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Jing Y, Wei Q, Zeng H, Cheng R, Tian P, Li Y. The clinical features and prognosis of fungal pleural infection: A case series and literature review. Medicine (Baltimore) 2023; 102:e36411. [PMID: 38050212 PMCID: PMC10695481 DOI: 10.1097/md.0000000000036411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/10/2023] [Indexed: 12/06/2023] Open
Abstract
Fungal pleural infections are infrequent and insidious, for which there are neither large clinical studies nor targeted guidelines to provide standardized treatment options. We reported 4 cases of fungal pleural infection and reviewed the cases of fungal pleural infections in previous studies to provide a basis for the diagnosis and treatment of fungal pleural infections. There were 2 females and 2 males with a mean age of 58.5 years in our data. The average time from onset to diagnosis was 30.25 days. Risk factors most frequently included pulmonary diseases (n = 4) and malignancy (n = 1). Two patients underwent pleural biopsy through a thoracoscope, and no pathogens were detected. Pleural fluid culture was positive in 2 out of 3 cases. The diagnoses were "possible" (n = 1), "probable" (n = 1), and "proven" (n = 2). All patients received systemic antifungal therapy, and 3 received combined thoracic drainage. The outcomes were cured (n = 1), improved (n = 2) and lost to follow-up (n = 1). We reviewed 12 cases of fungal pleural infection in previous studies. The diagnosis was confirmed via culture in 7 cases and via biopsy in 8 cases. The pathogen was Aspergillus in 7 cases. After a combination of systemic antifungal (n = 12) and local treatment (n = 11), 10 patients improved and 2 patients died. Diagnosis of fungal pleural infection should incorporate risk factors, clinical presentation and fungal evidence, with pleural fluid culture being an important and feasible mean of confirming the diagnosis; and treatment should be based on systemic antifungal therapy supplemented by topical therapy.
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Affiliation(s)
- Yawan Jing
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Gerontology and Geriatrics, Tibet Autonomous Region People’s Hospital, Lhasa, Tibet Autonomous Region, China
| | - Qi Wei
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hao Zeng
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruixin Cheng
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Panwen Tian
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yalun Li
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Ichikawa H, Doi R, Matsumoto K, Tomoshige K, Hirabaru M, Machino R, Obata T, Mizoguchi S, Irie J, Tsuchiya T, Nagayasu T. Spontaneous pleural aspergillosis in an immunocompetent young adult treated with minimally invasive surgery. Respir Med Case Rep 2023; 44:101869. [PMID: 37229483 PMCID: PMC10203767 DOI: 10.1016/j.rmcr.2023.101869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
Spontaneous cases of pleural aspergillosis in healthy adults are rare, and the optimal therapeutic approach has not been established. Here we report a rare case of spontaneous pleural aspergillosis in an otherwise healthy young adult. Two-stage surgery with decortication and cavernostomy, followed by systemic antifungal therapy, finally resulted in a successful resolution of his empyema without any serious complications. In young patients with good pulmonary compliance, less invasive procedures, such as thoracoscopic decortication and/or carvernotomy, is a potential treatment option.
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Affiliation(s)
- Hiromi Ichikawa
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Ryoichiro Doi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Koichi Tomoshige
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Masataka Hirabaru
- Department of Respiratory Surgery, Nagasaki Harbor Medical Center, Shinchi-machi 6-39, Nagasaki, 850-0842, Japan
| | - Ryusuke Machino
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Tomohiro Obata
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Satoshi Mizoguchi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Junji Irie
- Department of Pathology, Nagasaki Harbor Medical Center, Shinchi-machi 6-39, Nagasaki, 850-0842, Japan
| | - Tomoshi Tsuchiya
- Department of Thoracic General Surgery, Toyama University Hospital, Sugitani 2630, Toyama, 930-0194, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
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3
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Hakamifard A, Gharedaghi B, Tabarsi P, Shokouhi S, Negahban H, Sharifynia S, Dorudinia A. Delayed post-pneumonectomy empyema necessitans caused by Aspergillus flavus: An unusual report. Respirol Case Rep 2022; 10:e0930. [PMID: 35309958 PMCID: PMC8907913 DOI: 10.1002/rcr2.930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 02/17/2022] [Accepted: 02/26/2022] [Indexed: 11/30/2022] Open
Abstract
Post-pneumonectomy empyema (PPE), with or without bronchopleural fistula, is a challenging and serious entity with significant mortality and morbidity. PPE is usually caused by bacteria such as staphylococci, streptococci and also gram-negative rods. Among fungal pathogens, Aspergillus species is a very rare cause of this entity. Herein, we describe an unusual case of delayed post-pneumonectomy empyema necessitans caused by Aspergillus flavus in a 65-year-old man with favourable clinical outcome by combined surgical and antifungal therapy.
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Affiliation(s)
- Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Babak Gharedaghi
- Lung Transplantation Research CenterNational Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical SciencesTehranIran
| | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research CenterNational Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical SciencesTehranIran
| | - Shervin Shokouhi
- Infectious Diseases and Tropical Medicine Research CenterShahid Beheshti University of Medical SciencesTehranIran
- Department of Infectious Diseases and Tropical MedicineLoghman Hakim Hospital, Shahid Beheshti University of Medical SciencesTehranIran
| | - Halimeh Negahban
- Infectious Diseases and Tropical Medicine Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Somayeh Sharifynia
- Clinical Tuberculosis and Epidemiology Research CenterNational Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical SciencesTehranIran
| | - Atosa Dorudinia
- Chronic Respiratory Diseases Research CenterNational Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical SciencesTehranIran
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4
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Benjanuwattra J, Leelaviwat N, Guerin C, Patel PU, Mekraksakit P, Nugent K. Empyema necessitans as a rare manifestation of Aspergillus fumigatus infection. Proc AMIA Symp 2021; 35:193-194. [DOI: 10.1080/08998280.2021.2008219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Juthipong Benjanuwattra
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Natnicha Leelaviwat
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Cynthia Guerin
- Department of Ophthalmology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Parth U. Patel
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Poemlarp Mekraksakit
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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Kudo F, Ohta H, Nagai Y, Minegishi K, Koyama S. A young immunocompetent patient with spontaneous Aspergillus empyema who developed severe eosinophilia. Respir Med Case Rep 2017; 22:220-223. [PMID: 28913161 PMCID: PMC5587871 DOI: 10.1016/j.rmcr.2017.08.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 08/25/2017] [Accepted: 08/27/2017] [Indexed: 12/03/2022] Open
Abstract
Aspergillus empyema is usually reported as a complication of surgical procedures, and spontaneous cases are quite rare. Here, we describe the case of a 16-year-old man who suddenly developed dyspnea despite previously being healthy. Chest computed tomography showed multiple mass-containing cavity lesions, pneumothorax, and pleural effusion in the left thorax. Within 2 weeks, Aspergillus fumigatus grew from his pleural effusion, thus he was diagnosed with Aspergillus empyema. He also developed severe eosinophilia after admission, and was treated with anti-fungal drugs. Although there are many factors that can cause eosinophilia, we suspect that infection with Aspergillus fumigatus was the major cause of the eosinophilia in this patient. The lack of bronchial symptoms and lesions were not consistent with a diagnosis of allergic bronchopulmonary aspergillosis. As far as we know, this is the first case of spontaneous Aspergillus empyema resulting in severe eosinophilia.
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Affiliation(s)
- Fumiaki Kudo
- Department of Pulmonary Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hiromitsu Ohta
- Department of Pulmonary Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yoshiaki Nagai
- Department of Pulmonary Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kentaro Minegishi
- Department of General Thoracic Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shinichiro Koyama
- Department of Pulmonary Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
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6
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Marshall AC, Kroker AJ, Murray LA, Gronthos K, Rajapaksha H, Wegener KL, Bruning JB. Structure of the sliding clamp from the fungal pathogen
Aspergillus fumigatus
(Afum
PCNA
) and interactions with Human p21. FEBS J 2017; 284:985-1002. [DOI: 10.1111/febs.14035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/16/2017] [Accepted: 02/02/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Andrew C. Marshall
- School of Biological Sciences The University of Adelaide South Australia Australia
| | - Alice J. Kroker
- School of Biological Sciences The University of Adelaide South Australia Australia
| | - Lauren A.M. Murray
- School of Biological Sciences The University of Adelaide South Australia Australia
| | - Kahlia Gronthos
- School of Biological Sciences The University of Adelaide South Australia Australia
| | - Harinda Rajapaksha
- Department of Biochemistry and Genetics La Trobe Institute for Molecular Life Science La Trobe University Bundoora Australia
| | - Kate L. Wegener
- School of Biological Sciences The University of Adelaide South Australia Australia
| | - John B. Bruning
- School of Biological Sciences The University of Adelaide South Australia Australia
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7
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Ashizawa N, Nakamura S, Ide S, Tashiro M, Takazono T, Imamura Y, Miyazaki T, Izumikawa K, Yamamoto Y, Yanagihara K, Miyazaki Y, Kohno S. Successful Treatment of Aspergillus Empyema Using Open Window Thoracostomy Salvage Treatment and the Local Administration of an Antifungal Agent. Intern Med 2016; 55:2093-9. [PMID: 27477422 DOI: 10.2169/internalmedicine.55.6250] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 76-year-old woman received long-term immunosuppressive treatment for collagen vascular disease-associated interstitial pneumonia. The patient developed a cavitary mass lesion in the right lower lung field, and both nontuberculous mycobacteria and Aspergillus spp. were isolated after bronchial washing. The patient underwent a right lower lobectomy but developed Aspergillus empyema. Empyema due to Aspergillus spp. is a rare and life-threatening condition; however, the standard therapeutic strategies for treating Aspergillus empyema are not clear. We herein report a case of Aspergillus empyema that was successfully treated with a combination therapy which included open-window thoracostomy and the administration of antifungal agents (systemic micafungin and local amphotericin-B).
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Affiliation(s)
- Nobuyuki Ashizawa
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
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8
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Rendon A, Rendon RA, Bauerle O. Empyema necessitatis: unique presentation in a coccidioidomycosis case. Am J Respir Crit Care Med 2015; 191:964-6. [PMID: 25876208 DOI: 10.1164/rccm.201411-1973le] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Adrian Rendon
- 1 Universidad Autónoma de Nuevo León Monterrey, México
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9
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Lee HW, Kim YW, Cho J, Lee CH. Empyema necessitatis due to Aspergillus fumigatus. BMJ Case Rep 2014; 2014:bcr-2014-206047. [PMID: 25452298 DOI: 10.1136/bcr-2014-206047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present an extremely rare case of empyema necessitatis secondary to Aspergillus fumigatus infection. A 58-year-old woman presented to our hospital with a painful skin rash on the right thorax. Three fistulas communicating with the pleural space were found. Since she did not show a clinical improvement despite antituberculous and antibacterial treatment, we looked for other causes. Pleural fungus culture showed A. fumigatus and chest wall biopsy revealed numerous fungal hyphae. Treatment with necrotic tissue debridement and antifungal agents was successful.
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Affiliation(s)
- Hyun Woo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yeon Wook Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jaeyoung Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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10
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Chakrabarti A, Singh R. The emerging epidemiology of mould infections in developing countries. Curr Opin Infect Dis 2012; 24:521-6. [PMID: 21799406 DOI: 10.1097/qco.0b013e32834ab21e] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The present review describes the emerging trends of mould infections in developing countries, and highlights the major epidemiological differences from the developed countries. RECENT FINDINGS The limited data available from developing countries suggest an alarming increase in invasive mould infections, especially aspergillosis and mucormycosis, and also a difference in risk factors and causative agents between the developed and developing world. Sino-orbital, cerebral and ophthalmic infections due to Aspergillus flavus are the major clinical types in aspergillosis, after pulmonary aspergillosis. Aspergillus and Fusarium spp. are frequent causes of trauma-associated keratitis in agricultural workers. Rhino-orbito-cerebral presentation associated with uncontrolled diabetes is the predominant mucormycosis. Isolated renal mucormycosis has emerged as a new clinical entity. Apophysomyces elegans and Mucor irregularis are emerging species in these regions and uncommon agents such as Rhizopus homothallicus have also been reported. Many pathogens are geographically restricted, with Pythium insidionum, Rhinocladiella mackenziei and M. irregularis being described almost exclusively from Thailand, Middle East and China, respectively. SUMMARY Despite limited studies, certain peculiarities have been observed in invasive mould infections in developing countries, including a high incidence of ophthalmic lesions, mucormycosis and aspergillosis; few different clinical presentations; and a varied spectrum of pathogens involved in such lesions.
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Affiliation(s)
- Arunaloke Chakrabarti
- Division of Mycology, Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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