Gamma-glutamyl transpeptidase-platelet ratio, systemic immune inflammation index, and system inflammation response index in invasive Aspergillosis

SUMMARY OBJECTIVE: Gamma-glutamyl transpeptidase-platelet ratio, system inflammation response index, and systemic immune inflammation index are three systemic immune and inflammation indexes that were investigated for their diagnostic and prognostic proficiencies in cardiovascular diseases and cancers. However, their predictive values for invasive aspergillosis have not yet been studied. The aim of this study was to evaluate Gamma-glutamyl transpeptidase-platelet ratio, system inflammation response index, and systemic immune inflammation index levels and their diagnostic values in invasive aspergillosis. METHODS: A total of 23 patients with invasive aspergillosis and 23 sex- and age-matched healthy participants were included in this study. Complete blood count parameters and liver function tests were studied. Gamma-glutamyl transpeptidase-platelet ratio, system inflammation response index, and systemic immune inflammation index were calculated. RESULTS: Leukocyte, neutrophil, lymphocyte, and monocyte levels were statistically significantly higher in IA group (p=0.031, p=0.027, p=0.033, and p=0.001, respectively). In invasive aspergillosis group, platelets were numerically lower; Aspartate transaminase, alanine aminotransferase, and lactic dehydrogenase levels were numerically higher than those in control group but differences between levels were not statistically significant (p>0.05). The γ-glutamyl transpeptidase levels of patients were statistically significantly higher (p=0.007), and in addition, statistically significant differences were found between groups in terms of gamma-glutamyl transpeptidase-platelet ratio, system inflammation response index, and systemic immune inflammation index (p<0.001, p=0.037, p=0.001, respectively). Receiver operating characteristic analysis was performed, and areas under the curves were evaluated. gamma-glutamyl transpeptidase-platelet ratio had the higher area under the curve than systemic immune inflammation index and system inflammation response index (AUC 0.849, 0.798, 0.693, respectively). The results from receiver operating characteristic analysis of the data suggested that the use of a cutoff value of 0.15 for gamma-glutamyl transpeptidase-platelet ratio would be optimum for clinical use to confirm independent predictors of patients with invasive aspergillosis. CONCLUSIONS: Gamma-glutamyl transpeptidase-platelet ratio is an independent, a useful predictor, and is superior to other evaluated markers in the diagnosis of inflammation in invasive aspergillosis. Gamma-glutamyl transpeptidase-platelet ratio may also be a helpful biomarker for clinicians to follow-up the inflammatory process of these patients.

Disseminated invasive aspergillosis in a prolonged stay in the intensive care unit

Aspergillus is a common cause of invasive mycosis, especially in immunocompromised individuals. We report the case of a 62-year-old male who was hospitalized after suffering severe physical injuries and died after few weeks of hospitalization. A medicolegal autopsy was conducted, and various organs were sent for histopathological examination of which heart, lungs, and kidneys showed extensive involvement by aspergillus. Thus, a diagnosis of disseminated invasive aspergillosis was made on autopsy, which itself is a rare entity. This case report illustrates a prolonged stay in the intensive care unit as a possible risk factor for the development of disseminated aspergillosis.

Primary cutaneous aspergillosis and idiopathic bone marrow aplasia

Abstract: We describe the case of a 9-year-old boy with idiopathic bone marrow aplasia and severe neutropenia, who developed skin ulcers under cardiac monitoring electrodes. The diagnosis of primary cutaneous aspergillosis was made after the second biopsy and culture. Imaging investigation did not reveal internal fungal infection. The child was treated, but did not improve and died 3 months after admission. The report highlights and discusses the preventable risk of aspergillus skin infection in immunocompromised patients.

Hialohifomicosis cutánea en un paciente con leucemia linfoblástica / Cutaneous hyalohyphomycosis in a patient with acute lymphoblastic leukemia

Las infecciones fúngicas causadas por Aspergillus sp. y Candida sp. son causa importante de morbilidad y mortalidad en pacientes gravemente inmunodeficientes, especialmente en aquellos con neutropenia o receptores de trasplante de médula ósea o de órganos sólidos. Informamos sobre una hialohifomicosis cutánea en una mujer de 24 años de edad con leucemia linfoblástica.

Invasive fungal infections most frequently caused by Aspergillus sp. and Candida sp. are significant causes of morbidity and mortality in severely immunocompromised patients, especially those who are neutropenic or who have undergone bone marrow or solid-organ transplant. We report a case of cutaneous hyalohyphomycosis in a 24-year-old female with acute lymphoblastic leukemia.

An unusual case of non-disseminated bladder aspergillosis in a setting of transitional cell carcinoma.

A bladder infection of Aspergillus with no evidence of dissemination is rare. We present a case of Aspergillus infection with transitional cell carcinoma of the urinary bladder without any evidence of systemic involvement. A 65-year-old male diabetic whose main complaints were intermittent painful haematuria and nocturia had undergone nephroureterectomy a year and a half back for transitional cell carcinoma of right renal pelvis. Cystoscopy revealed bladder mucosa having fixed broad tumour with encrustation and bleeding on touch at the right vesico-ureteric junction. The histopathologic diagnosis was a high-grade transitional carcinoma with Aspergillus infection. Fungal culture of urine obtained after bladder wash yielded Aspergillus fumigatus.

Aspergilosis meningovascular: caso clínico / Meningovascular aspergillosis: case report

El diagnóstico precoz de la infección por Aspergillus del Sistema Nervioso Central (SNC) es un gran desafío, donde la sospecha clínica fundamentada es clave por la alta letalidad de la entidad aún con tratamiento oportuno. La importante dificultad diagnostica es favorecida por algunas características de la entidad: baja incidencia, compromiso de individuos inmunocomprometidos que presentan múltiples infecciones, manifestaciones neurológicas clínicas e imagenológicas inespecíficas y métodos diagnósticos etiológicos de resultados tardíos. Presentamos el caso de un paciente diabético y alcohólico, con aspergilosis meningovascular precedida en 8 meses por un foco fúngico pulmonar. La presentación clínica fue a la manera de una meningoencefalitis subaguda con: cefalea, vértigo, compromiso de lenguaje, hemiparesia, alteración de conciencia y crisis convulsiva. Se trato con Anfotericina B con recuperación clínica completa. En este artículo revisamos algunos aspectos del compromiso por Aspergillus del SNC: mecanismos patogénicos, formas clínicas, factores de riesgo, principales métodos diagnósticos y alternativas de tratamiento.

Orbital apex syndrome due to aspergillosis: case report

We report the case of a 73-year-old female who presented facial numbness and pain in the first division of the trigeminal nerve, ptosis, diplopia and visual loss on the right side for the previous four months. The neurological, radiological and histological examination demonstrated a rare case of invasive fungal aspergillosis of the central nervous system, causing orbital apex syndrome, later transformed in temporal brain abscess. She died ten months later due to respiratory and renal failure in spite of specific antimycotic therapy

Isolated cardiac aspergillosis.

A 40-year-old man, a known case of Wolff-Parkinson-White syndrome, was admitted to the hospital in an unconscious state. In spite of medical treatment, the patient died within two hours of admission. At autopsy, the deceased was found to have aspergillosis involving the interatrial septum, aortic valve and root of the aorta. The rest of the organs were unremarkable. The patient did not show any obvious signs of being immunocompromised. We report this case of isolated cardiac aspergillosis in an apparently healthy individual.

Dermatoses do pavilhäo auricular / External ear dermatosis

Apresentamos uma atualizaçäo sobre as dermatoses que ocorrem no pavilhäo auricular. Propomos uma classificaçäo em sete grupos e realizamos uma sucinta descriçäo clínica de cada uma das 84 entidades catalogadas, de forma didática, com a finalidade de auxiliar o médico, sobretudo o clínico geral, o dermatologista e o otorrinolaringologista, no diagnóstico de tais patologias.

Fungal discitis due to Aspergillus terreus in a patient with acute lymphoblastic leukemia

We report a case of Aspergillus terreus discitis which developed in a patient with acute lymphoblastic leukemia following induction chemotherapy. A. terreus was isolated from sputum, one month earlier, but the physician did not consider it significant at the time. Magnetic resonance imaging study showed the involvement of L3-4, L4-5 and L5-S1 intervertebral discs. Etiology was established by means of histology and culturing a surgical specimen of disc materials. Our patient survived after a surgical debridement and amphotericin B administration with a total dose of 2.0 g. Discitis caused by Aspergillus terreus is a very rare event. A. terreus is one of the invasive Aspergillus species. The pathogenetic mechanism is discussed and the literature is reviewed.

Aspergioma de seio frontal com expansäo para a órbita: revisäo / Frontal sinus aspergilloma with expansion to the orbit: review

Aspergilose é a infecçao fúngica mais comum dos seios paranasais. É classificada em quatro tipos, de acordo com sua apresentaçao clínica: sinusite fulminante, sinusite crônica indolente, aspergiloma e aspergilose alérgica sinusal. O seu diagnóstico requer um alto índice de suspeita diagnóstica, visando a detecçao precoce e o tratamento adequado da infecçao (8). Apresentamos um caso de aspergilose frontoetmoidal em sua forma nao-invasiva, em paciente masculino, de 66 anos, imunocompetente, cujo diagnóstico foi realizado por exame histopatológico das lesoes encontradas durante o ato cirúrgico.

Hipopituitarismo originado por metastasis de carcinoma de colon asociado con aspergilosis hipofisaria / Hypopituitarism originating to colonic carcinoma metastasis associated with hypophysial aspergillosis

Las metástasis hipofisiarias constituyen el 1 al 8,3 por ciento del total de tumores metastásicos cerebrales. La localización más frecuente es en el lóbulo posterior y la diabetes insípida puede ser el único síntoma de disfunción. La aspergilosis cerebral es una enfermedad inusual y ha sido descripta complicando una malignidad preexistente, o posteriormente a una cirugía intracraneal. Describimos un hipopituitarismo e hiperprolactinemia en una paciente quien presentó metástasis hipofisarias de un carcinoma de colon y aspergilosis coexistente. Dos años antes, se le había resecado un adenocarcinoma de colon (clase Cl de Duke). Ningún signo clínico de hipopituitarismo o galactorrea estaban presentes. Los hallazgos de laboratorio reflejan déficit de corticotrofina (ACTH), hormona luteinizante (LH), hormona folículo estimulante (FSH), y una leve hiperprolactinemia (PRL). Una resonancia magnética cerebral reveló una massa intra y supraselar la cual se extendía a hipotálamo. La radiografía de tórax y la tomografía computada confirmó una massa macronodular en el segmento apical del lóbulo pulmonar inferior izquierdo con nódulos hipertróficos meidastinales. Fue diagnosticado un tumor hipofisario no funcionante realizándose cirugía transfenoidal. El examen microscópico confirmó una proliferación maligna que sugería diferenciación colónica. Fragmentos de tejido ipofisário tumoral mostraron hifas de aspergilus formando abscesos. La aspergilosis como complicación de enfermedades neoplásicas, es mayor en leucemias y linfomas que en tumores sólidos. El diagnóstico de aspergilosis del SNC es dificultoso, siendo éste generalmente confirmado durante la necropsia. Esta localización puede aparecer como parte de una aspergilosis diseminada, o como una infección única del SNC, aunque la mayoría de los casos está asociada a una aspergilosis pulmonar. Hasta la fecha, no hemos encontrado publicada la asociación de hipopituitarismo y moderada hiperprolactinemia cuya etiología fue metástasis hipofisaria de carcinoma de colon y aspergilosis coexistente

Aspergilosis de la herida en trasplantes hepáticos / Aspergillosis of the wound in liver transplantation

La aspergilosis cutánea se asocia, generalmente, a inmunosupresión, quemaduras o traumatismos severos. La mayoría de los casos son adquiridos por inoculación directa, aunque ocasionalmente, el compromiso cutáneo es secundario a una enfermedad diseminada. Hasta el momento no existen comunicaciones de infecciones de la herida quirúrgica causadas por Aspergillus. En este trabajo describimos dos pacientes trasplantados hepáticos, los cuales desarrollan aspergilosis de la herida quirúrgica, durante un brote de aspergilosis relacionado con la renovación del Hospital. La infección se desarrolló en el postoperatorio inmediato y simuló en apariencia una fascitis necrotizante. Ambos pacientes murieron a pesar del debridamiento local y del tratamiento con anfotericina B. Debe adicionarse el Aspergillus a la lista de posibles agentes que pueden infectar las heridas quirúrgicas, especialemente en los casos de trasplantes de órganos.

Aspergilosis de la pared orbitaria / Aspergillus of orbit wall

Las especies de Aspergillus son contaminantes comunes en el medio ambiente humano. Presentamos un caso excepcional de ataque a la pared de la órbita en una paciente a quien se la había practicado enucleación del globo ocular por el desarrollo local de un epitelioma basocelular recidivante

Aspergiloses pulmonares / Pulmonary aspergilloses

Comentam-se a ubiqüidade dos aspergilos em natureza, a inevitável inalaçäo de seus propágulos por seres humanos, a fraca patogenicidade do fungo para o indivíduo normal e a gravidade das manifestaçöes que causa em imunodeficientes. Descreve-se a morfologia típica dos aspergilos em cultivo e ressalta-se a impossibilidade de reconhecer suas hifas em cortes histológicos de tecidos. Säo considerados três tipos de aspergilose pulmonar: alérgica, invasiva e de colonizaçäo. Descrevem-se as duas formas clínicas de tipo alérgico, uma incidindo em pessoas atópicas, a outra resultante da inalaçäo repetida de antígenos; as possibilidades diagnósticas e o tratamento säo comentados. Distingue-se a forma de tipo invasivo em indivíduos normais da que ocorre em imunodeprimidos. Na primeira, ressalta-se a ocorrência de lesöespontaneamente regressivas, e discutem-se as manifestaçöes progressivas. Na segunda, consideram-se três formas clínicas, dependentes do grau de imunocompromentimento; elas apresentam quadros clínico-radiológicos incaracterísticos, porém sugestivos na forma necrosante aguda. O diagnóstico das doenças de tipo invasivo requer a visualizaçäo e o isolamento biopsia; outras possibilidades säo apontadas. O tratamento é discutido. A colonizaçäo intracavitária pulmonar pode ser incipiente ou bem-sucedida; nesta, é descrito o sugestivo quadro clínico-radiológico, as possibilidades diagnósticas e o tratamento