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Zhang M, Luo Q, Li X, Mu X, Wu W. Pulmonary Artery Pseudoaneurysm Caused by Pulmonary Mucormycosis. Am J Respir Crit Care Med 2024; 209:879-880. [PMID: 38306668 DOI: 10.1164/rccm.202307-1125im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 02/02/2024] [Indexed: 02/04/2024] Open
Affiliation(s)
| | - Qiongzhen Luo
- Department of Respiratory and Critical Care Medicine and
| | - Xuesong Li
- Department of Respiratory and Critical Care Medicine and
| | - Xiangdong Mu
- Department of Respiratory and Critical Care Medicine and
| | - Weiwei Wu
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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2
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Kurahara Y, Shimatani Y, Ryuge M, Tsuyuguchi K. Pulmonary Mucormycosis Caused by Cunninghamella bertholletiae. Intern Med 2024; 63:879-880. [PMID: 37532541 PMCID: PMC11008992 DOI: 10.2169/internalmedicine.2465-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 08/04/2023] Open
Affiliation(s)
- Yu Kurahara
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
- Department of Infectious Diseases, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Yasuaki Shimatani
- Department of Clinical Laboratory, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Misaki Ryuge
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Kazunari Tsuyuguchi
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
- Department of Infectious Diseases, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
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3
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Chen Q, Guo W, Guo W, Mu X, Guo J. Pulmonary histoplasmosis on the Chinese mainland: two case reports and literature review. J Infect Dev Ctries 2024; 18:318-325. [PMID: 38484351 DOI: 10.3855/jidc.17934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 08/23/2023] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION Pulmonary histoplasmosis is a fungal disease that is endemic in North and Central America. It is relatively rare in China and commonly misdiagnosed as tuberculosis or cancer due to nonspecific clinical and radiographic manifestations. Rapid and accurate pathogen tests are critical for the diagnosis of pulmonary histoplasmosis. METHODOLOGY We report two cases of pulmonary histoplasmosis. We collected all the relevant case reports on the Chinese mainland (from 1990 to 2022) to analyze features of this disease among Chinese patients. RESULTS A total of 42 articles reporting 101 cases were identified, and the two cases reported in this article were also included for analysis. Sixty-three (61.2%) patients had respiratory symptoms and 35 (34.0%) patients were asymptomatic. The most common radiographic findings were pulmonary nodules or masses (81.6%). Twenty-two (21.4%) patients were misdiagnosed as tuberculosis, and 37 (35.9%) were misdiagnosed as lung tumors before pathological findings. Metagenomic next‑generation sequencing (mNGS) testing provided a rapid diagnostic and therapeutic basis for three patients. CONCLUSIONS Clinical features and imaging findings of pulmonary histoplasmosis are not specific. Relevant epidemiological history and timely pathogen detection are important for diagnosis. mNGS can shorten the time required for diagnosis and allow earlier initiation of targeted antibiotic therapy.
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Affiliation(s)
- Qi Chen
- Department of Geriatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wei Guo
- Department of Respiratory and Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wenjia Guo
- Department of Respiratory and Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xiangdong Mu
- Department of Respiratory and Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jun Guo
- Department of Geriatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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da Costa FM, Moreira BL, Cerezoli MT, Shiang C, Haddad FJ. Cryptococcosis with an endobronchial tumor-like growth in an immunocompetent patient. Rev Soc Bras Med Trop 2024; 57:e009022024. [PMID: 38324812 PMCID: PMC10852461 DOI: 10.1590/0037-8682-0497-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/01/2023] [Indexed: 02/09/2024] Open
Affiliation(s)
| | | | | | - Christina Shiang
- Hospital Beneficência Portuguesa de São Paulo. São Paulo, SP, Brasil
| | - Fábio José Haddad
- Hospital Beneficência Portuguesa de São Paulo. São Paulo, SP, Brasil
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Bosch Fragueiro JJ, Iudica MM. [Tomography guided biopsy for the diagnosis of pediatric pulmonary Cryptococcosis]. Andes Pediatr 2024; 95:77-83. [PMID: 38587347 DOI: 10.32641/andespediatr.v95i1.4816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/16/2023] [Indexed: 04/09/2024]
Abstract
Pulmonary cryptococcosis is a lung infection caused by the Cryptococcus yeast. It is rare in pediatrics, especially in immunocompetent children. The diagnosis of pulmonary cryptococcosis can be challenging due to the low specificity of symptoms, low index of suspicion, and limited diagnostic resources. OBJECTIVE To describe a clinical case of pulmonary cryptococcosis in an immunocompetent adolescent, detailing the diagnostic approach. CLINICAL CASE A 15-year-old patient, previously healthy, from a rural town, who consulted due to cough and a 1-month rib stitch pain, without fever or associated respiratory difficulty, with two images of condensation in the left lung on the chest x-ray. In the Computed Tomography, the images showed a nodular appearance. Due to suspicion of neoplastic pathology, a Positron Emission Tomography was performed, which showed hypermetabolic nodular lesions. The tomographic characteristics could correspond to fungal or granulomatous involvement. Considering the images and epidemiological risk factors such as rural origin and contact with bird droppings, the possibility of a mycosis was considered. A lung needle biopsy was performed under tomographic guidance. Cryptococcus neoformans was identified in the microbiology laboratory culture. The patient received treatment with itraconazole and fluconazole with good clinical and imaging response after 10 months of therapy and follow-up. CONCLUSION In immunocompetent patients with a nonspecific clinical presentation, images can guide the diagnosis of pulmonary cryptococcosis, and an etiological search is essential to confirm it. In our case, the CT-guided needle biopsy was of great diagnostic utility.
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Bourne-Watrin M, Adenis A, Doppelt G, Zappa M, Epelboin L, Nacher M, Bigot J, Drak Alsibai K, Blaizot R, Blanchet D, Demar M, Guillot G, Djossou F, Couppié P. Pulmonary Histoplasmosis in People Living with Human Immunodeficiency Virus in French Guiana: Clinical Epidemiology, Medical Imaging and Prognostic. Mycopathologia 2023; 188:1065-1078. [PMID: 37839020 PMCID: PMC10687118 DOI: 10.1007/s11046-023-00799-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Histoplasmosis is mainly described as a disseminated disease in people living with HIV (PLHIV). Compared to historical descriptions in immunocompetent individuals, knowledge is lacking on the detailed clinical and radiological findings and outcomes of pulmonary histoplasmosis (PH). Overlooked or misdiagnosed with other AIDS-defining condition, prognostic of PLHIV may be at risk because of inappropriate care. METHODS A retrospective multicentric study was conducted in PLHIV from French Guiana between January 1988 and October 2019. Proven PH were documented through mycological direct examination, culture, or histology. Patients with concomitant respiratory infections were excluded. RESULTS Among 65 patients, sex ratio M:F was 2.4 with a median age of 39 years [IQR 25-75%: 34-44]. Median CD4 count was 24 cells/mm3 [11-71], with histoplasmosis as the AIDS-defining condition in 88% and concomitant AIDS-defining conditions in 29%. Clinical findings were fever (89%), cough (58%), dyspnea (35%), expectoration (14%), and hemoptysis (5%). Sixty-one X-rays and 24 CT-scans were performed. On X-rays, an interstitial lung disease was mainly found (77%). On CT-scans, a nodular pattern was predominant (83%): mostly miliary disease (63%), but also excavated nodules (35%). Consolidations were present in 46%, associated with miliary disease in 21%. Thoracic lymphadenopathies were found in 58%, mainly hilar and symmetric (33%). Despite antifungal treatment, case-fatality rate at one month was 22%. CONCLUSION When faced with an interstitial lung disease on X-rays or a miliary pattern on CT-scans in advanced PLHIV, physicians in endemic areas, apart from tuberculosis or pneumocystosis, should include histoplasmosis as part of their differential diagnoses.
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Affiliation(s)
- Morgane Bourne-Watrin
- Service de Dermatologie-Vénérologie, Centre Hospitalier de Cayenne, Cayenne, France.
| | - Antoine Adenis
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424, Centre Hospitalier de Cayenne, Cayenne, France
| | - Gary Doppelt
- Service de Radiologie, Centre Hospitalier de Cayenne, Cayenne, France
| | - Magaly Zappa
- Service de Radiologie, Centre Hospitalier de Cayenne, Cayenne, France
| | - Loïc Epelboin
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424, Centre Hospitalier de Cayenne, Cayenne, France
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Cayenne, France
| | - Mathieu Nacher
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424, Centre Hospitalier de Cayenne, Cayenne, France
| | - Jeanne Bigot
- Service de Parasitologie-Mycologie, Centre Hospitalier Saint Antoine APHP, Paris, France
| | - Kinan Drak Alsibai
- Laboratoire d'Anatomie et Cytologie Pathologique, Centre Hospitalier de Cayenne, Cayenne, France
| | - Romain Blaizot
- Service de Dermatologie-Vénérologie, Centre Hospitalier de Cayenne, Cayenne, France
| | - Denis Blanchet
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, Cayenne, France
| | - Magalie Demar
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, Cayenne, France
| | - Geneviève Guillot
- Service de Médecine B, Centre Hospitalier de Cayenne, Cayenne, France
| | - Félix Djossou
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Cayenne, France
| | - Pierre Couppié
- Service de Dermatologie-Vénérologie, Centre Hospitalier de Cayenne, Cayenne, France
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Lewis RE, Stanzani M, Morana G, Sassi C. Radiology-based diagnosis of fungal pulmonary infections in high-risk hematology patients: are we making progress? Curr Opin Infect Dis 2023; 36:250-256. [PMID: 37431554 PMCID: PMC10351900 DOI: 10.1097/qco.0000000000000937] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
PURPOSE OF REVIEW In patients with hematological malignancies, high-resolution computed tomography (CT) is the recommended imaging approach for diagnosis, staging and monitoring of invasive fungal disease (IFD) but lacks specificity. We examined the status of current imaging modalities for IFD and possibilities for more effective applications of current technology for improving the specificity of IFD diagnosis. RECENT FINDINGS Although CT imaging recommendations for IFD are largely unchanged in the last 20 years, improvements in CT scanner technology and image processing algorithms now allow for technically adequate examinations at much lower radiation doses. CT pulmonary angiography can improve both the sensitivity and specificity of CT imaging for angioinvasive molds in both neutropenic and nonneutropenic patients, through detection of the vessel occlusion sign (VOS). MRI-based approaches also show promise not only for early detection of small nodules and alveolar hemorrhage but can also be used to detect pulmonary vascular occlusion without radiation and iodinated contrast media. 18F-fluorodeoxyglucose (FDG) PET/computed tomography (FDG-PET/CT) is increasingly used to monitor long-term treatment response for IFD, but could become a more powerful diagnostic tool with the development of fungal-specific antibody imaging tracers. SUMMARY High-risk hematology patients have a considerable medical need for more sensitive and specific imaging approaches for IFD. This need may be addressable, in part, by better exploiting recent progress in CT/MRI imaging technology and algorithms to improve the specificity of radiological diagnosis for IFD.
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Affiliation(s)
- Russell E Lewis
- Infectious Diseases, Department of Molecular Medicine, University of Padua, Gabelli, Padua
| | - Marta Stanzani
- Hematopoietic Stem Cell Transplantation and Cellular Therapy, Hematology Unit, Regional Hospital Ca’ Foncello, AULSS 2- Marca Trevigiana, Piazza Ospedale
| | - Giovanni Morana
- Department of Radiology, Regional Hospital Ca’ Foncello, AULSS 2- Marca Trevigiana. Piazza Ospedale 1, Treviso
| | - Claudia Sassi
- Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, DIMEC-Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, IRCCS S. Orsola-Malpighi Hospital, Bologna, Italy
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Wang JW, Yang FF, Zhang CY, Lin JZ, Wang HX, Xu WJ. Imaging Characteristics of Invasive Pulmonary Fungal Infection Secondary to Hematological Diseases and Comparison before and after Treatment. J Healthc Eng 2021; 2021:3736108. [PMID: 34630984 PMCID: PMC8500768 DOI: 10.1155/2021/3736108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022]
Abstract
Fungal infections have become crucial factors that threaten the prognosis and survival of blood disease patients. Here, we aim to analyze the epidemiological characteristics and early and advanced CT (computed tomography) manifestations of patients with invasive pulmonary fungal infections secondary to blood system diseases. 65 hospitalized patients from October 2018 to October 2020 with invasive pulmonary fungal infections secondary to blood diseases were enrolled. Blood diseases were recorded according to clinical and imaging data, and the serum galactomannan test (GM test) was conducted. Two senior radiologists analyzed the CT data and recorded the distribution of the lesions and CT signs. We analyzed and counted the first chest CT scan images of patients with nodule/mass type secondary to hematological diseases and invasive pulmonary fungal infection. The first CT nodules or mass-type lesions were statistically significant in nodule size, the number of lesions, distribution, and accompanying signs. Pulmonary fungal infection was common in both lungs during 7-day, 14-day, and 30-day follow-up CT. We also found that the nodular mass type was the main manifestation in the positive group of the GM test. Both the positive group and the negative group had the highest incidence of nodules. The incidence of air crescent signs in nodules or mass lesions in the positive group was higher than in the negative group, and the difference was statistically significant. To conclude, follow-up CT signs after antifungal treatment were highly sensitive to the early diagnosis of hematological diseases and secondary invasive pulmonary Eumycetes infection, which could be used for clinical treatment to provide help. GM test results were also related to CT manifestations such as air crescent sign, cavity, and halo sign.
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Affiliation(s)
- Jun-Wei Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao 266001, Shandong, China
| | - Fang-Fang Yang
- Department of Nephrology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao 266001, Shandong, China
| | - Chuan-Yu Zhang
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao 266001, Shandong, China
| | - Ji-Zheng Lin
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao 266001, Shandong, China
| | - He-Xiang Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao 266001, Shandong, China
| | - Wen-Jian Xu
- Department of Radiology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao 266001, Shandong, China
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10
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Diongue K, Diallo MA, Sarr L, Seck MC, Bréchard L, Ndiaye M, Badiane AS, Ranque S, Ndiaye D. Pulmonary Madurella mycetomatis mycetoma secondary to knee eumycetoma, Senegal. PLoS Negl Trop Dis 2021; 15:e0009238. [PMID: 33764976 PMCID: PMC7993608 DOI: 10.1371/journal.pntd.0009238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Mycetoma is a neglected tropical disease which is endemic in Senegal. Although this subcutaneous mycosis is most commonly found on the foot, extrapodal localisations have also been found, including on the leg, knee, thigh, hand, and arm. To our knowledge, no case of blood-spread eumycetoma has been reported in Senegal. Here, we report a case of pulmonary mycetoma secondary to a Madurella mycetomatis knee eumycetoma. The patient was a 41-year-old farmer living in Louga, Senegal, where the Sudano-Sahelian climate is characterised by a short and unstable rainy season and a steppe vegetation. He suffered a trauma to the right more than 20 years previously and had received treatment for more than 10 years with traditional medicine. He consulted at Le Dantec University Hospital in Dakar for treatment of a right knee mycetoma which had been diagnosed more than 10 years ago. He had experienced a chronic cough for more than a year; tuberculosis documentation was negative. Grains collected from the knee and the sputum isolated M. mycetomatis, confirmed by the rRNA gene ITS regions nucleotide sequence analysis. An amputation above the knee was performed, and antibacterial and antifungal therapy was started with amoxicillin-clavulanic acid and terbinafine. The patient died within a month of his discharge from hospital.
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Affiliation(s)
- Khadim Diongue
- Laboratory of Parasitology and Mycology, Aristide Le Dantec University Hospital, Dakar, Senegal
- Service of Parasitology-Mycology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University of Dakar, Dakar, Senegal
- * E-mail:
| | - Mamadou Alpha Diallo
- Laboratory of Parasitology and Mycology, Aristide Le Dantec University Hospital, Dakar, Senegal
| | - Lamine Sarr
- Service of Orthopedics, Aristide Le Dantec University Hospital, Dakar, Senegal
| | - Mame Cheikh Seck
- Laboratory of Parasitology and Mycology, Aristide Le Dantec University Hospital, Dakar, Senegal
- Service of Parasitology-Mycology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University of Dakar, Dakar, Senegal
| | - Ludivine Bréchard
- University Hospital Institute Méditerranée Infection, Marseille, France
| | - Mouhamadou Ndiaye
- Laboratory of Parasitology and Mycology, Aristide Le Dantec University Hospital, Dakar, Senegal
- Service of Parasitology-Mycology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University of Dakar, Dakar, Senegal
| | - Aida Sadikh Badiane
- Laboratory of Parasitology and Mycology, Aristide Le Dantec University Hospital, Dakar, Senegal
- Service of Parasitology-Mycology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University of Dakar, Dakar, Senegal
| | - Stéphane Ranque
- University Hospital Institute Méditerranée Infection, Marseille, France
| | - Daouda Ndiaye
- Laboratory of Parasitology and Mycology, Aristide Le Dantec University Hospital, Dakar, Senegal
- Service of Parasitology-Mycology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University of Dakar, Dakar, Senegal
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Jain A, Knoll B, Lim S, Kleinman G, Epelbaum O. For Whom the Atoll Tolls: Targeting the Reversed Halo Sign. Am J Med 2021; 134:e150-e152. [PMID: 33353726 DOI: 10.1016/j.amjmed.2020.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 01/15/2023]
Affiliation(s)
| | | | | | | | - Oleg Epelbaum
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Westchester Medical Center, Valhalla, NY
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12
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Wang S, Zha Y, Li W, Wu Q, Li X, Niu M, Wang M, Qiu X, Li H, Yu H, Gong W, Bai Y, Li L, Zhu Y, Wang L, Tian J. A fully automatic deep learning system for COVID-19 diagnostic and prognostic analysis. Eur Respir J 2020; 56:2000775. [PMID: 32444412 PMCID: PMC7243395 DOI: 10.1183/13993003.00775-2020] [Citation(s) in RCA: 267] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/16/2020] [Indexed: 02/05/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has spread globally, and medical resources become insufficient in many regions. Fast diagnosis of COVID-19 and finding high-risk patients with worse prognosis for early prevention and medical resource optimisation is important. Here, we proposed a fully automatic deep learning system for COVID-19 diagnostic and prognostic analysis by routinely used computed tomography.We retrospectively collected 5372 patients with computed tomography images from seven cities or provinces. Firstly, 4106 patients with computed tomography images were used to pre-train the deep learning system, making it learn lung features. Following this, 1266 patients (924 with COVID-19 (471 had follow-up for >5 days) and 342 with other pneumonia) from six cities or provinces were enrolled to train and externally validate the performance of the deep learning system.In the four external validation sets, the deep learning system achieved good performance in identifying COVID-19 from other pneumonia (AUC 0.87 and 0.88, respectively) and viral pneumonia (AUC 0.86). Moreover, the deep learning system succeeded to stratify patients into high- and low-risk groups whose hospital-stay time had significant difference (p=0.013 and p=0.014, respectively). Without human assistance, the deep learning system automatically focused on abnormal areas that showed consistent characteristics with reported radiological findings.Deep learning provides a convenient tool for fast screening of COVID-19 and identifying potential high-risk patients, which may be helpful for medical resource optimisation and early prevention before patients show severe symptoms.
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Affiliation(s)
- Shuo Wang
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China
- Contributed equally
| | - Yunfei Zha
- Dept of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
- Contributed equally
| | - Weimin Li
- Dept of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- Contributed equally
| | - Qingxia Wu
- College of Medicine and Biomedical Information Engineering, Northeastern University, Shenyang, China
- Contributed equally
| | - Xiaohu Li
- Dept of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Contributed equally
| | - Meng Niu
- Dept of Interventional Radiology, the First Hospital of China Medical University, Shenyang, China
- Contributed equally
| | - Meiyun Wang
- Dept of Medical Imaging, Henan Provincial People's Hospital and the People's Hospital of Zhengzhou University, Zhengzhou, China
- Contributed equally
| | - Xiaoming Qiu
- Dept of Radiology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, China
- Contributed equally
| | - Hongjun Li
- Dept of Radiology, Beijing Youan Hospital of Capital Medical University, Beijing, China
- Contributed equally
| | - He Yu
- Dept of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Gong
- Dept of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yan Bai
- Dept of Medical Imaging, Henan Provincial People's Hospital and the People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Li Li
- Dept of Radiology, Beijing Youan Hospital of Capital Medical University, Beijing, China
| | - Yongbei Zhu
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China
| | - Liusu Wang
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China
| | - Jie Tian
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
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13
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Boumaza X, Lelièvre L, Guenounou S, Borel C, Huynh A, Beziat G, Delavigne K, Guinault D, Garric M, Piel-Julian M, Paricaud K, Moulis G, Astudillo L, Sailler L, Farge D, Pugnet G. Pulmonary mucormycosis following autologous hematopoietic stem cell transplantation for rapidly progressive diffuse cutaneous systemic sclerosis: A case report. Medicine (Baltimore) 2020; 99:e21431. [PMID: 32756151 PMCID: PMC7402716 DOI: 10.1097/md.0000000000021431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
RATIONALE The use of autologous hematopoietic stem cell transplantation (AHSCT) for autoimmune diseases has become the first indication for transplant in nonmalignant disease. Mucormycosis is a rare invasive infection with increasing incidence in patients treated with AHSCT. We report the first case of pulmonary mucormycosis following AHSCT for systemic sclerosis (SSc). PATIENT CONCERNS A 24-year-old woman with rapidly progressive diffuse cutaneous SSc presented with an acute respiratory distress syndrome 6 days after AHSCT. DIAGNOSES The results of clinical and computed tomography scan were consistent with pulmonary mucormycosis and the diagnosis was confirmed by a positive Mucorales Polymerase Chain Reaction on a peripheral blood sample. INTERVENTIONS AND OUTCOMES Early antifungal therapy by intravenous amphotericin B provided rapid improvement within 4 days and sustained recovery after 2 years of follow-up. LESSONS With the progressively increasing use of AHSCT and other stem cell therapy for treatment of severe SSc and other autoimmune diseases, the potential onset of rare post-transplant fungal infections, such as mucormycosis, requires careful patient monitoring and better awareness of early initiation of adequate therapy.
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Affiliation(s)
| | - Lucie Lelièvre
- Department of infectious and tropical diseases, Toulouse University Hospital
| | | | | | | | | | - Karen Delavigne
- Department of Internal Medicine, Institut Universitaire du Cancer de Toulouse - Oncopole
| | | | | | | | | | - Guillaume Moulis
- Department of Internal Medicine
- Clinical Investigation Center, Toulouse University Hospital
- UMR 1027 INSERM, University of Toulouse, Toulouse
| | | | - Laurent Sailler
- Department of Internal Medicine
- Clinical Investigation Center, Toulouse University Hospital
- UMR 1027 INSERM, University of Toulouse, Toulouse
| | - Dominique Farge
- Unité de Médecine Interne: Maladies Auto-immunes et Pathologie Vasculaire (UF 04), Hôpital St-Louis, AP-HP, 1 Avenue Claude Vellefaux
- Centre de Référence des Maladies auto-immunes Systémiques Rares d’Ile-de-France
- EA 3518, Université Denis Diderot, Paris, France
- Department of Internal Medicine, McGill University, Montréal, Canada
| | - Grégory Pugnet
- Department of Internal Medicine
- Clinical Investigation Center, Toulouse University Hospital
- UMR 1027 INSERM, University of Toulouse, Toulouse
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14
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Abstract
To investigate the characteristics of spiral computed tomography (CT), positron emission tomography-computed tomography (PET/CT) and clinical manifestations of talaromycosis to improve the diagnostic level and deepen its recognition in radiology.Radiological, clinical, and pathological manifestations of 15 patients of non-HIV talaromycosis confirmed by bronchofiberscope lung biopsy and/or abscess puncture fluid culture and/or blood culture and/or sputum culture were analyzed retrospectively. All patients underwent chest CT, among them, six had a brain MRI, and six had a PET/CT scan before treatment.On plain CT scan, there were multiple patches and massive consolidation in 6 patients, multiple patchy consolidations and patchy ground-glass opacities in 3 patients, solitary or multiple nodules and masses in 3 patients, multiple cavities and small nodules in 3 patients. Multiple lymphadenectasis appeared in bilateral hila, mediastinum, and neck in 10 patients. In contrast CT scan, the parenchyma of the lesions had a slight enhancement in 10 patients, moderate enhancement in 3 patients, obvious enhancement in 2 patients. Seven cases had bone destruction and hyperplasia, cranial involvement in 1 patient and liver involvement in 3 patients, respectively. On PET/CT, five patients showed elevated standard uptake value (SUV).The radiological manifestations of non-HIV talaromycosis show multiple consolidations, ground-glass opacities, multiple nodules or masses in bilateral lungs, deep-seated enlarged lymph nodes and bone destruction in multiple systems. The final diagnosis should be based on the culture of talaromycosis.
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Affiliation(s)
- Xinchun Li
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University
| | - Wenqing Hu
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University
| | - Qi Wan
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University
| | - Qiang Lei
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University
| | - Chongpeng Sun
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University
| | - Zhongjun Hou
- Department of Radiology, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nitesh Shrestha
- Department of Radiology, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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15
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Fujioka K, Nagai T, Kinoshita Y, Urushihara M, Hamasaki Y, Shishido S, Kagami S. Successful treatment with voriconazole combined with amphotericin B-liposome for fluconazole-resistant pulmonary cryptococcosis after renal transplantation. CEN Case Rep 2019; 8:261-265. [PMID: 31161376 DOI: 10.1007/s13730-019-00403-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/23/2019] [Indexed: 11/26/2022] Open
Abstract
Cryptococcosis is an invasive fungal infection that is common among organ transplant recipients, and it is challenging to treat among these patients because of their immunocompromised status. Fluconazole (FLCZ) is recommended as a first-line treatment modality for pulmonary cryptococcosis in organ transplant recipients. However, cases of FLCZ resistance among Cryptococcus neoformans isolates have been reported from the Asia Pacific region. Previous studies have reported the efficacy of voriconazole (VRCZ) in patients with FLCZ-resistant fungal infections. Herein, we report a case of FLCZ-resistant pulmonary cryptococcosis after renal transplantation that was successfully treated with VRCZ combined with amphotericin B-liposome (L-AMB). The patient was a-23-year-old woman who underwent living-donor kidney transplantation at age 20 years. She has attended our hospital since before for mental retardation, epilepsy, and dilated cardiomyopathy. At age 23 years, she presented to our hospital with fever and cough. She was diagnosed with pulmonary cryptococcosis based on positive-serum cryptococcal antigen. Chest radiography showed bilateral consolidations. Fosfluconazole (F-FLCZ) was administered, and her condition improved. However, she developed cough and fever again on day 60 of hospitalization. Cryptococcosis recurrence was suspected due to the high degree of cryptococcal antigen titers showed (1:2048) taken on the same day. Therefore, L-AMB was added, and F-FLCZ was substituted with VRCZ. Her condition improved, but L-AMB was discontinued due to hyponatremia, hypokalemia, and elevated serum creatinine. This indicates that VRCZ caused the remission. She was discharged after 6 months of admission. In conclusion, this case shows the efficacy of VRCZ combined with L-AMB for refractory pulmonary cryptococcosis.
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Affiliation(s)
- Keisuke Fujioka
- Department of Pediatrics, Institute of Biochemical Sciences, Tokushima University Graduate School, Kuramoto-cho 3-18-15, Tokushima, Tokushima, 770-8503, Japan.
| | - Takashi Nagai
- Department of Pediatrics, Institute of Biochemical Sciences, Tokushima University Graduate School, Kuramoto-cho 3-18-15, Tokushima, Tokushima, 770-8503, Japan
| | - Yukiko Kinoshita
- Department of Pediatrics, Institute of Biochemical Sciences, Tokushima University Graduate School, Kuramoto-cho 3-18-15, Tokushima, Tokushima, 770-8503, Japan
| | - Maki Urushihara
- Department of Pediatrics, Institute of Biochemical Sciences, Tokushima University Graduate School, Kuramoto-cho 3-18-15, Tokushima, Tokushima, 770-8503, Japan
| | - Yuko Hamasaki
- Department of Pediatric Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Seiichiro Shishido
- Department of Pediatric Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Shoji Kagami
- Department of Pediatrics, Institute of Biochemical Sciences, Tokushima University Graduate School, Kuramoto-cho 3-18-15, Tokushima, Tokushima, 770-8503, Japan
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16
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Inagaki T, Futagawa Y, Sato S, Okamoto T, Yabe M, Matsudaira H, Hirano J, Morikawa T. [Pulmonary Cryptcoccosis Mimicking Malignant Tumor;Report of a Case]. Kyobu Geka 2018; 71:556-559. [PMID: 30042261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pulmonary cryptococcosis is difficult to distinguish from lung cancer clinically, and is often diagnosed by surgery. A 72-year-old woman, who underwent distal pancreatectomy and splenectomy for pancreatic carcinoma. Four months after surgery, a tumor shadow was detected in the left lung as a groundglass nodule (GGN)of 12 mm in diameter, which was found to change to 15 mm with increased density by the computed tomography(CT)scan after 2 months. The nodule showed positive accumulation of fluorodeoxyglucose(FDG)by positron emission tomography(PET), and was suspected of malignant tumor. She underwent a partial resection of the left lung under thoracoscopy.
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Affiliation(s)
- Takuya Inagaki
- Department of Surgery, Jikei University School of Medicine Daisan Hospital, Komae, Japan
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17
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Bau-Gaudreault L, Gara-Boivin C. Pathology in Practice. J Am Vet Med Assoc 2018; 252:813-815. [PMID: 29553898 DOI: 10.2460/javma.252.7.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Abstract
This study draws attention to difficulties in the diagnosis and the understanding of the mechanism of action of mushroom compost worker's lung. Descriptions are given of 4 workers in one factory who developed acute respiratory failure within a 6-month period; 13 others who were unaffected were also studied. Serological investigation appears to be largely unhelpful, and the evidence against the condition being included amongst the extrinsic allergic alveolitides is discussed. A detailed clinical and occupational history is essential for diagnosis.
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19
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Chen XQ, Tan WH, Jiang FF, Chen X. [A clinical analysis of children with invasive pulmonary fungal infections after biliary atresia surgery]. Zhongguo Dang Dai Er Ke Za Zhi 2018; 20:121-124. [PMID: 29429460 PMCID: PMC7389236 DOI: 10.7499/j.issn.1008-8830.2018.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 12/25/2017] [Indexed: 06/08/2023]
Abstract
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.
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Affiliation(s)
- Xiu-Qi Chen
- Department of Pediatrics, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China.
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20
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Chen XQ, Tan WH, Jiang FF, Chen X. [A clinical analysis of children with invasive pulmonary fungal infections after biliary atresia surgery]. Zhongguo Dang Dai Er Ke Za Zhi 2018; 20:121-124. [PMID: 29429460 PMCID: PMC7389236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 12/25/2017] [Indexed: 11/04/2023]
Abstract
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.
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Affiliation(s)
- Xiu-Qi Chen
- Department of Pediatrics, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China.
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21
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Lu J, Palavecino EL, Salih ZT. Pulmonary cryptococcosis diagnosed on a lung fine-needle aspiration. Diagn Cytopathol 2017; 46:160-161. [PMID: 29063707 DOI: 10.1002/dc.23842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/28/2017] [Accepted: 10/04/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Jing Lu
- Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Elizabeth L Palavecino
- Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Ziyan T Salih
- Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
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22
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Patterson J, Graham D, George A, Will M, Sutter D. Right Middle Lobe Collapse and Pleural Effusion in an 18-Year-Old Man. Chest 2017; 152:e33-e38. [PMID: 28797398 DOI: 10.1016/j.chest.2017.04.187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 04/14/2017] [Accepted: 04/18/2017] [Indexed: 11/19/2022] Open
Abstract
An 18-year-old African American male subject presented to an acute care clinic with 3 days of productive cough, chills, pleuritic right chest pain, sore throat with hoarseness, congestion, and intermittent shortness of breath. He recently relocated to Texas from Georgia to undergo basic military training. He denied any other recent travel or contact with persons with pulmonary TB or other respiratory illnesses. His medical history was significant for glucose-6-phosphate dehydrogenase deficiency and sickle cell trait.
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Affiliation(s)
- Joshua Patterson
- Department of Pediatrics, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX
| | - David Graham
- Department of Cardiothoracic Surgery, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX
| | - Alan George
- Department of Pathology, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX
| | - Micah Will
- Department of Pathology, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX
| | - Deena Sutter
- Department of Pediatrics, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX.
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23
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Kansagra K, Ploch S, Neitzschman HR. Radiology Case of the Month: TB or Not TB… That is the Question. J La State Med Soc 2017; 169:111-113. [PMID: 28850560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
45-year-old female presenting initially with fever, nonproductive cough, night sweats, pleuritic chest pain, fatigue and weight loss over the past month.
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Affiliation(s)
| | - Stefan Ploch
- Tulane University Health Sciences Center - New Orleans, LA
| | - Harold R Neitzschman
- Tulane University Health Sciences Center, Department of Radiology - New Orleans, LA
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24
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Hu Z, Chen J, Wang J, Xiong Q, Zhong Y, Yang Y, Xu C, Wei H. Radiological characteristics of pulmonary cryptococcosis in HIV-infected patients. PLoS One 2017; 12:e0173858. [PMID: 28301552 PMCID: PMC5354418 DOI: 10.1371/journal.pone.0173858] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/28/2017] [Indexed: 11/19/2022] Open
Abstract
Background Current understanding of human immunodeficiency virus (HIV)-associated pulmonary cryptococcosis (PC) is largely based on studies performed about 2 decades ago which reported that the most common findings on chest radiograph were diffuse interstitial infiltrates. Few studies are available regarding the computed tomography (CT) findings. The aim of this study was to characterize chest CT features of HIV-associated PC. Methods HIV patients with cryptococccal infection and pulmonary abnormalities on Chest CT between September 2010 and May 2016 in the Second Affiliated Hospital of the Southeast University were retrospectively analyzed. Confirmed cases of tumors, mycobacterial infections and other fungal infections were excluded from the analysis. Results 60 cases were identified. The median CD4 T-cell counts were 20 cells/μL (range, 0–205 cells/μL). Chest CT scans demonstrated nodular lesions in 93.3% of the studied patients. Those nodular lesions were usually cavitated and solitary nodule was the most common form. Pleural effusions and pneumonic infiltrates occurred in 11.6% and 31.7% of the cases respectively. Those lesions were usually had co-existing nodular lesions. Etiological analysis suggested that 76.8% of the nodular lesions could have a relationship with PC that 12.5% of the nodular lesions were “laboratory-confirmed” cases, 48.2% were “clinically confirmed” cases and 16.1% were “clinically probable” cases. 85.7% of the pleural effusions could be “clinically confirmed” cases of PC. At least, 38.5% of the diffuse pneumonic infiltrates may be clinically attributed to pneumocystis pneumonia. Conclusions This study suggested that pulmonary nodules but not diffuse pneumonia are the most common radiological characteristics of HIV-associated PC. HIV-infected patients with pulmonary nodules on Chest CT should particularly be screened for cryptococcal infection.
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Affiliation(s)
- Zhiliang Hu
- Department of Infectious Disease, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China
| | - Jun Chen
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Juan Wang
- Department of Pathology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qingfang Xiong
- Department of Infectious Disease, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China
| | - Yandan Zhong
- Department of Infectious Disease, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China
| | - Yongfeng Yang
- Department of Infectious Disease, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China
| | - Chuanjun Xu
- Department of radiology, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China
- * E-mail: (CX); (HW)
| | - Hongxia Wei
- Department of Infectious Disease, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China
- * E-mail: (CX); (HW)
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25
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Barthes N, Morin F, Pommier de Santi V, Briolant S. Lung nodule in French Guiana in a immunocompetent patient. Med Sante Trop 2017; 27:26-28. [PMID: 28406413 DOI: 10.1684/mst.2017.0652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We report the case of an immunocompetent French soldier stationed in French Guiana, who developed symptomatic pulmonary histoplasmosis.
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Affiliation(s)
| | - F Morin
- Centre médical interarmées de Kourou
| | | | - S Briolant
- Institut de recherche appliquée aux armées - unité de parasitologie, Antenne médicale de La Cavalerie
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26
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Toma P, Bertaina A, Castagnola E, Colafati GS, D'Andrea ML, Finocchi A, Lucidi V, Mastronuzzi A, Granata C. Fungal infections of the lung in children. Pediatr Radiol 2016; 46:1856-1865. [PMID: 27663906 DOI: 10.1007/s00247-016-3696-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/04/2016] [Accepted: 08/21/2016] [Indexed: 01/12/2023]
Abstract
Fungal infections of the lungs are relatively common and potentially life-threatening conditions in immunocompromised children. The role of imaging in children with lung mycosis is to delineate the extension of pulmonary involvement, to assess response to therapy, and to monitor for adverse sequelae such as bronchiectasis and cavitation. The aim of this paper is to show imaging findings in a series of patients with fungal pneumonia from two tertiary children's hospitals, to discuss differential diagnoses and to show how imaging findings can vary depending on the host immune response.
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Affiliation(s)
- Paolo Toma
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Alice Bertaina
- Department of Pediatric Hematology/Oncology and Transfusion Medicine, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Elio Castagnola
- Department of Infective Diseases, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | | | - Andrea Finocchi
- Department of Pediatrics, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Vincenzina Lucidi
- Cystic Fibrosis Center, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Angela Mastronuzzi
- Department of Pediatric Hematology/Oncology and Transfusion Medicine, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Claudio Granata
- Department of Pediatric Radiology, IRCCS Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.
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27
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Chan TSY, Khong PL, Kwong YL. Pembrolizumab for relapsed anaplastic large cell lymphoma after allogeneic haematopoietic stem cell transplantation: efficacy and safety. Ann Hematol 2016; 95:1913-5. [PMID: 27473193 DOI: 10.1007/s00277-016-2764-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 07/20/2016] [Indexed: 11/26/2022]
MESH Headings
- Adult
- Antibodies, Monoclonal, Humanized/immunology
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents/immunology
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- B7-H1 Antigen/antagonists & inhibitors
- B7-H1 Antigen/immunology
- Brentuximab Vedotin
- Female
- Graft vs Host Disease/etiology
- Hematopoietic Stem Cell Transplantation
- Humans
- Immunoconjugates/administration & dosage
- Lung Diseases, Fungal/diagnostic imaging
- Lung Diseases, Fungal/etiology
- Lymphoma, Large-Cell, Anaplastic/drug therapy
- Lymphoma, Large-Cell, Anaplastic/therapy
- Neoplasm Proteins/antagonists & inhibitors
- Neoplasm Proteins/immunology
- Positron Emission Tomography Computed Tomography
- Recurrence
- Remission Induction
- Salvage Therapy
- Transplantation, Homologous
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Affiliation(s)
- Thomas S Y Chan
- Department of Medicine, Queen Mary Hospital, Pokfulam Road, Pok Fu Lam, Hong Kong
| | - Pek-Lan Khong
- Department of Diagnostic Radiology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Yok-Lam Kwong
- Department of Medicine, Queen Mary Hospital, Pokfulam Road, Pok Fu Lam, Hong Kong.
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28
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Abstract
Records of 59 patients (41 males and 18 females) who underwent 70 operations for pulmonary aspergilloma in a 23-year period were examined retrospectively. Sixty-three operations were for primary treatment of pulmonary aspergilloma, and 7 were for complications of surgery. Twenty-six postoperative complications occurred in 19 patients. Three lobectomies that resulted in bronchopleural fistula were managed by intercostal muscle-flap closure and partial thoracomyoplasty. Two patients died within the first week of surgery. Surgery is the treatment of choice for most patients with pulmonary aspergilloma. Selective bronchial artery embolization is helpful only in combating hemoptysis, and this has been considered a temporary measure in most reports. Thus, open thoracotomy and anatomical resection are recommended as early as possible after the diagnosis is established.
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Affiliation(s)
- Ismail C Kurul
- Department of Thoracic Surgery, Gazi University Medical Faculty, Ankara, Turkey.
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29
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Affiliation(s)
- Prashant Sharma
- Department of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA,
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30
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Hagos G, Esayas R. PULMONARY COCCIDIODOMYCOSIS PRESENTING AS A MASS, AN UNCOMMON DISEASE ENTITY IN ETHIOPIA. Ethiop Med J 2015; 53:35-37. [PMID: 26591290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Coccidiodomycosis is a disease caused by the spores of the fungi coccidiodes immitis and pulmonary coccidiodomycosis comes after inhalation of the spores which are mainly found in desert areas of the United States, central and South America. Reported cases from outside the endemic areas have always history of travel to these areas. There are no reports so far from Ethiopia or the whole Africa. We report here a case of pulmonary coccidodomycosis with no history of travel to such areas. A 24 years old female patient from Samre, South-Eastern Tigray, presented with right side chest pain and productive cough of yellowish sputum which sometimes is blood streaked. She had completed anti-tuberculosis treatment without any improvement. With a preliminary diagnosis of pulmonary mass, surgical exploration was made and histology of the excised tissue showed appedrances consistent with pulmonary coccidioidomycosis. There was marked clinical and radiological improvement after three weeks of treatment with ketoconazole. Though there are no reported cases from Ethiopia and Africa as a whole, Coccidiodomycosis should be considered as differential diagnosis especially for patients from arid areas like that of our patient before any empirical treatment.
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31
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Yanagawa N, Sakai F, Takemura T, Ishikawa S, Takaki Y, Hishima T, Kamata N. Pulmonary cryptococcosis in rheumatoid arthritis (RA) patients: comparison of imaging characteristics among RA, acquired immunodeficiency syndrome, and immunocompetent patients. Eur J Radiol 2013; 82:2035-42. [PMID: 23954014 DOI: 10.1016/j.ejrad.2013.07.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 06/17/2013] [Accepted: 07/16/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE The imaging characteristics of cryptococcosis in rheumatoid arthritis (RA) patients were analyzed by comparing them with those of acquired immunodeficiency syndrome (AIDS) and immunocompetent patients, and the imaging findings were correlated with pathological findings. METHODS Two radiologists retrospectively compared the computed tomographic (CT) findings of 35 episodes of pulmonary cryptococcosis in 31 patients with 3 kinds of underlying states (10 RA, 12 AIDS, 13 immunocompetent), focusing on the nature, number, and distribution of lesions. The pathological findings of 18 patients (8 RA, 2 AIDS, 8 immunocompetent) were analyzed by two pathologists, and then correlated with imaging findings. RESULTS The frequencies of consolidation and ground glass attenuation (GGA) were significantly higher, and the frequency of peripheral distribution was significantly lower in the RA group than in the immunocompetent group. Peripheral distribution was less common and generalized distribution was more frequent in the RA group than in the AIDS group. The pathological findings of the AIDS and immunocompetent groups reflected their immune status: There was lack of a granuloma reaction in the AIDS group, and a complete granuloma reaction in the immunocompetent group, while the findings of the RA group varied, including a complete granuloma reaction, a loose granuloma reaction and a hyper-immune reaction. Cases with the last two pathologic findings were symptomatic and showed generalized or central distribution on CT. CONCLUSION Cryptococcosis in the RA group showed characteristic radiological and pathological findings compared with the other 2 groups.
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Affiliation(s)
- Noriyo Yanagawa
- Departments of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-8-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.
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Pasticci MB, Barchiesi F, Fallani S, Palladino N, Lapalorcia LM, Gubbiotti M, Cozzari M, Novelli A, Baldelli F. Clinical Efficacy and Tolerability of Caspofungin in a Renal Transplant Patient withAspergillus flavusLung Infection: Case Report. J Chemother 2013; 18:549-53. [PMID: 17127234 DOI: 10.1179/joc.2006.18.5.549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Organ transplant recipients are at increased risk for severe invasive aspergillosis, and amphotericin deoxycholate has been the standard treatment for many years. Currently, however, lipid formulations are preferred due to their few side effects. Also, a number of new antifungal drugs have been developed including new azoles and echinocandins. Caspofungin is the first of the echinocandin derivatives patented to treat patients with invasive aspergillosis who are refractory or intolerant to other therapies. A renal transplant patient on immunosuppressive treatment with chronic hepatitis B virus infection was admitted with fever, hemophthisis and lung consolidation, diagnosed to be probably caused by Aspergillus flavus. The patient developed cholestatic hepatitis most likely related to itraconazole. Clinical failure and in vitro itraconazole resistance of the isolate was also documented while the patient was receiving itraconazole at a reduced dosage. Caspofungin was administered once a day as ambulatory treatment and was well tolerated. Clinical improvement was observed after 6 weeks of treatment and no hepatic toxicity was documented. Caspofungin seems to be a potentially useful antifungal agent in renal transplant patients with invasive aspergillosis. Further evaluation of the efficacy of caspofungin is needed.
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Affiliation(s)
- M B Pasticci
- Clinica di Malattie Infettive, Dipartimento Medicina Sperimentale e Scienze Biochimiche, Università di Perugia, Perugia, Italy.
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Ourari-Dhahri B, Ben Amar J, El Gharbi L, Baccar MA, Azzabi S, Aouina H, Bouacha H. [Lung mycosis in non neuropenic patients]. J Mycol Med 2013; 22:217-20. [PMID: 23518077 DOI: 10.1016/j.mycmed.2012.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 04/24/2012] [Accepted: 05/03/2012] [Indexed: 11/16/2022]
Abstract
UNLABELLED Lung mycosis is rare. Diagnosis and treatment must be done the earliest possible. METHODS It is about a retrospective study on clinical records including patients hospitalized for lung infection. RESULTS From 2008 to 2011, 16 patients (13 men and three women, average age 42 years) developed a pulmonary infection. Twelve of our patients had respiratory or extrarespiratory histories. None of our patients had a neutropenia. The diagnoses were lung aspergilloma in four cases, invasive lung aspergillosis in three cases, allergic bronchopulmonary aspergillosis in three cases, mucormycosis in three cases, trichosporonosis in a case, actinomycosis in one case and penicilliosis in one case. An antifungal treatment consisting in amphotericin B or itraconazole was given to four patients and six patients, respectively. Surgery was chosen for six patients. The evolution was good for 12 patients, one presented renal failure, and three patients died.
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Affiliation(s)
- B Ourari-Dhahri
- Service de pneumologie, faculté de médecine de Tunis, université Tunis El Manar, centre hospitalo-universitaire Charles-Nicolle, Bab Saadoun, 1106 Tunis, Tunisie
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DiNicola AF, Snow WH, Bahadori AH, Bingamon TW, Garner S, Montalvo R. RE: histopathological documented cryptococcal lung lesion associated with diabetes mellitus and dental abscess. Mil Med 2012; 177:vii. [PMID: 23113433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
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Anstead GM, Sutton DA, Graybill JR. Adiaspiromycosis causing respiratory failure and a review of human infections due to Emmonsia and Chrysosporium spp. J Clin Microbiol 2012; 50:1346-54. [PMID: 22259200 PMCID: PMC3318518 DOI: 10.1128/jcm.00226-11] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 01/04/2012] [Indexed: 11/20/2022] Open
Abstract
We report a case of a 27-year-old male who presented with respiratory distress that required mechanical ventilation. Transbronchial biopsy revealed adiaspores of the fungus Emmonsia crescens within granulomata, a condition known as adiaspiromycosis. The patient received amphotericin products and corticosteroids, followed by itraconazole, and made a full recovery. Emmonsia crescens is a saprobe with a wide distribution that is primarily a rodent pathogen. The clinical characteristics of the 20 cases of human pulmonary adiaspiromycosis reported since the last comprehensive case review in 1993 are described here, as well as other infections recently reported for the genus Emmonsia. Pulmonary adiaspiromycosis has been reported primarily in persons without underlying host factors and has a mild to severe course. It remains uncertain if the optimal management of severe pulmonary adiaspiromycosis is supportive or if should consist of antifungal treatment, corticosteroids, or a combination of the latter two. The classification of fungi currently in the genus Emmonsia has undergone considerable revision since their original description, including being grouped with the genus Chrysosporium at one time. Molecular genetics has clearly differentiated the genus Emmonsia from the Chrysosporium species. Nevertheless, there has been a persistent confusion in the literature regarding the clinical presentation of infection with fungi of these two genera; to clarify this matter, the reported cases of invasive Chrysosporium infections were reviewed. Invasive Chrysosporium infections typically occur in impaired hosts and can have a fatal course. Based on limited in vitro susceptibility data for Chrysosporium zonatum, amphotericin B is the most active drug, itraconazole susceptibility is strain-dependent, and fluconazole and 5-fluorocytosine are not active.
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Affiliation(s)
- Gregory M Anstead
- Department of Medicine, Division of Infectious Diseases, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
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36
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White FN, Zedek DC, Collins DL, Boswell JS. Granuloma annulare arising in association with pulmonary coccidioidomycosis. Dermatol Online J 2012; 18:7. [PMID: 22483518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Granuloma annulare (GA) is a reactive process in the dermis, related to degeneration of collagen. It may occur as an idiopathic phenomenon or in conjunction with a myriad of systemic conditions, including infectious disease. We report an interesting case of GA precipitated by pulmonary coccidioidomycosis.
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Affiliation(s)
- Forrest N White
- Columbia University College of Physicians and Surgeons, New York, New York, USA
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Rais H, Jghaimi F, Baalal H, Naji Y, Essaadouni L, Essadki O, Oussehal A, Mejjati M, Aitbenali S, Elyazidi AA, Belaabidia B. [Blastomycosis in Morocco: imported mycosis]. Rev Pneumol Clin 2012; 68:45-49. [PMID: 22305137 DOI: 10.1016/j.pneumo.2011.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 03/17/2011] [Accepted: 04/03/2011] [Indexed: 05/31/2023]
Abstract
Blastomycosis is a rare case. We report a first Moroccan case. A 41-year-old male presented with a 6-month history of dyspnea, fever and significant chest pain associated with night sweats and weight loss. The physical examination disclosed a firm painful paravertebral mass. The chest radiograph demonstrated a left apical opacity. The thoracic scan showed parenchymal infiltration of the apico-dorsal segment of the left upper lobe with vertebral and costal lytic lesions. Surgical biopsy showed granulomatous inflammation with giant-cell intracytoplasmic inclusions. Fungal studies yielded Blastomyces dermatitidis which responded excellently to ketoconazole. Outcome has been excellent at 3.5 years months follow-up. The clinical and radiographic presentation of blastomycosis is non-specific and can be mistaken for a neoplasm. Delay in diagnosis is common.
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Affiliation(s)
- H Rais
- Service d'anatomie pathologie, faculté de médecine et de pharmacie, CHU Mohammed VI, université Cadi Ayyad, Marrakech, Maroc
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El Fane M, Ouladlahsen A, Bakhatar A, Sodqi M, El Filali KM, Bahlaoui A, Chakib A. [Pulmonary aspergillosis and HIV infection: about two cases]. Rev Pneumol Clin 2012; 68:36-39. [PMID: 22056792 DOI: 10.1016/j.pneumo.2011.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 04/19/2011] [Accepted: 05/02/2011] [Indexed: 05/31/2023]
Abstract
The occurrence of invasive pulmonary aspergillosis is unusual during the course of AIDS. Patients at risk have a CD4 T-lymphocyte count under 50 cells/mm(3) combined with other risk factors in 50% of the cases. Positive diagnosis is based on chest CT scan imaging and isolation of Aspergillus in broncho-alveolar fluid. Detection of galactomannan antigen in serum and broncho-alveolar lavage fluid (BALF) is a reliable complementary tool in assessing the diagnosis. The first line therapy is Voriconazole. The prognosis, often severe, depends on prompt initiation of the appropriate antifungal treatment. We report two cases of invasive pulmonary aspergillosis in AIDS patients.
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Affiliation(s)
- M El Fane
- Service des maladies infectieuses, CHU Ibn Rochd, quartier des hôpitaux, Casablanca 20100, Maroc.
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39
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Affiliation(s)
- B Ziso
- Royal London Hospital, Barts and the London NHS Trust, London, UK
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Li XS, Zhu HX, Fan HX, Zhu L, Wang HX, Song YL. Pulmonary fungal infections after bone marrow transplantation: the value of high-resolution computed tomography in predicting their etiology. Chin Med J (Engl) 2011; 124:3249-3254. [PMID: 22088516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND The correct diagnosis of etiology of fungal infection after bone marrow transplantation is very important to the choice of antifungal drugs and a premise for improvement of therapeutic efficacy. This study aimed to compare high-resolution computed tomography (HRCT) findings of the pulmonary fungal infections to determine whether the etiology of various fungal infections could be diagnosed with HRCT. METHODS Eighty-five cases were enrolled. According to the pathogens responsible for fungal infections, the patients were classified into three groups including invasive aspergillosis (n = 52), candidiasis (n = 19) and cryptococcosis (n = 14) groups. All the patients underwent HRCT scans. Two independent radiologists retrospectively analyzed the HRCT scans regarding CT patterns and distribution of lung abnormality. RESULTS Most fungal infections in the three groups occurred in the neutropenic phase. There was no significant difference in the constituent ratio of fungal infections at different phases after bone marrow transplantation among the three groups. Agreement between the two observers for all the CT characteristics of fungal infections was excellent (k > 0.75). There was a significant difference in occurrence ratio of mass among the three groups (P = 0.02). Occurrence ratio of mass (43.3%, 13/30) in the group with invasive aspergillosis was higher than in each of other two groups (20.0%, 2/10; 14.3%, 1/7). There was no significant difference in other CT characteristics of nodules or masses; including number, margin, halo sign, cavitation and air-crescent sign. There was no significant difference in number, margin, air bronchogram and distribution of air-space consolidation. CONCLUSIONS The HRCT appearance of various pulmonary fungal infections has a great deal of overlap and is nonspecific. Mass is more common in invasive aspergillosis, which is helpful to the diagnosis of invasive aspergillosis after bone marrow transplantation.
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Affiliation(s)
- Xiang-Sheng Li
- Department of CT, Air Force General Hospital, People's Liberation Army, Beijing 100142, China.
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Affiliation(s)
- Jordan Kempker
- Department of Medicine, Emory University School of Medicine, Second Flr of Glenn Building, 49 Jesse Hill Jr Dr, Atlanta, GA 30303, USA.
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Ghimire P, Sah AK. Pulmonary cryptococcosis and tuberculoma mimicking primary and metastatic lung cancer in 18F-FDG PET/CT. Nepal Med Coll J 2011; 13:142-143. [PMID: 22364103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
18F-fluorodeoxyglucose positron emission tomography (FDG-PET) has been widely incorporated in cancer management. Although, it has increased sensitivity, 18F-FDG is not tissue specific thus posing diagnostic dilemma in certain situations. False positivity in pulmonary nodules have been seen in various inflammatory, infective as well as post operative conditions while false negativity is common with adenomas, low grade lymphomas, bronchoalveolar carcinomas and carcinoid tumors. We present two cases of granulomatous diseases as pulmonary cryptococcosis and tuberculosis showing false positivity in a resected colorectal cancer patient and highlight the importance of recognition of this entity in an endemic region for granulomatous infections.
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Affiliation(s)
- P Ghimire
- Department of Radiology and Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, PR China.
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Takata S, Yoshioka Y, Naito H, Kozuma K, Kinuwaki E. [A case of secondary pulmonary cryptococcosis presenting with multiple cystic shadows]. Nihon Kokyuki Gakkai Zasshi 2011; 49:315-320. [PMID: 21591463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
An 80-year-old woman with a history of rheumatoid arthritis and steroid diabetes had been given a diagnosis of multiple bilateral pulmonary cystic lesions 16 months previously, and these lesions were observed to gradually increase on follow-up. She presented with a fever of 38 degrees C, cough, and sputum for 2 weeks, and the pulmonary cystic lesions had enlarged, and therefore she was admitted. A chest X-ray film revealed multiple cystic lesions 4 cm in greatest dimension in both the left upper and middle lung fields, and chest computed tomography (CT) scans revealed that the lesions of the left S1+2 had niveau formation with a partially thickened wall. However, the lesions in the left S4 and S5 areas and the right S8 area had thin, smooth walls. Transbronchial lung biopsy of the left S4 lesion yielded granuloma formation and yeast-like fungus bodies within multinucleated giant cells, while bronchial lavage fluid culture showed cryptococcus neoformans. It is known that pulmonary cryptococcosis presents various images and histopathologic findings, according to the immune interactions between the fungus body and the host. We report a rare case that presented with multiple cryptococcal cystic lesions.
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Affiliation(s)
- Seiichi Takata
- Department of Respiratory Medicine, Asahino General Hospital
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45
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Wang YC, Huang ZG, Shi J, Zhang XZ. [Diagnostic value of computed tomography in invasive pulmonary fungal infections]. Zhonghua Yi Xue Za Zhi 2011; 91:20-22. [PMID: 21418956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To analyze the computed tomographic (CT) features of invasive pulmonary fungal infections (IPFI) and evaluate the value of CT-guided percutaneous biopsy. METHODS Seventeen IPFI cases diagnosed by CT-guided percutaneous biopsy were recruited. The distribution, extent, density and size of IPFI were analyzed in correlation with the final diagnosis retrospectively. And the relationship with the causative factor of mycosis was also assessed. RESULTS (1) Candida albicans (n = 7) and cryptococcosis & aspergillus (n = 5) were identified. (2) It showed segmental on lobar consolidation within lung field (n = 6), mixture of patterns and nodule (n = 4) and mass (n = 7). (3) The overall diagnostic accuracy of fiberoptic bronchoscopy examination was 35.3%. (4) The incidence of complicated pneumothorax was 11.8% (2/17). These cases were self-limited without any special treatment. CONCLUSION The CT findings of PFI are too complex to be easily distinguished from other diseases. And the CT-guided percutaneous is a safe and effective procedure.
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Affiliation(s)
- Yong-Chun Wang
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China.
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Gao JB, Zhang YG, Yue SW, Li HJ, Ning PG, Guo H, Xiao HJ. Analysis on the imaging features of AIDS with pulmonary fungal infection. Chin Med J (Engl) 2010; 123:3583-3586. [PMID: 22166635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Pulmonary fungal infection is one type of the common opportunistic infections in AIDS patients. The disease is hard to diagnose because of its complicated imaging features. The objective of this study was to investigate the imaging performance characteristics of pulmonary fungal infection in AIDS patients. METHODS Fifty-one patients with AIDS complicated with pulmonary fungal infection and 56 patients of non-AIDS with pulmonary fungal infection were examined by CT scans and high-resolution CT scans. The contrast enhanced scans were performed in patients with the mass or suspected enlarged mediastinal lymph nodes. Results were compared between the two groups. RESULTS The most common fungal infection in the two groups of patients was Candida albicans. The infection rates were 54.8% (28 cases) in the group (AIDS patients with pulmonary fungal infection) and 58.3% (32 cases) in another group (non-AIDS patients with pulmonary fungal infection). In the two groups, the difference in diffuse distribution and the difference in incidence of affected upper and lower lobes in the bilateral lung fields were statistically significant. The differences in patchy or large consolidation shadow, cavitas, enlarged lymph nodes in mediastinum and pleural effusion were also significant when comparing the two groups. CONCLUSIONS The lesion in most of AIDS patients with pulmonary fungal infection tends to exhibit diffuse distribution, patchy or large consolidation shadow covering a more extensive region. The differences between AIDS with pulmonary fungal infection and non-AIDS with pulmonary fungal infection are statistically significant in lesion location and complicated imaging features. The most common fungal infection in AIDS patients is Candida albicans.
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Affiliation(s)
- Jian-Bo Gao
- Department of Radiology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan 450052, China
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Goldman JD, Vollmer ME, Luks AM. Cryptococcosis in the immunocompetent patient. Respir Care 2010; 55:1499-1503. [PMID: 20979679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Jason D Goldman
- Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA
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Matos Figueroa JR, Vázquez Torres OL, Hernández I, Vila A. PET-CT scan positive pulmonary nodule revealing histoplasmosis: a case report. Bol Asoc Med P R 2010; 102:47-50. [PMID: 21766547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Our medical staff identified a case of a forty-six years old Armed Force active duty female that presented with multiple systemic and pulmonary signs and symptoms, such as hemoptysis, arthralgias, chest pain and dyspnea after being exposed to a humid and old wooden building one year ago in the state of Georgia. Various imaging studies (cervical & thoracic x-rays and CT Scans), revealed diffuse small nodules at cervical & thoracic areas, osteolytic lesions and lymphadenopathy. Suspecting a malignant process, a PET-CT Scan was performed revealing a right lung lower lobe nodule consistent with a primary malignancy, metastatic disease, active infectious or inflammatory process. She underwent a CT-guided needle biopsy followed by an open thoracotomy. These results were negative for malignancy and positive for chronic granulomatous inflammatory process. Therefore, special immunologic stains were undertaken revealing a granulomatous process with Histoplasmosis capsulatum. This case was diagnosed in the most unusual manner, given the presenting symptoms and pathological findings which suggested a malignant process, later confirmed by multiple specialized imaging studies and tests. This presumptive diagnosis turned out to be an inflammatory/infectious (fungal) process. We must keep in mind that not all mass lesions encountered by special imaging studies should be considered malignant. This case exemplifies the need of clinicians to exercise strong clinical and critical thinking skills to consider the broad diagnostic possibilities of pulmonary nodules presenting as a malignancy.
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Satyavani M, Viswanathan R, Harun NS, Mathew L. Pulmonary Scopulariopsis in a chronic tobacco smoker. Singapore Med J 2010; 51:e137-e139. [PMID: 20848053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A 70-year-old male smoker, with a three-month status of post-balloon angioplasty for ischaemic heart disease, presented with a one-week history of fever, haemoptysis and chest discomfort on coughing. The patient did not report any loss of weight or appetite. On examination, he was febrile. Pulmonary function tests revealed obstructive airway disease. High resolution computed tomography of the lungs revealed fibrosis with bronchiectasis in both the upper lobes, and a spiculating subpleural mass in the posterior aspect of the right lung apex. Subsequent bronchoalveolar lavage (BAL) culture yielded the Scopulariopsis species. Our patient was treated with a four-week course of amphotericin B, followed by itraconazole. At the 24-month follow-up, the patient was asymptomatic. Subsequent BAL cultures revealed no fungal growths, and radiological studies showed a regression in the lesion.
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Affiliation(s)
- M Satyavani
- Department of Laboratory Services, Raja Isteri Pengiran Anak Saleha Hospital, Ministry of Health, Bandar Seri Begawan, BA 1710 Brunei Darussalam
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Tsitsikas DA, Vinicombe S, Sheaff M, Ellis S, Rizvi H, Manuel R, Agrawal SG. A patient with CLL and a dry cough. BMJ 2010; 340:c3051. [PMID: 20591962 DOI: 10.1136/bmj.c3051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Dimitris A Tsitsikas
- Department of Haematological Oncology, Barts and the London NHS Trust, London EC1A 7BE.
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