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1.
Autops. Case Rep ; 8(4): e2018065, Oct.-Dec. 2018. ilus
Article in English | LILACS | ID: biblio-986613

ABSTRACT

Histoplasmosis is a mycosis caused by the dimorphic fungus, Histoplasma capsulatum, which is transmitted via dust and aerosols. Lung involvement is the most common, with a varied clinical presentation. Although it is not the only source of infection, H. capsulatum is frequently found in bat guano, which is the reason why it is highly prevalent among caving practitioners. The solitary histoplasmoma of the lung is an unusual and chronic manifestation of this entity, which mimics, or at least is frequently misconstrued, as a malignancy. Almost invariably, the diagnosis of this type of histoplasmosis presentation is achieved after lung biopsy. The authors present the case of a young woman who sought medical care because of chest pain. The diagnostic work-up revealed the presence of a pulmonary nodule. She was submitted to a thoracotomy and wedge pulmonary resection. The histologic analysis rendered the diagnosis of histoplasmoma. Thisreport aims to call attention to this diagnosis as the differential diagnosis of a pulmonary nodule.


Subject(s)
Humans , Female , Adult , Histoplasmosis/diagnosis , Lung Diseases, Fungal/diagnosis , Diagnosis, Differential , Granulomatous Disease, Chronic , Histoplasmosis/pathology , Lung Diseases, Fungal/pathology
2.
Rev. Soc. Bras. Med. Trop ; 51(2): 249-252, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-897059

ABSTRACT

Abstract Paracoccidioidomycosis is an endemic disease in Latin America that is rarely associated with immunosuppression and biological therapy. Herein, we report for the first time a case of pulmonary paracoccidioidomycosis reactivation after infliximab treatment. A 47-year-old man from Brazil received infliximab to treat psoriatic spondyloarthropathy and presented with cough, dyspnea, weight loss, and fever. Chest computed tomography revealed a pulmonary nodule and biopsy confirmed paracoccidioidomycosis. Treatment with sulfamethoxazole and trimethoprim was initiated for fungal infection and infliximab was reintroduced two months later. Considering his clinical improvement and favorable radiologic evolution, antifungal therapy was discontinued after 29 months.


Subject(s)
Humans , Male , Paracoccidioidomycosis/immunology , Antirheumatic Agents/adverse effects , Infliximab/adverse effects , Lung Diseases, Fungal/immunology , Paracoccidioidomycosis/diagnosis , Antirheumatic Agents/therapeutic use , Spondylarthritis/drug therapy , Infliximab/therapeutic use , Lung Diseases, Fungal/diagnosis , Middle Aged
3.
Neumol. pediátr. (En línea) ; 13(1): 5-10, ene. 2018.
Article in Spanish | LILACS | ID: biblio-999202

ABSTRACT

Pulmonary mycoses are invasive fungal infections that occur more and more frequently. The rising number of patients with immunodeficiencies, HIV infection, hematopoietic stem cell and solid organ transplant recipients, as well as the use of immunosuppressive therapies have increased the incidence of this disease. Diagnosis remains a challenge because the most accurate procedure is the isolation of the germ through culture of body fluids which have low sensitivity and a long development time (4-6 weeks). The diagnosis of pulmonary mycoses is based on the presence of risk factors, clinical and/or radiological symptoms suggestive of fungal infection and a positive microbiological test. Due to the fact that pulmonary mycoses are not usually considered in the differential diagnosis in the initial clinical evaluation of diseases and that the studies to establish the diagnosis are complex, they are diagnosed late when they have already become chronic with a high risk of morbidity and mortality


Las micosis pulmonares son infecciones invasivas que se presentan cada vez con mayor frecuencia en la población. El aumento del número de pacientes con inmunodeficiencias, infección por VIH, receptores de trasplante de células hematopoyéticas y órgano sólido, así como el uso de terapias inmunosupresoras ha incrementado la incidencia de esta enfermedad. El diagnóstico continúa siendo un reto debido a que el estándar de oro es el aislamiento del germen mediante cultivo de líquidos corporales los cuales tienen baja sensibilidad y un tiempo de desarrollo prolongado (4-6 semanas). El diagnóstico de las micosis pulmonares se basa en la presencia de factores de riesgo, cuadro clínico y/o radiológico sugestivo de infección fúngica y el estudio microbiológico positivo. Debido a que las micosis pulmonares habitualmente no se consideran dentro del diagnóstico diferencial en la evaluación clínica inicial de las enfermedades, asociado a la complejidad de estudios para establecer el diagnostico, las micosis pulmonares se diagnostican en forma tardía cuando ya existe enfermedad crónica, con alto riesgo de morbimortalidad


Subject(s)
Humans , Child , Lung Diseases, Fungal/diagnosis , Risk Factors , Diagnosis, Differential , Lung Diseases, Fungal/physiopathology , Lung Diseases, Fungal/microbiology , Lung Diseases, Fungal/epidemiology
4.
Braz. j. infect. dis ; 21(6): 606-612, Nov.-Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-888923

ABSTRACT

ABSTRACT Introduction: The etiology of pulmonary infections in HIV patients is determined by several variables including geographic region and availability of antiretroviral therapy. Materials and methods: A cross-sectional prospective study was conducted from 2012 to 2016 to evaluate the occurrence of pulmonary fungal infection in HIV-patients hospitalized due to pulmonary infections. Patients' serums were tested for (1-3)-β-D-Glugan, galactomannan, and lactate dehydrogenase. The association among the variables was analyzed by univariate and multivariate regression analysis. Results: 60 patients were included in the study. The patients were classified in three groups: Pneumocystis jirovecii pneumonia (19 patients), community-acquired pneumonia (18 patients), and other infections (23 patients). The overall mortality was 13.3%. The time since diagnosis of HIV infection was shorter in the pneumocystosis group (4.94 years; p = 0.001) than for the other two groups of patients. The multivariate analysis showed that higher (1-3)-β-D-Glucan level (mean: 241 pg/mL) and lactate dehydrogenase (mean: 762 U/L) were associated with the diagnosis of pneumocystosis. Pneumocystosis was the aids-defining illness in 11 out of 16 newly diagnosed HIV-infected patients. Conclusion: In the era of antiretroviral therapy, PJP was still the most prevalent pulmonary infection and (1-3)-β-D-Glucan and lactate dehydrogenase may be suitable markers to help diagnosing pneumocystosis in our HIV population.


Subject(s)
Humans , Male , Female , AIDS-Related Opportunistic Infections/diagnosis , beta-Glucans/blood , L-Lactate Dehydrogenase/blood , Lung Diseases, Fungal/diagnosis , Mannans/blood , Biomarkers/blood , Cross-Sectional Studies , Predictive Value of Tests , Prospective Studies , Regression Analysis , Sensitivity and Specificity , AIDS-Related Opportunistic Infections/blood , Lung Diseases, Fungal/blood
6.
Braz. j. microbiol ; 47(1): 172-176, Jan.-Mar. 2016. tab
Article in English | LILACS | ID: lil-775126

ABSTRACT

Abstract Candida species, especially C. albicans, are commensals on human mucosal surfaces, but are increasingly becoming one of the important invasive pathogens as seen by a rise in its prevalence in immunocompromised patients and in antibiotic consumption. Thus, an accurate identification of Candida species in patients with pulmonary symptoms can provide important information for effective treatment. A total of 75 clinical isolates of Candida species were obtained from the bronchoalveolar lavage fluid of both immunocompromised and immunocompetent patients with pulmonary symptoms. Candida cultures were identified based on nuclear ribosomal Internal Transcribed Spacer (ITS1-ITS2 rDNA) sequence analysis by polymerase chain reaction–restriction fragment length polymorphisms (PCR-RFLP). Molecular identification indicated that the isolates belonged predominantly to C. albicans (52%), followed by C. tropicalis (24%), C. glabrata (14.7%), C. krusei (5.3%), C. parapsilosis (1.3%), C. kefyr (1.3%) and C. guilliermondii (1.3%). Given the increasing complexity of disease profiles and their management regimens in diverse patients, rapid and accurate identification of Candida species can lead to timely and appropriate antifungal therapy.


Subject(s)
Humans , Bronchoalveolar Lavage Fluid/microbiology , Candida/isolation & purification , Candidiasis/diagnosis , Lung Diseases, Fungal/diagnosis , Candida/classification , Candida/genetics , DNA, Fungal/chemistry , DNA, Fungal/genetics , DNA, Ribosomal Spacer/chemistry , DNA, Ribosomal Spacer/genetics , Polymerase Chain Reaction , Polymorphism, Restriction Fragment Length , Sequence Analysis, DNA , Time Factors
7.
Rev. cuba. med. trop ; 67(3): 0-0, dic. 2015. ilus, tab
Article in Spanish | LILACS, CUMED | ID: lil-777074

ABSTRACT

Introducción: el género Mycobacterium provoca infecciones pulmonares y extrapulmonares, dentro de estas últimas las localizaciones más frecuentes son; sistema nervioso linfático, central, circulatorio, genitourinario, gastrointestinal, tejido osteoarticular, y la piel. Objetivo: realizar las caracterizaciones etiológica de infecciones extra pulmonares producidas por el género Mycobacterium, destacar su importancia diagnóstica tanto en pacientes VIH- como VIH/sida. Métodos: se realiza un estudio descriptivo-prospectivo de corte transversal realizado de enero 2012 a mayo 2014. Durante este período se recibió un total de 825 muestras, 232 de pacientes VIH- y 593 de pacientes con VIH/sida. Las muestras que lo requerían se le aplicaron descontaminación cultivo, se utilizó el método de ácido sulfúrico al 4 por ciento, para el cultivo se usó el medio de Löwenstein-Jensen. Resultados: de las 825 muestras extra pulmonares en 29 (3,5 por ciento) se obtuvo cultivo positivo,14 (48,3 por ciento) con aislamiento de Mycobacterium tuberculosis (11 VIH+ y 3 VIH-), y 15 (51,7 por ciento) con aislamiento de otras especies micobacterianas (12 VIH+ y 3 VIH-), Mycobacterium avium-intracellulare, y Mycobacterium malmoense fueron las especies más aisladas. Conclusión: por todo lo anterior expuesto se recomienda mantener la vigilancia diagnóstica en este tipo de infección extra pulmonar, en especial en pacientes con sida, pues en muchos casos pueden tener fatales consecuencias por su diagnóstico tardío(AU)


Subject(s)
Humans , Lung Diseases, Fungal/diagnosis , Mycobacterium Infections/complications , Mycobacterium Infections/diagnosis , Specimen Handling/methods , Epidemiology, Descriptive , Cross-Sectional Studies , Prospective Studies
8.
Yonsei Medical Journal ; : 871-874, 2015.
Article in English | WPRIM | ID: wpr-137561

ABSTRACT

Korea is not known as an endemic area for Histoplasma. However, we experienced a case of histoplasmosis in a person who had never been abroad. A 65-year-old female was admitted to the hospital for evaluation of multiple lung nodules. A computed tomography (CT) scan of the chest showed multiple ill-defined consolidations and cavitations in all lobes of both lungs. The patient underwent a CT-guided lung biopsy, and a histopathology study showed findings compatible with histoplasmosis. Based on biopsy results and clinical findings, the patient was diagnosed with chronic cavitary pulmonary histoplasmosis. The patient recovered completely following itraconazole treatment. This is the first case report of pulmonary histoplasmosis unconnected with either HIV infection or endemicity in Korea.


Subject(s)
Aged , Antifungal Agents/therapeutic use , Biopsy , Female , Histoplasma/isolation & purification , Histoplasmosis/diagnosis , Humans , Immunocompromised Host , Itraconazole/therapeutic use , Lung Diseases, Fungal/diagnosis , Republic of Korea , Tomography, X-Ray Computed , Treatment Outcome
9.
Yonsei Medical Journal ; : 871-874, 2015.
Article in English | WPRIM | ID: wpr-137560

ABSTRACT

Korea is not known as an endemic area for Histoplasma. However, we experienced a case of histoplasmosis in a person who had never been abroad. A 65-year-old female was admitted to the hospital for evaluation of multiple lung nodules. A computed tomography (CT) scan of the chest showed multiple ill-defined consolidations and cavitations in all lobes of both lungs. The patient underwent a CT-guided lung biopsy, and a histopathology study showed findings compatible with histoplasmosis. Based on biopsy results and clinical findings, the patient was diagnosed with chronic cavitary pulmonary histoplasmosis. The patient recovered completely following itraconazole treatment. This is the first case report of pulmonary histoplasmosis unconnected with either HIV infection or endemicity in Korea.


Subject(s)
Aged , Antifungal Agents/therapeutic use , Biopsy , Female , Histoplasma/isolation & purification , Histoplasmosis/diagnosis , Humans , Immunocompromised Host , Itraconazole/therapeutic use , Lung Diseases, Fungal/diagnosis , Republic of Korea , Tomography, X-Ray Computed , Treatment Outcome
10.
J. bras. med ; 102(6)dez. 2014. ilus, tab, ilus
Article in Portuguese | LILACS | ID: lil-737126

ABSTRACT

A colonização intracavitária pulmonar aspergilar (CIPA) é caracterizada pela presença de massa miceliana de crescimento endocavitário. O agente mais frequente é o Aspergillus fumigatus, e a lesão cavitária é geralmente sequela de tuberculose e curada com história de hemoptise de repetição e baciloscopia negativa. Os autores analisaram retrospectivamente 190 casos de CIPA, entre abril de 1978 e março de 2008, no Serviço de Arquivo Médico do Hospital Universitário Lauro Wanderley e no Complexo Hospitalar Clementino Fraga, enfatizando a incidência, forma de apresentação clínica, enfermidades associadas, métodos, diagnósticos e conduta terapêutica.


The colonized intrapulmonary aspergilloma (CIPA) is characterized by the mass fungal in a existing pulmonary cavity, where the most commonly agent is the Aspergillus fumigatus. The pulmonary cavity is often result cured pulmonary tuberculosis with hemoptisis repletion history and bacilloscopy negative. The authors analyzed retrospectively 190 cases of CIPA from April 1978 to March 2008 in the University Hospital Lauro Wanderley and Hospital Complex Clementino Fraga emphasizing the incidence, clinical evolution, illness association, diagnosis method and treatment.


Subject(s)
Humans , Pulmonary Aspergillosis/diagnosis , Lung Diseases, Fungal/diagnosis , Amphotericin B/therapeutic use , Itraconazole/therapeutic use , Pulmonary Aspergillosis/surgery , Lung Diseases, Fungal/surgery
12.
Rev. chil. infectol ; 30(6): 669-672, dic. 2013. ilus
Article in Spanish | LILACS | ID: lil-701717

ABSTRACT

Treatment failure in community-acquired pneumonia is defined as a clinical condition with inadequate response to antimicrobial therapy. Resistant and unusual microorganisms and noninfectious causes are responsible for treatment failure. Coccidioides immitis is a fungus that causes pneumonia in the northern hemisphere, especially in the United States and northern Mexico. We report a case of pulmonary coccidioidomycosis imported from Mexico to Chile. After a comprehensive study, histopathology was able to establish Coccidiodes immitis as the causative agent, achieving clinical and radiological improvement with antifungal therapy.


La neumonía de evolución tórpida son aquellas en que no se logra una respuesta clínica adecuada con el uso de terapia antimicrobiana. Existen múltiples causas a esta falta de respuesta: resistencia antimicrobiana, microorganismos no cubiertos o infecciones por microorganismos atípicos. Coccidioides immitis es un hongo causante de neumonía en el hemisferio norte, especialmente en E.U.A y norte de México. No existen reportes de casos pulmonares importados en Chile. Presentamos el caso de una mujer adulta con una neumonía que no respondió al tratamiento antimicrobiano habitual. Una vez realizado un estudio exhaustivo, se logró establecer mediante el estudio histopatológico la existencia de una coccidiodomicosis como entidad causal, logrando una respuesta clínica y radiológica favorable al tratamiento antifúngico.


Subject(s)
Female , Humans , Middle Aged , Coccidioidomycosis , Lung Diseases, Fungal , Antifungal Agents/therapeutic use , Chile , Coccidioidomycosis/diagnosis , Coccidioidomycosis/drug therapy , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Community-Acquired Infections/microbiology , Diagnosis, Differential , Lung Diseases, Fungal/diagnosis , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/microbiology , Mexico , Pneumonia/diagnosis , Travel , Treatment Failure
13.
Rev. Inst. Med. Trop. Säo Paulo ; 55(3): 209-211, May-Jun/2013. graf
Article in English | LILACS | ID: lil-674685

ABSTRACT

We present a case of histoplasmosis with multiple pulmonary nodules in a patient with a history of melanoma. This case closely simulated malignancy, including the presence of feeding vessel sign, which occurs in pulmonary metastasis. We emphasize the need to be aware of this infection in areas where histoplasmosis is endemic.


Apresentamos caso de histoplasmose com múltiplos nódulos pulmonares em paciente com história de melanoma. Este caso simula malignidade, incluindo o sinal de vaso nutridor que ocorre na metástase pulmonar. Enfatizamos a necessidade de considerar esta infecção em áreas onde a histoplasmose é endêmica.


Subject(s)
Female , Humans , Middle Aged , Lung Diseases, Fungal/diagnosis , Lung Neoplasms/diagnosis , Multiple Pulmonary Nodules/diagnosis , Diagnosis, Differential , Lung Neoplasms/secondary , Multiple Pulmonary Nodules/microbiology , Tomography, X-Ray Computed
14.
Neumol. pediátr ; 8(1): 34-38, 2013. ilus, mapas
Article in Spanish | LILACS | ID: lil-701688

ABSTRACT

A 8-year-old girl, born and resident of Guárico state, was referred to our Department because of a history of recurrent pneumonia and a history of deceased sister by unspecified lung disease. At the age of 4 years she had suffered several episodes of pneumonia requiring hospitalization. These episodes were no-responsive to antibiotic therapy and treatment for tuberculosis. Subsequently, At the age of 8 years she was hospitalized again for an episode of left lower lobe pneumonia that did not improve. Studies were performed to rule out pulmonary pathology disease: Cystic Fibrosis was discarded and also Pulmonary Tuberculosis. Serology for HIV and Fungi were negative. Because serological studies were inconclusive, a videobronchoscopy plus Bronchoalveolar lavage and lung tissue biopsy were performed, which reported bronchitis and chronic granulomatous and caseous necrosis. Special stains were observed that suggest fungus infection. Primary immunodeficiency was suspected in the patient, because the presence of recurrent pneumonia of different etiologies. The presence of the granuloma observed by the videobronchoscopy. A positive culture for Histoplasma and Aspergillus fungi, and the result of the oxidative capacity test, where the deficiency was observed in the microbicidal activity of macrophages. They were strong evidence that corroborated the immunodeficiency called Chronic Granulomatous Disease.


Escolar femenino de 8 años de edad, natural y procedente del Estado Guárico, con antecedente de hospitalizaciones por neumonías recurrente desde los 4, recibió antibioticoterapia endovenosa y cumplió tratamiento antifímico en dos oportunidades, persistiendo con sintomatología respiratoria. A los 8 años precisó nueva hospitalización por diagnóstico de neumonía del lóbulo inferior izquierdo. Por no presentar mejoría y antecedente de hermana fallecida por patología pulmonar no precisada fue referida a nuestro centro. Se realizaron estudios por patología pulmonar crónica: se descartó Fibrosis Quística y Tuberculosis Pulmonar. Serología para HIV y Hongos Negativa. Por no ser concluyentes los estudios serológicos se realizó Videobroncoscopia más lavado y biopsia, la cual reportó bronquitis crónica granulomatosa y necrosis caseosa. Coloraciones especiales: hongos intracitoplasmáticos sugestivos de Histoplasma Sp. y en el cultivo presentó crecimiento de Aspergillus fumigatus. Ante la presencia de paciente con neumonía recurrente por diferentes etiologías se sospechó la presencia de Inmunodeficiencia Primaria, planteando en base al reporte de la videobroncoscopia de granuloma y la confirmación de Infección por Histoplasma y Aspergillus una Enfermedad Granulomatosa Crónica que fue documentada al medir la deficiencia en la actividad microbicida dependiente de oxigeno evaluada a través del Test de Capacidad Oxidativa.


Subject(s)
Humans , Female , Child , Granulomatous Disease, Chronic/complications , Granulomatous Disease, Chronic/diagnosis , Lung Diseases, Fungal/complications , Lung Diseases, Fungal/microbiology , Antifungal Agents/therapeutic use , Aspergillus fumigatus/isolation & purification , Lung Diseases, Fungal/diagnosis , Lung Diseases, Fungal/drug therapy , Fatal Outcome , Pneumonia/etiology , Pulmonary Aspergillosis , Radiography, Thoracic , Immunologic Deficiency Syndromes/complications , Tomography, X-Ray Computed
15.
Einstein (Säo Paulo) ; 10(4): 502-504, Oct.-Dec. 2012. ilus
Article in English | LILACS | ID: lil-662477

ABSTRACT

We report of a case of pulmonary cryptococcosis mimicking lymphoma in a positron emission tomography (FDG-PET) scan. A 62-year old man with diffuse large B-cell lymphoma had complete resolution of abdominal and pulmonary lesions after three cycles of rituximab-based chemotherapy (R-CHOP). However, FDG-PET showed new pulmonary nodules, suggesting active lymphoma. Chronic inflammatory granuloma was seen in the histopathological exam, with round-shaped structures compatible with fungus, later identified as Cryptococcus neoformans on culture. The lesions disappeared after 6 weeks of fluconazole therapy, and the patient could continue chemotherapy without further infectious complications.


Relato de caso de criptococose pulmonar mimetizando linfoma num exame de tomografia por emissão de pósitrons (PET-scan). Homem de 62 anos com resolução completa, ao PET-scan, de seu linfoma não Hodgkin de células B, lesões abdominais e pulmonares, após três ciclos de quimioterapia baseada em ritoximabe (R-CHOP). Entretanto, o mesmo exame mostrou também novos nódulos pulmonares, sugestivos de lesões do linfoma. Granuloma inflamatório crônico foi observado no exame anatomopatológico, com estruturas circulares compatíveis com fungo. Cultura revelou Cryptococcus neoformans. As lesões desapareceram após 6 semanas de fluconazol, e o paciente pôde continuar a quimioterapia sem complicações infecciosas.


Subject(s)
Humans , Male , Middle Aged , Cryptococcosis/diagnosis , Lung Diseases, Fungal/diagnosis , Lymphoma/diagnosis , Positron-Emission Tomography , Diagnosis, Differential
16.
Braz. j. infect. dis ; 16(6): 531-539, Nov.-Dec. 2012. ilus, tab
Article in English | LILACS | ID: lil-658923

ABSTRACT

OBJECTIVE: To investigate the clinical features, management, and prognosis of pulmonary cryptococcosis in non-acquired immunodeficiency syndrome (AIDS) patients. METHOD: 24 cases of pulmonary cryptococcosis with accurate pathological diagnosis were retrospectively studied. RESULTS: 15 male patients and nine female patients were diagnosed at the first affiliated hospital of Sun Yat-sen University from November 1999 to November 2011. The mean age at the time of diagnosis was 44.2 ± 11.3 years (range: 24 to 65 years). Among these patients, 13 had other comorbidities. 15 were symptomatic and the other nine were asymptomatic. The most common presenting symptoms were cough, chest tightness, expectoration, and fever. None had concurrent cryptococcal meningitis. The most frequent radiologic abnormalities on chest computed tomography (CT) scans were solitary or multiple pulmonary nodules, and masses or consolidations, and most lesions were located in the lower lobes. All patients had biopsies for the accurate diagnosis. Among the 24 patients, nine patients underwent surgical resections (eight had pneumonectomy via thoracotomy and one had a pneumonectomy via thoracoscopy). Five of the patients who underwent surgery also received antifungal drug therapy (fluconazole) for one to three months after the surgery. The other 15 only received antifungal drug therapy (fluconazole or voriconazole) for three to six months (five patients are still on therapy). The follow-up observation of 19 patients who had already finished their treatments lasted from two to 11 years, and there was no relapse, dissemination, or death in any of these patients. CONCLUSION: Non-AIDS patients with pulmonary cryptococcosis have a good prognosis with appropriate management.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Cryptococcosis/diagnosis , Cryptococcus neoformans/isolation & purification , Lung Diseases, Fungal/diagnosis , Antifungal Agents/therapeutic use , Combined Modality Therapy , Cryptococcosis/therapy , Fluconazole/therapeutic use , Lung Diseases, Fungal/microbiology , Lung Diseases, Fungal/therapy , Prognosis , Pyrimidines/therapeutic use , Retrospective Studies , Thoracotomy , Tomography, X-Ray Computed , Triazoles/therapeutic use
17.
Mem. Inst. Oswaldo Cruz ; 107(6): 813-815, set. 2012. ilus
Article in English | LILACS | ID: lil-649499

ABSTRACT

Coccidioidomycosis is a systemic mycosis with a variable clinical presentation. Misdiagnosis of coccidioidomycosis as bacterial pneumopathy leads to inappropriate prescription of antibiotics and delayed diagnosis. This report describes an outbreak among armadillo hunters in northeastern Brazil in which an initial diagnosis of bacterial pneumonia was later confirmed as coccidioidomycosis caused by Coccidioides posadasii. Thus, this mycosis should be considered as an alternative diagnosis in patients reporting symptoms of pneumonia, even if these symptoms are only presented for a short period, who are from areas considered endemic for this disease.


Subject(s)
Adolescent , Animals , Humans , Male , Middle Aged , Armadillos/microbiology , Coccidioidomycosis/diagnosis , Lung Diseases, Fungal/diagnosis , Pneumonia, Bacterial/diagnosis , Pneumonia/diagnosis , Brazil/epidemiology , Coccidioides/isolation & purification , Coccidioidomycosis/epidemiology , Disease Outbreaks , Lung Diseases, Fungal/epidemiology , Pneumonia, Bacterial/drug therapy , Pneumonia/epidemiology , Soil Microbiology
18.
J. bras. pneumol ; 38(2): 264-268, mar.-abr. 2012. ilus
Article in Spanish | LILACS | ID: lil-623406

ABSTRACT

La incidencia de las micosis pulmonares en Uruguay es muy baja, y estas usualmente aparecen en pacientes inmunocomprometidos. Se discute el caso de un paciente inmunocompetente proveniente de área rural, que presenta tos, disnea y fiebre de dos meses de evolución. La imagenología mostró una neumonitis extensa y fibrosis pulmonar. Los test micológicos directos, cultivo y serológicos muestran histoplasmosis y paraccocidioidomicosis en forma concomitante. El paciente presentó hipotensión arterial diagnosticándose una insuficiencia suprarrenal. A pesar de que la extensa fibrosis pulmonar y la neumonitis no fueron reversibles, el paciente mejoró clínicamente con el tratamiento antifúngico. Se trata de un caso excepcional de dos micosis pulmonares en un mismo paciente.


The incidence of pulmonary fungal infections is very low in Uruguay, and such infections typically affect immunocompromised patients. We report the case of an immunocompetent patient presenting with a two-month history of cough, dyspnea, and fever. The patient resided in a rural area. Imaging tests revealed extensive pneumonitis and pulmonary fibrosis. On the basis of direct mycological examination, culture, and serological testing, we made a diagnosis of concomitant histoplasmosis and paracoccidioidomycosis. The patient presented arterial hypotension that was diagnostic of adrenocortical insufficiency. Although the pulmonary fibrosis and pneumonia were irreversible, the clinical condition of the patient improved after antifungal treatment. This was an exceptional case of two pulmonary fungal infections occurring simultaneously in the same patient.


Subject(s)
Humans , Male , Middle Aged , Coinfection/diagnosis , Histoplasmosis/diagnosis , Lung Diseases, Fungal/diagnosis , Paracoccidioidomycosis/diagnosis , Uruguay
19.
Rev. argent. microbiol ; 43(4): 268-272, dic. 2011. ilus
Article in Spanish | LILACS | ID: lil-634703

ABSTRACT

Se presenta el primer caso humano de peniciliosis por Penicillium marneffei observado en la República Argentina. El paciente era un joven de 16 años, HIV-positivo, procedente de un área rural del sur de China. El paciente fue internado en el Hospital "F. J. Muñiz" por padecer una neumonía grave con insufciencia respiratoria aguda. El agente causal fue aislado de un lavado broncoalveolar y se lo observó en un citodiagnóstico de piel. La identifcación de P. marneffei fue confrmada por las características fenotípicas del aislamiento y la amplifcación del ADNr. El enfermo padecía una infección muy avanzada por HIV que condujo a la aparición simultánea de infecciones por citomegalovirus, Pneumocystis jirovecii y procesos bacterianos nosocomiales. Este complejo cuadro derivó en una evolución fatal.


The frst case observed in Argentina of AIDS-related human penicillosis is herein presented. The patient was a six- teen year-old young man coming from a rural area of southern China. He was admitted at the F. J. Muñiz Hospital of Buenos Aires city with severe pneumonia and adult respiratory distress. Penicillium marneffei was isolated from bronchoalveolar lavage fuid and was microscopically observed in a skin cytodiagnosis. P. marneffei identifcation was confrmed by rRNA amplifcation and its phenotypic characteristics. The patient suffered an advanced HIV infection and also presented several AIDS-related diseases due to CMV, nosocomial bacterial infections and Pneumocystis jirovecii which led to a fatal outcome.


Subject(s)
Adolescent , Humans , Male , AIDS-Related Opportunistic Infections/microbiology , Dermatomycoses/microbiology , HIV-1 , HIV-2 , Lung Diseases, Fungal/microbiology , Penicillium/isolation & purification , AIDS-Related Opportunistic Infections/epidemiology , Argentina/epidemiology , Bronchoalveolar Lavage Fluid/microbiology , China/ethnology , Cytomegalovirus Infections/complications , Diagnosis, Differential , DNA, Fungal/analysis , Dermatomycoses/epidemiology , Fatal Outcome , Histoplasmosis/diagnosis , Lung Diseases, Fungal/diagnosis , Lung Diseases, Fungal/epidemiology , Pneumocystis carinii , Polymerase Chain Reaction , Penicillium/classification , Pneumonia, Pneumocystis/complications , Ribotyping
20.
Rev. Soc. Bras. Med. Trop ; 44(2): 260-262, Mar.-Apr. 2011. ilus
Article in Portuguese | LILACS | ID: lil-586095

ABSTRACT

A actinomicose é uma infecção rara que pode envolver diversos órgãos. O envolvimento torácico é incomum (10-20 por cento). No presente trabalho, é descrito o caso de um paciente de 33 anos, HIV negativo, com dor torácica posterior à esquerda em queimação com irradiação para membro superior esquerdo e diminuição da força com parestesias. A tomografia computadorizada evidenciou uma massa em contato com a parede torácica. Após realização de toracotomia foi visualizada lesão pulmonar sólida vascularizada aderida no lobo superior esquerdo, infiltrando a parede torácica posterior e ápice da cavidade. A biopsia incisional da lesão e o estudo microbiológico evidenciaram actinomicose.


Actinomycosis is a rare infection that may involve several organs. Thoracic involvement is uncommon (10-20 percent). This article describes the case of a 33 year-old patient, HIV negative, complaining of burning pain in the left posterior chest radiating to the left upper arm and reduced strength and paresthesias. The CT scan showed a mass in close contact with the chest wall. Following a thoracotomy, observation verified a solid pulmonary lesion adhered to the left upper lobe, infiltrating the posterior thoracic wall and apex of the cavity with rich vascularization. An incisional biopsy of the lesion and microbiological study revealed actinomycosis.


Subject(s)
Adult , Humans , Male , Actinomycosis/diagnosis , Lung Diseases, Fungal/diagnosis , Pancoast Syndrome/diagnosis , Diagnosis, Differential , Tomography, X-Ray Computed , Thoracic Wall/microbiology
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