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Objective:To explore the incidence, clinical characteristics and prognosis of invasive pulmonary fungal infection(IPFI)in recipients of lung transplantation(LT)in southern China.Methods:From January 2003 to August 2019, retrospective analysis was performed for 300 recipients of lung transplantation at three hospitals in southern China. There were 254 males and 46 females with an average age of (54.98±14.2)years. Clinical data were collected from medical records, including symptoms and signs, imaging studies, bronchoscopy examination, pathogen separation and culture from deep sputum and bronchoalveolar lavage fluid(BALF), fungal-related laboratory tests and tissue pathology.Results:Among 300 cases, 93(31.0%)had at least one episode of IPFI. The most common pathogen was aspergillosis(60.2%), followed by candida(15 cases, 16.1%)and Pneumocystis jeroveci (13 cases, 14.0%). Kaplan Meier analysis indicated that all-cause mortality was significantly higher in IPFI group than that in non-IPFI(nIPFI)group with one-year mortality of 45.2% vs. 26.7% in IPFI and nIPFI groups respectively( P<0.05). Conclusions:IPFI is prevalent after LT in southern China. And aspergillosis is the most common pathogen and Candida comes the next. The median occurring time for aspergillosis is 6 months after LT. Candida infection occurs earlier at airway anastomosis. A higher incidence of invasive fungal disease(IFD)associated with a lower survival indicates that IPFI has a substantial mortality among recipients after LT. Prophylactic agents should be optimized based upon an epidemiologically likely pathogen.
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A forma extracutânea pulmonar da esporotricose, uma infecção causada por espécies geneticamente distintas de um fungo dimórfico do gênero Sporothrix, é rara, com poucos casos relatados na literatura. Trata-se de um caso de uma mulher de 55 anos, residente da região do Barreiro de Belo Horizonte/Minas Gerais, que buscou o serviço de infectologia de um hospital público de Belo Horizonte com história de emagrecimento, dispneia aos pequenos esforços, tosse crônica e calafrios vespertinos de três anos de evolução. Foi tratada para pneumonia bacteriana, em cinco ocasiões, sem melhora clínica. Apresentou tomografia computadorizada de tórax com cavitação residual e lesões escavadas pulmonares. A paciente foi internada com quadro de dispneia aos pequenos esforços, tosse e expectoração purulenta, sendo sua cultura de escarro positiva para Sporothrix spp. Foi instituído o tratamento padrão ouro para esporotricose pulmonar, inicialmente, com itraconazol, 200 mg, duas vezes ao dia, entretanto, após 10 meses, a melhora clínica e radiológica não foi satisfatória e optou-se pela internação a administração de anfotericina B complexo lipídico endovenosa 4 mg/kg/dia. Em menos de 1 mês a paciente apresentou piora do quadro e evoluiu a óbito, apesar de ter recebido 2g de dose acumulada de anfotericina
The pulmonary extracutaneous form of sporotrichosis, an infection caused by genetically distinct species of a dimorphic fungus of the genus Sporothrix, is rare, with few cases reported in the literature. This is a case of a 55-year-old woman, resident of the Barreiro region in Belo Horizonte/ Minas Gerais, who sought the infectious disease service of a public hospital in Belo Horizonte with a history of weight loss, dyspnea at small efforts, chronic cough and three-year-old vespertinus chills. She was treated for bacterial pneumonia on five occasions without clinical improvement. He presented computed tomography of the chest with residual cavitation and excavated pulmonary lesions. The patient was hospitalized with dyspnea on small efforts, cough and purulent sputum, and her sputum culture was positive for Sporothrix spp. The gold standard treatment for pulmonary sporotrichosis was instituted, initially with itraconazole, 200 mg twice a day, however, after 10 months, the clinical and radiological improvement was not satisfactory and the administration of intravenous amphotericin B lipid complex 4 mg/kg/day was chosen. In less than 1 month the patient presented worsening of the condition and died, despite receiving 2g of accumulated dose of amphotericin B lipid complex.
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Female , Middle Aged , Sporotrichosis , Immunocompetence , Lung Diseases, Fungal , Tobacco Use Disorder/complications , Immunosuppression Therapy/adverse effectsABSTRACT
OBJECTIVE:To investigate the risk factors for secondary pulmonary fungal infection in patients with severe craniocerebral trauma after tracheotomy,and to provide reference for clinical prevention and treatment. METHODS:In retrospective study,87 severe craniocerebral trauma patients with secondary pulmonary fungal infection after tracheotomy were selected from Ezhou Municipal Central Hospital(called"our hospital"for short)during Jan. 2014-Jun. 2017 as observation group;87 severe craniocerebral trauma inpatients without secondary pulmonary fungal infection after tracheotomy were selected as control group. The distribution and drug resistance of infected fungal in observation group were analyzed. χ2 test and binary Logistic analysis were adopted to investigate risk factors of secondary pulmonary fungal infection in patients with severe craniocerebral trauma after tracheotomy. RESULTS:Totally 174 clinical specimens were detected in observation group of our hospital;7 kinds of fungus were detected and isolated from 87 strains,and the fungi with high detection rate were Candida albicans(41 strains,47.13%)and Candida glabrata(23 strains,26.44%). The resistance rates of C. albicans and Candida tropicalis to commonly used antifungal agents as fluconazole,itraconazole and fluoncytosine were lower than 20%;resistance rates of C. glabrata to fluconazole,itraconazole and fluoncytosine were more than 25%,to amphotericin B and nystatin were lower than 20%. χ 2test and binary Logistic analysis showed that independent risk factors of secondary pulmonary fungal infection included hypoproteinemia,Glasgow coma score(GCS,<8 points)at admission,serum creatinine clearance(<30 mL/min)at admission,tracheal incision ventilation time(≥7 days),the time of antibiotics use(≥14 days),combined use of antibiotics,the use of carbapenems and systemic glucocorticoid [odd ratios were 3.02,2.98,2.21, 2.05,2.48,2.35,4.74,5.97;95%CI were(1.59,5.74),(1.58,5.63),(1.18,4.41),(1.11,3.78),(1.34,4.59),(1.27,4.34), (2.49,8.35),(3.08,11.49),P<0.05]. CONCLUSIONS:The fungus of secondary pulmonary fungal infection in patients with severe craniocerebral trauma after tracheotomy in our hospital are mainly C. albicans and C. glabrata,which are sensitive to commonly used antifungal agents. Hypoproteinemia,GCS at admission,serum creatinine clearance rate at admission,tracheal incision ventilation time,the time of antibiotics use,combined use of antibiotics,the use of carbapenems and systemic glucocorticoid are independent risk factors of secondary fungal infection in patients with severe craniocerebral trauma after tracheotomy. It is necessary to pay attention to predictive value of above risk factors,improve sensitivity and specificity of diagnosis and treatment. Antifungal agent should be selected rationally according to the results of drug sensitivity test. At the same time,early prophylactic or empirical antifungal treatment should be given in time for high risk patients with above factors.
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Objective To analyze the characteristics of chest CT in children with invasive pulmonary fungal infections(IPFIs),and to explore the influencing factors on chest CT manifestations in children with IPFIs.Methods A retrospective case-control study was conducted to select 97 children with IPFIs from October 2010 to October 2016 in the department of respiratory medicine,PICU and hematology.The children were divided into CT characteristic change group(39 cases) and CT non-characteristic change group(58 cases) according to the chest CT manifestations. Non-conditional multivariate Logistic regression analysis was used to identify the independent influencing factors of CT characteristic changes in children with IPFIs. Results The ratios of less than 3-year-old infants, Candida, the proportion of ICU admission in the CT characteristic change group were lower than those in the CT non-characteristic change group(P<0.05). The proportions of more than 3-year-old, neutropenia,Aspergillus,central venous catheter,hematological malig-nancies were higher than those in the CT non-characteristic change group(P<0.05).Multivariate Logistic regression analysis showed that the hematological malignancies was an independent influencing factor for the characteristic changes of CT in children with IPFIs.Conclusion When children with blood system malignant tumors manifest as fever,cough and other symptoms of infection,chest CT manifestations show characteristic changes,Aspergillus infection should be considered,and empirical antifungal treatment should be focused.
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Objective To explore the measurement of(1,3)-β-D glucan in plasma for the diagnosis of pulmonary fungal infections in pulmonary tuberculosis patients. Methods 40 pulmonary tuberculosis patients with pulmonary fungal infections in Guangzhou chest hospital from January 2015 to December 2015 were enrolled as a test group,among which 35 were confirmed and 5 were suspected pulmonary fungal infections. 52 pulmonary tuber-culosis patients without fungal infections were selected as a control group.(1,3)-β-D glucan content(G test)in this 92 patients plasma were detected. The results of G tests were compared with those from etiological diagnosis to assess the performance of G test. Results 13 strains of candida albicans,13 strains of aspergillus,2 strains of candida tropicalis,2 strains of candida glabrata and 6 strains of other yeast were obtained from patients of test group,but no fungal identified from those of control group. The median of G test in test group and in control group was 126.1 and 29.56 pg/mL,respectively,the level in test group was significantly higher than that in control group (P<0.001). 35 cases were identified as positive and 5 were negative in test group by G test ,while 41 cases were identified as negative and 11 were positive in control group. The sensitivity,specificity,positive predictive value, negative predictive value ,concordance and Youden index of G test were 87.5%,78.85%,76.09%,89.13%, 82.6%and 0.663,respectively. Conclusions Candida albicans and aspergillus are more common pathogens than the other fungi isolated from pulmonary tuberculosis patients with pulmonary fungal infection. G test ,used in pul-monary tuberculosis with pulmonary fungal infections diagnosis,is reliable and fast,and has a higher sensitivity, specificity and accuracy.
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Background: The coexistance among fungal pathogens and tuberculosis pulmonary is a clinical condition that generally occurs in immunosuppressive patients, however, immunocompetent patients may have this condition less frequently. Objective: We report the case of an immunocompetent patient diagnosed with coinfection Mycobacterium tuberculosis and Candida albicans. Case Description: A female patient, who is a 22-years old, with fever and a new onset of hemoptysis. Clinical findings and diagnosis: PDiminished vesicular breath sounds in the apical region and basal crackling rales in the left lung base were found in the physical examination. Microbiological tests include: chest radiography and CAT scan pictograms in high resolution, Ziehl-Neelsen stain, growth medium for fungus and mycobacteria through Sabouraudís agar method with D-glucose. Medical examinations showed Candida albicans fungus and Mycobacterium tuberculosis present in the patient. Treatment and Outcome: Patient was treated with anti-tuberculosis and anti-fungal medications, which produced good responses. Clinical relevance: Pulmonary tuberculosis and fungal co-infection are not common in immunocompetent patients. However, we can suspect that there is a presence of these diseases by detecting new onset of hemoptysis in patients.
Antecedentes: La coexistencia entre los hongos patógenos y la tuberculosis pulmonar es una condición clínica que se produce generalmente en pacientes inmunosuprimidos, sin embargo, los pacientes inmunocompetentes puede tener esta condición con menor frecuencia. Objetivo: Presentamos el caso de un paciente inmunocompetente con diagnóstico de una coinfección de tuberculosis Mycobacterium tuberculosis y Candida albicans. Caso clínico: Paciente femenina de 22 años con cuadro abrupto de tos, fiebre y hemoptisis sin antecedentes de enfermedad. Hallazgos clínicos y métodos diagnósticos: Al examen respiratorio se halló disminución del murmullo vesicular en la región apical y estertores crepitantes basales en el pulmón izquierdo. Se realizó estudios microbiológicos de muestras tomadas por expectoración y por fibrobroncoscopia en el que se incluyó la tinción de Ziehl-Neelsen, cultivo para micobacteria y hongos en medio Agar Dextrosa Sabouraud y filamentización en suero obteniéndose positividad para Mycobacterium tuberculosis y Candida albicans. Tratamiento y resultado: Se le realizó manejo con antifímicos de primera categoría y antimicóticos con buena respuesta clínica. Relevancia clínica: La coinfección fúngica y tuberculosis pulmonar no es frecuente en pacientes inmunocompetentes, debe sospecharse en episodios abruptos de hemoptisis.
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Female , Humans , Young Adult , Tuberculosis, Pulmonary/diagnosis , Candidiasis/diagnosis , Coinfection/diagnosis , Lung Diseases, Fungal/diagnosis , Tuberculosis, Pulmonary/microbiology , Candida albicans , Candidiasis/microbiology , Coinfection/microbiology , Hemoptysis/etiology , Immunocompetence , Lung Diseases, Fungal/microbiologyABSTRACT
Invasive pulmonary fungal infection (IPFI) is a potentially fatal complication in patients with connective tissue disease (CTD). The current study aimed to uncover the clinical characteristics and risk factors of patients with IPFI-CTD. The files of 2186 CTD patients admitted to a single center in northern China between January 2011 and December 2013 were retrospectively reviewed. A total of 47 CTD patients with IPFI were enrolled into this study and assigned to the CTD-IPFI group, while 47 uninfected CTD patients were assigned to the control group. Clinical manifestations were recorded, and risk factors of IPFI were calculated by stepwise logistical regression analysis. Forty-seven (2.15%) CTD patients developed IPFI. Systemic lupus erythematosus patients were responsible for the highest proportion (36.17%) of cases with IPFI. Candida albicans (72.3%) accounted for the most common fungal species. CTD-IPFI patients had significantly elevated white blood cell count, erythrocyte sedimentation rate, C-reactive protein and fasting glucose values compared to controls (P<0.05). Cough, sputum and blood in phlegm were the most common symptoms. Risk factors of IPFI in CTD included maximum prednisone dose ≥30 mg/day within 3 months prior to infection, anti-microbial drug therapy, and interstitial pneumonia. CTD patients who have underlying interstitial pneumonia, prior prednisone or multiple antibiotics, were more likely to develop IPFI.
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OBJECTIVE:To observe the clinical efficacy and safety of caspofungin acetate in the treatment of invasive pulmo-nary fungal infection(IPFI). METHODS:70 patients with IPFI were selected and randomly divided into observation group(40 cas-es) and control group (30 cases). Control group was given Itraconazole injection with initial dose of 250 mg,bid,decreasing to 200 mg,qd,2 days later;observation group was given Caspofungin acetate injection 70 mg on the first day,decreasing to 50 mg, ivgtt,qd,within 1 h. Clinical efficacy,the rate of nacterial smear negative conversion and ADR were observed in 2 groups. RE-SULTS:The total effective rate of observation group was 92.50%,which was significantly higher than that of control group (76.67%);the rate of nacterial smear negative conversion was 72.00% in observation group,which was significantly higher than that of control group(42.10%);the incidence of ADR was 7.50%in observation group,which was significantly lower than that of control group (13.33%),with statistical significance (P<0.05). CONCLUSIONS:Caspofungin acetate is effective for IPFI with low incidence of ADR.
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The incidence of invasive fungal infection in critically ill patients is increasing year by year. Its clinical manifestation lacks specificity which is difficult for early diagnosis. It′s hard to identify inva-sive fungal infection with fungal colonization in clinical practice. We need to find out the way to distinguish them.
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With wide applications of invasive diagnostic and therapeutic techniques,as well as immu-nosuppressors clinically,the morbidity of invasive pulmonary fungal infections( IPFIs)in children were in-creasing considerably and becoming one of the important diseases threat to life. The mortality of IPFIs in chil-dren would be reduced and the prognosis would be improved significantly with early diagnosis and treatment in-time. Radiological examinations were the basal component of the clinical evidences for diagnosing IPFIs. The main presentations include pulmonary nodules,some with“halo sign”in invasive pulmonary aspergillo-sis and pulmonary candidiasis,lobular consolidations and a little pleural effusion. Although there was no spe-cific findings radiologically,they would provide the proofs and clues for diagnosis of IPFIs combining with the data of clinics and laboratory.
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Objective To study the risk factors for pulmonary fungal infection associated with chronic obstructive pulmonary disease (COPD),and evaluate the efficacy and safety of itraconazole for treatment of pulmonary fungal infection associated COPD.Methods A retrospective analysis were conducted on clinical data of 42 COPD patients who were confirmed pulmonary fungal infection in a respiratory disease department from September 1 ,2007 to May 31 ,2012,and 53 COPD patients who had no pulmonary fungal infection were as control.Results Of 42 patients with COPD and pulmonary fungal infection,8 were confirmed by histopathological examination,34 were confirmed by clinical diagnosis;6 were acute cases,36 were chronic cases;28 were positive for fungal detection,6 of whom were detected Candida albicans ,13 were detected Aspergillus ,7 were detected unclassified fungi,and 2 had mixed fungal infection.Univariate analysis showed that underlying diseases,long-term use of broad-spectrum antimicrobi-als,long-term use of glucocorticoid,hypoproteinemia,invasive procedure,invasive mechanical ventilation,diabetes mellitus,history of invasive fungal infection were major risk factors for pulmonary fungal infection associated with COPD.After patients were treated by itraconazole,the improvement rate of clinical symptoms was 66.67%,fungal eradication rate was 60.71 %,total effective rate was 64.29%.Of 28 cases with positive fungal detection,the im-provement rate of clinical symptoms,fungal eradication rate,and total effective rate was 71 .43%(n=20),60.71 %(n=17),and 67.86%(n=19)respectively.Itraconazole had good therapeutic efficacy on acute and chronic pulmo-nary fungal infection associated with COPD.Adverse drug reaction rate was 23.81 %,most were mild and reversi-ble,and had no obvious impact on the treatment.Conclusion Itraconazole has positive clinical efficacy on treating pulmonary fungal infection associated with COPD,it is highly safe.
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Objective To evaluate the value of (1 ,3)‐β‐D‐glucan(G test) in the diagnosis of invasive pulmonary fungal infection (IPFI)in patients with chronic obstructive pulmonary disease (COPD) .Methods 96 COPD patients with high risk of IPFI were en‐rolled in the study ,and were divided into IPFI group and non‐IPFI group .The G test were performed on those people while the tra‐ditional methods sputum smear and fungal culture were also performed .The (1 ,3)‐β‐D‐glucan concentrations of IPFI group and non‐IPFI group were compared ,and then the areas under receiver operating characteristic curve (ROC) were calculated .The sensi‐tivity ,specificity ,positive predictive value ,negative predictive value ,and the area under ROC of the two methods (G test and tradi‐tional methods) were compared .Results The sensitivity ,specificity ,positive predictive value ,negative predictive value of G test were 89 .5% ,89 .6% ,68 .0% ,97 .2% ,respectively ,when 20 pg/mL was the critical value .Areas under curve were 0 .942 for G test ,and 0 .790 for traditional method .Conclusion The detection of (1 ,3)‐β‐D‐glucan might be faster and with higher positive rate than traditional method ,and could be used for the early diagnosis of IPFI ,provide reference for the treatment .
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Coccidioidomycosis is a fungal infection caused by Coccidioides immitis. The endemic area is mostly south-western United States. As increasing in overseas travel to endemic areas, the incidence rate has been recently increased in non-endemic areas. The diagnosis may be delayed in non-endemic area. It is important to elicit traveling histories and to differentiate lung consolidation with eosinophilia, for timely diagnosis of coccidioidomycosis. Recently, we experienced a case with pulmonary coccidioidomycosis in a Korean American who visited Korea showed consolidation in right lower lobe on chest X-ray and prolonged eosinophilia. In the case, a confirmatory diagnostic method was percutaneous transthoracic needle biopsy of lung. We report acute pulomonary coccidioidomycosis case and review previous published reports with pulmonary manifestation in Korea.
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Humans , Asian , Biopsy, Needle , Coccidioides , Coccidioidomycosis , Diagnosis , Endemic Diseases , Eosinophilia , Incidence , Korea , Lung Diseases, Fungal , Lung , Thorax , United StatesABSTRACT
OBJECTIVE To investigate pulmonary fungal infection spectrum and its resistance in older COPD patients with mechanical ventilation.METHODS Retrospective study were performed in 67 cases of COPD patients with mechanical ventilation treatment who were admitted to our ICU from Jan 2004 to Doc 2007.Bronchoalveolar lavage fluid was cultured,differentiation and antifungal susceptilibity testing were taken.RESULTS Seventy-eight fungi strains were cultured in 78 cases,among them,41 strains were Candida albicans(52.56%),14 of C.tropicalis,9 of C.krusei,5 of C.parapsilosis,7 of yeast-like fungi and 2 of Aspergillus.CONCLUSIONS There were increasing fungal infection rate in older COPD patients with mechanical ventilation and C.albicans is still the most frequent type.The resistance to triazole antifungal drug is also increasing.
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Objective:To discover the risk factors,clinical features,treatment and prognosis of fungal infection in the lungs.Methods:The data of 103 patients suffering from fungal infection in the lungs were analyzed retrospectively.Results:There were ninety percent(91/103) of patients with underlying diseases,mainly chronic obstructive pulmonary disease(COPD) and chronic cor pulmonale.68(66.02%) patients suffered from two or more than two kinds of underlying diseases.Type 2 diabetes also took an important position in all underlying diseases.Clinical manifestations of pulmonary fungal infection showed no specificity.X-ray appearance showed that bronchopneumonitis was predominated(60%).The fungal culture results showed that blastocystis was the major pathogenic fungus,including 73(70.8%)strains of Candida albicans,11(10.7%) strains of Candida tropicalis,10(9.7%) strains of Torulopsis glabrata,6(5.8%) strains of aspergilli and 3(2.9%)trains of mold fungus,and early diagnosis of this disease remained difficult.The results of sputum cultuer showed that 48(46.6%) patients suffered from pumomary fungal infection combined with other bacterial infections,such as Pseudomonas aeruginosa,Acinetobacteria,Methicillin-resistant Staphylococcus aureus(MRSA),Escherichia coli and so on.The mortality of pulmonary fungal infection in this group was high(21.36%).6 patients died from uncontrolled fungal infections in the lungs and other16 patients died from mutiple organ failure due to delayed antifungeal therapy.Conclusions:Pulmonary fungal infection with few specific clinical manifestations and high mortality was an important cause of secondary infections in the patients suffering from many kinds of diseases,which is worthy of more attention in clinic.
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Objective To investigate the risk factors of pulmonary fungal infection in intensive care unit(ICU),and discuss the strategy of prevention and treatment.Methods Forty children with pulmonary fungal infection in ICU of Wuhan Children's Hospital from Jan.2003 to Jan.2007 were analyzed retrospectively,including primarily diseases,application of antibiotics,adrenal cortical hormone and virulence operation,therapy and turnover.Results All children were accepted the therapies of broad spectrum antibiotics and glucocorticoids for long time before definite diagnosis of pulmonary fungal infection.Seventy-five percent children were received invasive operations or therapies.Their average time of stayed in hospital was 37.8 d.The clinical symptoms and imaging examinations were untypical.Blastomyces albicans was the main pathogen.After the antifungal agents and supportive treatment used in time,35 cases(87.5%) were cured and 5 cases(12.5%) died.Conclusions The major risk factors of children pulmonary fungal infection are long-time use of broad spectrum antibiotics and glucocorticoids.The pulmonary fungal infection can decrease by rational use of broad spectrum antibiotics and glucocorticoids,decreasing the unnecessary invasive operations,strengthening the supportive therapies of micro-ecosystem,and applying the antifungal agents in time.
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Objective To investigate the risk factors for nosocomial pulmonary fungal infection(PFI) in COPD patients.Methods The data of 44 cases of nosocomial PFI were analyzed from Jan 2000 to Jun 2003 in Department of Pulmonary Medicine,the First Hospital of Chongqing Medical University.44 cases of COPD patients were randomized as control.Results According to univariate analysis ,the risk factors associated with nosocomial pulmonary fungal infection include those of long-term use of broad-spectrum antibiotics,long-term use of adrenocortical steroid,diabetes mellitus,type Ⅱ respiratory failure,mechanical ventilation and hypoalbuminemia.But according to multivariate logistic regression analysis long-term use of broad-spectrum antibiotics,hypoalbuminemia,mechanical ventilation diabetes mellitus were risk factors.Conclusion Long-term use of broad-spectrum antibiotics,hypoalbuminemia,mechanical ventilation and diabetes mellitus are independent risk factors for nosocomial pulmonary fungal infection in COPD patients.
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Acute cavitating pulmonary infection with a mycetoma is sometimes occur in immunocompromised patient. Most mycetoma lesions are due to Aspergillus species, and lesion caused by Candida species is rare. So we report an experienced case that pulmonary and rib infection caused by Candida species-'in -AML patient and complete remission with previous reports.