Asunto(s)
COVID-19/complicaciones , Fibrinolíticos/uso terapéutico , Arteria Pulmonar , Venas Pulmonares , SARS-CoV-2 , Estreptoquinasa/uso terapéutico , Terapia Trombolítica , Trombosis/tratamiento farmacológico , Anciano , Anticuerpos Monoclonales Humanizados/uso terapéutico , COVID-19/sangre , COVID-19/terapia , Coinfección , Terapia Combinada , Femenino , Hemorragia/inducido químicamente , Humanos , Hipoxia/etiología , Enfermedades Pulmonares Fúngicas/complicaciones , Enfermedades Pulmonares Fúngicas/terapia , Masculino , Persona de Mediana Edad , Neumonía Bacteriana/complicaciones , Neumonía Bacteriana/terapia , Proteínas Recombinantes/efectos adversos , Proteínas Recombinantes/uso terapéutico , Respiración Artificial , Estreptoquinasa/efectos adversos , Trombofilia/etiología , Trombosis/etiologíaRESUMEN
BACKGROUND: A relevant case of pulmonary sporotrichosis due to Sporothrix brasiliensis is reported in a 50-year-old immunocompetent woman who had no history of skin trauma, but was in close contact with several stray cats at her nap time. The patient was hospitalized after 7 months of illness. The survey was conducted for pulmonary tuberculosis, an endemic disease in Brazil. She presented multiple central pulmonary nodules images, with central cavitation. METHODOLOGY/PRINCIPAL FINDINGS: The patient bronchoalveolar lavage was cultured and Sporothrix sp. growth was obtained. Then, the isolate (LMMM1097) was accurately identified to the species level by using species-specific polymerase chain reaction (PCR). Molecular diagnosis revealed that the emerging species Sporothrix brasiliensis was the agent of primary pulmonary sporotrichosis and the patient was treated with Amphotericin B lipid complex, but presented severe clinical symptoms and the fatal outcome was observed at day 25 after hospitalization. CONCLUSIONS/SIGNIFICANCE: Our report adds important contributions to the clinical-epidemiological features of sporotrichosis, showing the geographic expansion of the agent within different regions of Brazil and a rare clinical manifestation (primary pulmonary sporotrichosis) caused by the emerging agent S. brasiliensis in an immunocompetent female patient.
Asunto(s)
Enfermedades Pulmonares Fúngicas/patología , Sporothrix/clasificación , Esporotricosis/patología , Brasil , Resultado Fatal , Femenino , Humanos , Inmunocompetencia , Enfermedades Pulmonares Fúngicas/terapia , Persona de Mediana Edad , Sporothrix/aislamiento & purificación , Esporotricosis/terapiaRESUMEN
Several studies have shown the potential use of bone marrow mesenchymal stem cells (BM-MSCs) as a therapeutic approach to infectious diseases. Since BM-MSCs can exert antimicrobial properties and influence the immune response against pathogens, our aim was to study the antimicrobial therapeutic potential of BM-MSCs in an experimental model of paracoccidioidomycosis (PCM). BM-MSCs were isolated from BALB/c donor mice. Paracoccidioides brasiliensis-infected male BALB/c mice were injected with purified BM-MSCs at 8th week post-infection. Mice were sacrificed at 12th week post-infection. Homing of BM-MSCs was confirmed by cellular labeling with fluorescent lipophilic dye and detected by flow cytometry. We found that, in comparison with nontransplanted infected animals, BM-MSCs-treated and P. brasiliensis-infected mice showed a significant increase in (i) fungal burdens, (ii) neutrophils, eosinophils and M2 macrophages counts, and (iii) interleukin (IL)-6, IL-9, GM-CSF, CXCL1, CXCL9, and CCL5 levels, while presenting a decrease in M1 macrophages and Treg cells in lungs. In addition, the histopathological analysis of the lungs showed an increased inflammatory process. This is the first study to our knowledge that evaluates the effects of BM-MSCs treatment in PCM. Our results indicate that the immunoregulatory function of BM-MSCs may be triggered by the interaction with P. brasiliensis, which exacerbates chronic pulmonary inflammatory response.
Asunto(s)
Inflamación , Enfermedades Pulmonares Fúngicas/terapia , Células Madre Mesenquimatosas/fisiología , Paracoccidioides/inmunología , Paracoccidioidomicosis/terapia , Trasplante de Células Madre , Animales , Recuento de Colonia Microbiana , Citocinas/análisis , Modelos Animales de Enfermedad , Histocitoquímica , Recuento de Leucocitos , Pulmón/patología , Enfermedades Pulmonares Fúngicas/inmunología , Masculino , Ratones Endogámicos BALB C , Paracoccidioidomicosis/inmunologíaRESUMEN
Bone marrow-derived mesenchymal stem cells (BMMSCs) have been consider as a promising therapy in fibrotic diseases. Experimental models suggest that BMMSCs may be used as an alternative therapy to treat chemical- or physical-induced pulmonary fibrosis. We investigated the anti-fibrotic potential of BMMSCs in an experimental model of lung fibrosis by infection with Paracoccidioides brasiliensis. BMMSCs were isolated and purified from BALB/c mice using standardized methods. BALB/c male mice were inoculated by intranasal infection of 1.5x106 P. brasiliensis yeasts. Then, 1x106 BMMSCs were administered intra venous at 8th week post-infection (p.i.). An additional group of mice was treated with itraconazole (ITC) two weeks before BMMSCs administration. Animals were sacrificed at 12th week p.i. Histopathological examination, fibrocytes counts, soluble collagen and fibrosis-related genes expression in lungs were evaluated. Additionally, human fibroblasts were treated with homogenized lung supernatants (HLS) to determine induction of collagen expression. Histological analysis showed an increase of granulomatous inflammatory areas in BMMSCs-treated mice. A significant increase of fibrocytes count, soluble collagen and collagen-3α1, TGF-ß3, MMP-8 and MMP-15 genes expression were also observed in those mice. Interestingly, when combined therapy BMMSCs/ITC was used there is a decrease of TIMP-1 and MMP-13 gene expression in infected mice. Finally, human fibroblasts stimulated with HLS from infected and BMMSCs-transplanted mice showed a higher expression of collagen I. In conclusion, our findings indicate that late infusion of BMMSCs into mice infected with P. brasiliensis does not have any anti-fibrotic effect; possibly because their interaction with the fungus promotes collagen expression and tissue remodeling.
Asunto(s)
Células de la Médula Ósea , Enfermedades Pulmonares Fúngicas/terapia , Trasplante de Células Madre Mesenquimatosas , Células Madre Mesenquimatosas , Paracoccidioidomicosis/terapia , Fibrosis Pulmonar/etiología , Animales , Modelos Animales de Enfermedad , Fibrosis/prevención & control , Enfermedades Pulmonares Fúngicas/patología , Masculino , Ratones , Ratones Endogámicos BALB C , Paracoccidioidomicosis/patologíaRESUMEN
Coccidioidomycosis is a highly prevalent disease in the Western hemisphere. It is considered one of the most virulent primary fungal infections. Coccidioides species live in arid and semi-arid regions, causing mainly pulmonary infection through inhalation of arthroconidia although many other organs can be affected. Primary inoculation is rare. Since the first case of coccidioidomycosis was reported in 1892, the skin has been identified as an important target of this disease. Knowledge of cutaneous clinical forms of this infection is important and very useful for establishing prompt diagnosis and treatment. The purpose of this article is to provide a review of this infection, emphasizing its cutaneous manifestations, diagnostic methods and current treatment.
Asunto(s)
Coccidioidomicosis/patología , Dermatomicosis/patología , Coccidioidomicosis/clasificación , Coccidioidomicosis/terapia , Dermatomicosis/terapia , Femenino , Humanos , Enfermedades Pulmonares Fúngicas/patología , Enfermedades Pulmonares Fúngicas/terapia , Masculino , Factores de Riesgo , Piel/patologíaRESUMEN
AbstractCoccidioidomycosis is a highly prevalent disease in the Western hemisphere. It is considered one of the most virulent primary fungal infections. Coccidioides species live in arid and semi-arid regions, causing mainly pulmonary infection through inhalation of arthroconidia although many other organs can be affected. Primary inoculation is rare. Since the first case of coccidioidomycosis was reported in 1892, the skin has been identified as an important target of this disease. Knowledge of cutaneous clinical forms of this infection is important and very useful for establishing prompt diagnosis and treatment. The purpose of this article is to provide a review of this infection, emphasizing its cutaneous manifestations, diagnostic methods and current treatment.
Asunto(s)
Femenino , Humanos , Masculino , Coccidioidomicosis/patología , Dermatomicosis/patología , Coccidioidomicosis/clasificación , Coccidioidomicosis/terapia , Dermatomicosis/terapia , Enfermedades Pulmonares Fúngicas/patología , Enfermedades Pulmonares Fúngicas/terapia , Factores de Riesgo , Piel/patologíaRESUMEN
Mucormycosis is a rare opportunistic fungal infection caused by saprophytic zygomycetes. These fungal infections are caused by members of the mucorales. The clinical importance of zygomycosis, an emerging and frequently fatal mycotic disease, has increased during recent years, due to several risk factors such as (a) the use of broad-spectrum antibiotic, (b) use of empirical antifungal treatment (mainly triazoles), and (c) aggressive chemotherapy and sustained leucopenia (i.e., peripheral stem cell transplantation). An almost fulminant pneumonia caused by Syncephalastrum racemosum in an immunocompromised patient with an aggressive non-Hodgkin lymphoma (NHL) is described. Despite treatment with amphotericin B, deoxycholate, caspofungin, and surgical resection of fungal bodies from both lungs, and survival of 10 months without relapsing from fungal infection, the patient died due to hematological complications from an unresponsive disease. Herein is the description of the first case of pulmonary infection caused by Syncephalastrum racemosum.
Asunto(s)
Enfermedades Pulmonares Fúngicas/diagnóstico , Enfermedades Pulmonares Fúngicas/patología , Linfoma no Hodgkin/complicaciones , Mucorales/aislamiento & purificación , Mucormicosis/diagnóstico , Mucormicosis/patología , Adulto , Antifúngicos/uso terapéutico , Desbridamiento , Femenino , Histocitoquímica , Humanos , Huésped Inmunocomprometido , Enfermedades Pulmonares Fúngicas/microbiología , Enfermedades Pulmonares Fúngicas/terapia , Microscopía , Mucormicosis/microbiología , Mucormicosis/terapiaRESUMEN
OBJECTIVE: The purpose of this study was to evaluate the clinical and radiological features of patients with fungal infection mimicking thoracic malignancy and to establish a diagnostic approach for both clinicians and radiologists to avoid misdiagnosis. METHODS: In this retrospective study, we reviewed clinical and computed tomography (CT) findings from 27 patients who presented with suspicion of thoracic malignancy who were ultimately diagnosed with fungal disease. RESULTS: Patients' median age was 55.7 (range 31-78) years. The most common clinical findings were cough (48.1 %), expectoration (33.3 %), chest pain (25.9 %), weakness (25.9 %), weight loss (18.5 %), and hemoptysis, dyspnea, and fever (7.4 % each). The median lesion size was 35.5 (range 10-85) mm. CT findings included a solid nodule (51.9 %), solid mass (37 %), or both (11.1 %). Nodule and mass margins were lobulated in 9 (33.3 %) patients, ill-defined in 5 (18.5 %), spiculated in 4 (14.8 %), and smooth in 4 (14.8 %) patients. Additional findings included consolidation in 4 (14.8 %) patients, cavitation in 3 (11.1 %), pleural effusion in 2 (7.4 %), and lymphadenopathy in 11 (40.7 %) patients. In all patients, specific diagnoses were made and confirmed by histopathology; final diagnoses were histoplasmosis (25.9 %), coccidiomycosis (22.2 %), cryptococcosis (22.2 %), aspergillosis (14.8 %), North American blastomycosis (7.4 %), mucormycosis (3.75 %), and paracoccidioidomycosis (3.75 %). CONCLUSIONS: Fungal infection can present with clinical and radiological features that are indistinguishable from thoracic malignancy, such as lung nodules or masses. Because the management and outcomes of fungal infection and malignancy are entirely distinct, the establishment of a specific diagnosis is critical to provide appropriate therapy.
Asunto(s)
Enfermedades Pulmonares Fúngicas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Adulto , Anciano , Biopsia , Brasil , Diagnóstico Diferencial , Errores Diagnósticos/prevención & control , Femenino , Humanos , Enfermedades Pulmonares Fúngicas/complicaciones , Enfermedades Pulmonares Fúngicas/diagnóstico por imagen , Enfermedades Pulmonares Fúngicas/patología , Enfermedades Pulmonares Fúngicas/terapia , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/terapia , Masculino , Persona de Mediana Edad , Imagen Multimodal/métodos , Tomografía de Emisión de Positrones , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Texas , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: In Argentina, there are no reports of autochthonous cases of histoplasmosis in the southern regions of the country. AIM: To report a histoplasmosis outbreak in Zapala town, Province of Neuquén, Patagonia Argentina. METHODS: We evaluated the clinical and epidemiological characteristics of 5 patients involved in the outbreak. Environmental studies were conducted to determine the source of infection. The genetic profile of Histoplasma capsulatum strains isolated from the index case (IC) were compared with clinical isolates from Argentinean patients not related to the outbreak, using RAPD-PCR with primers 1281-1283. RESULTS: The patients were residents of Zapala, and had not visited other geographical areas before. All patients had an influenza-like syndrome, and X-ray revealed disseminated micronodular images throughout the lung parenchyma. The IC needed specific antifungal therapy; the remaining 4 patients had mild symptoms, and did not require therapy. All of them had a good clinical outcome. Strains of H. capsulatum isolated from blood culture and lung biopsy of the IC showed a genetic profile different from other strains analyzed. The presence of the fungus in the environment was demonstrated by the detection of anti-Histoplasma antibodies in BALB/c mice inoculated with soil obtained in a culvert where workers had dug up earth after a landslide. CONCLUSIONS: This outbreak suggests the histoplasmosis endemic area is under the 38° S parallel. Patients from Neuquén, Patagonia Argentina, with compatible symptoms of histoplasmosis should be tested, regardless of their travel or exposure history.
Asunto(s)
Brotes de Enfermedades , Fungemia/epidemiología , Histoplasmosis/epidemiología , Enfermedades Pulmonares Fúngicas/epidemiología , Adulto , Animales , Anticuerpos Antifúngicos/sangre , Antifúngicos/uso terapéutico , Argentina/epidemiología , Terapia Combinada , Industria de la Construcción , ADN de Hongos/análisis , Diagnóstico Diferencial , Enfermedades Endémicas , Fungemia/tratamiento farmacológico , Fungemia/microbiología , Histoplasma/clasificación , Histoplasma/genética , Histoplasma/aislamiento & purificación , Histoplasmosis/diagnóstico por imagen , Histoplasmosis/terapia , Humanos , Enfermedades Pulmonares Fúngicas/diagnóstico por imagen , Enfermedades Pulmonares Fúngicas/terapia , Masculino , Ratones , Ratones Endogámicos C57BL , Persona de Mediana Edad , Exposición Profesional , Terapia por Inhalación de Oxígeno , Filogenia , Técnica del ADN Polimorfo Amplificado Aleatorio , Microbiología del SueloRESUMEN
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.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Criptococosis/diagnóstico , Cryptococcus neoformans/aislamiento & purificación , Enfermedades Pulmonares Fúngicas/diagnóstico , Antifúngicos/uso terapéutico , Terapia Combinada , Criptococosis/terapia , Fluconazol/uso terapéutico , Enfermedades Pulmonares Fúngicas/microbiología , Enfermedades Pulmonares Fúngicas/terapia , Pronóstico , Pirimidinas/uso terapéutico , Estudios Retrospectivos , Toracotomía , Tomografía Computarizada por Rayos X , Triazoles/uso terapéuticoRESUMEN
Mucormycosis is an uncommon but fatal fungal infection of airborne transmission. Its is usually seen in immunocompromised patients including diabetics, malignancies, transplant patients and renal insufficiency. We review the case of an immunocompromised patient unresponsive to broad-spectrum antibiotics and conventional antifungal therapy with lung mucormycosis.
Asunto(s)
Huésped Inmunocomprometido , Enfermedades Pulmonares Fúngicas , Mucormicosis , Anciano de 80 o más Años , Resultado Fatal , Humanos , Enfermedades Pulmonares Fúngicas/diagnóstico , Enfermedades Pulmonares Fúngicas/terapia , Masculino , Mucormicosis/diagnóstico , Mucormicosis/terapiaRESUMEN
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.
Asunto(s)
Criptococosis/diagnóstico , Cryptococcus neoformans/aislamiento & purificación , Enfermedades Pulmonares Fúngicas/diagnóstico , Adulto , Anciano , Antifúngicos/uso terapéutico , Terapia Combinada , Criptococosis/terapia , Femenino , Fluconazol/uso terapéutico , Humanos , Enfermedades Pulmonares Fúngicas/microbiología , Enfermedades Pulmonares Fúngicas/terapia , Masculino , Persona de Mediana Edad , Pronóstico , Pirimidinas/uso terapéutico , Estudios Retrospectivos , Toracotomía , Tomografía Computarizada por Rayos X , Triazoles/uso terapéutico , Voriconazol , Adulto JovenRESUMEN
Zygomycosis (mucormycosis) is a rare but highly invasive infection caused by fungi belonging to the order Mucorales, which includes the genera Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Saksenaea, Cunninghamella, Cokeromyces and Syncephalastrum. This type of infection is usually associated with hematologic diseases, diabetic ketoacidosis and organ transplantation. The most common form of presentation is rhinocerebral mucormycosis, with or without pulmonary involvement. Pulmonary zygomycosis is more common in patients with profound, prolonged neutropenia and can present as segmental or lobar infiltrates, isolated nodules, cavitary lesions, hemorrhage or infarction. The clinical and radiological manifestations are often indistinguishable from those associated with invasive aspergillosis. This article describes the general characteristics of pulmonary zygomycosis, emphasizing laboratory diagnosis, and illustrates the morphology of some lesions.
Asunto(s)
Enfermedades Pulmonares Fúngicas , Cigomicosis , Diagnóstico Diferencial , Técnicas de Diagnóstico del Sistema Respiratorio/clasificación , Humanos , Enfermedades Pulmonares Fúngicas/diagnóstico , Enfermedades Pulmonares Fúngicas/microbiología , Enfermedades Pulmonares Fúngicas/terapia , Aspergilosis Pulmonar/diagnóstico , Cigomicosis/diagnóstico , Cigomicosis/microbiología , Cigomicosis/terapiaRESUMEN
A zigomicose (mucormicose) é uma infecção rara, mas altamente invasiva, causada por fungos da ordem Mucorales (gêneros Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Saksenaea, Cunninghamella, Cokeromyces e Syncephalastrum). Esse tipo de infecção é usualmente associado a doenças hematológicas, cetoacidose diabética e transplante de órgãos. A apresentação clínica mais frequente é a mucormicose rinocerebral, com ou sem envolvimento pulmonar. A zigomicose pulmonar ocorre mais frequentemente em pacientes com neutropenia profunda e prolongada e pode se apresentar como infiltrado lobar ou segmentar, nódulos isolados, lesões cavitárias, hemorragia ou infarto. As manifestações clínicas e radiológicas são na maioria dos casos indistinguíveis daquelas associadas com aspergilose invasiva. Este artigo descreve as características gerais da zigomicose pulmonar, com ênfase no diagnóstico laboratorial, e ilustra a morfologia de algumas lesões.
Zygomycosis (mucormycosis) is a rare but highly invasive infection caused by fungi belonging to the order Mucorales, which includes the genera Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Saksenaea, Cunninghamella, Cokeromyces and Syncephalastrum. This type of infection is usually associated with hematologic diseases, diabetic ketoacidosis and organ transplantation. The most common form of presentation is rhinocerebral mucormycosis, with or without pulmonary involvement. Pulmonary zygomycosis is more common in patients with profound, prolonged neutropenia and can present as segmental or lobar infiltrates, isolated nodules, cavitary lesions, hemorrhage or infarction. The clinical and radiological manifestations are often indistinguishable from those associated with invasive aspergillosis. This article describes the general characteristics of pulmonary zygomycosis, emphasizing laboratory diagnosis, and illustrates the morphology of some lesions.
Asunto(s)
Humanos , Enfermedades Pulmonares Fúngicas , Cigomicosis , Diagnóstico Diferencial , Técnicas de Diagnóstico del Sistema Respiratorio/clasificación , Enfermedades Pulmonares Fúngicas/diagnóstico , Enfermedades Pulmonares Fúngicas/microbiología , Enfermedades Pulmonares Fúngicas/terapia , Aspergilosis Pulmonar/diagnóstico , Cigomicosis/diagnóstico , Cigomicosis/microbiología , Cigomicosis/terapiaRESUMEN
Histoplamosis is the most common primary systemic mycosis in the USA and is becoming more common as an opportunistic infection in HIV patients worldwide. In children the rate of asymptomatic infection is high. However, in infants with an immature immunological system, disseminated disease may occur. The clinical picture is variable depending on the immunological status. At the onset of the infection clinical manifestations are non specific (headache, fever, cough and nausea). Usually, these symptoms are self-limited and improve without treatment. However, patients with disseminated diseases present with prolonged fever, malaise, cough and weight loss. Hepatosplenomegaly is frequent in infants. Chest radiographs may be normal in 40 to 50% of patients with disseminated disease but findings such as lobar or diffuse infiltrates, cavitations, hilar adenopathy, or any combination of these may be found. Frequently, the clinical presentation is misdiagnosed as tuberculosis. Skin tests, serological reaction and specific cultures are used for diagnosis confirmation. Treatment indications and regimens are similar to those for adults, except that amphotericin B deoxycholate is usually well tolerated in children.
Asunto(s)
Histoplasmosis , Enfermedades Pulmonares Fúngicas , Diagnóstico Diferencial , Histoplasmosis/diagnóstico , Histoplasmosis/epidemiología , Histoplasmosis/terapia , Humanos , Enfermedades Pulmonares Fúngicas/diagnóstico , Enfermedades Pulmonares Fúngicas/epidemiología , Enfermedades Pulmonares Fúngicas/terapiaRESUMEN
Os autores relatam um caso de paciente do sexo masculino, 38 anos de idade, motorista, soropositivo para HIV há oito anos, sem acompanhamento, com quadro de tosse produtiva com secrecão acinzentada e episódios intermitentes de dispnéia há 15 dias. Informava dois episódios pregressos de tuberculose pulmonar (1983 e 2001) tratados. A radiografia de tórax evidenciou áreas de hipotransparência nodular e broncogramas aéreos bilateralmente. A tomografia computadorizada de tórax evidenciou vários achados inespecíficos, dentre eles áreas esparsas de consolidacão, cavitacão, bronquiectasia, opacidade em vidro fosco, espessamento intersticial e broncogramas aéreos. A lavagem broncoalveolar evidenciou numerosas hifas com raros septos bifurcados sugestivos de Aspergillus sp. e a cultura foi positiva para Nocardia sp. e Mycobacterium tuberculosis. Foi instituída terapia com anfotericina B, sulfametoxazol-trimetoprim e anti-retrovirais. Após 20 dias, recebeu alta sem queixas pulmonares. Decorridos 15 dias, retornou com diarréia, febre, disfagia e emagrecimento importante. Foi a óbito após cinco dias, por sepse estafilocócica.
Asunto(s)
Humanos , Masculino , Adulto , Aspergilosis , VIH , Enfermedades Pulmonares Fúngicas , Enfermedades Pulmonares Fúngicas/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Anfotericina B/administración & dosificación , Nocardiosis/terapia , Enfermedades Pulmonares Fúngicas/terapiaRESUMEN
La criptococosis pulmonar diseminada en pacientes HIV negativos es infrecuente, aunque otras causas de inmunocompromiso pueden facilitarla. Dada la potencial letalidad de este cuadro se requiere un alto nivel de sospecha clínica para instaurar el tratamiento adecuado en el momento oportuno. Se presenta el caso de una mujer de 84 años, con antecedente de neoplasia hematológica (AREBT) y tratamiento crónico con glucocorticoides que ingresa por un cuadro de disnea progresiva hasta CF IV y desarrolla posteriormente insuficiencia respiratoria, síndrome de distress respiratorio agudo y shock refractario falleciendo a las 48 horas. Posteriormente se obtuvo rescate de Criptococo neoformans en hemocultivos y el análisis anatomopatológico del material pulmonar obtenido postmortem fue compatible con daño alveolar difuso y criptococosis pulmonar.
Asunto(s)
Humanos , Femenino , Anciano , Criptococosis/diagnóstico , Enfermedades Pulmonares Fúngicas/diagnóstico , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Enfermedades Pulmonares Fúngicas/terapia , Antibacterianos/uso terapéutico , Seronegatividad para VIH , Terapia por Inhalación de OxígenoRESUMEN
La criptococosis pulmonar diseminada en pacientes HIV negativos es infrecuente, aunque otras causas de inmunocompromiso pueden facilitarla. Dada la potencial letalidad de este cuadro se requiere un alto nivel de sospecha clínica para instaurar el tratamiento adecuado en el momento oportuno. Se presenta el caso de una mujer de 84 años, con antecedente de neoplasia hematológica (AREBT) y tratamiento crónico con glucocorticoides que ingresa por un cuadro de disnea progresiva hasta CF IV y desarrolla posteriormente insuficiencia respiratoria, síndrome de distress respiratorio agudo y shock refractario falleciendo a las 48 horas. Posteriormente se obtuvo rescate de Criptococo neoformans en hemocultivos y el análisis anatomopatológico del material pulmonar obtenido postmortem fue compatible con daño alveolar difuso y criptococosis pulmonar. (AU)
Asunto(s)
Humanos , Femenino , Anciano , Criptococosis/diagnóstico , Enfermedades Pulmonares Fúngicas/diagnóstico , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Enfermedades Pulmonares Fúngicas/terapia , Seronegatividad para VIH , Antibacterianos/uso terapéutico , Terapia por Inhalación de OxígenoRESUMEN
We report here a case of pulmonary aspergilloma in a patient with acute myeloblastic leukemia. We present the clinical and radiological characteristics of this case. Aspergillus flavus was isolated. The antifungal treatment was unsuccessful. Pulmonary aspergillomas are associated with a high mortality in the immunocompromised host. It is important to know the diagnostic approach and the surgical and medical treatment of this disease.