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Vignals C, Emmerich J, Begueret H, Garcia-Hermoso D, Martin-Blondel G, Angoulvant A, Blez D, Bruneval P, Cassaing S, Catherinot E, Cahen P, Moluçon-Chabrot C, Chevenet C, Delhaes L, Escaut L, Faruch M, Grenouillet F, Larosa F, Limousin L, Longchampt E, Mellot F, Nourrisson C, Bougnoux ME, Lortholary O, Roux A, Rozenblum L, Puges M, Lanternier F, Bronnimann D. Deciphering Unexpected Vascular Locations of Scedosporium spp. and Lomentospora prolificans Fungal Infections, France. Emerg Infect Dis 2024; 30:1077-1087. [PMID: 38781681 PMCID: PMC11138966 DOI: 10.3201/eid3006.231409] [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: 05/25/2024] Open
Abstract
Scedosporium spp. and Lomentospora prolificans are emerging non-Aspergillus filamentous fungi. The Scedosporiosis/lomentosporiosis Observational Study we previously conducted reported frequent fungal vascular involvement, including aortitis and peripheral arteritis. For this article, we reviewed 7 cases of Scedosporium spp. and L. prolificans arteritis from the Scedosporiosis/lomentosporiosis Observational Study and 13 cases from published literature. Underlying immunosuppression was reported in 70% (14/20) of case-patients, mainly those who had solid organ transplants (10/14). Osteoarticular localization of infection was observed in 50% (10/20) of cases; infections were frequently (7/10) contiguous with vascular infection sites. Scedosporium spp./Lomentospora prolificans infections were diagnosed in 9 of 20 patients ≈3 months after completing treatment for nonvascular scedosporiosis/lomentosporiosis. Aneurysms were found in 8/11 aortitis and 6/10 peripheral arteritis cases. Invasive fungal disease--related deaths were high (12/18 [67%]). The vascular tropism of Scedosporium spp. and L. prolificans indicates vascular imaging, such as computed tomography angiography, is needed to manage infections, especially for osteoarticular locations.
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2
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Hirama R, Kono M, Kobayashi T, Oshima Y, Takeda K, Miyashita K, Miwa H, Tsutsumi A, Miki Y, Hashimoto D, Otsuki Y, Nakamura H. Intra-abdominal Hemorrhage Due to Splenic Vein Aneurysm Rupture Caused by Invasive Aspergillosis during Treatment for Advanced Non-small-cell Lung Cancer. Intern Med 2023; 62:423-429. [PMID: 35732455 PMCID: PMC9970813 DOI: 10.2169/internalmedicine.9714-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A 71-year-old man was admitted for left-sided chest pain. He had a history of diabetes, treatment with epidermal growth factor receptor-tyrosine kinase inhibitor for advanced non-small-cell lung cancer, and corticosteroid treatment for underlying lung diseases. Chest computed tomography showed consolidations in the bilateral lower lobes, and Aspergillus fumigatus was detected by bronchoscopy. Invasive pulmonary aspergillosis was suspected, and antifungal therapy with voriconazole was initiated; however, the patient passed away suddenly. Autopsy revealed disseminated Aspergillus infection and intra-abdominal hemorrhage due to the rupture of a splenic vein aneurysm caused by Aspergillus necrotizing vasculitis, which was considered the cause of death.
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Affiliation(s)
- Ryutaro Hirama
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Masato Kono
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Takeshi Kobayashi
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Yuiko Oshima
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Kenichiro Takeda
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Koichi Miyashita
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Hideki Miwa
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Akari Tsutsumi
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Yoshihiro Miki
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Dai Hashimoto
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, Japan
| | - Hidenori Nakamura
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
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3
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Muacevic A, Adler JR. Mycotic Thoracic Aortic Aneurysm: Epidemiology, Pathophysiology, Diagnosis, and Management. Cureus 2022; 14:e31010. [PMID: 36349070 PMCID: PMC9632233 DOI: 10.7759/cureus.31010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/30/2022] Open
Abstract
Mycotic thoracic aortic aneurysm (MTAA) is an aneurysm of the aorta caused by infection of the vessel tissue through microbial inoculation of the diseased aortic endothelium. It is most commonly caused by bacteria. Rarely, it can be caused by fungi. However, viral aortic aneurysm has never been reported. Depending on the area and time period investigated, the infections organism discovered may vary significantly. Little is known about the natural history of MTAA due to its rarity. It is not known if they follow the same pattern as other TAAs. However, it is unclear whether MTAA follows a similar clinical course. The combination of clinical presentation, laboratory results, and radiographic results are used to make the diagnosis of MTAA. Treatment of MTAA is complex since patients frequently present at a late stage, frequently with fulminant sepsis, as well as concomitant complications such as aneurysm rupture. While medical treatment, including antibiotics, is recommended, surgery is still the mainstay of management. Surgery to treat MTAA is complicated and carries a high risk of morbidity and mortality and includes both open repairs and endovascular ones. In this review, we explore the etiology, pathogenesis, clinical presentations, diagnostic modalities as well as treatment management available for MTAA.
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Choinski KN, Harris JD, Cooke PV, Tadros RO. Treatment of a descending thoracic mycotic aneurysm secondary to disseminated aspergillosis infection with thoracic endovascular aortic repair. J Vasc Surg Cases Innov Tech 2022; 8:319-322. [PMID: 35812126 PMCID: PMC9259443 DOI: 10.1016/j.jvscit.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/04/2022] [Indexed: 12/02/2022] Open
Abstract
Mycotic aortic aneurysms are a rare and potentially fatal aortic pathology. Advancements in vascular technology have allowed endovascular repair to be a durable and less invasive option for the treatment of mycotic aortic aneurysms. We have presented the case of a 51-year-old man with a mycotic aneurysm of the descending thoracic aorta secondary to chronic, disseminated aspergillosis infection after liver transplantation. The aneurysm was successfully treated with thoracic aortic stent graft deployment. No perioperative complications occurred, and follow-up computed tomography angiography showed no signs of an endoleak. The patient will continue with lifelong antifungal therapy and close follow-up with vascular surgery.
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5
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Hirani R, Ohira S, Malekan R, de la Pena C, Kleinman G, Spielvogel D. Repair of fungal pseudoaneurysm of the common brachiocephalic trunk. J Card Surg 2022; 37:2912-2915. [PMID: 35690893 DOI: 10.1111/jocs.16676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/13/2022] [Accepted: 05/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM To date, little is known about the aneurysms of the bovine aortic arch, known as a "common brachiocephalic trunk (CBT)" from where the left carotid and innominate arteries bifurcate. PATIENT AND RESULTS Here we report a case of a fungal pseudoaneurysm of the bovine aortic arch in a patient who had prior history of multiple aortic valve replacement, hepatitis C infection, and human immunodeficiency virus infection. A re-operative replacement of the aortic arch repair utilizing a bifurcated graft was successfully performed under deep hypothermia and selective antegrade cerebral perfusion. Pathological examination demonstrated a pseudoaneurysm of the CBT. Intraoperative cultures from the aneurysmal wall showed Aspergillus fumigatus DISCUSSION AND CONCLUSION: we experienced a complex surgical repair of CBT pseudoaneurysm caused by Aspergillus species.
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Affiliation(s)
- Rahim Hirani
- Department of Surgery, Westchester Medical Center, Division of Cardiothoracic Surgery, New York Medical College, Valhalla, New York, USA
| | - Suguru Ohira
- Department of Surgery, Westchester Medical Center, Division of Cardiothoracic Surgery, New York Medical College, Valhalla, New York, USA
| | - Ramin Malekan
- Department of Surgery, Westchester Medical Center, Division of Cardiothoracic Surgery, New York Medical College, Valhalla, New York, USA
| | - Corazon de la Pena
- Department of Surgery, Westchester Medical Center, Division of Cardiothoracic Surgery, New York Medical College, Valhalla, New York, USA
| | - George Kleinman
- Department of Pathology, Westchester Medical Center, Valhalla, New York, USA
| | - David Spielvogel
- Department of Surgery, Westchester Medical Center, Division of Cardiothoracic Surgery, New York Medical College, Valhalla, New York, USA
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6
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Veiga IB, Hahn K, Wenker C, Wyss F, Mühlethaler K, Posthaus H, Jan Janzen. Pulmonary Artery Aneurysm in a Greater Flamingo (Phoenicopterus roseus) Associated with Aspergillus fumigatus Infection. J Comp Pathol 2021; 184:19-23. [PMID: 33894873 DOI: 10.1016/j.jcpa.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/13/2020] [Accepted: 01/16/2021] [Indexed: 12/01/2022]
Abstract
We report necropsy findings in a captive 60-year-old female greater flamingo (Phoenicopterus roseus) that died suddenly following rupture of a pulmonary artery aneurysm. Histologically, there was focally extensive, intramural granulomatous inflammation with intralesional fungal hyphae, and adjacent severe mixed-cell inflammation and acute haemorrhage at the rupture site. Aspergillus fumigatus was identified as the aetiological agent following DNA PCR amplification and sequencing from paraffin-embedded pulmonary artery tissue sections. The most likely explanation is that this lesion was a consequence of haematogenous spread, secondary to mycotic pneumonia or aerosacculitis, following aspiration of A. fumigatus conidiospores. However, no further fungal-related lesions were observed on gross or histopathological examination.
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Affiliation(s)
- Inês B Veiga
- Institute of Animal Pathology, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
| | - Kerstin Hahn
- Institute of Animal Pathology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | | | | | - Konrad Mühlethaler
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Horst Posthaus
- Institute of Animal Pathology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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7
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Emerole K, Kozhevnikova G, Isakov V, Voznesenskiy S, Konnov V, Pilipenko V, Golub V, Polovinkina N, Barysheva I, Kharlamova T, Konnov D. Clinical Assessment of Nutritional and Metabolic Status in HIV Outpatients. Open AIDS J 2020. [DOI: 10.2174/1874613602014010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
After the World Health Organization’s first technical consultation on Nutrient Requirements for People Living with HIV/AIDS in Geneva, 2003, a lot of research questions that are considered crucial for enhancing our understanding of the interaction of nutrition and HIV infection were raised and until this moment, left unanswered. To gain a better understanding of HIV and nutrition, we implemented a comprehensive approach. The aim of our study was to assess the nutritional and metabolic status in order to enhance the provision of medical care to people living with HIV.
Methods:
45 HIV patients and 32 healthy volunteers were enrolled in the study. Within the HIV group, 32 (71%) were male and 13 (29%) female. Only 7 (15%) were ART naïve. Overall their median age, CD4 count and viral load were 30 years (IQR: 28-40), 407 (IQR: 357-490) cells/mm3 and 500 (IQR: 0-1000) copies/ml, respectively. None of the participants in the HIV group had any active infection. Food intake by monthly dietary recall was determined. Body composition was measured using bioelectrical impedance analysis. The selected biochemical parameters were evaluated and the resting metabolic rates were calculated using indirect calorimetry to accurately understand the metabolism of participants.
Results:
Participants in the HIV group did not meet the recommended daily allowance level (RDA) of carbohydrate requirements. The fat-free mass significantly decreased in the HIV group (P < 0.05). Resting energy expenditure was excessive in the HIV group compared to the control group (P < 0.05). Values of urea nitrogen concentration, fat and protein oxidation rates in the HIV group significantly increased (P < 0.01). The carbohydrate oxidation in the HIV group significantly decreased (P < 0.01)
Conclusions:
The study reveals a catabolic status in the HIV group and suggests an adjustment in the nutrient RDA to compensate such status. Further investigation should be extended to vulnerable population group particularly children.
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8
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Tresson P, Roussel A, Mordant P, Cerceau P, Castier Y, Pellenc Q. Endovascular Repair as a Bridge to Open Repair of a Ruptured Descending Thoracic Aspergillus Aortitis. Ann Thorac Surg 2017; 104:e425-e428. [DOI: 10.1016/j.athoracsur.2017.04.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 04/06/2017] [Accepted: 04/22/2017] [Indexed: 12/15/2022]
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9
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Saedi S, Khajali Z, Alizadehasl A. Aspergillus Infection in an Immunocompetent Host With Supravalvular Aortic Stenosis. World J Pediatr Congenit Heart Surg 2017; 11:NP99-NP102. [DOI: 10.1177/2150135117725456] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supravalvular aortic stenosis is the rarest form of left ventricular outflow tract obstruction. Aspergillus endocarditis is also rare and generally reported in immunocompromised hosts. Here we present a case of an immunocompetent patient with supravalvular aortic stenosis complicated by aortic mycotic pseudoaneurysm due to invasive aspergillosis.
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Affiliation(s)
- Sedigheh Saedi
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Khajali
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Alizadehasl
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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10
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Zargaran M, Taghipour S, Kiasat N, Aboualigalehdari E, Rezaei-Matehkolaei A, Zarei Mahmoudabadi A, Shamsizadeh F. Luliconazole, an alternative antifungal agent against Aspergillus terreus. J Mycol Med 2017; 27:351-356. [PMID: 28483449 DOI: 10.1016/j.mycmed.2017.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/09/2017] [Accepted: 04/10/2017] [Indexed: 11/29/2022]
Abstract
Aspergillus terreus is the fourth leading cause of invasive and non-invasive aspergillosis and one of the causative agents of morbidity and mortality among immunocompromised and high-risk patients. A. terreus appears to have increased as a cause of opportunistic fungal infections from superficial to serious invasive infections. Although, invasive aspergillosis is often treated empirically with amphotericin B, most A. terreus isolates are resistant both in vivo and in vitro to some antifungal drugs. In this study, we aimed to evaluate antifungals susceptibility profiles of the different strains of A. terreus against amphotericin B, caspofungin, fluconazole, voriconazole, posaconazole and luliconazole. Forty A. terreus strains originating from environmental sources (air and soil) were identified using by macroscopic and microscopic features. Six antifungals including, amphotericin B, caspofungin, fluconazole, voriconazole, posaconazole and luliconazole were applied for susceptibility tests. Our results show that tested isolates had different susceptibility to antifungals. The lowest MICGM related to luliconazole (0.00236μg/ml), followed by posaconazole (0.18621μg/ml), voriconazole (0.22925μg/ml), caspofungin (0.86μg/ml), fluconazole (8μg/ml) and amphotericin B (11.12μg/ml). This study demonstrated that luliconazole had an excellent in vitro activity against all tested isolates of A. terreus, with MICGM 0.00236μg/mL than other tested antifungals. As a result, luliconazole could be a possible alternative antifungal for the treatment of aspergillosis due to A. terreus.
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Affiliation(s)
- M Zargaran
- Infectious and tropical diseases research center, health research institute, Ahvaz Jundishapur university of medical sciences, Ahvaz, Iran; Department of medical mycology, school of medicine, Ahvaz Jundishapur university of medical sciences, Ahvaz, Iran
| | - S Taghipour
- Department of medical mycology, school of medicine, Ahvaz Jundishapur university of medical sciences, Ahvaz, Iran
| | - N Kiasat
- Department of medical mycology, school of medicine, Ahvaz Jundishapur university of medical sciences, Ahvaz, Iran
| | - E Aboualigalehdari
- Department of medical mycology, school of medicine, Ahvaz Jundishapur university of medical sciences, Ahvaz, Iran
| | - A Rezaei-Matehkolaei
- Infectious and tropical diseases research center, health research institute, Ahvaz Jundishapur university of medical sciences, Ahvaz, Iran; Department of medical mycology, school of medicine, Ahvaz Jundishapur university of medical sciences, Ahvaz, Iran
| | - A Zarei Mahmoudabadi
- Infectious and tropical diseases research center, health research institute, Ahvaz Jundishapur university of medical sciences, Ahvaz, Iran; Department of medical mycology, school of medicine, Ahvaz Jundishapur university of medical sciences, Ahvaz, Iran.
| | - F Shamsizadeh
- Department of medical mycology, school of medicine, Ahvaz Jundishapur university of medical sciences, Ahvaz, Iran
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11
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Lee JH, Han JH, Park JH, Song IC. Invasive Aspergillosis of the Abdominal Aorta with Multiple Peripheral Embolic Lesions. Korean Circ J 2017; 47:422-423. [PMID: 28567096 PMCID: PMC5449540 DOI: 10.4070/kcj.2016.0358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/12/2016] [Accepted: 11/29/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jae-Hwan Lee
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ji Hye Han
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae-Hyeong Park
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ik-Chan Song
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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12
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Maleszewski JJ. Inflammatory ascending aortic disease: Perspectives from pathology. J Thorac Cardiovasc Surg 2015; 149:S176-83. [DOI: 10.1016/j.jtcvs.2014.07.046] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/24/2014] [Indexed: 12/11/2022]
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13
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Watanabe I, Nakayama T, Yamada E, Tsukino M, Hayashi E. Invasive aspergillosis in the aortic arch with infectious Aspergillus lesions in pulmonary bullae. Med Mycol Case Rep 2014; 7:15-9. [PMID: 27330942 PMCID: PMC4909881 DOI: 10.1016/j.mmcr.2014.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/23/2014] [Accepted: 12/19/2014] [Indexed: 11/17/2022] Open
Abstract
A patient with pulmonary bullae died of massive hemoptysis. At autopsy a hole was observed in the aortic wall. A microscopic examination indicated small Aspergillus lesions in pulmonary bullae and extensive necrotic lesions with Aspergillus hyphae in the media of the thoracic aorta. These findings led to a diagnosis of invasive aspergillosis in the aortic arch. This is a rare case in which Aspergillus invaded the aorta in a patient without hematologic neoplasms or neutropenia.
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Affiliation(s)
- Isao Watanabe
- Department of Respiratory Diseases, Hikone Municipal Hospital, 1882 Hassaka-cho, Hikone, Shiga, Hikone 522-8539, Japan
| | - Takahisa Nakayama
- Laboratory of Diagnostic Pathology, Hikone Municipal Hospital, 1882 Hassaka-cho, Hikone, Shiga, Hikone 522-8539, Japan
| | - Eiji Yamada
- Laboratory of Diagnostic Pathology, Hikone Municipal Hospital, 1882 Hassaka-cho, Hikone, Shiga, Hikone 522-8539, Japan
| | - Mitsuhiro Tsukino
- Department of Respiratory Diseases, Hikone Municipal Hospital, 1882 Hassaka-cho, Hikone, Shiga, Hikone 522-8539, Japan
| | - Eiichi Hayashi
- Department of Respiratory Diseases, Hikone Municipal Hospital, 1882 Hassaka-cho, Hikone, Shiga, Hikone 522-8539, Japan
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14
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Reischies F, Hoenigl M. The role of surgical debridement in different clinical manifestations of invasive aspergillosis. Mycoses 2014; 57 Suppl 2:1-14. [PMID: 25186615 DOI: 10.1111/myc.12224] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/30/2014] [Accepted: 07/09/2014] [Indexed: 11/30/2022]
Abstract
Invasive aspergillosis (IA) has a wide spectrum of clinical presentations and is associated with high mortality rates. Early initiation of systemic antimould therapy remains the most important measure to reduce mortality. Surgical debridement is an important additional therapeutic option mainly in cases of extrapulmonary IA. The main intention for surgical intervention in IA is to obtain material for diagnosis and antifungal susceptibility testing. There are, however, also therapeutic implications for surgical interventions in rare manifestation of IA such as endocarditis or mycotic aneurysm. Here, we will review the role of surgical interventions in the treatment of different clinical manifestations of IA.
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Affiliation(s)
- Frederike Reischies
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
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15
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Tihan D, Aksoy M. A real mycotic aneurysm-mycotic aneurysm of the abdominal aorta due to fungal infection. ULUSAL CERRAHI DERGISI 2014; 30:222-4. [PMID: 25931934 DOI: 10.5152/ucd.2014.2703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 03/27/2014] [Indexed: 01/16/2023]
Abstract
A 53-year-old male who was being followed up by a nephrology department because of type V crescentic glomerulonephritis was admitted with abdominal pain to our clinic. He was diagnosed with abdominal aortic aneurysm after the examinations. Aortic repair with a tubular graft was performed. Pathological examination of the aneurysm tissue showed fungal hyphae. We started antifungal chemotherapy with amphotericin B. A separation of the graft body occurred, and the patient was reoperated on. An excision of the graft, ligation of the aorta, and axillobifemoral graft by-pass was performed. At the 15(th) month of his discharge, the patient was readmitted to the emergency room of our clinic suffering from hematemesis. According to the examinations, an aortoduodenal fistula was diagnosed, and we performed a partial duodenal resection and end-to-end duodenoduodenostomy. We want to share this unusual, interesting, and complicated case, operated on several times because of a mycotic aneurysm due to a fungal infection.
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Affiliation(s)
- Deniz Tihan
- Clinic of General Surgery, Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
| | - Murat Aksoy
- Department of General Surgery, Bahçeşehir University Faculty of Medicine, İstanbul, Turkey
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16
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Cooper V, Bera R, Sherman R, Beed M. Pulmonary Artery Aneurysm Caused by Aspergillus Pneumonia Presenting as an Endobronchial Mass Lesion. J Intensive Care Soc 2013. [DOI: 10.1177/175114371301400318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We present a case of pulmonary artery aneurysm (PA aneurysm) following Aspergillus fumigatus pneumonia treated by coil embolisation. Although rare, PA aneurysms have a high mortality rate with a large proportion of the cases reported being found at post-mortem examination. Aspergillus infection is known to result in aneurysms in immunocompromised patients and in patients with infective endocarditis. The case we report is unusual in that the patient was not obviously immunocompromised, and initially presented with a different pathology. Treatment by endovascular coil embolisation was successfully employed in this instance, allowing the patient to be weaned from ventilatory support. Although this is an unusual complication of Aspergillus pneumonia, the identification and successful treatment of pulmonary artery aneurysms requires a high-index of suspicion.
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Affiliation(s)
- Victoria Cooper
- Specialist Registrar in Anaesthesia
- Nottingham University Hospital
| | - Rahul Bera
- Specialist Registrar in Radiology
- Nottingham University Hospital
| | - Richard Sherman
- Consultant in Intensive Care and Anaesthesia
- Nottingham University Hospital
| | - Martin Beed
- Consultant in Intensive Care and Anaesthesia
- Nottingham University Hospital
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17
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Guarro J. Lessons from animal studies for the treatment of invasive human infections due to uncommon fungi. J Antimicrob Chemother 2011; 66:1447-66. [PMID: 21493649 DOI: 10.1093/jac/dkr143] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Clinical experience in the management of opportunistic infections, especially those caused by less common fungi, is, due to their rarity, very scarce; therefore, the most effective treatments remain unknown. The ever-increasing numbers of fungal infections due to opportunistic fungi have repeatedly proven the limitations of the antifungal armamentarium. Moreover, some of these fungi, such as Fusarium spp. or Scedosporium spp., are innately resistant to almost all the available antifungal drugs, which makes the development of new and effective therapies a high priority. Since it is difficult to conduct randomized clinical trials in these uncommon mycoses, the use of animal models is a good alternative for evaluating new therapies. This is an extensive review of the numerous studies that have used animal models for this purpose against a significant number of less common fungi. A table describing the different studies performed on the efficacy of the different drugs tested is included for each fungal species. In addition, there is a summary table showing the conclusions that can be derived from the analysis of the studies and listing the drugs that showed the best results. Considering the wide variability in the response to the antifungals that the different strains of a given species can show, the table highlights the drugs that showed positive results using at least two parameters for evaluating efficacy against at least two different strains without showing any negative results. These data can be very useful for guiding the treatment of rare infections when there is very little experience or when controversial results exist, or when treatment fails.
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Affiliation(s)
- Josep Guarro
- Mycology Unit, Medical School, IISPV, Rovira i Virgili University, 43201 Reus, Spain.
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18
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Pellier I, Dupuis Girod S, Loisel D, Benabidallah S, Proust A, Malhlaoui N, Picard C, Najioullah F, de Saint Basile G, Blanche S, Rialland X, Casanova JL, Fischer A. Occurrence of aortic aneurysms in 5 cases of Wiskott-Aldrich syndrome. Pediatrics 2011; 127:e498-504. [PMID: 21262885 DOI: 10.1542/peds.2009-2987] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aortic aneurysms are a rare condition in children. Here we report the occurrence of aortic aneurysms in 5 children with Wiskott-Aldrich syndrome (WAS). Three patients had a WAS score of 4, and 2 patients had a WAS score of 5, but autoimmunity was only present in 1 patient. Discovery was fortuitous in 4 cases after chest radiography or thoracic or abdominal computed tomography, which was performed to investigate unrelated symptoms; in 1 patient, thoracic pain was an alerting sign. Age at diagnosis was 10 to 16 years. Aneurysms were confined to the thoracic aorta in 4 cases and to the abdominal aorta in 1 case and were from 2 to 6 cm in size. Aortic surgery was successfully performed on the single symptomatic patient. Two other patients are alive: there has been a low progression of the aneurysm 15 years after hematopoietic stem cell transplantation in 1 patient and no evidence of progression after 12 years of follow-up without hematopoietic stem cell transplantation in the second patient. Two patients died 2 and 4 years after diagnosis from unrelated complications. A systematic retrospective search of 33 other patients with WAS for whom imaging material was available did not reveal the presence of aortic aneurysms. This unusual frequency of aortic aneurysm found in patients with WAS (5 of 38) indicates that aneurysm can be an underdiagnosed complication of WAS. It is presently unclear whether it is caused by an infectious and/or autoimmune/inflammatory process. Therefore, we suggest that aneurysms of large vessels should be systematically searched for in patients with WAS.
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Affiliation(s)
- Isabelle Pellier
- Department of Pediatrics, Unité d'Hématologie-Immunologie-Oncologie Pédiatrique, Centre Hospitalier Universitaire d'Angers, Angers, France.
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19
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Update on Multidetector Computed Tomography Angiography of the Abdominal Aorta. Radiol Clin North Am 2010; 48:283-309, viii. [PMID: 20609875 DOI: 10.1016/j.rcl.2010.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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20
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Ozer B, Kalaci A, Duran N, Dogramaci Y, Yanat AN. Cutaneous infection caused by Aspergillus terreus. J Med Microbiol 2009; 58:968-970. [PMID: 19502369 DOI: 10.1099/jmm.0.007799-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aspergillus species are widely distributed in nature, and more than 30 species have been reported to be involved in human and animal infection. Cutaneous infections due to Aspergillus terreus are particularly rare. In this report, we describe a case of cutaneous infection caused by A. terreus in a paediatric patient who underwent surgical treatment for an open tibial fracture secondary to an agricultural accident.
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Affiliation(s)
- Burcin Ozer
- Department of Microbiology and Clinical Microbiology, School of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Aydiner Kalaci
- Department of Orthopaedics and Traumatology, School of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Nizami Duran
- Department of Microbiology and Clinical Microbiology, School of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Yunus Dogramaci
- Department of Orthopaedics and Traumatology, School of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Ahmet Nedim Yanat
- Department of Orthopaedics and Traumatology, School of Medicine, Mustafa Kemal University, Hatay, Turkey
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21
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Abstract
OBJECTIVE To report a case of aortic pseudoaneurysm in a child with a metallic bronchial stent. DESIGN Case report and literature review. SETTING Pediatric intensive care unit at a freestanding tertiary children's hospital. PATIENT A 12-yr-old boy with a left mainstem bronchomalacia managed with a metallic stent presenting with bleeding from his tracheostomy. INTERVENTIONS Emergent flexible tracheobronchoscopy, computed tomography angiogram. MEASUREMENTS AND MAIN RESULTS Discovery of a pseudoaneurysm of the descending thoracic aorta adjacent to the bronchial stent. CONCLUSIONS We report the first case of an aortic pseudoaneurysm in association with a bronchial stent in a child.
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22
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Akhaddar A, Gazzaz M, Albouzidi A, Lmimouni B, Elmostarchid B, Boucetta M. Invasive Aspergillus terreus sinusitis with orbitocranial extension: case report. SURGICAL NEUROLOGY 2008; 69:490-5; discussion 495. [PMID: 18262257 DOI: 10.1016/j.surneu.2007.02.059] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Accepted: 02/24/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aspergillosis of the paranasal sinuses is infrequent and usually involves the species Aspergillus fumigatus and A. flavus. The maxillary sinus is the most common sinus to be affected. Invasive cranio-orbital aspergillosis originating in the sphenoid sinus is rare and mostly occurs in immunocompromised patients with poor outcomes. We present a case of invasive A. terreus sphenoidal sinusitis with intraorbital and intracranial extension in an immunocompetent patient. CASE DESCRIPTION This 62-year-old man presented with a 2-month history of left retroorbital pain followed by rapid decreasing vision and 2 episodes of epistaxis. Ophthalmologic examination revealed no light perception left. Computed tomographic scan and MR images demonstrated an enhanced sphenoid lesion within the left sphenoid sinus with bone destruction and intraorbital and cavernous sinus extensions. A malignant tumor was suspected. The patient underwent a transphenoidal biopsy of the sphenoid mass. Histologic analysis revealed numerous Aspergillus hyphea, and the species A. terreus was isolated from fungal cultures of specimens. No systemic fungal infection was found, and the patient had no evidence of immunosuppression. After 3 months' administration of oral voriconazole, the patient became well, and the orbitocranial mass regressed in size. It was stabilized on the ninth postoperative month. CONCLUSION A. terreus sinusitis with orbitocranial extension had never been reported in the literature. Even in an immunocompetent host, ISOA is difficult to eradicate using surgical debridement combined with optimal antifungal agents because of the intracranial extension and the relative resistance of conventional antifungal therapy. Early diagnosis is important to prevent an unfavorable outcome of this emergent infection.
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Affiliation(s)
- Ali Akhaddar
- Department of Neurosurgery, Mohammed V Military Hospital, Rabat, Morocco.
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23
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Parameswaran V. Multiple mycotic aneurysms with a rare fungus, Aspergillus niger: A complex case report. JOURNAL OF VASCULAR NURSING 2008; 26:22-6. [DOI: 10.1016/j.jvn.2007.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 09/25/2007] [Accepted: 09/26/2007] [Indexed: 11/26/2022]
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24
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Economopoulos N, Kelekis D, Papadopoulos A, Kontopoulou C, Brountzos EN. Subclavian Artery Occlusion and Pseudoaneurysm Caused by Lung Apex Mucormycosis: Successful Treatment with Transcatheter Embolization. Cardiovasc Intervent Radiol 2006; 30:143-5. [PMID: 16832593 DOI: 10.1007/s00270-005-0328-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Subclavian artery pseudoaneurysm and occlusion in young patients are usually post-traumatic. We report the case of a 33-year-old diabetic woman with subclavian artery occlusion and pseudoaneurysm formation caused by pulmonary mucormycosis infection. The patient presented with diabetic ketoacidosis, Horner's syndrome, and absent left arm pulses. A cystic lesion of the left lung apex was found by imaging, was surgically resected, and was histologically diagnosed as mucormycosis infection. Magnetic resonance angiography depicted a left subclavian artery pseudoaneurysm and occlusion adjacent to the mucormycosis lesion. To protect against thromboembolic complications and rupture, the pseudoaneurysm was embolized with coils. The patient is clinically well 1 year after the intervention with no perfusion of the pseudoaneurysm.
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Affiliation(s)
- Nikolaos Economopoulos
- 2nd Department of Radiology, Athens University Medical School, Attikon Hospital, 1 Rimini Street, Athens, Greece
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25
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Imaging features of fungal infection in immuno-suppressed patients in a local ward outbreak. Biomed Imaging Interv J 2006; 2:e21. [PMID: 21614228 PMCID: PMC3097612 DOI: 10.2349/biij.2.2.e21] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Revised: 03/07/2006] [Accepted: 03/15/2006] [Indexed: 11/18/2022] Open
Abstract
Purpose of study To examine the role of imaging in diagnosing and assessing fungal infections in paediatric patients undergoing chemotherapy in a facility, which had high fungal air contamination due to adjacent building construction work. Materials and method Nineteen patients aged five months to 12 years with various malignancies, mainly leukaemia, along with probable fungal infection were referred for imaging over a period of 12 months. The imaging findings from their CT and chest radiographs were reviewed by two radiologists and correlated with the clinical findings. Blood culture and/or biopsy of relevant lesions were performed for all patients. Results Fungus was positively isolated in 11 out of 19 patients, but the remaining patients clinically had fungal infection. The most common species isolated was Candida sp. (five patients), followed by Aspergillus sp. The most common site of fungal infection was the lungs (10 out of 19 patients), where consolidation or cavitating nodules were seen on CT or the plain chest radiograph. One patient developed pulmonary artery aneurysm as a complication. The other sites affected were the intra-abdominal organs (liver, kidneys, and spleen) and the paranasal sinuses, shown on CT. Two patients with clinical evidence of infection and Candida sp. isolated from their blood, however, showed no abnormal findings on imaging. Conclusion Early diagnosis of fungal infections in oncology patients undergoing chemotherapy is important, but diagnosis may be difficult through imaging because of the non-specific changes and the presence of abnormalities from the underlying disease. Even if a specific diagnosis cannot be reached, imaging is useful to monitor response to treatment and detect complications.
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26
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Hosono M, Hattori K, Shibata T, Sasaki Y, Hirai H, Suehiro S. Mycotic aneurysm of the distal aortic arch caused byAspergillus. Gen Thorac Cardiovasc Surg 2006; 54:160-3. [PMID: 16642922 DOI: 10.1007/bf02662471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We describe an unusual case of a thoracic aortic aneurysm caused by Aspergillus. A 70-year-old man underwent prednisolone and Ara-C treatments for a myelodysplastic syndrome. Blood examination revealed pancytopenia. Under these treatments, an aneurysm presented at the distal aortic arch. He underwent resection of the aneurysm with a graft repair covered by a pedicled omentum flap, followed by prolonged administration of micafungin and itraconazole for a mycotic aneurysm. The postoperative course was favorable without complications. Serum C-reactive protein became negative and he was discharged 2 months after the surgery. However, 4 months after the surgery, he died from worsening of the myelodysplastic syndrome. The prognosis for patients with mycotic aneurysms is poor due to their immunocompetent condition arising from underlying diseases. Therefore, in addition to prompt treatment with antifungal agents combined with surgical debridement, control of the underlying disease is essential for improving the outcome.
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Affiliation(s)
- Mitsuharu Hosono
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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27
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Salanitri GC, Huo E, Miller FH, Gupta A, Pereles FS. MRI of mycotic sinus of valsalva pseudoaneurysm secondary to Aspergillus pericarditis. AJR Am J Roentgenol 2005; 184:S25-7. [PMID: 15728012 DOI: 10.2214/ajr.184.3_supplement.01840s25] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Giovanni C Salanitri
- Department of Radiology, Northwestern Memorial Hospital, Suite 700, 448 East Ontario Street, Chicago, IL 60611, USA.
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28
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Steinbach WJ, Perfect JR, Schell WA, Walsh TJ, Benjamin DK. In vitro analyses, animal models, and 60 clinical cases of invasive Aspergillus terreus infection. Antimicrob Agents Chemother 2004; 48:3217-25. [PMID: 15328076 PMCID: PMC514747 DOI: 10.1128/aac.48.9.3217-3225.2004] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- William J Steinbach
- Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA.
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29
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Miller DV, Oderich GS, Aubry MC, Panneton JM, Edwards WD. Surgical pathology of infected aneurysms of the descending thoracic and abdominal aorta: Clinicopathologic correlations in 29 cases (1976 to 1999). Hum Pathol 2004; 35:1112-20. [PMID: 15343514 DOI: 10.1016/j.humpath.2004.05.013] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Infected aortic aneurysms are uncommon, and only rarely have their surgical pathological features been described. Clinical and histopathologic features were evaluated in patients undergoing surgical repair of infected aneurysms of the descending thoracic or abdominal aorta over a 24-year period. Findings were compared with observations (primarily from autopsy studies) from the previous 25-year period (1950 to 1975) and other more recent reports. Of the 29 patients in our study, 79% were men, 90% had risk factors for atherosclerosis, and 72% had an identifiable risk or source of infection. Fever was present in 76%, and abdominal or back pain was seen in 66%. Among the 20 cases with an identifiable causative organism, staphylococcus accounted for 30%, streptococcus for 20%, salmonella for 20%, Escherichia coli for 15%, and other organisms for 15%. Aneurysms were saccular in 59% and infrarenal in 42%, and had a mean diameter of 5.6 cm. Microscopically, 6 patterns were recognized: acute inflammation superimposed on severe chronic atherosclerosis (55%), atherosclerosis with chronic inflammation (20%), acute inflammation without atherosclerosis (7%), chronic adventitial inflammation (7%), pseudoaneurysm formation (7%), and necrotizing granulomatous inflammation (4%). Special stains for organisms were positive in only 38% of the cases. Pathological findings of this series of surgical specimens spanning the fourth quarter of the twentieth century were not appreciably different from those described in autopsy series from the preceding years, although the causative microorganisms and agents used to treat them, preoperative diagnostic modalities, and surgical approaches have evolved.
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Affiliation(s)
- Dylan V Miller
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
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30
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Cooke FJ, Terpos E, Boyle J, Rahemtulla A, Rogers TR. Disseminated Aspergillus terreus infection arising from cutaneous inoculation treated with caspofungin. Clin Microbiol Infect 2003; 9:1238-41. [PMID: 14686991 DOI: 10.1111/j.1469-0691.2003.00797.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A case of disseminated Aspergillus terreus infection in a patient with prolonged neutropenia after stem cell transplant for myeloma is reported. The isolate was resistant to amphotericin B in vitro, and the patient was successfully managed with surgical debridement and the recently licensed antifungal agent caspofungin. There are many challenges associated with treating invasive aspergillosis, particularly that due to A. terreus, and the early use of caspofungin should be considered.
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Affiliation(s)
- F J Cooke
- Infectious Diseases and Microbiology, Imperial College, The Hammersmith Hospital, Du Cane Road, London W12 0NN, UK.
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31
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Affiliation(s)
- Ali Nawaz Khan
- North Manchester General Hospital, Department of Diagnostic Imaging, UK.
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32
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Khoury H, Poh CF, Williams M, Lavoie JC, Nevill TJ. Acute myelogenous leukemia complicated by acute necrotizing ulcerative gingivitis due to Aspergillus terreus. Leuk Lymphoma 2003; 44:709-13. [PMID: 12769350 DOI: 10.1080/1042819031000060573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Infections caused by Aspergillus terreus are rare but have been associated with a poor outcome in immunocompromised patients due to frequent resistance to conventional antifungal therapy. This report describes a case of a woman who developed acute necrotizing ulcerative gingivitis (ANUG) due to A. terreus during induction chemotherapy for acute myelogenous leukemia. She initially failed to respond to treatment with amphotericin B but the infection resolved following the introduction of oral itraconazole. Opportunistic infections caused by A. terreus are an emerging problem and can be associated with a high mortality rate. Early microbiological diagnosis is critical since resistance to amphotericin B is likely and itraconazole appears to be an effective treatment for this infection.
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Affiliation(s)
- H Khoury
- The Leukemtia/Bone Marrow Transplantation Program of British Columbia: Division of Hematology, Vancouver General Hospital, British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada
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