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Kietrungruang K, Sookkree S, Sangboonruang S, Semakul N, Poomanee W, Kitidee K, Tragoolpua Y, Tragoolpua K. Ethanolic Extract Propolis-Loaded Niosomes Diminish Phospholipase B1, Biofilm Formation, and Intracellular Replication of Cryptococcus neoformans in Macrophages. Molecules 2023; 28:6224. [PMID: 37687052 PMCID: PMC10488685 DOI: 10.3390/molecules28176224] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Secretory phospholipase B1 (PLB1) and biofilms act as microbial virulence factors and play an important role in pulmonary cryptococcosis. This study aims to formulate the ethanolic extract of propolis-loaded niosomes (Nio-EEP) and evaluate the biological activities occurring during PLB1 production and biofilm formation of Cryptococcus neoformans. Some physicochemical characterizations of niosomes include a mean diameter of 270 nm in a spherical shape, a zeta-potential of -10.54 ± 1.37 mV, and 88.13 ± 0.01% entrapment efficiency. Nio-EEP can release EEP in a sustained manner and retains consistent physicochemical properties for a month. Nio-EEP has the capability to permeate the cellular membranes of C. neoformans, causing a significant decrease in the mRNA expression level of PLB1. Interestingly, biofilm formation, biofilm thickness, and the expression level of biofilm-related genes (UGD1 and UXS1) were also significantly reduced. Pre-treating with Nio-EEP prior to yeast infection reduced the intracellular replication of C. neoformans in alveolar macrophages by 47%. In conclusion, Nio-EEP mediates as an anti-virulence agent to inhibit PLB1 and biofilm production for preventing fungal colonization on lung epithelial cells and also decreases the intracellular replication of phagocytosed cryptococci. This nano-based EEP delivery might be a potential therapeutic strategy in the prophylaxis and treatment of pulmonary cryptococcosis in the future.
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Affiliation(s)
- Kritapat Kietrungruang
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (K.K.); (S.S.); (S.S.)
| | - Sanonthinee Sookkree
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (K.K.); (S.S.); (S.S.)
| | - Sirikwan Sangboonruang
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (K.K.); (S.S.); (S.S.)
| | - Natthawat Semakul
- Department of Chemistry, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Worrapan Poomanee
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Kuntida Kitidee
- Center for Research Innovation and Biomedical Informatics, Faculty of Medical Technology, Mahidol University, Salaya, Nakhon Pathom 73170, Thailand;
| | - Yingmanee Tragoolpua
- Natural Extracts and Innovative Products for Alternative Healthcare Research Group, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand;
- Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Khajornsak Tragoolpua
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (K.K.); (S.S.); (S.S.)
- Department of Chemistry, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand;
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do Monte Alves M, Pipolo Milan E, da Silva-Rocha WP, Soares de Sena da Costa A, Araújo Maciel B, Cavalcante Vale PH, de Albuquerque PR, Lopes Lima S, Salles de Azevedo Melo A, Messias Rodrigues A, Chaves GM. Fatal pulmonary sporotrichosis caused by Sporothrix brasiliensis in Northeast Brazil. PLoS Negl Trop Dis 2020; 14:e0008141. [PMID: 32453723 PMCID: PMC7274469 DOI: 10.1371/journal.pntd.0008141] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 04/22/2019] [Revised: 06/05/2020] [Accepted: 02/14/2020] [Indexed: 02/07/2023] Open
Abstract
Background A relevant case of pulmonary sporotrichosis due to Sporothrix brasiliensis is reported in a 50-year-old immunocompetent woman who had no history of skin trauma, but was in close contact with several stray cats at her nap time. The patient was hospitalized after 7 months of illness. The survey was conducted for pulmonary tuberculosis, an endemic disease in Brazil. She presented multiple central pulmonary nodules images, with central cavitation. Methodology/Principal findings The patient bronchoalveolar lavage was cultured and Sporothrix sp. growth was obtained. Then, the isolate (LMMM1097) was accurately identified to the species level by using species-specific polymerase chain reaction (PCR). Molecular diagnosis revealed that the emerging species Sporothrix brasiliensis was the agent of primary pulmonary sporotrichosis and the patient was treated with Amphotericin B lipid complex, but presented severe clinical symptoms and the fatal outcome was observed at day 25 after hospitalization. Conclusions/Significance Our report adds important contributions to the clinical-epidemiological features of sporotrichosis, showing the geographic expansion of the agent within different regions of Brazil and a rare clinical manifestation (primary pulmonary sporotrichosis) caused by the emerging agent S. brasiliensis in an immunocompetent female patient. Sporotrichosis is a fungal infection caused by different species belonging to the genus Sporothrix. In the past, the disease was usually associated with armadillo hunting and horticulturists, acquired after traumatic inoculation. Nevertheless, from 1997 to 2011, 4,188 human cases of sporotrichosis associated with feline transmissions were recorded in Rio de Janeiro, Brazil. Since then, the disease became an epidemic that is currently spreading within different regions of the country. Nevertheless, pulmonary sporotrichosis, specifically after conidial inhalation (without traumatic inoculation) is still a rare entity. In the present study, a female patient had the habit to have a nap at her workplace in a small room full of stray cats, daily. Tuberculosis was investigated, but the laboratory tests were negative. Then, pulmonary aspergillosis was suspected and Amphotericin B was initiated. A culture of the bronchoalveolar lavage was performed, which evidenced Sporothrix sp. growth. The final species identification was Sporothrix brasilensis, as demonstrated by PCR. However, the patient evolved to death. This finding reinforces the idea of exploring different possibilities of etiological agents involved in pulmonary infections, specific in areas of the globe where zoonotic sporotrichosis transmitted by cats have been reported.
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Affiliation(s)
- Manoella do Monte Alves
- Departamento de Infectologia, Instituto de Medicina Tropical, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
| | - Eveline Pipolo Milan
- Departamento de Infectologia, Instituto de Medicina Tropical, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
| | - Walicyranison Plinio da Silva-Rocha
- Laboratório de Micologia Médica e Molecular, Departamento de Análises Clínicas e Toxicológicas, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
| | - Alexandre Soares de Sena da Costa
- Laboratório de Micologia Médica e Molecular, Departamento de Análises Clínicas e Toxicológicas, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
| | - Bruno Araújo Maciel
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
| | | | - Paulo Roberto de Albuquerque
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
| | - Soraia Lopes Lima
- Laboratório Especial de Micologia, Disciplina de Infectologia,Universidade Federal de São Paulo, São Paulo, Brasil
| | - Analy Salles de Azevedo Melo
- Laboratório Especial de Micologia, Disciplina de Infectologia,Universidade Federal de São Paulo, São Paulo, Brasil
| | - Anderson Messias Rodrigues
- Laboratório de Fungos Patogênicos Emergentes, Divisão de Biologia Celular, Departamento de Microbiologia, Imunobiologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Guilherme Maranhão Chaves
- Laboratório de Micologia Médica e Molecular, Departamento de Análises Clínicas e Toxicológicas, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
- * E-mail:
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Santos Silva J, Torres C, Clemente S, Calvinho P. Isolated Pulmonary Mucormycosis in an immunocompetent patient. Rev Port Cir Cardiotorac Vasc 2019; 26:151-153. [PMID: 31476818] [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] [Received: 06/18/2019] [Indexed: 06/10/2023]
Abstract
Mucormycosis is a life-threatening fungal infection that occurs mainly in immunocompromised patients. Its occurrence isolated in the lung rare and carries a high mortality risk if untreated. We report the case of a 76-year old male immunocompetent patient, under treatment for pulmonary tuberculosis, admitted to the emergency department with hemoptysis. Bronchoscopy was performed and active bleeding from the middle lobe bronchus was found. Chest CT scan identified a solitary cavitary lesion in the middle lobe. The patient was proposed for urgent open middle lobectomy. Postoperative period was uneventful. Pulmonary mucormycosis was confirmed and adjuvant therapy with Amphotericin B was performed for 30 days. Despite its rarity, mucormycosis prevalence is expected to raise together with increasing number of immunocompromised patients. A high level of suspicion is recommended as early diagnosis can be determinant.
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Affiliation(s)
- João Santos Silva
- Cardiothoracic Surgery Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Carolina Torres
- General Surgery, Emergency Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Susana Clemente
- Pneumology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Paulo Calvinho
- Cardiothoracic Surgery Department, Hospital Beatriz Ângelo, Loures, Portugal
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Uehara Y, Kasai H, Nakajima T, Tanabe N, Tatsumi K, Yoshino I. Aspergillus Sternomyelitis Developed from Chronic Pulmonary Aspergillosis as a Late Complication to Lobectomy for Lung Cancer. Intern Med 2018; 57:2991-2994. [PMID: 29877261 PMCID: PMC6232016 DOI: 10.2169/internalmedicine.0334-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/10/2022] Open
Abstract
Progressive fibrobullous changes in the residual lobes are sometimes observed after lobectomy. Aspergillus osteomyelitis is an uncommon infection that rarely occurs sternally. A 70-year-old man who had undergone lobectomy 12 years earlier was admitted to our hospital for chest pain. He was diagnosed with Aspergillus sternomyelitis based on sternal bone culture after an ultrasound-guided percutaneous needle biopsy. The fibrosis and right residual lung apex volume loss had gradually progressed over 12 years, and therefore, chronic pulmonary aspergillosis (CPA) with direct invasion sternal from the CPA was considered. Aspergillus sternomyelitis can develop from CPA as a late complication of lobectomy.
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Affiliation(s)
- Yuji Uehara
- Department of Medicine, School of Medicine, Chiba University, Japan
| | - Hajime Kasai
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Takahiro Nakajima
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Nobuhiro Tanabe
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Japan
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Studemeister A, Studemeister L, Brun F. The role of extracorporeal membrane oxygenation in severe pulmonary coccidioidomycosis. Heart Lung 2018; 47:261-263. [PMID: 29622277 DOI: 10.1016/j.hrtlng.2018.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/13/2017] [Accepted: 02/16/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Severe coccidioidal pneumonia with acute respiratory distress syndrome (ARDS) is associated with high mortality. Extracorporeal membrane oxygenation (ECMO) has been applied successfully to other severe fungal pneumonia associated with ARDS. We review our experience with the use of ECMO in severe coccidioidal ARDS. OBJECTIVES To review indications and outcome of ECMO in severe pulmonary coccidioidomycosis. METHODS Three cases of severe ARDS caused by coccidioidomycosis are presented. All were managed with ECMO. Clinical course, complications, antifungal therapy and outcome are reviewed. RESULTS Three cases of severe coccidioidal ARDS survived after treatment with ECMO. Common complications included bacterial pneumonia, encephalopathy and critical illness myopathy. They received liposomal amphotericin during ECMO, and transitioned to azole therapy. All required prolonged hospitalization and rehabilitation. CONCLUSIONS ECMO was life-saving in cases of coccidioidal ARDS. Common complications included pneumonia, encephalopathy and critical illness myopathy. All cases were successfully managed with liposomal amphotericin followed by azole therapy. They required prolonged hospitalization and rehabilitation.
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Affiliation(s)
- Alex Studemeister
- Department of Infection Prevention and Control, Regional Medical Center of San Jose, 225 North Jackson Ave, San Jose, CA 95116, USA.
| | - Lucy Studemeister
- Department of Chemistry and Biochemistry, Santa Clara University, 500 El Camino Real, Santa Clara, CA 95053, USA
| | - Francisco Brun
- Critical Care Medicine, Regional Medical Center of San Jose, 225 North Jackson Ave, San Jose, CA 95116, USA
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Arango JC, Puerta-Arias JD, Pino-Tamayo PA, Salazar-Peláez LM, Rojas M, González Á. Impaired anti-fibrotic effect of bone marrow-derived mesenchymal stem cell in a mouse model of pulmonary paracoccidioidomycosis. PLoS Negl Trop Dis 2017; 11:e0006006. [PMID: 29040281 PMCID: PMC5659794 DOI: 10.1371/journal.pntd.0006006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 07/12/2017] [Revised: 10/27/2017] [Accepted: 10/02/2017] [Indexed: 02/06/2023] Open
Abstract
Bone marrow-derived mesenchymal stem cells (BMMSCs) have been consider as a promising therapy in fibrotic diseases. Experimental models suggest that BMMSCs may be used as an alternative therapy to treat chemical- or physical-induced pulmonary fibrosis. We investigated the anti-fibrotic potential of BMMSCs in an experimental model of lung fibrosis by infection with Paracoccidioides brasiliensis. BMMSCs were isolated and purified from BALB/c mice using standardized methods. BALB/c male mice were inoculated by intranasal infection of 1.5x106P. brasiliensis yeasts. Then, 1x106 BMMSCs were administered intra venous at 8th week post-infection (p.i.). An additional group of mice was treated with itraconazole (ITC) two weeks before BMMSCs administration. Animals were sacrificed at 12th week p.i. Histopathological examination, fibrocytes counts, soluble collagen and fibrosis-related genes expression in lungs were evaluated. Additionally, human fibroblasts were treated with homogenized lung supernatants (HLS) to determine induction of collagen expression. Histological analysis showed an increase of granulomatous inflammatory areas in BMMSCs-treated mice. A significant increase of fibrocytes count, soluble collagen and collagen-3α1, TGF-β3, MMP-8 and MMP-15 genes expression were also observed in those mice. Interestingly, when combined therapy BMMSCs/ITC was used there is a decrease of TIMP-1 and MMP-13 gene expression in infected mice. Finally, human fibroblasts stimulated with HLS from infected and BMMSCs-transplanted mice showed a higher expression of collagen I. In conclusion, our findings indicate that late infusion of BMMSCs into mice infected with P. brasiliensis does not have any anti-fibrotic effect; possibly because their interaction with the fungus promotes collagen expression and tissue remodeling. This is the first study that evaluates the effect of BMMSCs therapy for lung fibrosis induced by the fungal pathogen Paracoccidioides brasiliensis, the causative agent of paracoccidioidomycosis, one of the most important systemic endemic mycosis diagnosed in South America and Central America. Our findings showed an impaired anti-fibrotic effect of BMMSCs transplantation. This effect could be triggered by either the chronic inflammatory microenvironment induced by P. brasiliensis or by a direct interaction between BMMSCs and the fungus, resulting in an exacerbation of the pulmonary fibrosis. In fact, the pro-fibrotic effect exerted by BMMSCs was toned-down by the usage of the antifungal ITC.
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Affiliation(s)
- Julián Camilo Arango
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB)–Universidad de Antioquia, Medellín, Colombia
- School of Microbiology, Universidad de Antioquia, Medellín, Colombia
| | - Juan David Puerta-Arias
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB)–Universidad de Antioquia, Medellín, Colombia
| | - Paula Andrea Pino-Tamayo
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB)–Universidad de Antioquia, Medellín, Colombia
- Department of Microbiology and Immunology, Weill Cornell Medical College, New York, New York, Unites States of America
| | | | - Mauricio Rojas
- Dorothy P. & Richard P. Simmons Center for Interstitial Lung Disease, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, Unites States of America
| | - Ángel González
- School of Microbiology, Universidad de Antioquia, Medellín, Colombia
- Basic and Applied Microbiology Research Group (MICROBA), Universidad de Antioquia, Medellín, Colombia
- * E-mail:
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Ayadi-Kaddour A, Braham E, Marghli A, Ismail O, Helal I, Mlika M, Kilani T, El Mezni F. [Fatal pulmonary mycosis in a diabetic and cirrhotic patient]. Tunis Med 2015; 93:259-262. [PMID: 26375745] [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
Pulmonary mucormycosis is a rare, devastating, opportunistic fungal infection, caused by the ubiquitous filamentous fungi of the Mucorales order of the class of Zygomycetes. This infection occurs principally in some particular conditions, specially in diabetic patients and immunocompromised host, and rarely in cirrhotic patients. The diagnosis of mucormycosis can only be confirmed by pathological and mycological examination of biopsy specimens. We report a case of pulmonary mucormycosis in a 68-year-old woman with underlying liver cirrhosis and diabetes mellitus. Endoscopic and radiologic findings supported the diagnosis of hydatid cyst of the lung. The patient underwent surgical resection and was started on amphotericin B, after pathological examination. Unfortunately, she succumbed to the infection within one month of surgery.
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Abstract
In the past decade, state-specific increases in the number of reported cases of coccidioidomycosis have been observed in areas of California and Arizona where the disease is endemic. Although most coccidioidomycosis is asymptomatic or mild, infection can lead to severe pulmonary or disseminated disease requiring hospitalization and costly disease management. To determine the epidemiology of cases and toll of coccidioidomycosis-associated hospitalizations in California, we reviewed hospital discharge data for 2000–2011. During this period, there were 25,217 coccidioidomycosis-associated hospitalizations for 15,747 patients and >$2 billion US in total hospital charges. Annual initial hospitalization rates increased from 2.3 initial hospitalizations/100,000 population in 2000 to 5.0 initial hospitalizations/100,000 population in 2011. During this period, initial hospitalization rates were higher for men than women, African Americans and Hispanics than Whites, and older persons than younger persons. In California, the increasing health- and cost-related effects of coccidioidomycosis-associated hospitalizations are a major public health challenge.
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Jha VK, Borpujari PJ, Shenoy G, Bhargav S. Empyema with pleuropulmonary mucormycosis. J Assoc Physicians India 2013; 61:665-667. [PMID: 24772711] [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: 06/03/2023]
Abstract
Pleuropulmonary mucormycosis is relatively rare disease and that too localised disease is very rare but has got better prognosis. Maintaining a high level of suspicion is important in right clinical setting with pleuropulmonary involvement that fails to antibacterial agent either clinically or radiologically.
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Alifano M, Gaucher S, Rabbat A, Brandolini J, Guinet C, Damotte D, Regnard JF. Alternatives to resectional surgery for infectious disease of the lung: from embolization to thoracoplasty. Thorac Surg Clin 2013; 22:413-29. [PMID: 22789603 DOI: 10.1016/j.thorsurg.2012.05.001] [Citation(s) in RCA: 4] [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] [Indexed: 11/19/2022]
Abstract
Surgical treatment of lung diseases is based on removal of the affected lung tissue, achieved by atypical or anatomic lung resection. Infectious lung diseases are generally treated by medical therapy, including medications, chest physiotherapy, bronchoscopic toilet, and respiratory rehabilitation. Surgical management of infectious disease of the lung is integrated in the multispecialty care. This article focuses exclusively on nonresectional surgery and other alternatives to lung resection and addresses bacterial infection and fungal disease of the lung.
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Affiliation(s)
- Marco Alifano
- Department of Thoracic Surgery, Hôtel-Dieu Hospital, Paris Descartes University, 1 Place du Parvis Notre Dame, 75181 Paris, France
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Abstract
Fungal infections are the most common opportunistic infections (OI) occurring during the course of HIV infection, though their incidence has decreased dramatically with the introduction of highly active antiretroviral therapy (cART). Most cases occur in untreated patients, noncompliant patients or patients whose multiple antiretroviral regimens have failed and they are a good marker of the severity of cellular immunodepression. Pneumocystis jiroveci pneumonia is the second most frequent OI in France and cryptococcosis remains a major problem in the Southern Hemisphere. With the increase in travel, imported endemic fungal infection can occur and may mimic other infections, notably tuberculosis. Fungal infections often have a pulmonary presentation but an exhaustive search for dissemination should be made in patients infected with HIV, at least those at an advanced stage of immune deficiency. Introduction of cART in combination with anti-fungal treatment depends on the risk of AIDS progression and on the risk of cumulative toxicity and the immune reconstitution inflammatory syndrome (IRIS) if introduced too early. Fungal infections in HIV infected patients remain a problem in the cART era. IRIS can complicate the management and requires an optimised treatment regime.
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Affiliation(s)
- B Denis
- Service des maladies infectieuses et tropicales, centre d'infectiologie Necker-Pasteur, université Paris Descartes, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France
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Gutiérrez-Acevedo M, Balleste-Frank CR, Fernández-González F, Fernández-González R, Colón-Nieves PJ, Camargo-Arias E, Defendini-Mauras E. Immuno compromised patients: what a challenge! Bol Asoc Med P R 2012; 104:62-64. [PMID: 23156896] [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: 06/01/2023]
Abstract
Mucormycosis is an uncommon but fatal fungal infection of airborne transmission. Its is usually seen in immunocompromised patients including diabetics, malignancies, transplant patients and renal insufficiency. We review the case of an immunocompromised patient unresponsive to broad-spectrum antibiotics and conventional antifungal therapy with lung mucormycosis.
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Affiliation(s)
- Madeleine Gutiérrez-Acevedo
- Internal Medicine Department, San Juan City Hospital, PMB # 79 PO Box 7034, San Juan, Puerto Rico 00936-8344.
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Chen Q, Hong GL, Qiu QM. [A case report of successful treatment of severe acute paraquat poisoning with pulmonary aspergillus infection]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2011; 29:543-544. [PMID: 22214167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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14
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Limper AH, Knox KS, Sarosi GA, Ampel NM, Bennett JE, Catanzaro A, Davies SF, Dismukes WE, Hage CA, Marr KA, Mody CH, Perfect JR, Stevens DA. An official American Thoracic Society statement: Treatment of fungal infections in adult pulmonary and critical care patients. Am J Respir Crit Care Med 2011; 183:96-128. [PMID: 21193785 DOI: 10.1164/rccm.2008-740st] [Citation(s) in RCA: 357] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
With increasing numbers of immune-compromised patients with malignancy, hematologic disease, and HIV, as well as those receiving immunosupressive drug regimens for the management of organ transplantation or autoimmune inflammatory conditions, the incidence of fungal infections has dramatically increased over recent years. Definitive diagnosis of pulmonary fungal infections has also been substantially assisted by the development of newer diagnostic methods and techniques, including the use of antigen detection, polymerase chain reaction, serologies, computed tomography and positron emission tomography scans, bronchoscopy, mediastinoscopy, and video-assisted thorascopic biopsy. At the same time, the introduction of new treatment modalities has significantly broadened options available to physicians who treat these conditions. While traditionally antifungal therapy was limited to the use of amphotericin B, flucytosine, and a handful of clinically available azole agents, current pharmacologic treatment options include potent new azole compounds with extended antifungal activity, lipid forms of amphotericin B, and newer antifungal drugs, including the echinocandins. In view of the changing treatment of pulmonary fungal infections, the American Thoracic Society convened a working group of experts in fungal infections to develop a concise clinical statement of current therapeutic options for those fungal infections of particular relevance to pulmonary and critical care practice. This document focuses on three primary areas of concern: the endemic mycoses, including histoplasmosis, sporotrichosis, blastomycosis, and coccidioidomycosis; fungal infections of special concern for immune-compromised and critically ill patients, including cryptococcosis, aspergillosis, candidiasis, and Pneumocystis pneumonia; and rare and emerging fungal infections.
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Shi Y. [Update of diagnosis and treatment of invasive pulmonary fungal diseases]. Zhonghua Jie He He Hu Xi Za Zhi 2011; 34:83-85. [PMID: 21426722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Invasive fungal infections: case-based presentation in pediatric patients. Curr Med Res Opin 2010; 26:1755-60; quiz 1789-92. [PMID: 20513208 DOI: 10.1185/03007995.2010.491342] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Zong F, Xie WP, Huang M, Zhu Q, Chen L, Zhang ZH. [Pulmonary coccidioidomycosis:a case report and review of the literature]. Zhonghua Jie He He Hu Xi Za Zhi 2010; 33:193-196. [PMID: 20450638] [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: 05/29/2023]
Abstract
OBJECTIVE To improve the understanding of the clinical manifestations of pulmonary coccidioidomycosis. METHODS A case of pulmonary coccidioidomycosis was reported, and the literature was reviewed. The epidemiologic, clinical and diagnostic aspects of coccidioidomycosis were discussed. RESULTS A 74 year old male was admitted to the hospital because of physical examination revealing lung space occupying lesions for 9 months and cough for 2 weeks. Lung puncture biopsy was carried out and the diagnosis of cryptococcosis was established in another hospital. After 6 months' therapy with fluconazole, the chest CT showed no change. After being hospitalized, thoracoscopic wedge resection of lung was performed and the final diagnosis was pulmonary coccidioidomycosis. After the surgery, he was immediately started on voriconazole 200 mg daily for 1 month. Then oral fluconazole was prescribed for 5 months. A follow-up chest CT performed 6 months after surgery was normal. CONCLUSIONS Coccidioidomycosis is uncommon. It's pathological appearance is similar to cryptococcus. With the extensive using of immune suppressive drugs, we should improve the recognition of coccidioidomycosis.
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Affiliation(s)
- Feng Zong
- Department of Respiratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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18
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Mihălţan F. [The Second Hungarian-Romanian Conference of Pneumology, Szeged, Hungary, November 6-9, 2009]. Pneumologia 2009; 58:266-267. [PMID: 20128135] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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19
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Deng L, Yin GQ. [Diagnosis and treatment of invasive pulmonary aspergillosis in children: how to use the guideline for diagnosis and treatment of pediatric invasive pulmonary fungal infections (2009)]. Zhonghua Er Ke Za Zhi 2009; 47:475-477. [PMID: 19951483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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20
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Abstract
Among the HIV-associated pulmonary complications, opportunistic pneumonias are major causes of morbidity and mortality. The spectrum of HIV-associated opportunistic pneumonias is broad and includes bacterial, mycobacterial, fungal, viral and parasitic pneumonias. Bacterial pneumonia is the most frequent opportunistic pneumonia in the United States and Western Europe while tuberculosis is the dominant pathogen in sub-Saharan Africa. With the use of combination antiretroviral therapy and prophylaxis, the incidence of Pneumocystis pneumonia (PCP) has declined. Nevertheless, PCP continues to occur in persons who are unaware of their HIV infection, those who fail to access medical care, and those who fail to adhere to antiretroviral therapy or prophylaxis. Although pneumonias due to Cryptococcus neoformans, Histoplasma capsulatum, Coccidioides immitis, cytomegalovirus and Toxoplasma gondii are less frequent, their presence in the lung is often indicative of disseminated disease and is associated with significant mortality.
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Affiliation(s)
- Laurence Huang
- Division of Pulmonary, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA.
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21
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Affiliation(s)
- Brahm H Segal
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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22
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Luo YC, Wang Q, Li CC. [Highlights of diagnosis and treatment of pulmonary cryptococcosis]. Zhonghua Er Ke Za Zhi 2009; 47:231-232. [PMID: 19573445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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23
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Jiang ZF, Dong ZQ. [Pay more attention to the diagnosis and treatment of invasive pulmonary fungal infection in children]. Zhonghua Er Ke Za Zhi 2009; 47:81-82. [PMID: 19573448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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24
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González de Olano D, González-Mancebo E, Gandolfo Cano M, Meléndez Baltanás A, Valeri-Busto V, Maracionero MA, Prats E, Donado Uña JR. Successful treatment of allergic bronchopulmonary candidiasis with a recombinant anti-immunoglobulin E antibody. J Investig Allergol Clin Immunol 2009; 19:416-417. [PMID: 19862945] [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: 05/28/2023] Open
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25
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Abstract
Among patients with haematologic disorders, mucormycosis most commonly occurs in those with acute leukaemia or lymphoma who have developed neutropenia due to malignancy or to chemotherapy, and in transplanted patients receiving immunosuppressive treatment. Here, we aim to present a retrospective study conducted over a 5-year period (2001-2005). The study included 20 patients with haematologic malignancies with a proven mucormycosis admitted in Medical Oncology Divisions in Cukurova University Hospital. The most frequent sites of infection were paranasal sinuses (95%) and lung (5%). Antifungal treatment was empirically administered in 18 (90%) patients; 18 patients underwent radical surgical debridement (90%). The therapy was successful for only eight patients (40%). Eleven patients died within 1 months of the diagnosis of fungal infection: the cause of death was only by mucormycosis in four patients (36.6%), mucormucosis and systematic inflamatuar response syndrome (SIRS) in two patients (18.2%) and progression of haematologic disease in five patients (45.5%). At univariate analysis, the factors that correlated with a positive outcome from infection were the following: amphotericin B treatment, neutrophil recovery from postchemotherapy aplasia. At multivariate analysis, the factors that significantly correlated with recovery from infection were the liposomal amphotericin B treatment (p = 0.026), doses of L-AmB (p = 0.008) and the length of the treatment (p = 0.01), respectively. It seems to have increased in recent years. Although a reduction of mortality has been observed recently, the mortality rate still remains high. Extensive and aggressive diagnostic and therapeutic procedures are essential to improve the prognosis in these patients.
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Affiliation(s)
- I O Kara
- Department of Medical Oncology, Faculty of Medicine, Cukurova University, Turkey.
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26
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De Pasqual A, Deprez M, Ghaye B, Frère P, Kaschten B, Hayette MP, Radermecker M, Martin D, Canivet JL. [Invasive pulmonary mucormycosis with invasion of the thoracic spine in a patient with myelodysplastic syndrome]. Rev Med Liege 2008; 63:702-706. [PMID: 19180827] [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: 05/27/2023]
Abstract
We report the case of a 67-year-old patient who presented with a myelodysplastic syndrome and who developed a pulmonary mucormycosis with a rare extension to the dorsal spine. A decompressive laminectomy was attempted after failure of broad-spectrum antifungal treatment (Cancidas, V-Fend). The diagnosis was obtained after surgical biopsy. The scheduled lobectomy could not be performed because of altered clinical condition. The patient eventually died despite adapted antifungal treatment (Abelcet, Posaconazole). Pulmonary mucormycosis is a rare cause of mycotic infection that reaches most of the time immunocompromised patients. The pathogenic agent is part of zygomyces that have angio-invasive ability. Perineural propagation was recently described. Immunodepression, late diagnosis and lack of response to new generation antifungal drugs (V-Fend, Cancidas) are responsible for therapeutic failure in this disease. This case emphasizes the risk inherent to empirical antifungal treatment and the need of early biopsy in cases that do not respond to treatment.
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27
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Chotirmall SH, Branagan P, Gunaratnam C, McElvaney NG. Aspergillus/allergic bronchopulmonary aspergillosis in an Irish cystic fibrosis population: a diagnostically challenging entity. Respir Care 2008; 53:1035-1041. [PMID: 18655741] [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: 05/26/2023]
Abstract
BACKGROUND Patients with cystic fibrosis (CF) can become colonized by aspergillus, which can act as an allergen and cause allergic bronchopulmonary aspergillosis (ABPA). OBJECTIVE To determine the rate of aspergillus colonization and ABPA in a population of Irish patients with CF. METHODS In 50 consecutive patients with CF who presented with exacerbations, we looked for the presence of aspergillus in their sputum and signs and symptoms of ABPA. RESULTS Fifteen patients (30%) grew aspergillus species in their sputum cultures. Six patients (12%) had ABPA. Matched for age, sex, genotype, and microbiology, there was no significant difference in forced expiratory volume in the first second (percent predicted, FEV(1)%) in subjects with aspergillus-positive sputum compared to those not colonized with aspergillus. Subjects with ABPA experienced sharp short-term deterioration in lung function (mean 6.7% predicted FEV(1)), which returned to baseline following at least 4 weeks of treatment. CONCLUSIONS The prevalence of ABPA was 12%. Aspergillus-positive sputum of itself was not a poor prognostic sign in terms of lung function over the 5-year study course. ABPA produces short-term reversible declines in lung function and responds to treatment. The frequency of aspergillus isolates did not correlate with the occurrence of ABPA. A low threshold for the diagnosis of ABPA should be maintained in any patient with CF who does not improve with antibiotics.
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Abstract
Chronic pulmonary aspergillosis is broad term encompassing chronic cavitary, chronic fibrosing pulmonary aspergillosis and aspergilloma. All affect patients with structural lung diseases and many have subtle genetic immune defects. Almost all cases are caused by Aspergillus fumigatus. Here we report a patient with an aspergilloma which had Aspergillus flavus recovered from a surgical specimen and serum containing detectable precipitating antibody.
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Affiliation(s)
- A C Pasqualotto
- School of Medicine, The University of Manchester and Wythenshawe Hospital, The Regional Mycology Laboratory, Manchester, UK.
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29
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Owens CM, Hamon MD, Graham TR, Wood AJ, Newland AC. Bronchopericardial fistula and pneumopericardium complicating invasive pulmonary aspergillosis. Clin Lab Haematol 2008; 12:351-4. [PMID: 2272163 DOI: 10.1111/j.1365-2257.1990.tb00045.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- C M Owens
- Department of Haematology, London Hospital, Whitechapel, UK
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30
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Pesut D, Adzic T, Tosic T, Zugi V, Stevic R, Nagorni-Obradovic L, Gvozdenovic E. Bilateral pulmonary shadows and incapsulated mediastinal effusion in a patient with respiratory blastoschizomycosis. Pneumologia 2008; 57:88-91. [PMID: 18822873] [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: 05/26/2023]
Abstract
INTRODUCTION Invasive blastoschizomycosis is an emerging and fatal infection of severely immunocompromised patients. Pneumonia caused by this fungus has been reported as a post mortem diagnosis in a patient with haematologic malignancy. CASE REPORT A 46-year-old unemployed Caucasian man, smoker, was admitted on emergency in a serious condition, with bilateral pulmonary infiltrates (chest x-ray) and incapsulated mediastinal pleural effusions (computed tomography scans). Blastoschizomyces capitatus (Trichosporon capitatum) has been isolated from two sputum samples and bronchial secretion aspirate obtained by bronchoscopy. CONCLUSION Pneumonia caused by Blastoschizomyces capitatus can develop in subjects without underlying malignancy but with history of heavy alcohol intake, tobacco smoking and malnutrition and may have favorable disease outcome.
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Affiliation(s)
- Dragica Pesut
- School of Medicine University of Belgrade, Belgrade, Serbia.
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31
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Mu XD, Wang GF, Diao XL, Zhang W, Li HC, Li GL, Que CL, He B. [Retrospective analysis of three cases of pulmonary mucormycosis]. Zhonghua Jie He He Hu Xi Za Zhi 2007; 30:835-838. [PMID: 18269844] [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: 05/25/2023]
Abstract
OBJECTIVE To describe the clinical characteristics of pulmonary mucormycosis and to evaluate the approaches to its diagnosis and treatment. METHODS Three cases of pulmonary mucormycosis were successfully diagnosed by histopathologic examination of infected tissues obtained by fiberoptic bronchoscopy in this hospital. The clinical features of the cases were analyzed and the literature reviewed. RESULTS Three patients were all farmers and two of them had had diabetic ketoacidosis. The first patient died from massive hemoptysis one day after the diagnosis was confirmed. The second patient was cured by large doses of intravenous amphotericin B (total dosage 2 g). The third patient presented with right middle bronchial stenosis after right upper lobectomy because of squamous carcinoma, and was cured by amphotericin B (1.5 g) combined with interventional therapy under fiberoptic bronchoscopy. The two patients were followed for 0.5 - 1 year without relapse. CONCLUSIONS The mortality of pulmonary mucormycosis is high. Fiberoptic bronchoscopy is a useful diagnostic method for histopathologic examination. Successful treatment of pulmonary mucormycosis includes early diagnosis, control of underlying diseases and surgical intervention of isolated lesions combined with large dosage of amphotericin B.
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Affiliation(s)
- Xiang-dong Mu
- Department of Respiratory Medicine, Peking University First Hospital, Beijing 100034, China
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32
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Shi Y. [The diagnosis and treatment of pulmonary cryptococcosis]. Zhonghua Jie He He Hu Xi Za Zhi 2007; 30:806-809. [PMID: 18269838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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33
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Sarvat B, Sarria JC. Implantable cardioverter-defibrillator infection due to Scedosporium apiospermum. J Infect 2007; 55:e109-13. [PMID: 17761293 DOI: 10.1016/j.jinf.2007.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 05/03/2007] [Revised: 06/01/2007] [Accepted: 07/15/2007] [Indexed: 10/22/2022]
Abstract
We report a case of implantable cardioverter-defibrillator infection due to Scedosporium apiospermum. This infection persisted despite systemic antifungal treatment with voriconazole and was controlled after removal of the foreign device and replacement of the involved tricuspid valve. This case underscores the importance of a combined surgical and medical approach for this complicated infection. Scedosporium species should be considered in the differential diagnosis of cardiac or intravascular device-related infections.
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Affiliation(s)
- Bilal Sarvat
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, 301 University Boulevard, Route 0435, Galveston, TX 77555-0435, USA
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Awaya Y, Nagao Y, Murakami I, Shigetou E, Okimasa S, Shibata S. [Case of pulmonary pseudallescheriasis responding successfully to treatment with voriconazole]. Nihon Kokyuki Gakkai Zasshi 2007; 45:788-792. [PMID: 18018628] [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: 05/25/2023]
Abstract
A 27-year-old man was admitted with hemoptysis in October 2005. Chest radiograph and CT showed multiple nodules forming a large mass in the left upper lobe. We suspected pulmonary aspergillosis because we detected filamentous fungi made of chains of cells in the bronchial washing fluid. On October 6, therapy with micafungin was initiated. Despite this intervention, the patient's clinical status worsened. On Octorber 11, we suspected pulmonary pseudallescheriasis because we detected colonis resembling white down in Sabouraud agar, thus mica-fungin was discontinued due to the lack of response and we began treatment with voriconazole. The patient's clinical status subsequently improved. We performed a left upper lobectomy, because residual the shadows were recognized on chest CT. Here we report a rare case of pulmonary pseudallescheriasis successfully treated with voriconazole and left upper lobectomy.
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35
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Tian Y, Tang XP, Li H. [Pulmonary aspergillosis in patients with severe hepatitis: its clinical features and treatments]. Zhonghua Gan Zang Bing Za Zhi 2007; 15:697-8. [PMID: 17903378] [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] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Yi Tian
- Liver Disease Research Center, Second Xiangya Hospital, Central South University, Changsha 410011, China.
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36
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Scholten KJ, Kulkarni V, Brodsky JB. Isolation of the right upper-lobe with a left-sided double-lumen tube after left-pneumonectomy. Anesth Analg 2007; 105:330-1. [PMID: 17646485 DOI: 10.1213/01.ane.0000270106.22502.e2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A patient with a prior left pneumonectomy required surgical drainage of a right upper lobe aspergilloma. A left double-lumen endobronchial tube was placed in the right bronchus intermedius, isolating the right upper lobe while allowing ventilation of the right middle and lower lobes.
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Affiliation(s)
- Kevin J Scholten
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA 94305, USA
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37
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Ilyas C, Forrest GN, Akpek G. Potential clinical benefit of donor lymphocyte infusion in the treatment of refractory invasive fungal pneumonia. Bone Marrow Transplant 2007; 40:599-601. [PMID: 17618316 DOI: 10.1038/sj.bmt.1705773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Tumor necrosis factor (TNF) inhibitors, such as infliximab, are highly effective in the management of rheumatoid arthritis; however, these agents are associated with an increased risk of infectious complications. Individuals developing coccidiomycosis pneumonia frequently acquire this while residing in endemic regions. We present a patient with rheumatoid arthritis treated with infliximab who developed acute respiratory distress syndrome (ARDS) from coccidiomycosis pneumonia while residing in a non-endemic region near the Texas-Louisiana border and was successfully treated with antifungal therapy. The source for coccidiomycosis was suspected to be from inhalation of pulverized rock dust imported from Arizona. Patients treated with TNF inhibitors may acquire coccidiomycosis infection through fomite dust exposure.
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Affiliation(s)
- Mahmood Dweik
- Division of Allergy, Pulmonary, Immunology, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
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Camuset J, Lavolé A, Wislez M, Khalil A, Bellocq A, Bazelly B, Mayaud C, Cadranel J. [Bronchopulmonary aspergillosis infections in the non-immunocompromised patient]. Rev Pneumol Clin 2007; 63:155-66. [PMID: 17675939 DOI: 10.1016/s0761-8417(07)90120-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The definition of broncho-pulmonary aspergillosis infections in non-immunocompromised patients remains vague and a wide range of clinical, radiological and pathological entities have been described with a variety of names, i.e. simple aspergilloma, complex aspergilloma, semi-invasive aspergillosis, chronic necrotizing pulmonary aspergillosis, chronic cavitary and fibrosing pulmonary and pleural aspergillosis, pseudomembranous tracheobronchitis caused by Aspergillus, and invasive aspergillosis. However, these disease entities share common characteristics suggesting that they belong to the same group of pulmonary aspergillosis infectious disorders: 1- a specific diathesis responsible for the deterioration in local or systemic defenses against infection (alcohol, tobacco abuse, or diabetes); 2- an underlying bronchopulmonary disease responsible or not for the presence of a residual pleural or bronchopulmonary cavity (active tuberculosis or tuberculosis sequelae, bronchial dilatation, sarcoidosis, COPD); 3- generally, the prolonged use of low-dose oral or inhaled corticosteroids and 4- little or no vascular invasion, a granulomatous reaction and a low tendency for metastasis. There are no established treatment guidelines for broncho-pulmonary aspergillosis infection in non-immunocompromised patients, except for invasive aspergillosis. Bronchial artery embolization may stop hemoptysis in certain cases. Surgery is generally impossible because of impaired respiratory function or the severity of the comorbidity and when it is possible morbidity and mortality are very high. Numerous clinical cases and short retrospective series have reported the effect over time of the various antifungal agents available. Oral triazoles, i.e. itraconazole, and in particular voriconazole, appear to provide suitable treatment for broncho-pulmonary aspergillosis infections in non-immunocompromised patients.
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Affiliation(s)
- J Camuset
- Service de Pneumologie, Hôpital Victor-Dupouy, Argenteuil
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Abstract
Fungal infections in solid organ transplant recipients continue to be a significant cause of morbidity and mortality. Candida spp. and Aspergillus spp. account for most invasive fungal infections. The incidence of fungal infection varies with type of solid organ transplant. Liver transplant recipients have highest reported incidence of candida infections while lung transplant recipients have highest rate of Aspergillus infections. Recent epidemiological studies suggest the emergence of resistant strains of candida as well as mycelial fungi other than Aspergillus in these patients. The current review incorporates the recent changes in the epidemiology of fungal infections in solid organ transplant recipients and highlights the newer data on the diagnosis, prophylaxis and treatment of fungal infections in these patients.
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Affiliation(s)
- Fernanda P Silveira
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Sainz J, Pérez E, Hassan L, Moratalla A, Romero A, Collado MD, Jurado M. Variable Number of Tandem Repeats of TNF Receptor Type 2 Promoter as Genetic Biomarker of Susceptibility to Develop Invasive Pulmonary Aspergillosis. Hum Immunol 2007; 68:41-50. [PMID: 17207711 DOI: 10.1016/j.humimm.2006.10.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [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: 05/03/2006] [Revised: 10/05/2006] [Accepted: 10/13/2006] [Indexed: 11/20/2022]
Abstract
Tumor necrosis factor alpha (TNF-alpha) and lymphotoxin alpha (LT-alpha) are pivotal mediators of inflammatory responses in fungal infection diseases. We hypothesized that polymorphisms in genes of these cytokines or their receptors might increase the susceptibility of hematologic patients to develop invasive pulmonary aspergillosis (IPA). One hundred two hematologic patients and 124 age-matched controls were enrolled in the study, and the following standard single nucleotide polymorphisms were investigated: TNF-alpha -308 and +489, LT-alpha +252 and Tumor Necrosis Factor Receptor 2 (TNFR2) +676. Variable number of tandem repeats (VNTRs) at position -322 of the TNFR2 gene were also studied. Genotypic and allelic frequencies were similar between patients and controls. IPA was diagnosed in 54 of the 102 patients according to consensus criteria published by the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group. TNF-alpha and LT-alpha polymorphisms were not associated with presence of IPA. Susceptibility to IPA was strongly associated with VNTR at position -322 in the promoter region of the TNR2 gene (p = 0.029) but was not associated with the presence of TNFR2 +676 polymorphism. A genetic difference in TNFR2 promoter VNTR may play a major role in susceptibility to IPA infection.
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Affiliation(s)
- Juan Sainz
- Unidad de Investigación, Servicio de Hematología, Hospital Universitario Virgen de las Nieves, Granada, Spain.
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Mamishi S, Parvaneh N, Salavati A, Abdollahzadeh S, Yeganeh M. Invasive aspergillosis in chronic granulomatous disease: report of 7 cases. Eur J Pediatr 2007; 166:83-4. [PMID: 16804696 DOI: 10.1007/s00431-006-0205-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 05/13/2006] [Accepted: 06/07/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Setareh Mamishi
- Department of Pediatrics, Infectious Disease Research Center, Children's Medical Center, Tehran University of Medical Sciences, No. 62, Gharib St, Tehran 14194, Iran
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Abstract
This is the first case report of acute respiratory distress syndrome (ARDS) due to chronic necrotizing pulmonary aspergillosis (CNPA). This patient had pulmonary fibrosis of unknown etiology with a right upper bulla. The wall of the bulla became thicker with the surrounding lung infiltration and the patient suddenly developed severe respiratory failure. It is necessary to confirm the possibility that ARDS may occur in CNPA and that peripheral eosinophilia might forebode worsening of CNPA.
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Affiliation(s)
- Shuichi Yano
- Department of Pulmonary Medicine, National Hospital Organization Matsue National Hospital.
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Abstract
We describe a well documented case of a fatal Phoma exigua lung infection in a patient with acute myeloid leukaemia and diabetes. The infection was histology and culture proven and a PCR assay was developed for detecting P. exigua DNA in deparaffinized lung-biopsy material. Confirmation of rare fungal pathogen infections requires a multidisciplinary approach involving clinical observations, mycology, histopathology and radiology.
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Affiliation(s)
- Evangelos Balis
- Third Department of Internal Medicine, Medical School, University of Athens, Sotiria General and Chest Hospital, Athens, Greece.
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45
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Pauksens K, Oberg G. Concomitant invasive pulmonary aspergillosis and aspergillus sinusitis in a patient with acute leukaemia. Acta Biomed 2006; 77 Suppl 4:23-5. [PMID: 17370567] [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: 05/14/2023]
Abstract
A 67 years old male otherwise healthy who had undergone surgery for nasal polyposis ten years earlier was recently diagnosed with B-cell acute lymphoblastic leukaemia. During induction treatment the patient developed sino-pulmonary aspergillosis caused byAspergillus flavus. The patient developed severe reactions against amphotericin- B and thereafter Abelcet, whereas he tolerated treatment with AmBisome. Surgery of the nasal cavities was performed whereas surgery of the pulmonary infiltrates was not possible. During subsequent treatment for his leukaemia and long periods of neutropenia, the patient was on AmBisome treatment and there were no signs of progression of the Aspergillus infection. The antifungal treatment was considered to be successful. The patient was referred back to his local hospital and antifungal treatment was switched to oral itraconazole.
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Affiliation(s)
- Karlis Pauksens
- Department of Medical Sciences, Infection and Haematology, Uppsala University Hospital, Akademiska Sjukhuset, Uppsala, Sweden.
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Pasquier F, Croxo C, Melliez H, Porte H, Bourgeois-Petit E, Cambier N, Rose C. [A possible complication of sickle-cell disease: pulmonary aspergillosis]. Rev Med Interne 2005; 27:260-3. [PMID: 16364507 DOI: 10.1016/j.revmed.2005.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Accepted: 10/19/2005] [Indexed: 11/20/2022]
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Shao C, Qu J, He L, Zhang Y, Wang J, Wang Y, Zhou H, Liu X. Transient overexpression of gamma interferon promotes Aspergillus clearance in invasive pulmonary aspergillosis. Clin Exp Immunol 2005; 142:233-41. [PMID: 16232209 PMCID: PMC1809513 DOI: 10.1111/j.1365-2249.2005.02828.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Cytokines are critical molecules necessary for normal lung pathogen host defences. Gamma interferon (IFN-gamma) and T1-phenotype immune responses are important components of host defence against Aspergillus. Therefore, we hypothesized that transient overexpression of IFN-gamma within the lung could augment host immunity against Aspergillus. Here it was showed that intranasal administration of 5 x 10(7) colony-forming units (CFU) of Aspergillus fumigatus (Af ) induced the expression of IFN-gamma. Mice were intranasally (i.n) administrated with 5 x 10(8) PFU of a recombinant adenovirus vector containing the murine IFN-gamma cDNA (AdmIFN-gamma), and challenged 24 h later with Af. We observed that i.n. administration of AdmIFN-gamma resulted in about a fourfold increase in levels of IFN-gamma and IL-12 within the lung, about a 75% reduction in lung fungal contents at day 2 and a more than threefold higher survival rate in the AdmIFN-gamma-treated group compared to the controls (P < 0.01). This protection effect was not found when AdmIFN-gamma was i.p. administrated. Alveolar macrophages and lung leucocytes isolated from i.n. AdmIFN-gamma-treated animals displayed enhanced killing of intracellular Aspergillus organisms ex vivo. These results demonstrate that transient overexpression of IFN-gamma could augment host defence against Aspergillus.
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Affiliation(s)
- C Shao
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
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Ader F, Nseir S, Le Berre R, Leroy S, Tillie-Leblond I, Marquette CH, Durocher A. Invasive pulmonary aspergillosis in chronic obstructive pulmonary disease: an emerging fungal pathogen. Clin Microbiol Infect 2005; 11:427-9. [PMID: 15882191 DOI: 10.1111/j.1469-0691.2005.01143.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [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: 11/28/2022]
Abstract
Acute invasive pulmonary aspergillosis occurs predominantly in immunocompromised hosts, with increasing numbers of cases of invasive aspergillosis among patients with chronic obstructive pulmonary disease (COPD) being reported. Among 13 cases of invasive aspergillosis diagnosed in COPD patients admitted to the intensive care unit with acute respiratory distress, the only risk factor for invasive fungal infection was corticosteroid treatment. Invasive aspergillosis should be suspected in COPD patients receiving steroid treatment who have extensive pulmonary infiltrates. Survival depends on rapid diagnosis and early appropriate treatment. A decrease or interruption of steroid treatment should be considered as part of the overall therapeutic strategy.
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Affiliation(s)
- F Ader
- Service de Réanimation Médicale et Maladies Infectieuses, CH de Tourcoing, Tourcoing, France.
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Machida K, Maekura R. [State of the art: sequelae of tuberculosis]. Kekkaku 2005; 80:655-74. [PMID: 16296394] [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: 05/05/2023]
Abstract
Sequela of tuberculosis (TB sequela) is defined as the state with various secondary complications after healing of TB, such as chronic respiratory failure (CRF), cor pulmonale or chronic pulmonary inflammation. Pathophysiology of TB sequelae is consisted of disturbed pulmonary function, CRF, sleep disorder and pulmonary hypertension. In addition, secondary pulmonary infection with mycosis or nontuberculous mycobacteriosis (NTM) is difficult to be controlled.
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Affiliation(s)
- Kazuko Machida
- Department of Pulmonary Medicine, NHO Tokyo National Hospital, 3-1-1, Takeoka, Kiyose-shi, Tokyo 204-8585, Japan.
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