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Bourne-Watrin M, Adenis A, Doppelt G, Zappa M, Epelboin L, Nacher M, Bigot J, Drak Alsibai K, Blaizot R, Blanchet D, Demar M, Guillot G, Djossou F, Couppié P. Pulmonary Histoplasmosis in People Living with Human Immunodeficiency Virus in French Guiana: Clinical Epidemiology, Medical Imaging and Prognostic. Mycopathologia 2023; 188:1065-1078. [PMID: 37839020 PMCID: PMC10687118 DOI: 10.1007/s11046-023-00799-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Histoplasmosis is mainly described as a disseminated disease in people living with HIV (PLHIV). Compared to historical descriptions in immunocompetent individuals, knowledge is lacking on the detailed clinical and radiological findings and outcomes of pulmonary histoplasmosis (PH). Overlooked or misdiagnosed with other AIDS-defining condition, prognostic of PLHIV may be at risk because of inappropriate care. METHODS A retrospective multicentric study was conducted in PLHIV from French Guiana between January 1988 and October 2019. Proven PH were documented through mycological direct examination, culture, or histology. Patients with concomitant respiratory infections were excluded. RESULTS Among 65 patients, sex ratio M:F was 2.4 with a median age of 39 years [IQR 25-75%: 34-44]. Median CD4 count was 24 cells/mm3 [11-71], with histoplasmosis as the AIDS-defining condition in 88% and concomitant AIDS-defining conditions in 29%. Clinical findings were fever (89%), cough (58%), dyspnea (35%), expectoration (14%), and hemoptysis (5%). Sixty-one X-rays and 24 CT-scans were performed. On X-rays, an interstitial lung disease was mainly found (77%). On CT-scans, a nodular pattern was predominant (83%): mostly miliary disease (63%), but also excavated nodules (35%). Consolidations were present in 46%, associated with miliary disease in 21%. Thoracic lymphadenopathies were found in 58%, mainly hilar and symmetric (33%). Despite antifungal treatment, case-fatality rate at one month was 22%. CONCLUSION When faced with an interstitial lung disease on X-rays or a miliary pattern on CT-scans in advanced PLHIV, physicians in endemic areas, apart from tuberculosis or pneumocystosis, should include histoplasmosis as part of their differential diagnoses.
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Affiliation(s)
- Morgane Bourne-Watrin
- Service de Dermatologie-Vénérologie, Centre Hospitalier de Cayenne, Cayenne, France.
| | - Antoine Adenis
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424, Centre Hospitalier de Cayenne, Cayenne, France
| | - Gary Doppelt
- Service de Radiologie, Centre Hospitalier de Cayenne, Cayenne, France
| | - Magaly Zappa
- Service de Radiologie, Centre Hospitalier de Cayenne, Cayenne, France
| | - Loïc Epelboin
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424, Centre Hospitalier de Cayenne, Cayenne, France
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Cayenne, France
| | - Mathieu Nacher
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424, Centre Hospitalier de Cayenne, Cayenne, France
| | - Jeanne Bigot
- Service de Parasitologie-Mycologie, Centre Hospitalier Saint Antoine APHP, Paris, France
| | - Kinan Drak Alsibai
- Laboratoire d'Anatomie et Cytologie Pathologique, Centre Hospitalier de Cayenne, Cayenne, France
| | - Romain Blaizot
- Service de Dermatologie-Vénérologie, Centre Hospitalier de Cayenne, Cayenne, France
| | - Denis Blanchet
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, Cayenne, France
| | - Magalie Demar
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, Cayenne, France
| | - Geneviève Guillot
- Service de Médecine B, Centre Hospitalier de Cayenne, Cayenne, France
| | - Félix Djossou
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Cayenne, France
| | - Pierre Couppié
- Service de Dermatologie-Vénérologie, Centre Hospitalier de Cayenne, Cayenne, France
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2
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Mango ALD, Gomes ACP, Hochhegger B, Zanetti G, Marchiori E. Computed tomography findings of pulmonary histoplasmosis: pictorial essay. Radiol Bras 2023; 56:162-167. [PMID: 37564080 PMCID: PMC10411766 DOI: 10.1590/0100-3984.2022.0106-en] [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] [Accepted: 12/12/2022] [Indexed: 08/12/2023] Open
Abstract
Endemic systemic mycoses are prevalent in specific geographic areas of the world and are responsible for high rates of morbidity and mortality in the populations of such areas, as well as in immigrants and travelers returning from endemic regions. Pulmonary histoplasmosis is an infection caused by Histoplasma capsulatum, a dimorphic fungus. This infection has a worldwide distribution, being endemic in Brazil. Histoplasmosis can affect the lungs, and its diagnosis and management remain challenging, especially in non-endemic areas. Therefore, recognition of the various radiological manifestations of pulmonary histoplasmosis, together with the clinical and epidemiological history of the patient, is essential to narrowing the differential diagnosis. This essay discusses the main computed tomography findings of pulmonary histoplasmosis.
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Affiliation(s)
- Ana Luiza Di Mango
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ,
Brazil
| | | | | | - Gláucia Zanetti
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ,
Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ,
Brazil
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3
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Wang S, Morrical J. Erythema nodosum as key manifestation of histoplasmosis case. BMJ Case Rep 2022; 15:e251876. [PMID: 36379636 PMCID: PMC9668023 DOI: 10.1136/bcr-2022-251876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Histoplasmosis is a systemic infection caused by the fungus, Histoplasma capsulatum Infection of H. capsulatum frequently occurs by inhaling the spores of the fungus, which is found in bat and bird droppings, or soil enriched with their excrement. If not detected and treated, histoplasmosis can develop late, severe complications such as mediastinal fibrosis, or even develop into a disseminated infection. However, histoplasmosis infections are often asymptomatic, making its detection more difficult. Further, only 6% of histoplasmosis cases will present with erythema nodosum, with most cases associated with female patients. This case presents a woman in her 50s with a pertinent history of fibromyalgia and hypothyroidism secondary to Hashimoto's who initially sought medical care for painful nodules on her legs and was eventually diagnosed with histoplasmosis. This report clearly demonstrates the importance of maintaining a broad differential when working up inflammatory manifestations, such as erythema nodosum.
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Affiliation(s)
- Susanna Wang
- Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Jennifer Morrical
- Internal Medicine and Pediatrics, Holland Hospital, Holland, Michigan, USA
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4
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Vitte J, Michel M, Malinovschi A, Caminati M, Odebode A, Annesi-Maesano I, Caimmi DP, Cassagne C, Demoly P, Heffler E, Menu E, Nwaru BI, Sereme Y, Ranque S, Raulf M, Feleszko W, Janson C, Galán C. Fungal exposome, human health, and unmet needs: A 2022 update with special focus on allergy. Allergy 2022; 77:3199-3216. [PMID: 35976185 DOI: 10.1111/all.15483] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/01/2022] [Accepted: 08/13/2022] [Indexed: 01/28/2023]
Abstract
Humans inhale, ingest, and touch thousands of fungi each day. The ubiquity and diversity of the fungal kingdom, reflected by its complex taxonomy, are in sharp contrast with our scarce knowledge about its distribution, pathogenic effects, and effective interventions at the environmental and individual levels. Here, we present an overview of salient features of fungi as permanent players of the human exposome and key determinants of human health, through the lens of fungal allergy and other fungal hypersensitivity reactions. Improved understanding of the fungal exposome sheds new light on the epidemiology of fungal-related hypersensitivity diseases, their immunological substratum, the currently available methods, and biomarkers for environmental and medical fungi. Unmet needs are described and potential approaches are highlighted as perspectives.
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Affiliation(s)
- Joana Vitte
- IDESP, University of Montpellier and INSERM, Montpellier, France.,MEPHI, IHU Méditerranée Infection, IRD, APHM, Aix-Marseille Univ, Marseille, France
| | - Moïse Michel
- IDESP, University of Montpellier and INSERM, Montpellier, France.,MEPHI, IHU Méditerranée Infection, IRD, APHM, Aix-Marseille Univ, Marseille, France.,Immunology Laboratory, University Hospital Nîmes, Nîmes, France
| | - Andrei Malinovschi
- Department of Medical Sciences Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Marco Caminati
- Asthma, Allergy and Clinical Immunology Section, Department of Medicine, University of Verona, Verona, Italy
| | - Adeyinka Odebode
- Department of Basic Science, Kampala International University, Kampala, Uganda
| | | | - Davide Paolo Caimmi
- IDESP, University of Montpellier and INSERM, Montpellier, France.,Departement of Pneumology, University Hospital of Montpellier, Montpellier, France
| | - Carole Cassagne
- VITROME, IHU Méditerranée Infection, IRD, APHM, Aix-Marseille Univ, Marseille, France
| | - Pascal Demoly
- IDESP, University of Montpellier and INSERM, Montpellier, France.,Departement of Pneumology, University Hospital of Montpellier, Montpellier, France
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy Humanitas Clinical and Research Center IRCCS Rozzano, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Estelle Menu
- VITROME, IHU Méditerranée Infection, IRD, APHM, Aix-Marseille Univ, Marseille, France
| | - Bright I Nwaru
- Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Youssouf Sereme
- MEPHI, IHU Méditerranée Infection, IRD, APHM, Aix-Marseille Univ, Marseille, France.,Department of Immunology, Infectiology and Hematology, Institut Necker-Enfants Malades (INEM), INSERM U1151, CNRS UMR 8253, Université Paris Descartes, Paris, France
| | - Stéphane Ranque
- VITROME, IHU Méditerranée Infection, IRD, APHM, Aix-Marseille Univ, Marseille, France
| | - Monika Raulf
- Department of Allergology and Immunology, Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | - Wojciech Feleszko
- Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Christer Janson
- Department of Medical Sciences Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Carmen Galán
- International Campus of Excellence on Agrifood (ceiA3), University of Cordoba, Córdoba, Spain.,Andalusian Inter-University Institute for Earth System Research (IISTA), University of Cordoba, Córdoba, Spain
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5
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Sousa C, Marchiori E, Youssef A, Mohammed TL, Patel P, Irion K, Pasini R, Mançano A, Souza A, Pasqualotto AC, Hochhegger B. Chest Imaging in Systemic Endemic Mycoses. J Fungi (Basel) 2022; 8:1132. [PMID: 36354899 PMCID: PMC9692403 DOI: 10.3390/jof8111132] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/14/2022] [Accepted: 10/24/2022] [Indexed: 09/20/2023] Open
Abstract
Endemic fungal infections are responsible for high rates of morbidity and mortality in certain regions of the world. The diagnosis and management remain a challenge, and the reason could be explained by the lack of disease awareness, variability of symptoms, and insidious and often overlooked clinical presentation. Imaging findings are nonspecific and frequently misinterpreted as other more common infectious or malignant diseases. Patient demographics and clinical and travel history are important clues that may lead to a proper diagnosis. The purpose of this paper is to review the presentation and differential diagnosis of endemic mycoses based on the most common chest imaging findings.
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Affiliation(s)
- Célia Sousa
- Radiology Department, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
| | - Edson Marchiori
- Radiology Department, Universidade Federal de Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | - Ali Youssef
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Tan-Lucien Mohammed
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Pratik Patel
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Klaus Irion
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Romulo Pasini
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Alexandre Mançano
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Arthur Souza
- Radiology Department, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto 15090-000, Brazil
| | | | - Bruno Hochhegger
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
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Damázio LODA, Lins EM, Ferraz ÁAB, Bezerra CDM, Carvalho Neto FACB, Oliveira LLRD, Costa MCSD, Santos PMC. Padrões tomográficos de agentes etiológicos da pneumonia durante o primeiro ano após transplante renal. Radiol Bras 2022; 55:84-89. [PMID: 35414733 PMCID: PMC8993179 DOI: 10.1590/0100-3984.2021.0069] [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: 04/20/2021] [Accepted: 06/18/2021] [Indexed: 11/22/2022] Open
Abstract
Objective: To evaluate the tomography patterns of pneumonia attributed to various
etiological agents during the first year after kidney transplantation. Materials and Methods: We analyzed the medical records of 956 patients who underwent kidney
transplantation between 2013 and 2018 at a transplant center in northeastern
Brazil. Among the kidney transplant recipients who developed pneumonia, the
etiologic agents were categorized as pyogenic bacteria, mycobacteria, fungi,
viruses, or polymicrobial pneumonia. The tomography patterns were
categorized as consolidation, bronchopneumonia, interstitial pneumonia, or
nodules/masses. To determine the statistical association between the
causative microorganism and the tomography pattern, we used Fisher’s
exact test, for which the level of significance was set at
p < 0.001. Results: Among 101 cases of pneumonia reported in kidney transplant recipients, the
etiologic agent was identified in 60 (59.4%), the most common category being
pyogenic bacteria, which were implicated in 22 cases (36.7%). Among the 60
patients in whom had the causal agent was identified, the pattern in which
nodules and masses predominated was the most common, being identified in 25
cases (41.7%). We detected associations between pyogenic bacteria and
consolidation, between fungi and nodules/masses, and between viruses and
interstitial pneumonia. Conclusion: There were statistical associations between tomography patterns and the
microorganisms that cause pneumonia. This knowledge could facilitate the
treatment planning for kidney transplant patients.
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Affiliation(s)
- Luiz Otávio de Andrade Damázio
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Brasil; Faculdade Pernambucana de Saúde (FPS), Brasil
| | - Esdras Marques Lins
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Brasil; Faculdade Pernambucana de Saúde (FPS), Brasil; Universidade Federal de Pernambuco (UFPE), Brasil
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7
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Imaging features of fungal pneumonia in haematopoietic stem cell transplant patients. Pol J Radiol 2021; 86:e335-e343. [PMID: 34322182 PMCID: PMC8297485 DOI: 10.5114/pjr.2021.107057] [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: 10/05/2020] [Accepted: 11/23/2020] [Indexed: 01/15/2023] Open
Abstract
Patients who have received haematopoietic stem cell transplantation (HSCT) have a high rate of pulmonary complications, and in this immunosuppressed population, fungal pneumonia is of great concern. Fungal pneumonia can have a similar appearance to non-infectious pulmonary processes in HSCT patients, and radiologists should be familiar with the subtle features that may help to differentiate these disease entities. The focus of this article is on the diagnosis of fungal pneumonia in HSCT patients with an emphasis on radiologists’ roles in establishing the diagnosis of fungal pneumonia and the guidance of clinical management.
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8
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Puglia EBMD, Rodrigues RS, Daltro PA, Souza AS, Paschoal MM, Labrunie EM, Irion KL, Hochhegger B, Zanetti G, Marchiori E. Tomographic findings in bronchial atresia. Radiol Bras 2021; 54:9-14. [PMID: 33574627 PMCID: PMC7863713 DOI: 10.1590/0100-3984.2019.0136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To evaluate computed tomography (CT) findings in 23 patients with bronchial atresia. Materials and Methods The CT images were reviewed by two radiologists who reached decisions by consensus. We included only patients who presented with abnormalities on CT and in whom the diagnosis had been confirmed by pathological examination of the surgical specimen (if the lesion was resected). The CT scans were assessed in order to identify the main findings and to map the distribution of the lesions (i.e., to determine whether the pulmonary involvement was unilateral or bilateral). Results The main CT finding was the combination of bronchocele and hyperinflation of the distal lung. That combination was observed in all of the patients. The lesions were unilateral in all 23 cases, being seen predominantly in the left upper lobe, followed by the right lower lobe, right upper lobe, middle lobe, and left lower lobe. Conclusion The diagnosis of bronchial atresia can be reliably made on the basis of a finding of bronchocele accompanied by hyperinflation of the adjacent lung parenchyma.
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Affiliation(s)
- Elazir Barbosa Mota Di Puglia
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Rosana Souza Rodrigues
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil
| | | | - Arthur Soares Souza
- Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil
| | | | | | | | - Bruno Hochhegger
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Gláucia Zanetti
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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9
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Takeda FR, Garcia RN, de Lima MS, Yogolare GG, Junior UR, Filho FM, Sallum RAA, Cecconello I. Esophagectomy in a patient with pulmonary histoplasmosis: A case report of surgical aspects and complications (with video). Int J Surg Case Rep 2020; 77:100-103. [PMID: 33160165 PMCID: PMC7649434 DOI: 10.1016/j.ijscr.2020.10.107] [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: 09/18/2020] [Accepted: 10/22/2020] [Indexed: 11/24/2022] Open
Abstract
Histoplasmose is an unfrequented associated to esophageal carcinoma. Pulmonary disease may interfere in the outcome after esophagectomy. Vacuum treatment is a good option after anastomotic leakage.
Introduction Esophagectomy is a challenging procedure associated with considerable morbidity. Previous pulmonary diseases, such as histoplasmosis fungal infection, may interfere in operative and postoperative outcomes after esophagectomy. Anastomotic leakage is one of the most feared complications after esophagectomy. However, new therapies developed such as vacuum procedure and esophageal prosthesis have been provenly beneficial. Presentation of case We present a case with squamous cell carcinoma of the mid esophagus portion on a young patient with a pulmonary histoplasmosis history. After a multidisciplinary board, the patient underwent transhiatal esophagectomy with gastric-pull up and cervical anastomosis due to pulmonary disease. The patient later developed an anastomotic leak with mediastinal abscess. We describe this complication's management via an endoscopic vacuum system, esophageal prosthesis, and exhibit a video illustrating the technique. Discussion We illustrate the management of esophageal cancer associated with previous pulmonary disease. Histoplasmosis may misunderstand the esophageal cancer staging, and it can contribute to anastomotic leakage occurrence. An endoscopic vacuum system is an excellent tool for treating esophagogastric anastomosis fistula after esophagectomy, even when the drainage is accumulated in the mediastinum. The esophageal prosthesis may be used after mediastinal abscess resolution. Conclusion Treatment of the association of esophageal cancer and histoplasmosis is feasible. However, care should be taken to avoid highly potential postoperative complications.
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Affiliation(s)
- Flavio Roberto Takeda
- Department of Gastroenterology, Digestive Surgery Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil.
| | - Rodrigo Nicida Garcia
- Department of Gastroenterology, Digestive Surgery Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil.
| | - Marcelo Simas de Lima
- Department of Gastroenterology, Digestive Surgery Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil.
| | - Gustavo Gonçalves Yogolare
- Department of Gastroenterology, Digestive Surgery Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil.
| | - Ulysses Ribeiro Junior
- Department of Gastroenterology, Digestive Surgery Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil.
| | - Fauze Maluf Filho
- Department of Gastroenterology, Digestive Surgery Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil.
| | - Rubens Antonio Aissar Sallum
- Department of Gastroenterology, Digestive Surgery Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil.
| | - Ivan Cecconello
- Department of Gastroenterology, Digestive Surgery Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil.
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10
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Wormser VR, Li ZY, Libke R, Rahmati E. Miliary pattern pulmonary infiltrates in a diabetic patient: Coccidioidomycosis. IDCases 2020; 22:e00977. [PMID: 33083229 PMCID: PMC7554356 DOI: 10.1016/j.idcr.2020.e00977] [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: 08/09/2020] [Revised: 09/26/2020] [Accepted: 09/27/2020] [Indexed: 11/15/2022] Open
Abstract
This is a case of miliary coccidioidomycosis. This case illustrates the importance of early suspicion for coccidioidomycosis in patients from an endemic area. Early identification and recognition of the disease are important to attain early therapy and disease control.
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Affiliation(s)
- Vanessa R Wormser
- Department of Internal Medicine, University of California San Francisco-Fresno, Fresno, CA, United States
| | - Zi Ying Li
- Department of Internal Medicine, University of California San Francisco-Fresno, Fresno, CA, United States
| | - Robert Libke
- Department of Medicine, Division of Infectious Diseases, University of California San Francisco-Fresno, Fresno, CA, United States
| | - Elham Rahmati
- Department of Medicine, Division of Infectious Diseases, University of California San Francisco-Fresno, Fresno, CA, United States
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11
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Louza GF, Nobre LF, Mançano AD, Hochhegger B, Souza AS, Zanetti G, Marchiori E. Lymphocytic interstitial pneumonia: computed tomography findings in 36 patients. Radiol Bras 2020; 53:287-292. [PMID: 33071371 PMCID: PMC7545736 DOI: 10.1590/0100-3984.2019.0107] [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] [Indexed: 11/22/2022] Open
Abstract
Objective To analyze the computed tomography (CT) findings of lymphocytic interstitial pneumonia (LIP). Materials and Methods We retrospectively reviewed the clinical and CT findings of 36 patients with LIP, including 25 women and 11 men, with a mean age of 52.5 years (age range, 22-78 years). Results The main associated diseases with LIP were Sjögren syndrome (42%), human immunodeficiency virus infection (17%), amyloidosis (17%), Sjögren syndrome associated with secondary amyloidosis (11%), idiopathic (8%), and systemic lupus erythematosus (5%). The predominant CT abnormalities were multiple cystic airspaces (n = 35), small nodules (n = 15), ground-glass opacities (n = 13), bronchiectasis and/or bronchiolectasis (n = 8), and thickening of the bronchovascular bundles (n = 8). Other CT findings included reticular opacities (n = 7), calcified nodules (n = 4), airspace consolidation (n = 4), emphysema (n = 3), honeycombing (n = 3), lymph node enlargement (n = 2), mosaic attenuation pattern (n = 1), and cavitated nodules (n = 1). Conclusion The main CT findings of LIP were multiple cysts, small nodules, and ground-glass opacities.
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Affiliation(s)
| | - Luiz Felipe Nobre
- Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | | | - Bruno Hochhegger
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Arthur Soares Souza
- Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil
| | - Gláucia Zanetti
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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12
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An Unusual Cause of Recurrent Pleural Effusion. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Adôrno IF, Tibana TK, Santos RFT, Leão VMM, Brustoloni YM, Silva PAI, Ferreira MA, Nunes TF. Initial chest X-ray findings in pediatric patients diagnosed with H1N1 virus infection. Radiol Bras 2019; 52:78-84. [PMID: 31019335 PMCID: PMC6472857 DOI: 10.1590/0100-3984.2018.0030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective To evaluate chest X-ray findings in pediatric patients diagnosed with
influenza A (H1N1) virus infection. Materials and Methods We retrospectively reviewed chest X-ray findings in 17 cases of pulmonary
infection with the H1N1 virus (in 7 males and 10 females) examined between
2012 and 2016. The mean age of the patients was 14 months (range, 2-89
months). The diagnosis was established on the basis of clinical and
radiographic criteria, and the virus was detected by polymerase chain
reaction. The radiographic findings were categorized by type/pattern of
opacity and by lung zone. The patients were divided into two groups: those
not requiring ventilatory support; and those requiring ventilatory support
or evolving to death. Results The abnormality most often seen on chest X-rays was that of
peribronchovascular opacities, the majority of which affected less than 25%
of the lung, the involvement being bilateral and asymmetric. The lung zone
most frequently involved was the middle third, with central and peripheral
distribution, without pleural effusion. There was a statistically
significant difference between the groups in terms of the symmetry of
pulmonary involvement, asymmetric findings predominating in the group that
required ventilatory support (p = 0.029). Conclusion In pediatric patients with H1N1 virus infection, the main alterations on the
initial chest X-rays are peribronchovascular opacities, nonspecific alveolar
opacities, and consolidations. Although the definitive diagnosis of H1N1
virus infection cannot be made on the basis of imaging characteristics
alone, using a combination of clinical and radiographic findings can
substantially improve the diagnostic accuracy.
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Affiliation(s)
- Isa Félix Adôrno
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Tiago Kojun Tibana
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Rômulo Florêncio Tristão Santos
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Victor Machado Mendes Leão
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Yvone Maia Brustoloni
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Pedro Augusto Ignácio Silva
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Marco Antônio Ferreira
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Thiago Franchi Nunes
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
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