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1.
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
2.
Clin Lab ; 65(8)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31414753

RESUMO

BACKGROUND: Detection of serum neuron specific enolase (NSE) has high sensitivity and specificity in the diagnosis of lung carcinoma, especially in small cell lung carcinoma, but sometimes serum NSE provided limited help. We report a case of a patient with right lung consolidation combined with elevated serum neuron specific enolase which mimicked lung carcinoma and was ultimately confirmed as pulmonary cryptococcosis by CT-guided percutaneous lung biopsy. METHODS: Chest computed tomography (CT) scan and CT-guided percutaneous lung biopsy were performed for diagnosis and blood tests explored the latent etiology. RESULTS: The chest CT scan showed right lung consolidation and a pulmonary nodule in lingual segment of upper lobe of left (Figure1A - F). Serum cryptococcal antigen was positive. Pathology of CT-guided percutaneous lung biopsy confirmed pulmonary cryptococcosis (Figure 1G - I). CONCLUSIONS: Elevated NSE is not a specific index of lung cancer. Serum cryptococcal antigen and CT-guided percutaneous lung biopsy has high specificity in cryptococcal pneumonia.


Assuntos
Criptococose/diagnóstico , Erros de Diagnóstico , Neoplasias Pulmonares/diagnóstico , Fosfopiruvato Hidratase/sangue , Biópsia/métodos , Criptococose/microbiologia , Humanos , Pulmão/microbiologia , Pulmão/patologia , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/microbiologia , Neoplasias Pulmonares/microbiologia , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
3.
BMC Infect Dis ; 19(1): 710, 2019 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-31405376

RESUMO

BACKGROUND: Pulmonary Cryptococcosis (PC) is diagnosed with increasing incidence in recent years, but it does not commonly involve the pleural space. Here, we report a HIV-negative case with advanced stage IIIB non-small cell lung cancer (NSCLC) treated with radiation therapy presented with dyspnea, a new PET-positive lung mass and bilateral pleural effusion suspecting progressive cancer. However, the patient has been diagnosed as pulmonary cryptococcal infection and successfully treated with oral fluconazole therapy. CASE PRESENTATION: A 77-year-old male with advanced stage non-small cell lung cancer treated with combined chemo-radiation therapy who presented with progressive dyspnea, a new PET-positive left lower lobe lung mass and bilateral pleural effusions. Initial diagnostic thoracentesis and bronchoscopy yielded no cancer, but instead found yeast forms consistent with cryptococcal organisms in the transbronchial biopsies of the left lower lobe lung mass. Subsequent to this, the previously collected pleural fluid culture showed growth of Cryptococcus neoformans. The same sample of pleural effusion was tested and was found to be positive for crytococcal antigen (CrAg) by a lateral flow assay (LFA). The patient has been treated with oral fluconazole therapy resulting in gradual resolution of the nodular infiltrates. CONCLUSION: PC should be considered in immunosuppressed cancer patients. Additionally, concomitant pleural involvement in pulmonary cryptococcal infections may occur. The incidence of false positive 18FDG-PET scans in granulomatous infections and the use of CrAg testing in pleural fluid to aid in diagnosis are reviewed.


Assuntos
Criptococose/diagnóstico por imagem , Criptococose/microbiologia , Pneumopatias Fúngicas/diagnóstico por imagem , Pneumopatias Fúngicas/microbiologia , Derrame Pleural/microbiologia , Administração Oral , Idoso , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Criptococose/tratamento farmacológico , Cryptococcus neoformans/patogenicidade , Fluconazol/administração & dosagem , Fluconazol/uso terapêutico , Humanos , Hospedeiro Imunocomprometido , Pneumopatias Fúngicas/tratamento farmacológico , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/radioterapia , Masculino , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Tomografia por Emissão de Pósitrons
4.
Emerg Infect Dis ; 25(9): 1776-1777, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31441756

RESUMO

Chronic pulmonary blastomycosis is often misdiagnosed and treated as tuberculosis in disease-endemic and non-disease-endemic areas. We report the case of a 32-year-old man who after visiting Chicago, Illinois, USA, returned to India and received treatment for tuberculosis for 12 months before receiving the correct diagnosis of blastomycosis.


Assuntos
Blastomyces/isolamento & purificação , Blastomicose/diagnóstico , Pneumopatias Fúngicas/diagnóstico , Adulto , Antifúngicos/uso terapêutico , Blastomicose/tratamento farmacológico , Blastomicose/microbiologia , Chicago , Diagnóstico Diferencial , Erros de Diagnóstico , Humanos , Índia , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/microbiologia , Masculino , Viagem , Tuberculose Pulmonar/diagnóstico
5.
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
6.
PLoS Negl Trop Dis ; 13(7): e0007566, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31329596

RESUMO

Pathogens and hosts require rapid modulation of virulence and defense mechanisms at the infection axis, but monitoring such modulations is challenging. In studying the human fungal pathogen Cryptococcus neoformans, mouse and rabbit infection models are often employed to shed light on the disease mechanisms but that may not be clinically relevant. In this study, we developed an animal infection model using the non-human primate cynomolgus monkey Macaca fascicularis. In addition, we systematically profiled and compared transcriptional responses between the infected mice and the cynomolgus monkey, using simultaneous or dual RNA next-generation sequencing. We demonstrated that there are shared but distinct transcriptional profiles between the two models following C. neoformans infection. Specifically, genes involved in immune and inflammatory responses are all upregulated. Osteoclastogenesis and insulin signaling are also significantly co-regulated in both models and disrupting an osteoclastogenesis-associated gene (OC-STAMP) or the insulin-signaling process significantly altered the host tolerance to C. neoformans. Moreover, C. neoformans was shown to activate metal sequestration, dampen the sugar metabolism, and control cell morphology during infection. Taking together, we described the development of a non-human primate model of cryptococcosis that allowed us to perform an in-depth analysis and comparison of transcriptome profiles during infections of two animal models and conceptually identify host genes important in disease responses. This study provides new insights in understanding fungal pathogenesis mechanisms that potentially facilitate the identification of novel drug targets for the treatment of cryptococcal infection.


Assuntos
Criptococose/genética , Cryptococcus neoformans , Perfilação da Expressão Gênica , Pneumopatias Fúngicas/genética , Animais , Criptococose/imunologia , Criptococose/microbiologia , Cryptococcus neoformans/genética , Cryptococcus neoformans/imunologia , Cryptococcus neoformans/patogenicidade , Modelos Animais de Doenças , Insulina/metabolismo , Pneumopatias Fúngicas/imunologia , Pneumopatias Fúngicas/microbiologia , Macaca fascicularis , Masculino , Proteínas de Membrana/metabolismo , Metais/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Osteogênese , Análise de Sequência de RNA , Transdução de Sinais , Virulência/genética
7.
Infez Med ; 27(2): 187-189, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31205044

RESUMO

Cryptococcosis is a systemic mycosis with a chronic or subacute progression caused by the inhalation of dehydrated yeasts or basidiospores. The causative agents are C. gattii and C. neoformans. The latter is more commonly associated with cellular immunodeficiency and is not rare in patients with Acquired Immunodeficiency Syndrome (AIDS). Cryptococcosis is common in pregnant women with AIDS; however, it is uncommon for the placenta to be affected, with few reported cases in the literature. We present the case of a pregnant woman with AIDS who had placental and pulmonary cryptococcosis associated with fungemia, with a satisfactory clinical outcome obtained after therapy.


Assuntos
Síndrome de Imunodeficiência Adquirida/microbiologia , Criptococose/microbiologia , Fungemia/microbiologia , Pneumopatias Fúngicas/microbiologia , Doenças Placentárias/microbiologia , Complicações Infecciosas na Gravidez/microbiologia , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/virologia , Humanos , Recém-Nascido , Masculino , Sepse Neonatal/tratamento farmacológico , Doenças Placentárias/patologia , Gravidez , Complicações Infecciosas na Gravidez/patologia , Adulto Jovem
8.
Lab Med ; 50(4): 426-431, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31065690

RESUMO

Hormographiella is a rare fungal pathogen in humans; however, case reports have described disseminated infection in immunocompromised hosts. This pathogen has been described to yield poor prognosis in patients who harbor it. Herein, we present a case report of autopsy-proven disseminated Hormographiella aspergillata infection, confirmed by DNA sequencing, in a patient experiencing a relapse of leukemia. This 54-year-old Caucasian man with chronic myelogenous leukemia (CML) that had been diagnosed in 1989, after having received a hematopoietic cell allotransplant from a compatible sibling donor, had B-cell lymphoid-blast phase of CML in April of 2013, with multiple relapses. His most recent relapse was in September of 2016, when bone marrow biopsy showed 90% blasts. The results of bronchoalveolar lavage (BAL) cultures were positive for filamentous fungus infection. The patient developed encephalopathy and worsening respiratory statusand tachycardia with flutter and hypotension, which resulted in his death. At autopsy, bilateral pleural effusions, multiple right pleural nodules, and subarachnoid hemorrhage were noted. Angioinvasive hyphal fungi were found in the right frontal lobe of the brain and the right upper lobe of the lung. Morphologically, the fungi had multiseptate, branching hyphae. The bronchoalveolar lavage specimen grew a fungus for which the colony morphologic characteristics and microscopic features were compatible with a Hormographiella species. H. aspergillata from the bronchoalveolar lavage was further identified by sequencing the D2 hypervariable region of the large-subunit (LSU) ribosomal DNA gene and the full internal transcribed spacer (ITS) regions.


Assuntos
Agaricales/isolamento & purificação , Infecções Fúngicas do Sistema Nervoso Central/diagnóstico , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Infecções Fúngicas Invasivas/diagnóstico , Pneumopatias Fúngicas/diagnóstico , Transplante Homólogo/efeitos adversos , Agaricales/classificação , Agaricales/genética , Autopsia , Encéfalo/microbiologia , Encéfalo/patologia , Líquido da Lavagem Broncoalveolar/microbiologia , Infecções Fúngicas do Sistema Nervoso Central/microbiologia , Infecções Fúngicas do Sistema Nervoso Central/patologia , Evolução Fatal , Histocitoquímica , Humanos , Infecções Fúngicas Invasivas/microbiologia , Infecções Fúngicas Invasivas/patologia , Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , Pulmão/microbiologia , Pulmão/patologia , Pneumopatias Fúngicas/microbiologia , Pneumopatias Fúngicas/patologia , Masculino , Pessoa de Meia-Idade
10.
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
11.
Vector Borne Zoonotic Dis ; 19(3): 199-206, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30383975

RESUMO

As human populaces develop, they are progressively squeezed into higher living densities. The same is true for horticulture and animals expected to bolster these communities. Despite the high potential for zoonotic transmission, connections among humans and cattle have been understudied; however, Candida albicans remains the most important medical mycosis. The genesis of the mycobiome can vary, and interactions between humans and cattle are progressively being perceived as a key interface for disease transmission. αINT1 is a unique gene from Candida albicans; hence, it has been used for detection as well as intraspecific and interspecific phylogenetic analysis of C. albicans collected from human patients and cattle with pulmonary distress in urban-rural populations. A total of 1,921 specimens were examined by direct microscopy and culture to recover yeast associated with human infection. Identification was performed by micromorphology using an API 20C AUX system. The fungal species identified in bovine nasal specimens were Alternaria species (15%), Penicillium species, and C. albicans (6.7%). Other fungal species, such as Aspergillus niger, Torulopsis species, Mucor species (5%), Aspergillus flavus, Fusarium species, Trichosporon species (3.3%), C. rugosa, C. tropical, and Saccharomyces species (1.7%), were also isolated. In human sputum specimens, C. albicans (20%) and C. parapsilosis (2.7%) were the only reported yeast species in our samples. The four identified C. albicans species (two human and two cattle) were subjected to αINT1 gene sequence analysis, which confirmed major phylogenetic relationships among human and cattle isolates. This finding highlights the public health importance of bovines as a potential source for C. albicans zoonotic transmission to humans in an urban-rural community. Additionally, the close relationship between circulating C. albicans strains recorded in Egypt and the United States indicates the possible cross-species transmission of C. albicans between imported foreign and native cattle breeds.


Assuntos
Candida albicans/genética , Candidíase/veterinária , Doenças dos Bovinos/microbiologia , Variação Genética , Pneumopatias Fúngicas/veterinária , Animais , Candidíase/epidemiologia , Candidíase/microbiologia , Bovinos , Doenças dos Bovinos/epidemiologia , Egito/epidemiologia , Humanos , Pulmão/microbiologia , Pneumopatias Fúngicas/epidemiologia , Pneumopatias Fúngicas/microbiologia , Zoonoses
12.
Clin Infect Dis ; 68(2): 188-195, 2019 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-29878145

RESUMO

Background: Blastomyces helicus (formerly Emmonsia helica) is a dimorphic fungus first isolated from a man with fungal encephalitis in Alberta, Canada. The geographic range, epidemiology, and clinical features of disease are unknown. Methods: We reviewed human and veterinary isolates of B. helicus identified among Blastomyces and Emmonsia isolates at the University of Alberta Microfungus Collection and Herbarium, University of Texas Health San Antonio's Fungus Testing Laboratory, and Associated Regional and University Pathologists Laboratories. Isolates were selected based on low Blastomyces dermatitidis DNA probe values and/or atypical morphology. Species identification was confirmed for most isolates by DNA sequence analysis of the internal transcribed spacer with or without D1/D2 ribosomal RNA regions. Epidemiological and clinical data were analyzed. Results: We identified isolates from 10 human and 5 veterinary cases of B. helicus infection; all were referred from western regions of Canada and the United States. Isolates remained sterile in culture, producing neither conidia nor sexual spores in the mycelial phase, but often producing coiled hyphae. Isolates were most frequently cultured from blood and bronchoalveolar lavage in humans and lungs in animals. Most infected persons were immunocompromised. Histopathological findings included pleomorphic, small or variably sized yeast-like cells, with single or multiple budding, sometimes proliferating to form short, branching, hyphal-like elements. Disease carried a high case-fatality rate. Conclusions: Blastomyces helicus causes fatal pulmonary and systemic disease in humans and companion animals. It differs from B. dermatitidis in morphological presentation in culture and in histopathology, by primarily affecting immunocompromised persons, and in a geographic range that includes western regions of North America.


Assuntos
Blastomyces/classificação , Doenças Transmissíveis Emergentes/microbiologia , Pneumopatias Fúngicas/microbiologia , Micoses/microbiologia , Animais , Canadá/epidemiologia , Doenças Transmissíveis Emergentes/epidemiologia , Humanos , Pneumopatias Fúngicas/epidemiologia , Micoses/epidemiologia , Estados Unidos/epidemiologia
13.
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
14.
Transplant Proc ; 50(10): 3943-3945, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30503525

RESUMO

Invasive fungal infections in solid organ transplant recipients are associated with significant morbidity and mortality. Of these fungal infections, mucormycosis presents as an aggressive, frequently fatal angioinvasive infection. Immunocompromised hosts and diabetes are important risk factors. These infections are frequently difficult to diagnose. A high index of suspicion in the appropriate setting and early, aggressive treatment with the newer antifungal agents have altered the previously grave prognosis. We present the first reported case of cavitating pulmonary mucormycosis in a renal transplant recipient caused by an unusual species of Mucorales. The patient was treated with a combination of lobectomy and antifungal treatment comprising of amphotericin B and posaconazole. He remains free of disease recurrence on monotherapy with posaconazole.


Assuntos
Hospedeiro Imunocomprometido , Transplante de Rim/efeitos adversos , Pneumopatias Fúngicas/imunologia , Mucormicose/imunologia , Anfotericina B/administração & dosagem , Antifúngicos/uso terapêutico , Humanos , Pneumopatias Fúngicas/microbiologia , Masculino , Pessoa de Meia-Idade , Mucorales , Mucormicose/tratamento farmacológico , Mucormicose/microbiologia , Transplantados , Triazóis/administração & dosagem
15.
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
16.
J Mycol Med ; 28(4): 659-662, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30477694

RESUMO

Trichoderma species are saprophytic filamentous fungi that can be found all over the word. These fungi show increasing medical importance as opportunistic human pathogens, particularly in immunocompromised patients. Invasive infections due to Trichoderma are rare and definitive diagnosis is complex to achieve because of the lack of specific diagnosis tools. We report in this work the first proven case of invasive pulmonary infection due to T. longibrachiatum in a 69-year-old white male with hematologic malignancy. The patient was successfully treated initially with voriconazole alone followed by a combination of voriconazole and caspofungine.


Assuntos
Hospedeiro Imunocomprometido , Infecções Fúngicas Invasivas/complicações , Infecções Fúngicas Invasivas/microbiologia , Leucemia Mieloide Aguda/complicações , Pneumopatias Fúngicas/complicações , Pneumopatias Fúngicas/microbiologia , Idoso , Antifúngicos/uso terapêutico , Caspofungina/uso terapêutico , Quimioterapia Combinada , Humanos , Infecções Fúngicas Invasivas/diagnóstico , Infecções Fúngicas Invasivas/tratamento farmacológico , Leucemia Mieloide Aguda/imunologia , Pulmão/microbiologia , Pulmão/patologia , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/tratamento farmacológico , Masculino , Resultado do Tratamento , Trichoderma/isolamento & purificação , Voriconazol/uso terapêutico
17.
PLoS Pathog ; 14(10): e1007358, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30304063

RESUMO

Development of vaccines against opportunistic infections is difficult as patients most at risk of developing disease are deficient in aspects of the adaptive immune system. Here, we utilized an experimental immunization strategy to induce innate memory in macrophages in vivo. Unlike current trained immunity models, we present an innate memory-like phenotype in macrophages that is maintained for at least 70 days post-immunization and results in complete protection against secondary challenge in the absence of adaptive immune cells. RNA-seq analysis of in vivo IFN-γ primed macrophages revealed a rapid up-regulation of IFN-γ and STAT1 signaling pathways following secondary challenge. The enhanced cytokine recall responses appeared to be pathogen-specific, dependent on changes in histone methylation and acetylation, and correlated with increased STAT1 binding to promoter regions of genes associated with protective anti-fungal immunity. Thus, we demonstrate an alternative mechanism to induce macrophage innate memory in vivo that facilitates pathogen-specific vaccine-mediated immune responses.


Assuntos
Criptococose/prevenção & controle , Cryptococcus neoformans/imunologia , Interferon gama/metabolismo , Pneumopatias Fúngicas/prevenção & controle , Ativação de Macrófagos/imunologia , Macrófagos Alveolares/imunologia , Fator de Transcrição STAT1/metabolismo , Animais , Criptococose/imunologia , Criptococose/microbiologia , Citocinas/metabolismo , Feminino , Pneumopatias Fúngicas/imunologia , Pneumopatias Fúngicas/microbiologia , Camundongos , Camundongos Endogâmicos BALB C , Transdução de Sinais
18.
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
19.
Transpl Infect Dis ; 20(6): e12976, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30120885

RESUMO

Cryptococcosis is a common invasive fungal infection (IFI) in solid organ transplant (SOT) recipients. Little is known about cryptococcosis in lung transplant (LTx) recipients despite having one of the highest risks of infection. The aim of this study was to describe demographic and clinical features of cryptococcal infection in LTx recipients. We performed a retrospective, observational study of cryptococcal infection in LTx recipients at The Alfred Hospital in Melbourne, Australia, from 2012 to 2017. A total of 11 cases were identified. Seven patients (64%) were male and the median age was 54.7 years (range 34-69 years). Diagnosis occurred at a median of 233 days (range 1-3650 days) post-transplant. Nine patients (82%) had isolated pulmonary infection of whom 7 (78%) were asymptomatic. All were treated with oral antifungal therapy and 1 required surgical resection of infected lung. Two patients (18%) had disseminated infection; 1 with pulmonary and central nervous system (CNS) infection and 1 with isolated CNS infection. Both patients presented with headache and brain imaging demonstrated cerebral edema, myelinosis, and leptomeningeal enhancement. One of these patients died. This study highlights the fact that cryptococcal infection should remain a consideration in asymptomatic LTx recipients, especially in the presence of non-specific nodules on chest imaging, and that the presence of headache in these patients requires urgent investigation for CNS infection.


Assuntos
Infecções Fúngicas do Sistema Nervoso Central/epidemiologia , Criptococose/epidemiologia , Cryptococcus/isolamento & purificação , Pneumopatias Fúngicas/epidemiologia , Transplante de Pulmão/efeitos adversos , Adulto , Idoso , Austrália/epidemiologia , Infecções Fúngicas do Sistema Nervoso Central/microbiologia , Criptococose/microbiologia , Feminino , Humanos , Pneumopatias Fúngicas/microbiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
20.
Artigo em Inglês | MEDLINE | ID: mdl-29988504

RESUMO

Metagenomic next-generation sequencing (mNGS) is a comprehensive approach for sequence-based identification of pathogenic microbes. However, reports on the use of mNGS in pulmonary infection applied to lung biopsy tissues remain scarce. In this study, we applied mNGS to detect the presence of pathogenic microbes in lung biopsy tissues from 20 patients with pulmonary disorders indicating possible infection. We applied a new data management for identifying pathogen species based on mNGS data. We determined the thresholds for the unique reads and relative abundance required to identify the infectious pathogens. Potential pathogens of pulmonary infections in 15 patients were identified by mNGS. The comparison between mNGS and culture method resulted that the sensitivity and specificity were 100.0% (95% CI: 31.0-100.0%) and 76.5% (95% CI: 49.8-92.2%) for bacteria, 57.1% (95% CI: 20.2-88.2%) and 61.5% (95% CI: 32.2-84.9%) for fungi. The positive predictive value (PPV) (42.9% for bacteria, 44.4% for fungi) was much lower than negative predictive value (NPV) (100% for bacteria, 72.7% for fungi) in mNGS vs. culture method. The mNGS showed the highest specificity (100.0 and 94.1%) and PPV (100.0 and 75.0%) in the evaluation of fungi and MTBC respectively, when compared with histopathology method. The study indicated that mNGS of lung biopsy tissues can be used to detect the presence (or absence) of pulmonary pathogens in patients, with potential benefits in speed and sensitivity. However, accurate data management and interpretation of mNGS are required, and should be combined with observations of clinical manifestations and conventional laboratory-based diagnostic methods.


Assuntos
Bactérias/isolamento & purificação , Biópsia , Fungos/isolamento & purificação , Pneumopatias Fúngicas/diagnóstico , Pulmão/microbiologia , Técnicas de Diagnóstico Molecular/métodos , Pneumonia Bacteriana/diagnóstico , Adolescente , Adulto , Idoso , Bactérias/classificação , Bactérias/genética , Criança , China , Feminino , Fungos/classificação , Fungos/genética , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Pneumopatias Fúngicas/microbiologia , Masculino , Metagenômica , Pessoa de Meia-Idade , Pneumonia Bacteriana/microbiologia , Sensibilidade e Especificidade , Adulto Jovem
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