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Gamaletsou MN, Rammaert B, Brause B, Bueno MA, Dadwal SS, Henry MW, Katragkou A, Kontoyiannis DP, McCarthy MW, Miller AO, Moriyama B, Pana ZD, Petraitiene R, Petraitis V, Roilides E, Sarkis JP, Simitsopoulou M, Sipsas NV, Taj-Aldeen SJ, Zeller V, Lortholary O, Walsh TJ. Osteoarticular Mycoses. Clin Microbiol Rev 2022; 35:e0008619. [PMID: 36448782 PMCID: PMC9769674 DOI: 10.1128/cmr.00086-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Osteoarticular mycoses are chronic debilitating infections that require extended courses of antifungal therapy and may warrant expert surgical intervention. As there has been no comprehensive review of these diseases, the International Consortium for Osteoarticular Mycoses prepared a definitive treatise for this important class of infections. Among the etiologies of osteoarticular mycoses are Candida spp., Aspergillus spp., Mucorales, dematiaceous fungi, non-Aspergillus hyaline molds, and endemic mycoses, including those caused by Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides species. This review analyzes the history, epidemiology, pathogenesis, clinical manifestations, diagnostic approaches, inflammatory biomarkers, diagnostic imaging modalities, treatments, and outcomes of osteomyelitis and septic arthritis caused by these organisms. Candida osteomyelitis and Candida arthritis are associated with greater events of hematogenous dissemination than those of most other osteoarticular mycoses. Traumatic inoculation is more commonly associated with osteoarticular mycoses caused by Aspergillus and non-Aspergillus molds. Synovial fluid cultures are highly sensitive in the detection of Candida and Aspergillus arthritis. Relapsed infection, particularly in Candida arthritis, may develop in relation to an inadequate duration of therapy. Overall mortality reflects survival from disseminated infection and underlying host factors.
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Affiliation(s)
- Maria N. Gamaletsou
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Blandine Rammaert
- Université de Poitiers, Faculté de médecine, CHU de Poitiers, INSERM U1070, Poitiers, France
| | - Barry Brause
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Marimelle A. Bueno
- Far Eastern University-Dr. Nicanor Reyes Medical Foundation, Manilla, Philippines
| | | | - Michael W. Henry
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Aspasia Katragkou
- Nationwide Children’s Hospital, Columbus, Ohio, USA
- The Ohio State University School of Medicine, Columbus, Ohio, USA
| | | | - Matthew W. McCarthy
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
| | - Andy O. Miller
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Zoi Dorothea Pana
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Ruta Petraitiene
- Weill Cornell Medicine of Cornell University, New York, New York, USA
| | | | - Emmanuel Roilides
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | | | - Maria Simitsopoulou
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Nikolaos V. Sipsas
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Valérie Zeller
- Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Olivier Lortholary
- Université de Paris, Faculté de Médecine, APHP, Hôpital Necker-Enfants Malades, Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, CNRS UMR 2000, Paris, France
| | - Thomas J. Walsh
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
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Peçanha PM, Bahiense IC, Kruschewsky WLL, Biasutti C, Júnior CUGF, Pinheiro BG, Maifrede SB, Camargo ZPD, Rodrigues AM, Grão-Velloso TR, Falqueto A, Gonçalves SS. Paracoccidioidomycosis due to Paracoccidioides brasiliensis S1 associated with acquired immunodeficiency syndrome: A case report. Rev Iberoam Micol 2020; 38:5-8. [PMID: 33317932 DOI: 10.1016/j.riam.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/03/2020] [Accepted: 09/14/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Paracoccidioidomycosis (PCM) is an endemic disease in Latin America. In immunocompetent hosts, PCM occurs in two main clinical forms: acute and chronic. However, in HIV-infected patients PCM may show up simultaneous manifestations of acute and chronic forms. CASE REPORT We present the case of a patient diagnosed with HIV who had disseminated skin lesions and generalized lymphadenopathy, as well as respiratory and central nervous system involvement. The PCM diagnosis was confirmed by direct KOH examination, double immunodiffusion and the isolation of the fungus in samples of an abscess in the subcostal region. The isolate was identified as Paracoccidioides brasiliensis S1 by species-specific PCR using primers for protein-coding gene GP43 (exon 2) followed by PCR-RFLP of the alpha-tubulin gene. CONCLUSIONS There are few data in literature reporting species-specific molecular identification of Paracoccidioides in HIV/PCM patients. Therefore, this case report may contribute to improve the knowledge about this severe disease, its causative cryptic species, and its consequences to patients.
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de Almeida JN, Peçanha-Pietrobom PM, Colombo AL. Paracoccidioidomycosis in Immunocompromised Patients: A Literature Review. J Fungi (Basel) 2018; 5:E2. [PMID: 30587784 PMCID: PMC6463037 DOI: 10.3390/jof5010002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/09/2018] [Accepted: 12/21/2018] [Indexed: 12/21/2022] Open
Abstract
Paracoccidioidomycosis (PCM) is an endemic mycosis found in Latin America that causes systemic disease mostly in immunocompetent hosts. A small percentage of PCM occurs in immunocompromised patients where low clinical suspicion of the infection, late diagnosis, and uncertainties about its management are factors that negatively impact their outcomes. We conducted a literature review searching reports on PCM associated to HIV, cancer, maligned hemopathies, solid organ transplantation, and immunotherapies, in order to check for peculiarities in terms of natural history and challenges in the clinical management of PCM in this population. HIV patients with PCM usually had low T CD4⁺ cell counts, pulmonary and lymph nodes involvement, and a poorer prognosis (≈50% mortality). Most of the patients with PCM and cancer had carcinoma of the respiratory tract. Among maligned hemopathies, PCM was more often related to lymphoma. In general, PCM prognosis in patients with malignant diseases was related to the cancer stage. PCM in transplant recipients was mostly associated with the late phase of kidney transplantation, with a high mortality rate (44%). Despite being uncommon, reactivation of latent PCM may take place in the setting of immunocompromised patients exhibiting clinical particularities and it carries higher mortality rates than normal hosts.
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Affiliation(s)
- João N de Almeida
- Central Laboratory Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, CEP 05403-000 São Paulo, Brazil.
| | - Paula M Peçanha-Pietrobom
- Department of Medicine, Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, CEP 04039-032 São Paulo, Brazil.
| | - Arnaldo L Colombo
- Department of Medicine, Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, CEP 04039-032 São Paulo, Brazil.
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Rosa Júnior M, Baldon IV, Amorim AFC, Fonseca APA, Volpato R, Lourenço RB, Baptista RM, de Mello RAF, Peçanha P, Falqueto A. Imaging paracoccidioidomycosis: A pictorial review from head to toe. Eur J Radiol 2018; 103:147-162. [PMID: 29685479 DOI: 10.1016/j.ejrad.2018.03.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 03/17/2018] [Accepted: 03/22/2018] [Indexed: 11/29/2022]
Abstract
Paracoccidioidomycosis is an infectious disease characterized primarily by pulmonary involvement and potential dissemination to other organs, mainly mucosa and skin; however, it can affect any organ in the body. Although difficult to diagnose purely based on imaging, imaging is important for diagnosis, follow-up, and assessment of disease-related complications. We provide a comprehensive review of the most notable imaging findings of paracoccidioidomycosis.
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Affiliation(s)
- Marcos Rosa Júnior
- Department of Neuroradiology, Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo - HUCAM/UFES/EBSERH, Vitória ES, Brazil.
| | - Isabella Vargas Baldon
- Department of Radiology, Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo - HUCAM/UFES/EBSERH, Vitória ES, Brazil.
| | - André Felipe Candeas Amorim
- Department of Radiology, Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo - HUCAM/UFES/EBSERH, Vitória ES, Brazil.
| | - Ana Paula Alves Fonseca
- Department of Radiology, Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo - HUCAM/UFES/EBSERH, Vitória ES, Brazil.
| | - Richard Volpato
- Department of Abdominal Radiology, Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo - HUCAM/UFES/EBSERH, Vitória ES, Brazil.
| | - Rafael B Lourenço
- Department of Musculoskeletal Radiology, Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo - HUCAM/UFES/EBSERH, Vitória ES, Brazil.
| | - Rodrigo Melo Baptista
- Department of Thoracic Radiology, Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo - HUCAM/UFES/EBSERH, Vitória ES, Brazil.
| | - Ricardo Andrade Fernandes de Mello
- Department of Musculoskeletal Radiology, Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo - HUCAM/UFES/EBSERH, Vitória ES, Brazil.
| | - Paulo Peçanha
- Department of Infectious Diseases, Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo - HUCAM/UFES/EBSERH, Vitória ES, Brazil.
| | - Aloísio Falqueto
- Department of Infectious Diseases, Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo - HUCAM/UFES/EBSERH, Vitória ES, Brazil.
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Almeida FAD, Neves FF, Mora DJ, Reis TAD, Sotini DM, Ribeiro BDM, Andrade-Silva LE, Nascentes GN, Ferreira-Paim K, Silva-Vergara ML. Paracoccidioidomycosis in Brazilian Patients With and Without Human Immunodeficiency Virus Infection. Am J Trop Med Hyg 2016; 96:368-372. [PMID: 27895278 DOI: 10.4269/ajtmh.16-0254] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022] Open
Abstract
Paracoccidioidomycosis (PCM) is endemic to Latin America, where 10 million people may be infected with Paracoccidioides brasiliensis/Paracoccidioides lutzii and 1,600,000 individuals live with human immunodeficiency virus (HIV) infection. An epidemiological overlapping of these infections occurred early in acquired immunodeficiency syndrome era with nearly 180 published cases. This study presents epidemiological, clinical, and outcome profiles for 31 PCM patients with HIV infection diagnosed in a teaching hospital in Brazil, and includes an update of previously reported cases. Medical records were reviewed and data compared with 64 PCM patients without HIV infection. Of the 31 PCM patients with HIV infection, 23 (74.1%) were male, with a median age of 36.7 years, whereas of the 64 PCM, 45 (70.3%) were male, with a median age of 35.1 years. Both groups presented similar proportions for smoking and alcoholism. PCM patients with HIV infection presented more fever, weight loss, and the acute clinical form than the PCM patients who had more mucosal and respiratory involvement characterizing the chronic form. Most PCM patients with HIV infection exhibited overlapping symptoms from both clinical forms with median symptom duration of 4.5 months compared with 8.3 months for the PCM control. Patients received sulfonamides and/or itraconazole for a median of 15.7 and 16.7 months for PCM/HIV-infected and PCM, respectively. Relapses occurred more in PCM (12 [30%]) than PCM/HIV-infected (4 [14.8%]) patients, whose mortality rate was higher (10 [32.8%]) than PCM patients (8 [20%]). The cases of PCM/HIV infection confirm that HIV can interact with some endemic diseases without increasing their frequency, while changing their natural history, clinical presentation, and outcome. The data presented here are in agreement with those observed in other studies.
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Affiliation(s)
- Fabrício Arantes de Almeida
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil
| | - Fernando Freitas Neves
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil
| | - Delio Jose Mora
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil
| | - Tarcisio Albertin Dos Reis
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil
| | - Diego Moelas Sotini
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil
| | - Barbara De Melo Ribeiro
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil
| | | | | | - Kennio Ferreira-Paim
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil
| | - Mario León Silva-Vergara
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil.
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Lima Júnior FVA, Savarese LG, Monsignore LM, Martinez R, Nogueira-Barbosa MH. Computed tomography findings of paracoccidiodomycosis in musculoskeletal system. Radiol Bras 2015; 48:1-6. [PMID: 25798000 PMCID: PMC4366020 DOI: 10.1590/0100-3984.2014.0049] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 08/01/2014] [Indexed: 11/21/2022] Open
Abstract
Objective To evaluate musculoskeletal involvement in paracoccidioidomycosis at computed
tomography. Materials and Methods Development of a retrospective study based on a review of radiologic and
pathologic reports in the institution database. Patients with histopathologically
confirmed musculoskeletal paracoccidioidomycosis and submitted to computed
tomography were included in the present study. The imaging findings were
consensually described by two radiologists. In order to avoid bias in the
analysis, one patient with uncountable bone lesions was excluded from the
study. Results A total of seven patients were included in the present study. A total of 18 bone
lesions were counted. The study group consisted of 7 patients. A total number of
18 bone lesions were counted. Osteoarticular lesions were the first manifestation
of the disease in four patients (57.14%). Bone lesions were multiple in 42.85% of
patients. Appendicular and axial skeleton were affected in 85.71% and 42.85% of
cases, respectively. Bone involvement was characterized by well-demarcated
osteolytic lesions. Marginal osteosclerosis was identified in 72.22% of the
lesions, while lamellar periosteal reaction and soft tissue component were present
in 5.55% of them. One patient showed multiple small lesions with bone
sequestra. Conclusion Paracoccidioidomycosis can be included in the differential diagnosis of either
single or multiple osteolytic lesions in young patients even in the absence of a
previous diagnosis of pulmonary or visceral paracoccidioidomycosis
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Affiliation(s)
- Francisco Valtenor Araújo Lima Júnior
- MDs, Residents of Radiology and Imaging Diagnosis, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRPUSP), Ribeirão Preto, SP, Brazil
| | - Leonor Garbin Savarese
- MDs, Residents of Radiology and Imaging Diagnosis, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRPUSP), Ribeirão Preto, SP, Brazil
| | - Lucas Moretti Monsignore
- Physician Assistant at Centro de Ciências das Imagens e Física Médica (CCIFM) da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRPUSP), Ribeirão Preto, SP, Brazil
| | - Roberto Martinez
- PhD, Professor, Department of Medical Practice, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Marcello Henrique Nogueira-Barbosa
- PhD, Professor, Centro de Ciências das Imagens e Física Médica (CCIFM) da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRPUSP), Ribeirão Preto, SP, Brazil
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Rodrigues MB. Current status of imaging diagnosis of musculoskeletal involvement in tropical diseases. Radiol Bras 2015; 48:IX. [PMID: 25987758 PMCID: PMC4433299 DOI: 10.1590/0100-3984.2015.48.2e3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Marcelo Bordalo Rodrigues
- MD, Physician Responsible for the Unit of Musculoskeletal Radiology –
Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da
Universidade de São Paulo (InRad/HC-FMUSP), Coordinator for the Unit of
Musculoskeletal Radiology – Hospital Sírio-Libanês, São Paulo, SP,
Brazil
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Guarner J. Detection of microorganisms in granulomas that have been formalin-fixed: review of the literature regarding use of molecular methods. SCIENTIFICA 2012; 2012:494571. [PMID: 24278704 PMCID: PMC3820445 DOI: 10.6064/2012/494571] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 12/11/2012] [Indexed: 06/02/2023]
Abstract
Granuloma is an organized aggregate of immune cells that under the microscope appear as epithelioid macrophages. A granuloma can only be diagnosed when a pathologist observes this type of inflammation under the microscope. If a foreign body or a parasite is not observed inside the granuloma, stains for acid-fast bacilli and fungi are ordered since mycobacteria and fungi are frequently the cause of this type of inflammation. It is calculated that 12 to 36% of granulomas do not have a specific etiology and many have wondered if with new molecular methods we could reduce this number. This paper will summarize the frequently known causes of granulomas and will present the recent literature regarding the use of molecular techniques on tissue specimens and how these have helped in defining causative agents. We will also briefly describe new research regarding formation and function of granulomas and how this impacts our ability to find an etiologic agent.
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Affiliation(s)
- Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322, USA
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Barreto MM, Marchiori E, Amorim VB, Zanetti G, Takayassu TC, Escuissato DL, Souza AS, Rodrigues RS. Thoracic paracoccidioidomycosis: radiographic and CT findings. Radiographics 2012; 32:71-84. [PMID: 22236894 DOI: 10.1148/rg.321115052] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Paracoccidioidomycosis (PCM) is the most common systemic mycosis in Latin America. Although most cases occur in developing countries, recent immigration patterns and an increase in travel have led to a growing number of PCM cases in the United States and Europe. PCM is caused by the dimorphic fungus Paracoccidioides brasiliensis, and the chronic form may progress to severe pulmonary involvement. Several radiologic patterns have been described for pulmonary PCM, including linear and reticular opacities, variable-sized nodules, patchy ill-defined opacities, airspace consolidation, and cavitary lesions. Fibrosis and paracicatricial emphysema are common associated findings. Chest computed tomography (CT) is the method of choice for evaluating pulmonary PCM, with the most common CT findings being ground-glass attenuation, consolidation, small or large nodules, masses, cavitations, interlobular septal thickening, emphysema, and fibrotic lesions. PCM is also an important cause of the "reversed halo" sign at high-resolution CT and should be considered in the differential diagnosis. Awareness of the multiple radiologic manifestations of PCM as well as its epidemiologic and clinical characteristics may permit early diagnosis and initiation of specific treatment, thereby reducing associated morbidity and mortality.
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Affiliation(s)
- Miriam M Barreto
- Department of Radiology, Federal University of Rio de Janeiro, Rúa Thomaz Cameron 438, Valparaiso CEP 25685.120, Petrópolis, Rio de Janeiro, Brazil
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Role of histology in the diagnosis of infectious causes of granulomatous lung disease. Curr Opin Pulm Med 2011; 17:189-96. [PMID: 21346573 DOI: 10.1097/mcp.0b013e3283447bef] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Histologic examination and microbiologic cultures are the gold standards for the diagnosis of infectious granulomatous lung diseases. Although biopsies require invasive procedures, they often yield information that cannot be obtained by other methods. The aims of this article are to outline the major infections that cause granulomatous inflammation in the lung and to familiarize clinicians with the utility of histologic examination in their diagnosis. RECENT FINDINGS The histopathologic features of acute pulmonary histoplasmosis and granulomatous Pneumocystis pneumonia have been described in detail, the relative contributions of histology and microbiologic cultures in the diagnosis of blastomycosis have been delineated, and Cryptococcus gattii has emerged as a significant cause of granulomatous pulmonary nodules. SUMMARY The major infectious causes of granulomatous lung disease are mycobacteria and fungi. Histologic examination is particularly important in the diagnosis of pulmonary granulomatous infections when clinical, radiologic and serologic findings are nonspecific. Histology and microbiology play complementary but distinct roles in diagnosis. For organisms that grow slowly in cultures, histology has the additional advantage of being able to provide a rapid diagnosis.
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