Clinical analysis of 68 patients with pulmonary mycosis in China

Pulmonary Cryptococcosis Diagnosed by a Transbronchial Lung Cryobiopsy in a Patient with Rheumatoid Arthritis

A 77-year-old woman with seronegative rheumatoid arthritis who was being treated with prednisolone (8 mg/day) and methotrexate (12 mg/week) visited our hospital with an 11-day history of a fever and dyspnea. Chest computed tomography showed infiltration in the right lower lobe. A transbronchial lung cryobiopsy (TBLC) showed cryptococcal cells, and bronchoalveolar lavage fluid later showed growth of Cryptococcus neoformans. She was treated with amphotericin B and flucytosine for about four weeks, and the pulmonary shadows improved. The treatment was then changed to fluconazole as outpatient consolidation and maintenance therapy. A rare case of pulmonary cryptococcosis diagnosed by a TBLC is reported.

[Pulmonary mycosis in patients with diabetes mellitus. Clinical characteristics and risk factors]

BACKGROUND

Diabetes mellitus is a public health problem in Mexico, and the trend of the disease is increasing. From 2000 to 2017, 7.32 million new cases were diagnosed, with pulmonary mycoses being one of the most serious complications.

AIMS

To describe the frequency and the clinical characteristics of patients diagnosed with pulmonary mycoses, and to identify the risk factors associated with this entity.

METHODS

Case-control study, paired by gender (1:1-3) and age (± 5 years), that analyzed patients with pulmonary mycosis (mucormycosis, histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis, cryptococcosis, paracoccidioidomycosis) and studied the risk factors present in each patient.

RESULTS

From the 162 patients studied, 56 suffered pulmonary mycosis and 106 were controls. The median of the age was 51 and 50 years for the cases and for the controls, respectively. Multiple logistic regression analysis showed that patients with diabetes mellitus had an odds ratio of 8,3 (p < 0.001), and patients with a history of tuberculosis had an odds ratio of 8,8 (p < 0.001).

CONCLUSIONS

Our results show that 52% of the patients with pulmonary mycoses had a history of diabetes mellitus. Diabetes mellitus is a relevant risk factor for pulmonary mycoses, which are usually diagnosed in advanced stages and have a high mortality.

Successful surgical management of invasive pulmonary fungal infection in patients with leukemia

Background: Invasive pulmonary aspergillosis (IPA) is an opportunistic fungal infection affecting patients who are undergoing chemotherapy for hematological malignancies, have hematopoietic stem cell transplants, and are immunosuppressed. Surgical treatment for IPA is remains challenging and controversial due to the potentially high risk of mortality and morbidity.

Methods: We discuss 4 leukemia patients who underwent surgery for IPA in our hospital who were successfully treated with curative lobectomy or wedge resection. All patients had uneventful postoperative courses, and all resumed long-term follow-up for their leukemia.

Results: All patients have suffered at least once of hemoptysis with radiological findings of lung nodules appearing as ovoid soft-tissue opacities in the lung parenchyma and had undergone antifungal agent treatment for at least 2 weeks. The symptoms and infection sites were not better. Lobectomy was performed in 3 cases and wedge resection in 1 case. Two of the cases suffered Aspergillus infection, 1 suffered Trichoderma and 1 suffered Candida albicans. Median hospital stay after surgery was 17.25 days. There was only 1 patient who had prolonged air leak (n=1; 25%) with empyema. There were no mortalities during the perioperative period or within 30 days of surgery, all patients survived without recurrence and resumed anti-leukemia treatment as soon as possible.

Conclusion: Surgical resection of focal invasive pulmonary aspergillosis can be a safe and feasible treatment option in appropriately selected cases.

New insights into the clinical characteristics and prognostic factors of pulmonary fungal infections from a retrospective study in Southwestern China

Background

Despite increasing incidence of pulmonary fungal infections (PFIs) worldwide, the clinical characteristics and prognostic factors remain poorly understood. The goal of this study was to investigate the clinical features, laboratory findings, and outcomes of hospitalized patients diagnosed with PFIs.

Methods

We retrospectively enrolled 123 patients at a university hospital in Southwestern China between February 2014 and May 2016, who were diagnosed with PFIs based on clinical presentations and laboratory tests including fungal culture and pathological examination. Medical records were reviewed and analyzed. Prognostic factor associated with mortality was evaluated by multivariate regression analysis.

Results

Of the 123 PFI patients enrolled, the mean age was 67 years with 72% of them being males. In addition to common clinical features reported previously, these patients exhibited distinct characteristics, with the elderly accounting for 79% of all cases, and with prolonged hospitalization being the most prevalent risk factor (74%) and chronic obstructive pulmonary disease (COPD) being the most common underlying disease (45%). Invasive operation was significantly more frequently involved in patients with unfavorable treatment responses than in patients with favorable responses (45.6 vs 7.4%, P=0.000). By multivariate regression analysis, invasive operation (odds ratio [OR]: 5.736, 95% confidence interval [CI]: 2.008–16.389, P=0.001) and hypoalbuminemia (OR: 3.936, 95% CI: 1.325–11.696, P=0.014) were independent prognostic factors of mortality in PFIs.

Conclusion

This study provides new insights into the clinical characteristics and prognostic factors of PFIs and highlights the necessity to be aware of PFIs in patients with COPD and patients receiving invasive operation in order to improve clinical management of these patients.

Pulmonary mycoses diagnosed using exfoliative cytology: infection or colonization?

OBJECTIVES

Flexible bronchoscopy with exfoliative cytology is an important tool for the diagnosis of pulmonary fungal infections. The question of colonization versus true fungal infection is of critical importance.

STUDY DESIGN

A 5-year retrospective analysis of all cases of pulmonary fungal infection diagnosed using exfoliative cytology was performed. Clinical, radiological, bronchoscopy and histopathology findings were recorded.

RESULTS

A total of 69 cases of mycoses were retrieved. The most common fungal organism identified was Aspergillus followed by Candida and Pneumocystis. Most cases of Aspergillus and Candida in cytological specimens presented as a pulmonary mass or endobronchial growth and were diagnosed as carcinomas in biopsy specimens, thus representing colonization. All cases of Pneumocystis with bilateral ground glass infiltrates and cryptococcosis with parenchymal mass lesion in radiology represented true infection. Histoplasma was identified in pleural fluid from a known case of lung carcinoma.

CONCLUSION

Aspergillus and Candida species are the most common fungal organisms. Most of these represent colonization of malignant growths. However, true fungal infections may also present as mass lesions and may masquerade malignancy clinically. Fluid cytological examination is an important diagnostic modality for pulmonary mycoses; however, it is important to correlate results with clinical, bronchoscopy and biopsy findings for accurate diagnosis and appropriate management.