1
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Kim S, Kim N, Park WB, Kang CK, Park JH, Lee ST, Jung KH, Park KI, Lee SK, Moon J, Chu K. Real-time application of ITS and D1-D3 nanopore amplicon metagenomic sequencing in fungal infections: Enhancing fungal infection diagnostics. Int J Med Microbiol 2024; 316:151630. [PMID: 39029415 DOI: 10.1016/j.ijmm.2024.151630] [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: 03/20/2024] [Revised: 05/28/2024] [Accepted: 07/09/2024] [Indexed: 07/21/2024] Open
Abstract
While fungal infections cause considerable morbidity and mortality, the performance of the current diagnostic tests for fungal infection is low. Even though fungal metagenomics or targeted next-generation sequencing have been investigated for various clinical samples, the real-time clinical utility of these methods still needs to be elucidated. In this study, we used internal transcribed spacer (ITS) and D1-D3 ribosomal DNA nanopore amplicon metagenomic sequencing to assess its utility in patients with fungal infections. Eighty-four samples from seventy-three patients were included and categorized into 'Fungal infection,' 'Fungal colonization,' and 'Fungal contamination' groups based on the judgement of infectious disease specialists. In the 'Fungal infection' group, forty-seven initial samples were obtained from forty-seven patients. Three fungal cases detected not by the sequencing but by conventional fungal assays were excluded from the analysis. In the remaining cases, the conventional fungal assay-negative/sequencing-positive group (n=11) and conventional fungal assay-positive/sequencing-positive group (n=33) were compared. Non-Candida and non-Aspergillus fungi infections were more frequent in the conventional-negative/sequencing-positive group (p-value = 0.031). We demonstrated the presence of rare human pathogens, such as Trichosporon asahii and Phycomyces blakesleeanus. In the 'Fungal infection' group and 'Fungal colonization' group, sequencing was faster than culturing (mean difference = 4.92 days, p-value < 0.001/ mean difference = 4.67, p-value <0.001). Compared to the conventional diagnostic methods including culture, nanopore amplicon sequencing showed a shorter turnaround time and a higher detection rate for uncommon fungal pathogens.
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Affiliation(s)
- Seondeuk Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Narae Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Hyeon Park
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, 152, Teheran-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jangsup Moon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Genomic Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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2
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Herrera Ortiz AF, Del Castillo V, Duarte JN, Gutiérrez MJ, Noguera V, Martínez de Los Ríos DA, Maldonado Acevedo SP, Torres JL, Pinzón B, Moreno A, Quiroz Alfaro AJ. Pulmonary Calcifying Fibrous Tumor in a Pediatric Patient: A Case Report. Cureus 2024; 16:e62053. [PMID: 38989355 PMCID: PMC11234803 DOI: 10.7759/cureus.62053] [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] [Accepted: 06/10/2024] [Indexed: 07/12/2024] Open
Abstract
A calcifying fibrous tumor (CFT), also known as calcifying fibrous pseudotumor, is an uncommon non-cancerous neoplasm usually located in the gastrointestinal tract. Its location in the lung is extremely rare, and only a few case reports have been published. This case report describes our diagnostic approach in a 9-year-old male patient with an incidental pulmonary mass. The mass was initially misdiagnosed, requiring multiple imaging tests and interventions to obtain the definitive diagnosis of pulmonary CFT. This paper aims to contribute to the limited information available on pulmonary CFT by presenting detailed findings from computed tomography and magnetic resonance imaging.
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Affiliation(s)
- Andrés Felipe Herrera Ortiz
- Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá D.C., COL
- Department of Radiology, Universidad El Bosque, Bogotá D.C., COL
| | - Valeria Del Castillo
- Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá D.C., COL
- Department of Radiology, Universidad El Bosque, Bogotá D.C., COL
| | - José N Duarte
- Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá D.C., COL
- Department of Radiology, Universidad El Bosque, Bogotá D.C., COL
| | - María J Gutiérrez
- Department of Medicine and Health Sciences, Universidad del Rosario, Bogotá D.C., COL
| | - Valeria Noguera
- Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá D.C., COL
- Department of Radiology, Universidad El Bosque, Bogotá D.C., COL
| | | | - Sandra P Maldonado Acevedo
- Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá D.C., COL
- Department of Radiology, Universidad El Bosque, Bogotá D.C., COL
| | - Jhon L Torres
- Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá D.C., COL
| | - Bibiana Pinzón
- Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá D.C., COL
- Department of Radiology, Universidad El Bosque, Bogotá D.C., COL
| | - Angela Moreno
- Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá D.C., COL
- Department of Radiology, Universidad El Bosque, Bogotá D.C., COL
| | - Alejandro J Quiroz Alfaro
- Department of Internal Medicine, North Mississippi Medical Center, Tupelo, USA
- Department of Medicine and Health Sciences, Universidad del Rosario, Bogotá D.C., COL
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3
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Reddy RN, Baikunje N, Belur G, Nair N. Adenocarcinoma of the Lung Masquerading As Invasive Pulmonary Aspergillosis in an Elderly Lady: A Diagnostic Challenge. Cureus 2024; 16:e53345. [PMID: 38435947 PMCID: PMC10907549 DOI: 10.7759/cureus.53345] [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] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
A 59-year-old hypertensive woman presented with a year-long history of cough, expectoration, and progressive breathlessness, recently complicated by hemoptysis and significant weight loss. Initial investigations, including a chest x-ray and contrast-enhanced computed tomography (CECT) of the thorax, suggested an infective pathology. Despite negative bacterial, fungal, and tuberculosis cultures, elevated bronchoalveolar lavage (BAL) galactomannan and serum Aspergillus-specific IgG levels led to a diagnosis of invasive pulmonary aspergillosis (IPA), and antifungal treatment commenced. The patient's initial response was positive; however, symptoms recurred three months later. Further investigations revealed adenocarcinoma, confirmed by cytology from a thoracentesis. The patient, a non-smoker, began targeted therapy with tyrosine kinase inhibitors but declined further diagnostic evaluation. Despite the poor prognosis and palliative care options, the patient opted for discharge to home care. This case underscores the complexity of diagnosing lung pathologies and the importance of considering alternative diagnoses in persistent respiratory symptoms.
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Affiliation(s)
| | | | - Giridhar Belur
- Pulmonary Medicine, KS Hegde Medical Academy, Mangaluru, IND
| | - Nandu Nair
- Pulmonary Medicine, KS Hegde Medical Academy, Mangaluru, IND
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4
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Otálora-Otálora BA, López-Rivera JJ, Aristizábal-Guzmán C, Isaza-Ruget MA, Álvarez-Moreno CA. Host Transcriptional Regulatory Genes and Microbiome Networks Crosstalk through Immune Receptors Establishing Normal and Tumor Multiomics Metafirm of the Oral-Gut-Lung Axis. Int J Mol Sci 2023; 24:16638. [PMID: 38068961 PMCID: PMC10706695 DOI: 10.3390/ijms242316638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/13/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
The microbiome has shown a correlation with the diet and lifestyle of each population in health and disease, the ability to communicate at the cellular level with the host through innate and adaptative immune receptors, and therefore an important role in modulating inflammatory process related to the establishment and progression of cancer. The oral cavity is one of the most important interaction windows between the human body and the environment, allowing the entry of an important number of microorganisms and their passage across the gastrointestinal tract and lungs. In this review, the contribution of the microbiome network to the establishment of systemic diseases like cancer is analyzed through their synergistic interactions and bidirectional crosstalk in the oral-gut-lung axis as well as its communication with the host cells. Moreover, the impact of the characteristic microbiota of each population in the formation of the multiomics molecular metafirm of the oral-gut-lung axis is also analyzed through state-of-the-art sequencing techniques, which allow a global study of the molecular processes involved of the flow of the microbiota environmental signals through cancer-related cells and its relationship with the establishment of the transcription factor network responsible for the control of regulatory processes involved with tumorigenesis.
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Affiliation(s)
| | - Juan Javier López-Rivera
- Grupo de Investigación INPAC, Specialized Laboratory, Clinica Universitaria Colombia, Clínica Colsanitas S.A., Bogotá 111321, Colombia;
| | - Claudia Aristizábal-Guzmán
- Grupo de Investigación INPAC, Unidad de Investigación, Fundación Universitaria Sanitas, Bogotá 110131, Colombia;
| | - Mario Arturo Isaza-Ruget
- Keralty, Sanitas International Organization, Grupo de Investigación INPAC, Fundación Universitaria Sanitas, Bogotá 110131, Colombia;
| | - Carlos Arturo Álvarez-Moreno
- Infectious Diseases Department, Clinica Universitaria Colombia, Clínica Colsanitas S.A., Bogotá 111321, Colombia;
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5
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Miranda N, Hoyer KK. Coccidioidomycosis Granulomas Informed by Other Diseases: Advancements, Gaps, and Challenges. J Fungi (Basel) 2023; 9:650. [PMID: 37367586 DOI: 10.3390/jof9060650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023] Open
Abstract
Valley fever is a respiratory disease caused by a soil fungus, Coccidioides, that is inhaled upon soil disruption. One mechanism by which the host immune system attempts to control and eliminate Coccidioides is through granuloma formation. However, very little is known about granulomas during Coccidioides infection. Granulomas were first identified in tuberculosis (TB) lungs as early as 1679, and yet many gaps in our understanding of granuloma formation, maintenance, and regulation remain. Granulomas are best defined in TB, providing clues that may be leveraged to understand Coccidioides infections. Granulomas also form during several other infectious and spontaneous diseases including sarcoidosis, chronic granulomatous disease (CGD), and others. This review explores our current understanding of granulomas, as well as potential mechanisms, and applies this knowledge to unraveling coccidioidomycosis granulomas.
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Affiliation(s)
- Nadia Miranda
- Quantitative Systems Biology Graduate Program, University of California Merced, Merced, CA 95343, USA
| | - Katrina K Hoyer
- Department of Molecular and Cell Biology, School of Natural Sciences, University of California Merced, Merced, CA 95343, USA
- Health Sciences Research Institute, University of California Merced, Merced, CA 95343, USA
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6
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Gorospe L, Gómez-Bermejo MÁ, Ventura-Díaz S, Ajuria-Illarramendi O, Benito-Berlinches A, de la Pedrosa EGG, Sánchez-Iglesias JF, Martín-Dávila P, Muñoz-Molina GM. Percutaneous diagnosis of an atypical presentation of pulmonary aspergillosis mimicking lung cancer in a renal transplant patient. Transpl Infect Dis 2023; 25:e14042. [PMID: 36815739 DOI: 10.1111/tid.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Luis Gorospe
- Department of Radiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Sofía Ventura-Díaz
- Department of Radiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | | | - Pilar Martín-Dávila
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Gemma M Muñoz-Molina
- Department of Thoracic Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
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7
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Ekeng BE, Emanghe UE, Davies AA, Oladele RO. A Critical Review of Diagnostic Methods for Disseminated Histoplasmosis with Special Focus on Resource-Limited Settings. CURRENT FUNGAL INFECTION REPORTS 2023. [DOI: 10.1007/s12281-023-00454-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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8
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Serce Unat D, Ulusan Bagci O, Unat OS, Kose S, Caner A. The Spectrum of Infections in Patients with Lung Cancer. Cancer Invest 2023; 41:25-42. [PMID: 36445108 DOI: 10.1080/07357907.2022.2153860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Although diagnostic and therapeutic advances in lung cancer (LC) have increased the survival of patients, infection and its complications are still among the most important causes of mortality. The disruption of tissue caused by tumor mass, management of cancer therapy and alteration in the humoral/cellular immune systems due to both cancer itself and therapy considerably increase susceptibility to infection in cancer patients. Particularly, opportunistic microorganisms should be considered, then applying rapid and sensitive diagnostic methods for them. Thus, cancer patients who are already exposed to difficult, long-term and expensive treatments can be prevented from dying from complications related to infections.
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Affiliation(s)
- Damla Serce Unat
- Department of Chest Disease, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Ozlem Ulusan Bagci
- Department of Microbiology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey.,Department of Basic Oncology, Institute of Health Sciences, Ege University, Izmir, Turkey
| | - Omer Selim Unat
- Department of Chest Disease, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Sukran Kose
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ayse Caner
- Department of Basic Oncology, Institute of Health Sciences, Ege University, Izmir, Turkey.,Translational Pulmonary Research Group (EGESAM), Ege University, Izmir, Turkey.,Department of Parasitology, Faculty of Medicine, Ege University, Izmir, Turkey.,Cancer Research Center, Ege University, Izmir, Turkey
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9
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Godoy MCB, Lago EAD, Pria HRFD, Shroff GS, Strange CD, Truong MT. Pearls and Pitfalls in Lung Cancer CT Screening. Semin Ultrasound CT MR 2022; 43:246-256. [PMID: 35688535 DOI: 10.1053/j.sult.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Annual LDCT lung cancer screening is recommended by the United States Preventive Services Task Force (USPSTF) for high-risk population based on the results from the National Lung Cancer Screening Trial (NLST) that showed a significant (20%) reduction in lung cancer-specific mortality rate with the use of annual low-dose computed tomography (LDCT) screening. More recently, the benefits of lung cancer screening were confirmed by the Dutch- Belgian NELSON trial in Europe. With the implementation of lung screening in large scale, knowledge of the limitations related to false positive, false negative and other potential pitfalls is essential to avoid misdiagnosis. This review outlines the most common potential pitfalls in the characterization of screen-detected lung nodules that include artifacts in LDCT, benign nodules that mimic lung cancer, and causes of false negative evaluations of lung cancer with LDCT and PET/CT studies. Awareness of the spectrum of potential pitfalls in pulmonary nodule detection and characterization, including equivocal or atypical presentations, is important for avoiding misinterpretation that can alter patient management.
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Affiliation(s)
- Myrna C B Godoy
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Eduardo A Dal Lago
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Girish S Shroff
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chad D Strange
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mylene T Truong
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
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10
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Invasive Fungal Pneumonia in Immunocompromised Patients. Radiol Clin North Am 2022; 60:497-506. [DOI: 10.1016/j.rcl.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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11
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D'Ambrosio PD, Costa AN, Scordamaglio PR, Terra RM. Endobronchial histoplasmosis mimicking primary bronchogenic carcinoma during the COVID-19 pandemic. J Bras Pneumol 2022; 48:e20210048. [PMID: 35475862 PMCID: PMC9064646 DOI: 10.36416/1806-3756/e20210048] [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: 11/17/2022] Open
Affiliation(s)
- Paula Duarte D'Ambrosio
- . Departamento de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brasil
| | - André Nathan Costa
- . Departamento de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brasil
| | - Paulo Rogério Scordamaglio
- . Divisão de Broncoscopia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brasil
| | - Ricardo Mingarini Terra
- . Departamento de Cirurgia Torácica, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brasil
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12
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Anan N, Zainon R, Tamal M. A review on advances in 18F-FDG PET/CT radiomics standardisation and application in lung disease management. Insights Imaging 2022; 13:22. [PMID: 35124733 PMCID: PMC8817778 DOI: 10.1186/s13244-021-01153-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
Radiomics analysis quantifies the interpolation of multiple and invisible molecular features present in diagnostic and therapeutic images. Implementation of 18-fluorine-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) radiomics captures various disorders in non-invasive and high-throughput manner. 18F-FDG PET/CT accurately identifies the metabolic and anatomical changes during cancer progression. Therefore, the application of 18F-FDG PET/CT in the field of oncology is well established. Clinical application of 18F-FDG PET/CT radiomics in lung infection and inflammation is also an emerging field. Combination of bioinformatics approaches or textual analysis allows radiomics to extract additional information to predict cell biology at the micro-level. However, radiomics texture analysis is affected by several factors associated with image acquisition and processing. At present, researchers are working on mitigating these interrupters and developing standardised workflow for texture biomarker establishment. This review article focuses on the application of 18F-FDG PET/CT in detecting lung diseases specifically on cancer, infection and inflammation. An overview of different approaches and challenges encountered on standardisation of 18F-FDG PET/CT technique has also been highlighted. The review article provides insights about radiomics standardisation and application of 18F-FDG PET/CT in lung disease management.
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13
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Afiani D, Soeroso NN, Tarigan SP, Syahruddin E. The Prevalence of Histoplasmic Skin Test in Lung Cancer Patients. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9292] [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] Open
Abstract
Background: Histoplasmosis is a disease caused by fungus called Histoplasma capsulatum. Several studies reported cases of histoplasmosis that resembled malignancy [3]. . It is a fact that the clinical syndrome of neoplastic disease is not limited to malignancy, so that infectious diseases should be considered in the differential diagnosis. Method: This is descriptive research with consecutive samples. The sample was the patients with lung cancer aged 25-75 years old. The researcher assessed histoplasmic skin test on interdemal administered with fungal protein [5]. After being observed for allergic reaction in 48-72 hours, induration > 5mm shows positive reaction. The Result: this research included 25 samples consisting of 21 men and 4 women. The Result showed 1 person (4%) with positive histoplasmic skin test result containing squamous cell carcinoma and radiological features of solitary pulmonary nodule. There is an insignificant relationship between cancer cell types and the histoplasmic skin test results (p = 0.24). There is an insignificant relationship between histoplamic skin test result and radiological features (p = 0.48).
The Conclusion: There is one person with positive histoplasmic skin test result with squamous cell carcinoma and radiological features of solitary pulmonary nodule.
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Eremiev S, Espejo D, Florencia Pilia M, Sempere A, Teresa Martín-Góme M, Ojanguren I, Ruiz I. Pulmonary Cryptococcosis Mimicking Lung Cancer. OPEN RESPIRATORY ARCHIVES 2022. [PMID: 37497319 PMCID: PMC10369628 DOI: 10.1016/j.opresp.2021.100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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15
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Tannous T, Mak A, Keating M. Small-Cell Lung Cancer Cavities: Primary or Secondary? Cureus 2021; 13:e13691. [PMID: 33824833 PMCID: PMC8012258 DOI: 10.7759/cureus.13691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Although non-small-cell lung cancer occasionally presents as cavitary lesions, it is rare for small-cell lung cancer (SCLC) to present or progress in such a manner. If a cavitary lesion is seen in the setting of small-cell lung carcinoma, infectious etiologies must be excluded first. We present the case of a 43-year-old man with refractory SCLC that progressed despite two lines of therapy, and who was ultimately found to have recurrent adenopathy and numerous widespread cavitary lung nodules. Fine-needle aspiration of a hilar lymph node revealed extensively necrotic SCLC, while bronchoalveolar cultures grew Aspergillus fumigatus and Candida albicans. The patient was subsequently treated with voriconazole; however, despite these measures, his overall clinical course deteriorated and the patient ultimately succumbed to his illness. Aspergillosis is a major cause of cavitary lung lesions, especially in immunocompromised patients. Our patient with refractory stage four SCLC was found to have several cavitary lung lesions. Before assuming that cavitary lesions are neoplastic, evaluation for aspergillosis should be conducted, particularly in SCLC patients. Although invasive fungal infections are often missed, it may be prudent to conduct such testing because aspergillosis is a treatable condition and the treatment can improve a patient’s hospitalization and overall clinical course.
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Affiliation(s)
- Toufic Tannous
- Department of Internal Medicine, Roger Williams Medical Center, Providence, USA
| | - Andrew Mak
- Division of Hematology/Oncology, Roger Williams Medical Center, Providence, USA
| | - Matthew Keating
- Division of Hematology/Oncology, University of California, Irvine School of Medicine, Irvine, USA
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16
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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: 5] [Impact Index Per Article: 1.7] [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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17
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Park M, Ho DY, Wakelee HA, Neal JW. Opportunistic Invasive Fungal Infections Mimicking Progression of Non-Small-Cell Lung Cancer. Clin Lung Cancer 2020; 22:e193-e200. [PMID: 33168426 DOI: 10.1016/j.cllc.2020.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 10/05/2020] [Accepted: 10/11/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many studies have shown that invasive pulmonary aspergillosis, cryptococcosis, and mucormycosis can mimic radiographic and clinical features of primary lung cancer. However, more research surveying the incidence and outcomes of these fungal infections among patients with a history of lung cancer is needed. The aim of this study was to describe the occurrence and clinical outcomes of opportunistic invasive fungal infections that can mimic tumors in non-small-cell lung cancer patients. PATIENTS AND METHODS Patients seen at Stanford University Medical Center from January 1, 2007, to May 1, 2020, with pulmonary aspergillosis, cryptococcosis, or mucormycosis after non-small-cell lung cancer (NSCLC) diagnosis were reviewed. The European Organization for Research and Treatment of Cancer National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria was used to classify patients with evidence of proven or probable invasive fungal infection within our cohort. RESULTS A total of 12 patients with proven or probable invasive mold infection (including 8 cases of aspergillosis) and 1 patient with proven cryptococcosis were identified, without any cases of mucormycosis. Of this cohort, 6 patients (46%) showed radiographic findings that were found to be most consistent with lung cancer by radiologists. Eight cases (62%) were suspected of cancer recurrence or progression by the treatment team on the basis of additional considerations of medical history and clinical symptoms. Most patients had active NSCLC or had a history of recurrence without active NSCLC at the time of fungal discovery (11 patients; 85%). Most patients died without full recovery (7 patients; 54%). CONCLUSIONS Invasive pulmonary aspergillosis and cryptococcosis can often be mistaken as cancer recurrence or progression in patients with a history of NSCLC because of mimicking radiographic and clinical characteristics.
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Affiliation(s)
- Marian Park
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA
| | - Dora Y Ho
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA
| | - Heather A Wakelee
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA
| | - Joel W Neal
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA.
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18
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Miranda D, Jafari P, Dempsey S, Samani A. 4D-CT Hyper-Elastography Using a Biomechanical Model. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:1791-1794. [PMID: 33018346 DOI: 10.1109/embc44109.2020.9176432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Low dose computed tomography (LDCT) is the current gold-standard for lung cancer diagnosis. However, accuracy of diagnosis is limited by the radiologist's ability to discern cancerous from non-cancerous nodules. To assist with diagnoses, a 4D-CT lung elastography method is proposed to distinguish nodules based on tissue stiffness properties. The technique relies on a patient-specific inverse finite element (FE) model of the lung solved using an optimization algorithm. The FE model incorporates hyperelastic material properties for tumor and healthy regions and was deformed according to respiration physiology. The tumor hyperelastic parameters and trans-pulmonary pressure were estimated using an optimization algorithm that maximizes similarity between the actual and simulated tumor and lung image data. The proposed technique was evaluated using an in-silico study where the lung tumor elastic properties were assumed. Following that evaluation, the technique was applied to clinical 4D-CT data of two lung cancer patients. Results from the evaluation study show that the elastography technique recovered known tumor parameters with only 6% error. Tumor hyperelastic properties from the clinical data are also reported. Results from this proof of concept study demonstrate the ability to perform lung elastography with 4D-CT data alone. Advancements in the technique could lead to improved diagnoses and timely treatment of lung cancer.
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19
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Passarin NDP, Pereira AAC, Passos BL, Gil CM, Preciliano Marques LN, Silveira GL, Bonafé S, Moreira Neto LJ. Prostatic involvement in disseminated paracoccidioidomycosis: An unusual presentation mimicking malignant neoplasm. Med Mycol Case Rep 2020; 28:46-48. [PMID: 32426216 PMCID: PMC7225591 DOI: 10.1016/j.mmcr.2020.04.006] [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: 02/18/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/24/2022] Open
Abstract
Paracoccidioidomycosis is a granulomatous fungal infection, endemic to Latin America, which has great economic impact. Prostatic involvement is rare and can simulate other conditions, which poses a diagnostic challenge for the clinician. This article describes the report of a case of disseminated paracoccidioidomycosis with prostatic involvement, initially confused with prostatic adenocarcinoma. We hope to contribute to the knowledge of this presentation as a differential diagnosis and reinforce the importance of thorough clinical investigation.
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Affiliation(s)
| | | | - Bruna Laginski Passos
- University Center of Maringá, Guedner Avenue, 1610, Maringá, Paraná, 87.050-390, Brazil
| | - Camila Mazeiro Gil
- University Center of Maringá, Guedner Avenue, 1610, Maringá, Paraná, 87.050-390, Brazil
| | | | - Giovana Locks Silveira
- University of South of Santa Catarina, Jose Acacio Moreira Avenue, 787, Tubarão, Santa Catarina, 88.704-900, Brazil
| | - Simone Bonafé
- University Center of Maringá, Guedner Avenue, 1610, Maringá, Paraná, 87.050-390, Brazil
| | - Luiz Jorge Moreira Neto
- University Center of Maringá, Guedner Avenue, 1610, Maringá, Paraná, 87.050-390, Brazil
- Corresponding author. Department of Medicine, University Center of Maringá (UniCesumar), 1610 Guedner Avenue, 87050-390 Maringá, PR, Brazil.
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20
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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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21
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Uthoff J, Nagpal P, Sanchez R, Gross TJ, Lee C, Sieren JC. Differentiation of non-small cell lung cancer and histoplasmosis pulmonary nodules: insights from radiomics model performance compared with clinician observers. Transl Lung Cancer Res 2019; 8:979-988. [PMID: 32010576 DOI: 10.21037/tlcr.2019.12.19] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Histoplasmosis pulmonary nodules often present in computed tomography (CT) imaging with characteristics suspicious for lung cancer. This presents a work-up decision issue for clinicians in regions where histoplasmosis is an endemic fungal infection, when a nodule suspicious for lung cancer is detected. We hypothesize the application of radiomic features extracted from pulmonary nodules and perinodular parenchyma could accurately distinguish between suspicious histoplasmosis lung nodules and non-small cell lung cancer (NSCLC). Methods A retrospective clinical cohort of pulmonary nodules with a confirmed diagnosis of histoplasmosis or NSCLC was collected from the University of Iowa Hospitals and Clincs. Radiomic features were extracted describing characteristics of the nodule and perinodular parenchyma regions and used to build a machine learning tool. These cases were assessed by four expert clinicians who gave a blinded risk prediction for NSCLC. Tool and observer performance were assessed by calculating the area under the curve for the receiver operating characteristic (AUC-ROC) and interclass correlation coefficient (ICC). Results A cohort of 71 subjects with confirmed histopathology (40 NSCLC, 31 histoplasmosis) were case-matched based on age, sex, and smoking history. Superior performance (AUC-ROC =0.89) was demonstrated using leave-one-subject out validation in the tool that incorporated radiomics from the nodule and perinodular parenchyma region extended to 100% nodule diameter. Observers had perfect intra-repeatability (ICC =1.0) and demonstrated fair inter-reader variability (ICC =0.52). Conclusions Radiomics have potential utility in the challenging task of differentiation between lung cancer and histoplasmosis. Expert clinician readers have high intra-repeatability but demonstrated inter-reader variability which could provide context for a supplemental radiomics-based tool.
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Affiliation(s)
- Johanna Uthoff
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA.,Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Prashant Nagpal
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Rolando Sanchez
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Thomas J Gross
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Changhyun Lee
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.,Department of Radiology, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jessica C Sieren
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA.,Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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22
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Ouellette CP, Stanek JR, Leber A, Ardura MI. Pediatric Histoplasmosis in an Area of Endemicity: A Contemporary Analysis. J Pediatric Infect Dis Soc 2019; 8:400-407. [PMID: 30124985 DOI: 10.1093/jpids/piy073] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/20/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data on pediatric histoplasmosis have been limited to those from outbreak and case reports. We sought to evaluate the contemporary clinical manifestations, laboratory findings, and outcomes in children with histoplasmosis living in an area of endemicity. METHODS This study was a single-center retrospective review of proven and probable cases of histoplasmosis in children aged 0 to 18 years between April 2008 and April 2014. Case ascertainment was ensured by us using International Classification of Diseases, Ninth Revision codes cross-referenced with laboratory, microbiology, and histopathology tests that detected Histoplasma capsulatum. Demographics, diagnostics, clinical management, and outcomes were evaluated. RESULTS Seventy-three children with histoplasmosis (41 males; median age, 13 years [range, 3-18 years]) were diagnosed with proven (n = 17 [23%]) or probable (n = 56 [77%]) histoplasmosis, which manifested as pulmonary (n = 52 [71%]) or disseminated (n = 21 [29%]) disease. Symptoms at presentation were nonspecific; the examination of 21 (29%) patients revealed abnormal physical findings. Detection of H capsulatum by serologic methods occurred in 93% (63 of 68) of the patients tested. Histoplasma antigen in blood or urine was detected in 42% (20 of 48) and 28% (15 of 53) of the patients tested, respectively. The 16 (22%) patients who were immunocompromised had significantly higher rates of disseminated disease (56% vs 21%, respectively; P = .01), antigenuria (62% vs 18%, respectively; P = .004), and antigenemia (69% vs 31%, respectively; P = .02) and longer durations of antigenuria (403 vs 120 days, respectively; P = .003) and antigenemia (451 vs 149 days, respectively; P < .0001) than did the immunocompetent children. CONCLUSIONS Pediatric histoplasmosis manifests most frequently as pulmonary disease. The highest diagnostic yield was achieved when multiple diagnostic modalities were used. Presentation with disseminated disease and evidence of antigenemia, antigenuria, and delayed antigen clearance were more likely to be seen in immunocompromised children.
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Affiliation(s)
| | | | - Amy Leber
- Laboratory Medicine, Nationwide Children's Hospital and The Ohio State University, Columbus
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23
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[Pseudotumor lesions induced by infectious agents. Case n o 5]. Ann Pathol 2019; 39:267-270. [PMID: 31303345 DOI: 10.1016/j.annpat.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/15/2019] [Accepted: 06/15/2019] [Indexed: 11/20/2022]
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24
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Shi W, Zhou L, Peng X, Ren H, Wang Q, Shan F, Zhang Z, Liu L, Shi Y. HIV-infected patients with opportunistic pulmonary infections misdiagnosed as lung cancers: the clinicoradiologic features and initial application of CT radiomics. J Thorac Dis 2019; 11:2274-2286. [PMID: 31372264 DOI: 10.21037/jtd.2019.06.22] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background To characterize clinicoradiologic and radiomic features for identifying opportunistic pulmonary infections (OPIs) misdiagnosed as lung cancers in patients with human immunodeficiency virus (HIV). Methods Twenty-four HIV-infected patients who were misdiagnosed with lung cancers on CT images and had OPIs confirmed by pathological examination or integration of clinical and laboratory findings and 49 HIV-infected patients with lung cancers confirmed pathologically were included. Semiautomated segmentation of the lesion was implemented with an in-house software. The lesion boundary was adjusted manually by radiologists. A total of 99 nonenhanced-CT-based radiomic features were then extracted with PyRadiomics. The clinicoradiologic and radiomic features were compared between the OPI and cancer groups. Results In the OPI group, 19 patients (79.2%) had tuberculosis (TB) infections, 2 (8.3%) had nontuberculosis mycobacterium (NTM) infections, 2 (8.3%) had cryptococcus infections and 1 (4.2%) had a mixed infection of TB and NTM. There were significant differences in age, proportion of smokers, smoking index, highly active antiretroviral therapy (HAART) duration, CD4+ counts and CD4+/CD8+ ratio between the two groups (P=0.000, 0.012, 0.007, 0.002, 0.000, and 0.000, respectively). In peripheral-type lesions, the presence of pleural indentation was less common, and the presence of satellite lesions was more common in the OPI group (P=0.016 and 0.020, respectively). Four radiomic parameters of central-type lesions were significantly different, including large dependence high gray level emphasis (LDHGLE), skewness, inverse difference normalized (IDN) and kurtosis (P=0.008, 0.017, 0.017, and 0.017, respectively). However, neither CT features of central-type lesions nor radiomic parameters of peripheral-type lesions were significantly different between the two groups. Conclusions Clinicoradiologic features together with radiomics may help identify OPIs mimicking lung cancers in HIV-infected patients.
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Affiliation(s)
- Weiya Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Lingxiao Zhou
- Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
| | - Xueqing Peng
- Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
| | - He Ren
- Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
| | - Qinglei Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Fei Shan
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Zhiyong Zhang
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China.,Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Headmaster's Office, Fudan University, Shanghai 200433, China
| | - Lei Liu
- Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
| | - Yuxin Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
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25
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Hofman P, Tauziède-Espariat A. [Pseudotumor lesions induced by infectious agents. Introduction]. Ann Pathol 2019; 39:246-247. [PMID: 31003708 DOI: 10.1016/j.annpat.2019.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/10/2019] [Accepted: 03/12/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Paul Hofman
- Laboratoire de pathologie clinique et expérimentale, hôpital Pasteur, FHU OncoAge, Biobanque BB-0033-00025, université Côte d'Azur, CHU de Nice, 30, voie Romaine, 06000 Nice, France
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26
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Abstract
Fungal infections throughout the world appear to be increasing. This may in part be due to the increase in the population of patients that are susceptible to otherwise rare fungal infections resulting from the use of immune modulating procedures such as hematopoietic stem cell transplants and drugs like tissue necrosis factor antagonists. Histoplasma capsulatum, an endemic fungus throughout North and South America, is reemerging among HIV+ patients in Central and South America and among patients taking tissue necrosis factor antagonists and other biologics in North America. Fusarium species, a relatively rare fungal infection, is reemerging worldwide in the immunocompromised populations, especially those who are neutropenic like hematopoietic stem cell transplant recipients. A new yeast species is currently emerging worldwide: Candida auris, unknown just a decade ago. It is causing large healthcare-associated outbreaks on four continents and is spreading throughout the world through patient travel. In this review the epidemiology, pathology, detection and treatment of these three emerging and reemerging fungi will be discussed.
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Affiliation(s)
- Shawn R Lockhart
- Mycotic Diseases Branch, Centers for Disease Control and Prevention 1600 Clifton Rd. Mailstop G-11, Atlanta, GA 30333, United States.
| | - Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
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27
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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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28
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Abstract
Coccidioidomycosis is the major systemic mycoses, considered to be 1 of the most infectious fungal diseases. In symptomatic patients, the most common manifestation is pulmonary disease, but many other organs can be affected. Disseminated disease occurs in 1%-5% of all patients affected by coccidioidomycosis and can affect any organ, with the skin, central nervous system, and musculoskeletal system being reported as the most prevalent. Here, we report a 42-year-old male farmer from the west Texas who presented with an approximately 2-month history of progressive shortness of breath and dyspnea on exertion, weight loss, and night sweats. He was treated with various antibiotics for possible upper respiratory tract infection without symptomatic improvement. Computed tomography of the chest revealed numerous subcentimeter noncalcified pulmonary nodules scattered throughout both lungs with extensive mediastinal and bilateral hilar lymphadenopathy. The patient was referred to our hospital for further evaluation of suspected metastatic lung disease. Physical examination revealed an erythematous 1.2 cm nodule on his left medial eyebrow. Skin biopsy of the lesion revealed prominent squamous epithelial hyperplasia with basal keratinocytic atypia and associated mixed inflammatory infiltrate and scattered large thick-walled spherules containing variable-sized endospores, predominantly within the multinucleated giant cells. Special stain Periodic acid-Schiff tissue culture studies confirmed these to be Coccidioides immitis. After appropriate treatment with antifungal therapy for 5.5 months, his symptoms have improved with complete disappearance of lung nodules and a partially cavitated (1.1 × 1.1 cm) lesion in the left upper lung confirmed by follow-up chest computed tomography. With this report, the authors highlight disseminated coccidioidomycosis, a great mimicker of metastatic lung disease, which was diagnosed by skin biopsy, to ensure its prompt recognition and appropriate antifungal therapy.
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29
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Anderson JL, Hall MC, Meece JK. Incidental findings of blastomycosis lung nodules in five asymptomatic patients. Med Mycol Case Rep 2018; 21:63-65. [PMID: 30094129 PMCID: PMC6076388 DOI: 10.1016/j.mmcr.2018.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/24/2018] [Indexed: 11/28/2022] Open
Abstract
Asymptomatic blastomycosis infections are rarely identified or described in the literature, but are believed to comprise 50% of cases. In this report we describe five sporadic cases of blastomycosis in asymptomatic patients. All of these cases were initially identified as incidental findings of lung nodules on CXR or CT. To our knowledge, these are the first detailed descriptions of asymptomatic blastomycosis, occurring as sporadic disease, in the literature.
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Affiliation(s)
| | - Matthew C Hall
- Department of Infectious Diseases, Marshfield Clinic, Marshfield, WI USA
| | - Jennifer K Meece
- Marshfield Clinic Research Institute, Marshfield Clinic, Marshfield, WI USA
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30
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Oshima K, Takazono T, Saijo T, Tashiro M, Kurihara S, Yamamoto K, Imamura Y, Miyazaki T, Tsukamoto M, Yanagihara K, Mukae H, Kohno S, Izumikawa K. Examination of cryptococcal glucuronoxylomannan antigen in bronchoalveolar lavage fluid for diagnosing pulmonary cryptococcosis in HIV-negative patients. Med Mycol 2018; 56:88-94. [PMID: 28419364 DOI: 10.1093/mmy/myx010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 03/23/2017] [Indexed: 12/17/2022] Open
Abstract
We clarified the performance of a cryptococcal glucuronoxylomannan (GXM) antigen test using bronchoalveolar lavage fluid (BALF) samples, in an HIV-negative Japanese population. Between March 2008 and December 2014, we examined cryptococcal GXM antigens in both serum and BALF specimens from 429 cases at Nagasaki University hospital. The diagnoses, underlying diseases, chest computed tomography findings, and cryptococcal GXM antigen test results were retrospectively investigated. Twenty-three patients were confirmed to have pulmonary cryptococcosis, another six were clinically diagnosed with cryptococcosis because they were seropositive for the GXM antigen, and five possible cryptococcosis cases had BALF samples that were positive for the GXM antigen and serum samples that were negative. The test's sensitivities for detecting cryptococcal GXM antigens in serum and BALF samples, for confirmed cases, were 73.9% and 82.6%, respectively, and their respective specificities were 98.5% and 97.8%. Three of the five putative patients with cryptococcosis were treated with antifungal agents; the pulmonary lesions decreased in size in all treated patients. Both the BALF and serum GXM antigen titers showed positive correlations with the lesion sizes; however, the serum antigen titers showed a higher correlation (r = 0.490, P = .0033) than did the BALF titres (r = 0.312, P = .0724). The rate of GXM-positive BALF samples was higher than the rate for serum samples, especially for patients with pulmonary lesion diameters ≤25 mm. Testing for the presence of the cryptococcal GXM antigen in BALF specimens might contribute to the early diagnosis of pulmonary cryptococcosis.
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Affiliation(s)
- Kazuhiro Oshima
- Leading Program, Graduate School of Biomedical Sciences, Nagasaki University.,Unit of Molecular Microbiology and Immunology, Department of Infectious Diseases, Graduate School of Biomedical Sciences, Nagasaki University.,Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University
| | - Takahiro Takazono
- Unit of Molecular Microbiology and Immunology, Department of Infectious Diseases, Graduate School of Biomedical Sciences, Nagasaki University.,Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University
| | - Tomomi Saijo
- Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University
| | - Masato Tashiro
- Unit of Molecular Microbiology and Immunology, Department of Infectious Diseases, Graduate School of Biomedical Sciences, Nagasaki University
| | | | - Kazuko Yamamoto
- Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University
| | - Yoshifumi Imamura
- Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University
| | - Taiga Miyazaki
- Unit of Molecular Microbiology and Immunology, Department of Infectious Diseases, Graduate School of Biomedical Sciences, Nagasaki University.,Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University
| | - Misuzu Tsukamoto
- Nagasaki University Hospital Infection Control and Education Center
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University
| | - Shigeru Kohno
- Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University
| | - Koichi Izumikawa
- Unit of Molecular Microbiology and Immunology, Department of Infectious Diseases, Graduate School of Biomedical Sciences, Nagasaki University
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31
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Abstract
A review of pulmonary infections of all types with diagnostic and morphological features.
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32
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Icard B, Biscardi F, Sofi U. Demonstrating Hickam's Dictum: Metachronous Pulmonary Adenocarcinoma, Carcinoid Tumor, and Histoplasmosis. Am J Med 2017; 130:1265-1268. [PMID: 28690073 DOI: 10.1016/j.amjmed.2017.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Bradley Icard
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Carilion Clinic, Virginia Tech Carilion School of Medicine and Research Institute, Roanoke.
| | - Frank Biscardi
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Carilion Clinic, Virginia Tech Carilion School of Medicine and Research Institute, Roanoke
| | - Umar Sofi
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Carilion Clinic, Virginia Tech Carilion School of Medicine and Research Institute, Roanoke
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33
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Lu J, Palavecino EL, Salih ZT. Pulmonary cryptococcosis diagnosed on a lung fine-needle aspiration. Diagn Cytopathol 2017; 46:160-161. [PMID: 29063707 DOI: 10.1002/dc.23842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/28/2017] [Accepted: 10/04/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Jing Lu
- Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Elizabeth L Palavecino
- Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Ziyan T Salih
- Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
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Queiroz-Telles F, Fahal AH, Falci DR, Caceres DH, Chiller T, Pasqualotto AC. Neglected endemic mycoses. THE LANCET. INFECTIOUS DISEASES 2017; 17:e367-e377. [PMID: 28774696 DOI: 10.1016/s1473-3099(17)30306-7] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/19/2016] [Accepted: 03/23/2017] [Indexed: 01/18/2023]
Abstract
Fungi often infect mammalian hosts via the respiratory route, but traumatic transcutaneous implantation is also an important source of infections. Environmental exposure to spores of pathogenic fungi can result in subclinical and unrecognised syndromes, allergic manifestations, and even overt disease. After traumatic cutaneous inoculation, several fungi can cause neglected mycoses such as sporotrichosis, chromoblastomycosis, mycetoma, entomophthoramycosis, and lacaziosis. Most of these diseases have a subacute to chronic course and they can become recalcitrant to therapy and lead to physical disabilities, including inability to work, physical deformities, and amputations. For many years, paracoccidioidomycosis was considered the most prevalent endemic systemic mycosis in the Americas, but this situation might be changing with recognition of the worldwide presence of Histoplasma capsulatum. Both paracoccidioidomycosis and histoplasmosis can mimic several infectious and non-infectious medical conditions and lead to death if not recognised early and treated. Cutaneous implantation and systemic mycoses are neglected diseases that affect millions of individuals worldwide, especially in low-income countries where their management is suboptimum because challenges in diagnosis and therapeutic options are substantial issues.
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Affiliation(s)
| | | | - Diego R Falci
- Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Centro Universitário La Salle, Canoas, Brazil
| | - Diego H Caceres
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alessandro C Pasqualotto
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Sreeram S, Lobo FD, Acharya V, Saralaya V. A Fortuitous Turn of Evidence in an Elderly Female - A Case of Pulmonary Fusariosis. J Clin Diagn Res 2017; 11:ED04-ED05. [PMID: 28384871 DOI: 10.7860/jcdr/2017/24736.9191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 11/28/2016] [Indexed: 12/28/2022]
Abstract
Pulmonary mycosis is seen infrequently in our country. It is more common in the immunocompromised. The infections caused by less known species like Fusarium have been found to be increasing in incidence in other parts of the world. We hereby report its occurrence in a 79-year-old, non-immunocompromised female who presented with pyrexia of unknown origin. Her Alanine Phosphatase (ALP) and Lactate Dehydrogenase (LHD) levels were raised. CT scan showed interstitial thickening in subpleural aspect of lungs and multiple enlarged lymph nodes in mediastinum. Liver showed multiple hypodense lesions. Metastasis was suspected for which Fine Needle Aspiration Cytology (FNAC) of liver was done which showed foci of regenerative hepatocytes with desmoplastic stromal tissue fragments and negative for tumour. Her Alpha Fetoprotein (AFP) was normal. The bronchial tree cytology showed endobronchial cells, dust-laden macrophages and chronic inflammatory cells along with fungi on Pap smear studies. This was confirmed by culture that grew Fusarium species. after one week of incubation. The acutely branching septate hyphae of Fusarium species are identical to those of Aspergillus species. In a patient who has a disseminated infection with a septate fungus, growth in culture is important to identify the specific organism and subsequently treatment with appropriate antifungals. In cases like ours, where the infection simulates malignancy, it is even more important to make the correct diagnosis to give the appropriate treatment.
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Affiliation(s)
- Saraswathy Sreeram
- Assistant Professor, Department of Pathology, Manipal University , Mangaluru, Karnataka, India
| | - Flora Dorothy Lobo
- Professor, Department of Pathology, Manipal University , Mangaluru, Karnataka, India
| | - Vishak Acharya
- Professor and Head of the Department, Department of Pulmonary Medicine, Manipal University , Mangaluru, Karnataka, India
| | - Vishwas Saralaya
- Associate Professor, Department of Microbiology, Manipal University , Mangaluru, Karnataka, India
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Denning DW, Cadranel J, Beigelman-Aubry C, Ader F, Chakrabarti A, Blot S, Ullmann AJ, Dimopoulos G, Lange C. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J 2016; 47:45-68. [PMID: 26699723 DOI: 10.1183/13993003.00583-2015] [Citation(s) in RCA: 520] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Chronic pulmonary aspergillosis (CPA) is an uncommon and problematic pulmonary disease, complicating many other respiratory disorders, thought to affect ~240 000 people in Europe. The most common form of CPA is chronic cavitary pulmonary aspergillosis (CCPA), which untreated may progress to chronic fibrosing pulmonary aspergillosis. Less common manifestations include: Aspergillus nodule and single aspergilloma. All these entities are found in non-immunocompromised patients with prior or current lung disease. Subacute invasive pulmonary aspergillosis (formerly called chronic necrotising pulmonary aspergillosis) is a more rapidly progressive infection (<3 months) usually found in moderately immunocompromised patients, which should be managed as invasive aspergillosis. Few clinical guidelines have been previously proposed for either diagnosis or management of CPA. A group of experts convened to develop clinical, radiological and microbiological guidelines. The diagnosis of CPA requires a combination of characteristics: one or more cavities with or without a fungal ball present or nodules on thoracic imaging, direct evidence of Aspergillus infection (microscopy or culture from biopsy) or an immunological response to Aspergillus spp. and exclusion of alternative diagnoses, all present for at least 3 months. Aspergillus antibody (precipitins) is elevated in over 90% of patients. Surgical excision of simple aspergilloma is recommended, if technically possible, and preferably via video-assisted thoracic surgery technique. Long-term oral antifungal therapy is recommended for CCPA to improve overall health status and respiratory symptoms, arrest haemoptysis and prevent progression. Careful monitoring of azole serum concentrations, drug interactions and possible toxicities is recommended. Haemoptysis may be controlled with tranexamic acid and bronchial artery embolisation, rarely surgical resection, and may be a sign of therapeutic failure and/or antifungal resistance. Patients with single Aspergillus nodules only need antifungal therapy if not fully resected, but if multiple they may benefit from antifungal treatment, and require careful follow-up.
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Affiliation(s)
- David W Denning
- The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester and the Manchester Academic Health Science Centre, Manchester, UK
| | - Jacques Cadranel
- Service de Pneumologie, AP-HP, Hôpital Tenon and Sorbonne Université, UPMC Univ Paris 06, Paris, France
| | | | - Florence Ader
- Dept of Infectious Diseases, Hospices Civils de Lyon, Lyon, France Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR5308, Lyon, France
| | - Arunaloke Chakrabarti
- Center of Advanced Research in Medical Mycology, Dept of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Stijn Blot
- Dept of Internal Medicine, Ghent University, Ghent, Belgium Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia
| | - Andrew J Ullmann
- Dept of Internal Medicine II, Division of Infectious Diseases, University Hospital Würzburg, Julius-Maximilians-University, Würzburg, Germany
| | - George Dimopoulos
- Dept of Critical and Respiratory Care, University Hospital Attikon, Medical School, University of Athens, Athens, Greece
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Coccidioidomycosis in Patients with Selected Solid Organ Cancers: A Case Series and Review of Medical Literature. Mycopathologia 2016; 181:787-798. [PMID: 27492230 DOI: 10.1007/s11046-016-0044-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/25/2016] [Indexed: 10/21/2022]
Abstract
Coccidioidomycosis is a common infection in the desert southwestern USA; approximately 3 % of healthy persons in Arizona alone become infected annually. Coccidioidomycosis may be severe in immunocompromised persons, but experience among patients with solid organ cancer has not been fully described. Therefore, we aimed to describe the clinical courses of patients whose cancers were complicated by coccidioidomycosis at our institution, which is located in an area with endemic Coccidioides. To do so, we conducted a retrospective review from January 1, 2000, through December 31, 2014, of all patients with breast, colorectal, or ovarian cancer whose cancer courses were complicated by coccidioidomycosis. We identified 17,576 cancer patients; 14 (0.08 %) of these patients met criteria for proven or probable coccidioidomycosis diagnosed within the first 2 years after the cancer diagnosis. All of these patients had primary pulmonary coccidioidomycosis, none had relapsed prior infection, and 1 had possible extrapulmonary dissemination. Five had active coccidioidal infection during chemotherapy, 1 of whom was hospitalized for coccidioidal pneumonia. All were treated with fluconazole, and all improved clinically. Eleven did not require prolonged courses of fluconazole. There were no clearly demonstrated episodes of relapsed infection. In conclusion, coccidioidomycosis was not a common complication of breast, colorectal, or ovarian cancers in patients treated at our institution, and it was not commonly complicated by severe or disseminated infection.
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Nunes JDO, Pillon KRAP, Bizerra PL, Paniago AMM, Mendes RP, Chang MR. The Simultaneous Occurrence of Histoplasmosis and Cryptococcal Fungemia: A Case Report and Review of the Literature. Mycopathologia 2016; 181:891-897. [PMID: 27423433 DOI: 10.1007/s11046-016-0036-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/29/2016] [Indexed: 12/11/2022]
Abstract
Simultaneous infections with Cryptococcus neoformans and Histoplasma capsulatum are rare and typically occur in immunocompromised individuals, particularly AIDS patients. Because both of those fungi can spur the development of latent infections, it is generally unknown which organism was first present. The diagnosis of one fungus can hide the diagnosis of the other, leading to underdiagnoses and poor prognosis. We report a case of C. neoformans and H. capsulatum co-infection. We also performed a systematic review of the literature. Our patient, a 69-year-old HIV-negative man, presented with a 9-month history of a productive cough, dyspnea and wheezing. His history showed chronic obstructive pulmonary disease and type II diabetes mellitus (DM). Pulmonary lesions of unidentified etiology were noted. Cryptococcal involvement of the central nervous system was confirmed, and C. neoformans and H. capsulatum were also isolated from blood cultures. In the literature, we found ten cases of simultaneous histoplasmosis and cryptococcosis. Including our patient, all of the cases were located in North America and Latin America, except for two, one Indian and one African diagnosed in France. AIDS was the main predisposing factor, followed by DM and age >60 years. Several diagnostic methods were employed. A blood culture and bronchoalveolar lavage (BAL) culture resulted in the growth of C. neoformans in most of the cases. H. capsulatum was more often detected in BAL and bone marrow cultures. Although co-infection by these pathogens is severe, it can be cured if it is diagnosed and treated early. We emphasized the importance of clinical suspicion and differential diagnosis of systemic mycoses.
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Affiliation(s)
- Joslaine de Oliveira Nunes
- Universidade Federal de Mato Grosso do Sul, Rua Alberto José Abrão, 53, Campo Grande, MS, 79081-732, Brazil.
| | | | - Patrícia Lira Bizerra
- Universidade Federal de Mato Grosso do Sul, Rua Alberto José Abrão, 53, Campo Grande, MS, 79081-732, Brazil
| | | | - Rinaldo Poncio Mendes
- Researcher of Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Marilene Rodrigues Chang
- Microbiological Research Laboratory, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
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Kaplan A, Berntson DG, Ferrieri P. Postpartum cryptococcal pulmonary lesion incidentally discovered during a pulmonary-embolism evaluation of a 28-year-old caucasian woman. Lab Med 2016; 46:69-73. [PMID: 25617397 DOI: 10.1309/lmrh7hxd8tat5ffk] [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] [Indexed: 10/23/2022] Open
Abstract
We report a case of localized pulmonary cryptococcal infection in a 28-year-old Caucasian woman who was 1 month postpartum at the time of her arrival at the hospital. The patient reported right-side chest pain; on further work up, she was found to have an incidental pulmonary lesion of the left lower lung lobe. Surgical pathology examination and microbiology studies revealed localized cryptococcal infection. Cases of cryptococcal pneumonia in pregnant women and in the postpartum period have been described in the literature. However, cryptococcal infections are usually associated with various immunocompromised states, including human immunodeficiency virus (HIV) infection. Because pregnancy is associated with physiological immunosuppression, cryptococcal pneumonia should be considered in pregnant women, or women in the postpartum period, who have respiratory symptoms.
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Affiliation(s)
- Alesia Kaplan
- Department of Pathology and Laboratory Medicine, University of Minnesota, and
| | - Daniel G Berntson
- Department of Clinical and Anatomic Pathology, Fairview Southdale Hospital, Minneapolis, Minnesota
| | - Patricia Ferrieri
- Department of Pathology and Laboratory Medicine, University of Minnesota, and
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40
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Ramírez-Romero R, Silva-Pérez RA, Lara-Arias J, Ramírez-Hernández C, Marino-Martínez IA, Barbosa-Quintana Á, López-Mayagoitia A. Coccidioidomycosis in Biopsies with Presumptive Diagnosis of Malignancy in Dogs: Report of Three Cases and Comparative Discussion of Published Reports. Mycopathologia 2015; 181:151-7. [PMID: 26419685 PMCID: PMC4676787 DOI: 10.1007/s11046-015-9948-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/16/2015] [Indexed: 12/01/2022]
Abstract
Coccidioidomycosis is a respiratory fungal infection with occasional systemic dissemination. The disseminated coccidioidomycosis is considered a multifaceted disease. In medicine, disseminated coccidioidomycosis is included within a group of infectious diseases that have been referred as the great imitators. In many cases, malignancies are included in the presumptive diagnosis. In veterinary medicine, disseminated coccidioidomycosis is common in dogs. Nonetheless, despite of being a diagnostic dilemma, disseminated coccidioidomycosis is underestimated and frequently not included into differentials, even in endemic zones. Herein, we describe three cases of granulomatous inflammation caused by Coccidioides spp. which were masquerading malignancies in dogs (0.39 %). The presumptive diagnoses in these cases were osteosarcoma, lymphoma and neurofibroma, respectively. A PCR assay employing tissues in paraffin blocks resulted positive for C. posadasii in one of these cases. A comparative discussion on the ambiguous clinic-pathological presentation of disseminated coccidioidomycosis in dogs and humans is included.
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Affiliation(s)
- Rafael Ramírez-Romero
- Posgrado Conjunto Agronomía-Veterinaria, Facultad de Medicina Veterinaria y Zootecnia, Campus de Ciencias Agropecuarias, Universidad Autónoma de Nuevo León, Av. Francisco Villa s/n, Ex-Hacienda el Canadá, C.P. 66050, Gral. Escobedo, N.L., México.
| | - Rolando Antonio Silva-Pérez
- Posgrado Conjunto Agronomía-Veterinaria, Facultad de Medicina Veterinaria y Zootecnia, Campus de Ciencias Agropecuarias, Universidad Autónoma de Nuevo León, Av. Francisco Villa s/n, Ex-Hacienda el Canadá, C.P. 66050, Gral. Escobedo, N.L., México
| | - Jorge Lara-Arias
- Banco de Hueso y Tejidos, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, N.L., México
| | - Cecilia Ramírez-Hernández
- Posgrado Conjunto Agronomía-Veterinaria, Facultad de Medicina Veterinaria y Zootecnia, Campus de Ciencias Agropecuarias, Universidad Autónoma de Nuevo León, Av. Francisco Villa s/n, Ex-Hacienda el Canadá, C.P. 66050, Gral. Escobedo, N.L., México
| | - Iván Alberto Marino-Martínez
- Centro de Investigación y Desarrollo en Ciencias de la Salud (CIDICS), Universidad Autónoma de Nuevo León, Monterrey, N.L., México
| | - Álvaro Barbosa-Quintana
- Departamento de Anatomía Patológica, Hospital Universitario, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, N.L., México
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41
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Wang XL, Wang S, An CL. Mini-Review of Published Reports on Coccidioidomycosis in China. Mycopathologia 2015; 180:299-303. [DOI: 10.1007/s11046-015-9935-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 08/27/2015] [Indexed: 12/30/2022]
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Godoy MCB, Truong MT, Carter BW, Viswanathan C, de Groot P, Ko JP. Pitfalls in pulmonary nodule characterization. Semin Roentgenol 2015; 50:164-74. [PMID: 26002236 DOI: 10.1053/j.ro.2015.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Myrna C B Godoy
- Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston, TX.
| | - Mylene T Truong
- Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Brett W Carter
- Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Chitra Viswanathan
- Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Patricia de Groot
- Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Jane P Ko
- Department of Radiology, Langone Medical Center, New York University, New York, NY
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Qiu L, Hu B, Chen H, Li S, Hu Y, Zheng Y, Wu X. Antifungal efficacy of itraconazole-loaded TPGS-b-(PCL-ran-PGA) nanoparticles. Int J Nanomedicine 2015; 10:1415-23. [PMID: 25733833 PMCID: PMC4337504 DOI: 10.2147/ijn.s71616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This research was conducted to formulate biodegradable itraconazole (ITZ)-loaded d-a-tocopheryl polyethylene glycol 1000 succinate-b-poly(e-caprolactone-ran-glycolide) (TPGS-b-(PCL-ran-PGA); TPP) nanoparticles (NPs) (designed as ITZ-loaded TPP NPs) to improve antifungal efficacy. ITZ-loaded TPP NPs were prepared by a modified double-emulsion method, and their size distribution, morphology, zeta potential, drug encapsulation efficiency, drug-release profile, and antifungal effects were characterized. The cytotoxicity of ITZ-loaded-TPP NPs on HeLa cells and fibroblasts was measured using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) method. The in vivo antifungal activity of ITZ-loaded-TPP NPs was examined in mice by administrating 5×10(5) colony forming units of Candida albicans through the tail vein. The survival rate and survival time of the mice was observed. The fungal count and pathology of lung tissue was analyzed. The data showed that ITZ-loaded-TPP NPs have size of 265±5.8 nm, zeta potential of -31±0.5 mV, high encapsulation efficiency (95%), and extended drug-release profile. ITZ-loaded-TPP NPs at a high concentration of 25 mg/mL had no cytotoxicity on HeLa cells and fibroblasts. Furthermore, ITZ-loaded-TPP NPs achieved a higher level of antifungal activity both in vitro and in vivo. The survival rate and duration was higher in mice treated by ITZ-loaded-TPP NPs than in the other groups (P<0.05). In conclusion, ITZ-loaded-TPP NPs significantly improved ITZ bioavailability by increasing its aqueous dispersibility and extending the duration of drug release, thereby improving the antifungal efficacy of the ITZ agent.
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Affiliation(s)
- Lixin Qiu
- Institute of Virology, School of Medicine, State Key Laboratory of Virology, Wuhan University, Wuhan, Hubei, People's Republic of China ; The Shenzhen Key Lab of Gene and Antibody Therapy, Center for Biotech and Biomedicine, Division of Life and Health Sciences, Graduate School at Shenzhen, Tsinghua University, Shenzhen, Guangdong, People's Republic of China
| | - Bicheng Hu
- Institute of Virology, School of Medicine, State Key Laboratory of Virology, Wuhan University, Wuhan, Hubei, People's Republic of China ; The Clinical Laboratory, Wuhan No 1 Hospital, Wuhan, Hubei, People's Republic of China
| | - Hongbo Chen
- The Shenzhen Key Lab of Gene and Antibody Therapy, Center for Biotech and Biomedicine, Division of Life and Health Sciences, Graduate School at Shenzhen, Tsinghua University, Shenzhen, Guangdong, People's Republic of China ; School of Life Sciences, Tsinghua University, Beijing, People's Republic of China
| | - Shanshan Li
- Department of Plant Pathology and Microbiology, Iowa State University, Ames, IA, USA
| | - Yuqian Hu
- The Shenzhen Key Lab of Gene and Antibody Therapy, Center for Biotech and Biomedicine, Division of Life and Health Sciences, Graduate School at Shenzhen, Tsinghua University, Shenzhen, Guangdong, People's Republic of China ; School of Life Sciences, Tsinghua University, Beijing, People's Republic of China
| | - Yi Zheng
- The Shenzhen Key Lab of Gene and Antibody Therapy, Center for Biotech and Biomedicine, Division of Life and Health Sciences, Graduate School at Shenzhen, Tsinghua University, Shenzhen, Guangdong, People's Republic of China ; School of Life Sciences, Tsinghua University, Beijing, People's Republic of China
| | - Xinxing Wu
- Institute of Virology, School of Medicine, State Key Laboratory of Virology, Wuhan University, Wuhan, Hubei, People's Republic of China
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Illnait-Zaragozi MT, Martínez-Machín GF, Fernández-Andreu CM, Perurena-Lancha MR, Hagen F, Meis JF. Cryptococcus and Cryptococcosis in Cuba. A minireview. Mycoses 2014; 57:707-17. [DOI: 10.1111/myc.12275] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 10/27/2014] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | | | - Ferry Hagen
- Department of Medical Microbiology and Infectious Diseases; Canisius-Wilhelmina Hospital; Nijmegen The Netherlands
| | - Jacques F. Meis
- Department of Medical Microbiology and Infectious Diseases; Canisius-Wilhelmina Hospital; Nijmegen The Netherlands
- Department of Medical Microbiology; Radboud University Medical Center; Nijmegen The Netherlands
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