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1.
Arch. argent. pediatr ; 115(6): 458-461, dic. 2017. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-887414

ABSTRACT

Antecedentes: Arthrographis kalrae es un hongo hialino de crecimiento lento que, en su desarrollo, forma artroconidios. Es un patógeno oportunista que causa infecciones en personas inmunocomprometidas e inmunocompetentes, y ha sido aislado muy raramente en muestras clínicas de seres humanos. Caso clínico: Se describe el caso de un paciente con inmunodeficiencia primaria y afectación pulmonar con evolución tórpida. Presentó compromiso de ambos pulmones a pesar del tratamiento antibiótico y antifúngico instaurado. Durante su seguimiento, se realizaron múltiples biopsias pulmonares y se aisló A. kalrae en el cultivo de tejido pulmonar. Recibió tratamiento con posaconazol, con buena respuesta y remisión de las lesiones. Conclusión: Este es el primer caso reportado de infección pulmonar por A. kalrae en un paciente pediátrico con enfermedad granulomatosa crónica en Argentina.


Background: Arthrographis kalrae is a hyaline fungus that grows forming arthroconidia. It is an opportunistic pathogen that causes infections in immunocompromised as in immunocompetent people and has been rarely isolated from human clinical samples. Case report: We describe the case of a male child with primary immunodeficiency who initially presented unilateral pneumonia and progressed to bilateral involvement despite antibiotic, antifungal treatment. A. kalrae was diagnosed by pulmonary biopsy. He received posaconazole with resolution of disease. Conclusions: This is the first case of A. kalrae pulmonary infection in a pediatric patient with chronic granulomatous disease in Argentina.


Subject(s)
Humans , Male , Child, Preschool , Ascomycota , Granulomatous Disease, Chronic/complications , Lung Diseases, Fungal/microbiology , Mycoses/complications , Lung Diseases, Fungal/drug therapy , Mycoses/microbiology , Mycoses/drug therapy
2.
Rev. Inst. Med. Trop. Säo Paulo ; 57(supl.19): 51-56, Sept. 2015.
Article in English | LILACS | ID: lil-762054

ABSTRACT

SUMMARYTherapy of coccidioidomycosis continues to evolve. For primary pulmonary disease, antifungal therapy is frequently not required while prolonged courses of antifungals are generally needed for those in whom extrathoracic disseminated has occurred. Intravenous amphotericin B should be reserved for those with severe disease. Oral triazole antifungals have had a great impact on the management of coccidioidomycosis. Both fluconazole and itraconazole at 400 mg daily have been effective for various forms of coccidioidomycosis, including meningitis, although relapse after therapy is discontinued is a problem. Individuals with suppressed cellular immunity are at increased risk for symptomatic coccidioidomycosis and they include those with HIV infection, those on immunosuppressive medications, and those who have received a solid organ transplant. Pregnant women and African-American men have been identified as two other groups who are at an increased risk for symptomatic and severe infection.


RESUMOA terapia da coccidioidomicose continua a evoluir. Para a doença pulmonar primária, o tratamento antifúngico frequentemente não é necessário, enquanto períodos prolongados de tratamento antifúngico são geralmente necessários para aqueles nos quais houve disseminação extratorácica. A anfotericina B intravenosa deve ser reservada para pacientes com doença grave. Antifúngicos triazólicos orais têm tido um grande impacto no manejo da coccidioidomicose. Tanto fluconazol quanto itraconazol em doses diárias de 400 mg foram eficazes contra várias formas de coccidioidomicose, incluindo a meníngea, embora recaídas após a interrupção da terapia ainda constituam um problema. Indivíduos com supressão da imunidade celular apresentam risco aumentado para a coccidioidomicose sintomática, incluindo pacientes infectados pelo HIV, em uso de medicações imunossupressoras, e os que receberam transplantes de órgãos sólidos. Mulheres grávidas e homens afro-americanos foram identificados como dois outros grupos que apresentam risco aumentado de infecção sintomática e grave.


Subject(s)
Humans , Female , Pregnancy , Antifungal Agents/therapeutic use , Coccidioidomycosis/drug therapy , HIV Infections/complications , HIV Infections/microbiology , Lung Diseases, Fungal/drug therapy , Severity of Illness Index
3.
Rev. chil. infectol ; 32(4): 472-475, ago. 2015. ilus
Article in Spanish | LILACS | ID: lil-762648

ABSTRACT

We reported a case of non-invasive pulmonary infection by Scedosporium apiospermum in 67 years old female with bronchiectasis and caverns secondary to tuberculosis. Diagnosis was made with lung CT and bronchial lavage cultures. The patient was initially treated with itraconazole for six weeks without success and then voriconazole for 16 weeks, with good clinical response.


Reportamos el caso clínico de una infección pulmonar no invasora por Scedosporium apiospermum en una mujer de 67 años de edad, con bronquiectasias y cavernas pulmonares secundarias a una tuberculosis. El diagnóstico se realizó con la TAC pulmonar y cultivos de lavado bronquial. La paciente fue tratada inicialmente con itraconazol oral por seis semanas sin respuesta y luego voriconazol vía oral por 16 semanas, con una buena respuesta clínica.


Subject(s)
Aged , Female , Humans , Lung Diseases, Fungal/microbiology , Scedosporium/isolation & purification , Antifungal Agents/therapeutic use , Bronchoalveolar Lavage Fluid/microbiology , Lung Diseases, Fungal/drug therapy , Scedosporium/growth & development , Tomography, X-Ray Computed , Triazoles/therapeutic use
5.
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
7.
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
8.
Braz. j. infect. dis ; 16(6): 590-593, Nov.-Dec. 2012. ilus, tab
Article in English | LILACS | ID: lil-658930

ABSTRACT

Pulmonary mucormycosis is a very rare clinical condition in patients without underlying risk factors. A limited number of cases have been reported in predominantly elderly patients; history of smoking appears to be a common feature. A case of non-smoking male who developed pulmonary mucormycosis with the longest reported follow-up is presented. In addition, this is also the first reported case with disease recurrence after lobectomy (two years) in an immunocompetent host. Treatment with an additional lobectomy and amphotericin B was successful in this patient.


Subject(s)
Adolescent , Humans , Male , Lung Diseases, Fungal/surgery , Mucormycosis/surgery , Rhizopus/isolation & purification , Immunocompetence , Lung Diseases, Fungal/drug therapy , Mucormycosis/drug therapy , Pneumonectomy , Recurrence , Risk Factors
9.
Medicina (B.Aires) ; 72(1): 23-27, feb. 2012. ilus, tab
Article in Spanish | LILACS | ID: lil-639647

ABSTRACT

El objetivo de este trabajo es presentar la incidencia, frecuencia, características clínicas y evolución de los pacientes con mucormicosis atendidos en el Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, entre los años 1982 y 2010. Durante ese período se diagnosticaron 10 casos de mucormicosis. Los tres primeros entre 1982 y 2004 y los últimos 7 entre 2005 y 2010. La incidencia y frecuencia de esta enfermedad, para el período 1980-2004 fue 0.13 pacientes/año y 0.1 casos/10 000 egresos (IC 95%: 0.00 a 0.3) respectivamente. En el período 2005-2010 la incidencia fue 0.86 pacientes/año y la frecuencia de 1.1 casos/10 000 egresos (IC 95%: 0.5 a 2.4). Hubo nueve casos de mucormicosis rinosinuso-orbitaria, siete en pacientes con diabetes mellitus, uno en una paciente con una hemopatía maligna y neutropenia, y el restante en un paciente con HIV/sida que además estaba neutropénico y con un síndrome hemofagocítico. En una paciente se realizó el diagnóstico post mortem de mucormicosis pulmonar. El diagnóstico se efectuó por la observación de filamentos cenocíticos en los diez casos. Hubo desarrollo de mucorales en los cultivos de 8/9 pacientes; cinco Rhizopus spp y tres Mucor spp. Todos los pacientes recibieron un tratamiento inicial con anfotericina B deoxicolato, que en tres de ellos fue continuado con anfotericina B liposomal, y cirugía. Tres enfermos recibieron además un tratamiento adyuvante con oxigeno hiperbárico. La mortalidad fue 30%.


Mucormycosis is an opportunistic infection caused by fungi of the order Mucorales. It is characterized by rapid progression and high morbidity and mortality in the absence of early diagnosis and prompt treatment. It was an infrequent disease, but in recent years, its incidence appears to have increased. The aim of this paper is to report the cases of mucormycosis diagnosed from 1982 to 2010 at the Hospital de Clinicas José de San Martín, University of Buenos Aires. We diagnosed 10 cases of mucormycosis; the first three between 1982 and 2004 and the last 7 between 2005 and 2010. The incidence from 1980 to 2004 was 0.13 patient-years and the frequency 0.1/10 000 discharges (95% CI 0.00- 0.3). In the period 2005 to 2010, the incidence was 0.86 patients per year with 1.1/10 000 discharges (95% CI 0.5-2.4). There was a pulmonary mucormycosis case (in a patient treated with corticosteroids) and nine rhinocerebral cases, two in neutropenic and seven in diabetic patients. The diagnosis was made by observation of cenocytic hyphae in 10/10 patients. Mucorales were recovered in 8/9 cultures (5 Rhizopus spp and 3 Mucor spp.). In one case diagnosis of pulmonary mucormycosis was made post-mortem. Nine patients were treated with amphotericin B deoxycholate (in 3 patients supplemented with liposomal amphotericin B) and surgery. Three patients underwent hyperbaric chamber. Seven patients had favorable outcome. In conclusion, mucormycosis is a rare disease, but its incidence has increased over the past five years. A good evolution of the patients is linked to early diagnosis and treatment.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Mucormycosis/epidemiology , Nose Diseases/epidemiology , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Argentina/epidemiology , Drug Combinations , Deoxycholic Acid/therapeutic use , Eye Infections, Fungal/drug therapy , Eye Infections, Fungal/epidemiology , Eye Infections, Fungal/microbiology , Incidence , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/epidemiology , Lung Diseases, Fungal/pathology , Mucormycosis/drug therapy , Mucormycosis/pathology , Nose Diseases/drug therapy , Nose Diseases/microbiology , Paranasal Sinus Diseases/drug therapy , Paranasal Sinus Diseases/epidemiology , Paranasal Sinus Diseases/microbiology
10.
An. bras. dermatol ; 86(6): 1178-1180, nov.-dez. 2011. ilus
Article in Portuguese | LILACS | ID: lil-610424

ABSTRACT

Os autores relatam caso de Criptococcose cutânea primária, causada pelo Cryptococcus neoformans, em paciente imunocompetente, fazendeiro que desenvolveu extensivas lesões, no antebraço, após injúria provocada por galináceo, quando fazia limpeza de seu celeiro. Tratamento oral com fluconazol resultou em cura total. A literatura relata raridade de criptococcose cutânea primária em imunocompetentes e sua relativa frequência em imunodeprimidos.


The authors report a primary cutaneous cryptococcosis, caused by Cryptococcus neoformans in immunocompetent patient, a farmer who developed extensive lesions at the site of an injury caused by one of the chickens on his right forearm, while he was cleaning out his barn. Oral treatment with fluconazole was totally successful. A review of the literature showed the rarity of cutaneous cryptococcosis in immunocompetent patients and in contrast, that skin lesions frequently occur in immunocompromised patients.


Subject(s)
Aged , Humans , Male , Cryptococcus neoformans , Cryptococcosis/immunology , Immunocompromised Host , Lung Diseases, Fungal/immunology , Antifungal Agents/therapeutic use , Cryptococcosis/drug therapy , Cryptococcosis/pathology , Cryptococcus neoformans/growth & development , Fluconazole/therapeutic use , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/pathology
11.
Radiol. bras ; 44(1): 20-28, jan.-fev. 2011. ilus, tab
Article in Portuguese | LILACS | ID: lil-579002

ABSTRACT

OBJETIVO: Foram analisadas as alterações radiográficas pulmonares em pacientes com paracoccidioidomicose crônica de modo evolutivo, verificando-se as diferenças entre os tratados com um novo agente antifúngico triazólico, o voriconazol, em relação aos que utilizaram a atual droga de escolha para o tratamento, o itraconazol. MATERIAIS E MÉTODOS: Realizou-se estudo comparativo, randomizado, com avaliação das radiografias do tórax obtidas antes, durante e após o tratamento de 39 pacientes, divididos em dois grupos: um recebendo o voriconazol e o outro, itraconazol. A avaliação das radiografias teve como parâmetro uma adaptação do método já estabelecido para a análise de outra doença pulmonar difusa, o esquema ILO (International Labour Office) de classificação das pneumoconioses, classificando-se as lesões em pequenas ou grandes opacidades. RESULTADOS: Os resultados obtidos coincidiram com as descrições prévias existentes em relação à apresentação das alterações radiográficas pulmonares, e a evolução destas ao longo do tratamento foi semelhante nos dois grupos. As pequenas opacidades regrediram parcialmente, ao passo que as grandes opacidades mostraram tendência à regressão completa. CONCLUSÃO: O uso da adaptação do modelo ILO de classificação das pneumoconioses revelou-se útil para o acompanhamento dos pacientes com paracoccidioidomicose crônica ao longo do tratamento, do ponto de vista radiográfico.


OBJECTIVE: Lung radiographic findings were reviewed to evaluate the differences in the progression of findings along the follow-up of patients with chronic paracoccidioidomycosis treated with a novel second-generation triazole antifungal agent (voriconazole) as compared with patients treated with the drug of choice for treatment of such disease (itraconazole). MATERIALS AND METHODS: A comparative, randomized study involved the review of chest radiographic images acquired before, during and after treatment of 39 patients divided into two groups: one receiving voriconazole and the other receiving itraconazole. The parameters adopted to describe and to measure lesions present on the radiographic images were based on an adaptation of the method used in cases of another diffuse pulmonary disease, the ILO (International Labour Office) classification of pneumoconioses, dividing the lesions into small and large opacities. RESULTS: The results coincided with previous descriptions regarding lung radiographic findings, and the progression of such findings along the treatment was similar for both groups. Partial regression was observed in the small opacities while large opacities showed a tendency towards complete regression. CONCLUSION: The adapted ILO classification demonstrated to be useful in the radiographic follow-up along treatment of patients with chronic paracoccidioidomycosis.


Subject(s)
Humans , Male , Female , Young Adult , Middle Aged , Aged, 80 and over , Antifungal Agents/administration & dosage , Paracoccidioidomycosis , Paracoccidioidomycosis/etiology , Paracoccidioidomycosis , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal , Antifungal Agents , Diagnostic Imaging , Outcome Assessment, Health Care
12.
Rev. Soc. Bras. Med. Trop ; 43(5): 599-601, set.-out. 2010. tab
Article in English | LILACS | ID: lil-564306

ABSTRACT

The type of pulmonary histoplasmosis presents limited lesions to the lungs, with symptoms that are clinically and radiological similar to chronic pulmonary tuberculosis. This paper describes the clinical features of four cases of pulmonary histoplasmosis. Aspects of diagnostic and clinical, epidemiological, laboratorial and imaging exams are discussed, in addition to the clinical status of the individuals five years after disease onset. The treatment of choice was oral medication, following which all the patients improved. It is important to understand the clinical status and the difficulties concerning the differential diagnosis of histoplasmosis, to assist the proper indication of cases, thus reducing potential confusion with other diseases.


A histoplasmose do tipo pulmonar apresenta lesões limitadas aos pulmões, cujos sintomas são clínica e radiologicamente similares à tuberculose pulmonar crônica. Esse trabalho descreve as características clínicas de quatro casos de histoplasmose. Os aspectos do diagnósticos clínicos, epidemiológicos, laboratoriais e exames de imagem são relacionados, além da situação clínica dos indivíduos, 5 após o início da doença. O tratamento de escolha foi atravésde medicação oral, aonde todos os pacientes evoluíram bem. É importante conhecer o quadro clínico e da dificuldade em diagnosticar a histoplasmose para ajudar a conduzir as boas indicações dos casos, reduzindo assim o malentendido com outras entidades patológicas.


Subject(s)
Adolescent , Adult , Humans , Male , Middle Aged , Young Adult , Histoplasmosis/diagnosis , Lung Diseases, Fungal/diagnosis , Histoplasmosis/drug therapy , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/microbiology , Tomography, X-Ray Computed , Young Adult
13.
Rev. Soc. Bras. Med. Trop ; 43(1): 95-97, Jan.-Feb. 2010. ilus
Article in Portuguese | LILACS | ID: lil-540522

ABSTRACT

Relata-se caso de lavrador de 40 anos acometido por adiaspiromicose pulmonar, com diagnóstico etiológico estabelecido mediante biópsia por toracoscopia. Optou-se por tratamento com corticosteróide, sem antifúngicos, tendo o paciente respondido bem, com melhora clínico-radiológica após três semanas do início dos sintomas.


The case of a 40-year-old agricultural worker affected by pulmonary adiaspiromycosis is reported. An etiological diagnosis had been established by means of a biopsy via thoracoscopy. Treatment with corticosteroids without antifungal drugs was chosen, and the patient responded well to this, with improvements in clinical and radiological conditions three weeks after the beginning of the symptoms.


Subject(s)
Adult , Humans , Male , Chrysosporium , Glucocorticoids/therapeutic use , Lung Diseases, Fungal/drug therapy , Prednisone/therapeutic use , Lung Diseases, Fungal/diagnosis
14.
J. bras. pneumol ; 35(11): 1136-1144, nov. 2009. ilus, tab
Article in Portuguese | LILACS | ID: lil-533293

ABSTRACT

Criptococose é uma micose sistêmica causada por duas espécies do basidiomiceto encapsulado, Cryptococcus neoformans e C. gattii, que, respectivamente, causam infecção em indivíduos imunocomprometidos e em hospedeiros imunocompetentes, respectivamente. Pacientes com deficiência em células T são mais suscetíveis. A infecção se inicia por lesões pulmonares assintomáticas e a doença disseminada frequentemente cursa com meningoencefalite. A importância médica da criptococose aumentou significativamente em consequência da epidemia da AIDS e dos transplantes de órgãos.


Cryptococcosis is a systemic mycosis caused by two species of the encapsulated basidiomycetes, Cryptococcus neoformans and C. gattii, which, respectively, cause infection in immunocompromised individuals and in immunologically normal hosts. Patients with T-cell deficiencies are more susceptible to this infection. The spectrum of the disease ranges from asymptomatic pulmonary lesions to disseminated infection with meningoencephalitis. The medical relevance of cryptococcosis increased dramatically as a consequence of the AIDS epidemic and organ transplants.


Subject(s)
Humans , Cryptococcosis/diagnosis , Lung Diseases, Fungal/diagnosis , Cryptococcosis/drug therapy , Cryptococcosis/microbiology , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/microbiology
15.
J. bras. pneumol ; 35(11): 1145-1151, nov. 2009. ilus
Article in Portuguese | LILACS | ID: lil-533294

ABSTRACT

Histoplasmose é uma micose sistêmica causada por um pequeno fungo, Histoplasma capsulatum var. capsulatum, cujo habitat é o solo rico em excrementos de pássaros e morcegos. A incidência da histoplasmose é mundial. No Brasil, a doença incide em todas as regiões; porém, o estado do Rio de Janeiro é responsável pelo maior número de microepidemias descritas até hoje. A infecção humana ocorre pela inalação de esporos do H. capsulatum. A forma clínica mais freqüente é a assintomática. Na histoplasmose aguda ou epidêmica, os sintomas são febre alta, tosse, astenia, dor retroesternal, acompanhados de aumento dos linfonodos cervicais, fígado e do baço. Os achados radiológicos mais frequentes são o infiltrado reticulonodular difuso em ambos os pulmões, associados a linfonodomegalias hílares e mediastinais. Na forma pulmonar crônica, o quadro clínico e radiológico é idêntico ao da tuberculose pulmonar do adulto. O diagnóstico da histoplasmose é feito pela identificação do fungo ou crescimento em cultura de escarro ou de material obtido por fibrobroncoscopia. A histopatologia identifica o fungo dentro e fora do macrófago em meio à lesão granulomatosa com ou sem necrose caseosa. A imunodifusão em duplo gel de ágar é o teste sorológico mais fácil e disponível para o diagnóstico imunológico. As formas agudas com sintomas prolongados, as formas disseminadas e a forma pulmonar crônica requerem tratamento. A droga de escolha é o itraconazol.


Histoplasmosis is systemic mycosis caused by a small fungus, Histoplasma capsulatum var. capsulatum, whose natural habitat is soil contaminated by bat or bird excrement. The incidence of histoplasmosis is worldwide. In Brazil, the disease is found in all regions; however, the state of Rio de Janeiro is responsible for most of the microepidemics described. Human infection occurs when airborne spores of H. capsulatum are inhaled. The most common clinical presentation is asymptomatic. The symptoms of acute or epidemic histoplasmosis are high fever, cough, asthenia and retrosternal pain, as well as enlargement of the cervical lymph nodes, liver and spleen. The most common radiological findings are diffuse reticulonodular infiltrates in both lungs, as well as hilar and mediastinal lymph node enlargement. In chronic pulmonary histoplasmosis, the clinical and radiological manifestations are identical to those of reinfection with pulmonary tuberculosis. Histoplasmosis is diagnosed by means of the identification or culture growth of the fungus in sputum or fiberoptic bronchoscopy specimens. Histopathological examination reveals the fungus itself within or surrounding macrophages, as well as granulomatous lesions with or without caseous necrosis. Double agar gel immunodiffusion is the most easily used and readily available serologic test for making the immunological diagnosis. Acute histoplasmosis with prolonged symptoms requires treatment, as do the disseminated or chronic pulmonary forms of the disease. The drug of choice is itraconazole.


Subject(s)
Humans , Histoplasmosis , Lung Diseases, Fungal , Histoplasmosis/diagnosis , Histoplasmosis/drug therapy , Histoplasmosis/etiology , Lung Diseases, Fungal/diagnosis , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/etiology
16.
Rev. Soc. Bras. Med. Trop ; 42(2): 192-198, Mar.-Apr. 2009. ilus, mapas
Article in Portuguese | LILACS | ID: lil-512928

ABSTRACT

A histoplasmose é uma micose causada por fungo dimórfico, o Histoplasma capsulatum. É considerada classicamente uma micose endêmica, embora o fungo tenha um comportamento oportunístico em pacientes com depressão da imunidade celular. O homem adquire a infecção através da inalação de conídeos presentes na natureza (cavernas com morcegos, galinheiros, etc). O quadro clínico pode variar, desde infecções assintomáticas até quadros graves disseminados, que acometem pacientes com Aids, transplantados ou com neoplasias hematológicas. O diagnóstico baseia-se no encontro do fungo em fluidos orgânicos (escarro, sangue, líquor) ou tecidos (histopatologia), na cultura de materiais biológicos e na sorologia. O tratamento das formas agudas graves, respiratória crônica ou de formas localizadas pode ser feito com azólicos orais (itraconazol) e nas disseminadas, a Anfotericina B (preferencialmente as formulações lipídicas) constitui a droga da eleição para iniciar a terapia. A histoplasmose representa, hoje uma das micoses sistêmicas mais importantes nas Américas, com ampla distribuição em todas as regiões do Brasil.


Histoplasmosis is a fungal infection caused by the dimorphic fungus Histoplasma capsulatum. It is classically considered an endemic mycosis, even though the fungus has an opportunistic behavior in immunocompromised patients. People acquired the infection through the inhalation of conidial forms present in the environmental, such as caves dwelling bats and soils inhabited by chickens. The clinical features may vary from asymptomatic infections to disseminated severe forms that affect patients with acquired immunodeficiency syndrome or hematological malignancies and allograft recipients. The diagnosis is based on the detection of the fungus in organic fluids (sputum, blood, liquor) or tissues (histopathological assays), in the culture of biological samples and serological assays. The treatment of severe chronic respiratory acute or localized forms can be performed with oral azolic (itraconazol) and in the disseminated forms, the amphotericin B (preferentially the lipidic formulations) consists in the elected drug to initiate the therapy. Nowadays, histoplasmosis represents one of the most important systemic mycosis in the Americas, with broad distribution in all regions of Brazil.


Subject(s)
Humans , Histoplasmosis , Acute Disease , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/epidemiology , AIDS-Related Opportunistic Infections/etiology , Chronic Disease , Histoplasma/pathogenicity , Histoplasmosis/diagnosis , Histoplasmosis/drug therapy , Histoplasmosis/epidemiology , Histoplasmosis/etiology , Lung Diseases, Fungal/diagnosis , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/microbiology
17.
Article in English | IMSEAR | ID: sea-35689

ABSTRACT

Blastomycosis, a fungal infection caused by Blastomyces dermatitidis, was once thought to be endemic only to the Central and Great Lakes regions of the United States of America. We present the first reported case series of patients documenting the diagnosis of blastomycosis in the Pacific region. In both cases, exposure to endemic areas was retrospectively identified.


Subject(s)
Adult , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Blastomyces/isolation & purification , Blastomycosis/diagnosis , Hawaii , Humans , Itraconazole/therapeutic use , Lung Diseases, Fungal/drug therapy , Male , Young Adult
18.
Rev. Soc. Bras. Med. Trop ; 40(1): 82-85, jan.-fev. 2007. ilus
Article in Portuguese | LILACS | ID: lil-449177

ABSTRACT

A Actinomicose é uma infecção rara, crônica, supurativa e granulomatosa que pode envolver diversos órgãos. A infecção pulmonar geralmente está relacionada à imunodepressão e à saúde bucal precária. O envolvimento torácico é incomum (10 - 20 por cento), a parede torácica é acometida em apenas 12 por cento destes casos. No presente trabalho, é descrito o caso de um paciente de 26 anos, não HIV e sem co-morbidades, assintomático respiratório, com massa infra-escapular, de crescimento progressivo, muito dolorosa, com sinais locais flogísticos, sem trauma local, apresentando febre persistente, com três meses de evolução. O diagnóstico inicial foi de neoplasia de partes moles de parede torácica. A biopsia incisional da referida massa, houve saída de secreção gelatinosa vinhosa com grânulos amarelados, sugestivos de actinomicose, sendo confirmado por exame anatomopatológico. Empiricamente foi instituída ciprofloxacina devido alergia à cefalosporina. Houve excelente resposta clínica à drenagem externa e à medicação prescrita. Não houve recaída da doença em 18 meses de seguimento.


Actinomycosis is an uncommon suppurative granulomatous chronic infection that may involve several organs. Lung infection is usually related to immunodepression and poor oral hygiene. Cases of thoracic involvement are rare (10 - 20 percent) and only 12 percent of such cases affect the chest wall. This report describes the case of a 26-year-old HIV-negative patient without comorbidities or respiratory complaints who presented a very painful, progressively growing infrascapular mass, with local phlogistic signs and no local trauma, and persistent fever. It had been progressing for three months. The initial diagnosis was neoplasia of chest wall soft tissue. However, incision biopsy in this mass produced a red wine-colored gelatinous secretion containing yellowish granules suggestive of actinomycosis, which was later confirmed by anatomopathological examination. Ciprofloxacin was instituted empirically because of cephalosporin allergy. There was an excellent clinical response to external drainage and the prescribed medication. Over the course of 18 months of follow-up, there was no disease recurrence.


Subject(s)
Humans , Male , Adult , Actinomycosis/diagnosis , Lung Diseases, Fungal/diagnosis , Lung Neoplasms/diagnosis , Soft Tissue Neoplasms/diagnosis , Thoracic Wall/microbiology , Actinomycosis/drug therapy , Diagnosis, Differential , Follow-Up Studies , Lung Diseases, Fungal/drug therapy
20.
J. bras. pneumol ; 32(5): 449-460, set.-out. 2006. ilus
Article in Portuguese | LILACS | ID: lil-452403

ABSTRACT

Aborda-se sumariamente o espectro de ação, aspectos farmacológicos e toxicológicos e eficácia clínica de anfotericina B lipossomal, anfotericina B em dispersão coloidal, complexo lipídico de anfotericina B, voriconazol e caspofungina. Discute-se o uso desses antifúngicos mais recentes considerando a segurança, a eficiência e o custo da terapia. Sugestões para o uso clínico dessas drogas em infecções pulmonares e sistêmicas são apresentadas, destacando-se a menor toxicidade das formulações lipídicas da anfotericina B em relação à medicação convencional, a possibilidade de terapia primária da aspergilose invasiva, scedosporiose e fusariose com voriconazol e a caspofungina como opção terapêutica na candidíase disseminada e na aspergilose invasiva.


We summarize here data regarding the spectrum of action, the pharmacological aspects, the toxicological aspects and the clinical efficacy of liposomal amphotericin B, amphotericin B in colloidal dispersion, amphotericin B lipid complex, voriconazole and caspofungin. We discuss the use of these more recently introduced antifungal agents in terms of their safety, efficiency and cost. We also offer suggestions for the clinical use of these drugs in pulmonary and systemic infections, with an emphasis on the lower toxicity of the lipid formulations of amphotericin B in comparison with conventional medications. In addition, we explore the possibility of using voriconazole as the primary treatment for invasive infections such as aspergillosis, as well as those caused by Scedosporium spp. and Fusarium spp., together with that of using caspofungin to treat disseminated candidiasis and invasive aspergillosis.


Subject(s)
Humans , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Lung Diseases, Fungal/drug therapy , Peptides, Cyclic/therapeutic use , Pyrimidines/therapeutic use , Triazoles/therapeutic use , Amphotericin B/adverse effects , Antifungal Agents/adverse effects , Echinocandins , Peptides, Cyclic/adverse effects , Pyrimidines/adverse effects , Triazoles/adverse effects
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