1
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Febbo J, Dako F. Pulmonary Infection. Clin Chest Med 2024; 45:373-382. [PMID: 38816094 DOI: 10.1016/j.ccm.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Pneumonia is a significant cause of morbidity and mortality in the community and hospital settings. Bacterial, viral, mycobacterial, and fungal pathogens are all potential causative agents of pulmonary infection. Chest radiographs and computed tomography are frequently utilized in the assessment of pneumonia. Learning the imaging patterns of different potential organisms allows the radiologist to formulate an appropriate differential diagnosis. An organism-based approach is used to discuss the imaging findings of different etiologies of pulmonary infection.
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Affiliation(s)
- Jennifer Febbo
- Department of Radiology, University of New Mexico, 2211 Lomas Boulevard NE, Albuquerque, NM 87106, USA.
| | - Farouk Dako
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Donner 1, Philadelphia, PA 19104, USA
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2
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Onder RO, Agca Nasuhbeyoglu E, Bekci T. Pulmonary Histoplasmosis Mimicking Lung Cancer. J Belg Soc Radiol 2024; 108:43. [PMID: 38680724 PMCID: PMC11049679 DOI: 10.5334/jbsr.3563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/07/2024] [Indexed: 05/01/2024] Open
Abstract
Teaching point: Due to the mass-like appearance of pulmonary histoplasmosis in the lung, radiological misdiagnosis may occur. Fungal infections should be considered in the differential diagnosis, especially in immune-compromised patients.
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Affiliation(s)
- Ramazan Orkun Onder
- Faculty of Medicine, Department of Radiology, Giresun University, Giresun, Turkey
| | | | - Tümay Bekci
- Faculty of Medicine, Department of Radiology, Giresun University, Giresun, Turkey
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3
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Wolfenbarger B, Britt E. A Case of Pulmonary Cryptococcosis Caused by Capsule-Deficient Cryptococcus neoformans. Cureus 2023; 15:e48196. [PMID: 38054144 PMCID: PMC10694392 DOI: 10.7759/cureus.48196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/03/2023] [Indexed: 12/07/2023] Open
Abstract
Cryptococcosis, a fungal infection primarily caused by Cryptococcus neoformans (CN), is a significant concern for immunocompromised individuals. This paper presents a case of a 51-year-old immunocompromised male who initially presented with symptoms suggestive of community-acquired pneumonia but was later diagnosed with pulmonary cryptococcosis caused by capsule-deficient CN. The patient's exposure to construction dust, coupled with his immunocompromised state due to immunosuppressive treatment for psoriatic arthritis, likely contributed to his susceptibility. The unique presentation of the disease, due to the absence of the characteristic thick capsule, presented a diagnostic challenge. A brief review is provided looking at the mechanism, pathogenesis, and implications of capsule deficiency in CN. The case provides an example of one of the many presentations of cryptococcosis, especially in immunocompromised individuals, and highlights the diagnostic complexities of capsule-deficient CN strains.
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Affiliation(s)
| | - Erin Britt
- Internal Medicine, Cullman Internal Medicine, Cullman, USA
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4
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Sousa C, Pasini RA, Pasqualotto A, Marchiori E, Altmayer S, Irion K, Mançano A, Hochhegger B. Imaging Findings in Aspergillosis: From Head to Toe. Mycopathologia 2023; 188:623-641. [PMID: 37380874 DOI: 10.1007/s11046-023-00766-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/16/2023] [Indexed: 06/30/2023]
Abstract
Aspergillosis is a mycotic infection induced by airborne fungi that are ubiquitous. Inhalation of Aspergillus conidia results in transmission through the respiratory tract. The clinical presentation is dependent on organism and host specifics, with immunodeficiency, allergies, and preexisting pulmonary disease constituting the most important risk factors. In recent decades, the incidence of fungal infections has increased dramatically, due in part to the increased number of transplants and the pervasive use of chemotherapy and immunosuppressive drugs. The spectrum of clinical manifestations can range from an asymptomatic or mild infection to a swiftly progressive, life-threatening illness. Additionally, invasive infections can migrate to extrapulmonary sites, causing infections in distant organs. Recognition and familiarity with the various radiological findings in the appropriate clinical context are essential for patient management and the prompt initiation of life-saving treatment. We discuss the radiological characteristics of chronic and invasive pulmonary aspergillosis, as well as some of the typically unexpected extrapulmonary manifestations of disseminated disease.
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Affiliation(s)
- Célia Sousa
- Radiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | | | - Alessandro Pasqualotto
- Radiology Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Edson Marchiori
- Radiology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Klaus Irion
- Radiology Department, University of Florida, Gainesville, FL, USA
| | | | - Bruno Hochhegger
- Radiology Department, University of Florida, Gainesville, FL, USA.
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5
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Abuladze LR, Blokhin IA, Gonchar AP, Suchilova MM, Vladzymyrskyy AV, Gombolevskiy VA, Balanyuk EA, Ni OG, Troshchansky DV, Reshetnikov RV. CT imaging of HIV-associated pulmonary disorders in COVID-19 pandemic. Clin Imaging 2023; 95:97-106. [PMID: 36706642 PMCID: PMC9846904 DOI: 10.1016/j.clinimag.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/30/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023]
Affiliation(s)
- Liya R. Abuladze
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, 127051 Moscow, 24, Petrovka str. 1, Russian Federation,The Vishnevsky Nаtionаl Mediсаl Reseаrсh Сenter of Surgery, 117997 Mosсow, Bol. Serpukhovskаyа str., 27, Russian Federation,Corresponding author at: Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, 127051 Moscow, 24, Petrovka str. 1, Russian Federation
| | - Ivan A. Blokhin
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, 127051 Moscow, 24, Petrovka str. 1, Russian Federation
| | - Anna P. Gonchar
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, 127051 Moscow, 24, Petrovka str. 1, Russian Federation
| | - Maria M. Suchilova
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, 127051 Moscow, 24, Petrovka str. 1, Russian Federation
| | - Anton V. Vladzymyrskyy
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, 127051 Moscow, 24, Petrovka str. 1, Russian Federation,I.M. Sechenov First Moscow State Medical University (Sechenov University), 8, Trubetskaya str. 2, 119991 Moscow, Russian Federation
| | - Victor A. Gombolevskiy
- Artificial Intelligence Research Institute (AIRI), 121170, Kutuzovsky pr. 32, 1, Moscow, Russian Federation
| | - Eleonora A. Balanyuk
- Clinic of Aesthetic Medicine “Olymp Clinic”, 129090, 7, Sadovaya-Sukharevskaya str.1, Moscow, Russian Federation
| | - Oksana G. Ni
- City Clinical Hospital №40, Moscow Health Care Department, 8 Sosensky stan, Kommunarka settlement, 129301 Moscow, Russian Federation
| | - Dmitry V. Troshchansky
- City Clinical Hospital №40, Moscow Health Care Department, 8 Sosensky stan, Kommunarka settlement, 129301 Moscow, Russian Federation
| | - Roman V. Reshetnikov
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, 127051 Moscow, 24, Petrovka str. 1, Russian Federation
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Sousa C, Marchiori E, Youssef A, Mohammed TL, Patel P, Irion K, Pasini R, Mançano A, Souza A, Pasqualotto AC, Hochhegger B. Chest Imaging in Systemic Endemic Mycoses. J Fungi (Basel) 2022; 8:1132. [PMID: 36354899 PMCID: PMC9692403 DOI: 10.3390/jof8111132] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/14/2022] [Accepted: 10/24/2022] [Indexed: 09/20/2023] Open
Abstract
Endemic fungal infections are responsible for high rates of morbidity and mortality in certain regions of the world. The diagnosis and management remain a challenge, and the reason could be explained by the lack of disease awareness, variability of symptoms, and insidious and often overlooked clinical presentation. Imaging findings are nonspecific and frequently misinterpreted as other more common infectious or malignant diseases. Patient demographics and clinical and travel history are important clues that may lead to a proper diagnosis. The purpose of this paper is to review the presentation and differential diagnosis of endemic mycoses based on the most common chest imaging findings.
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Affiliation(s)
- Célia Sousa
- Radiology Department, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
| | - Edson Marchiori
- Radiology Department, Universidade Federal de Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | - Ali Youssef
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Tan-Lucien Mohammed
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Pratik Patel
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Klaus Irion
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Romulo Pasini
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Alexandre Mançano
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Arthur Souza
- Radiology Department, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto 15090-000, Brazil
| | | | - Bruno Hochhegger
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
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7
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Wang C, You Z, Fu J, Chen S, Bai D, Zhao H, Song P, Jia X, Yuan X, Xu W, Zhao Q, Pang F. Application of metagenomic next-generation sequencing in the diagnosis of pulmonary invasive fungal disease. Front Cell Infect Microbiol 2022; 12:949505. [PMID: 36237437 PMCID: PMC9551268 DOI: 10.3389/fcimb.2022.949505] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/05/2022] [Indexed: 12/16/2022] Open
Abstract
BackgroundMetagenomic next-generation sequencing (mNGS) is increasingly being used to detect pathogens directly from clinical specimens. However, the optimal application of mNGS and subsequent result interpretation can be challenging. In addition, studies reporting the use of mNGS for the diagnosis of invasive fungal infections (IFIs) are rare.ObjectiveWe critically evaluated the performance of mNGS in the diagnosis of pulmonary IFIs, by conducting a multicenter retrospective analysis. The methodological strengths of mNGS were recognized, and diagnostic cutoffs were determined.MethodsA total of 310 patients with suspected pulmonary IFIs were included in this study. Conventional microbiological tests (CMTs) and mNGS were performed in parallel on the same set of samples. Receiver operating characteristic (ROC) curves were used to evaluate the performance of the logarithm of reads per kilobase per million mapped reads [lg(RPKM)], and read counts were used to predict true-positive pathogens.ResultThe majority of the selected patients (86.5%) were immunocompromised. Twenty species of fungi were detected by mNGS, which was more than was achieved with standard culture methods. Peripheral blood lymphocyte and monocyte counts, as well as serum albumin levels, were significantly negatively correlated with fungal infection. In contrast, C-reactive protein and procalcitonin levels showed a significant positive correlation with fungal infection. ROC curves showed that mNGS [and especially lg(RPKM)] was superior to CMTs in its diagnostic performance. The area under the ROC curve value obtained for lg(RPKM) in the bronchoalveolar lavage fluid of patients with suspected pulmonary IFIs, used to predict true-positive pathogens, was 0.967, and the cutoff value calculated from the Youden index was −5.44.ConclusionsIn this study, we have evaluated the performance of mNGS-specific indicators that can identify pathogens in patients with IFIs more accurately and rapidly than CMTs, which will have important clinical implications.
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Affiliation(s)
- Chengtan Wang
- Department of Clinical Laboratory, Liaocheng People’s Hospital, Liaocheng, China
| | - Zhiqing You
- Department of Clinical Laboratory, Liaocheng People’s Hospital, Liaocheng, China
| | - Juanjuan Fu
- Department of Clinical Laboratory, Liaocheng People’s Hospital, Liaocheng, China
| | - Shuai Chen
- Department of Clinical Laboratory, Liaocheng Third People’s Hospital, Liaocheng, China
- Department of Virology, School of Public Health, Shandong University, Jinan, China
| | - Di Bai
- Department of Clinical Laboratory, Liaocheng Third People’s Hospital, Liaocheng, China
| | - Hui Zhao
- Department of Clinical Laboratory, Liaocheng People’s Hospital, Liaocheng, China
| | - Pingping Song
- Department of Clinical Laboratory, Liaocheng People’s Hospital, Liaocheng, China
| | - Xiuqin Jia
- The Key Laboratory of Molecular Pharmacology, Liaocheng People’s Hospital, Liaocheng, China
| | - Xiaoju Yuan
- Department of Gastroenterology, Liaocheng People’s Hospital, Liaocheng, China
| | - Wenbin Xu
- Department of Clinical Laboratory, Liaocheng People’s Hospital, Liaocheng, China
| | - Qigang Zhao
- Department of Clinical Laboratory, Liaocheng People’s Hospital, Liaocheng, China
- *Correspondence: Feng Pang, ; Qigang Zhao,
| | - Feng Pang
- Department of Clinical Laboratory, Liaocheng People’s Hospital, Liaocheng, China
- *Correspondence: Feng Pang, ; Qigang Zhao,
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8
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Ong CC, Teo LL. Endemic Thoracic Infections in Southeast Asia. Radiol Clin North Am 2022; 60:445-459. [DOI: 10.1016/j.rcl.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Imaging features of fungal pneumonia in haematopoietic stem cell transplant patients. Pol J Radiol 2021; 86:e335-e343. [PMID: 34322182 PMCID: PMC8297485 DOI: 10.5114/pjr.2021.107057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/23/2020] [Indexed: 01/15/2023] Open
Abstract
Patients who have received haematopoietic stem cell transplantation (HSCT) have a high rate of pulmonary complications, and in this immunosuppressed population, fungal pneumonia is of great concern. Fungal pneumonia can have a similar appearance to non-infectious pulmonary processes in HSCT patients, and radiologists should be familiar with the subtle features that may help to differentiate these disease entities. The focus of this article is on the diagnosis of fungal pneumonia in HSCT patients with an emphasis on radiologists’ roles in establishing the diagnosis of fungal pneumonia and the guidance of clinical management.
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10
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Cordeiro R, Moura S, Castelo-Branco D, Rocha MF, Lima-Neto R, Sidrim JJ. Coccidioidomycosis in Brazil: Historical Challenges of a Neglected Disease. J Fungi (Basel) 2021; 7:85. [PMID: 33513773 PMCID: PMC7911456 DOI: 10.3390/jof7020085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/11/2021] [Accepted: 01/19/2021] [Indexed: 11/16/2022] Open
Abstract
Coccidioidomycosis is a deep-seated fungal infection that occurs exclusively in semiarid areas in the Americas. In Brazil, coccidioidomycosis occurs exclusively in rural areas in the northeast region and affects counties that are hit by recurrent droughts, poverty and economic stagnation. Since 1978, approximately 136 cases of the disease have been reported in Brazil, according to scientific publications. However, a lack of governmental epidemiological data as well as a similarity to tuberculosis have led scientists and experts to assume that a greater number of cases occur in the country, which are not diagnosed and/or reported. In this review, general characteristics of coccidioidomycosis are presented, followed by a description of the main clinical and epidemiological data of cases in Brazil. The purpose of this article is to discuss the inclusion of coccidioidomycosis in the list of neglected tropical diseases. We believe that the adoption of coccidioidomycosis as a neglected tropical disease will enable the creation of an effective epidemiological surveillance system and the development of feasible public health solutions for its control in vulnerable populations.
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Affiliation(s)
- Rossana Cordeiro
- Department of Pathology, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-270, Brazil
| | - Santiago Moura
- Department of Pathology, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-270, Brazil
| | - Débora Castelo-Branco
- Department of Pathology, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-270, Brazil
| | - Marcos Fábio Rocha
- Department of Pathology, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-270, Brazil
- Postgraduate Program in Veterinary Sciences, School of Veterinary Medicine, Ceará State University, Fortaleza 60740-000, Brazil
| | - Reginaldo Lima-Neto
- Center of Medical Sciences, Department of Tropical Medicine, Federal University of Pernambuco (UFPE), Recife-PE 50740-600, Brazil
| | - José Júlio Sidrim
- Department of Pathology, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-270, Brazil
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11
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Etiological profile and main imaging findings in patients with granulomatous diseases who underwent lung biopsy. Eur J Radiol Open 2021; 8:100325. [PMID: 33521170 PMCID: PMC7820493 DOI: 10.1016/j.ejro.2021.100325] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 01/26/2023] Open
Abstract
Background Granulomatous Lung Diseases (GLD) encompasses a wide range of infectious and non-infectious conditions characterized by chronic inflammatory response. However, different GLD may share similar imaging findings. In this context, the purpose of this study was to outline the etiological profile and their imaging features in patients with GLD who underwent lung biopsy. Methods Patients with granulomatous lesions in lung biopsies and previous chest CT performed from 2014 to 2017 at our institution had imaging data reviewed by three blinded radiologists. The imaging features were analyzed according to the Fleischner Society glossary. Categorical data were represented by absolute (n) and relative (%) frequency. The contingency matrices were analyzed by Pearson's Chi-square test. Interreader agreement was assessed by calculating the intraclass correlation coefficient, using kappa (κ) statistic. Results Thirty-eight of 75 (50.7%) patients were women with a mean age of 59 ± 39 years. Infection was the most common cause of GLD (47/75, 62.7%) and Histoplasma capsulatum (27/75, 36%) was the most prevalent etiology. Nodular pattern was the most common imaging feature in histoplasmosis cases (25/27, 92.6%), whereas it occurred in half of cases (24/48) of GLD of other causes (p < 0.05). Among patients with tuberculosis, the second etiology of GLD in our study population, the most common imaging pattern was centrilobular micronodules (3/7, 42.9%), significantly more frequent than in other causes of GLD (6/68, 8.8%). Interreader agreement in detecting imaging features was almost perfect (κ = 0.88-1.00), except the nodular pattern, which had substantial agreement (κ = 0.73). Conclusions In our study population, the main etiologies found in patients with granulomatous disease who underwent lung biopsy were fungal or mycobacterial disease, specially histoplasmosis and tuberculosis, and nodular pattern with focal distribution was the most common imaging finding which was detected with substantial interreader agreement.
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12
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Diep AL, Hoyer KK. Host Response to Coccidioides Infection: Fungal Immunity. Front Cell Infect Microbiol 2020; 10:581101. [PMID: 33262956 PMCID: PMC7686801 DOI: 10.3389/fcimb.2020.581101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/15/2020] [Indexed: 12/22/2022] Open
Abstract
Coccidioidomycosis is a fungal, respiratory disease caused by Coccidioides immitis and Coccidioides posadasii. This emerging infectious disease ranges from asymptomatic to pulmonary disease and disseminated infection. Most infections are cleared with little to no medical intervention whereas chronic disease often requires life-long medication with severe impairment in quality of life. It is unclear what differentiates hosts immunity resulting in disease resolution versus chronic infection. Current understanding in mycology-immunology suggests that chronic infection could be due to maladaptive immune responses. Immunosuppressed patients develop more severe disease and mouse studies show adaptive Th1 and Th17 responses are required for clearance. This is supported by heightened immunosuppressive regulatory responses and lowered anti-fungal T helper responses in chronic Coccidioides patients. Diagnosis and prognosis is difficult as symptoms are broad and overlapping with community acquired pneumonia, often resulting in misdiagnosis and delayed treatment. Furthermore, we lack clear biomarkers of disease severity which could aid prognosis for more effective healthcare. As the endemic region grows and population increases in endemic areas, the need to understand Coccidioides infection is becoming urgent. There is a growing effort to identify fungal virulence factors and host immune components that influence fungal immunity and relate these to patient disease outcome and treatment. This review compiles the known immune responses to Coccidioides spp. infection and various related fungal pathogens to provide speculation on Coccidioides immunity.
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Affiliation(s)
- Anh L. Diep
- Quantitative and Systems Biology, Graduate Program, University of California Merced, Merced, CA, United States
| | - Katrina K. Hoyer
- Quantitative and Systems Biology, Graduate Program, University of California Merced, Merced, CA, United States
- Department of Molecular and Cell Biology, School of Natural Sciences, University of California Merced, Merced, CA, United States
- Health Sciences Research Institute, University of California Merced, Merced, CA, United States
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Abstract
Infectious diseases are one of the main causes of morbidity and mortality worldwide. With new pathogens continuously emerging, known infectious diseases reemerging, increasing microbial resistance to antimicrobial agents, global environmental change, ease of world travel, and an increasing immunosuppressed population, recognition of infectious diseases plays an ever-important role in surgical pathology. This becomes particularly significant in cases where infectious disease is not suspected clinically and the initial diagnostic workup fails to include samples for culture. As such, it is not uncommon that a lung biopsy becomes the only material available in the diagnostic process of an infectious disease. Once the infectious nature of the pathological process is established, careful search for the causative agent is advised. This can often be achieved by examination of the hematoxylin and eosin-stained sections alone as many organisms or their cytopathic effects are visible on routine staining. However, ancillary studies such as histochemical stains, immunohistochemistry, in situ hybridization, or molecular techniques may be needed to identify the organism in tissue sections or for further characterization, such as speciation.
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Affiliation(s)
- Annikka Weissferdt
- Associate Professor, Department of Pathology, Division of Pathology and Laboratory Medicinec, The University of Texas MD Anderson Cancer Center, Houston, TX USA
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14
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Hadadi-Fishani M, Shakerimoghaddam A, Khaledi A. Candida coinfection among patients with pulmonary tuberculosis in Asia and Africa; A systematic review and meta-analysis of cross-sectional studies. Microb Pathog 2019; 139:103898. [PMID: 31794817 DOI: 10.1016/j.micpath.2019.103898] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/24/2019] [Accepted: 11/28/2019] [Indexed: 10/25/2022]
Abstract
Diagnosis of fungal co-infections in patients suffering from pulmonary tuberculosis has critical importance. Therefore, we aimed to determine the prevalence of candida coinfection in patients with pulmonary tuberculosis. The present systematic review of cross-sectional studies was conducted based on the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) Protocol. Studies published online in English from January 2001 to March 2019 were assessed. Literature search was done in Web of Science, MEDLINE/PubMed, and Scopus databases and search engines using keywords combinations of "pulmonary fungi", "pulmonary coinfection", OR "pulmonary mycosis", "pulmonary fungal infections/agents", OR "polymicrobial infection", OR "secondary infection", OR "mixed infections", "pulmonary candidiasis", "fungi coinfection", "fungal co-colonization", AND "pulmonary tuberculosis", OR "pulmonary TB", AND "Asia", AND "Africa". Data was analyzed using Comprehensive Meta-Analysis software (CMA). Heterogeneity between studies was evaluated by Cochran's Q and I2 tests. The pooled prevalence of candida coinfection among patients with pulmonary tuberculosis was 25.7% (95% CI: 23.7-27.9). C. albicans was the most prevalent Candida spp. with a pooled prevalence of 65.8% (95% CI: 54.3-75.7). Risk factors of candida coinfection were smoking, diabetes, advanced age, and low body mass index. The present review showed a high rate of candida coinfection among patients suffering from pulmonary tuberculosis. So, appropriate measures are necessary to early diagnose and treat these infections.
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Affiliation(s)
- Mehdi Hadadi-Fishani
- Department of Medical Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ali Shakerimoghaddam
- Infectious Diseases Research Center, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran; Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Azad Khaledi
- Infectious Diseases Research Center, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran; Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran.
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15
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Cheng J, Li C, Corsini EM, Antonoff MB, Hekmat K, Liu L. Left destroyed lung caused by a pen cap in the left lower lobe bronchus "swallowed" 25 years ago. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:711. [PMID: 31930110 DOI: 10.21037/atm.2019.11.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A delayed diagnosis of tracheobronchial foreign body aspiration (FBA) may result in severe respiratory complications such as pneumonia, bronchiectasis, and atelectasis. Here, we present a rare case of a left lung destruction caused by a pen cap that remained in the left lower lobe bronchus for 25 years and was previously misdiagnosed as cavitary tuberculosis. The foreign body was not detected in bronchoscopic examination prior to surgery due to severe stenosis of the left main bronchus. The foreign body was found incidentally while the patient was undergoing left pneumonectomy. To the best of our knowledge, this the second longest delay to diagnosis of FBA reported. This case also exemplifies the grave consequences of misdiagnosis of FBA.
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Affiliation(s)
- Jiahan Cheng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China.,Department of Pathology, School of Medicine, Stanford University, Palo Alto, CA,94304, USA
| | - Chuan Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Erin M Corsini
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Khosro Hekmat
- Department of Cardiothoracic Surgery, University of Cologne, 50937 Cologne, Germany
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
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16
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Radiologische Diagnostik von Thorax und Abdomen bei immunkompromittierten Patienten. Med Klin Intensivmed Notfmed 2019; 114:526-532. [DOI: 10.1007/s00063-017-0331-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 11/25/2022]
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17
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Di Mango AL, Zanetti G, Penha D, Menna Barreto M, Marchiori E. Endemic pulmonary fungal diseases in immunocompetent patients: an emphasis on thoracic imaging. Expert Rev Respir Med 2019; 13:263-277. [PMID: 30668231 DOI: 10.1080/17476348.2019.1571914] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Systemic endemic mycoses are prevalent in specific geographical areas of the world and are responsible for high rates of morbidity and mortality in these populations, and in immigrants and travelers returning from endemic regions. The most common fungal infections that can affect the lungs of immunocompetent patients include histoplasmosis, coccidioidomycosis, paracoccidioidomycosis, blastomycosis, sporotrichosis, aspergillosis, and cryptococcosis. Diagnosis and management of these diseases remain challenging, especially in non-endemic areas due to the lack of experience. Therefore, recognition of the various radiologic manifestations of pulmonary fungal infections associated with patients' clinical and epidemiologic history is imperative for narrowing the differential diagnosis. Areas covered: This review discusses the clinical and radiological findings of the main endemic fungal diseases affecting the lungs in immunocompetent patients. Specific topics discussed are their etiology, epidemiology, pathogenesis, clinical manifestations, methods of diagnosis, pathology and main imaging findings, especially in computed tomography. Expert commentary: Imaging plays an important role in the diagnosis and management of pulmonary fungal infection and may reveal useful signs. Although definitive diagnosis cannot be made based on imaging features alone, the use of a combination of epidemiologic, clinical and imaging findings may permit the formulation of an adequate differential diagnosis.
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Affiliation(s)
- Ana Luiza Di Mango
- a Department of Radiology , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Gláucia Zanetti
- a Department of Radiology , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Diana Penha
- b Cardiothoracic Consultant and Intervention , Liverpool Heart and Chest Hospital , Liverpool , UK
| | - Miriam Menna Barreto
- a Department of Radiology , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Edson Marchiori
- a Department of Radiology , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
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18
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Singh D. Imaging of Pulmonary Infections. THORACIC IMAGING 2019. [PMCID: PMC7120992 DOI: 10.1007/978-981-13-2544-1_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pulmonary infections have always been a cause of high morbidity and mortality, particularly in the pediatric and geriatric population and in immunocompromised hosts [1]. Pulmonary infections have various etiologies and have variegated patterns on radiographs and computed tomography (CT). Imaging plays an important role in the initial diagnosis and follow-up of various lung infections. Radiographs can be normal or non-specific during the initial evaluation, and CT findings may be more definitive. CT not only helps with the diagnosis but can also aid in management by guiding the diagnostic and therapeutic procedure. The pulmonary infections spread by direct or indirect contact with the infected host, droplet transmission, or an airborne spread. In rare cases, some infections can also be transmitted by vectors, namely, insect or animal hosts, and rarely by direct invasion from nearby infected organs. Pulmonary infections may have typical imaging patterns and distribution based on the mode of spread. There are a number of well-described imaging patterns of alveolar infections. The localization and morphological features on imaging may help in the diagnosis of infection and identification of mode of infection and, in certain cases, the microorganism responsible for the infection.
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19
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Torres PPTES, Rabahi MF, Moreira MAC, Santana PRP, Gomes ACP, Marchiori E. Tomographic assessment of thoracic fungal diseases: a pattern and signs approach. Radiol Bras 2018; 51:313-321. [PMID: 30369659 PMCID: PMC6198837 DOI: 10.1590/0100-3984.2017.0223] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 02/14/2018] [Indexed: 02/06/2023] Open
Abstract
Pulmonary fungal infections, which can be opportunistic or endemic, lead to considerable morbidity and mortality. Such infections have multiple clinical presentations and imaging patterns, overlapping with those of various other diseases, complicating the diagnostic approach. Given the immensity of Brazil, knowledge of the epidemiological context of pulmonary fungal infections in the various regions of the country is paramount when considering their differential diagnoses. In addition, defining the patient immunological status will facilitate the identification of opportunistic infections, such as those occurring in patients with AIDS or febrile neutropenia. Histoplasmosis, coccidioidomycosis, and paracoccidioidomycosis usually affect immunocompetent patients, whereas aspergillosis, candidiasis, cryptococcosis, and pneumocystosis tend to affect those who are immunocompromised. Ground-glass opacities, nodules, consolidations, a miliary pattern, cavitary lesions, the halo sign/reversed halo sign, and bronchiectasis are typical imaging patterns in the lungs and will be described individually, as will less common lesions such as pleural effusion, mediastinal lesions, pleural effusion, and chest wall involvement. Interpreting such tomographic patterns/signs on computed tomography scans together with the patient immunological status and epidemiological context can facilitate the differential diagnosis by narrowing the options.
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Affiliation(s)
| | - Marcelo Fouad Rabahi
- Department of Internal Medicine, School of Medicine, Universidade
Federal de Goiás (UFG), Goiânia, GO, Brazil
| | | | | | | | - Edson Marchiori
- Department of Radiology, Universidade Federal do Rio de Janeiro
(UFRJ), Rio de Janeiro, RJ, Brazil
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20
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Denning DW, Page ID, Chakaya J, Jabeen K, Jude CM, Cornet M, Alastruey-Izquierdo A, Bongomin F, Bowyer P, Chakrabarti A, Gago S, Guto J, Hochhegger B, Hoenigl M, Irfan M, Irurhe N, Izumikawa K, Kirenga B, Manduku V, Moazam S, Oladele RO, Richardson MD, Tudela JLR, Rozaliyani A, Salzer HJF, Sawyer R, Simukulwa NF, Skrahina A, Sriruttan C, Setianingrum F, Wilopo BAP, Cole DC, Getahun H. Case Definition of Chronic Pulmonary Aspergillosis in Resource-Constrained Settings. Emerg Infect Dis 2018; 24:e171312. [PMID: 30016256 PMCID: PMC6056117 DOI: 10.3201/eid2408.171312] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Chronic pulmonary aspergillosis (CPA) is a recognized complication of pulmonary tuberculosis (TB). In 2015, the World Health Organization reported 2.2 million new cases of nonbacteriologically confirmed pulmonary TB; some of these patients probably had undiagnosed CPA. In October 2016, the Global Action Fund for Fungal Infections convened an international expert panel to develop a case definition of CPA for resource-constrained settings. This panel defined CPA as illness for >3 months and all of the following: 1) weight loss, persistent cough, and/or hemoptysis; 2) chest images showing progressive cavitary infiltrates and/or a fungal ball and/or pericavitary fibrosis or infiltrates or pleural thickening; and 3) a positive Aspergillus IgG assay result or other evidence of Aspergillus infection. The proposed definition will facilitate advancements in research, practice, and policy in lower- and middle-income countries as well as in resource-constrained settings.
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21
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Hussien A, Lin CT. CT findings of fungal pneumonia with emphasis on aspergillosis. Emerg Radiol 2018; 25:685-689. [PMID: 29956050 DOI: 10.1007/s10140-018-1621-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/20/2018] [Indexed: 01/15/2023]
Abstract
Fungal pneumonias are increasingly common in the population of immunosuppressed patients. The diagnosis of fungal pneumonias represents a challenge for clinicians, and the morbidity and mortality of these infections are high in immunocompromised patients. CT findings may be nonspecific; however, in the appropriate clinical setting, they may suggest and even help establish the specific diagnosis. This article provides an overview about the CT findings and possible differential diagnosis of the most common pulmonary fungal infections.
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22
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23
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Katragkou A, Fisher BT, Groll AH, Roilides E, Walsh TJ. Diagnostic Imaging and Invasive Fungal Diseases in Children. J Pediatric Infect Dis Soc 2017; 6:S22-S31. [PMID: 28927203 DOI: 10.1093/jpids/pix055] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Invasive fungal disease (IFD) is a life-threatening condition, especially in immunocompromised children. The role of diagnostic imaging in children at risk for an IFD is multifactorial, including initially detecting it, evaluating for dissemination of infection beyond the primary site of disease, monitoring the response to antifungal therapy, and assessing for potential relapse. The objective of this review was to synthesize the published literature relevant to the use of various imaging modalities for the diagnosis and management of IFD in children.
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Affiliation(s)
- Aspasia Katragkou
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Nationwide Children's Hospital and Ohio State University, Columbus
| | - Brian T Fisher
- Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness Research, Children's Hospital of Philadelphia, Pennsylvania.,Departments of Pediatrics and Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Andreas H Groll
- Infectious Disease Research Program, Department of Pediatric Hematology and Oncology and Center for Bone Marrow Transplantation, University Children's Hospital Muenster, Germany
| | - Emmanuel Roilides
- Infectious Diseases Section, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Thomas J Walsh
- Transplantation-Oncology Infectious Diseases Program and Departments of Medicine, Pediatrics, Microbiology and Immunology, Weill Cornell Medicine of Cornell University and New York Presbyterian Hospital
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24
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Hirayama T, Takazono T, Iwata K, Senju H, Shimazaki T, Tashiro M, Saijo T, Tanaka T, Nakamura S, Imamura Y, Kojiro M, Miyazaki T, Tsukamoto M, Furumoto A, Morimoto K, Muraosa Y, Matsubara Y, Yanagihara K, Mukae H, Kamei K, Kohno S, Izumikawa K. A case series of histoplasmosis patients with elevated serum soluble interleukin-2 receptor levels. J Infect Chemother 2017; 23:642-647. [PMID: 28395939 DOI: 10.1016/j.jiac.2017.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/01/2017] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
Abstract
Histoplasmosis is a common endemic mycosis that is usually asymptomatic but occasionally results in severe illness. Histoplasmosis and its causative agent, Histoplasma capsulatum, are found worldwide but rarely in Japan. In recent years, however, the number of histoplasmosis patients in Japan has increased. In addition, to our knowledge, there are no previous reports of increased serum soluble interleukin-2 receptor (sIL-2R) levels in patients with histoplasmosis. We report a case series of histoplasmosis in three Japanese temporary workers in Manzanillo, Mexico. All three patients developed a persistent high fever and general fatigue. Laboratory tests showed increased C-reactive protein levels and mild liver dysfunction. All patients also showed increased soluble interleukin-2 receptor (sIL-2R) levels. Chest computed tomography revealed multiple nodules in both lung fields. All patients were positive for serum anti-Histoplasma antibodies, and two patients were positive for Histoplasma on polymerase chain reaction tests. After treatment that included antifungals, their conditions gradually improved and laboratory data normalized. Although one patient developed respiratory failure, this patient recovered with antifungal therapy in combination with methylprednisolone. Serum sIL-2R levels in all patients gradually declined to normal levels, indicating their recovery from Histoplasma infection. From our experience with these patients, sIL-2R levels may be a useful biomarker for patients with histoplasmosis.
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Affiliation(s)
- Tatsuro Hirayama
- Second Department of Internal Medicine, Nagasaki University Hospital, Nagasaki, Japan; Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takahiro Takazono
- Second Department of Internal Medicine, Nagasaki University Hospital, Nagasaki, Japan; Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Kazuma Iwata
- Department of Infectious Diseases, Nagasaki University Hospital, Nagasaki, Japan; Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Hiroaki Senju
- Second Department of Internal Medicine, Nagasaki University Hospital, Nagasaki, Japan; Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takaharu Shimazaki
- Department of Infectious Diseases, Nagasaki University Hospital, Nagasaki, Japan; Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Masato Tashiro
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Tomomi Saijo
- Second Department of Internal Medicine, Nagasaki University Hospital, Nagasaki, Japan; Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takeshi Tanaka
- Department of Infectious Diseases, Nagasaki University Hospital, Nagasaki, Japan; Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Shigeki Nakamura
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yoshifumi Imamura
- Second Department of Internal Medicine, Nagasaki University Hospital, Nagasaki, Japan; Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Maiko Kojiro
- Department of Infectious Diseases, Nagasaki University Hospital, Nagasaki, Japan; Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Taiga Miyazaki
- Second Department of Internal Medicine, Nagasaki University Hospital, Nagasaki, Japan; Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Misuzu Tsukamoto
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Akitsugu Furumoto
- Department of Infectious Diseases, Nagasaki University Hospital, Nagasaki, Japan; Division of Infectious Diseases Department of Internal Medicine Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Konosuke Morimoto
- Department of Infectious Diseases, Nagasaki University Hospital, Nagasaki, Japan; Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Yasunori Muraosa
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | | | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroshi Mukae
- Second Department of Internal Medicine, Nagasaki University Hospital, Nagasaki, Japan; Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Katsuhiko Kamei
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Shigeru Kohno
- Second Department of Internal Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan
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25
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Bajaj SK, Tombach B. Respiratory infections in immunocompromised patients: Lung findings using chest computed tomography. RADIOLOGY OF INFECTIOUS DISEASES (BEIJING, CHINA) 2017; 4:29-37. [PMID: 32363227 PMCID: PMC7185396 DOI: 10.1016/j.jrid.2016.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 10/17/2016] [Accepted: 11/10/2016] [Indexed: 01/15/2023]
Abstract
Respiratory infections and subsequent complications are one of the leading causes of high mortality in immunocompromised patients. Although chest radiograph and computed tomography are the commonly used diagnostic tools for the early diagnosis of lung manifestations of infections, they lack the specificity for the wide range of chest infections which can occur in immunocompromised patients. Systematic analysis of the imaging findings in correlation with the clinical settings along with comparison with the old images can expedite early and accurate diagnosis for subsequent appropriate management. Computer tomography findings in immunocompromised patients with respiratory infections, with regards to various clinical settings, will be discussed here.
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Affiliation(s)
| | - Bernd Tombach
- Department of Radiology, Klinikum Osnabrueck, Germany
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26
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Abstract
Many different diseases present as cavitary pulmonary nodules. The spectrum of diseases ranges from acute to chronic infections, chronic systemic diseases, and malignancies. To decide on the most likely or correct diagnosis may be challenging. Knowledge of common and uncommon radiological findings in correlation with relevant clinical history and findings is necessary to make the right diagnosis and recommend the correct follow-up or step forward. The aim of this pictorial review is to present a brief overview of CT findings of common cavitary lung diseases seen in adult patients.
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27
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Kuroda T, Takeuchi H, Nozawa Y, Sato H, Nakatsue T, Wada Y, Moriyama H, Nakano M, Narita I. Acute exacerbation of interstitial pneumonia associated with rheumatoid arthritis during the course of treatment for Pneumocystis jirovecii pneumonia: a case report. BMC Res Notes 2016; 9:240. [PMID: 27113212 PMCID: PMC4845314 DOI: 10.1186/s13104-016-2052-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 04/19/2016] [Indexed: 12/20/2022] Open
Abstract
Background Pneumocystis jirovecii pneumonia (PCP) is potentially fatal infectious complication in patients with rheumatoid arthritis (RA) during immunosuppressive therapy. Hospital survival due to human immunodeficiency virus—unrelated PCP reaches to 60 %. The high mortality rate results from difficulties in establishing an early diagnosis, concurrent use of prophylactic drugs, possible bacterial coinfection. We herein report a case of PCP in RA patients who developed the architectural distortions of lung in spite of combined modality therapy. Case presentation A 73-year-old Japanese woman with RA was admitted with shortness of breath. Five weeks previously, she had been started on etanercept in addition to methotrexate (MTX). Chest computed tomography (CT) demonstrated diffuse ground glass opacities distributed throughout the bilateral middle to lower lung fields, and serum β-d-glucan was elevated. Bronchoalveolar lavage fluid revealed no P. jirovecii, but the organism was detected by polymerase chain reaction method. Trimethoprim/sulfamethoxazole was administered with methylprednisolone pulse therapy. However, the follow-up chest X-ray and chest CT demonstrated aggravation of the pneumonia with architectural distortions. Additional direct hemoperfusion with polymyxin B-immobilized fibers and intravenous cyclophosphamide therapy were insufficiently effective, and the patient died on day 25. Conclusion The architectural distortions of lung should be considered as a cause of death of PCP. For this reason, a high suspicion of this infectious complication must be kept in mind in order to establish an early diagnosis and treatment in patients with RA managed with MTX and biologics.
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Affiliation(s)
- Takeshi Kuroda
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuoku, Niigata City, 951-8510, Japan.
| | - Hiroyuki Takeuchi
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuoku, Niigata City, 951-8510, Japan
| | - Yukiko Nozawa
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuoku, Niigata City, 951-8510, Japan
| | - Hiroe Sato
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuoku, Niigata City, 951-8510, Japan
| | - Takeshi Nakatsue
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuoku, Niigata City, 951-8510, Japan
| | - Yoko Wada
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuoku, Niigata City, 951-8510, Japan
| | - Hiroshi Moriyama
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuoku, Niigata City, 951-8510, Japan
| | - Masaaki Nakano
- Department of Medical Technology, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746 Asahimachi-Dori, Chuoku, Niigata City, Niigata, 951-8518, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuoku, Niigata City, 951-8510, Japan
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28
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Parsons CS, Helm EJ. Pneumonia and acute respiratory distress syndrome. IMAGING 2016. [DOI: 10.1183/2312508x.10003315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Ferreira Francisco FA, Soares Souza A, Zanetti G, Marchiori E. Multiple cystic lung disease. Eur Respir Rev 2015; 24:552-64. [DOI: 10.1183/16000617.0046-2015] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Multiple cystic lung disease represents a diverse group of uncommon disorders that can present a diagnostic challenge due to the increasing number of diseases associated with this presentation. High-resolution computed tomography of the chest helps to define the morphological aspects and distribution of lung cysts, as well as associated findings. The combination of appearance upon imaging and clinical features, together with extrapulmonary manifestations, when present, permits confident and accurate diagnosis of the majority of these diseases without recourse to open-lung biopsy. The main diseases in this group that are discussed in this review are lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis and folliculin gene-associated syndrome (Birt–Hogg–Dubé); other rare causes of cystic lung disease, including cystic metastasis of sarcoma, are also discussed. Disease progression is unpredictable, and understanding of the complications of cystic lung disease and their appearance during evolution of the disease are essential for management. Correlation of disease evolution and clinical context with chest imaging findings provides important clues for defining the underlying nature of cystic lung disease, and guides diagnostic evaluation and management.
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Arıkan Akdağlı S, Azap A, Başaran Demirkazık F, Ener B, Aşcıoğlu Hayran S, Özdemir Kumbasar Ö, Metan G, Odabaşı Z, Uzun Ö, Akan H. Diagnosis of Invasive Fungal Diseases in Hematological Malignancies: A Critical Review of Evidence and Turkish Expert Opinion (TEO-2). Turk J Haematol 2015; 31:342-56. [PMID: 25541650 PMCID: PMC4454048 DOI: 10.4274/tjh.2014.0218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
One of the most problematic issues in hematological malignancies is the diagnosis of invasive fungal diseases. Especially, the difficulty of mycological diagnosis and the necessity of immediate intervention in molds have led to the adoption of “surrogate markers” that do not verify but rather strongly suggest fungal infection. The markers commonly used are galactomannan (GM), beta-glucan, and imaging methods. Although there are numerous studies on these diagnostic approaches, none of these markers serve as a support for the clinician, as is the case in human immunodeficiency virus (HIV) or cytomegalovirus (CMV) infections. This paper has been prepared to explain the diagnostic tests. As molecular tests have not been standardized and are not used routinely in the clinics, they will not be mentioned here.
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31
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Radiologic Imaging Techniques for the Diagnosis and Management of Invasive Fungal Disease. CURRENT FUNGAL INFECTION REPORTS 2015. [DOI: 10.1007/s12281-015-0227-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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32
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Moodley L, Pillay J, Dheda K. Aspergilloma and the surgeon. J Thorac Dis 2014; 6:202-9. [PMID: 24624284 DOI: 10.3978/j.issn.2072-1439.2013.12.40] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 12/24/2013] [Indexed: 11/14/2022]
Abstract
Aspergillus fungus is a ubiquitous saprophyte that is the causative organism for the development of an aspergilloma. The most common species causing an aspergilloma is the Apergillus fumigatus. An aspergilloma is a conglomeration of mucus, inflammatory cells and altered blood elements. Aspergillomas typically form in pre-existing lung pathology, most notably and commonly in old healed tuberculosis cavities. They are classified into simple and complex types that have clinical relevance. Symptoms are very variable and it is not uncommon to incidentally find a lung aspergilloma. In most case series, the most common presenting symptom is haemoptysis which varies from mild to catastrophic bleeds. Given the limited information about the natural history of the disease, there is unfortunately no recognised factor or variable which can predict how an aspergilloma will manifest itself, hence the manner of treatment is a still a topic of debate among treating physicians. The mainstay of treatment is surgical intervention and medical options although disappointing at the current stage, require further investigation in light of the newer available anti-fungal agents. The need for surgical intervention is however not as clear-cut as one would like, since many patients have multiple co-morbidities and other diffuse or focal lung pathology, making the decision process indeterminate in certain instances. In this review, we focus on the different surgical options available for the management of aspergilloma across variable clinical settings, and we propose an approach to its management.
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Affiliation(s)
- Loven Moodley
- 1 Chris Barnard Division of Cardiothoracic Surgery, 2 Division of Pulmonology, Groote Schuur Hospital, University of Cape Town, South Africa
| | - Jehron Pillay
- 1 Chris Barnard Division of Cardiothoracic Surgery, 2 Division of Pulmonology, Groote Schuur Hospital, University of Cape Town, South Africa
| | - Keertan Dheda
- 1 Chris Barnard Division of Cardiothoracic Surgery, 2 Division of Pulmonology, Groote Schuur Hospital, University of Cape Town, South Africa
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34
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Pereira GH, Almeida LY, Okubo RS, Marchiori E. Pulmonary histoplasmosis presenting with a halo sign on CT in an immunocompetent patient. J Bras Pneumol 2013; 39:523-4. [PMID: 24068277 PMCID: PMC4075861 DOI: 10.1590/s1806-37132013000400019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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35
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Kizjakina K, Tanner JJ, Sobrado P. Targeting UDP-galactopyranose mutases from eukaryotic human pathogens. Curr Pharm Des 2013; 19:2561-73. [PMID: 23116395 PMCID: PMC3624792 DOI: 10.2174/1381612811319140007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 10/30/2012] [Indexed: 12/19/2022]
Abstract
UDP-Galactopyranose mutase (UGM) is a unique flavin-dependent enzyme that catalyzes the conversion of UDP-galactopyranose(UDP-Galp) to UDP-galactofuranose (UDP-Galf). The product of this reaction is the precursor to Galf, a major component of the cell wall and of cell surface glycoproteins and glycolipids in many eukaryotic and prokaryotic human pathogens. The function of UGM is important in the virulence of fungi, parasites, and bacteria. Its role in virulence and its absence in humans suggest that UGM is an ideal drug target. Significant structural and mechanistic information has been accumulated on the prokaryotic UGMs; however, in the past few years the research interest has shifted to UGMs from eukaryotic human pathogens such as fungi and protozoan parasites. It has become clear that UGMs from prokaryotic and eukaryotic organisms have different structural and mechanistic features. The amino acid sequence identity between these two classes of enzymes is low, resulting in differences in oligomeric states, substrate binding, active site flexibility, and interaction with redox partners. However, the unique role of the flavin cofactor in catalysis is conserved among this enzyme family. In this review, recent findings on eukaryotic UGMs are discussed and presented in comparison with prokaryotic UGMs.
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Affiliation(s)
- Karina Kizjakina
- Department of Biochemistry, Virginia Tech, Blacksburg, VA 24061, USA
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Jepson SL, Pakkal M, Bajaj A, Raj V. Pulmonary complications in the non-HIV immunocompromised patient. Clin Radiol 2012; 67:1001-10. [PMID: 22595083 DOI: 10.1016/j.crad.2012.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/16/2012] [Accepted: 02/26/2012] [Indexed: 10/28/2022]
Abstract
The incidence of non-HIV immunocompromised patients is increasing. This is primarily due to improved immunosuppressive regimes for autoimmune diseases and also increases in stem cell transplantation. Pulmonary complications are a major cause of morbidity and mortality in these patients. Imaging is frequently used to assess these complications and to streamline therapies, as microbiological and/or pathological diagnosis can often be difficult, invasive, or protracted. This review provides the reader with a structured approach to interpret the imaging findings and differentiate between different infective and non-infective complications in these patients.
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Affiliation(s)
- S L Jepson
- Department of Radiology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, UK
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Kim MS, Lee SM, Sung HS, Won CH, Chang S, Lee MW, Choi JH, Moon KC. Clinical analysis of deep cutaneous mycoses: a 12-year experience at a single institution. Mycoses 2012; 55:501-6. [DOI: 10.1111/j.1439-0507.2012.02191.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dhatwalia R, Singh H, Oppenheimer M, Karr DB, Nix JC, Sobrado P, Tanner JJ. Crystal structures and small-angle x-ray scattering analysis of UDP-galactopyranose mutase from the pathogenic fungus Aspergillus fumigatus. J Biol Chem 2012; 287:9041-51. [PMID: 22294687 PMCID: PMC3308763 DOI: 10.1074/jbc.m111.327536] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 01/16/2012] [Indexed: 11/06/2022] Open
Abstract
UDP-galactopyranose mutase (UGM) is a flavoenzyme that catalyzes the conversion of UDP-galactopyranose to UDP-galactofuranose, which is a central reaction in galactofuranose biosynthesis. Galactofuranose has never been found in humans but is an essential building block of the cell wall and extracellular matrix of many bacteria, fungi, and protozoa. The importance of UGM for the viability of many pathogens and its absence in humans make UGM a potential drug target. Here we report the first crystal structures and small-angle x-ray scattering data for UGM from the fungus Aspergillus fumigatus, the causative agent of aspergillosis. The structures reveal that Aspergillus UGM has several extra secondary and tertiary structural elements that are not found in bacterial UGMs yet are important for substrate recognition and oligomerization. Small-angle x-ray scattering data show that Aspergillus UGM forms a tetramer in solution, which is unprecedented for UGMs. The binding of UDP or the substrate induces profound conformational changes in the enzyme. Two loops on opposite sides of the active site move toward each other by over 10 Å to cover the substrate and create a closed active site. The degree of substrate-induced conformational change exceeds that of bacterial UGMs and is a direct consequence of the unique quaternary structure of Aspergillus UGM. Galactopyranose binds at the re face of the FAD isoalloxazine with the anomeric carbon atom poised for nucleophilic attack by the FAD N5 atom. The structural data provide new insight into substrate recognition and the catalytic mechanism and thus will aid inhibitor design.
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Affiliation(s)
| | | | - Michelle Oppenheimer
- the Department of Biochemistry, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061, and
| | | | - Jay C. Nix
- the Molecular Biology Consortium, Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - Pablo Sobrado
- the Department of Biochemistry, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061, and
| | - John J. Tanner
- From the Departments of Chemistry and
- Biochemistry, University of Missouri, Columbia, Missouri 65211
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Ruiz Júnior RL, de Oliveira FHS, Piotto BLB, Muniz FAESDSL, Cataneo DC, Cataneo AJM. Surgical treatment of pulmonary aspergilloma. J Bras Pneumol 2011; 36:779-83. [PMID: 21225182 DOI: 10.1590/s1806-37132010000600016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 06/25/2010] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to analyze the outcome of surgical treatment of pulmonary aspergilloma. To that end, we evaluated 14 adult patients so treated between 1981 and 2009 at the Botucatu School of Medicine University Hospital, in the city of Botucatu, Brazil. Data were collected from the medical records of the patients. Ten patients (71%) presented with simple pulmonary aspergilloma, and 4 (29%) presented with complex pulmonary aspergilloma. Hemoptysis was the most common symptom, and tuberculosis was the most prevalent preexisting lung disease. Two patients (14%) underwent surgery on more than one occasion. There were no intraoperative deaths. Half of the patients developed postoperative complications, prolonged air leak and empyema being the most common.
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Affiliation(s)
- Raul Lopes Ruiz Júnior
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil.
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HRCT-features of Pneumocystis jiroveci pneumonia and their evolution before and after treatment in non-HIV immunocompromised patients. Eur J Radiol 2011; 81:1315-20. [PMID: 21420818 DOI: 10.1016/j.ejrad.2011.02.052] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 02/11/2011] [Accepted: 02/24/2011] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study retrospectively analyzes the characteristics and kinetics of pulmonary changes in Pneumocystis jiroveci pneumonia (PJP) before and after treatment as depicted by thin-section-CT in HIV-negative patients. MATERIALS AND METHODS Serial CT scans of 84 consecutive HIV-negative PJP patients were reviewed retrospectively encompassing a median follow-up of 76 (range, 37-506) days. Along with underlying disease and time span between the onset of symptoms and specific antimicrobial therapy, early and late pulmonary CT-findings were evaluated. RESULTS Imaging findings at initial diagnosis differed from those in the posttherapeutic setting. In the acute (initial) PJP-phase, most frequent finding was symmetric, apically distributed ground glass opacities (GGO) with peripheral sparing 43% (n = 36). These initial changes resolved up to 1st follow-up-examination in 57% (n = 48), and finally in all except for two patients after a median period of 13 (mean 26, range 1-58) days following application of specific therapy. In 42% (n = 35) architectural distortions occurred, but they resolved after a median period of 27 (mean 60, range 11-302) days. Only in 9 patients, complete resolution could not be documented. Significant correlations of the underlying disease or the time span between the onset of symptoms and specific antibiotic therapy and morphologic kinetic could not be found. CONCLUSION Thin-section CT-findings of PJP usually resolve soon after onset of specific therapy. Postinfectious fibrosis rarely occurs following PJP in HIV-negative patients.
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Azoulay E. Pleuropulmonary Changes Induced by Drugs in Patients with Hematologic Diseases. PULMONARY INVOLVEMENT IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES 2011. [PMCID: PMC7123804 DOI: 10.1007/978-3-642-15742-4_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Patients with hematologic diseases who are being treated with therapy drugs, or receive radiation therapy or blood transfusions may develop a host of potentially fatal infectious and noninfectious pulmonary complications [1]. The increased complexity of multimodality and high-dose treatment regimens with the intended benefit of augmented antineoplastic efficacy and prolonged disease-free survival, the use of a panel of novel drugs to treat malignant and nonmalignant hematologic conditions (e.g., azacytidine, bortezomib, cladribine, dasatinib, fludarabine, imatinib, lenalidomide, rituximab, and thalidomide), total body irradiation (TBI) and hematopietic stem cell transplantation (HSCT) have increased the incidence of severe sometimes life-threatening pulmonary complications.
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Affiliation(s)
- Elie Azoulay
- Service de Réanimation Médicale, Hôpital Saint Louis, Avenue Claude Vellefaux 1, Paris, 75010 France
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Abstract
Hemoptysis and thoracic fungal infections are infrequent but challenging problems, especially when encountered in the emergency setting. The evaluation and management of massive and nonmassive hemoptysis is described with special attention to radiologic, bronchcoscopic, and surgical interventions. The important principles of airway control, stabilization, and definitive management are emphasized. Endemic and opportunistic fungal infections are more common than they seem. The role of the surgeon is to assist in diagnosis, evaluate and treat pulmonary nodules, and consider resectional therapy for mycetoma and invasive fungal infections in selected candidates.
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Oppenheimer M, Poulin MB, Lowary TL, Helm RF, Sobrado P. Characterization of recombinant UDP-galactopyranose mutase from Aspergillus fumigatus. Arch Biochem Biophys 2010; 502:31-8. [PMID: 20615386 DOI: 10.1016/j.abb.2010.06.035] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 06/29/2010] [Accepted: 06/29/2010] [Indexed: 11/26/2022]
Abstract
UDP-galactopyranose mutase (UGM) is a flavin-containing enzyme that catalyzes the conversion of UDP-galactopyranose to UDP-galactofuranose, the precursor of galactofuranose, which is an important cell wall component in Aspergillus fumigatus and other pathogenic microbes. A. fumigatus UGM (AfUGM) was expressed in Escherichia coli and purified to homogeneity. The enzyme was shown to function as a homotetramer by size-exclusion chromatography and to contain approximately 50% of the flavin in the active reduced form. A k(cat) value of 72 +/- 4 s(-1) and a K(M) value of 110 +/- 15 microM were determined with UDP-galactofuranose as substrate. In the oxidized state, AfUGM does not bind UDP-galactopyranose, while UDP and UDP-glucose bind with K(d) values of 33 +/- 9 microM and 90 +/- 30 microM, respectively. Functional and structural differences between the bacterial and eukaryotic UGMs are discussed.
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Santos JWAD, Michel GT, Lazzarotto M, Figaro JK, Spilmann D, Homrich GK. Chronic cavitary pulmonary histoplasmosis. J Bras Pneumol 2010; 35:1161-4. [PMID: 20011854 DOI: 10.1590/s1806-37132009001100016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 09/08/2009] [Indexed: 11/21/2022] Open
Abstract
Histoplasmosis is a systemic mycosis caused by the thermally dimorphic fungus Histoplasma capsulatum, which can be isolated from soil contaminated with droppings from birds or bats. Chronic cavitary pulmonary histoplasmosis is one of the rarest clinical presentations of this disease. The differential diagnosis with tuberculosis should be made in patients presenting with cavitated lesions in upper lung segments. We report the case of a female patient with chronic cavitary pulmonary histoplasmosis who had presented with progressive dyspnea and worsening of the radiological pattern over a four-year period.
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Udeani TKC, Moses J, Uzoechina A, Okwori AEJ, Okwosa CN. Microbial aetiologic agents associated with pneumonia in immunocompromised hosts. Afr J Infect Dis 2010; 4:1-6. [PMID: 23878695 PMCID: PMC3497840 DOI: 10.4314/ajid.v4i1.55084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pulmonary infections are a major cause of morbidity and mortality in the immunosuppressed patients. The aim of this study was to determine the etiologic agents and predisposing factors associated with pneumonia infections in immunocompromised patients. Cross-sectional survey of 100 immunocompromised patients due to HIV and Mycobacterium tuberculosis infections were enlisted for the study. The patients completed a structured questionnaire to abstract information on demographic features and risk factors. Sputum samples were collected from the patients with clinical suspicion of having pneumonia and the sputa examined by cultural methods. The tuberculosis patients had the highest number of isolates, 119 (70%) while those with co-infections of HIV/AIDS and tuberculosis had 41(24.1%) and those with only HIV infection were 10 (5.9%). The distribution of isolates were as follows, Staphylococcus aureus 63 (37.9%), Streptococcus pyogenes 44 (25.9%), Streptococcus pneumoniae 27 (15.9%), Candida albicans 24 (14.1%), Klebsiella pneumoniae 7 (4.1%), Proteus mirabilis 4 (2.4%) and Escherichia coli 1 (0.5%). Those with previous history of alcoholism and tobacco smoking had relatively high isolates. This study demonstrated that secondary infections are prevalent in the immunocompromised patients due to HIV/AIDS and TB or co-infection with TB/HIV-AIDS. This may lead to drug resistance, DOTS or HAART programme, thereby leading to high mortality and morbidity.
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Affiliation(s)
- Theophilus K C Udeani
- Department of Medical Laboratory Sciences, College of Medicine, University of Nigeria Enugu Campus, Nigeria
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Cadena J, Hartzler A, Hsue G, Longfield RN. Coccidioidomycosis and tuberculosis coinfection at a tuberculosis hospital: clinical features and literature review. Medicine (Baltimore) 2009; 88:66-76. [PMID: 19352301 DOI: 10.1097/md.0b013e318194757a] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Tuberculosis (TB) and coccidioidomycosis can have similar clinical and radiologic presentations but require different treatments. Coinfection with TB and Coccidioides immitis is uncommonly reported and may be underdiagnosed in endemic areas.We performed a retrospective review of the medical records of all patients admitted to a TB referral hospital between 1995 and 2007, and selected all cases of TB and coccidioidomycosis coinfection in patients aged 18 years or older. All admitted patients had a diagnosis of TB and had sputum cultures for both pathogens. We reviewed clinical, laboratory, and radiologic features of the cases, and noted antimicrobial treatments received and outcomes.We identified 9 patients, of whom 7 (78%) were Hispanic. Most patients were male (8/9, 89%), and all were diagnosed with coccidioidomycosis after TB. Three (33%) patients had drug-resistant TB. Six patients had culture-positive TB at the time of the double diagnosis, and 2 patients developed active coccidioidomycosis during their hospital stay. Only 1 had human immunodeficiency virus/acquired immunodeficiency syndrome (HIV-AIDS) (CD4 count, 20 cells/mm). All but 2 patients were treated with antifungal agents. Two patients died, 1 of whom had AIDS. Radiologic studies were unable to distinguish between TB and coccidioidomycosis, except for a patient who developed a new air-fluid level in a previously stable cavity.TB and coccidioidomycosis coinfection should be suspected in coccidioidomycosis-endemic regions among patients with TB who fail to improve clinically or radiologically despite adequate, culture-directed therapy.
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Hussein R, Khan S, Levy F, Mehta JB, Sarubbi FA. Blastomycosis in the mountainous region of northeast Tennessee. Chest 2008; 135:1019-1023. [PMID: 19017881 DOI: 10.1378/chest.08-1947] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In the United States, cases of human blastomycosis are largely described in defined geographic areas, with Mississippi reporting the highest prevalence of disease in the southeast region. The infection is uncommonly recognized in mountainous areas, and our previous report of blastomycosis in the southern Appalachian mountains of northeast Tennessee appeared to be an exception to the usual disease distribution. METHODS Our current retrospective study was undertaken to determine whether blastomycosis has persisted as an endemic fungal infection in our northeast Tennessee geographic area and whether epidemiologic features have changed over a 25-year time period. RESULTS Results show that clinical aspects of the disease have remained fairly constant with few exceptions; mass-type pulmonary lesions have become more common, and itraconazole has emerged as the therapy of choice. Most notably, however, are the observations that blastomycosis persists as a major endemic fungal infection in our mountain region, more than half of all cases occurring during the period from 1996 to 2005 were found in a core area centered on two counties, Washington and Unicoi; three of five counties surrounding the core counties experienced rate increases compared to our previous study. CONCLUSIONS These findings suggest a further expansion of this endemic fungal disease beyond the core region.
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Affiliation(s)
- Rezhan Hussein
- Divisions of Infectious Diseases, East Tennessee State University, Johnson City, TN
| | - Saad Khan
- Divisions of Infectious Diseases, East Tennessee State University, Johnson City, TN
| | - Foster Levy
- Department of Biological Sciences, East Tennessee State University, Johnson City, TN
| | - Jay B Mehta
- Pulmonary Medicine, Department of Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN
| | - Felix A Sarubbi
- Divisions of Infectious Diseases, East Tennessee State University, Johnson City, TN.
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Sharma S. Computed tomography for the diagnosis of infectious diseases of the chest. ACTA ACUST UNITED AC 2008; 2:1247-62. [PMID: 23496684 DOI: 10.1517/17530059.2.11.1247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pulmonary infection is a common reason for imaging of the lung in immunocompetent and immunosuppressed patients. Findings on chest radiography are nonspecific and encompass poor sensitivity. The role of computed tomography (CT) has been evolving in the diagnosis of lung infections. OBJECTIVE This paper reviews recent developments in the efficacy and utility of CT in the diagnosis of suspected pulmonary infections in a variety of patient populations. METHODS Recent published literature was reviewed to prepare this treatise on the role of CT. CONCLUSION Knowledge and skills at pattern recognition are crucial for the CT interpretation in lung infections. Computed tomography scan is increasingly used to increase the sensitivity of the radiologic diagnosis of thoracic infections. The greatest value of CT is when the radiograph is normal, findings are equivocal, and to differentiate infection from non-infectious disorders.
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Affiliation(s)
- Sat Sharma
- Professor and Head University of Manitoba, St Boniface General Hospital, Section of Respirology, Department of Internal Medicine, BG034, 409 Tache Avenue, Winnipeg MB, R2H 2A6, Canada +204 237 2217 ; +204 231 1927 ;
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