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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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Iwata E, Nishiuma T, Hori S, Sugiura K, Taki M, Tokunaga S, Kusumoto J, Hasegawa T, Tachibana A, Akashi M. Relationship between oral health and prognosis in patients with empyema: Single center retrospective study with propensity score matching analysis. PLoS One 2023; 18:e0282191. [PMID: 36888568 PMCID: PMC9994691 DOI: 10.1371/journal.pone.0282191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/09/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Empyema is a life-threatening infection often caused by oral microbiota. To the best of our knowledge, no reports have investigated the association between the objective assessment of oral health and prognosis in patients with empyema. MATERIALS AND METHODS A total of 63 patients with empyema who required hospitalization at a single institution were included in this retrospective study. We compared non-survivors and survivors to assess risk factors for death at three months, including the Renal, age, pus, infection, diet (RAPID) score, and Oral Health Assessment Tool (OHAT) score. Furthermore, to minimize the background bias of the OHAT high-score and low-score groups determined based on the cut-off value, we also analyzed the association between the OHAT score and death at 3 months using the propensity score matching method. RESULTS The 3-month mortality rate was 20.6% (13 patients). Multivariate analysis showed that a RAPID score ≥5 points (odds ratio (OR) 8.74) and an OHAT score ≥7 points (OR 13.91) were significantly associated with death at 3 months. In the propensity score analysis, a significant association was found between a high OHAT score (≥7 points) and death at 3 months (P = 0.019). CONCLUSION Our results indicated that oral health assessed using the OHAT score may be a potential independent prognostic factor in patients with empyema. Similar to the RAPID score, the OHAT score may become an important indicator for the treatment of empyema.
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Affiliation(s)
- Eiji Iwata
- Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, Kakogawa, Japan
- * E-mail:
| | - Teruaki Nishiuma
- Department of Respiratory Medicine, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Suya Hori
- Department of Respiratory Medicine, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Keiko Sugiura
- Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Masato Taki
- Department of Respiratory Medicine, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Shuntaro Tokunaga
- Department of Respiratory Medicine, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Junya Kusumoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akira Tachibana
- Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Allen R, Estroff J, Sarani B. Surgical Stabilization of Rib Fractures in a Patient with Empyema: A Case Report. JBJS Case Connect 2020; 9:e0202. [PMID: 31770114 DOI: 10.2106/jbjs.cc.19.00202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A patient sustained flail chest and diaphragmatic rupture with perforation of the stomach. She underwent gastrorrhaphy with chest lavage. She developed empyema and underwent decortication. Intraoperative cultures grew bacteria and yeast. She failed extubation because of pain despite maximal medical therapy. She underwent surgical stabilization of rib fractures (SSRF). Intraoperative cultures remained positive. She was extubated 9 days after SSRF. She was ultimately discharged to home with a total of 2 months of antibiotics and no need for plate removal. CONCLUSION The presence of infection should not be considered a contraindication to SSRF in patients who are mechanical ventilation dependent due to flail chest.
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Affiliation(s)
- Rebecca Allen
- Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, DC
| | - Jordan Estroff
- Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, DC
| | - Babak Sarani
- Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, DC
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4
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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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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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Yan L, Rohra P, Cheng L, Gattuso P. Pleural Effusion in Pulmonary and Extrapulmonary Blastomycosis. Acta Cytol 2019; 64:241-247. [PMID: 31266012 DOI: 10.1159/000500973] [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: 02/28/2019] [Accepted: 05/14/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Pleural effusion secondary to blastomycosis infection is an uncommon clinical manifestation of the disease. We undertook a retrospective study to assess the incidence and involvement of pleural effusion in patients with blastomycosis infection. STUDY DESIGN Institutional cytology and surgical pathology records were searched from December 1995 to October 2017 for cases of blastomycosis. The cytologic, surgical pathology, and clinical pertinent information was reviewed in detail. RESULTS A total of 77 cases of blastomycosis infection were recorded, with a male-to-female ratio of 1.7:1.0. Forty-eight cases of blastomycosis were pulmonary (62.3%), while 29 cases of blastomycosis were found in extrapulmonary sites (37.7%). The diagnosis of pulmonary blastomycosis was established by 24 lung biopsies/wedge resections, 22 bronchial alveolar lavages, and 2 lung fine needle aspirations. The 29 cases of extrapulmonary blastomycosis included 13 cases of bone (44.8%), 8 cases of skin (27.6%), 6 cases of soft tissue (20.7%), and 2 cases of brain infections (6.8%). Twenty-eight of 48 pulmonary cases were complicated by unilateral or bilateral pleural effusion (58.3%) detected by imaging studies. Four of the 28 pleural effusions were aspirated and examined by cytology. Two of the 4 pleural fluid cytologies showed involvement by blastomycosis (50%). In the extrapulmonary blastomycosis group, 9 of 29 patients showed unilateral or bilateral pleural effusions (31.0%), including 4 cases of bone, 4 cases of skin, and 1 case of brain involvement. Only 2 of the 9 pleural effusions were aspirated for cytology study. One of the 2 pleural fluid cytologies showed blastomycosis (50%). CONCLUSION Pleural effusion detected by imaging is common in blastomycosis patients. Blastomycosis can involve pleural fluid in both pulmonary and extrapulmonary diseases. A broad infectious differential that includes blastomycosis should be considered to make a timely diagnosis and initiate antifungal therapy to prevent systemic infection and further dissemination of the disease.
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Affiliation(s)
- Lei Yan
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA,
| | - Prih Rohra
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Lin Cheng
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
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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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Sersar SI, Maghrabi LA. Respiratory-digestive tract fistula: two-center retrospective observational study. Asian Cardiovasc Thorac Ann 2018; 26:218-223. [PMID: 29392975 DOI: 10.1177/0218492318755013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Aerodigestive fistulae can be defined as abnormal communications between the gastrointestinal tract and the respiratory tract. Choking after meals, coughing, feeding difficulties, tachycardia, and persistent pneumonia are the main presentations. The aim of our study was to review our experience in the management of 27 cases of acquired aerodigestive fistulae of different types, levels, and management. Methods We conducted a retrospective observational study on 27 cases of fistulae between the respiratory and digestive tracts, which were managed in 2 hospitals in Saudi Arabia in the last 5 years. The patients comprised 16 females and 11 males, with a mean age of 29 years (range 17-67 years). Results The most common aerodigestive tract fistula was tracheoesophageal in 8 patients, followed by esophagobronchial in 6, and esophagopleural in 5. Four postendoscopic fistulae were included. The least common were gastropleural and esophagopulmonary fistulae. The most common etiologies were iatrogenic and esophageal cancer, and the least common was blunt chest trauma. The main presentations were fever, chocking after or during meals, and tachycardia. We used various modalities of treatment: conservative, cervical repair, thoracoabdominal repair, hybrid insertion of a T-tube, endoscopic esophageal stenting, and endoscopic clipping of the fistulous tract. During follow-up, 6 patients died due to advanced esophageal cancer in 5 and upper airway obstruction after iatrogenic tracheobronchial fistula in one. Conclusion Acquired aerodigestive fistula is a devastating condition that should be managed early and aggressively by a multidisciplinary team.
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Affiliation(s)
| | - Lamees A Maghrabi
- 2 Ibn Sina National College for Medical Studies, Jeddah, Saudi Arabia
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9
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Massarrat S, Saniee P, Siavoshi F, Mokhtari R, Mansour-Ghanaei F, Khalili-Samani S. The Effect of Helicobacter pylori Infection, Aging, and Consumption of Proton Pump Inhibitor on Fungal Colonization in the Stomach of Dyspeptic Patients. Front Microbiol 2016; 7:801. [PMID: 27252698 PMCID: PMC4879133 DOI: 10.3389/fmicb.2016.00801] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 05/11/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The importance of coinfection of Helicobacter pylori (H.pylori) and Candida albicans (C. albicans) in the development of gastric diseases is not known. In this study, the frequency of concurrent infection of H. pylori and C. albicans in dyspeptic patients was assessed while considering age, gender, and PPI consumption of patients. METHODS Gastric biopsies were taken from 74 yeast-positive dyspeptic patients and gastric disease, age, gender, and proton pump inhibitor (PPI) consumption of subjects were recorded. One antral biopsy was used for rapid urease test (RUT) and one for H. pylori and yeast cultivation and smear preparation. Bacterial isolates were identified according to spiral morphology and the biochemical characteristics. Yeast isolates were identified on Chromagar and by the Nested-PCR amplification of C. albicans-specific topoisomerase II gene. Twenty-seven biopsy smears were Gram-stained and examined by the light microscope for observing H. pylori and yeast cells. RESULTS Fifty-four (73%) of patients were >40 year. Of 68 patients with PPI consumption record, 46 (67.6%) consumed PPI (p = 0). Comparison of patients in peptic ulcer group (12, 16.2%) with (6, 8.1%) or without (6, 8.1%) H. pylori or in gastritis group (62, 83.8%) with (25, 33.8%) or without (37, 50%) H. pylori showed no significant difference (p > 0.05). Of the 46 patients who consumed PPI, 13 (17.5%) were H. pylori-positive and 33 (44.6%) H. pylori-negative (p = 0). Ten out of twenty-seven smears showed the occurrence of H. pylori cells, including three with yeast cells. Of the 17 H. pylori-negative smears, three showed the occurrence of yeast cells only. Yeasts stained Gram-positive or Gram-negative and appeared as single or budding cells. CONCLUSION The older age and PPI consumption could favor fungal colonization in the human stomach. The occurrence of a considerable number of H. pylori-positive or H. pylori-negative patients with gastritis or peptic ulcer shows that co-infection of Candida and H. pylori or infection of yeast alone could be associated with dyspeptic diseases. The occurrence of yeast cells in gastric biopsies with different Gram's reactions indicates that fungi might change their cell wall components for establishing a persistent colonization in the stomach.
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Affiliation(s)
- Sadegh Massarrat
- Endoscopy Department, Digestive Disease Research Institute, Tehran University of Medical Sciences Tehran, Iran
| | - Parastoo Saniee
- Department of Microbiology, School of Biology, University College of Sciences, University of Tehran Tehran, Iran
| | - Farideh Siavoshi
- Department of Microbiology, School of Biology, University College of Sciences, University of Tehran Tehran, Iran
| | - Reyhane Mokhtari
- Department of Microbiology, School of Biology, University College of Sciences, University of Tehran Tehran, Iran
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences Rasht, Iran
| | - Saman Khalili-Samani
- Department of Microbiology, School of Biology, University College of Sciences, University of Tehran Tehran, Iran
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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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Utility of transjejunostomal endoscopy following bypass surgery for refractory esophageal ulceration after thoracic aortic aneurysm operation in a patient with Marfan’s syndrome. Esophagus 2015. [DOI: 10.1007/s10388-013-0406-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Srinivasnakshatri VK, Subramani P, Venkateshwaraprasad KN, Varma P. A fatal case of fungal empyema due to Candida krusei and Candida tropicalis: a rare occurrence with an atypical presentation. J Clin Diagn Res 2014; 8:DD01-2. [PMID: 25584222 PMCID: PMC4290240 DOI: 10.7860/jcdr/2014/10466.5205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 09/10/2014] [Indexed: 11/24/2022]
Abstract
Infections of the pleural cavity remain an important cause of morbidity and mortality despite advancement in diagnostic modalities and therapy. Community acquired empyema thoracis due to Candida species are rarely reported in paediatric literature. We hereby report an interesting case of empyema due to co-infection of Candida krusei with Candida tropicalis. A 11-year-old female child presented with respiratory distress. Chest X-ray showed massive pleural effusion, thoracocentesis showed it as purulent exudate and she was empirically treated with antibiotics. C. tropicalis and C. krusei were isolated from the pus sample proving to be fungal empyema. Inspite of antifungal agents and mechanical ventilation, her general condition rapidly deteriorated and she succumbed.
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Affiliation(s)
- Venkatesh Karkada Srinivasnakshatri
- Assistant Professor, Department of Paediatrics, Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Tamaka, Kolar, Karanataka, India
| | - Parimala Subramani
- Assistant Professor, Department of Microbiology, SDUAHER, Tamaka, Kolar, Karanataka, India
| | | | - Puneet Varma
- Assistant Professor, Department of Microbiology, SDUAHER, Tamaka, Kolar, Karanataka, India
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Lin HS, Chao CM, Lin WT, Lai CC. Candida empyema thoracis at a hospital in Taiwan. Surg Infect (Larchmt) 2014; 15:540-3. [PMID: 24841623 DOI: 10.1089/sur.2013.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We conducted a study of the clinical manifestations and outcomes of empyema thoracis caused by Candida spp. in hospitalized patients. METHODS We identified patients who from January 2010 to June 2012 had signs of inflammation, such as fever and leukocytosis, and concomitant positive cultures of Candida spp. from specimens of pleural fluid. We reviewed retrospectively the medical records of all such patients. RESULTS Eight of the patients in whom we identified fever and leukocytosis with concomitant positive pleural fluid cultures of Candida spp. were found to have Candida empyema thoracis. Candida albicans was the most common species causing empyema (n=4), followed by C. glabrata (n=3) and C. tropicalis (n=1). Among the eight patients with Candida empyema thoracis, malignant disease was the most common underlying disease. Seven of the eight patients' episodes of Candida empyema thoracis (87.5%) were classified as health care-associated infections. One patient had a mixed infection with Candida spp. and Pseudomonas aeruginosa. None of the patients had concomitant candidemia. Fluconazole was the antifungal agent used most commonly in treating the patients, and all of the patients had drainage of pleural effusions, including tube thoracostomy in five patients and drainage through a pigtail catheter in three patients. One patient underwent video-assisted thoracic surgery for the management of empyema thoracis, and the patients' overall in-hospital mortality was 62.5%. CONCLUSION Although Candida empyema thoracis is encountered rarely, it can develop in immunocompromised patients and can be associated with a high mortality rate.
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Affiliation(s)
- Hong-Shen Lin
- 1 Department of Surgery, Yaun's General Hospital, Kaohsiung , Taiwan
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Report of a 63-case series of Candida empyema thoracis: 9-year experience of two medical centers in central Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 47:36-41. [DOI: 10.1016/j.jmii.2012.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 07/06/2012] [Accepted: 08/13/2012] [Indexed: 11/17/2022]
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16
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Khalbuss WE, Hooda S, Auger M. Cytomorphology of Boerhaave's syndrome: A critical value in cytology. Cytojournal 2013; 10:8. [PMID: 23858318 PMCID: PMC3709518 DOI: 10.4103/1742-6413.111811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 04/09/2013] [Indexed: 11/08/2022] Open
Abstract
Spontaneous esophageal perforation into the pleural cavity (Boerhaave's syndrome) is a rare life-threatening condition, which requires early diagnosis and urgent management. The diagnosis of such critical condition in many cases is delayed because of atypical clinical presentation, resulting in increased morbidity and mortality. Cytological examination of pleural fluid can provide early, fast and accurate diagnosis of such critical condition and help in better and early management of this disease. We describe a case of an 81-year-old female with esophageal perforation who presented with a left sided pleural effusion. The correct diagnosis was established in this case by observing gastrointestinal-like fluid characteristics of the thoracic drainage upon cytological and chemical analyses and the rupture was confirmed by esophagography. The cytological examination of pleural fluid revealed benign reactive squamous cells, fungal organisms, bacterial colonies, and vegetable material consistent with a ruptured esophagus. Cytological examination of pleural fluid is a rapid and accurate technique that can help in establishing the diagnosis of this challenging entity and guide initiation proper management of this unusual entity.
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Affiliation(s)
- Walid E Khalbuss
- Departments of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Mansueto P, Pisciotta G, Tomasello G, Cabibi D, Seidita A, D'Alcamo A, Patti AM, Sprini D, Carroccio A, Rini GB, Fede GD. Malignant tumor-like gastric lesion due to Candida albicans in a diabetic patient treated with cyclosporin: a case report and review of the literature. Clin Exp Med 2011; 12:201-5. [PMID: 21904834 DOI: 10.1007/s10238-011-0158-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 08/26/2011] [Indexed: 11/29/2022]
Abstract
The gastrointestinal tract of healthy individuals is colonized by hundreds of saprophytes and mycetes, especially the Candida species, are habitual ones. Under certain conditions, the fungal flora may overgrow, resulting in lesions of the digestive mucosa which, rarely, can have a local diffusion and/or spread to the lympho-hematogenous system. Mycotic infections of the stomach can sometimes look like benign gastric ulcers. Here, we present the case report of a woman, aged 64, who presented with type II diabetes mellitus and psoriasis, on chronic treatment with cyclosporin A and with endoscopic evidence of an ulcerated, vegetating gastric lesion secondary to Candida albicans infection. Although strongly suggestive of malignancy, it completely healed after cyclosporin withdrawal and the administration of oral antifungal drugs.
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Affiliation(s)
- Pasquale Mansueto
- Internal Medicine, Department of Clinical Medicine and Emerging Diseases, University Hospital of Palermo, Via del Vespro, 141-90146, Palermo, Italy.
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Chuang TY, Yeh CY, Ko SW, Lin CJ, Lee SW, Hsueh PR. Fatal case of community-acquired empyema thoracis and candidemia caused by Candida albicans. Diagn Microbiol Infect Dis 2011; 71:156-8. [PMID: 21775087 DOI: 10.1016/j.diagmicrobio.2011.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 06/14/2011] [Accepted: 06/14/2011] [Indexed: 10/17/2022]
Abstract
We report a fatal case of community-acquired empyema thoracis and candidemia caused by Candida albicans. The patient responded poorly to human recombinant activated protein C and intravenous fluconazole treatment and died of profound shock with multiple organ failure 8 days after admission.
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Affiliation(s)
- Tzu-Yi Chuang
- Department of Internal Medicine, Taoyaun General Hospital, Department of Health, Executive Yuan, Taiwan
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