Acurácia da detecção do antígeno galactomanana no soro para o diagnóstico precoce de aspergilose pulmonar invasiva: uma revisão rápida / Accuracy of serum galactomannan antigen detection for the early diagnosis of invasive pulmonary aspergillosis: a rapid review

Tecnologia: Detecção do antígeno galactomanana no soro. Contexto: A aspergilose pulmonar invasiva (API) é uma infecção fúngica oportunista de grande risco para pacientes imunocomprometidos. A detecção do antígeno galactomanana no soro por meio de um imunoensaio (ELISA) pode ser um teste não invasivo que auxilie no diagnóstico precoce da doença nestes pacientes. Objetivo: Avaliar a acurácia da detecção do antígeno galactomana no soro para o diagnóstico precoce de aspergilose pulmonar invasiva. Métodos: Revisão rápida sistematizada sobre acurácia de diagnóstico. As bases de dados utilizadas na pesquisa foram: PUBMED, EMBASE, SCOPUS, BVS e Cochrane Library. A avaliação da qualidade metodológica dos estudos incluídos foi realizada por meio da ferramenta AMSTAR-2. Resultados: Foram selecionadas três revisões sistemáticas que atendiam aos critérios de elegibilidade com as quais foi realizada uma análise descritiva dos dados encontrados. A avaliação da qualidade metodológica demonstrou que duas das revisões sistemáticas (RS) apresentaram qualidade criticamente baixa e uma das RS apresentou qualidade alta. Conclusão: A detecção da galactomanana sérica por ELISA pode ser um teste auxiliar no diagnóstico de API, entretanto, possui várias limitações e deve ser utilizado juntamente com outros critérios diagnósticos do consenso do EORTC/MSG. Novas pesquisas devem ser fomentadas para avaliar a utilização do teste no tempo do diagnóstico e no monitoramento da API

Technology: Detection of galactomannan antigen in serum. Background: Invasive pulmonary aspergillosis (IPA) is an opportunistic fungal infection of serious risk for immunocompromised patients. Detection of galactomannan antigen in serum by immunoassay (ELISA) could be a noninvasive test that contributes to the early diagnosis of the disease in this group of patients. Objective: To evaluate the accuracy of serum galactomannan antigen detection for the early diagnosis of invasive pulmonary aspergillosis. Methods: Rapid review of diagnostic accuracy. Databases used in the search were: PUBMED, EMBASE, SCOPUS, BVS, and Cochrane Library. The methodological quality of the included studies was assessed using the AMSTAR-2 tool. Results: Three systematic reviews that satisfied the eligibility criteria were selected, and a descriptive analysis of the data found was performed. The methodological quality assessment showed that two of the systematic reviews (SR) presented critically low quality, and one of the SR presented high quality. Conclusion: Detection of serum galactomannan by ELISA may be a valuable test for diagnosing IPA; however, it has a series of limitations and should be used in conjunction with other diagnostic criteria of the EORTC/MSG consensus. Further research should be encouraged to evaluate the use of this assay, considering the time to diagnosis and IPA monitoring

Retrospective analysis of 77 pathologically confirmed cases of pulmonary mycosis in a hospital in the south Sichuan Basin, 2014-2021 / 中国热带医学

@#Abstract: Objective To observe the etiological distribution, basic information, clinical characteristics, imaging and pathological features, treatment regimens, and prognosis of pathologically confirmed cases of pulmonary mycosis, aiming to improve the diagnosis and treatment level of pulmonary mycosis. Methods The clinical, imaging and pathological data of patients with pulmonary mycosis diagnosed by pathological biopsy in the Affiliated Hospital of Southwest Medical University from January 2014 to December 2021 were retrospectively analyzed. Results There were 77 cases of pulmonary mycosis who were diagnosed by pathology, and of these patients, 42 cases (54.54%) suffered from pulmonary aspergillosis, 34 cases (44.16%) suffered from pulmonary cryptococcosis, and 1 case (1.30%) suffered from pulmonary mucormycosis. Among the 77 patients, there were 38 male and 39 female patients, with an age range of 25 to 68 years old (mean age 51.13±10.32 years old). The common respiratory symptoms on admission included cough (33 cases, 42.86%), hemoptysis (24 cases, 31.17%), expectoration (22 cases, 28.57%) and chest pain (13 cases, 16.88%). Chest imaging features mainly included pulmonary nodules (37 cases, 48.05%), cavity (14 cases, 18.18%) and air crescent sign (10 cases, 12.99%). In this study, the main treatment measures for pulmonary mycosis were surgical resection (47 cases, 61.04%) and antifungal therapy combined with surgical resection (19 cases, 24.68%). After active treatments, most of these patients (72/77, 93.51%) discharged with better condition. Conclusions Pulmonary aspergillosis and pulmonary cryptococcosis are common pulmonary mycosis diagnosed by pathology. The main respiratory symptoms on admission are cough, expectoration and hemoptysis. Pulmonary nodules are the most common imaging features, and "air crescent sign" can be seen in some patients with pulmonary aspergillosis. Most pulmonary mycosis can have good treatment outcomes. Combining fungal histopathological characteristics and fungal special staining such as Periodic Acid-Schiff (PAS) staining and Gomori methenamine silver (GMS) staining can identify most pathogenic fungi into genera, which has important clinical significance for the timely diagnosis and treatment of pulmonary mycosis

Subacute invasive pulmonary aspergillosis misdiagnosed as tuberculosis in a Nigerian man: A case report

Subacute invasive pulmonary aspergillosis is a form of chronic pulmonary aspergillosis (CPA) with rapid progression. The clinical features of CPA mimic tuberculosis (TB) and may lead to delayed and/or misdiagnosis. We report a 39-year-old Nigerian previously managed in a peripheral hospital as a case of TB despite negative Gene-X pert results with no resolution of symptoms. Chest X-ray and computer tomography findings were suggestive of CPA and galactomannan assay positive. Symptoms resolved 2 months into itraconazole treatment. There is a dire need to drive awareness of CPA among clinicians, especially in our primary and secondary healthcare facilities where the knowledge base and expertise in the management of fungal infections is still at a rudimentary level or perhaps not available at all.

A rare case report of tracheobronchial aspergillosis with endobronchial aspergilloma in a patient clinically recovered from COVID-19

The novel coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 has led to an increased incidence of fungal infections. However, pulmonary infections are rare. COVID-associated pulmonary aspergillosis has been reported; however, there is no prior report of tracheobronchial aspergillosis with endobronchial aspergilloma as per the authors' literature search. We report such a case of a 65-year-old male with radiology and biopsy-proven endobronchial aspergilloma upon a background of tracheobronchial and pulmonary aspergillosis after having recovered clinically from severe COVID-19 disease.

LDBio Aspergillus immunochromatographic test lateral flow assay for IgG/IgM antibody detection in chronic pulmonary aspergillosis: Single-centre evaluation and meta-analysis

Purpose: Chronic pulmonary aspergillosis (CPA) is an infection of the lung usually caused by Aspergillus fumigatus in patients with pre-existing pulmonary diseases. Its diagnosis hinges on demonstrating IgG antibodies against A. fumigatus. Herein, we evaluated the performance of a newly introduced point of care test (POCT) kit, the LDBio Aspergillus IgG/IgM lateral flow assay (LFA) in India with the standard ImmunoCAP kit for diagnosing CPA. Methods: A total of 60 serum samples (30 CPA cases and 30 controls) were evaluated by the Aspergillus immunochromatographic test (ICT) IgG/IgM LFA. Fluorescent-enzyme immunoassay was used to determine specific A. fumigatus-IgG concentrations (positive >27 mgA/L). Further, a systematic review and meta-analysis of studies (up to August 26, 2021) reporting the performance of LDBio ICT for the diagnosis of CPA was performed. Result: A sensitivity of 86.7%, specificity of 90%, negative predictive value of 87.1%, positive predictive value of 89.7%, negative likelihood ratio of 0.15, positive likelihood ratio of 8.67, and was observed for the LDBio IC. There was good agreement between LDBio ICT and ImmunoCAP (88.3%) with a Cohen's Kappa score of 0.77. Our systematic review identified four studies and the pooled sensitivity of 90%, specificity of 91%, area under the curve of 0.94 and diagnostic odds ratio of 57.2, for CPA diagnosis by LDBio ICT. Conclusion: Aspergillus LDBio ICT assay exhibits good sensitivity and can be used to screen CPA cases

Spectrum of Aspergillus infections in post TB patients

Background: Fungal colonisation of airways in Post TB patients, can lead to a spectrum of diseases based on the immune response of the host. This study was aimed at studying the different entities of this spectrum. Methods: A cross sectional observational study was conducted over 100 patients of post TB patients to make an observation of the diseases of the spectrum of Aspergillus infections. Results: Of the 100 patients who were studied, IPA was found in 24 (48%), ABPA in 13(26%), CPA in 5(10%) patients out of the 50 diabetics. ABPA in 23 (46%) patients, Simple colonization, CPA in 11(22%) and 4 (8%) patients showed IPA out of the 50 non-diabetics. Conclusion: Chronic pulmonary Aspergillosis was the most common disease from Aspergillus among Post TB patients. Diabetes was associated to invasive forms of Aspergillosis, Invasive Pulmonary aspergillosis (IPA) and subacute invasive pulmonary aspergillosis (SAIA).

Therapeutic potential of Calotropis gigantea extract against invasive pulmonary aspergillosis: In vitro and in vivo study

Objective: To characterize the antifungal activity of methanolic leaf extract of Calotropis gigantea alone or in combination with amphotericin B against invasive pulmonary aspergillosis in mice. Methods: GC/MS was used for analysis of active constituents of Calotropis gigantea extract. Spore germination assay and broth micro-dilution method were used to determine antifungal potential of Calotropis gigantea/amphotericin B against Aspergillus fumigatus. Neutropenic mice were randomly assigned into 5 groups: group 1 was neutropenic (control); group 2 was infected with Aspergillus fumigatus; group 3 was infected with Aspergillus fumigatus, and treated with Calotropis gigantea extract; group 4 was infected with Aspergillus fumigatus and treated with amphotericin B; group 5 was infected with Aspergillus fumigatus and treated with both Calotropis gigantea extract and amphotericin B. Fresh lung tissues were histopathologically examined. Fungal burden and gliotoxin concentration were evaluated in lung tissues. Catalase, superoxide dismutase, and malondialdehyde content were determined in lung tissues. Myeloperoxidase, tumor necrosis factor-alpha, interleukin-1, and interleukin-17 were also estimated by the sandwich enzyme-linked immuno-sorbent assay. Results: Calotropis gigantea/amphotericin B had a minimum inhibitory concentration and minimum fungicidal concentration of 80 and 160 μg/mL, respectively, for Aspergillus fumigatus. Additionally, Calotropis gigantea/amphotericin B significantly reduced lung fungal burden by 72.95% and inhibited production of gliotoxin in lung tissues from 6 320 to 1 350 μg/g lung. Calotropis gigantea/amphotericin B reduced the oxidative stress of the lung via elevating the activity of antioxidant enzymes and decreasing the levels of lipid peroxidation. Myeloperoxidase activity and the production of pro-inflammatory cytokines were also significantly reduced. Scanning electron microscopy revealed deteriorations in the hyphae ultrastructure in Calotropis gigantea/amphotericin B treated Aspergillus fumigatus and leak of cellular components after damage of the cell wall. In vivo study revealed the suppression of lung tissue damage in mice of invasive pulmonary aspergillosis, which was improved with Calotropis gigantea/amphotericin B compared to the control group. Conclusions: Calotropis gigantea/amphotericin B is a promising treatment to reduce lung fungal burden and to improve the drugs' therapeutic effect against invasive pulmonary aspergillosis.

Clinical neglect of aspergillosis in pulmonary tuberculosis co-infection: a case report of avoidable mortality in a resource-constrained setting

Background: Pulmonary aspergillosis (PA) is common among patients with tuberculosis (TB). With both infections presenting with similar clinical and radiologic features, diagnosis of PA is often made too late or missed completely due to lack of clinical suspicion and poor diagnostic laboratory capacity for mycotic infections prevalent in our settings. We present a case of preventable mortality caused by delayed diagnosis and treatment of PA in a patient with pulmonary TB (PTB). Case presentation: A 13-year-old female was diagnosed and treated for PTB, having received anti-TB regimen for 8 months in a mission hospital from where she was referred due to worsening cough, chest pain and progressive breathlessness. The patient was re-assessed and investigated, with GeneXpert detecting Mycobacterium tuberculosis, susceptible to rifampicin. Diagnosis of pulmonary tuberculosis complicated by right pneumothorax was made indicating an emergency thoracotomy and chest tube insertion and continuation of the first line anti-TB regimen. At about 2 weeks into admission, patients had features of superimposed acute bacterial sepsis with fever becoming high grade, marked neutrophilia with toxic granulation and elevated sepsis biomarker, and this necessitated empiric antibiotic treatment with parenteral meropenem and vancomycin. However, the patient only had mild clinical improvement following which there was progressively worsening respiratory symptoms and massive haemoptysis. Result of sputum fungal study was available on admission day 20 and revealed a growth of Aspergillus flavus. Treatment with intravenous voriconazole was however commenced rather late when the fungal respiratory disease could no longer be remedied. The patient died on admission day 23. Conclusion: Diagnosis of PA in patients with background TB is often made too late to guarantee timely and effective antifungal treatment with negative consequences on patients' outcomes. Improving clinical and laboratory capacities is essential to reducing mortality from PA in healthcare facilities.

Aspergillus-specific IgM/IgG antibody serostatus of patients hospitalized with moderate-critical COVID-19 in Uganda

Invasive pulmonary aspergillosis is known to complicate the coronavirus diseases-2019 (COVID-19), especially those with critical illness. We investigated the baseline anti Aspergillus antibody serostatus of patients with moderate-critical COVID-19 hospitalized at 3 COVID-19 Treatment Units in Uganda. All 46 tested patients, mean age 30, and 11% with underlying respiratory disease had a negative serum anti-Aspergillus IgM/IgG antibody immunochromatographic test on day 3 (mean) of symptom onset (range 1-26), but follow up specimens to assess seroconversion were not available

Clinical diagnostic value of combined detection of serum and bronchoalveolar lavage fluid galactomannan for invasive pulmonary aspergillosis in non-neutropenic children / 中华微生物学和免疫学杂志

Objective:To investigate the clinical diagnostic value of combined detection of serum and bronchoalveolar lavage fluid (BALF) galactomannan (GM) for invasive pulmonary aspergillosis (IPA) in children with non-neutropenia.Methods:An analysis was made on 100 children with non-neutropenia suspected of invasive pulmonary aspergillosis in the respiratory ward of the Children′s Hospital Affiliated to Capital Institute of Pediatrics from January 2019 to March 2020. All of them were tested by serum and BALF GM tests as well as sputum and BALF culture for fungi. The sensitivity, specificity and accuracy of serum and BALF GM in the diagnosis of IPA in non-neutropenic children were analyzed. The receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC) were used to evaluate the clinical diagnostic value of serum and BALF GM tests for IPA in children with non-neutropenia.Results:The recruited 100 cases included one confirmed case, 85 clinically diagnosed cases and two suspected cases, while the 12 cases were excluded. The accuracy and 95% confidence interval (95%CI) of serum and BALF GM tests used alone and in combination in the clinical diagnosis of IPA in non-neutropenic children were 29.0% (95%CI: 20.1%-37.9%), 75.0% (95%CI: 66.5%-83.5%) and 81.0% (95%CI: 73.3%-88.7%), respectively. The AUC and 95%CI were 0.645 (95%CI: 0.513-0.778), 0.785 (95%CI: 0.644-0.926) and 0.819 (95%CI: 0.681-0.953), respectively.Conclusions:The combined detection of serum and BALF GM was better than a single indicator in the clinical diagnosis of IPA in non-neutropenic children, suggesting the combined detection was of great value in clinical diagnosis.

Factores de Riesgo de Mortalidad en Pacientes Hematológicos con Aspergilosis Pulmonar en Clínica Médica Instituto de Previsión Social - Hospital Central. Año 2016 A 2018

ResumenIntroducción: Es una de las infecciones oportunistas de mayor impacto en el paciente con patologías hematooncológicas, su detección precoz y tratamiento oportuno impide su diseminación. Objetivo: Determinar factores de riesgo de mortalidad en pacientes hematológicos con aspergilosis pulmonar de pacientes internados en clínica médica en el Instituto de Previsión Social del Hospital Central durante 2016 a 2018. Metodología: Estudio observacional, descriptivo, transversal, se incluyó a pacientes con patologías hematooncológicas e infección por aspergillus internados por un periodo de tres años. Resultados: Se incluyó a 55 pacientes, con edad promedio de 57,2±19,5 años. El 36,3% con edades comprendidas entre 40 a 59 años. 52,8% fue sexo femenino. 56,3% presentó hipertensión arterial. 27,2% linfoma no Hodking. 34,5% se encontraba en fase de mantenimiento al momento del diagnóstico de aspergilosis pulmonar. Respecto al grado de neutropenia el 34,7% presentó neutropenia severa. El 83,6% fue diagnosticado a traves de TACAR y galactomanano. El tiempo de inicio de síntomas hasta el momento del diagnóstico en promedio de días fue de 12,4±4,7 días. 38,1% presentó esputo con aislamiento positivo. Del tratamiento antifúngicos el 78,2% recibió anfotericina B y 21,8% Voriconazol. En relación a la evolución clínica 50,9% fueron alta, el 25,45% requirieron de Unidad de cuidados intensivos, 23,6%obitaron. Conclusión: Las aspergilosis pulmonar se presentó con predominio femenino, la mayoría se encontraba con neutropenia severa en fase de mantenimiento quimioterápico, dos tercios fue tratado con anfotericina B y la mitad fue dado de alta médica.

AbstractIntroduction: It is one of the opportunistic infections with the greatest impact on the patient with hemato-oncological pathologies, its early detection and timely treatment prevents its spread. Objective: To determine risk factors for mortality in hematological patients with pulmonary aspergillosis of patients hospitalized in a medical clinic at the Social Security Institute of the Central Hospital during 2016 to 2018. Methodology: Observational, descriptive, cross-sectional study included patients with hemato-oncological pathologies and infection by aspergillus hospitalized for a period of three years. Results: 55 patients were included, with an average age of 57.2 ± 19.5 years. 36.3% with ages between 40 to 59 years. 52.8% were female. 56.3% presented hypertension. 27.2% non-Hodking lymphoma. 34.5% were in the maintenance phase at the time of pulmonary aspergillosis diagnosis. Regarding the degree of neutropenia, 34.7% presented severe neutropenia. 83.6% were diagnosed through TACAR and galactomannan. Symptom onset time until diagnosis on average days was 12.4 ± 4.7 days. 38.1% presented sputum with positive isolation. Of the antifungal treatment, 78.2% received amphotericin B and 21.8% Voriconazole. In relation to the clinical evolution, 50.9% were high, 25.45% required an intensive care unit, 23.6% obliged. Conclusion: Pulmonary aspergillosis presented with a female predominance, the majority were with severe neutropenia in the phase of chemotherapy maintenance, two thirds were treated with amphotericin B and half were discharged medically.

Neumonía por coinfección de Aspergillus fumigatus y Pneumocystis jirovecii en un paciente no VIH: Reporte de caso / Pneumonia due to Aspergillus fumigatus and Pneumocystis jirovecii coinfection in a non-HIV- infected patient: Case report

RESUMEN La aspergilosis pulmonar invasiva es una enfermedad presente principalmente en pacientes inmunocomprometidos con alta carga de mortalidad. La neumonía por Pneumocystis jirovecii es una infección oportunista potencialmente mortal que afecta a pacientes inmunocomprometidos por diversas etiologías. La coinfección por estos patógenos en pacientes inmunocompetentes es inusual. Reportamos un caso de un paciente sin las causas tradicionales de inmunocompromiso en el desarrollo de una neumonía en coinfección por Aspergillus fumigatus y Pneumocystis jirovecii.

ABSTRACT Invasive pulmonary aspergillosis is a condition that mainly occurs in immunosuppressed patients, and it has a high mortality rate. Pneumonia caused by Pneumocystis jirovecii is a potentially lethal opportunistic infection affecting immunosuppressed patients with different etiology. Coinfection by Aspergillus and P. jirovecii in immunocompetent patients is unusual. We report a case of a patient with no common causes of immunosuppression who developed pneumonia coinfection caused by Aspergillus fumigatus and Pneumocystis jirovecii.

Invasive pulmonary aspergillosis with brain dissemination in an immunocompetent host

Invasive aspergillosis is an uncommon infection, which is mainly seen among immunocompromised patients. In recent years, cases of aspergillosis involving immunocompetent hosts are increasingly being reported. Herein, we report the case of a 27-year-old man with fever, productive cough, shortness of breath, and left hemiparesis. He had suffered trauma to his head 25 days prior. Imaging of the chest showed bilateral cavitary lesions in the lungs, and neuroimaging revealed a space-occupying lesion in the right frontoparietal cerebrum. He was suspected of having an abscess or metastasis. He died on day 3 of hospitalization, and an autopsy was performed. The autopsy revealed the cause of death to be invasive pulmonary aspergillosis, with brain dissemination. Invasive aspergillosis is uncommon in apparently immunocompetent individuals, and we discuss the autopsy findings in detail.

COVID-19 associated pulmonary aspergillosis (CAPA) in a pregnant woman

Viral or bacterial co-infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported in the literature. However, the knowledge on Aspergillus co-infection among patients with coronavirus disease 2019 (COVID-19) is limited. COVID‐19‐associated pulmonary aspergillosis (CAPA) has been seen in critically ill COVID-19 patients with acute respiratory distress syndrome (ARDS), which has raised concerns about the worsening disease course of COVID-19 and increasing mortality. We describe a clinical case of CAPA infection and acute respiratory distress syndrome (ARDS) with a deathly outcome in a previously well, non-immunocompromised pregnant woman with intrauterine death of the fetus. Hence, we suggest that clinicians and pathologists keep alerting the possible occurrence of pulmonary aspergillosis in severe/critical COVID-19 patients, and aggressive investigations should be done to rule out the possibility of CAPA so that early treatment can be administrated.

Enfoque del paciente con cavitación pulmonar / Approach to the patient with lung cavitation / Enfoque do paciente com cavitação pulmonar

Cavitation is a common finding in lung images, secondary to infectious, inflammatory, tumor, and autoimmune conditions, the former being the most common cause in all levels of care and geography. The diagnostic approach must be judicious, integrating the image, with the patient's medical history, personal history, and exposures, as well as the time of evolution of the symptoms; which are key elements for the approach. It is always essential to integrate the clinical findings with the laboratory and the pathology in order to reach an accurate diagnosis and timely treatment, since the isolated image is not enough, given the multiple etiologies described and variety of presentation that make this radiological sign only a premise to the confirmation of an underlying disease.

Una cavitación es un hallazgo común en imágenes pulmonares, secundaria a condiciones infecciosas, inflamatorias, tumorales y autoinmunes, siendo las primeras la causa más común en todos los niveles de atención y geográficos. El abordaje diagnóstico debe ser riguroso, integrando la imagen con la historia clínica del paciente, sus antecedentes personales y exposiciones, así como el tiempo de evolución de los síntomas; estos son elementos clave para el enfoque. Siempre es fundamental integrar los hallazgos clínicos con el laboratorio y la patología para llegar a un diagnóstico preciso y a un tratamiento oportuno, pues la imagen aislada no es suficiente, dadas las múltiples etiologías descritas y la variedad de presentación que hacen de este signo radiológico solo una premisa a la confirmación de una enfermedad subyacente.

Uma cavitação é uma descoberta comum em imagens pulmonares, secundária a condições infecciosas, inflamatórias, tumorais e autoimunes, sendo as primeiras a causa mais comum em todos os níveis de atenção e geográficos. A abordagem diagnóstica deve ser rigorosa, integrando a imagem com a história clínica do paciente, seus antecedentes pessoais e exposições, assim como o tempo de evolução dos sintomas; estes são elementos chave para o enfoque. Sempre é fundamental integrar as descobertas clínicas com o laboratório e a patologia para chegar a um diagnóstico preciso e a um tratamento oportuno, pois a imagem isolada não é suficiente, dadas as múltiplas etiologias descritas e a variedade de apresentação que fazem deste signo radiológico só uma premissa à confirmação de uma doença subjacente.

Necrosis pulmonar masiva por micosis / Massive pulmonary necrosis due to mycosis

Introducción: La aspergilosis es una infección micótica oportunista que se presenta fundamentalmente en pacientes inmunodeprimidos y su principal fuente de transmisión lo constituyen las esporas presentes en el aire de salones de operaciones y unidades de cuidados intensivos. Objetivo: Presentar un caso de una micosis pulmonar masiva por una variante angioinvasiva de Aspergillus. Caso clínico: Se presenta un paciente con aspergilosis pulmonar grave, diagnosticada después de la resección de un tumor mediastinal. Se describen las características de la primera intervención, la evolución postoperatoria que condujo a la segunda, se muestran las imágenes tomográficas, quirúrgicas, microbiológicas y anátomo-patológicas que permitieron definir el diagnóstico. Conclusiones: La posibilidad de una micosis pulmonar debe tenerse en cuenta, aun cuando sea una afección rara y de manejo difícil, en pacientes inmunodeprimidos, con condensación pulmonar rebelde al tratamiento(AU)

Introduction: Aspergillosis is an opportunistic fungal infection that occurs mainly in immunosuppressed patients and its main source of transmission is the spores present in the air of operating rooms and intensive care units. Objective: To present a case of a massive pulmonary mycosis due to an angioinvasive variant of Aspergillus. Clinical case: A patient with severe pulmonary aspergillosis, diagnosed after resection of a mediastinal tumor, is presented. The characteristics of the first intervention are described, the postoperative evolution that led to the second one, the tomographic, surgical, microbiological and anatomo-pathological images that allowed to define the diagnosis are shown. Conclusions: The possibility of a pulmonary mycosis should be taken into account, even when it is a rare and difficult-to-handle condition, in immunocompromised patients, with pulmonary condensation that is rebellious to treatment. Aspergillosis is an opportunistic fungal infection that occurs mainly in immunosuppressed patients and its main source of transmission is the spores present in the air of operating rooms and intensive care units(AU)

Diagnóstico de un caso inusual de micetoma por Aspergillus / Diagnosis of an unusual case of Mycetoma due to Aspergillus

Introducción: Las aspergilosis comprenden un amplio y heterogéneo grupo de enfermedades oportunistas causadas por hongos del género Aspergillus, considerados como una causa inusual de infección. Es la causa más frecuente de muerte por neumonía infecciosa e infección diseminada o respiratoria oportunista, en pacientes inmunocomprometidos. Objetivos: Describir las características clínicas de un caso inusual de aspergilosis pulmonar. Caso clínico: Paciente de 56 años de edad con antecedentes personales de hepatopatía alcohólica, ingresado por episodios de expectoración con sangre y tos seca. Se realizaron estudios de laboratorio, imagenológicos y anatomopatológicos que condujeron al diagnóstico de micetoma por Aspergillus fumigatus, lo cual posibilitó indicar el tratamiento adecuado y realizar el seguimiento clínico. Conclusiones: La infección por Aspergillus fumigatus debe ser considerada por el médico de cabecera, debido a que su reporte constituye una herramienta para que pueda establecer una terapéutica temprana y adecuada, dada sus implicaciones pronósticas, su morbilidad y mortalidad en pacientes inmunodeprimidos(AU)

Introduction: Aspergillosis comprises a wide and heterogeneous group of opportunistic diseases caused by fungi of the Aspergillus genus, considered as an unusual cause of infection. It is the most frequent cause of death from infectious pneumonia and disseminated or opportunistic respiratory infection in immunocompromised patients. Objectives: Describe the clinical characteristics of an unusual case of pulmonary aspergillosis. Case report: 56-year-old patient with a personal history of alcoholic liver disease, admitted due to episodes of expectoration with blood and dry cough. Laboratory, imaging, and pathological studies were conducted that led to the diagnosis of mytoma by Aspergillus fumigatus, which made it possible to indicate the appropriate treatment and perform clinical follow-up. Conclusions: Aspergillus fumigatus infection should be considered by the attending physician, because his report constitutes a tool for him to establish an early and adequate therapy, given its prognostic implications and for its morbidity and mortality in immunocompromised patients(AU)

Secuestro pulmonar intralobar y aspergilosis pulmonar: reporte de un caso / Intralobar pulmonary sequestration and pulmonary aspergilosis: a case report

El secuestro pulmonar es un tipo de malformación congénita pulmonar poco frecuente, con presentación clínica variable y de usual diagnóstico durante la infancia. Puede coexistir con otras patologías pulmonares, principalmente de tipo infecciosas y su manejo definitivo es mediante un procedimiento quirúrgico. Se presenta el caso de una paciente adulta con secuestro pulmonar, asociado a una infección fúngica, manejada con cirugía mínimamente invasiva

Pulmonary sequestration is a rare type of congenital pulmonary malformation, with variable clinical presentation and usually diagnosed during childhood. It can coexist with other pulmonary pathologies, mainly infectious, and its definitive management is through a surgical procedure. We present the case of an adult patient with pulmonary sequestration associated with a fungal infection, managed with minimally invasive surgery

Clinical analysis on a case of occupational stage Ⅲ silicosis combined with pulmonary tuberculosis and aspergillosis / 中国职业医学

OBJECTIVE: To analyze the clinical characteristics and diagnosis of silicosis with pulmonary tuberculosis and pulmonary aspergillosis. METHODS: The clinical data of a case of silicosis combined with pulmonary tuberculosis and aspergillosis was analyzed retrospectively. RESULTS: The clinical symptoms of this patient were chest tightness, suffocation, cough, expectoration and hemoptysis. The patient was diagnosed as tuberculosis in the local hospital in 2015. Two previous sputum smears of the patient were positive for mycobacterium tuberculosis. Both qualitative analysis of blood tubercle bacilli and sputum smear examination of acid-fast bacilli were negative. Chest computed tomography(CT) showed right lung pneumoconiosis with large shadow, left lower lobe of lung with uneven density and flake shadow, low density necrotic foci, a cavity with smooth wall. Sputum fungal culture: Aspergillus fumigatus(+++); bronchoscopic lung biopsy showed: Aspergillus pneumoniae. CONCLUSION: Low immunity, malnutrition and long-term use of antibiotics and hormones are the high risk factors of pulmonary aspergillosis. It is helpful to combine laboratory examination, patients′ clinical manifestations and chest CT characteristics, and to analyze the condition comprehensively for the early diagnosis of silicosis with pulmonary aspergillosis.

Identificación molecular de Aspergillus fumigatus aislados de pacientes con aspergilosis invasiva / Molecular identification of Aspergillus fumigatus isolated from patients with invasive aspergillosis

RESUMEN El objetivo del estudio fue identificar molecularmente cepas de aspergillus aislados de pacientes con aspergilosis invasiva (AI), que fueron tipificadas primariamente como Aspergillus fumigatus sensu lato por métodos fenotípicos convencionales. Se trabajó con 20 cepas de la micoteca de la sección de micología del Instituto de Medicina Tropical "Daniel A. Carrión". Para obtener el ADN fúngico se emplearon las técnicas de choque térmico, tratamiento enzimático y columnas de silica-gel; y se almacenó a -20 0C para conservarlo. En el procedimiento de la reacción en cadena de la polimerasa en tiempo real (qPCR) se incluyeron primers marcados con fluorocromo, los cuales amplificaron las secuencias específicas de A. fumigatus. La fluorescencia se midió con el termociclador al final de la fase de hibridación de cada ciclo. Se identificó molecularmente que sólo el 50% de las cepas estudiadas pertenecen a la especie Aspergillus fumigatus sensu stricto.

ABSTRACT The objective of the study was to identify molecularly-isolated strains of Aspergillus from patients with invasive aspergillosis (IA); these strains were primarily typed as Aspergillus fumigatus sensu lato by conventional phenotypic methods. We worked with 20 strains from the mycology section of the Institute of Tropical Medicine "Daniel A. Carrión." To obtain the fungal DNA, thermal shock, enzymatic treatment, and silica gel column techniques were used; and it was stored at -20°C to preserve it. The real-time polymerase chain reaction (qPCR) procedure included fluorochrome-labeled primers, which amplified the specific sequences of A. fumigatus. Fluorescence was measured with the thermocycler at the end of the hybridization phase of each cycle. It was molecularly-identified that only 50% of the strains studied belong to the species Aspergillus fumigatus sensu stricto.