[Mycological and parasitological examinations in the management of lung infections]. / Examens mycologiques et parasitologiques dans la prise en charge des infections pulmonaires.

Pulmonary parasitic diseases are rare whereas pulmonary fungal infections are increasing. The diversity of clinical presentations requires laboratory tests to confirm the diagnosis. Direct examination of lung samples and antibody detection are the basis of parasitological diagnosis. With regard to mycoses, the range of biological tests is broader. The conventional mycological examination allows identification of any type of fungus except Pneumocystis jirovecii. Its specificity is excellent but it lacks sensitivity. Detection of antibodies, antigens or nucleic acid complements the diagnostic tools. With regard to aspergillosis, there is a broad nosological set with variable prognosis. The choice of appropriate laboratory procedures depends on the clinical presentation and patient risk factors. The search for galactomannan antigen is effective and a new technique, "Lateral Flow Device", seems very promising. The detection of antibodies is also informative but various techniques are used. A good knowledge of the performance and limitations of these techniques allows targeted prescription. The use of PCR for the diagnosis of pulmonary fungal infections has limited indications. Biological and clinical co-operation is essential for the choice and interpretation of laboratory tests for parasitic or fungal pulmonary disease.

IL-13 induces disease-promoting type 2 cytokines, alternatively activated macrophages and allergic inflammation during pulmonary infection of mice with Cryptococcus neoformans.

In the murine model of Cryptococcus neoformans infection Th1 (IL-12/IFN-gamma) and Th17 (IL-23/IL-17) responses are associated with protection, whereas an IL-4-dependent Th2 response exacerbates disease. To investigate the role of the Th2 cytokine IL-13 during pulmonary infection with C. neoformans, IL-13-overexpressing transgenic (IL-13Tg(+)), IL-13-deficient (IL-13(-/-)), and wild-type (WT) mice were infected intranasally. Susceptibility to C. neoformans infection was found when IL-13 was induced in WT mice or overproduced in IL-13Tg(+) mice. Infected IL-13Tg(+) mice had a reduced survival time and higher pulmonary fungal load as compared with WT mice. In contrast, infected IL-13(-/-) mice were resistant and 89% of these mice survived the entire period of the experiment. Ag-specific production of IL-13 by susceptible WT and IL-13Tg(+) mice was associated with a significant type 2 cytokine shift but only minor changes in IFN-gamma production. Consistent with enhanced type 2 cytokine production, high levels of serum IgE and low ratios of serum IgG2a/IgG1 were detected in susceptible WT and IL-13Tg(+) mice. Interestingly, expression of IL-13 by susceptible WT and IL-13Tg(+) mice was associated with reduced IL-17 production. IL-13 was found to induce formation of alternatively activated macrophages expressing arginase-1, macrophage mannose receptor (CD206), and YM1. In addition, IL-13 production led to lung eosinophilia, goblet cell metaplasia and elevated mucus production, and enhanced airway hyperreactivity. This indicates that IL-13 contributes to fatal allergic inflammation during C. neoformans infection.

Lung parasites of shrews from Pennsylvania.

We examined lung parasites of three species of soricids, Sorex cinereus (n = 58), Sorex fumeus (n = 23) and Blarina brevicauda (n = 45) collected from Pennsylvania (USA), from 1990 to 1995. Yeast-like cells of Hisfoplasma capsulatum var. capsulatum were found in lung sections stained with Grocott's modification of Gomori's methenamine silver, periodic acid-Schiff, Giemsa, and hematoxylin-eosin in two (3%) S. cinereus, eight (35%) S. fumeus and two (4%) B. brevicauda. The number of spores of H. capsulatum in the lungs was low and no inflammatory reaction was evident. The infection was not disseminated to other organs. This is the first report of H. capsulatum infection in any species of shrews of the genus Sorex and the prevalence in S. fumeus was remarkably high compared to those reported for other wild mammals. A nematode, possibly Angiostrongylus michiganensis, was found in the lungs of one S. fumeus on necropsy and in a stained lung section of one S. cinereus. In both cases the host was also infected with the fungus. Pneumocystis carinii, which is the most common lung parasite in Sorex araneus (the numerically dominant Eurasian species of shrew), was not found in any of the North American species of shrew examined in this study.

Pneumopatia por dermatófito em contato de paciente com a síndrome da imunodeficiência adquirida / Pneumopathy by dermatophyte in contact of patient with AIDS

Os autores relatam o isolamento de um dermatófito M. canis em três amostras de escarro de uma mulher de 41 anos, esposa de paciente portador da síndrome da imunodeficiência adquirida (AIDS), acompanhada no Centro de Referência para DST-AIDS (CSB-8) no Distrito Federal. O exame clínico da paciente, filhos (3) e parceiro mostrou presença de lesöes circinadas difusas em abdômen e membros. Em todo o material suspeito examinado foi isolado M. canis. Foram avaliados oito gatos (animais de convivência familiar) também com exames micológicos positivos. Na análises parasitológicas realizadas na paciente, parceiro e gatos detectou-se a presença de Cryptosporidium sp

[Pulmonary mycoses and parasitosis]. / Les mycoses et parasitoses pulmonaires.

Lungs can be the target of many fungal parasitic organisms. Some of them are specific to the lung (Pneumocystis); while others will migrate there in the course of their life cycle (Ascaris) or be caught in it (Paragonimus, Echinococcus). Sometimes, they also generate hypersensitivity reactions (fungi). In making a diagnosis one has to consider the present state of health or the disease history of the patient. A great number of parasites or mycetes are opportunist agents found in immuno-compromised patients. The epidemiological investigation giving details of a trip, even a long time ago, in a tropical region allows the suspicion of an imported parasitosis or an exotic mycosis. At present, we have on one hand, the mixing of populations, and on the other hand, many immuno-compromised situations which has given rise to a renewed interest in fungal and parasitic lung diseases.