1
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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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2
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Fitzgerald DB, Polverino E, Waterer GW. Expert Review on Nonsurgical Management of Parapneumonic Effusion: Advances, Controversies, and New Directions. Semin Respir Crit Care Med 2023; 44:468-476. [PMID: 37429296 DOI: 10.1055/s-0043-1769095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Parapneumonic effusion and empyema are rising in incidence worldwide, particularly in association with comorbidities in an aging population. Also driving this change is the widespread uptake of pneumococcal vaccines, leading to the emergence of nonvaccine-type pneumococci and other bacteria. Early treatment with systemic antibiotics is essential but should be guided by local microbial guidelines and antimicrobial resistance patterns due to significant geographical variation. Thoracic ultrasound has emerged as a leading imaging technique in parapneumonic effusion, enabling physicians to characterize effusions, assess the underlying parenchyma, and safely guide pleural procedures. Drainage decisions remain based on longstanding criteria including the size of the effusion and fluid gram stain and biochemistry results. Small-bore chest drains appear to be as effective as large bore and are adequate for the delivery of intrapleural enzyme therapy (IET), which is now supported by a large body of evidence. The IET dosing regimen used in the UK Multicenter Sepsis Trial -2 has the most evidence available but data surrounding alternative dosing, concurrent and once-daily instillations, and novel fibrinolytic agents are promising. Prognostic scores used in pneumonia (e.g., CURB-65) tend to underestimate mortality in parapneumonic effusion/empyema. Scores specifically based on pleural infection have been developed but require validation in prospective cohorts.
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Affiliation(s)
- Deirdre B Fitzgerald
- Department of Respiratory Medicine, Tallaght University Hospital, Dublin, Ireland
- Medical School, University of Western Australia, Australia
| | - Eva Polverino
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; CIBER de enfermedades respiratorias
| | - Grant W Waterer
- Medical School, University of Western Australia, Australia
- Royal Perth Hospital, Perth, WA, Australia
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3
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Roberts ME, Rahman NM, Maskell NA, Bibby AC, Blyth KG, Corcoran JP, Edey A, Evison M, de Fonseka D, Hallifax R, Harden S, Lawrie I, Lim E, McCracken DJ, Mercer R, Mishra EK, Nicholson AG, Noorzad F, Opstad K, Parsonage M, Stanton AE, Walker S. British Thoracic Society Guideline for pleural disease. Thorax 2023; 78:s1-s42. [PMID: 37433578 DOI: 10.1136/thorax-2022-219784] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Affiliation(s)
- Mark E Roberts
- Respiratory Medicine, Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, UK
| | - Najib M Rahman
- University of Oxford, Oxford Respiratory Trials Unit, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Oxford Pleural Unit, Churchill Hospital, Oxford, UK
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol and North Bristol NHS Trust, Bristol, UK
| | - Anna C Bibby
- Academic Respiratory Unit, University of Bristol and North Bristol NHS Trust, Bristol, UK
| | - Kevin G Blyth
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cancer Sciences, University of Glasgow/Cancer Research UK Beatson Institute, Glasgow, UK
| | - John P Corcoran
- Interventional Pulmonology Service, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - Matthew Evison
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Rob Hallifax
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Susan Harden
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Iain Lawrie
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Eric Lim
- Academic Division of Thoracic Surgery, The Royal Brompton Hospital and Imperial College London, London, UK
| | - David J McCracken
- Regional Respiratory Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Rachel Mercer
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Eleanor K Mishra
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, UK
| | - Farinaz Noorzad
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Maria Parsonage
- North Cumbria Integrated Care NHS Foundation Trust, Cumbria, UK
| | - Andrew E Stanton
- Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Steven Walker
- Academic Respiratory Unit, University of Bristol and North Bristol NHS Trust, Bristol, UK
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4
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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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5
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Bedawi EO, Ricciardi S, Hassan M, Gooseman MR, Asciak R, Castro-Añón O, Armbruster K, Bonifazi M, Poole S, Harris EK, Elia S, Krenke R, Mariani A, Maskell NA, Polverino E, Porcel JM, Yarmus L, Belcher EP, Opitz I, Rahman NM. ERS/ESTS statement on the management of pleural infection in adults. Eur Respir J 2023; 61:2201062. [PMID: 36229045 DOI: 10.1183/13993003.01062-2022] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/22/2022] [Indexed: 02/07/2023]
Abstract
Pleural infection is a common condition encountered by respiratory physicians and thoracic surgeons alike. The European Respiratory Society (ERS) and European Society of Thoracic Surgeons (ESTS) established a multidisciplinary collaboration of clinicians with expertise in managing pleural infection with the aim of producing a comprehensive review of the scientific literature. Six areas of interest were identified: 1) epidemiology of pleural infection, 2) optimal antibiotic strategy, 3) diagnostic parameters for chest tube drainage, 4) status of intrapleural therapies, 5) role of surgery and 6) current place of outcome prediction in management. The literature revealed that recently updated epidemiological data continue to show an overall upwards trend in incidence, but there is an urgent need for a more comprehensive characterisation of the burden of pleural infection in specific populations such as immunocompromised hosts. There is a sparsity of regular analyses and documentation of microbiological patterns at a local level to inform geographical variation, and ongoing research efforts are needed to improve antibiotic stewardship. The evidence remains in favour of a small-bore chest tube optimally placed under image guidance as an appropriate initial intervention for most cases of pleural infection. With a growing body of data suggesting delays to treatment are key contributors to poor outcomes, this suggests that earlier consideration of combination intrapleural enzyme therapy (IET) with concurrent surgical consultation should remain a priority. Since publication of the MIST-2 study, there has been considerable data supporting safety and efficacy of IET, but further studies are needed to optimise dosing using individualised biomarkers of treatment failure. Pending further prospective evaluation, the MIST-2 regimen remains the most evidence based. Several studies have externally validated the RAPID score, but it requires incorporating into prospective intervention studies prior to adopting into clinical practice.
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Affiliation(s)
- Eihab O Bedawi
- Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Sara Ricciardi
- Unit of Thoracic Surgery, San Camillo Forlanini Hospital, Rome, Italy
- PhD Program Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Maged Hassan
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Michael R Gooseman
- Department of Thoracic Surgery, Hull University Teaching Hospitals NHS Trust, Hull York Medical School, University of Hull, Hull, UK
| | - Rachelle Asciak
- Department of Respiratory Medicine, Queen Alexandra Hospital, Portsmouth, UK
- Department of Respiratory Medicine, Mater Dei Hospital, Msida, Malta
| | - Olalla Castro-Añón
- Department of Respiratory Medicine, Lucus Augusti University Hospital, EOXI Lugo, Cervo y Monforte de Lemos, Lugo, Spain
- C039 Biodiscovery Research Group HULA-USC, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Karin Armbruster
- Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Sarah Poole
- Department of Pharmacy and Medicines Management, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Elinor K Harris
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Stefano Elia
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
- Thoracic Surgical Oncology Programme, Policlinico Tor Vergata, Rome, Italy
| | - Rafal Krenke
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Alessandro Mariani
- Thoracic Surgery Department, Heart Institute (InCor) do Hospital das Clnicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Eva Polverino
- Pneumology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Barcelona, Spain
| | - Jose M Porcel
- Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, Lleida, Spain
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth P Belcher
- Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Najib M Rahman
- Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Chinese Academy of Medical Health Sciences, University of Oxford, Oxford, UK
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6
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Cheng YF, Chen CM, Chen YL, Cheng CY, Huang CL, Hung WH, Wang BY. The outcomes of thoracoscopic decortication between fungal empyema and bacterial empyema. BMC Infect Dis 2023; 23:8. [PMID: 36609233 PMCID: PMC9817236 DOI: 10.1186/s12879-022-07978-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Fungal empyema is an uncommon disease and is associated with a high mortality rate. Surgical intervention is suggested in stage II and III empyema. However, there were no studies that reported the outcomes of surgery for fungal empyema. METHODS This study is a retrospective analysis in a single institute. Patients with empyema thoracis who underwent thoracoscopic decortication between January 2012 and December 2021 were included in the study. We separated the patients into a fungal empyema group and a bacterial empyema group according to culture results. We used 1:3 propensity score matching to reduce selection bias. RESULTS There were 1197 empyema patients who received surgery. Of these, 575 patients showed positive culture results and were enrolled. Twenty-eight patients were allocated to the fungal empyema group, and the other 547 patients were placed in the bacterial empyema group. Fungal empyema showed significantly longer intensive care unit stay (16 days vs. 3 days, p = 0.002), longer median ventilator usage duration (20.5 days vs. 3 days, p = 0.002), longer hospital stay duration (40 days vs. 17.5 days, p < 0.001) and a higher 30-day mortality rate (21.4% vs. 5.9%, p < 0.001). Fungal empyema revealed significantly poorer 1-year survival rate than bacterial empyema before matching (p < 0.001) but without significant difference after matching. CONCLUSIONS The fungal empyema patients had much worse surgical outcomes than the bacterial empyema patients. Advanced age and high Charlson Comorbidity Index score are independent predictors for poor prognosis. Prompt surgical intervention combined with the use of antifungal agents was the treatment choice for fungal empyema.
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Affiliation(s)
- Ya-Fu Cheng
- grid.413814.b0000 0004 0572 7372Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, No. 135 Nanxiao St., 500 Changhua City, Taiwan
| | - Chun-Min Chen
- grid.413814.b0000 0004 0572 7372Big Data Center, Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua City, Taiwan
| | - Yi-Ling Chen
- grid.413814.b0000 0004 0572 7372Surgery Clinical Research Center, Changhua Christian Hospital, Changhua City, Taiwan
| | - Ching-Yuan Cheng
- grid.413814.b0000 0004 0572 7372Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, No. 135 Nanxiao St., 500 Changhua City, Taiwan
| | - Chang-Lun Huang
- grid.413814.b0000 0004 0572 7372Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, No. 135 Nanxiao St., 500 Changhua City, Taiwan
| | - Wei-Heng Hung
- grid.413814.b0000 0004 0572 7372Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, No. 135 Nanxiao St., 500 Changhua City, Taiwan
| | - Bing-Yen Wang
- grid.413814.b0000 0004 0572 7372Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, No. 135 Nanxiao St., 500 Changhua City, Taiwan ,grid.260542.70000 0004 0532 3749Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan ,grid.411641.70000 0004 0532 2041School of Medicine, Chung Shan Medical University, Taichung, Taiwan ,grid.412019.f0000 0000 9476 5696School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ,grid.260542.70000 0004 0532 3749Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan ,Center for General Education, Ming Dao University, Changhua City, Taiwan
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7
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Muacevic A, Adler JR, Guzman J, Desai R, Cartagena J, Chang AY. An Unusual Case of Candida albicans Empyema in Patient With Gastric Cancer and Colon Metastasis. Cureus 2023; 15:e34023. [PMID: 36824548 PMCID: PMC9941036 DOI: 10.7759/cureus.34023] [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: 01/20/2023] [Indexed: 01/22/2023] Open
Abstract
Candida empyema is a rare presentation seen in immunocompromised patients, with a high mortality rate if not treated appropriately. We present a rare case of Candida albicans empyema in a patient with gastric cancer undergoing chemotherapy who recently underwent cholecystectomy, successfully treated with fluconazole and drainage. This case not only highlights an unusual presentation of a common pathogen but stresses the fact that when patients with malignancy, present with pleural effusion, candida should be in the differential. Early detection is key in such cases, as outcomes are poor if diagnosis and treatment are delayed.
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Affiliation(s)
- Alexander Muacevic
- Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - John R Adler
- Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
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8
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Lau EPM, Sidhu C, Popowicz ND, Lee YCG. Pharmacokinetics of antibiotics for pleural infection. Expert Rev Respir Med 2022; 16:1057-1066. [DOI: 10.1080/17476348.2022.2147508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- E P M Lau
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Calvinjit Sidhu
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Natalia D Popowicz
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- School of Allied Health, Division of Pharmacy, University of Western Australia, Perth, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Y C Gary Lee
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
- Centre for Respiratory Health, School of Medicine, University of Western Australia, Perth, Australia
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9
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Xin S, Wu Y, He Z, He X, Wang L, Qi Y. Surgical operation combined with bronchoscopy in the treatment of fungal empyema: 5 cases report. Medicine (Baltimore) 2022; 101:e31080. [PMID: 36281178 PMCID: PMC9592517 DOI: 10.1097/md.0000000000031080] [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] [Indexed: 11/06/2022] Open
Abstract
RATIONALE Fungal empyema is a chronic refractory disease. It is difficult to control thoracic infection, and it is faced with the problem of recurrence. How to control the infection and reduce the probability of recurrence is a difficult problem. Surgical operation combined with endobronchial therapy was used to control infection, seal the fistula and eliminate residual cavity and achieved good results. PATIENT CONCERNS A total of 5 patients with fungal empyema were treated from 2019 to 2021, aged 27 to 72 years, with an average age of 54.8 ± 7.6 years. Two cases were on the left side and 3 cases on the right side. DIAGNOSIS While meeting the diagnostic criteria of empyema, the diagnosis of fungus in pus culture or the discovery of fungus in deep tissue pathology confirmed the diagnosis of fungal empyema in the 5 cases. INTERVENTIONS Through surgical operations combined with bronchoscopy and individualized treatment, the infection was controlled, the fistulas were blocked, and the pus cavity was filled. OUTCOMES After 11 to 30 months of follow-up, the muscle flap in the abscess cavity was mildly atrophied, and there was no recurrence of empyema. Three patients who completed the second-stage operation had their chest tubes removed and returned to normal life. The 2 patients who did not complete the second-stage operation had no recurrence of thoracic infection and no recurrence of cough or fever, and their quality of life was greatly improved. LESSONS Surgical operation combined with bronchoscopy is a reliable method for the treatment of fungal empyema, which can find and plug the fistula more efficiently and eliminate the residual cavity by surgery to avoid recurrence. Therefore, it is a recommended treatment method.
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Affiliation(s)
- Shunxin Xin
- Department of Cardiothoracic Surgery, Hangzhou, Zhejiang Province, China
| | - Yongyong Wu
- Department of Cardiothoracic Surgery, Hangzhou, Zhejiang Province, China
| | - Zhongliang He
- Department of Cardiothoracic Surgery, Hangzhou, Zhejiang Province, China
| | - Xueming He
- Department of Cardiothoracic Surgery, Hangzhou, Zhejiang Province, China
| | - Lei Wang
- Department of Cardiothoracic Surgery, Hangzhou, Zhejiang Province, China
| | - Yaoli Qi
- Department of Cardiothoracic Surgical Nursing, Hangzhou, Zhejiang Province, China
- *Correspondence: Yaoli Qi, Department of Cardiothoracic Surgical Nursing, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou 310004, Zhejiang Province, China (e-mail: )
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10
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Swaminathan N, Anderson K, Nosanchuk JD, Akiyama MJ. Candida glabrata Empyema Thoracis—A Post-COVID-19 Complication. J Fungi (Basel) 2022; 8:jof8090923. [PMID: 36135649 PMCID: PMC9502712 DOI: 10.3390/jof8090923] [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: 08/09/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
The COVID-19 pandemic is associated with a significant increase in the incidence of invasive mycosis, including pulmonary aspergillosis, mucormycosis, and candidiasis. Fungal empyema thoracis (FET) is an uncommon clinical presentation of invasive fungal disease (IFD) associated with significant mortality. Here, we describe the first report of a patient with post-COVID-19 multifocal necrotizing pneumonia complicated by a polymicrobial empyema that included Candida glabrata. Candida empyemas represent another manifestation of a COVID-19-associated fungal opportunistic infection, and this infrequently encountered entity requires a high degree of clinical suspicion for timely identification and management. Therapy for empyemas and other non-bloodstream Candida infections may differ from candidemia due to several pharmacokinetic parameters impacting bioavailability of the antifungal in the affected tissue (e.g., pleural space) and is an area that needs more investigation.
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Affiliation(s)
- Neeraja Swaminathan
- Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10467, USA
- Correspondence:
| | - Katherine Anderson
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Joshua D. Nosanchuk
- Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10467, USA
| | - Matthew J. Akiyama
- Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10467, USA
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11
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Aspergillus pleural empyema in a chronic smoker - A case report and review of literature. J Mycol Med 2022; 32:101299. [PMID: 35640524 DOI: 10.1016/j.mycmed.2022.101299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 05/05/2022] [Accepted: 05/22/2022] [Indexed: 11/22/2022]
Abstract
Aspergillus species are ubiquitous saprophytic fungi that are present in the air, water, soil, and decaying vegetables. Clinical features of Aspergillus infection largely depend on the interplay between the fungi and the host immune status. We present a case of a chronic smoker with shortness of breath who was found to have diffuse bronchiectatic changes and empyema of the right lung. Emphysema was also noticed in the left lung. Rare Aspergillus fumigatus was identified in the pleural fluid, while the acid-fast stain and bacterial cultures were negative. The patient's serum Aspergillus fumigatus IgG antibody and galactomannan antigen were negative; however, the pleural galactomannan antigen was elevated. He was treated with video-assisted thoracoscopic surgery (VATS) and partial decortication of the right lung, along with intravenous voriconazole. Despite aggressive therapeutic measures, he died after a prolonged hospital stay. Aspergillus pleural empyema is rare but can be fatal; however, it is not included in the classification for pulmonary aspergillosis. Clinicians should be vigilant to evaluate for fungal empyema in patients with chronic obstructive pulmonary diseases, even without profound immunosuppression.
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12
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Cheng YF, Cheng CY, Huang CL, Hung WH, Wang BY. Pleural Peels Tissue Culture plus Pleural Fluid Culture Help to Improve Culture Rate for Empyema. J Clin Med 2022; 11:jcm11071882. [PMID: 35407489 PMCID: PMC8999404 DOI: 10.3390/jcm11071882] [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] [Received: 02/26/2022] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Empyema is known as a serious infection, and outcomes of empyema cases remain poor. Pleural fluid culture and blood culture have been reported to give unsatisfactory results. We introduce a novel pleural peels tissue culture during surgery and aim to improve the culture results of empyema. Methods: This was a retrospective study and was obtained from our institute. Patients with stage II or III empyema undergoing video-assisted thoracic surgery decortication from January 2019 to June 2021 were included in the study. Results: There were 239 patients that received a pleural peels tissue culture, a pleural fluid culture, and a blood culture concurrently during the perioperative period. Of these, 153 patients had at least one positive culture and 86 patients showed triple negative culture results. The positive culture rates were 46.9% for pleural peels tissue cultures, 46.0% for pleural fluid cultures, and 10% for blood cultures. The combination of pleural peels tissue culture and pleural fluid culture increased the positive rate to 62.7%. Streptococcus species and Staphylococcus species were the most common pathogens. Conclusion: The combination of pleural peels tissue culture and pleural fluid culture is an effective method to improve the positive culture rate in empyema.
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Affiliation(s)
- Ya-Fu Cheng
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan; (Y.-F.C.); (C.-Y.C.); (C.-L.H.); (W.-H.H.)
| | - Ching-Yuan Cheng
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan; (Y.-F.C.); (C.-Y.C.); (C.-L.H.); (W.-H.H.)
| | - Chang-Lun Huang
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan; (Y.-F.C.); (C.-Y.C.); (C.-L.H.); (W.-H.H.)
| | - Wei-Heng Hung
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan; (Y.-F.C.); (C.-Y.C.); (C.-L.H.); (W.-H.H.)
| | - Bing-Yen Wang
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan; (Y.-F.C.); (C.-Y.C.); (C.-L.H.); (W.-H.H.)
- School of Medicine, Chung Shan Medical University, Taichung 201, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung 402, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Center for General Education, Ming Dao University, Changhua 523, Taiwan
- Correspondence: ; Tel.: +886-(2)-7238595; Fax: +886-(2)-7228289
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13
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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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14
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Tobys D, Johannis W, Juebner M, Drinhaus H. A New Kind of Barrel Chest: Alcoholic Fermentation due to Candida albicans in a Pleural Effusion. Am J Med 2021; 134:e482-e483. [PMID: 33864766 DOI: 10.1016/j.amjmed.2021.03.026] [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: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 11/15/2022]
Affiliation(s)
- David Tobys
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany; German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Germany
| | - Wibke Johannis
- Institute for Clinical Chemistry, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany
| | - Martin Juebner
- Institute of Legal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany
| | - Hendrik Drinhaus
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany.
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15
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Evaluation and management of pleural sepsis. Respir Med 2021; 187:106553. [PMID: 34340174 DOI: 10.1016/j.rmed.2021.106553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 11/21/2022]
Abstract
Pleural sepsis stems from an infection within the pleural space typically from an underlying bacterial pneumonia leading to development of a parapneumonic effusion. This effusion is traditionally divided into uncomplicated, complicated, and empyema. Poor clinical outcomes and increased mortality can be associated with the development of parapneumonic effusions, reinforcing the importance of early recognition and diagnosis. Management necessitates a multimodal therapeutic strategy consisting of antimicrobials, catheter/tube thoracostomy, and at times, video-assisted thoracoscopic surgery.
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16
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Firstcase of pneumonia-parapneumonic effusion due to Trichoderma longibrachiatum. IDCases 2021; 25:e01239. [PMID: 34377673 PMCID: PMC8329512 DOI: 10.1016/j.idcr.2021.e01239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 11/21/2022] Open
Abstract
Trichoderma longibrachiatum is a fungus belonging to the genus Trichoderma. Trichoderma longibrachiatum is not thought as a pathogenic for healthy individuals. However, it has the ability to produce toxic peptides and extracellular proteases and has been described to cause invasive infections in immunocompromised hosts. Trichoderma longibrachiatum has been reported as the causative microorganism of lung infections, skin infections, sinus infections, otitis, stomatitis endocarditis, pericarditis, gastrointestinal infections, mediastinitis and peritonitis. We report the first case of pneumonia with parapneumonic effusion in an old woman with diabetes mellitus due to Trichoderma longibrachiatum.
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Key Words
- ADA, adenosine deaminase
- ALP, alkaline phosphatase
- ALT, alanine transaminase
- AST, aspartate aminotransferase
- CRP, C-reactive protein
- CT, computerized tomography
- Diabetes mellitus
- ESR, erythrocyte sedimentation rate
- FiO2, fraction of inspired oxygen
- Fungal infection
- GGT, gamma glutamyl transferase
- HIV, human immunodeficiency virus
- Hb, hemoglobin
- Ht, hematocrit
- LDH, serum lactate dehydrogenase
- PTLS, platelets
- Pleural effusion
- SG, specific gravity
- TSH, thyroid-stimulating hormone
- Trichoderma longibrachiatum
- WBC, white blood cells
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17
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Hassan M, Patel S, Sadaka AS, Bedawi EO, Corcoran JP, Porcel JM. Recent Insights into the Management of Pleural Infection. Int J Gen Med 2021; 14:3415-3429. [PMID: 34290522 PMCID: PMC8286963 DOI: 10.2147/ijgm.s292705] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/29/2021] [Indexed: 01/15/2023] Open
Abstract
Pleural infection in adults has considerable morbidity and continues to be a life-threatening condition. The term “pleural infection” encompasses complicated parapneumonic effusions and primary pleural infections, and includes but is not limited to empyema, which refers to collection of pus in the pleural cavity. The incidence of pleural infection in adults has been continuously increasing over the past two decades, particularly in older adults, and most of such patients have comorbidities. Management of pleural infection requires prolonged duration of hospitalization (average 14 days). There are recognized differences in microbial etiology of pleural infection depending on whether the infection was acquired in the community or in a health-care setting. Anaerobic bacteria are acknowledged as a major cause of pleural infection, and thus anaerobic coverage in antibiotic regimens for pleural infection is mandatory. The key components of managing pleural infection are appropriate antimicrobial therapy and chest-tube drainage. In patients who fail medical therapy by manifesting persistent sepsis despite standard measures, surgical intervention to clear the infected space or intrapleural fibrinolytic therapy (in poor surgical candidates) are recommended. Recent studies have explored the role of early intrapleural fibrinolytics or first-line surgery, but due to considerable costs of such interventions and the lack of convincing evidence of improved outcomes with early use, early intervention cannot be recommended, and further evidence is awaited from ongoing studies. Other areas of research include the role of routine molecular testing of infected pleural fluid in improving the rate of identification of causative organisms. Other research topics include the benefit of such interventions as medical thoracoscopy, high-volume pleural irrigation with saline/antiseptic solution, and repeated thoracentesis (as opposed to chest-tube drainage) in reducing morbidity and improving outcomes of pleural infection. This review summarizes current knowledge and practice in managing pleural infection and future research directions.
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Affiliation(s)
- Maged Hassan
- Chest Diseases Department, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Shefaly Patel
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals, Oxford, UK
| | - Ahmed S Sadaka
- Chest Diseases Department, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Eihab O Bedawi
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals, Oxford, UK
| | - John P Corcoran
- Department of Respiratory Medicine, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - José M Porcel
- Department of Internal Medicine, Arnau de Vilanova University Hospital, Lleida, Spain
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18
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Senger SS, Thompson GR, Samanta P, Ahrens J, Clancy CJ, Nguyen MH. Candida Empyema Thoracis at Two Academic Medical Centers: New Insights Into Treatment and Outcomes. Open Forum Infect Dis 2021; 8:ofaa656. [PMID: 33889656 PMCID: PMC8052497 DOI: 10.1093/ofid/ofaa656] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/01/2021] [Indexed: 11/26/2022] Open
Abstract
Background Candida empyema thoracis (pleural empyema) is an uncommon manifestation of invasive candidiasis, for which optimal treatment is unknown. Methods This is a retrospective study of patients with Candida empyema at 2 academic medical centers from September 2006 through December 2015. Results We identified 81 patients with Candida empyema (median age, 62 years; 68% men). Sixty-five percent of patients underwent surgery or an invasive intervention of the thorax or abdomen within the preceding 90 days. Candida empyema originated from intrathoracic (51%) or intra-abdominal sources (20%), spontaneous esophageal rupture (12%), pleural space manipulation (9%), and pneumonia (6%). Eighty-four percent and 41% of patients were intensive care unit residents and in septic shock, respectively, within 3 days of diagnosis. Causative species were Candida albicans (65%), Candida glabrata (26%), Candida parapsilosis (11%), Candida tropicalis (4%), Candida krusei (2%), and Candida dubliniensis (1%). Bacteria were recovered from empyemas in 51% of patients. Concurrent candidemia was diagnosed in only 2% of patients. Management included pleural drainage and antifungal treatment in 98% and 85% of patients, respectively. Mortality at 100 days was 27%, and it was highest for cases stemming from esophageal rupture (67%). Spontaneous esophageal rupture and echinocandin rather than fluconazole treatment were independent risk factors for death at 100 days (P = .003 and .04, respectively); receipt of antifungal therapy was an independent predictor of survival (P = .046). Conclusions Candida empyema mortality rates were lower than reported previously. Optimal management included pleural drainage and fluconazole treatment. Superiority of fluconazole over echinocandins against Candida empyema needs to be confirmed in future studies.
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Affiliation(s)
- Suheyla S Senger
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Turkey, Tepecik Training and Research Hospital, Izmir, Turkey.,Division of Infectious Diseases, Department of Internal Medicine University of California Davis Medical Center, Sacramento, California, USA
| | - George R Thompson
- Division of Infectious Diseases, Department of Internal Medicine University of California Davis Medical Center, Sacramento, California, USA.,Department of Medical Microbiology and Immunology, University of California Davis Medical Center, Sacramento, California, USA
| | - Palash Samanta
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jillian Ahrens
- Division of Infectious Diseases, Department of Internal Medicine University of California Davis Medical Center, Sacramento, California, USA
| | - Cornelius J Clancy
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - M Hong Nguyen
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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19
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Newman JS, Renzi AS, Glassman L, Lee PC, Jurado J, Hyman K, Zeltsman D. Uniportal VATS Lobectomy and Decortication: Not an Everyday Occurrence. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 16:108-111. [PMID: 33283574 DOI: 10.1177/1556984520972370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Management of trapped lung with an underlying lung lesion and hydropneumothorax remains controversial. Furthermore, Aspergillus empyema and aspergilloma are rare pathologies for which uniportal video-assisted thoracoscopic (VATS) surgical management remains controversial. We present a young patient referred to our service after recent hospitalization for pneumonia. The patient was found to have a chronic effusion with a right lower lobe cystic parenchymal lesion and was taken to the operating room. The patient underwent right uniportal VATS surgery with evacuation of empyema, total pulmonary decortication, and right lower lobectomy. His postoperative course was unremarkable, and he was discharged home. Postoperative workup demonstrated lymphocyte variant hypereosinophilia. He continues to follow with thoracic surgery at the time of this report and remains asymptomatic. We conclude that uniportal VATS is a most minimally invasive, safe, and efficient approach for management of complex intrathoracic pathology including total pulmonary decortication and lobectomy.
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Affiliation(s)
- Joshua S Newman
- 23289025049 Department of Cardiovascular and Thoracic Surgery, Long Island Jewish Medical Center, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA
| | - Alexandra S Renzi
- 23289025049 Department of Cardiovascular and Thoracic Surgery, Long Island Jewish Medical Center, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA
| | - Lawrence Glassman
- 23289025049 Department of Cardiovascular and Thoracic Surgery, Long Island Jewish Medical Center, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA
| | - Paul C Lee
- 23289025049 Department of Cardiovascular and Thoracic Surgery, Long Island Jewish Medical Center, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA
| | - Julissa Jurado
- 23289025049 Department of Cardiovascular and Thoracic Surgery, Long Island Jewish Medical Center, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA
| | - Kevin Hyman
- 23289025049 Department of Cardiovascular and Thoracic Surgery, Long Island Jewish Medical Center, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA
| | - David Zeltsman
- 23289025049 Department of Cardiovascular and Thoracic Surgery, Long Island Jewish Medical Center, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA
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20
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Affiliation(s)
- K K Sahu
- Department of Internal Medicine, Saint Vincent Hospital, MD Medicine, 123 Summer Street, Worcester, MA 01608, USA
| | - A K Mishra
- Department of Internal Medicine, Saint Vincent Hospital, MD Medicine, 123 Summer Street, Worcester, MA 01608, USA
| | - R Patel
- Department of Internal Medicine, Saint Vincent Hospital, MD Medicine, 123 Summer Street, Worcester, MA 01608, USA
| | - N Suramaethakul
- Department of Internal Medicine, Saint Vincent Hospital, MD Medicine, 123 Summer Street, Worcester, MA 01608, USA
| | - G Abraham
- Department of Internal Medicine, Saint Vincent Hospital, MD Medicine, 123 Summer Street, Worcester, MA 01608, USA
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21
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Iqbal N, Ammar M, Irfan M, Jabeen K. Trichosporon Species and Fusarium Species as a Cause of Empyema Thoracis in a Diabetic Patient. Cureus 2020; 12:e8973. [PMID: 32775055 PMCID: PMC7402428 DOI: 10.7759/cureus.8973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Of late, fungal infections are increasingly being recognized in diabetic patients. Here we present a case of polymicrobial fungal empyema due to Trichosporon species and Fusarium species developed after community-acquired pneumonia in a diabetic patient. Trichosporon species are basidiomycetous yeast and Fusarium species are soil saprophytes with a worldwide distribution. Fungal empyema cases are rare and are mostly caused by Aspergillus and Candida species. Polymicrobial fungal empyema with Trichosporon species and Fusarium species has not been reported previously. Our patient was successfully treated with antifungal therapy. This case highlights that fungal empyema should be considered in diabetic patients especially if they are not responding to antibiotics.
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Affiliation(s)
- Nousheen Iqbal
- Section of Pulmonary and Critical Care Medicine, Aga Khan University, Karachi, PAK.,Medicine / Pulmnonology, Jinnah Medical and Dental College, Karachi, PAK
| | - Muhammad Ammar
- Internal Medicine, Dow International Medical College, Karachi, PAK.,Section of Pulmonary and Critical Care Medicine, Aga Khan University, Karachi, PAK
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22
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Rolfe R, Schell WA, Smith B, Klapper J, Perfect JR, Messina JA. Black mold takes hold and story told. Med Mycol Case Rep 2020; 29:12-14. [PMID: 32528839 PMCID: PMC7281360 DOI: 10.1016/j.mmcr.2020.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/09/2020] [Accepted: 05/15/2020] [Indexed: 11/25/2022] Open
Abstract
We present a case of an invasive Curvularia infection in a patient who developed following bilateral orthotopic lung transplantation despite receiving post-transplant antifungal prophylaxis. This infection presented as mold colonies studding the interior surface of his chest tubes. Despite surgical washout of his bilateral pleural cavities and antifungal treatment with liposomal amphotericin B, micafungin, and isavuconazonium sulfate, the patient died.
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Affiliation(s)
- Robert Rolfe
- Duke University Department of Medicine, Division of Infectious Diseases, 315 Trent Drive, Hanes House, Durham, NC, 27710, USA
| | - Wiley A Schell
- Duke University Department of Medicine, Division of Infectious Diseases, 315 Trent Drive, Hanes House, Durham, NC, 27710, USA
| | - Becky Smith
- Duke University Department of Medicine, Division of Infectious Diseases, 315 Trent Drive, Hanes House, Durham, NC, 27710, USA
| | - Jacob Klapper
- Duke University Department of Surgery, Division of Cardiovascular and Thoracic Surgery, DUMC Box 3442 Durham, NC, 27710, USA
| | - John R Perfect
- Duke University Department of Medicine, Division of Infectious Diseases, 315 Trent Drive, Hanes House, Durham, NC, 27710, USA
| | - Julia A Messina
- Duke University Department of Medicine, Division of Infectious Diseases, 315 Trent Drive, Hanes House, Durham, NC, 27710, USA
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23
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Surgical Management of an Aspergillus Empyema in a 3-Year-Old Child. Case Rep Med 2020; 2020:5179292. [PMID: 32454834 PMCID: PMC7225848 DOI: 10.1155/2020/5179292] [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: 01/19/2020] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 11/18/2022] Open
Abstract
Aspergillus empyema in nonimmunocompromised children is rare. A case of surgical management of invasive aspergillosis in a previously healthy 3-year-old child is presented. The patient was initially admitted to a hospital with severe respiratory deterioration and clinical instability, originally attributed to sepsis. After surgical intervention and the diagnosis of invasive aspergillosis, intravenous therapy with voriconazole was initiated. During postoperative care, the patient's condition remained stable with mild functional respiratory deficits. The diagnosis and treatment of Aspergillus empyema remains challenging, especially in cases that the recognition of aspergillosis is delayed and urgent surgical management of the empyema is required due to rapid clinical deterioration of the patient. The early initiation, prolonged administration, and close monitoring of high-dose antifungal treatment are highly recommended.
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24
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Takatsuka H, Yamazaki S, Watanabe A, Yokoyama I, Suzuki T, Kamei K, Ishii I. Successful treatment of Aspergillus empyema using combined intrathoracic and intravenous administration of voriconazole: A case report. J Infect Chemother 2020; 26:847-850. [PMID: 32414688 DOI: 10.1016/j.jiac.2020.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/06/2020] [Accepted: 03/20/2020] [Indexed: 11/19/2022]
Abstract
Aspergillus empyema is treated with either systemic administration of antifungal drugs or surgery, but the mortality rate is very high. Here, we report a case of Aspergillus empyema successfully treated using combined intrathoracic and intravenous administration of voriconazole (VRCZ). Treatment success was achieved by monitoring VRCZ plasma trough concentration. The patient was a 71-year-old Japanese woman diagnosed with Aspergillus empyema whom we started on intravenous administration of VRCZ. Although penetration of VRCZ into the pleural effusion was confirmed, the level was below 1 μg/mL, which is the minimum inhibitory concentration for Aspergillus fumigatus determined by antifungal susceptibility testing in pleural effusion culture. Therefore, we initiated combination therapy with intrathoracic and intravenous administration of VRCZ. VRCZ 200 mg was first dissolved in 50-100 mL of saline and administered into the thoracic cavity via a chest tube. The chest tube was clamped for 5-6 h, and then VRCZ solution was excreted though the chest tube. When a single dose of the VRCZ was administered into the intrathoracic space, the plasma concentration before intravenous administration increased from 1.45 μg/mL on day 27 to 1.53 μg/mL on day 28. Although intravenous administration was continued, the VRCZ plasma trough concentration decreased to 1.36 μg/mL on day 29. We therefore decided on an intrathoracic administration schedule of 2-3 times a week. Intrathoracic administration was performed 14 times in total until fenestration surgery on day 64. Our case suggests that combined intrathoracic and intravenous administration of VRCZ may be a valid treatment option for Aspergillus empyema.
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Affiliation(s)
| | | | - Akira Watanabe
- Divison of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | | | - Takaaki Suzuki
- Division of Pharmacy, Chiba University Hospital, Japan; Graduate School of Pharmaceutical Sciences, Chiba University, Japan.
| | - Katsuhiko Kamei
- Divison of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Itsuko Ishii
- Division of Pharmacy, Chiba University Hospital, Japan; Graduate School of Pharmaceutical Sciences, Chiba University, Japan
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25
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Candida Empyema as a Red Flag for Esophageal Rupture: A Case Report and Literature Review. Case Rep Infect Dis 2020; 2020:3935691. [PMID: 32351745 PMCID: PMC7178516 DOI: 10.1155/2020/3935691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/02/2020] [Accepted: 03/18/2020] [Indexed: 11/30/2022] Open
Abstract
Background. Candida empyema is a rare entity with an extremely high mortality rate.We present a case of multi species Candida empyema in an immunocompetent female patient with Boerhaave syndrome secondary to retching and vomiting after heroin withdrawal. This case highlights an unusual presentation of a common infection but stresses on the fact that a high index of suspicion is necessary for early identification, prompt initiation of antifungal therapy, and drainage with surgical repair to improve overall survival and outcomes.
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26
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Abreu I, Guedes M, Duro R, Lopes S, Maciel J, Santos L. Pleural aspergillosis in a patient with recurrent spontaneous pneumothorax: The challenge of an optimal therapeutic approach. Med Mycol Case Rep 2020; 28:4-7. [PMID: 32181124 PMCID: PMC7063088 DOI: 10.1016/j.mmcr.2020.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 11/29/2022] Open
Abstract
Pleural aspergillosis (PA) is a rare but potentially fatal disease. Most cases are secondary to bronchopleural fistulae or pleural intervention and can occur in the absence of immunosuppression. We report a case of PA in a young patient after pleurodesis for recurrent pneumothorax. Clinical resolution was achieved with systemic and local antifungal therapy combined with surgical debridement. Hepatotoxicity led to a switch from voriconazole to isavuconazole, with a successful outcome.
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Affiliation(s)
- Isabel Abreu
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Oporto, 4200-319, Portugal
| | - Mariana Guedes
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Oporto, 4200-319, Portugal
| | - Raquel Duro
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Oporto, 4200-319, Portugal
| | - Sara Lopes
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Oporto, 4200-319, Portugal
| | - João Maciel
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Oporto, 4200-319, Portugal
| | - Lurdes Santos
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Oporto, 4200-319, Portugal
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Campos LG, da Silva EC, Rangel AFR, de Souza MD, Musso C. Pulmonary artery aneurysm rupture. AUTOPSY AND CASE REPORTS 2019; 10:e2019131. [PMID: 32039062 PMCID: PMC6945309 DOI: 10.4322/acr.2019.131] [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] [Received: 06/17/2019] [Accepted: 10/07/2019] [Indexed: 11/28/2022] Open
Abstract
Pulmonary artery aneurysm is a disorder of varying etiology and should be diagnosed early for appropriate interventions. A 45-year-old man was hospitalized for chest pain, dyspnea, cough, chills, diarrhea, and vomiting, which had started 3 weeks before admission. Physical examination indicated a reduced vesicular murmur in the right hemithorax. A chest x-ray performed indicated a pneumothorax and pulmonary abscess in the right hemithorax. Thoracostomy released abundant purulent and fetid fluid. Direct examination of the pleural fluid using saline revealed structures similar to Trichomonas. Non-contrast chest computed tomography revealed right pneumothorax along with an irregular cavitation located at the pleuropulmonary interface of the posterior margin of the right lower lobe. A pleurostomy was performed. On the second postoperative day, the patient suffered a sudden major hemorrhage through the surgical wound and died on the way to the operating room. The autopsy revealed an abscess and ruptured aneurysm of the lower lobar artery in the lower right lung. Microscopic examination revealed extensive liquefactive necrosis associated with purulent inflammation and the presence of filamentous fungi and spores. This case can be characterized as a severe disorder that requires early diagnosis to achieve a good therapeutic response and to avoid fatal outcomes.
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Affiliation(s)
- Leticia Goulart Campos
- Federal University of Espírito Santo (UFES), Department of Pathology, Hospital Universitário Cassiano Antônio Moraes (HUCAM), Unidade de Anatomia Patológica. Vitória, ES, Brazil
| | - Eveline Cristina da Silva
- Federal University of Espírito Santo (UFES), Department of Pathology, Hospital Universitário Cassiano Antônio Moraes (HUCAM), Unidade de Anatomia Patológica. Vitória, ES, Brazil
| | - Ana Fernanda Ribeiro Rangel
- Federal University of Espírito Santo (UFES), Department of Pathology, Hospital Universitário Cassiano Antônio Moraes (HUCAM), Unidade de Anatomia Patológica. Vitória, ES, Brazil
| | - Marina Dias de Souza
- Federal University of Espírito Santo (UFES), Department of Pathology, Hospital Universitário Cassiano Antônio Moraes (HUCAM), Unidade de Anatomia Patológica. Vitória, ES, Brazil
| | - Carlos Musso
- Federal University of Espírito Santo (UFES), Department of Pathology, Hospital Universitário Cassiano Antônio Moraes (HUCAM), Unidade de Anatomia Patológica. Vitória, ES, Brazil
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Khan Y, Hussain M, Shahabuddin S. Fungal empyema in complicated chronic pancreatitis: A rare possibility. Int J Surg Case Rep 2019; 57:25-27. [PMID: 30877989 PMCID: PMC6423361 DOI: 10.1016/j.ijscr.2019.02.040] [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] [Received: 12/14/2018] [Revised: 02/01/2019] [Accepted: 02/25/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Fungal empyema a rare cause of empyema thoracis is commonly associated with nosocomial infection or gastrointestinal disease with very high mortality. Its association with chronic pancreatitis is rarely been described. PRESENTATION OF CASE We present a case of young male known alcoholic with chronic pancreatitis and cystgastrostomy who presented with dyspnea and fever. Thorough workup showed left sided amylase rich loculated pleural effusion. Culture grew candida albicans. Esophagogram carried out for any esophageal rupture turned out to be negative. Histopathology was negative for malignancy. Intraoperative left sided yellowish colour fluid was drained, Loculation broken and rind removed. No pleuro-peritoneal fistula could be identified. Postoperatively patient remained well and discharged on antifungal. CONCLUSION No obvious cause of fungal empyema could be found except for pancreatico-pleural spread as suggested by amylase rich pleural effusion along with growth of candida spp. Hence in patient with chronic pancreatitis and cystgastrostomy pleural effusion should be evaluated for fungal infection to avoid morbidity and mortality and commence early treatment.
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Affiliation(s)
- Yasir Khan
- Section of Cardiothoracic, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| | - Munawar Hussain
- Section of Cardiothoracic, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Syed Shahabuddin
- Section of Cardiothoracic, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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29
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Bedawi EO, Hassan M, McCracken D, Rahman NM. Pleural infection: a closer look at the etiopathogenesis, microbiology and role of antibiotics. Expert Rev Respir Med 2019; 13:337-347. [PMID: 30707629 DOI: 10.1080/17476348.2019.1578212] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Pleural infection is a condition that continues to pose a significant challenge to respiratory physicians. We hypothesize that the main barriers to progress include limited understanding of the etiopathogenesis, microbiology,and role of antibiotics in the pleural space. Areas covered: PubMed was searched for articles related to adult pleural infection using the terms 'pleural infection', 'empyema' and 'parapneumonic'. The search focused on relevant literature within the last 10 years, with any older citations used only to display context or lack of progress. Tuberculous pleural infection was excluded. We chose to give specific attention to the etiopathogenesis of pleural infection, including recent advances in diagnostics and biomarkers. We discuss our understanding of the pleural microbiome and rationalize the current use of antibiotics in treating this condition. Expert commentary: Understanding of key events in the development of this condition remains limited. The microbiology is unique compared to the lung, and highly variable. Higher culture yields from pleural biopsy may add new insights into the etiopathogenesis. There is little evidence into achievable effective antibiotic concentration within the pleura. Research into issues including the relevance of biofilm formation and significance of pleural thickening is necessary for treatment progress.
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Affiliation(s)
- Eihab O Bedawi
- a Oxford Pleural Unit , Oxford University Hospitals , Oxford , UK.,b Oxford Respiratory Trials Unit , University of Oxford , Oxford , UK
| | - Maged Hassan
- a Oxford Pleural Unit , Oxford University Hospitals , Oxford , UK.,b Oxford Respiratory Trials Unit , University of Oxford , Oxford , UK.,c Chest Diseases Department, Faculty of Medicine , Alexandria University , Alexandria , Egypt
| | - David McCracken
- a Oxford Pleural Unit , Oxford University Hospitals , Oxford , UK.,b Oxford Respiratory Trials Unit , University of Oxford , Oxford , UK
| | - Najib M Rahman
- a Oxford Pleural Unit , Oxford University Hospitals , Oxford , UK.,b Oxford Respiratory Trials Unit , University of Oxford , Oxford , UK.,d Oxford NIHR Biomedical Research Centre , Oxford , UK
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30
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Rajagopalan N, Mahadevaiah A, Sapkal T, Chakraborty D. Syndrome Evaluation System Contributes to Higher and Faster Pathogen Identification with Superior Clinical Correlation as Compared to Conventional Cultures in Patients with Empyema and Parapneumonic Effusions. THE JOURNAL OF ASSOCIATION OF CHEST PHYSICIANS 2019. [DOI: 10.4103/jacp.jacp_6_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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31
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Bedawi EO, Hassan M, Rahman NM. Recent developments in the management of pleural infection: A comprehensive review. CLINICAL RESPIRATORY JOURNAL 2018; 12:2309-2320. [PMID: 30005142 DOI: 10.1111/crj.12941] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/25/2018] [Accepted: 06/27/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Pleural infection is a condition commonly encountered by the respiratory physician. This review aims to provide the reader with an update on the most recent data regarding the epidemiology, microbiology, and the management of pleural infection. DATA SOURCE Medline was searched for articles related to pleural infection using the terms "pleural infection," "empyema," and "parapneumonic." The search was limited to the years 1997-2017. Only human studies and reports in English were included. RESULTS A rise in the incidence of pleural infection is seen worldwide. Despite the improvement in healthcare practices, the mortality from pleural infection remains high. The role of oral microflora in the etiology of pleural infection is firmly established. A concise review of the recent insights on the pathogenesis of pleural infections is presented. A particular focus is made on the role of tPA, DNAse and similar substances and their interaction with inflammatory cells and how this affects the pathogenesis and treatment of pleural infection. CONCLUSION Pleural infection is a common disease with significant morbidity and mortality, as well as a considerable economic burden. The role of medical management is expanding thanks to the widespread use of newer treatments.
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Affiliation(s)
- Eihab O Bedawi
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals, Oxford, United Kingdom.,Oxford Respiratory Trials Unit, University of Oxford, Oxford, United Kingdom
| | - Maged Hassan
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals, Oxford, United Kingdom.,Oxford Respiratory Trials Unit, University of Oxford, Oxford, United Kingdom.,Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals, Oxford, United Kingdom.,Oxford Respiratory Trials Unit, University of Oxford, Oxford, United Kingdom.,NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
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32
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Comparison of Killing Activity of Micafungin Against Six Candida Species Isolated from Peritoneal and Pleural Cavities in RPMI-1640, 10 and 30% Serum. Mycopathologia 2018; 183:905-912. [PMID: 30382508 DOI: 10.1007/s11046-018-0302-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/11/2018] [Indexed: 12/20/2022]
Abstract
Currently echinocandins are recommended in Candida peritonitis and pleuritis. We determined micafungin killing rates (k values) at therapeutic concentrations (0.25-2 mg/L) in RPMI-1640 with and without 10 and 30% serum mimicking in vivo conditions against six Candida species isolated from peritoneal and pleural fluid. In RPMI-1640, micafungin was fungicidal against C. glabrata, C. krusei and C. kefyr within 2.27 ± 10.68, 2.69 ± 10.29 and 3.10 ± 4.41 h, respectively, while was fungistatic against C. albicans, C. tropicalis and C. parapsilosis. In 10% serum, ≥ 0.25, ≥ 0.5, ≥ 0.5 and ≥ 1 mg/L micafungin produced positive k values (killing) for all C. albicans, C. glabrata, C. kefyr and C. krusei, respectively. In 30% serum, 2 mg/L micafungin produced killing against all C. albicans, C. glabrata and C. kefyr isolates, but was ineffective against C. krusei, C. parapsilosis and 2 of 3 C. tropicalis. Micafungin exposure should be increased against non-albicans species to eradicate fungi from peritoneal and pleural cavities.
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33
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Lee JS, Park IK, Park S, Hyun KY, Kang CH, Kim YT. Treatment of Fungal Empyema Combined with Osteoradionecrosis by Thoracoplasty and Myocutaneous Flap Transposition. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 51:273-276. [PMID: 30109206 PMCID: PMC6089627 DOI: 10.5090/kjtcs.2018.51.4.273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/07/2018] [Accepted: 03/12/2018] [Indexed: 11/16/2022]
Abstract
We report the rare case of a 58-year-old woman who was diagnosed with fungal empyema thoracis combined with osteoradionecrosis. After 32 months of home care followed by open window thoracostomy, thoracoplasty with serratus anterior muscle transposition and a latissimus dorsi myocutaneous flap was performed successfully. Although thoracoplasty is now rarely indicated, it is still the treatment of choice for the complete obliteration of thoracic spaces.
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Affiliation(s)
- Joon Seok Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Kwan Yong Hyun
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
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34
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Ferreiro L, Porcel JM, Bielsa S, Toubes ME, Álvarez-Dobaño JM, Valdés L. Management of pleural infections. Expert Rev Respir Med 2018; 12:521-535. [DOI: 10.1080/17476348.2018.1475234] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Lucía Ferreiro
- Pneumology Service, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, SPAIN
- Interdisciplinary Group of Research in Pneumology, Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, SPAIN
| | - José M. Porcel
- Pleural Medicine Unit. Department of Internal Medicine, Arnau de Vilanova University Hospital. Lleida, SPAIN
- Dr. Pifarré Foundation Biomedical Research Institute, IRBLLEIDA, Lleida, SPAIN
| | - Silvia Bielsa
- Pleural Medicine Unit. Department of Internal Medicine, Arnau de Vilanova University Hospital. Lleida, SPAIN
- Dr. Pifarré Foundation Biomedical Research Institute, IRBLLEIDA, Lleida, SPAIN
| | - María Elena Toubes
- Pneumology Service, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, SPAIN
| | - José Manuel Álvarez-Dobaño
- Pneumology Service, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, SPAIN
- Interdisciplinary Group of Research in Pneumology, Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, SPAIN
| | - Luis Valdés
- Pneumology Service, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, SPAIN
- Interdisciplinary Group of Research in Pneumology, Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, SPAIN
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35
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Suzuki A, Kimura T, Kataoka K, Matsuda T, Yokoyama T, Mori Y, Kondoh Y. Acute exacerbation of idiopathic pulmonary fibrosis triggered by Aspergillus empyema. Respir Med Case Rep 2018; 23:103-106. [PMID: 29719792 PMCID: PMC5925856 DOI: 10.1016/j.rmcr.2018.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/19/2018] [Indexed: 11/22/2022] Open
Abstract
Acute exacerbation (AE) is a severe and life-threatening complication of idiopathic pulmonary fibrosis (IPF). In 2016, the definition and diagnostic criteria for AE-IPF were updated by an international working group. The new definition includes any acute, clinically significant respiratory deterioration (both idiopathic and triggered events) characterized by evidence of new widespread alveolar abnormality in patients with IPF. There are no currently proven beneficial management strategies for idiopathic and triggered AE-IPF. This is the first report describing AE-IPF triggered by Aspergillus empyema, which was improved by a combination of corticosteroid, systemic antifungal therapy, local antifungal therapy, and additional pharmacological therapies. Future research may reveal optimal strategies for both idiopathic and triggered AE-IPF.
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Affiliation(s)
- Atsushi Suzuki
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan.,Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tomoki Kimura
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Kensuke Kataoka
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Toshiaki Matsuda
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Toshiki Yokoyama
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Yuta Mori
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
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36
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Candida krusei Empyema Thoracis: A Community-Acquired Infection Requiring a High Index of Suspicion. Case Rep Infect Dis 2018; 2018:8039803. [PMID: 29670781 PMCID: PMC5835298 DOI: 10.1155/2018/8039803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 01/10/2018] [Accepted: 01/28/2018] [Indexed: 11/21/2022] Open
Abstract
Empyema thoracis is a serious condition characterized by the accumulation of purulent fluid in the pleural cavity, typically following a pneumonia, subdiaphragmatic abscess, or esophageal rupture. Fungal empyema thoracis is a rare form of this condition with especially high mortality, in which the most frequently isolated fungus is Candida spp. This article presents a 74-year-old female with Candida krusei pneumonia and a complicated hospital course, initially presenting with nausea, vomiting, and dysphagia. She was initially suspected to have community-acquired pneumonia and was started on azithromycin and ceftriaxone. Worsening respiratory function led to the diagnosis of hydropneumothorax. Pleural fluid and an independent sample of pus and pleural tissue grew Candida krusei, giving the diagnosis of fungal empyema. With further respiratory deterioration, the patient was intubated and switched to piperacillin/tazobactam and micafungin. Decortication with extensive pleural peel and removal of foul-smelling pus and food particles within the chest was performed. This further lead to confirmation of esophageal perforation, and she was started on voriconazole and meropenem. After developing septic shock, the patient was managed with phenylephrine and vasopressin. Finally, after improving she was weaned off pressors and extubated, followed by an esophagogastroduodenoscopy (EDG) with pneumatic balloon dilation and WallFlex stent placement. This patient's case demonstrated an example of empyema thoracis, which required a high index of suspicion since the presentation was with a community-acquired infection. Candida empyema thoracis may be a complication of operation, gastroesophageal fistula, and spontaneous esophageal rupture. On the other hand, the course of this patient's hospital stay progressed from esophageal perforation to Candida krusei pneumonia, empyema, and pneumothorax. Thus, community-acquired fungal empyema should be considered in patients with respiratory symptoms and suspected esophageal perforation; nevertheless, after a diagnosis of fungal empyema, esophageal perforation should also be ruled out in addition to other causes like pneumonia, subphrenic abscess, and hematogenous spread. Improved communication between clinicians and microbiologists can lead to early diagnosis and a reduction in the morbidity and mortality of this condition.
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37
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Fukuda Y, Homma T, Suzuki S, Takuma T, Tanaka A, Yokoe T, Ohnishi T, Niki Y, Sagara H. High burden of Aspergillus fumigatus infection among chronic respiratory diseases. Chron Respir Dis 2018. [PMID: 29519142 PMCID: PMC6100170 DOI: 10.1177/1479972318761654] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aspergillus fumigatus (AF) is a ubiquitous fungus in our environment and
causes severe airway disorders. Chronic respiratory diseases (CRDs) are a series of
chronic airway and lung diseases. Although both are chronic disorders, however, the
relationships between AF and CRDs are still unclear. Therefore, we examined 104
Aspergillus species (spp.) isolated samples in our hospital during three consecutive years
to further elucidate the relationships between Aspergillus spp. and CRDs.
Based on sample isolates, we then grouped these into two groups, AF and non-AF, to
retrospectively analyse the clinical features and to clarify the relationships between AF
and CRDs. Importantly, the manifestation of CRD was more frequent in the AF group than in
the non-AF group (p = 0.035). Among CRDs, lung fibrosis was more evident
in the AF group (p = 0.025). Moreover, diabetes mellitus was tended to be
evident in AF group than non-AF group (p = 0.035). In conclusion, CRDs,
especially lung fibrosis, were highly prevalent in AF group than non-AF group.
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Affiliation(s)
- Yosuke Fukuda
- 1 Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Tetsuya Homma
- 1 Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Shintaro Suzuki
- 1 Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan.,2 Krefting Research Centre, University of Gothenburg, Göteborg, Sweden
| | - Takahiro Takuma
- 3 Department of Medicine, Division of Clinical Infectious Diseases, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Akihiko Tanaka
- 1 Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Takuya Yokoe
- 1 Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Tsukasa Ohnishi
- 1 Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Yoshihito Niki
- 3 Department of Medicine, Division of Clinical Infectious Diseases, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Hironori Sagara
- 1 Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
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38
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Management of Aspergillus pleural empyema with combined systemic and intrapleural antifungal therapy in a pediatric patient: Case report. J Infect Public Health 2018; 11:280-282. [DOI: 10.1016/j.jiph.2017.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/05/2017] [Accepted: 04/28/2017] [Indexed: 11/17/2022] Open
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39
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de Vega Sánchez B, López Ramos I, Ortiz de Lejarazu R, Disdier Vicente C. Fungal Empyema: An Uncommon Entity With High Mortality. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.arbr.2017.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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40
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Ross B, Taha K, Taggart LR, Blitz M, Anand A. Isolated pleural aspergillosis: Case description and challenges in management. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2017. [DOI: 10.1080/24745332.2017.1370679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Bryan Ross
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karim Taha
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Linda R. Taggart
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Division of Infectious Diseases, St. Michaels Hospital, Toronto, Ontario, Canada
| | - Maurice Blitz
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Division of Thoracic Surgery, St. Josephs Hospital, Toronto, Ontario, Canada
| | - Anju Anand
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Division of Respirology, St. Michaels Hospital, Toronto, Ontario, Canada
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41
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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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42
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de Vega Sánchez B, López Ramos I, Ortiz de Lejarazu R, Disdier Vicente C. Fungal Empyema: An Uncommon Entity With High Mortality. Arch Bronconeumol 2017; 53:641-642. [PMID: 28495076 DOI: 10.1016/j.arbres.2017.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Blanca de Vega Sánchez
- Servicio de Neumología, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - Irene López Ramos
- Servicio de Microbiología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Raúl Ortiz de Lejarazu
- Servicio de Microbiología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Carlos Disdier Vicente
- Servicio de Neumología, Hospital Clínico Universitario de Valladolid, Valladolid, España; CIBERES (Centro de Investigación en Red Enfermedades Respiratorias), Valladolid, España
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Ferreiro L, Pérez Del Molino ML, González-Pérez MS, Valdés L. Aspergillus Fumigatus Empyema. Arch Bronconeumol 2016; 53:399-400. [PMID: 28024667 DOI: 10.1016/j.arbres.2016.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Lucía Ferreiro
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, La Coruña, España.
| | - M Luisa Pérez Del Molino
- Servicio de Microbiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España
| | - Marta Sonia González-Pérez
- Servicio de Hematología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España
| | - Luis Valdés
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, La Coruña, España
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Balandin B, Aguilar M, Sánchez I, Monzón A, Rivera I, Salas C, Valdivia M, Alcántara S, Pérez A, Ussetti P. Scedosporium apiospermum and S. prolificans mixed disseminated infection in a lung transplant recipient: An unusual case of long-term survival with combined systemic and local antifungal therapy in intensive care unit. Med Mycol Case Rep 2016; 11:53-6. [PMID: 27222774 PMCID: PMC4865649 DOI: 10.1016/j.mmcr.2016.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 04/12/2016] [Accepted: 04/25/2016] [Indexed: 12/26/2022] Open
Abstract
Infections due Scedosporium spp. in lung transplant recipients are associated with disseminated disease with high mortality rates. The adjunctive local antifungal therapy may be a useful option when systemic treatment is insufficient and/or surgery is not feasible. We present a case of mixed disseminated infection due Scedosporium apiospermum and S. prolificans in a lung transplant recipient. Combined local and systemic antifungal therapy provided an unusual long-term survival in the intensive care unit.
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Affiliation(s)
- Bárbara Balandin
- Intensive Care Unit, Hospital Universitario Puerta de Hierro Majadahonda, Spain
| | - Miriam Aguilar
- Department of Pneumology and Lung Transplant Unit, Hospital Universitario Puerta de Hierro Majadahonda, Spain
| | - Isabel Sánchez
- Department of Microbiology, Hospital Universitario Puerta de Hierro Majadahonda, Spain
| | - Araceli Monzón
- Department of Mycology, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Isabel Rivera
- Department of Radiology, Hospital Universitario Puerta de Hierro Majadahonda, Spain
| | - Clara Salas
- Department of Pathology, Hospital Universitario Puerta de Hierro Majadahonda, Spain
| | - Miguel Valdivia
- Intensive Care Unit, Hospital Universitario Puerta de Hierro Majadahonda, Spain
| | - Sara Alcántara
- Intensive Care Unit, Hospital Universitario Puerta de Hierro Majadahonda, Spain
| | - Aris Pérez
- Intensive Care Unit, Hospital Universitario Puerta de Hierro Majadahonda, Spain
| | - Piedad Ussetti
- Department of Pneumology and Lung Transplant Unit, Hospital Universitario Puerta de Hierro Majadahonda, Spain
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Corcoran JP, Wrightson JM, Belcher E, DeCamp MM, Feller-Kopman D, Rahman NM. Pleural infection: past, present, and future directions. THE LANCET RESPIRATORY MEDICINE 2016; 3:563-77. [PMID: 26170076 DOI: 10.1016/s2213-2600(15)00185-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/13/2015] [Accepted: 05/05/2015] [Indexed: 02/09/2023]
Abstract
Pleural space infections are increasing in incidence and continue to have high associated morbidity, mortality, and need for invasive treatments such as thoracic surgery. The mechanisms of progression from a non-infected, pneumonia-related effusion to a confirmed pleural infection have been well described in the scientific literature, but the route by which pathogenic organisms access the pleural space is poorly understood. Data suggests that not all pleural infections can be related to lung parenchymal infection. Studies examining the microbiological profile of pleural infection inform antibiotic choice and can help to delineate the source and pathogenesis of infection. The development of radiological methods and use of clinical indices to predict which patients with pleural infection will have a poor outcome, as well as inform patient selection for more invasive treatments, is particularly important. Randomised clinical trial and case series data have shown that the combination of an intrapleural tissue plasminogen activator and deoxyribonuclease therapy can potentially improve outcomes, but the use of this treatment as compared with surgical options has not been precisely defined, particularly in terms of when and in which patients it should be used.
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Affiliation(s)
- John P Corcoran
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK; University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK
| | - John M Wrightson
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK; University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Elizabeth Belcher
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Malcolm M DeCamp
- Division of Thoracic Surgery, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David Feller-Kopman
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK; University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
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Nigo M, Vial MR, Munita JM, Jiang Y, Tarrand J, Jimenez CA, Kontoyiannis DP. Fungal empyema thoracis in cancer patients. J Infect 2016; 72:615-21. [PMID: 26945845 DOI: 10.1016/j.jinf.2016.02.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/19/2016] [Accepted: 02/25/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Fungal empyema thoracis (FET) is a rare life-threatening infection. We sought to describe the clinical characteristics of FET in a large academic cancer center. METHODS We conducted a retrospective chart review of all cancer patients who had a fungal isolate from the pleural fluid culture between 1/2005 and 8/2013. RESULTS A total of 106 fungal isolates were identified in 97 patients. Yeasts accounted for 62% of the isolates whereas 38% were identified as molds. The most frequent pathogens were Candida spp. (58%) and Aspergillus spp. (12%). All patients with Aspergillus and 83% with Candida met criteria for proven fungal disease. Compared to the Aspergillus group, Candida FET was associated with recent abdominal or thoracic surgical procedures (44% vs. 0%, p = 0.01). Overall, 6-week mortality was high, with no significant differences between Candida and Aspergillus (31% vs. 45%, respectively [p = 0.48]). Only 1 out of 11 patients with uncommon molds died at 6 weeks, despite only 2 of them received appropriate antifungal therapy. CONCLUSIONS Development of FET carries a high mortality in cancer patients. A history of a recent surgical procedure is a risk factor for FET due to Candida. Isolation of uncommon molds is likely to represent a contamination of the pleural fluid.
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Affiliation(s)
- Masayuki Nigo
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA
| | - Macarena R Vial
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile; Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jose M Munita
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA; Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey Tarrand
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos A Jimenez
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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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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Affiliation(s)
- Mohamed A Hendaus
- Hamad Medical Corporation, Doha, Qatar Weill-Cornell Medical College, Ar-Rayyan, Qatar
| | - Ibrahim A Janahi
- Hamad Medical Corporation, Doha, Qatar Weill-Cornell Medical College, Ar-Rayyan, Qatar
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A 19-year-old woman with pleuritic chest pain. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2015; 26:100-2. [PMID: 26015794 PMCID: PMC4419811 DOI: 10.1155/2015/652758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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