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1.
Medicine (Baltimore) ; 99(2): e18688, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914067

RESUMO

INTRODUCTION: Estrogen is a key factor in breast cancer carcinogenesis, and reductions in its synthesis can decrease breast cancer risk. Anastrozole can reduce plasma estrogen levels by inhibiting the enzyme aromatase, and is approved for adjuvant treatment of breast cancer. We report a case of pulmonary cryptococcosis in a patient who was treated with anastrozole for an early-stage tumor. This case is of special interest because the patient achieved a better curative effect after the administration of anastrozole was discontinued. PATIENT CONCERNS: A 61-year-old woman was found to have multiple pulmonary nodules on chest computed tomography (CT) after being treated for 5 months with anastrozole as an adjuvant breast cancer therapy. A biopsy of the largest lesion of the right lung showed cryptococcus fungal bodies with granulomatous inflammation, so the patient was diagnosed with pulmonary cryptococcosis. She was treated with fluconazole (400 mg/day) for 1 month, but a follow-up CT scan of chest showed no improvement. DIAGNOSIS: Pulmonary cryptococcosis. INTERVENTIONS: Because the pulmonary cryptococcosis was not improving, the administration of anastrozole was discontinued. Fluconazole was continued. OUTCOMES: The pulmonary lesions diminished in size 2 months after discontinuing anastrozole. The patient continued taking fluconazole for a total of 6 months without re-administration of anastrozole, and the lesions of pulmonary cryptococcosis almost disappeared. CONCLUSION: This case of pulmonary cryptococcosis may have been induced by a decrease in estrogen level caused by the aromatase inhibitor, anastrozole. Treatment of pulmonary cryptococcosis with concurrent anastrozole use may be ineffective, and it may be better to discontinue the aromatase inhibitor.


Assuntos
Anastrozol/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Criptococose/etiologia , Pneumopatias Fúngicas/etiologia , Anastrozol/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade
2.
Rev Mal Respir ; 36(7): 889-901, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31303366

RESUMO

Exposure to mould is a potential risk factor for asthma in both adults and children. In adult, the relation between exposure, sensitization and symptoms has been demonstrated in severe asthmatics sensitized to Alternaria. For children, exposure to mould in childhood is a risk factor for asthma in both atopic and non-atopic individuals. Exposure or sensitization to moulds are a risk factor for severe asthma and/or exacerbations in children. There appears to be a causal relationship between exposure and asthma. This link seems less significant in adults. However, in adults mould sensitive asthma seems to determine a phenotype of severe asthma associated with more marked obstructive lung disease. Moulds can stimulate either innate or the acquired immunity. They are responsible for a marked Th2 inflammation leading to more severe asthma. Besides the immunological mechanisms, toxic mechanisms can also intervene. It is therefore not correct to reduce the effect of moulds, particularly in respiratory symptoms, to only allergic mechanisms.


Assuntos
Poluição do Ar em Ambientes Fechados/efeitos adversos , Características da Família , Fungos , Pneumopatias Fúngicas/etiologia , Hipersensibilidade Respiratória , Adulto , Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Asma/epidemiologia , Asma/etiologia , Criança , Exposição Ambiental/efeitos adversos , Exposição Ambiental/estatística & dados numéricos , Humanos , Pneumopatias Fúngicas/epidemiologia , Material Particulado/efeitos adversos , Hipersensibilidade Respiratória/epidemiologia , Hipersensibilidade Respiratória/etiologia , Fatores de Risco
3.
Am J Hematol ; 94(10): 1104-1112, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31321791

RESUMO

Bronchoalveolar lavage (BAL) is recommended for diagnosing lung infiltrates (LI) in patients with hematologic malignancy (HM). Prospective data on the impact of BAL on survival are still lacking. We conducted a prospective observational study on patients who performed BAL for LI among 3055 HM patients hospitalized from January to September 2018. The BAL was performed in 145 out of 434 patients who developed LI, at a median time of four days from LI detection. The median age was 60 (1-83). Most patients had an acute myeloid leukemia/myelodisplastic syndrome (81), followed by lymphoma (41), acute lymphoblastic leukemia (27), and other types of HM (36). A putative causal agent was detected in 111 cases (76%), and in 89 cases (61%) the BAL results provided guidance to antimicrobial treatment. We observed a significantly improved outcome of LI at day +30 in patients who could receive a BAL-driven antimicrobial treatment (improvement/resolution rate: 71% vs 55%; P = .04). Moreover, we observed a significantly improved outcome in 120-day overall survival (120d-OS) (78% vs 59%; P = .009) and 120-day attributable mortality (120d-AM) (11% vs 30%; P = 0.003) for patients who could receive a BAL-driven treatment. The multivariate analysis showed that BAL-driven antimicrobial treatment was significantly associated with better 120d-OS and lower 120d-AM. We did not observe any severe adverse events. In conclusion BAL allows detection of a putative agent of LI in about 75% of cases, it is feasible and well tolerated in most cases, demonstrating that a BAL-driven antimicrobial treatment allows improvement of clinical outcome and survival.


Assuntos
Anti-Infecciosos/uso terapêutico , Líquidos Corporais/microbiologia , Lavagem Broncoalveolar , Neoplasias Hematológicas/complicações , Pneumopatias Fúngicas/tratamento farmacológico , Pulmão/microbiologia , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Líquidos Corporais/química , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Estimativa de Kaplan-Meier , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/etiologia , Pneumopatias Fúngicas/microbiologia , Masculino , Mananas/análise , Pessoa de Meia-Idade , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/etiologia , Pneumonia Bacteriana/microbiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/etiologia , Pneumonia Viral/virologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Adulto Jovem
4.
Immunology ; 155(2): 155-163, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29781185

RESUMO

The mucosal surface of the respiratory tract encounters microbes, such as fungal particles, with every inhaled breath. When pathogenic fungi breach the physical barrier and innate immune system within the lung to establish an infection, adaptive immunity is engaged, often in the form of helper CD4 T-cell responses. Type 1 responses, characterized by interferon-γ production from CD4 cells, promote clearance of Histoplasma capsulatum and Cryptococcus neoformans infection. Likewise, interleukin-17A (IL-17A) production from Th17 cells promotes immunity to Blastomyces dermatitidis and Coccidioides species infection by recruiting neutrophils. In contrast the development of T helper type 2 responses, characterized by IL-5 production from T cells and eosinophil influx into the lungs, drives allergic bronchopulmonary aspergillosis and poor outcomes during C. neoformans infection. Experimental vaccines against several endemic mycoses, including Histoplasma capsulatum, Coccidioides, Cryptococcus and Blastomyces dermatitidis, induce protective T-cell responses and foreshadow the development of vaccines against pulmonary fungal infections for use in humans. Additionally, recent work using antifungal T cells as immunotherapy to protect immune-compromised patients from opportunist fungal infections also shows great promise. This review covers the role of T-cell responses in driving protection and pathology in response to pulmonary fungal infections, and highlights promising therapeutic applications of antifungal T cells.


Assuntos
Interações Hospedeiro-Patógeno/imunologia , Pneumopatias Fúngicas/etiologia , Linfócitos T Auxiliares-Indutores/imunologia , Linfócitos T Auxiliares-Indutores/metabolismo , Animais , Humanos , Pneumopatias Fúngicas/metabolismo , Ativação Linfocitária/imunologia , Subpopulações de Linfócitos T/imunologia , Subpopulações de Linfócitos T/metabolismo
5.
Rev Mal Respir ; 35(3): 342-346, 2018 Mar.
Artigo em Francês | MEDLINE | ID: mdl-29602478

RESUMO

INTRODUCTION: Aspergillomas occur due to colonization of a pre-existing pulmonary, bronchial or pleural cavity by Aspergillus spp. Often asymptomatic, this pathology can reveal itself by recurrent haemoptysis or when bacterial superinfections occur. Aspergillomas occurring in post-traumatic cavities are rare and their management is poorly codified. CASE REPORT: A child suffered from a chest wound at the age of 13 years. Two years later, investigation of recurrent haemoptysis revealed a residual pneumatocele in the right lower lobe colonized by Aspergillus spp. Initial treatment with systemic azole antifungals was unsuccessful because of digestive and ophthalmological intolerance. Surgical treatment by right lower lobectomy was finally decided on by the multidisciplinary team. This revealed an intrabronchial foreign body of vegetal type with cellulosic reinforcement, causing a polymorphic granulomatous reaction around, and associated with a proliferation of filamentous fungi including Aspergillus fumigatus. Surgery was followed by liposomal amphotericin B treatment for three weeks with a favourable outcome. CONCLUSIONS: This clinical case illustrates the benefits of surgical management of post-traumatic aspergillomas, even in children, in order to eradicate the aspergillus implant and to remove any foreign body to prevent recurrence.


Assuntos
Acidentes por Quedas , Granuloma de Corpo Estranho/complicações , Granuloma de Corpo Estranho/diagnóstico , Pneumopatias Fúngicas/diagnóstico , Lesão Pulmonar/complicações , Aspergilose Pulmonar/diagnóstico , Adolescente , Feminino , Granuloma de Corpo Estranho/microbiologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Pulmão/patologia , Pneumopatias Fúngicas/etiologia , Lesão Pulmonar/microbiologia , Aspergilose Pulmonar/etiologia , Recidiva , Árvores
6.
Heart Surg Forum ; 21(2): E072-E074, 2018 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-29658861

RESUMO

Invasive mucormycosis infections occur in less than 1% of recipients of orthotopic heart transplants. Given the angioinvasive nature of these infections, the mortality rate is high. Little literature exists regarding the presentation and management of these infections. We present a case of a patient who developed an infection after orthotopic heart transplant, describe the successful multidisciplinary management surrounding his care, and review the available literature regarding mucormycosis infections in heart transplant recipients.


Assuntos
Insuficiência Cardíaca/cirurgia , Transplante de Coração/efeitos adversos , Pneumopatias Fúngicas/etiologia , Pulmão/diagnóstico por imagem , Mucormicose/etiologia , Complicações Pós-Operatórias , Transplantados , Idoso , Antifúngicos/uso terapêutico , Seguimentos , Humanos , Pulmão/cirurgia , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/terapia , Masculino , Mucormicose/diagnóstico , Mucormicose/terapia , Pneumonectomia/métodos , Tomografia Computadorizada por Raios X
7.
Ann Thorac Surg ; 106(1): e1-e2, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29530771

RESUMO

We present a case of a young female patient with end-stage lung failure because of pulmonary arterial hypertension who was failing maximal medical therapy and was listed for a single sequential lung transplantation. The challenge of the case was a concomitant presence of a large atrial septal defect. The novelty of our approach was a device closure of atrial septal defect before performing transplantation with the use of intraoperative venoarterial extracorporeal membrane oxygenation.


Assuntos
Oxigenação por Membrana Extracorpórea , Comunicação Interatrial/cirurgia , Transplante de Pulmão , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Adulto , Antifúngicos/uso terapêutico , Fibrilação Atrial/etiologia , Fibrilação Atrial/terapia , Candidíase/tratamento farmacológico , Candidíase/etiologia , Ponte Cardiopulmonar/efeitos adversos , Contraindicações de Procedimentos , Cardioversão Elétrica , Feminino , Comunicação Interatrial/complicações , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/cirurgia , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/etiologia , Complicações Pós-Operatórias/terapia , Disfunção Primária do Enxerto/terapia , Terapia de Substituição Renal , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/cirurgia , Dispositivo para Oclusão Septal
8.
Zhongguo Dang Dai Er Ke Za Zhi ; 20(2): 121-124, 2018 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-29429460

RESUMO

OBJECTIVE: To investigate the clinical features of invasive pulmonary fungal infections (IPFIs) after biliary atresia (BA) surgery and related risk factors. METHODS: A retrospective analysis was performed for the clinical data of 49 children with IPFIs after BA surgery, including clinical features, lung imaging findings, and pathogenic features. The risk factors for IPFIs after BA surgery were also analyzed. RESULTS: The most common pathogens of IPFIs after BA surgery was Candida albicans (17 strains, 45%), followed by Candida tropicalis (7 strains, 18%), Aspergillus (6 strains, 16%), Candida krusei (3 strains, 8%), Candida glabrata (3 strains, 8%), and Candida parapsilosis (2 strains, 5%). Major clinical manifestations included pyrexia, cough, and shortness of breath, as well as dyspnea in severe cases; the incidence rate of shortness of breath reached 78%, and 35% of all children had no obvious rale. The multivariate logistic regression analysis showed that age at the time of surgery, time of glucocorticoid application, cumulative time of the application of broad-spectrum antibiotics, and recurrent cholangitis were major risk factors for IPFIs after BA surgery. CONCLUSIONS: The three most common pathogens of IPFIs after BA surgery are Candida albicans, Candida tropicalis, and Aspergillus. It is important to perform surgery as early as possible, avoid recurrent cholangitis, and shorten the course of the treatment with broad-spectrum antibiotics and glucocorticoids for decreasing the risk of IPFIs.


Assuntos
Atresia Biliar/cirurgia , Infecções Fúngicas Invasivas/etiologia , Pneumopatias Fúngicas/etiologia , Complicações Pós-Operatórias/etiologia , Humanos , Lactente , Infecções Fúngicas Invasivas/diagnóstico por imagem , Infecções Fúngicas Invasivas/tratamento farmacológico , Modelos Logísticos , Pneumopatias Fúngicas/diagnóstico por imagem , Pneumopatias Fúngicas/tratamento farmacológico , Estudos Retrospectivos
9.
J Cyst Fibros ; 17(3): e32-e34, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29456196
11.
Zhonghua Er Ke Za Zhi ; 55(11): 844-847, 2017 Nov 02.
Artigo em Chinês | MEDLINE | ID: mdl-29141316

RESUMO

Objective: To investigate the efficacy and safety of micafungin (MCF) for pulmonary invasive fungal disease (PIFD) in pediatric patients with acute leukemia or post hematopoietic stem cells transplantation. Method: Twenty-five neutropenic PIFD children with acute leukemia or post hematopoietic stem cells transplantation in Sun Yat-sen Memorial Hospital of Sun Yat-sen University were selected from January 2012 to June 2015, including 12 males and 13 females, age range 2-15 (average 6.2±2.0) years. There were 12 cases of acute leukemia (AL) after chemotherapy, 4 cases of acute leukemia (AL) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and 9 cases of ß-thalassemia major after allo-HSCT. All children received MCM for the treatment of PIFD, the dosage of MCM was 3-4 mg/ (kg·d) , once a day. The children received 2 to 6 courses of treatment, individually with a course of 7 days. 1, 3-ß-D glucan assay (G test), galactomannan antigen test (GM test), high-resolution CT and the biochemical indexes for organ functions were closely monitored. Result: Twenty-five cases were diagnosed as PIFD, including 2 patients diagnosed as proven, 6 as probable and 17 as possible. Of the 25 cases, 1 was confirmed aspergillus by biopsy pathology and 1 was candida albicans by blood culture. The G and GM test with positive results was 5 and 2 respectively. Chest CT scans of the 25 cases had obvious lesions: air crescent sign and cavitation in 4 cases, diffuse ground glass change in 9 cases, double lung scattered patchy, small nodules and cord like high density shadow in 7 cases, unilateral or bilateral chest wall wedge-shaped consolidation edge in 5 cases and pleural effusion in 5 patients. The effective rate of MCF in treatment of PIFD was 68% (17/25), including 13 cases cured, 4 cases improved, 4 cases were improved clinically and in 4 cases the treatment was ineffective. Eight cases were effective in MCF monotherapy group (12 cases) and nine were effective in MCF combined therapy group(13 cases), respectively. Side-effects including allergies, gastrointestinal side effects, electrolyte disturbances, impairment of liver and kidney function, and myelosuppression were not found in those children treated with MCF. Conclusion: Micafungin is effective and safe in the treatment of pulmonary invasive fungal disease in pediatric patients with acute leukemia or post hematopoietic stem cell transplantation.


Assuntos
Equinocandinas/uso terapêutico , Transplante de Células-Tronco Hematopoéticas , Infecções Fúngicas Invasivas/tratamento farmacológico , Leucemia Mieloide Aguda/complicações , Lipopeptídeos/uso terapêutico , Pneumopatias Fúngicas/tratamento farmacológico , Adolescente , Biópsia , Criança , Pré-Escolar , Feminino , Células-Tronco Hematopoéticas , Humanos , Infecções Fúngicas Invasivas/etiologia , Fígado , Pneumopatias Fúngicas/etiologia , Masculino , Micafungina , Neutropenia , Transplante Homólogo , Talassemia beta
12.
Clin Transplant ; 31(11)2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28871606

RESUMO

BACKGROUND: Prospective studies to determine associated risk factors and related outcomes for pulmonary fungal infection (PFI) after pediatric lung transplant (PLT) are lacking. METHODS: NIH-sponsored Clinical Trials in Organ Transplantation in Children enrolled PLT candidates, collecting data prospectively for 2 years post-transplant. Demographics, signs/symptoms, radiology, pathology and microbiology were collected. Analyses evaluated for PFI-related risks and outcomes. RESULTS: In 59 PLT, pre-transplant fungal colonization occurred in 6 donors and 15 recipients. Cystic fibrosis (CF) was associated with pre-transplant colonization (P < .01). Twenty-five (42%) PLT had 26 post-transplant colonizations (median = 67 days, range = 0-750 days) with Candida (13), Aspergillus (4), mold (6) or yeast (3). Post-PLT colonization was not associated with CF, age, or pre-PLT colonization. Thirteen PFIs occurred in 10 (17%) patients, 3 proven (Candida species) and 10 probable (Candida [3], Aspergillus [3], Penicillium [3], and mold [1]). Pulmonary fungal infection was preceded by post-PLT colonization with the same organism in 4 of 13 PFI, but post-PLT colonization did not predict subsequent PFI (P = .87). Older age at transplant was a risk for PFI (P < .01). No mortality was attributed to PFI. Prophylaxis use was not associated with decreased post-PLT colonization (P = .60) or PFI (P = .48). CONCLUSION: In PLT, PFI and fungal colonization are common but without associated mortality. Post-PLT colonization did not predict PFI. Optimal prevention strategies require additional study.


Assuntos
Fibrose Cística/complicações , Rejeição de Enxerto/mortalidade , Pneumopatias Fúngicas/mortalidade , Transplante de Pulmão/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Adolescente , Criança , Fibrose Cística/microbiologia , Fibrose Cística/cirurgia , Feminino , Seguimentos , Rejeição de Enxerto/etiologia , Sobrevivência de Enxerto , Humanos , Estudos Longitudinais , Pneumopatias Fúngicas/etiologia , Masculino , Prognóstico , Estudos Prospectivos , Fatores de Risco
13.
Med Mal Infect ; 47(6): 375-381, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28602386

RESUMO

Anti-TNFα agents have proved effective in the treatment of various inflammatory, rheumatologic, dermatologic, and gastrointestinal diseases. Severe respiratory tract infections of bacterial or fungal origin have emerged as important complications in patients receiving such treatments. The risk of infection due to anti-TNFα therapy is difficult to assess in these patients who are immunocompromised because of the underlying disease itself and of previous or concomitant immunosuppressive drugs. This excessive infection risk seems real, particularly in the first six months following treatment initiation, and higher for patients receiving anti-TNFα monoclonal antibodies than for those receiving soluble TNFα receptor. The involved pathogens are pyogenic bacteria but also Mycobacterium tuberculosis, mostly by reactivation of latent tuberculosis infection, warranting a systematic preventive approach to screening and chemoprophylaxis before initiating the anti-TNFα therapy. In countries with low tuberculosis endemicity, an increased prevalence of nontuberculous mycobacterial infections has been reported. The incidence rate of legionellosis is high in this population. In case of pneumonia, empirical antibiotic therapy should cover Legionella pneumophila. Several cases of histoplasmosis have also been reported and this diagnosis should be suspected in patients who have traveled to endemic areas. Other opportunistic infections have been reported including Pneumocystis pneumonia, aspergillosis, and nocardiosis mostly in patients receiving other immunosuppressive treatments. The risk of infection should be evaluated as an individual risk depending on comorbidities and past or concomitant treatments.


Assuntos
Imunossupressores/uso terapêutico , Infecções Respiratórias/etiologia , Fator de Necrose Tumoral alfa/imunologia , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/efeitos adversos , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/etiologia , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Imunossupressores/imunologia , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/epidemiologia , Pneumopatias Fúngicas/etiologia , Micoses/tratamento farmacológico , Micoses/epidemiologia , Micoses/etiologia , Receptores do Fator de Necrose Tumoral/imunologia , Receptores do Fator de Necrose Tumoral/uso terapêutico , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia , Fatores de Risco , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Viroses/tratamento farmacológico , Viroses/epidemiologia , Viroses/etiologia
14.
BMC Infect Dis ; 17(1): 328, 2017 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-28476105

RESUMO

BACKGROUND: Disseminated Histoplasmosis (DH) is a rare manifestation of Acquired Immune Deficiency Syndrome (AIDS) in European countries. Naso-maxillar osteolysis due to Histoplasma capsulatum var. capsulatum (Hcc) is unusual in endemic countries and has never been reported in European countries. Differential diagnoses such as malignant tumors, cocaine use, granulomatosis, vasculitis and infections are more frequently observed and could delay and/or bias the final diagnosis. CASE PRESENTATION: We report the case of an immunocompromised patient infected by Human Immunodeficiency Virus (HIV) with naso-maxillar histoplasmosis in a non-endemic country. Our aim is to describe the clinical presentation, the diagnostic and therapeutic issues. A 53-year-old woman, originated from Haiti, was admitted in 2016 for nasal deformation with alteration of general condition evolving for at least 6 months. HIV infection was diagnosed in 2006 and classified at AIDS stage in 2008 due to cytomegalovirus infection associated with pulmonary histoplasmosis. At admission, CD4 cell count was 9/mm3. Surgical biopsies were performed and ruled out differential or associated diagnoses. Mycological cultures identified Hcc and Blood Polymerase Chain Reaction (PCR) for Hcc was positive. The patient was given daily Amphothericin B liposomal infusion during 1 month. Hcc PCR became negative in the blood under treatment, and then oral switch by itraconazole was introduced. Antiretroviral treatment was reintroduced after a 3-week histoplasmosis treatment. Normalization of naso-maxillar mucosa enabled a palatal prosthesis. CONCLUSION: Naso-maxillar histoplasmosis is extremely rare; this is the first case ever reported in a non-endemic country. Differential diagnoses must be ruled out by conducting microbiologic tools and histological examinations on surgical biopsies. Early antifungal treatment should be initiated in order to prevent DH severe outcomes.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/etiologia , Histoplasmose/tratamento farmacológico , Histoplasmose/etiologia , Osteólise/etiologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Antifúngicos/uso terapêutico , Contagem de Linfócito CD4 , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/etiologia , Diagnóstico Diferencial , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Haiti , Histoplasmose/diagnóstico , Humanos , Hospedeiro Imunocomprometido , Itraconazol/uso terapêutico , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/etiologia , Doenças Maxilares/tratamento farmacológico , Doenças Maxilares/etiologia , Doenças Maxilares/microbiologia , Pessoa de Meia-Idade , Osteólise/microbiologia
16.
PLoS One ; 12(2): e0171485, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28178337

RESUMO

BACKGROUND: An increasing rate of respiratory colonization and infection in cystic fibrosis (CF) is caused by fungi of the Scedosporium apiospermum species complex or Lomentospora prolificans (Sac-Lp). These fungi rank second among the filamentous fungi colonizing the CF airways, after Aspergillus fumigatus. However, the epidemiology, clinical relevance and risk of pulmonary colonization with Sac-Lp are rarely understood in CF. The objective of the present prospective multicenter study was to study pathogen distribution and determine association factors of pulmonary Sac-Lp colonization in patients with CF. MATERIAL AND METHODS: Clinical, microbiological and laboratory data of 161 patients aged 6-59 years with CF in Germany were analyzed for Sac-Lp distribution and association factors. The free statistical software R was utilized to investigate adjusted logistic regression models for association factors. RESULTS: Of the 161 patients included in the study, 74 (56%) were male. The median age of the study cohort was 23 years (interquartile range 13-32 years). 58 patients of the total cohort (36%) were < 18 years old. Adjusted multivariate regression analysis revealed that Sac-Lp colonization was associated with younger age (OR 0.8684, 95%CI: 0.7955-0.9480, p<0.005) and less colonization with H. influenzae (OR 0.0118, 95%CI: 0.0009-0.1585, p<0.001). In addition, Sac-Lp-colonized patients had more often allergic bronchopulmonary aspergillosis (ABPA) (OR 14.6663, 95%CI: 2.1873-98.3403, p<0.01) and have been colonized more often with the mucoid phenotype of Pseudomonas aeruginosa (OR 9.8941, 95%CI: 1.0518-93.0705, p<0.05). CONCLUSION: Newly found association of ABPA and Pseudomonas revealed new probable risk factors for Sac-Lp colonization. Allergy might play a role in inducing immunologic host reactions which lead to a less effective response to species of Sac-Lp.


Assuntos
Fibrose Cística/complicações , Fibrose Cística/epidemiologia , Pneumopatias Fúngicas/epidemiologia , Pneumopatias Fúngicas/etiologia , Infecções Oportunistas , Scedosporium , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Estudos de Coortes , Fibrose Cística/diagnóstico , Feminino , Alemanha/epidemiologia , Humanos , Pneumopatias Fúngicas/diagnóstico , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Sistema de Registros , Testes de Função Respiratória , Fatores de Risco , Scedosporium/classificação , Adulto Jovem
17.
J Cyst Fibros ; 16(2): e3-e7, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28185887

RESUMO

BACKGROUND: Disseminated fungal infections are a known serious complication in individuals with cystic fibrosis (CF) following orthotopic lung transplantation. Aspergillus fumigatus and Scedosporium species are among the more common causes of invasive fungal infection in this population. However, it is also important for clinicians to be aware of other emerging fungal species which may require markedly different antifungal therapies. CASE SUMMARY: We describe the first laboratory-documented case of a fatal disseminated fungal infection caused by Rasamsonia aegroticola in a 21-year-old female CF patient status post-bilateral lung transplantation, which was only identified post-mortem. Molecular analysis revealed the presence of the identical Rasamsonia strains in the patient's respiratory cultures preceding transplantation. DISCUSSION: We propose that the patient's disseminated fungal disease and death occurred as a result of recrudescence of Rasamsonia infection from her native respiratory system in the setting of profound immunosuppression post-operatively. Since Rasamsonia species have been increasingly recovered from the respiratory tract of CF patients, we further review the literature on these fungi and discuss their association with invasive fungal infections in the CF lung transplant host. CONCLUSION: Our report suggests Rasamsonia species may be important fungal pathogens that may have fatal consequences in immunosuppressed CF patients after solid organ transplantation.


Assuntos
Fibrose Cística/cirurgia , Imunossupressão , Pneumopatias Fúngicas , Transplante de Pulmão , Infecções Oportunistas , Complicações Pós-Operatórias , Adulto , Evolução Fatal , Feminino , Humanos , Hospedeiro Imunocomprometido , Imunossupressão/efeitos adversos , Imunossupressão/métodos , Infecções Fúngicas Invasivas/diagnóstico , Infecções Fúngicas Invasivas/etiologia , Infecções Fúngicas Invasivas/fisiopatologia , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/etiologia , Pneumopatias Fúngicas/fisiopatologia , Transplante de Pulmão/efeitos adversos , Transplante de Pulmão/métodos , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/etiologia , Infecções Oportunistas/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia
19.
J Clin Immunol ; 37(1): 36-41, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27766541

RESUMO

PURPOSE: The purpose of this study is to evaluate the possibility of early detection of pulmonary fungal infections by lung CT scan in chronic granulomatous disease (CGD). METHODS: A retrospective study on 14 patients affected with CGD for a total of 18 infectious episodes was performed. Revision of clinical data and CT scan analysis before and after treatment was performed. RESULTS: The presence of lung nodules <30 mm was evaluated in 18 infectious episodes in 14 patients. A total of 125 nodules in 18 CT scans were identified. Identification of the infectious agent through biopsy and in vitro culture resulted positive only in 3/18 cases. The remaining cases received clinical/radiologic diagnosis of suspected pulmonary fungal infection. In all cases, the introduction of empirical antifungal treatment resulted in reduction in size or complete resolution of the pulmonary lung nodules in all patients affected with CGD. CONCLUSIONS: Lung CT scan allows for early detection of pulmonary fungal infection in CGD. Pulmonary nodules (<30 mm), single or multiple, uni- or bilateral, with or without a halo sign may represent the first radiologic sign of pulmonary fungal infection in CGD.


Assuntos
Doença Granulomatosa Crônica/complicações , Doença Granulomatosa Crônica/diagnóstico por imagem , Pneumopatias Fúngicas/diagnóstico por imagem , Pneumopatias Fúngicas/etiologia , Tomografia Computadorizada por Raios X/métodos , Biomarcadores , Pré-Escolar , Diagnóstico Precoce , Feminino , Humanos , Lactente , Recém-Nascido , Pneumopatias Fúngicas/terapia , Masculino , Estudos Retrospectivos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/patologia
20.
Med Mycol J ; 57(4): J155-J162, 2016.
Artigo em Japonês | MEDLINE | ID: mdl-27904061

RESUMO

The risk of invasive fungal infections (IFIs) is extremely high in patients with hematological malignancies due to the prolonged and profound neutropenia and immunosuppression after chemotherapy and hematopoietic stem cell transplantation. There has been increasing interest in mucormycosis despite its relatively uncommon occurrence, because occasional breakthrough infections have been observed under anti-aspergillus prophylaxis. The aggressive nature of mucormycosis easily leads to high mortality because of delays in diagnosis and incorrect treatment decisions, which are due in part to lack of adjunctive diagnostic tools and having similar clinical and radiological features with aspergillosis. The only currently available antifungals against Mucorales in Japan are amphotericin B formulations. Thus, comprehensive therapeutic strategies, including surgery, should be considered in order to achieve a successful outcome.


Assuntos
Neoplasias Hematológicas/complicações , Hospedeiro Imunocomprometido , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/terapia , Mucormicose/diagnóstico , Mucormicose/terapia , Anfotericina B/uso terapêutico , Didanosina , Diagnóstico Precoce , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas , Humanos , Pneumopatias Fúngicas/etiologia , Mucormicose/etiologia , Neutropenia , Risco , Procedimentos Cirúrgicos Operatórios
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