ABSTRACT
ABSTRACT We report a case of keratis infection after cataract phacoemulsification with intraocular lens implantation in a 65-year-old female patient. The patient initially underwent cataract surgery on the right eye. Intraocular inflammation appeared on the second post-operative day and was initially treated as Toxic Anterior Segment Syndrome (TASS). The inflammation was reduced and vision improved initially but very aggressive and progressive keratitis destroyed the cornea due to the delay in correct diagnosis. Aspergillus flavus was isolated from a biopsy.The infection was treated with antifungal agents and loss of the eye was avoided by total corneal transplantation associated with Gundersen conjunctiva cover. To restore the lost vision, a second penetrating corneal graft with removal of the conjunctiva cover was performed 17 months later. The final best-corrected vision was 20/40 but prognosis for long-term graft survival is poor.
RESUMO Nós relatamos um caso de ceratite após facoemulsificação de catarata com implantação de lente intraocular em uma paciente de 65 anos. A paciente inicialmente passou cirurgia para catarata no olho direito. A inflamação apareceu no segundo dia pós-cirurgia, inicialmente tratada como Toxic Anterior Segment Syndrome (TASS). A inflamação foi reduzida e a visão melhorou, porém uma ceratite progressiva e agressivo destruiu a córnea devido à demora do diagnóstico correto. O fungo Aspergillus flavus foi isolado de uma biópsia. A infecção foi tratada com agentes antifúngicos e a perda do olho foi evitada por transplantação da córnea associada com cobertura da conjuntiva tipo Gunderson. Para recuperar a visão, um segundo enxerto corneal penetrante com remoção da cobertura conjuntival foi realizado após 17 meses. A qualidade visual final era 20/40, porém o prognóstico para sobrevivência do enxerto no longo prazo é negativo.
Subject(s)
Humans , Female , Aged , Aspergillosis/etiology , Aspergillus flavus , Cataract Extraction , Keratitis/complications , Lens Implantation, Intraocular , PhacoemulsificationABSTRACT
Postsurgical aspergillosis occurs primarily in immunocompetent patients whose main predisposing factor is the loss of skin and mucosal integrity during surgery. Local infection tends to be destructive and refractory to treatment and relapses are common. It is important to consider aspergillosis in the differential diagnosis of slowly progressive and destructive surgical site infections with negative bacterial cultures. We present the case of a child who developed Aspergillus fumigatus mediastinitis months after heart surgery.
Subject(s)
Adolescent , Humans , Male , Aspergillosis/diagnosis , Aspergillus fumigatus/isolation & purification , Mediastinitis/diagnosis , Aspergillosis/etiology , Heart Valve Prosthesis Implantation/adverse effects , Immunocompromised Host , Mediastinitis/microbiology , Postoperative ComplicationsABSTRACT
Aspergillosis is an infection caused by saprophytic fungi of the genus Aspergillus, which typically occurs in immunosuppressed individuals, but has also been reported in immunocompetent patients. The main routes of entry are the respiratory tract, skin, cornea, and ear, and the infection may be localized or disseminated by contiguity or vascular invasion. We report a severe case of rhinosinusitis with cutaneous involvement, caused by invasive aspergillosis, in an immunocompetent user of inhaled cocaine. Invasive aspergillosis related to cocaine abuse has not yet been reported in the literature. After itraconazole treatment and surgical debridement, complete clinical remission was achieved. Nasal reconstruction with a skin graft over a silicone prosthesis resulted in a satisfactory esthetic outcome.
Subject(s)
Adult , Female , Humans , Aspergillosis/etiology , Cocaine-Related Disorders/complications , Nose Deformities, Acquired/microbiology , Rhinitis/microbiology , Sinusitis/microbiology , Immunocompromised HostABSTRACT
We present the case of a 54-year-old male, who presented with respiratory complaints four months after he underwent renal transplantation. Bronchoscopy showed ulcerated mucosa of the left main bronchus and computed tomography (CT) of the thorax showed foci of air within the bronchial wall. A biopsy from the lesion showed septate fungal hyphae, dichotomously branching at acute angles. A locally invasive Aspergillus ulcerative tracheobronchitis with no parenchymal involvement is an important cause of tracheobronchitis in post-renal transplant patients. An early diagnosis and institution of appropriate treatment can improve the outcome. A combination treatment of caspofungin and voriconazole can be considered if patient is not responding to voriconazole alone.
Subject(s)
Antifungal Agents/administration & dosage , Aspergillosis/diagnosis , Aspergillosis/drug therapy , Aspergillosis/etiology , Aspergillosis/physiopathology , Biopsy , Bronchitis/diagnosis , Bronchitis/drug therapy , Bronchitis/etiology , Bronchitis/physiopathology , Bronchoscopy/methods , Early Diagnosis , Echinocandins/administration & dosage , Humans , Kidney Transplantation/adverse effects , Lung/pathology , Male , Middle Aged , Pyrimidines/administration & dosage , Tomography, X-Ray Computed , Tracheitis/diagnosis , Tracheitis/drug therapy , Tracheitis/etiology , Tracheitis/physiopathology , Treatment Outcome , Triazoles/administration & dosage , Ulcer/etiology , VoriconazoleABSTRACT
Paracoccidioidomicosis y Aspergilosis son micosis causadas respectivamente por los hongos Paracoccidioides brasiliensis y Aspergillus fumigatus, que afectan con mayor frecuencia los pulmones y posteriormente se propagan para otras regiones del cuerpo. La asociación de estas dos micosis en pacientes que no presentaban inmunosupresión es poco común. Descripción de caso clínico resaltadas: Paciente de sexo masculino de 49 años, presentó lesión en el paladar, orofaringe y región retromolar. Los exámenes histológicos, citopatológicos y microbiológicos confirmaron el diagnóstico de paracoccidioidomicosis asociada a aspergilosis. Históricamente los hongos se han considerado como la causa de infecciones de relativa significancia; sin embargo, en los últimos años se ha visto un aumento importante de las enfermedades que causan. El reconocimiento del agente etiológico en cultivos es importante para poder implementar el tratamiento adecuado, ya que éstos pueden producir daños irreversibles o llevar a la muerte del paciente. El objetivo de este trabajo fue mostrar por medio del caso clínico de un paciente que presentaba las dos mucosis asociadas em mucosa bucal y orofaringe la necesidad de exámenes complementares para el diagnóstico de las enfermedades bucales cuando los exámenes de laboratorio de rutina indican la presencia de enfermedades asociadas
Paracoccidioidomycosis and aspergillosis are, respectively, mycosis caused by Paracoccidioides brasiliensis and Aspergillus fumigatus fungi, which, most frequently, attack the lungs and later spread to other body regions. The association between both mycosis is rare in patients that do not present immunosuppression. A 49-year-old man presented with oral lesion, besides lesions on palatum, retromolar and oropharyngeal regions. Histopathological and microbiological exams confirmed the diagnosis of paracoccidioidomycosis associated to aspergillosis. Historically, fungi have been considered as the cause of relatively important infections, but, in the last years, a significant increase of diseases caused by fungi is evidenced. The recognition of the etiological agent in culture is important for the suitable treatment, once these fungi can cause irreversible damages or even death. The purpose of this study was to demonstrate, through the case of a patient who presented both mycosis associated, the need of complementary exams for the diagnosis of oral diseases, when routine laboratorial exams indicate the presence of another disease associated
Subject(s)
Humans , Male , Middle Aged , Aspergillosis/complications , Aspergillosis/etiology , Mouth Diseases/diagnosis , Mouth Diseases/pathology , Paracoccidioidomycosis/diagnosis , Paracoccidioidomycosis/etiology , DentistryABSTRACT
A 44-year-old man presented 28 days after cataract surgery (phacoemulsification) in right eye with multiple pinpoint infiltrates in posterior stroma at cataract surgery wound site. Visual acuity was 20/60. Corneal scraping from the floor of the corneal tunnel revealed fungus which was later identified to be Aspergillus flavus. The patient was started on oral voriconazole 200 mg twice daily and topical voriconazole 1% every hour. Two intracameral injections of voriconazole (50 micrograms/ 0.1 ml) were given 72 h apart, five days after starting initial therapy. Infiltrates increased in size and density in spite of 20 days of voriconazole therapy. Full-thickness patch graft was done to arrest progressive necrosis. Four months after surgery, patient had 20/60 best-corrected visual acuity. There was no recurrence in one-year follow-up. Present case illustrates the therapeutic challenge in fungal tunnel infections and possibility of voriconazole-resistant Aspergillus species.
Subject(s)
Adult , Antifungal Agents/therapeutic use , Aspergillosis/drug therapy , Aspergillosis/etiology , Cataract Extraction/methods , Drug Resistance, Fungal , Eye Infections, Fungal/drug therapy , Eye Infections, Fungal/etiology , Humans , Male , Phacoemulsification/adverse effects , Pyrimidines/therapeutic use , Triazoles/therapeutic useABSTRACT
A case of invasive aspergillosis caused by Aspergillus niger in a lung transplant recipient is described. The patient presented hyperglycemia starting postoperatively, with other complications such as cytomegalovirus infection. The associated predisposing factors and other implications are discussed. Aspergillus niger seems to be a fungal species of low virulence that requires the presence of a severely immunosuppressed host to cause invasive disease.
Descreve-se um caso de aspergilose invasiva causada por Aspergillus niger em um paciente transplantado de pulmão com quadros hiperglicêmicos desde o pós-operatório e outras complicações como infecção por citomegalovírus. Os fatores predisponentes associados e outras implicações são discutidos. Aspergillus niger parece ser uma espécie fúngica de baixa virulência, necessitando a presença de um hospedeiro gravemente imunodeprimido para causar doença invasiva.
Subject(s)
Female , Humans , Middle Aged , Aspergillosis/etiology , Aspergillus niger/isolation & purification , Bronchitis/microbiology , Lung Diseases, Fungal/microbiology , Lung Transplantation/adverse effects , Tracheitis/microbiology , Aspergillosis/diagnosis , Bronchitis/diagnosis , Fatal Outcome , Immunocompromised Host , Lung Diseases, Fungal/diagnosis , Tracheitis/diagnosisABSTRACT
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.
Subject(s)
Male , Adult , Humans , Aspergillosis/diagnosis , Aspergillosis/pathology , Aspergillosis/therapy , Antifungal Agents/therapeutic use , Aspergillus/isolation & purification , Aspergillosis/etiology , Cerebrospinal Fluid/microbiology , Mannans , Meningoencephalitis/etiology , Risk Factors , Immunologic Deficiency Syndromes/complications , Vasculitis, Central Nervous System/complicationsABSTRACT
Chronic necrotizing pulmonary aspergillosis (CNPA) is an unusual form of pulmonary aspergillosis arising in the setting of mildly immune compromised state or altered local defense system. CNPA rarely shows histological findings mimicking bronchocentric granulomatosis (BCG), which is characterized by peribronchiolar granulomatous destruction. We describe a case representing CNPA with elements of BCG. A-64 year-old woman was admitted because of atypical pneumonia with multi-focal variable sized consolidations and cavitary lesions on high-resolution computed tomography (HRCT). The open lung biopsy specimen showed large areas of necrotizing pneumonia with some scattered aspergillus hyphae within the lung parenchyma. Some terminal bronchioles were found to be destroyed and were replaced by peribronchiolar granulomatous inflammation. There was no evidence of angioinvasion by aspergillus or aspergillous emboli. Despite vigorous antifungal agent and steroid treatment, she died of acute airway obstruction by bronchial casts on the thirty-fourth hospital day.
Subject(s)
Female , Humans , Aspergillosis/etiology , Chronic Disease , Granuloma/etiology , Lung Diseases, Fungal/etiology , Middle Aged , NecrosisABSTRACT
Invasive fungal infections are an increasingly common problem in patients with cancer and other vulnerable groups. We report a case of hepatosplenic hialohifomycosis probably by Aspergillus sp. In a patient with acute leukemia, and prolonged neutropenia, treated with corticosteroids and broad spectrum antibiotics. A review concerning diagnosis, clinical course and treatment of this condition is presented
Subject(s)
Humans , Male , Adult , Aspergillosis/etiology , Chemotherapy, Adjuvant/adverse effects , Splenectomy , Immunosuppression Therapy/adverse effects , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complicationsABSTRACT
The invasive Pulmonary Aspergillosis [lPA] is the principal cause of death in patients with chronic granulomatosis disease [CGD]. It can happen before age of one and can reveal the [CGD]. Usually, the transmission of GSD is linked to in 65% of cases. We report, the case of a girl aged 3 years issued from consanguine mariage referred to hospital for hemoptysia. We note that at 40 days she presents an suppurate adenitis. She is hypotrophic at 3DS without respiratory problem, she has a splenomegaly. The radiography chest note an alveolar and interstitiel opacity bilateral, apical right and basal left. There is a biological inflammatory syndrome. During the evolution, the child presents a paraplegia secondary to cornpression myelitis. A D5 laminectomy in urgency was done. The vertebral Biopsia, the serology and the culture isolate fumigatus aspergillus the GCD is evoqued confirmed by the NBT test who was negatif. In We have to look for GCD in front of pulmonary aspergillus The vertebra lesion is secondary to pulmonary lesion. Our observation is noticeable by the recessive autosomal transmission who was seen in 35% of cases, and by the neurologic complication rarely reported
Subject(s)
Humans , Female , Aspergillosis/etiology , Lung Diseases , Paraplegia/etiology , Muscle Hypotonia/etiology , Myelitis/etiology , Granulomatous Disease, Chronic/complicationsABSTRACT
Relata-se caso de paciente de 19 anos de idade que apresentou quadro de Aspergilose Pulmonar associada a complicações sistêmicas, características do tipo invasiva. São também discutidas as diversas manifestações clínicas da infecção por Aspergillus, revisando-se a literatura
Subject(s)
Humans , Male , Adult , Aspergillosis/etiology , Lung Diseases, Fungal , Aspergillus/pathogenicity , Risk FactorsABSTRACT
Fungal infection of burn wounds was investigated in a prospective study of 130 patients managed either with open or occlusive treatment methods. In all, 30 fungal isolates were recovered from 26 patients all of whom had bacterial infection also, except for one patient. The predominant fungi recovered were Aspergillus spp. and Candida spp. Fungal infection was more common in patients treated with open dressing [25.5%] than occlusive dressing [16.0%]. Fungal culture from tissue specimens gave a better isolation rate of fungi than from cotton swab specimens
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Infant , Male , Middle Aged , Aspergillosis/etiology , Bacterial Infections/diagnosis , Bandages/adverse effects , Wound Infection/etiology , Candidiasis/etiology , Child, Preschool , Infection Control , Mycoses/etiology , Prospective Studies , Risk Factors , Specimen Handling/methodsABSTRACT
Los aspergillus son hongos que se encuentran ampliamente diseminados por el ambiente. Pueden producir colonización, alergia e invasión. Los casos pediátricos descritos en la literatura son escasos y la mayoría en pacientes inmunocomprometidos. Describimos un caso de aspergillosis pulmonar invasiva en un paciente de un año y medio de edad, aparentemente sano que presenta una bronconeumonia probablemente de etiología mixta, luego de la cual evoluciona con bronquitis obstructiva persistente, hipogammaglobulinemia moderada y que desarrolla una neumopatía de evolución tórpida de la que fallece. En cultivo de aspirado traqueal se aisla Aspergillus fumigatus y la anatomía patológica confirma el diagnóstico
Subject(s)
Humans , Male , Infant , Aspergillosis/diagnosis , Aspergillus fumigatus/isolation & purification , Lung Diseases, Fungal/diagnosis , Aspergillosis/drug therapy , Aspergillosis/etiology , Aspergillus fumigatus/pathogenicity , Bronchopneumonia/complications , Lung/pathology , Trachea/microbiologyABSTRACT
O transplante renal tem sido uma alternativa terapêutica para os pacientes portadores de insuficiência renal terminal, desde o advento da imunossupressäo. Diante desta realidade, as infecçöes têm sido causa frequente de morbidade e mortalidade durante o curso pós-transplante. A propósito de dois casos, os autores discutem as causas mais frequentes de infecçäo pós-transplante renal