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Xin S, Wu Y, He Z, He X, Wang L, Qi Y. Surgical operation combined with bronchoscopy in the treatment of fungal empyema: 5 cases report. Medicine (Baltimore) 2022; 101:e31080. [PMID: 36281178 PMCID: PMC9592517 DOI: 10.1097/md.0000000000031080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
RATIONALE Fungal empyema is a chronic refractory disease. It is difficult to control thoracic infection, and it is faced with the problem of recurrence. How to control the infection and reduce the probability of recurrence is a difficult problem. Surgical operation combined with endobronchial therapy was used to control infection, seal the fistula and eliminate residual cavity and achieved good results. PATIENT CONCERNS A total of 5 patients with fungal empyema were treated from 2019 to 2021, aged 27 to 72 years, with an average age of 54.8 ± 7.6 years. Two cases were on the left side and 3 cases on the right side. DIAGNOSIS While meeting the diagnostic criteria of empyema, the diagnosis of fungus in pus culture or the discovery of fungus in deep tissue pathology confirmed the diagnosis of fungal empyema in the 5 cases. INTERVENTIONS Through surgical operations combined with bronchoscopy and individualized treatment, the infection was controlled, the fistulas were blocked, and the pus cavity was filled. OUTCOMES After 11 to 30 months of follow-up, the muscle flap in the abscess cavity was mildly atrophied, and there was no recurrence of empyema. Three patients who completed the second-stage operation had their chest tubes removed and returned to normal life. The 2 patients who did not complete the second-stage operation had no recurrence of thoracic infection and no recurrence of cough or fever, and their quality of life was greatly improved. LESSONS Surgical operation combined with bronchoscopy is a reliable method for the treatment of fungal empyema, which can find and plug the fistula more efficiently and eliminate the residual cavity by surgery to avoid recurrence. Therefore, it is a recommended treatment method.
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Affiliation(s)
- Shunxin Xin
- Department of Cardiothoracic Surgery, Hangzhou, Zhejiang Province, China
| | - Yongyong Wu
- Department of Cardiothoracic Surgery, Hangzhou, Zhejiang Province, China
| | - Zhongliang He
- Department of Cardiothoracic Surgery, Hangzhou, Zhejiang Province, China
| | - Xueming He
- Department of Cardiothoracic Surgery, Hangzhou, Zhejiang Province, China
| | - Lei Wang
- Department of Cardiothoracic Surgery, Hangzhou, Zhejiang Province, China
| | - Yaoli Qi
- Department of Cardiothoracic Surgical Nursing, Hangzhou, Zhejiang Province, China
- *Correspondence: Yaoli Qi, Department of Cardiothoracic Surgical Nursing, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou 310004, Zhejiang Province, China (e-mail: )
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Aspergillus pleural empyema in a chronic smoker - A case report and review of literature. J Mycol Med 2022; 32:101299. [PMID: 35640524 DOI: 10.1016/j.mycmed.2022.101299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 05/05/2022] [Accepted: 05/22/2022] [Indexed: 11/22/2022]
Abstract
Aspergillus species are ubiquitous saprophytic fungi that are present in the air, water, soil, and decaying vegetables. Clinical features of Aspergillus infection largely depend on the interplay between the fungi and the host immune status. We present a case of a chronic smoker with shortness of breath who was found to have diffuse bronchiectatic changes and empyema of the right lung. Emphysema was also noticed in the left lung. Rare Aspergillus fumigatus was identified in the pleural fluid, while the acid-fast stain and bacterial cultures were negative. The patient's serum Aspergillus fumigatus IgG antibody and galactomannan antigen were negative; however, the pleural galactomannan antigen was elevated. He was treated with video-assisted thoracoscopic surgery (VATS) and partial decortication of the right lung, along with intravenous voriconazole. Despite aggressive therapeutic measures, he died after a prolonged hospital stay. Aspergillus pleural empyema is rare but can be fatal; however, it is not included in the classification for pulmonary aspergillosis. Clinicians should be vigilant to evaluate for fungal empyema in patients with chronic obstructive pulmonary diseases, even without profound immunosuppression.
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Legault-Dupuis A, Roy FE, Giroux I, Bernard-Genest M, Cote F, Laliberte AS. Successful management of Aspergillus infection of an open window thoracostomy with topical liposomal amphotericin B. Med Mycol Case Rep 2021; 34:38-41. [PMID: 34804785 PMCID: PMC8581452 DOI: 10.1016/j.mmcr.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/04/2021] [Accepted: 08/11/2021] [Indexed: 11/14/2022] Open
Abstract
We present the case of a previously healthy 54-year-old man who was hospitalized for an Aspergillus fumigatus infection of an open window thoracotomy. Patient was successfully treated for 8 consecutives weeks with daily topical pleural liposomal amphotericine B administered by soaked gauzes combined with systemic therapy.
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Affiliation(s)
- Alexis Legault-Dupuis
- Institut Universitaire de cardiologie et pneumologie de Québec- Université Laval, 2725, Chemin Ste-Foy, Quebec, Qc, Canada, G1V 4G5
| | - France-Emilie Roy
- Institut Universitaire de cardiologie et pneumologie de Québec- Université Laval, 2725, Chemin Ste-Foy, Quebec, Qc, Canada, G1V 4G5
| | - Isabelle Giroux
- Institut Universitaire de cardiologie et pneumologie de Québec- Université Laval, 2725, Chemin Ste-Foy, Quebec, Qc, Canada, G1V 4G5
| | - Michelle Bernard-Genest
- Institut Universitaire de cardiologie et pneumologie de Québec- Université Laval, 2725, Chemin Ste-Foy, Quebec, Qc, Canada, G1V 4G5
| | - Florence Cote
- Institut Universitaire de cardiologie et pneumologie de Québec- Université Laval, 2725, Chemin Ste-Foy, Quebec, Qc, Canada, G1V 4G5
| | - Anne-Sophie Laliberte
- Institut Universitaire de cardiologie et pneumologie de Québec- Université Laval, 2725, Chemin Ste-Foy, Quebec, Qc, Canada, G1V 4G5
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Surgical Management of an Aspergillus Empyema in a 3-Year-Old Child. Case Rep Med 2020; 2020:5179292. [PMID: 32454834 PMCID: PMC7225848 DOI: 10.1155/2020/5179292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 11/18/2022] Open
Abstract
Aspergillus empyema in nonimmunocompromised children is rare. A case of surgical management of invasive aspergillosis in a previously healthy 3-year-old child is presented. The patient was initially admitted to a hospital with severe respiratory deterioration and clinical instability, originally attributed to sepsis. After surgical intervention and the diagnosis of invasive aspergillosis, intravenous therapy with voriconazole was initiated. During postoperative care, the patient's condition remained stable with mild functional respiratory deficits. The diagnosis and treatment of Aspergillus empyema remains challenging, especially in cases that the recognition of aspergillosis is delayed and urgent surgical management of the empyema is required due to rapid clinical deterioration of the patient. The early initiation, prolonged administration, and close monitoring of high-dose antifungal treatment are highly recommended.
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Cooper JD, Gotoff RA, Foltzer MA, Carter RA, Walsh TJ. Mediastinal Mucormycosis: Case report, review of literature and treatment with continuous liposomal amphotericin B irrigation. Mycoses 2019; 62:739-745. [PMID: 31044442 DOI: 10.1111/myc.12922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/08/2019] [Accepted: 04/25/2019] [Indexed: 01/12/2023]
Abstract
Mediastinal mucormycosis is an uncommon but lethal infection associated with an 83% mortality. We describe a case of fatal Rhizopus microsporus mediastinitis despite three exploratory mediastinal surgeries and complementary systemic and mediastinal irrigation with liposomal amphotericin B. We further review the literature on surgical and antifungal management of mediastinal mucormycosis.
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Affiliation(s)
- Joseph D Cooper
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, The Bronx, New York
| | - Robert A Gotoff
- Division of Hospital Medicine, Department of Medicine, Geisinger Medical Center, Danville, Pennsylvania
| | - Michael A Foltzer
- Division of Infectious Diseases, Department of Medicine, Geisinger Medical Center, Danville, Pennsylvania
| | - Russell A Carter
- Division of Cardiac Surgery, Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Thomas J Walsh
- Transplantation-Oncology Infectious Diseases Program, Departments of Medicine, Pediatrics, and Microbiology & Immunology, Weill Cornell Medical Center of Cornell University, New York, New York
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Suzuki A, Kimura T, Kataoka K, Matsuda T, Yokoyama T, Mori Y, Kondoh Y. Acute exacerbation of idiopathic pulmonary fibrosis triggered by Aspergillus empyema. Respir Med Case Rep 2018; 23:103-106. [PMID: 29719792 PMCID: PMC5925856 DOI: 10.1016/j.rmcr.2018.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/19/2018] [Indexed: 11/22/2022] Open
Abstract
Acute exacerbation (AE) is a severe and life-threatening complication of idiopathic pulmonary fibrosis (IPF). In 2016, the definition and diagnostic criteria for AE-IPF were updated by an international working group. The new definition includes any acute, clinically significant respiratory deterioration (both idiopathic and triggered events) characterized by evidence of new widespread alveolar abnormality in patients with IPF. There are no currently proven beneficial management strategies for idiopathic and triggered AE-IPF. This is the first report describing AE-IPF triggered by Aspergillus empyema, which was improved by a combination of corticosteroid, systemic antifungal therapy, local antifungal therapy, and additional pharmacological therapies. Future research may reveal optimal strategies for both idiopathic and triggered AE-IPF.
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Affiliation(s)
- Atsushi Suzuki
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan.,Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tomoki Kimura
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Kensuke Kataoka
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Toshiaki Matsuda
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Toshiki Yokoyama
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Yuta Mori
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
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Ashizawa N, Nakamura S, Ide S, Tashiro M, Takazono T, Imamura Y, Miyazaki T, Izumikawa K, Yamamoto Y, Yanagihara K, Miyazaki Y, Kohno S. Successful Treatment of Aspergillus Empyema Using Open Window Thoracostomy Salvage Treatment and the Local Administration of an Antifungal Agent. Intern Med 2016; 55:2093-9. [PMID: 27477422 DOI: 10.2169/internalmedicine.55.6250] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 76-year-old woman received long-term immunosuppressive treatment for collagen vascular disease-associated interstitial pneumonia. The patient developed a cavitary mass lesion in the right lower lung field, and both nontuberculous mycobacteria and Aspergillus spp. were isolated after bronchial washing. The patient underwent a right lower lobectomy but developed Aspergillus empyema. Empyema due to Aspergillus spp. is a rare and life-threatening condition; however, the standard therapeutic strategies for treating Aspergillus empyema are not clear. We herein report a case of Aspergillus empyema that was successfully treated with a combination therapy which included open-window thoracostomy and the administration of antifungal agents (systemic micafungin and local amphotericin-B).
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Affiliation(s)
- Nobuyuki Ashizawa
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Effective treatment of invasive Aspergillus fumigatus infection using combinations of topical and systemic antifungals in a severely burned patient. J Burn Care Res 2015; 36:e85-9. [PMID: 25127025 DOI: 10.1097/bcr.0000000000000143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors describe an invasive Aspergillus fumigatus deep-burn wound infection in a severely burned patient that was successfully treated with a combination of topical terbinafine and systemic voriconazole antifungal therapy. To our knowledge, this is the first case report describing the effective control of an invasive deep-burn wound infection using this combination.
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