Subject(s)
Lung Diseases, Fungal/diagnosis , Lymphohistiocytosis, Hemophagocytic/diagnosis , Mucormycosis/diagnosis , Autopsy , Fatal Outcome , Humans , Infant , Lung Diseases, Fungal/blood , Lung Diseases, Fungal/cerebrospinal fluid , Lymphohistiocytosis, Hemophagocytic/blood , Lymphohistiocytosis, Hemophagocytic/cerebrospinal fluid , Male , Mucormycosis/blood , Mucormycosis/cerebrospinal fluidABSTRACT
Cryptococcus gattii is a known, emerging infectious disease pathogen predominantly in the Pacific Northwest, the United States, and British Columbia, Canada. We report a case of an immunocompetent adolescent from New England who had severe pulmonary and central nervous system infection caused by the VGI genotype of C. gattii.
Subject(s)
Cryptococcus gattii/isolation & purification , Meningitis, Cryptococcal/microbiology , Adolescent , Antifungal Agents/therapeutic use , Brain/pathology , Communicable Diseases, Emerging/cerebrospinal fluid , Communicable Diseases, Emerging/drug therapy , Communicable Diseases, Emerging/microbiology , Cryptococcus gattii/genetics , Female , Genotype , Humans , Lung Diseases, Fungal/cerebrospinal fluid , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/microbiology , Lung Diseases, Fungal/pathology , Magnetic Resonance Imaging , Meningitis, Cryptococcal/cerebrospinal fluid , Meningitis, Cryptococcal/drug therapy , Multilocus Sequence Typing , New England , Radiography, Thoracic , Tomography, X-Ray ComputedSubject(s)
Antifungal Agents/cerebrospinal fluid , Aspergillosis/cerebrospinal fluid , Aspergillosis/drug therapy , Hematopoietic Stem Cell Transplantation/methods , Lung Diseases, Fungal/cerebrospinal fluid , Lung Diseases, Fungal/drug therapy , Triazoles/cerebrospinal fluid , Acute Disease , Antifungal Agents/administration & dosage , Antifungal Agents/pharmacokinetics , Central Nervous System Fungal Infections/cerebrospinal fluid , Central Nervous System Fungal Infections/drug therapy , Humans , Leukemia, Myeloid/therapy , Male , Triazoles/administration & dosage , Triazoles/pharmacokinetics , Young AdultABSTRACT
An unusual case of chronic pulmonary paracoccidiodomycosis and disseminated cryptococcosis in a non-HIV infected patient is reported in a 72-year-old previously healthy man. A chest radiograph disclosed a bilateral diffused interstitial infiltrate involving middle and lower lung fields. Specimen samples taken from the tracheal tube revealed yeast-like organisms suggestive of Cryptococcus neoformans and Paracoccidiodes brasiliensis. Blood and cerebrospinal fluid culture was positive for C. neoformans and the immunodiffusion test against paracoccidiodin revealed a precipitation band. The patient died 24 days after the admission.
Subject(s)
Cryptococcosis/complications , Cryptococcus neoformans/isolation & purification , Lung Diseases, Fungal/microbiology , Paracoccidioides/isolation & purification , Paracoccidioidomycosis/complications , Aged , Chronic Disease , Cryptococcosis/diagnostic imaging , Fatal Outcome , Fungemia , HIV Seronegativity , Humans , Lung Diseases, Fungal/cerebrospinal fluid , Lung Diseases, Fungal/diagnostic imaging , Male , Paracoccidioidomycosis/diagnostic imaging , Sputum/microbiology , Tomography, X-Ray Computed , Trachea/microbiologyABSTRACT
A recently developed sandwich ELISA, which detects Aspergillus galactomannan, was tested retrospectively in serial serum samples from an allogeneic bone marrow transplant recipient with proven invasive aspergillosis (patient 1) and another with suspected disease (patient 2). Galactomannan was detected in the serum 4 and 28 days, respectively, before pulmonary infiltrates suggestive of fungal infection first became apparent on the chest X-ray. Aspergillus was detected by ELISA and PCR in BAL fluid samples from both patients, and in CSF from patient 1. The diagnosis was confirmed at autopsy for patient 1 by histopathology and the recovery of Aspergillus fumigatus from the lung and brain. Furthermore, in both patients the course of the antigen titer in the serum during antifungal treatment corresponded with the clinical outcome. These results confirm that the sandwich ELISA appears to be useful for the early diagnosis of invasive aspergillosis. The value of the test for monitoring the response to antifungal treatment remains to be established in prospective trials.
Subject(s)
Antigens, Fungal/analysis , Antigens, Fungal/immunology , Aspergillosis/diagnosis , Aspergillosis/immunology , Aspergillus/immunology , Lung Diseases, Fungal/diagnosis , Lung Diseases, Fungal/immunology , Mannans/analysis , Mannans/immunology , Adult , Antibodies, Fungal/immunology , Antigens, Fungal/blood , Aspergillosis/cerebrospinal fluid , Aspergillus/genetics , Aspergillus fumigatus/isolation & purification , Autopsy , Bone Marrow Transplantation/adverse effects , Brain/microbiology , Brain/pathology , Bronchoalveolar Lavage Fluid/microbiology , Enzyme-Linked Immunosorbent Assay/methods , Female , Galactose/analogs & derivatives , Humans , Lung/microbiology , Lung/pathology , Lung Diseases, Fungal/cerebrospinal fluid , Male , Mannans/blood , Middle Aged , Polymerase Chain ReactionABSTRACT
An aspergilloma developed in a lung cyst in a 53-year-old man. Aspergillus infection then contiguously spread to the epidural space, causing an abscess, vertebral destruction, and paraplegia at the level of T4. Chronic alcoholism, liver cirrhosis, and corticosteroid treatment may have been predisposing factors in this patient. Although Aspergillus epidural abscess has been described infrequently, this complication has not been described in association with an aspergilloma. Symptoms, signs, or roentgenographic or laboratory findings suggestive of vertebral or meningeal pathologic lesions in patients with aspergilloma should alert the physician to the possibility of contiguous spread of infection.
