Pulmonary Coccidioidomycosis: A Case Report and Literature Review.

Coccidioidomycosis is an infectious disease caused by Coccidioides immitis or C. posadasii fungus. Humans usually get infected by inhaling spores risen from the soil. Although in 60 percent of cases symptoms are absent, remaining patients can develop various manifestations of the disease, from flu-like symptoms to severe dissemination or meningitis. In endemic regions (California, Arizona, Mexico, Central, and South America), pulmonary coccidioidomycosis causes 25% of community-acquired cases of pneumonia. We present the first registered case of pulmonary coccidioidomycosis in Lithuania. Clinical presentation, pathogenesis, treatment options, and diagnostic alternatives are discussed.

Mirizzi Syndrome: Is There a Place for Minimally Invasive Surgery?

Objectives: Mirizzi syndrome (MS) is a condition when an impacted stone in the cystic duct or the Hartmann's pouch due to its extrinsic compression and concomitant inflammation causes an obstruction of the common bile duct. Laparotomy was the preferred surgical technique to treat this syndrome. However, with advances in technologies, an increasing number of surgeons are starting to choose minimally invasive surgery. The objective of this study is to review existing literature relating to minimally invasive surgery treatment of MS. Methods: PubMed and ClinicalKey were used to search and identify relevant articles since January 2000 to December 2020. The following keywords were applied: Mirizzi syndrome, laparoscopy, minimally invasive. The criteria for exclusion were applied: case reports with less than 2 patients, nonsurgical treatments, and reviews were excluded from this study. Results: Thirty-two articles were identified for analysis, 17 (540 patients in total) of these articles fulfilled the inclusion criteria: 8 retrospective studies, 4 case series, and 5 prospective studies. In the analyzed cohort, 295 patients were treated laparoscopically. Out of 17 articles included in the manuscript, 14 articles provided the information on minimally invasive surgery approach. There were 221 minimally invasive surgeries, out of which 143 (64.7%) were successful, thus according to the type of MS: MS I-175 (79.2%), successful 105 (60%); MS II-40 (18%), successful 32 (80%); MS III-6 (2.7%), successful 6 (100%). The mean conversion rate from laparoscopic to open surgery was 26.2% (range 0-67%), and the median complication rate in seventeen studies was 18.1% (range 0-40%), respectively. The female/male ratio was 1.2:1, and the median age in fifteen studies providing overall data on age was 57.4 years (range 40.1-70.1 years). Conclusions: Current evidence presents that open surgery remains the main treatment for MS. Minimally invasive approaches are feasible, safe, and are associated with short-term recovery, significant differences in the operation time and blood loss during operation. However, minimally invasive approaches are mainly restricted to selected patients with type I MS.