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Davies AA, Adegbite IA, Akintan PE, Ibrahim UO, Adekoya AO, Oladele RO. Chronic cavitary pulmonary aspergillosis in an immunocompetent child. Med Mycol Case Rep 2022; 37:33-6. [PMID: 35865451 DOI: 10.1016/j.mmcr.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 11/23/2022] Open
Abstract
Chronic pulmonary aspergillosis (CPA) is a progressive and destructive disease of the lung parenchyma. We report a 9-year-old boy diagnosed with CPA with a positive Aspergillus IgG and chest imaging of cavitary lung lesions. He was treated with oral Itraconazole with significant improvement. This shows that an index of suspicion should be heightened in the paediatric population with cavitary lung lesions because not all cavitary lung lesions are caused by Mycobacterium tuberculosis.
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Oladele RO, Otu AA, Balogun OJ, Babalola OM, Nwosu AO, Iyabo Osaigbovo I, Gbajabiamila T, Irurhe NK, Fayemiwo SA, Shettima SA, Uwaezuoke NS, Edwin CP, Ayanbeku TS, Okaa JU, Elikwu CJ, Denning DW, Kanki PJ, Ogunsola FT. Standardization of Aspergillus IgG diagnostic cutoff in Nigerians. Ther Adv Infect Dis 2021; 8:20499361211050158. [PMID: 34646555 PMCID: PMC8504277 DOI: 10.1177/20499361211050158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022] Open
Abstract
Background and objectives: Commercial Aspergillus IgG antibody assays have become pivotal in the current diagnosis of chronic pulmonary aspergillosis (CPA). However, diagnostic cutoffs have been found to vary from manufactures’ recommendations in different settings. This study aimed to establish the Aspergillus IgG reference range among Nigerians and determine a diagnostic cutoff for CPA. Methods: Sera from 519 prospectively recruited healthy blood donors and 39 previously confirmed cases of CPA were analysed for Aspergillus IgG levels using the Bordier test kit (Bordier Affinity Products SA, Crissier, Switzerland). Accuracy versus cutoff profile and receiver operating characteristics (ROC) curve were analysed for both CPA cases and controls using the R-Studio (2020), (Window desktop, version 4.0.2 software with R packages “nnet” and “ROCR”). Results: Among healthy blood donors, 141 (27.2%) were aged 16–25 years with median (interquartile range, IQR) of 22 (20–24) years; 304 (58.6%) were aged 26–40 years with median (IQR) of 32 (29–36) years; while 74 (14.2%) were aged 41–60 years with median (IQR) of 46 (44–49.75). Median IgG level in respective age groups were 0.069 (0.009–0.181), 0.044 (0.014–0.202) and 0.056 (0.01–0.265) with no significant difference found in the three age categories (p = 0.69). The overall diagnostic cutoff for the diagnosis of CPA was 0.821 with an accuracy of 97.1% and area under the curve (AUC) = 0.986. Conclusion: The optimal diagnostic cutoff for diagnosing CPA in Nigerians using the Bordier kit was 0.821 which is lower than the manufacturer’s recommended cutoff of 1.0. The determination of this cutoff among Nigerians will significantly enhance accurate identification of CPA and assessment of its true burden in Nigeria.
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Affiliation(s)
- Rita O Oladele
- Department of Medical Microbiology & Parasitology, College of Medicine, University of Lagos, PMB 12003, Lagos, Nigeria
| | - Akaninyene A Otu
- Department of Internal Medicine, University of Calabar, Calabar, Nigeria
| | - Oluwaseyi J Balogun
- Department of Biomedical Engineering, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Oladayo M Babalola
- Department of Biochemistry, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Augustina O Nwosu
- Central Research Laboratory, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Iriagbonse Iyabo Osaigbovo
- Department of Medical Microbiology, College of Medical Sciences, University of Benin, Benin City, Nigeria
| | | | - Nicholas K Irurhe
- Department of Radiology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Samuel A Fayemiwo
- Department of Medical Microbiology & Parasitology, College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Shuwaram A Shettima
- Department of Medical Microbiology, Parasitology and Immunology, Federal Medical Centre, Yola, Nigeria
| | | | | | | | - Joy U Okaa
- Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka, Nigeria
| | - Charles John Elikwu
- Department of Medical Microbiology, Benjamin Carson College of Medicine, Babcock University, Ilishan-Remo, Nigeria
| | - David W Denning
- National Aspergillosis Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Phyllis J Kanki
- Department of Immunology and Infectious Diseases, Harvard T.H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Folasade T Ogunsola
- Department of Medical Microbiology & Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
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Lee MR, Huang HL, Keng LT, Chang HL, Sheu CC, Fu PK, Wang JY, Chong IW, Shih JY, Yu CJ. Establishing Aspergillus-Specific IgG Cut-Off Level for Chronic Pulmonary Aspergillosis Diagnosis: Multicenter Prospective Cohort Study. J Fungi (Basel) 2021; 7:jof7060480. [PMID: 34204844 PMCID: PMC8231598 DOI: 10.3390/jof7060480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Aspergillus-specific IgG (Asp-IgG) cut-off level in diagnosing chronic pulmonary aspergillosis (CPA) remains unknown. METHODS We prospectively recruited participants with clinical suspicion of CPA in three centers in Taiwan during 2019 June to 2020 August. Serum Aspergillus fumigatus-specific IgG (Asp-IgG) (Phadia, Uppsala, UPPS, Sweden) was examined. Optimal cut-off level was determined by Youden's index and validated. RESULTS A total of 373 participants were recruited. In the derivation cohort (n = 262), Asp-IgG had an area under the receiver-operating-characteristic curve (AUC) of 0.832. The optimal cut-off level was 40.5 mgA/L. While applying this cut-off level to the validation cohort (n = 111), the sensitivity and specificity were 86.7% and 80.2%. Lowering the cut-off level from 40.5 to 27 mgA/L, the sensitivity was steady (30/36, 83.3% to 31/36, 86.1%) while specificity dropped from 81.9% (276/337) to 63.5% (214/337). Restricting CPA diagnosis to only chronic cavitary pulmonary aspergillosis (CCPA) and chronic fibrosing pulmonary aspergillosis (CFPA) yielded a cut-off level of 42.3 mgA/L in the derivation cohort with a sensitivity of 100% and specificity of 84.4% in the validation cohort. CONCLUSIONS Serum Asp-IgG performs well for CPA diagnosis and provides a low false-positive rate when using a higher cut-off level (preferably around 40 mgA/L).
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Affiliation(s)
- Meng-Rui Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 10002, Taiwan; (M.-R.L.); (L.-T.K.); (J.Y.-S.); (C.-J.Y.)
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu 30059, Taiwan
| | - Hung-Ling Huang
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 80145, Taiwan; (H.-L.H.); (H.-L.C.)
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Kaohsiung 80708, Taiwan; (C.-C.S.); (I.-W.C.)
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Kaohsiung 80708, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Li-Ta Keng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 10002, Taiwan; (M.-R.L.); (L.-T.K.); (J.Y.-S.); (C.-J.Y.)
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu 30059, Taiwan
| | - Hsu-Liang Chang
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 80145, Taiwan; (H.-L.H.); (H.-L.C.)
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Kaohsiung 80708, Taiwan; (C.-C.S.); (I.-W.C.)
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Kaohsiung 80708, Taiwan; (C.-C.S.); (I.-W.C.)
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Kaohsiung 80708, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Pin-Kuei Fu
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 40254, Taiwan
- College of Human Science and Social Innovation, Hungkuang University, Taichung 43302, Taiwan
- Department of Computer Science, Tunghai University, Taichung 40704, Taiwan
- Correspondence: (P.-K.F.); (J.-Y.W.)
| | - Jann-Yuan Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 10002, Taiwan; (M.-R.L.); (L.-T.K.); (J.Y.-S.); (C.-J.Y.)
- Correspondence: (P.-K.F.); (J.-Y.W.)
| | - Inn-Wen Chong
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Kaohsiung 80708, Taiwan; (C.-C.S.); (I.-W.C.)
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Kaohsiung 80708, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Departments of Respiratory Therapy, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Jin-Yuan Shih
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 10002, Taiwan; (M.-R.L.); (L.-T.K.); (J.Y.-S.); (C.-J.Y.)
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 10002, Taiwan; (M.-R.L.); (L.-T.K.); (J.Y.-S.); (C.-J.Y.)
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu 30059, Taiwan
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Bongomin F, Garcez T, Denning DW. Impact of high baseline Aspergillus-specific IgG levels on weight and quality-of-life outcomes of patients with chronic pulmonary aspergillosis. Med Mycol 2021; 58:1000-1004. [PMID: 32343313 DOI: 10.1093/mmy/myaa026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/29/2020] [Accepted: 04/02/2020] [Indexed: 12/28/2022] Open
Abstract
This study aimed to evaluate the impact of quantitative baseline Aspergillus-specific immunoglobulin G (IgG) serum levels on weight changes of patients with chronic pulmonary aspergillosis (CPA) under antifungal treatment. We retrospectively reviewed data of patients diagnosed with CPA between April 2015 and March 2018 at the National Aspergillosis Centre (Manchester, UK). All patients were on continued antifungal treatment for 12 months. Data on Aspergillus-specific IgG levels, St George's quality of life (SGQoL) variables and weight at baseline, 6 months and 12 months were extracted. We defined a high serum Aspergillus-specific IgG as ≥ 200 mg/l (Group A) and low level < 200 mg/l (Group B). Forty-nine patients (37 male; 12 female), median age 65 years (range: 29-86) were studied. Overall, 33% (n = 16) of the patients were in Group A. The baseline characteristics between the two groups were similar. The median Charlson comorbidity index was 4 (range: 0-5) and 3 (range: 0-9) for Group A and Group B, respectively (P = .543). There was a sustained decline in median Aspergillus IgG levels from baseline, through 6 month to 12 months of continues therapy from 170 (range: 20-1110) to 121 (range: 20-1126), and finally 107 (15-937) mg/l, respectively (P < .001). Group A patients gained more weight at 6 months (9/15 [60%] vs. 7/33 [21%], P = .012) and at 12 months of treatment (9/15 [60%] vs. 7/33 [22%]), and more patients in Group B lost weight ((13/33 [41%] vs. 1/15 [7%]), P = .015). However, there was no difference in QoL outcomes across groups at 6 (P = .3) and 12 (P = .7) months. A very high Aspergillus IgG may confer a higher likelihood of weight gain as a key, objective marker of clinical response, if patients can tolerate 12 months of antifungal therapy.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, School of Medicine, Gulu University, Gulu, Uganda
| | - Tomaz Garcez
- Greater Manchester Immunology Service, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - David W Denning
- The National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom.,Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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Ramachandran P, Savio J, Padaki P, Chhabra R, Veluthat C, Devaraj U, Venkatanarayan K, Krishnaswamy UM, Ghosh S, D'souza GA. A simple x-ray scoring system for the diagnosis of chronic pulmonary aspergillosis. Mycoses 2021; 64:788-793. [PMID: 33835600 DOI: 10.1111/myc.13284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic pulmonary aspergillosis (CPA) is a severe form of post-tuberculosis lung disease (PTBLD). Considering the high burden of TB in India, it can be concluded that the prevalence of CPA is also high. Chest x-ray though most feasible, interpretation is subjective. Therefore, decision on evaluation for CPA cannot be based on x-ray alone. OBJECTIVE Present study evaluated an x-ray score as a marker for extent of lung damage in patients with PTBLD presenting with haemoptysis and its utility to predict Aspergillus serum IgG levels. METHODS We used a modified scoring system developed by Anna Ralph et al X-ray score cut-offs of >71 and 40, with or without history of massive haemoptysis, were compared with serum IgG levels. RESULTS With a chest x-ray score cut-off of 71, specificity was 88%. With an x-ray score of >71 combined with history of massive haemoptysis, 86% cases were found to be IgG positive. The specificity of this combination was 96%. CONCLUSION This study concluded that a simple chest x-ray scoring system in addition to the symptom of massive haemoptysis helped in the decision on further evaluation of the subject for CPA, especially in resource constrained settings.
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Affiliation(s)
- Priya Ramachandran
- Department of Pulmonary Medicine, St. John's Medical college Hospital, Bengaluru, India
| | - Jayanthi Savio
- Department of Microbiology, St. John's Medical college Hospital, Bengaluru, India
| | - Priyadarshini Padaki
- Department of Microbiology, St. John's Medical college Hospital, Bengaluru, India
| | - Ruchita Chhabra
- Department of Microbiology, St. John's Medical college Hospital, Bengaluru, India
| | - Chitra Veluthat
- Department of Pulmonary Medicine, St. John's Medical college Hospital, Bengaluru, India
| | - Uma Devaraj
- Department of Pulmonary Medicine, St. John's Medical college Hospital, Bengaluru, India
| | | | - Uma M Krishnaswamy
- Department of Pulmonary Medicine, St. John's Medical college Hospital, Bengaluru, India
| | - Santu Ghosh
- Department of Biostatistics, St. John's Medical college Hospital, Bengaluru, India
| | - George A D'souza
- Department of Pulmonary Medicine, St. John's Medical college Hospital, Bengaluru, India
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Jabeen K, Farooqi J, Iqbal N, Wahab K, Irfan M. Aspergillus fumigatus and Aspergillus flavus-Specific IgG Cut-Offs for the Diagnosis of Chronic Pulmonary Aspergillosis in Pakistan. J Fungi (Basel) 2020; 6:jof6040249. [PMID: 33114653 PMCID: PMC7711809 DOI: 10.3390/jof6040249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 12/14/2022] Open
Abstract
Despite a high burden of chronic pulmonary aspergillosis (CPA) in Pakistan, Aspergillus-specific IgG testing is currently not available. Establishing cut-offs for Aspergillus-specific IgG for CPA diagnosis is crucial due to geographical variation. In settings such as Pakistan, where non-Aspergillus fumigatus (mainly A. flavus) Aspergillus species account for the majority of CPA cases, there is a need to explore additional benefit of Aspergillus flavus-specific IgG detection along with A. fumigatus-specific IgG detection. This study was conducted at the Aga Khan University, Karachi, Pakistan after ethical approval. Serum for IgG detection were collected after informed consent from healthy controls (n = 21), diseased controls (patients with lung diseases, n = 18), and CPA patients (n = 21). A. fumigatus and A. flavus IgG were detected using Siemens immulite assay. The sensitivity and specificity of A. fumigatus-specific IgG were 80.95% and 82.05%, respectively at a cut-off of 20 mg/L. The sensitivity and specificity of A. flavus-specific IgG were 80.95% and 79.49% at a cut-off of 30 mg/L. We report, for the first time, performance of A. flavus-specific IgG for CPA diagnosis. Although there was no statistically significant difference between the performance of both antigens, it seems contextually relevant to include A. flavus IgG in the CPA diagnostic algorithm in regions with higher non-A. fumigatus CPA infections.
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Affiliation(s)
- Kauser Jabeen
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi 74800, Pakistan; (J.F.); (K.W.)
- Correspondence: ; Tel.: +92-21-34930051
| | - Joveria Farooqi
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi 74800, Pakistan; (J.F.); (K.W.)
| | - Nousheen Iqbal
- Section of Pulmonary Medicine, Department of Medicine, Aga Khan University, Karachi 74800, Pakistan; (N.I.); (M.I.)
- Department of Medicine, Jinnah Medical and Dental College, Karachi 75400, Pakistan
| | - Khalid Wahab
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi 74800, Pakistan; (J.F.); (K.W.)
| | - Muhammad Irfan
- Section of Pulmonary Medicine, Department of Medicine, Aga Khan University, Karachi 74800, Pakistan; (N.I.); (M.I.)
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Bongomin F, Asio LG, Baluku JB, Kwizera R, Denning DW. Chronic Pulmonary Aspergillosis: Notes for a Clinician in a Resource-Limited Setting Where There Is No Mycologist. J Fungi (Basel) 2020; 6:E75. [PMID: 32498415 PMCID: PMC7345130 DOI: 10.3390/jof6020075] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/29/2020] [Accepted: 05/31/2020] [Indexed: 02/07/2023] Open
Abstract
Chronic pulmonary aspergillosis (CPA) is a spectrum of several progressive disease manifestations caused by Aspergillus species in patients with underlying structural lung diseases. Duration of symptoms longer than three months distinguishes CPA from acute and subacute invasive pulmonary aspergillosis. CPA affects over 3 million individuals worldwide. Its diagnostic approach requires a thorough Clinical, Radiological, Immunological and Mycological (CRIM) assessment. The diagnosis of CPA requires (1) demonstration of one or more cavities with or without a fungal ball present or nodules on chest imaging, (2) direct evidence of Aspergillus infection or an immunological response to Aspergillus species and (3) exclusion of alternative diagnoses, although CPA and mycobacterial disease can be synchronous. Aspergillus antibody is elevated in over 90% of patients and is the cornerstone for CPA diagnosis. Long-term oral antifungal therapy improves quality of life, arrests haemoptysis and prevents disease progression. Itraconazole and voriconazole are alternative first-line agents; voriconazole is preferred for patients with contra-indications to itraconazole and in those with severe disease (including large aspergilloma). In patients co-infected with tuberculosis (TB), it is not possible to treat TB with rifampicin and concurrently administer azoles, because of profound drug interactions. In those with pan-azole resistance or intolerance or progressive disease while on oral triazoles, short-term courses of intravenous liposomal amphotericin B or micafungin is used. Surgery benefits patients with well-circumscribed simple aspergillomas and should be offered earlier in low-resource settings.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu P.O. Box 166, Uganda;
| | - Lucy Grace Asio
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu P.O. Box 166, Uganda;
| | - Joseph Baruch Baluku
- Division of Pulmonology, Mulago National Referral Hospital, Kampala P.O. Box 7051, Uganda;
| | - Richard Kwizera
- Translational Research Laboratory, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala P.O. Box 22418, Uganda;
| | - David W. Denning
- The National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK;
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
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Kalyango N, Kwizera R, Baluku JB, Bongomin F. Intra-cavitary pulmonary cryptococcoma in poorly controlled diabetes mellitus. Med Mycol Case Rep 2020; 28:1-3. [PMID: 32154097 PMCID: PMC7056601 DOI: 10.1016/j.mmcr.2020.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/17/2020] [Accepted: 02/21/2020] [Indexed: 01/09/2023] Open
Abstract
A 59-year-old HIV-negative Ugandan man presented with a long-standing history of respiratory symptoms and was found to have an intra-cavitary pulmonary cryptococoma by chest imaging and sputum culture. The serum cryptococcal antigen was negative. The sputum Xpert® MTB RIF Ultra assay was negative. He was previously treated for cavitary pulmonary tuberculosis. The patient had poorly controlled diabetes (HbA1c, 9.3%). The patient was successfully treated with oral fluconazole.
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Affiliation(s)
- Najibu Kalyango
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, P.o.Box, 7072, Uganda
| | - Richard Kwizera
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, P.o.Box, 7072, Uganda
| | - Joseph B Baluku
- Department of Pulmonology, Mulago National Referral Hospital, Kampala, P.o.Box, 7051, Uganda
| | - Felix Bongomin
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, P.o.Box, 7072, Uganda.,Department of Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, P.o.Box 166, Uganda
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