinical findings explain the massive mycotic invasion in a normal immune state. Case Summary: This case is about a female patient, adult, with medical background, who debuted with acute respiratory failure and hemoptysis, the imaging and microbiological evidence allowed the diagnosis of pulmonary angio-invasive aspergillosis coexisting with pulmonary candidiasis; Antifungal therapy was used to solve the infection Conclusion: A mixed pulmonary mycosis depends on the exposure of the source of infection and can coexist in immunocompetence due to the exfoliative action of the pathogens and the substrates that the host produces.


Assuntos
Humanos , Terapêutica , Pneumopatias , Pneumopatias Fúngicas , Sorologia , Diagnóstico por Imagem , Epidemiologia , Infecção Focal
15.
Medicine (Baltimore) ; 97(39): e12612, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30278580

RESUMO

RATIONALE: Aspergillus and Cryptococcus exposure can cause serious secondary infections in human lungs, especially in immunocompromised patients or in conjunction with a chronic disease caused by low disease resistance. Primary invasive fungal infections are clinically rare; therefore, coexistence of 2 fungi at an infection site is uncommon. This paper reports a case of healthy male who was diagnosed with both Cryptococcus neoformans and Aspergillus infections. PATIENT CONCERNS: A healthy 33-year-old male office worker was admitted to the Second Hospital of Jilin University for hemoptysis. A chest computed tomography (CT) scan showed a cavity, which was formed by the thick dorsal wall of the lower left lobe with an irregular inner wall and burr changes around the lesion. INTERVENTION: After 1.0 week of antibiotic and antituberculosis treatment, the hemoptysis symptoms remained. A resection of the left lower lobe was performed. DIAGNOSES: The postoperative pathological reports indicated the presence of both Aspergillus and Cryptococcus. The 2 fungal lesions were separate but within the same location. OUTCOMES: After treatment, the patient no longer had hemoptysis. LESSONS: The current study indicated that fungi can infect not only immunocompromised patients but also healthy people, and that there can be 2 separate fungal infections at the same infection site.


Assuntos
Aspergilose/diagnóstico , Coinfecção , Criptococose/diagnóstico , Cryptococcus neoformans , Pneumopatias Fúngicas/diagnóstico , Adulto , Aspergilose/imunologia , Criptococose/imunologia , Hemoptise/microbiologia , Humanos , Imunocompetência , Pneumopatias Fúngicas/imunologia , Masculino
16.
Rev. patol. respir ; 21(3): 92-95, jul.-sept. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-175821

RESUMO

La actinomicosis es una enfermedad crónica granulomatosa infrecuente causada por Actinomyces spp, una bacteria anaerobia gram positiva que normalmente coloniza la boca, genitales y tracto digestivo en humanos1. En la mayor parte de los casos, la enfermedad se manifiesta en la región cervicofacial. Sin embargo, se han descrito varios casos en los que la actinomicosis puede simular procesos malignos en localizaciones no comunes, como en el pulmón. Se presenta el caso de una paciente con un cuadro constitucional de 20 días de evolución con una masa paramediastínica, a la que se le diagnostica de actinomicosis pulmonar tras una lobectomía por sospecha clínica de malignidad


Actinomycosis is a rare chronic granulomatous disease caused by Actinomyces spp, an anaerobic gram positive bacteria that colonizes mouth, large bowel and genitals. Actinomycosis occurs most frequently at oral and cervicofacial region. Less commonly affected areas include thoracic, abdominal, pelvic and central nervous system. We report a case about a patient with constitucional syndrome and a paramediastinal ma ss who was diagnosed with pulmonary actinomycosis after a lobectomy because of clinical suspicion of malingnancy


Assuntos
Humanos , Feminino , Idoso , Pneumopatias Fúngicas , Neoplasias Pulmonares/diagnóstico , Actinomicose/diagnóstico , Diagnóstico Diferencial
17.
Rev. iberoam. micol ; 35(3): 117-122, jul.-sept. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-179570

RESUMO

Background: The role of culture-independent techniques (galactomannan, (1-3)-ß-d-glucan) in the early diagnosis of invasive fungal diseases (IFD) is well assessed in hematological patients, but there are no clear conclusions in patients with chronic obstructive pulmonary disease (COPD). Aims: To study the usefulness of nonculture-based techniques in the diagnosis of IFD in COPD-patients at risk for IFD. Methods: A prospective observational study based on monitoring COPD patients at risk for IFD during 2007-2010 was carried out. The presence of galactomannan, (1-3)-ß-d-glucan and an indirect immunofluorescence of Candida albicans germ tube specific antibodies (CAGTA) were performed. Results: Among 43 COPD patients, 16 (37.2%) were diagnosed with IFD: seven cases were proven IFD (five invasive candidemia - IC, one invasive aspergillosis - IA and a rhinocerebral zygomycosis) and nine probable IFD (seven IA and two IC). In the diagnosis of IC and IA, the negative predictive value (NPV) of (1-3)-ß-d-glucan was 100%. Regarding CAGTA in IC, NPV was 96.2%. Finally, NPV of galactomannan in IA was 91.2%. The area under the ROC curve for (1-3)-ß-d-glucan in IC and for the rest of the IFD cases was 0.86 (95% CI, 0.79-0.93) and 0.60 (95% CI, 0.43-0.77), for CAGTA in IC was 0.83 (95% CI, 0.74-0.91) and for galactomannan in IA was 0.71 (95% CI, 0.56-0.85). Positive (1-3)-ß-d-glucan preceded the growth of Candida (average of 1.7 days) in blood culture. Conclusions: In COPD patients at risk for IFD the assayed techniques are especially useful to rule out the presence of IFD


Antecedentes: El papel de las técnicas independientes de cultivo [galactomanano, (1-3)-ß-D-glucano] en el diagnóstico precoz de micosis invasoras (MI) está bien establecido en pacientes hematológicos, pero no existen conclusiones claras en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Objetivos: Estudiar la utilidad de las técnicas independientes de cultivo en el diagnóstico de MI en pacientes con EPOC que corren el riesgo de contraer una MI. Métodos: Se llevó a cabo un estudio prospectivo y observacional en que se supervisaron pacientes con EPOC que corrían el riesgo de contraer una MI de 2007 a 2010. Para ello se estableció la existencia de galactomanano, (1-3)-ß-D-glucano y se realizó el ensayo CAGTA (inmunofluorescencia indirecta para determinar la existencia de anticuerpos IgG frente a antígenos de la superficie de la fase micelial de Candida albicans). Resultados: Se diagnosticaron 16MI en 43pacientes con EPOC (37,2%): siete fueron MI probadas (cinco candidemias invasoras [CI], una aspergilosis invasora [AI] y una cigomicosis rinocerebral) y nueve fueron MI probables (siete AI y dos CI). En el diagnóstico de CI y AI, el valor predictivo negativo (VPN) del (1-3)-ß-D-glucano fue del 100%. En cuanto al CAGTA en CI, el VPN fue del 96,2%. Finalmente, el VPN del galactomanano en AI fue del 91,2%. El área bajo la curva ROC (receiver operating characteristic) del (1-3)-ß-D-glucano en CI y en el resto de los casos de MI fue 0,86 (IC95%=0,79-0,93) y 0,60 (IC95%=0,43-0,77), para CAGTA en CI fue 0,83 (IC95%=0,74-0,91) y para galactomanano en AI fue 0,71 (IC95%=0,56-0,85). La positividad del (1-3)-ß-D-glucano se anticipó como media 1,7días al crecimiento de Candida en el hemocultivo. Conclusiones: En pacientes con EPOC que corren el riesgo de contraer MI, estas técnicas son muy útiles para descartar la existencia de MI


Assuntos
Humanos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Doença Pulmonar Obstrutiva Crônica/complicações , Infecções Respiratórias/microbiologia , Infecções Fúngicas Invasivas/microbiologia , Candida albicans/isolamento & purificação , Infecção Hospitalar/microbiologia , Pneumopatias Fúngicas/epidemiologia , Estudos Prospectivos , Candidíase/epidemiologia
18.
BMJ Case Rep ; 20182018 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-30061139

RESUMO

Coccidioides is a fungus endemic to Southwestern USA and Northern Mexico which can be asymptomatic or result in a well-defined clinical syndrome of community-acquired pneumonia. On rare occasion, coccidioidomycosis may have atypical presentations as in our patient, a 25-year-old man admitted with a 2-month history of progressive dyspnoea and cough. He was found to have a large right-sided pneumothorax with exudative pleural effusion which did not resolve following thoracentesis. Decortication was performed which revealed a dense rind of inflammatory tissue covering all lobes of his right lung. Histopathology demonstrated hyphae resembling Aspergillus, but culture and serology confirmed Coccidioides immitis Following several months of antifungal therapy, he achieved complete clinical recovery with near-complete resolution of radiographic findings.


Assuntos
Antifúngicos/uso terapêutico , Coccidioides/isolamento & purificação , Coccidioidomicose/diagnóstico , Tosse/microbiologia , Pneumopatias Fúngicas/diagnóstico , Pneumotórax/microbiologia , Adulto , Coccidioidomicose/tratamento farmacológico , Coccidioidomicose/fisiopatologia , Dispneia/microbiologia , Humanos , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/fisiopatologia , Masculino , Pneumotórax/tratamento farmacológico , Pneumotórax/fisiopatologia , Resultado do Tratamento
19.
Rev. méd. hondur ; 86(1/2): 52-55, ene-. jul. 2018. ilus
Artigo em Espanhol | LILACS | ID: biblio-1008651

RESUMO

Introducción: El embolismo séptico es una enfermedad grave caracterizada por iniltrados pulmonares bilaterales aso-ciados a un foco infeccioso extrapulmonar. Se relaciona con endocarditis derecha, trombolebitis pelviana, accesos vasculares y a infecciones como osteomielitis, artritis séptica o piomiositis. El Staphylococcus aureus meticilino-resistente adquirido en la comunidad (SAMR-AC) es un patógeno virulento y emergente, que afecta a sujetos sin factores de riesgo conocidos. Casos clínicos: Primer caso; Masculino 17 años de edad, sano, antecedente de herida por clavo en pie izquierdo. Inicia 15 días después iebre, disnea y expectoración hemoptoica. Segundo caso; Masculino de 26 años sano, con antecedente de absceso submandibular el cual fue dre-nado por el servicio de Otorrinolaringología. Una semana después reiere iebre, disnea, dolor torácico y expectoración hemoptoica. Discusión; El embolismo séptico se produce con la llegada al pulmón de productos infectados, con microorganismos que general-mente son bacterias. En pacientes graves, que requieren tratamiento endovenoso, las drogas de elección son vancomicina, linezolid, tigeciclina o daptomicina...(AU)


Assuntos
Humanos , Masculino , Adolescente , Adulto , Embolia Pulmonar , Tromboflebite , Endocardite/complicações , Pneumopatias Fúngicas
20.
Autops. Case Rep ; 8(2): e2018028, Apr.-May 2018. tab, ilus
Artigo em Inglês | LILACS | ID: biblio-905529

RESUMO

In the advanced stage of AIDS, the diagnosis of the opportunistic infections may be challenging due to the high risk of performing invasive diagnostic methods in a patient with a critical clinical condition, as well as the correct interpretation of the results of microbiological exams. One of the challenges for the diagnosis and treatment of the opportunistic infections is that they may occur concomitantly in the same patient and they may mimic each other, leading to a high discrepancy between clinical and autopsy diagnoses. We describe the case of a 52-year-old man who was hospitalized because of weight loss, anemia, cough, and hepatosplenomegaly. During the investigation, the diagnosis of AIDS was made, and the patient developed respiratory failure and died on the fourth day of hospitalization. At autopsy, disseminated non-tuberculosis mycobacteriosis was found, affecting mainly the organs of the reticuloendothelial system. Also, severe and diffuse pneumonia caused by multiple agents (Pneumocystis jirovecii, Histoplasma capsulatum, suppurative bacterial infection, non-tuberculosis mycobacteria, and cytomegalovirus) was seen in a morphological pattern that could be called "collision pneumonia." The lesson from this case, revealed by the autopsy, is that in advanced AIDS, patients often have multiple opportunistic infections, so the principle of Ockham's razor­that a single diagnosis is most likely the best diagnosis­fails in this clinical context.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Síndrome de Imunodeficiência Adquirida/complicações , Infecções Oportunistas Relacionadas com a AIDS/complicações , Pneumopatias Fúngicas/complicações , Infecções Oportunistas Relacionadas com a AIDS/patologia , Autopsia , Infecções por Citomegalovirus/complicações , Evolução Fatal , Histoplasmose/complicações , Infecções por Micobactéria não Tuberculosa/complicações , Infecções por Pneumocystis/complicações
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