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1.
Radiol Med ; 125(1): 31-38, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31587180

RESUMO

RATIONAL AND OBJECTIVES: To compare thin-section computed tomography (CT) features of pulmonary cryptococcosis (PC) in immunocompetent and non-AIDS immunocompromised patients. MATERIALS AND METHODS: We retrospectively reviewed CT findings of 18 immunocompetent and 24 non-AIDS immunocompromised patients with clinically proven PC. Different patterns of pulmonary abnormalities between the two groups of patients were compared by Fisher's exact test. RESULTS: Pulmonary nodules were present in 37 of the 42 patients. Masses were detected in 16 patients and consolidation in 9. There were 12 patients with a solitary nodule or mass. Masses were associated with nodules in 12 patients. Consolidation was associated with nodules/masses in nine patients. The nodules/masses were associated with cavitations in 13 patients. Margination of nodules/masses was well defined in nine patients and ill-defined in 33. The abnormalities were predominantly distributed in the peripheral region of the lung (n = 29, 69.0%). The presence of cavitations in nodules/masses was significantly more frequent in non-AIDS immunocompromised than in immunocompetent patients (P = 0.001). CONCLUSIONS: The most common thin-section CT feature of PC was pulmonary nodules/masses, which were ill-defined and located peripherally. Cavitations within nodules/masses were more commonly found in non-AIDS immunocompromised patients. PC should be considered in the differential diagnosis of pulmonary nodules/masses.


Assuntos
Criptococose/diagnóstico por imagem , Imunocompetência , Hospedeiro Imunocomprometido , Pneumopatias Fúngicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Criptococose/patologia , Criptococose/cirurgia , Feminino , Humanos , Pneumopatias Fúngicas/patologia , Pneumopatias Fúngicas/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
2.
Medicine (Baltimore) ; 98(50): e18316, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852116

RESUMO

To describe the characteristics of concomitant lung cancer and pulmonary cryptococcosis (PC) cases.A total of 8 patients with lung cancer and coexisting PC, who were admitted to Fuzhou Pulmonary Hospital of Fujian from 1st January 2009 to 31st December 2015 and whose diagnoses were confirmed by pathological examinations, were studied.One patient had a history of diabetes mellitus and 1 had a history of treated with surgery. The lesions in 7 cases manifested as nodular shadows; only 1 case showed the lesion of the 2 diseases mergedmixed together, and it manifested as a large flake-like infiltrated shadow in the same lobe. The histological type in all of the patients was lung adenocarcinoma. Lung cancer stage was advanced (III-IV) in 25.0% of the cases. The 5 patients who received surgery and drug treatment are presently healthy following resection. Recurrence and metastasis of lung cancer following surgery occurred in 2 patients in whom the tumor was controlled again after anti-tumor treatment. One patient with advanced lung cancer and PC was treated with antifungal therapy in combination with antineoplastic chemotherapy, but she failed to improve and died 10 months after symptom onset during the follow-up period.PC coexisting with pulmonary carcinoma is rare. PC can manifest as pulmonary nodules and mimic malignant lesions, so it must be considered during a differential diagnosis of pulmonary nodules, especially in immunosuppressed patients.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico , Criptococose/diagnóstico , Biópsia Guiada por Imagem/métodos , Pneumopatias Fúngicas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Adenocarcinoma de Pulmão/complicações , Adenocarcinoma de Pulmão/cirurgia , Adulto , Idoso , Criptococose/complicações , Criptococose/cirurgia , Feminino , Seguimentos , Humanos , Pneumopatias Fúngicas/complicações , Pneumopatias Fúngicas/cirurgia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Pneumonectomia/métodos , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios X
3.
Medicine (Baltimore) ; 98(41): e17535, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593129

RESUMO

Scedosporium genus as a significant emerging opportunist causes a broad spectrum of disease in not only immunosuppressed but also immunocompetent patients. The lung is one of the most commonly encountered sites of Scedosporium infection. Due to its very high levels of antifungal resistance, surgery has been recommended as an important part in the treatment of pulmonary Scedosporium spp infection, even in immunocompetent cases. However, whether lung surgery could help to reduce the risk of death in immunocompetent patients is not clear.We retrospectively retrieved the records of pulmonary infections with Scedosporium species in immunocompetent patients through a comprehensive literature search. The association of surgery on all-cause mortality was explored using binary logistic regression (BLR). Receiver operating characteristic (ROC) curve analysis was carried out to evaluate the capability of the model.The comprehensive searching strategy yielded 33 case reports and 3 case series in total, with 40 individual patients being included. The overall mortality was 12.50%. The fatality rate was 9.09% (2/22) in cases with surgery and 16.67% (3/18) in cases without surgery (odds ratio, 0.50; 95% confidence interval, 0.07-3.38; P = .48). Consistently, BLR analysis identified no statistical association between surgery and reduced mortality (odds ratio, 1.19; 95% confidence interval, 0.09-15.64; P = .89), after adjusting for age, gender, and antifungal chemotherapy. The area under the ROC curve was 0.88.For immunocompetent patients with pulmonary Scedosporium spp infection, surgical therapy may not be associated with reduced mortality. Surgical excision could be considered but is not imperative in this group of patients.


Assuntos
Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/cirurgia , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/cirurgia , Scedosporium/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Farmacorresistência Fúngica/fisiologia , Feminino , Humanos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Pneumopatias Fúngicas/microbiologia , Pneumopatias Fúngicas/mortalidade , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Micoses/tratamento farmacológico , Micoses/epidemiologia , Micoses/microbiologia , Micoses/mortalidade , Estudos Observacionais como Assunto , Cuidados Pós-Operatórios , Infecções Respiratórias/microbiologia , Infecções Respiratórias/mortalidade , Estudos Retrospectivos , Scedosporium/isolamento & purificação , Voriconazol/administração & dosagem , Voriconazol/uso terapêutico
4.
BMC Infect Dis ; 19(1): 684, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31375066

RESUMO

BACKGROUND: Botrytis species are well known fungal pathogens of various plants but have not been reported as human pathogens, except as allergenic precipitants of asthma and hypersensitivity pneumonitis. CASE PRESENTATION: The asymptomatic patient was referred because of a nodule revealed by chest X-ray. Computed tomography (CT) showed a cavitary nodule in the right upper lobe of the lung. He underwent wedge resection of the nodule, which revealed necrotizing granulomas and a fungus ball containing Y-shaped filamentous fungi, which was confirmed histopathologically. Culture of the specimen yielded white to grayish cotton-like colonies with black sclerotia. We performed multilocus gene sequence analyses including three single-copy nuclear DNA genes encoding glyceraldehyde-3-phosphate dehydrogenase, heat-shock protein 60, and DNA-dependent RNA polymerase subunit II. The analyses revealed that the isolate was most similar to Botrytis elliptica. To date, the pulmonary Botrytis sp. infection has not recurred after lung resection and the patient did not require any additional medication. CONCLUSIONS: We report the first case of an immunocompetent patient with pulmonary Botrytis sp. infection, which has not recurred after lung resection without any additional medication. Precise evaluation is necessary for the diagnosis of pulmonary Botrytis infection because it is indistinguishable from other filamentous fungi both radiologically and by histopathology. The etiology and pathophysiology of pulmonary Botrytis infection remains unclear. Further accumulation and analysis of Botrytis cases is warranted.


Assuntos
Botrytis/patogenicidade , Pneumopatias Fúngicas/diagnóstico por imagem , Pneumopatias Fúngicas/microbiologia , Biópsia , Botrytis/genética , Proteínas Fúngicas/genética , Humanos , Pneumopatias Fúngicas/patologia , Pneumopatias Fúngicas/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
5.
Mycoses ; 62(10): 893-907, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31173415

RESUMO

BACKGROUND: Mucormycosis portends a poor prognosis with mortality rates ranging from 50% to 70% in pulmonary mucormycosis (PM) and up to 95% in disseminated disease. However, detailed outcomes data have been lacking. It remains unknown how to identify patients who would benefit from surgical resection. OBJECTIVES: We present our experience with patients undergoing surgical resection for PM, including an analysis of factors affecting postoperative survival. We also describe a thoracic surgeon's approach through illustrative cases. PATIENTS/METHODS: We conducted a single-centre retrospective study of all adult patients with PM who received antifungal therapy and underwent surgical resection or who received antifungal therapy alone at Stanford between January 2004 and June 2018. RESULTS: Twelve patients received antifungal therapy and underwent surgical resection and 13 patients received antifungal therapy alone. From infection onset to death (or right-censoring if still alive), patients who underwent surgical resection had a median survival of 406 days (mean, 561.3; range, 22-2510), and patients who received antifungal therapy alone had a median survival of 28 days (mean, 66.7; range, 8-447). In patients who underwent surgical resection, median postoperative survival time was 154 days (range, 11-2495), in-hospital mortality was 16.7%, and 1-year mortality was 50.0%. Age, primary disease, ASA status, extrapulmonary dissemination, laterality, multilobar involvement, number of lesions, largest lesion size, platelet count, surgical approach, type of resection or extent of resection were not significantly associated with postoperative survival. CONCLUSIONS: Surgical resection significantly increases survival and should be strongly considered for selected patients with PM.


Assuntos
Pneumopatias Fúngicas/cirurgia , Mucormicose/cirurgia , Procedimentos Cirúrgicos Pulmonares/métodos , Adulto , Idoso , Antifúngicos/uso terapêutico , Terapia Combinada/métodos , Feminino , Humanos , Pneumopatias Fúngicas/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Mucormicose/tratamento farmacológico , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
6.
Intern Med ; 57(23): 3485-3490, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30101932

RESUMO

Scedosporium apiospermum is an opportunistic fungus that can cause various types of infections, including localized infections and life-threatening disseminated infections, particularly in immunocompromised patients. Treatment is especially challenging due to its multidrug resistance. We herein report the case of a 73-year-old woman who was non-immunocompromised but developed S. apiospermum lung infection and a pulmonary tumorlet. To our knowledge, this is the first report of the coexistence of pulmonary S. apiospermum infection and tumorlet. The lung lesion was successfully treated by surgical excision without any antifungal agents, and no recurrence of the tumorlet or S. apiospermum infection has occurred.


Assuntos
Pneumopatias Fúngicas/complicações , Pneumopatias Fúngicas/microbiologia , Nódulos Pulmonares Múltiplos/complicações , Nódulos Pulmonares Múltiplos/microbiologia , Scedosporium/isolamento & purificação , Idoso , Feminino , Humanos , Imunocompetência , Pneumopatias Fúngicas/cirurgia , Nódulos Pulmonares Múltiplos/cirurgia
7.
Ann Thorac Surg ; 106(5): e239-e241, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29807006

RESUMO

Mucormycosis is a rare fungal infection that poses a severe threat to immunocompromised patients. In the case presented herein, a 56-year-old leukemic patient, who was treated with amphotericin B and posaconazole, was scheduled for surgical resection of mucormycosis lesions that had spread to the thorax and abdomen. Surgery was aggressive and the resection involved the left lateral thoracoabdominal wall, 2 ribs, the left diaphragm, and the spleen. The patient tolerated the procedure well and the leukemia went into remission. Aggressive surgery can benefit immunocompromised patients with mucormycosis.


Assuntos
Hospedeiro Imunocomprometido , Laparotomia/métodos , Leucemia Mieloide Aguda/imunologia , Pneumopatias Fúngicas/cirurgia , Mucormicose/cirurgia , Toracotomia/métodos , Seguimentos , Humanos , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/tratamento farmacológico , Pneumopatias Fúngicas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Mucormicose/diagnóstico por imagem , Doenças Raras , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
8.
Ann Thorac Surg ; 106(2): e93-e95, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29391149

RESUMO

Mucormycosis is a devastating opportunistic fungal infection to which the immunosuppressed are particularly vulnerable. We report the case of a 60-year-old man who was found to have multifocal pulmonary mucormycosis 10 weeks after concomitant heart and kidney transplantation. Despite appropriate antifungal therapy, the infection progressed rapidly and soon involved critical pulmonary vasculature. He successfully underwent staged operative resection of his pulmonary mucormycosis without recurrence of infection. Although surgical debridement of pulmonary mucormycosis is typically reserved for localized disease, this case demonstrates that surgical intervention should be considered as an adjunct to antifungal therapy in multifocal disease.


Assuntos
Hospedeiro Imunocomprometido/imunologia , Pneumopatias Fúngicas/cirurgia , Mucormicose/cirurgia , Infecções Oportunistas/cirurgia , Pneumonectomia/métodos , Seguimentos , Transplante de Coração/efeitos adversos , Humanos , Pneumopatias Fúngicas/patologia , Transplante de Pulmão/efeitos adversos , Masculino , Pessoa de Meia-Idade , Mucormicose/diagnóstico por imagem , Infecções Oportunistas/diagnóstico por imagem , Infecções Oportunistas/microbiologia , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
9.
Rev Iberoam Micol ; 35(1): 59-61, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-29191631

RESUMO

The case of a 60 year old woman with hemoptysis and a thin-walled cavitary lesion at the upper lobe of the right lung is presented. The woman presented at the Mycology Unit of the Muñiz Hospital in Buenos Aires City 3 months after the beginning of her clinical manifestations. A hyaline micelial fungus with chlamido-arthroconidias was isolated from the bronchoalveolar lavage. Immunodiffusion and counter-immnunoelectrophoresis with coccidioidin and histoplasmin rendered positive results against both antigents, and skin tests with coccidioidin and histoplasmin were also positive with strong reactions. The isolated fungus was identified as Coccidioides posadasii at the National Microbiology Institute Carlos Malbrán, by means of a molecular technique. The patient was treated with itraconazole by oral route at a daily dose of 200mg with good clinical response, but due to the persistence of the lung cavity, a surgical removal of the upper lobe of the right lung had to be scheduled.


Assuntos
Coccidioides/isolamento & purificação , Coccidioidomicose/microbiologia , Pneumopatias Fúngicas/microbiologia , Antifúngicos/uso terapêutico , Antígenos de Fungos/sangue , Coccidioides/imunologia , Coccidioidomicose/diagnóstico por imagem , Coccidioidomicose/tratamento farmacológico , Coccidioidomicose/cirurgia , Feminino , Hemoptise/etiologia , Humanos , Itraconazol/uso terapêutico , Pneumopatias Fúngicas/diagnóstico por imagem , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
10.
Mycopathologia ; 182(9-10): 847-853, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28577122

RESUMO

Infection caused by Cunninghamella bertholletiae carries one of the highest mortality rates among mucormycosis, and there are no reported cases that survived from the infection in allogeneic hematopoietic stem cell transplantation recipients occurring before neutrophil engraftment. Here, we present two cases of pulmonary mucormycosis caused by C. bertholletiae occurring before neutrophil engraftment after cord blood transplantation. Both were successfully treated with high-dose liposomal amphotericin B (10 mg/kg/day) combined with micafungin, which was then followed by neutrophil recovery, reduction in immunosuppressive agents, and a subsequent lobectomy. The intensive antifungal therapy immediately administered upon suspicion of mucormycosis greatly suppressed the infection in its early stage and was well tolerated despite its prolonged administration and simultaneous use of nephrotoxic agents after transplantation. Although the synergic effect of micafungin remains unclear, these cases highlight the importance of prompt administration of high-dose lipid polyene when suspecting mucormycosis in highly immunocompromised patients, which enables subsequent diagnostic and therapeutic interventions, resulting in a favorable outcome.


Assuntos
Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Cunninghamella/isolamento & purificação , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/cirurgia , Mucormicose/tratamento farmacológico , Mucormicose/cirurgia , Adulto , Idoso , Transplante de Células-Tronco de Sangue do Cordão Umbilical/efeitos adversos , Quimioterapia Combinada , Equinocandinas/administração & dosagem , Feminino , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Lipopeptídeos/administração & dosagem , Pulmão/cirurgia , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/microbiologia , Masculino , Micafungina , Mucormicose/diagnóstico , Mucormicose/microbiologia , Transplantados , Resultado do Tratamento
11.
Ann Thorac Surg ; 103(6): e531-e533, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28528060

RESUMO

A 57 year old man was referred from an outside facility for an unresolving pneumonia. Imaging of the chest demonstrated a right lung mass with a consolidation in the middle lobe, pleural effusion, and mediastinal lymphadenopathy. Cytologic examination of cultures from the bronchoscopy and thoracentesis did not yield a definitive diagnosis. Video-assisted thoracoscopic surgery (VATS) was performed because of a retained hemothorax and a suggestive lesion. Biopsy specimens obtained during VATS were consistent with mucormycosis. The patient underwent a middle lobectomy and pleurectomy without any adverse event. When bronchoscopy and thoracentesis cannot provide a diagnosis, thoracoscopic pleural biopsy can be the next step in the diagnosis of mucormycosis.


Assuntos
Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/cirurgia , Mucormicose/diagnóstico , Mucormicose/cirurgia , Pneumonectomia , Cirurgia Torácica Vídeoassistida , Humanos , Masculino , Pessoa de Meia-Idade
12.
Intern Med ; 56(8): 973-977, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28420849

RESUMO

Scedosporium prolificans is a fungus that has demonstrated resistance against most currently available antifungal agents and which causes a rapidly disseminating and potentially fatal infection. A 68-year-old woman presented with a fever and consolidation in the lung field. Her symptoms and inflammatory reaction did not improve despite treatment with tazobactam/piperacillin, meropenem, and micafungin. Scedosporium prolificans was detected from the patient's bronchial lavage fluid, and we initiated treatment with voriconazole. Voriconazole was effective in shrinking the consolidation and suppressing the inflammatory reaction. The residual lesion was surgically resected because of the risk of systemic dissemination. The patient is currently alive without relapse or dissemination.


Assuntos
Antifúngicos/uso terapêutico , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/cirurgia , Scedosporium/isolamento & purificação , Voriconazol/uso terapêutico , Idoso , Feminino , Humanos , Resultado do Tratamento
15.
BMC Infect Dis ; 17(1): 135, 2017 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-28183273

RESUMO

BACKGROUND: Phanerochaete sordida is a species of wood rotting fungus, which can degrade lignin, cellulose and hemicellulose contained in wood and other hard-to-biodegrade organic substances. However, to date, there have been no other reports demonstrating that P. sordida can infect humans. CASE PRESENTATION: A 66-year-old Japanese man presented for a mass increasing in size on his left thigh. He had been suffering from rheumatoid arthritis for 18 years and chronic obstructive pulmonary disease for 20 years, for which he was being treated with 5 mg/day prednisolone and 8 mg/week methotrexate. The mass resection was performed two months later, and was diagnosed as malignant fibrous histiocytosis. However, a computed tomography examination for tumor recurrence after surgery showed a newly emergent pulmonary nodule. We therefore decided to resect the nodule by thoracoscopic procedure. Histopathological examination of the excised specimen showed that the lesion was a granuloma, with necrotic tissue and clumping of Aspergillus-like hyphae. Therefore, the nodule was diagnosed as a fungal infection and tissue specimens were cultured microbiologically. However, fungal growth was not observed. We consequently performed genetic analysis using a broad-range polymerase chain reaction. The 28S rRNA sequence demonstrated 100% homology with P. sordida using the NCBI BLAST program against the GenBank DNA databases. CONCLUSIONS: Using broad-range polymerase chain reaction, we identified P. sordida as the causative agent of a pulmonary nodule. These findings indicate that P. sordida may be an additional opportunistic causative organism of pulmonary infection in immunocompromised patients.


Assuntos
Hospedeiro Imunocomprometido , Pneumopatias Fúngicas/diagnóstico , Phanerochaete/isolamento & purificação , Idoso , Artrite Reumatoide , DNA Fúngico/análise , Diagnóstico Diferencial , Humanos , Pneumopatias Fúngicas/diagnóstico por imagem , Pneumopatias Fúngicas/microbiologia , Pneumopatias Fúngicas/cirurgia , Masculino , Phanerochaete/genética , Reação em Cadeia da Polimerase , Doença Pulmonar Obstrutiva Crônica
16.
Intern Med ; 56(1): 91-93, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28050006

RESUMO

We herein report the case of a 72-year-old-man with pulmonary cryptococcoma along with cryptococcal meningitis who underwent surgery for pulmonary lesions while receiving chemotherapy. We noted two major clinical issues. First, the presence of pulmonary cryptococcoma had a detrimental influence on the cryptococcal meningitis. Second, resolution of the pulmonary cryptococcoma through antifungal therapy had a beneficial influence on the recovery from cryptococcal meningitis. As observed in the current case with pulmonary and meningeal cryptococcosis, surgery for pulmonary cryptococcoma with continuous antifungal treatment should be considered for cases where the symptoms respond poorly to antifungal therapy and radiographic abnormalities persist.


Assuntos
Antifúngicos/uso terapêutico , Criptococose/diagnóstico , Criptococose/cirurgia , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/cirurgia , Meningite Criptocócica/diagnóstico , Meningite Criptocócica/cirurgia , Idoso , Humanos , Masculino , Resultado do Tratamento
17.
J Pediatric Infect Dis Soc ; 6(1): 49-56, 2017 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-26703241

RESUMO

Background: Blastomyces spp. are endemic in regions of the United States and result in blastomycosis, a serious and potentially fatal infection. Little is known about the presentation, clinic course, epidemiology, and genetics of blastomycosis in children. Methods: A retrospective review of children with blastomycosis confirmed by culture or cytopathology between 1999 and 2014 was completed. Blastomyces sp. isolates were genotyped by using microsatellite typing, and species were typed by sequencing of internal transcribed spacer 2 (its2). Results: Of the 114 children with blastomycosis identified, 79% had isolated pulmonary involvement and 21% had extrapulmonary disease. There were more systemic findings, including fever (P = .01), poor intake (P = .01), elevated white blood cell count (P < .01), and elevated C-reactive protein level (P < .01), in children with isolated pulmonary disease than in children with extrapulmonary disease. Children with extrapulmonary disease had more surgeries (P = .01) and delays in diagnosis (P < .01) than those with isolated pulmonary infection. Of 52 samples genotyped, 48 (92%) were Blastomyces gilchristii and 4 (8%) were Blastomyces dermatitidis. Conclusion: This is the first large-scale study of the clinical, epidemiologic, and genetic features of blastomycosis in children. The majority of the children had isolated pulmonary disease with systemic findings. Patients with extrapulmonary disease were less likely to have systemic symptoms or additional laboratory evidence of infection, which made delays in diagnosis more common. More than 90% of the pediatric cases were caused by B gilchristii.


Assuntos
Blastomyces/genética , Blastomicose/epidemiologia , Blastomicose/microbiologia , Doenças Endêmicas/estatística & dados numéricos , Genótipo , Adolescente , Blastomicose/diagnóstico , Blastomicose/cirurgia , Criança , Estudos Transversais , Diagnóstico Tardio , Feminino , Seguimentos , Humanos , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/epidemiologia , Pneumopatias Fúngicas/microbiologia , Pneumopatias Fúngicas/cirurgia , Masculino , Estudos Retrospectivos
19.
Eur J Cardiothorac Surg ; 49(1): 314-20, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25732975

RESUMO

OBJECTIVES: Pulmonary invasive fungal infections (IFIs) are associated with high mortality in patients being treated for haematological malignancy. There is limited understanding of the role for surgical lung resection and outcomes in this patient population. METHODS: This is a retrospective cohort of 50 immunocompromised patients who underwent lung resection for IFI. Patient charts were reviewed for details on primary malignancy and treatment course, presentation and work-up of IFI, reasons for surgery, type of resection and outcomes including postoperative complications, mortality, disease relapse and survival. Analysis was also performed on two subgroups based on year of surgery from 1990-2000 and 2001-2014. RESULTS: The median age was 39 years (range: 5-64 years). Forty-seven patients (94%) had haematological malignancies and 38 (76%) underwent haematopoietic stem cell transplantation (HSCT). Surgical indications included haemoptysis, antifungal therapy failure and need for eradication before HSCT. The most common pathogen was Aspergillus in 34 patients (74%). Wedge resections were performed in 32 patients (64%), lobectomy in 9 (18%), segmentectomy in 2 (4%) and some combination of the 3 in 7 (14%) for locally extensive, multifocal disease. There were 9 (18%) minor and 14 (28%) major postoperative complications. Postoperative mortality at 30 days was 12% (n = 6). Acute respiratory distress syndrome was the most common cause of postoperative death. Overall 5-year survival was 19%. Patients who had surgery in the early period had a median survival of 24 months compared with 5 months for those who had surgery before 2001 (P = 0.046). At the time of death, 15 patients (30%) had probable or proven recurrent IFI. Causes of death were predominantly related to refractory malignancy, fungal lung disease or complications of graft versus host disease (GVHD). Patients who had positive preoperative bronchoscopy cultures had a trend towards worse survival compared with those with negative cultures (hazard ratio: 1.80, P = 0.087). CONCLUSIONS: Surgical resection of IFI in immunocompromised patients is associated with high perioperative mortality. Long-term survival is limited by recurrent malignancy, persistent fungal infection and GVHD but has improved in recent years. Selection for surgical resection is difficult in this patient population, but should be carefully considered in those who are symptomatic, or have failed antifungal treatment.


Assuntos
Hospedeiro Imunocomprometido , Pneumopatias Fúngicas/cirurgia , Infecções Oportunistas/cirurgia , Pneumonectomia/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/imunologia , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas , Humanos , Pneumopatias Fúngicas/complicações , Pneumopatias Fúngicas/imunologia , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/complicações , Infecções Oportunistas/imunologia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
20.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 41(12): 1345-1351, 2016 Dec 28.
Artigo em Chinês | MEDLINE | ID: mdl-28070050

RESUMO

OBJECTIVE: To compare clinical features, diagnosis and therapeutic effect between pulmonary histoplasmosis and progressive disseminated histoplasmosis.
 Methods: A retrospective analysis for 12 cases of hospitalized patients with histoplasmosis, who was admitted in Xiangya Hospital, Central South University during the time from February 2009 to October 2015, was carried out. Four cases of pulmonary histoplasmosis and 8 cases of progressive disseminated histoplasmosis were included. The differences of clinical features, imaging tests, means for diagnosis and prognosis were analyzed between the two types of histoplasmosis.
 Results: The clinical manifestations of pulmonary histoplasmosis were mild, such as dry cough. However, the main clinical symptoms of progressive disseminated histoplasmosis were severe, including recurrence of high fever, superficial lymph node enlargement over the whole body, hepatosplenomegaly, accompanied by cough, abdominal pain, joint pain, skin changes, etc.Laboratory examination showed pancytopenia, abnormal liver function and abnormal coagulation function. One pulmonary case received the operation of left lower lung lobectomy, 3 cases of pulmonary histoplasmosis and 6 cases of progressive disseminated histoplasmosis patients were given deoxycholate amphotericin B, itraconazole, voriconazole or fluconazole for antifungal therapy. One disseminated case discharged from the hospital without treatment after diagnosis of histoplasmosis, and 1 disseminated case combined with severe pneumonia and active tuberculosis died ultimately.
 Conclusion: As a rare fungal infection, histoplasmosis is easily to be misdiagnosed. The diagnostic criteria depends on etiology through bone marrow smear and tissues biopsy. Liposomeal amphotericin B, deoxycholate amphotericin B and itraconazole are recommended to treat infection for histoplasma capsulatum.


Assuntos
Histoplasmose/diagnóstico , Histoplasmose/terapia , Infecções Fúngicas Invasivas/diagnóstico , Infecções Fúngicas Invasivas/terapia , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/terapia , Dor Abdominal/etiologia , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Biópsia , Tosse/epidemiologia , Morte , Ácido Desoxicólico/uso terapêutico , Erros de Diagnóstico , Combinação de Medicamentos , Febre/etiologia , Hepatomegalia/etiologia , Histoplasma , Histoplasmose/complicações , Histoplasmose/mortalidade , Humanos , Infecções Fúngicas Invasivas/complicações , Itraconazol/uso terapêutico , Pulmão/microbiologia , Pulmão/cirurgia , Pneumopatias Fúngicas/cirurgia , Pneumonia/complicações , Pneumonia/mortalidade , Recidiva , Estudos Retrospectivos , Esplenomegalia/etiologia , Resultado do Tratamento , Tuberculose/complicações , Tuberculose/mortalidade
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