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Naito M, Maekura T, Kurahara Y, Tahara M, Ikegami N, Kimura Y, Sonobe S, Kobayashi T, Minomo S, Tsuji T, Tsuyuguchi K, Hayashi S, Suzuki K. Clinical Features of Nontuberculous Mycobacterial Pleurisy: A Review of 12 Cases. Intern Med 2018; 57:13-16. [PMID: 29033435 PMCID: PMC5799050 DOI: 10.2169/internalmedicine.9119-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective The incidence of pulmonary nontuberculous mycobacterial (NTM) infections has increased in recent decades. Nevertheless, NTM pleurisy is still a rare disease. The objective of the present study was to elucidate the clinical features and outcomes of NTM pleurisy. Methods A retrospective study was undertaken of consecutive patients whose pleural effusion culture yielded NTM, from 2002 to 2016 at a respiratory hospital in Japan. The clinical features, treatment, and outcomes of these patients were analyzed. Result The 12 patients with NTM pleurisy were predominantly male, with a median age of 69 years (range, 48-93 years). They included eight patients with a history of smoking and six patients with immunosuppressive comorbidities such as malignancy, diabetes mellitus, and conditions requiring steroid administration. Fibrocavitary disease was the most common radiographic feature of these patients, and Mycobacterium avium complex was the most common pathogen. Pneumothorax was complicated in 11 patients. Surgery was performed on seven patients, in addition to thoracic drainage for the treatment of pleurisy and pneumothorax. Three patients died of respiratory failure. Conclusion Pneumothorax is a frequent complication of NTM pleurisy, often making the condition difficult to treat. Surgery at an appropriate time should therefore considered for refractory cases.
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Affiliation(s)
- Maiko Naito
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Toshiya Maekura
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Yu Kurahara
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Masahiro Tahara
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Naoya Ikegami
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Yohei Kimura
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Shoko Sonobe
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Takehiko Kobayashi
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Shojiro Minomo
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Taisuke Tsuji
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Kazunari Tsuyuguchi
- Department of Infectious Diseases, Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Seiji Hayashi
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Katsuhiro Suzuki
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
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2
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Vukicevic TA, Dudvarski-Ilic A, Zugic V, Stevanovic G, Rubino S, Barac A. Subacute invasive pulmonary aspergillosis as a rare cause of pneumothorax in immunocompetent patient: brief report. Infection 2017; 45:377-380. [PMID: 28233110 DOI: 10.1007/s15010-017-0994-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/17/2017] [Indexed: 11/28/2022]
Abstract
Subacute invasive pulmonary aspergillosis (IPA) represents a form of chronic pulmonary aspergillosis which affects immunocompetent individuals or mildly immunocompromised persons with underlying pulmonary disease. Pneumothorax can be a rare complication of subacute IPA due to a leakage of air from an air-filled lung cavitation into the pleural space. Herein, we report rare and unusual case of pneumothorax in a patient with pulmonary cavity infection. A 40-year-old woman was admitted to thoracic surgery due to complete pneumothorax of the left lung. She was active smoker with untreated chronic obstructive pulmonary disease (COPD). After thoracic drainage multiple cavity forms in the both lungs were noticed. Galactomannan antigen was positive in bronchoalveolar lavage as well as culture of Aspergillus fumigatus. Antifungal treatment by voriconazole was started and continued during 6 months with a favorable outcome. This case highlights that subacute IPA is a diagnose that should be considered in patients with end-stage COPD, low body mass index, or patient who developed pneumothorax. The results of our case show that voriconazole is a safe and effective treatment as primary or salvage therapy in subacute forms of IPA, irrespective of the immunological status of the patients.
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Affiliation(s)
- Tatjana Adzic Vukicevic
- School of Medicine, University of Belgrade, Belgrade, Serbia.
- Clinic for Pulmonology, Clinical Centre of Serbia, Koste Todorovica 2, Belgrade, 11000, Serbia.
| | - Aleksandra Dudvarski-Ilic
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Pulmonology, Clinical Centre of Serbia, Koste Todorovica 2, Belgrade, 11000, Serbia
| | - Vladimir Zugic
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Pulmonology, Clinical Centre of Serbia, Koste Todorovica 2, Belgrade, 11000, Serbia
| | - Goran Stevanovic
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Infectious and Tropic Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - Salvatore Rubino
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Aleksandra Barac
- Clinic for Infectious and Tropic Diseases, Clinical Centre of Serbia, Belgrade, Serbia
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3
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Ueyama M, Asakura T, Morimoto K, Namkoong H, Matsuda S, Osawa T, Ishii M, Hasegawa N, Kurashima A, Goto H. Pneumothorax associated with nontuberculous mycobacteria: A retrospective study of 69 patients. Medicine (Baltimore) 2016; 95:e4246. [PMID: 27442650 PMCID: PMC5265767 DOI: 10.1097/md.0000000000004246] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The incidence of nontuberculous mycobacterial pulmonary disease (NTMPD) is increasing worldwide. Secondary spontaneous pneumothorax occurs as a complication of underlying lung disease and is associated with higher morbidity, mortality, and recurrence than primary spontaneous pneumothorax. We here investigated the clinical features and long-term outcomes of pneumothorax associated with NTMPD.We conducted a retrospective study on consecutive adult patients with pneumothorax associated with NTMPD at Fukujuji Hospital and Keio University Hospital from January 1992 to December 2013. We reviewed the medical records of 69 such patients to obtain clinical characteristics, radiological findings, and long-term outcomes, including pneumothorax recurrence and mortality.The median age of the patients was 68 years; 34 patients were women. The median body mass index was 16.8 kg/m. Underlying pulmonary diseases mainly included chronic obstructive pulmonary disease and pulmonary tuberculosis. On computed tomography, nodules and bronchiectasis were observed in 46 (98%) and 45 (96%) patients, respectively. Consolidation, pleural thickening, interlobular septal thickening, and cavities were most common, and observed in 40 (85%), 40 (85%), 37 (79%), and 36 (77%) patients, respectively. Regarding pneumothorax treatment outcomes, complete and incomplete lung expansion were observed in 49 patients (71%) and 15 patients (22%), respectively. The survival rate after pneumothorax was 48% at 5 years. By the end of the follow-up, 33 patients had died, and the median survival was 4.4 years with a median follow-up period of 1.7 years. The rate of absence of recurrence after the first pneumothorax was 59% at 3 years. By the end of the follow-up, 18 patients had experienced pneumothorax recurrence. Furthermore, 12/18 patients (66%) with recurrent pneumothorax died during the study period. Twenty-three patients (70%) died because of NTMPD progression. Low body mass index (BMI) was a negative prognostic factor for pneumothorax associated with NTMPD in multivariate analysis (HR 0.79, 95% CI 0.64-0.96; P = 0.018)Patients with pneumothorax associated with NTMPD have advanced disease, a high rate of pneumothorax recurrence, and poor prognosis, regardless of the pneumothorax treatment used. Further improvements in early diagnosis of NTMPD and appropriate management in both NTMPD and NTMPD-associated pneumothorax are needed.
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Affiliation(s)
- M Ueyama
- Department of Health Care, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Matsuyama, Kiyose
- Correspondence: M Ueyama, Department of Health Care, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3–1–24, Matsuyama, Kiyose, Tokyo, Japan (e-mail: )
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku
- Correspondence: M Ueyama, Department of Health Care, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3–1–24, Matsuyama, Kiyose, Tokyo, Japan (e-mail: )
| | - Kozo Morimoto
- Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Matsuyama, Kiyose
| | - Ho Namkoong
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku
| | - Shuichi Matsuda
- Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Matsuyama, Kiyose
| | - Takeshi Osawa
- Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Matsuyama, Kiyose
| | - Makoto Ishii
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku
| | - Naoki Hasegawa
- Center for Infectious Diseases and Infection Control, Keio University School of Medicine, Shinjuku, Tokoyo, Japan
| | - Atsuyuki Kurashima
- Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Matsuyama, Kiyose
| | - Hajime Goto
- Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Matsuyama, Kiyose
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4
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Berring DC, Nygaard U. [Lung cavities caused by Nocardia cyriacigeorgica in an immunosuppressed boy]. Ugeskr Laeger 2014; 176:V01140077. [PMID: 25294520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The identification of nodules and/or cavitations in the chest X-ray of a chronically or acute ill patient will rise the suspicion of tuberculosis. However, it is important to be aware of pulmonary nocardiosis as a rare but important differential diagnosis, especially in case of no hilar adenitis. In this case report, we describe a six-year-old boy receiving prednisolone due to nephrotic syndrome, who developed pneumothorax because of pulmonal nocardiosis. The prognosis is good in case of early diagnosis and antibiotic treatment.
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5
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Blibech S, Kasdallah N, Ben Salem H, Boujemaab H, Ben Abdallah N, Douagi M. [Right congenital diaphragmatic hernia following neonatal streptococcus B pyopneumothorax]. Tunis Med 2014; 92:232-233. [PMID: 24955974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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6
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Jiang LB, Zhu YH, Yao YF, Xu J, Wang Z. [Pyopneumothorax caused by Salmonella choleraesuis: a case report and review of the literature]. Zhonghua Jie He He Hu Xi Za Zhi 2012; 35:683-686. [PMID: 23158072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To improve understanding of the clinical features, diagnosis and treatment of pyopneumothorax caused by Salmonella choleraesuis. METHODS One case of pyopneumothorax caused by Salmonella choleraesuis diagnosed and treated in our hospital in 2010 was reported and the related literatures were reviewed. As of May 2011, the literature review was carried out with "Salmonella choleraesuis" and "thoracic empyema" as the search terms in Wanfang Med Online and Pubmed Database. RESULTS A 43-year-old Chinese woman presenting with fever and chest pain for 4 days was admitted to our hospital. A CT scan of the chest revealed a massive shadow with mixed density in the right hemithorax, from the top of thorax to diaphragmatic surface, and there was air inside or surrounding the mass irregularly but without an air-fluid level. Blood culture and bronchial secretion culture by bronchoscope both showed some serotypes of Salmonella strains. At first intravenous antibiotic therapy (piperacillin-tazobactam, ceftazidime, and then imipenem-cilastatin) was ineffective. Open chest surgery was performed, and chest tube placed. Salmonella choleraesuis was isolated from the drained pleural fluid. Chest tube drainage remained in place for more than 6 weeks, and with prolonged antibiotic therapy, which contributed to a good outcome. Literature review found no related reports in Wanfang Med Online, while 3 literatures were found in Pubmed, including 2 of case report and 1 of retrospective study. Among 973 patients with empyema thoracis in the retrospective study, 12 of these patients, including 9 men and 3 women, were infected with Salmonella species. The median age was 49 years, and 10 patients were immunocompromised, including malignancy, liver cirrhosis, and diabetes mellitus. Seven patients were infected with Salmonella choleraesuis, and 4 (57%) of them died. CONCLUSIONS Pyopneumothorax or thoracic empyema is a rare complication of Salmonella choleraesuis infection. Higher rates of death were noted in this disease. Salmonella choleraesuis infection is even more serious in adult patients with underlying diseases. Early diagnosis, appropriate antimicrobial drug therapy, and aggressive drainage are necessary to improve the outcome of patients with pyopneumothorax or thoracic empyema due to Salmonella choleraesuis.
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Affiliation(s)
- Li-bin Jiang
- Department of Respiratory Medicine, Zhejiang Chinese Medical University, Hangzhou, China.
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7
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Vázquez-Lamadrid J, Iñiguez-Rodríguez MDR, Criales-Vera SA. [Spontaneous pneumothorax due to pulmonary coccidioidomycosis]. GAC MED MEX 2011; 147:169-171. [PMID: 21527974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Coccidioidomycosis is a systemic infection caused by the soil fungus Coccidioides immitis. It is endemic in northern Mexico and the southwest part of the United States. Radiologic manifestations are varied. Rupture of a coccidioidal pulmonary cavity with subsequent pneumothorax is a rare clinical event, even in endemic areas. We present a case with a brief review of this rare condition.
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Affiliation(s)
- Jorge Vázquez-Lamadrid
- Departamento de Radiología e Imagen Adán Pitol Croda, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, D.F.
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8
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Ryu YJ, Lee JH, Chun EM, Chang JH, Shim SS. Clinical outcomes and prognostic factors in patients with tuberculous destroyed lung. Int J Tuberc Lung Dis 2011; 15:246-i. [PMID: 21219689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVE To characterise the prognosis and identify factors contributing to mortality in patients with tuberculous destroyed lung (TDL). DESIGN Following a retrospective review of clinical data and radiographic findings, 169 patients with TDL were enrolled in this study. All patients were graded on a 4-point scale (field score 1-4) based on the extent of destroyed lung parenchyma on chest radiography. RESULTS The mean patient age was 64 years (range 33-90); 103 (61%) were male. The median number of hospitalisations was 1 (range 0-11) during follow-up, with a mean duration of 31 months (range 0-172). Pneumonia developed in 96 patients (57%), while 50 patients (30%) developed acute respiratory failure requiring mechanical ventilation, 37 (22%) haemoptysis, 24 (14%) spontaneous pneumothorax and 22 (13%) reactivation of tuberculosis. Overall mortality was 28% (47/169), with a median survival of 39 months (range 0-176) after diagnosis. TDL-related mortality was 19% (32/169), and a field score ≥ 3 was the only independent predictor of shorter survival based on a Cox proportional hazards model (HR 3.520, 95%CI 1.51-8.20, P = 0.004). CONCLUSION TDL has a poor prognosis, particularly in patients with more extensive lung destruction.
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Affiliation(s)
- Y J Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Medical Center and Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
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9
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Affiliation(s)
- Ahmed Fathy
- Department of Cardiology, National Heart Institute, Cairo, Egypt.
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10
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Vázquez JL, Vázquez I, González ML, García-Tejedor JL, Repáraz A. Pneumomediastinum and pneumothorax as presenting signs in severe Mycoplasma pneumoniae pneumonia. Pediatr Radiol 2007; 37:1286-8. [PMID: 17899058 DOI: 10.1007/s00247-007-0611-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Revised: 07/18/2007] [Accepted: 07/31/2007] [Indexed: 10/22/2022]
Abstract
We present a 3-year-old child with severe extensive Mycoplasma pneumoniae pneumonia complicated with pneumomediastinum and pneumothorax. Pneumothorax and pneumomediastinum have only exceptionally been described in mild cases of the disease. The radiological findings, differential diagnosis and clinical course are discussed.
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Affiliation(s)
- José L Vázquez
- Department of Radiology, Complejo Hospitalario Universitario de Vigo, Pizarro 22, Vigo, 36204, Spain.
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11
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Affiliation(s)
- D D Duttaroy
- Department of Surgery, Government Medical College and Sir Sayajirao General Hospital, Baroda, Gujarat, India 390001.
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12
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Affiliation(s)
- Philipp Eller
- Department of Internal Medicine, Medical University Innsbruck, Austria.
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13
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Winne L, Praet M, Brusselle G, Veys E, Mielants H. Bilateral spontaneous pneumothorax in a patient with pulmonary rheumatoid nodules, secondary infected by Aspergillus. Clin Rheumatol 2006; 26:1180-2. [PMID: 16670823 DOI: 10.1007/s10067-006-0319-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Accepted: 03/21/2006] [Indexed: 10/24/2022]
Abstract
This case report describes a 50-year-old woman with rheumatoid arthritis (RA) in whom nodular opacities were found on chest X-ray. She developed a bilateral spontaneous pneumothorax treated with surgical pleurodesis. Cultures remained negative. Histological examination of specimens confirmed the clinical diagnosis of rheumatoid granulomata. Therefore, corticosteroid therapy was started, after which the nodules decreased slightly in size and inflammatory parameters normalized. Three months later, she presented with respiratory insufficiency based on pulmonary fungus infection. Differential diagnosis between rheumatoid nodules and granulomas caused by Aspergillus is difficult in RA patients with pulmonary nodular lesions; in this case, both complications appeared subsequently.
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Affiliation(s)
- Linsey Winne
- Department of Rheumatology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
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14
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Abstract
Nontuberculous mycobacterial infection is rarely accompanied by pleural involvement. We report a very rare case of M. intracellulare pulmonary disease with pleural empyema. A 56-year-old man was admitted to our hospital because of fever, purulent sputum and pleuritic chest pain. A chest radiograph and CT revealed pneumonic consolidation in the left lower lobe and loculated hydropneumothorax. The sputum smear was positive for acid fast bacilli. The aspirated pleural fluid was grossly purulent and the smear of the pleural effusion was also positive for acid fast bacilli. M. intracellulare was identified by culture and PCR from sputum and pleural fluid specimens. The patient improved with percutaneous tube drainage of the purulent effusion and antibiotic treatment including clarithromycin, rifampicin, ethambutol and streptomycin.
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Affiliation(s)
- Sang-Un Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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15
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Abstract
Rupture of a coccidioidal pulmonary cavity with subsequent pyopneumothorax is a rare clinical event, even in areas endemic for coccidioidomycosis. Our encounter with a patient diagnosed with this condition in northeast Tennessee serves notice to clinicians that coccidioidomycosis is indeed a traveling fungal disease, and practitioners must be alert to common and uncommon manifestations of infection associated with this fungus. A literature review pertaining to coccidioidal pyopneumothorax revealed that patients usually present with a recent onset of chest pain. Serologic testing and pleural fluid culture are highly useful, and management includes surgical intervention with or without antifungal therapy.
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Affiliation(s)
- Souad S Youssef
- James H. Quillen Veterans Affairs Medical Center and James H. Quillen College of Medicine, Johnson City, TN, USA
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16
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Morimatsu Y, Sano A, Yukutake N, Imaoka H, Nishimura K, Aizawa H. [A case of receipieut of kidney transplantation presenting life-threatning preumothorax due to the rupture of intrapulmonary multiple infections cavities caused by Absidia corymbifera and methicillin-resistant Staphylococcus aureus]. ACTA ACUST UNITED AC 2005; 78:984-8. [PMID: 15628531 DOI: 10.11150/kansenshogakuzasshi1970.78.984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We report a rare case of life-threatning pneumothorax induced by multiple intrapulmonary cavitary lesion due to Absidia corymbifera and methicillin-resistant Staphylococcus aureus (MRSA). The patient was a 58-year-old man who had undergone kidney transplantation three year ago due to diabetes renal failure. He had been treated with immunosuppressive drugs and prednisolone, but he had neutropenia and an abnormal shadow on the chest X-ray. His chest X-ray findings became worse inspite of broad-spectrum antibiotis, vancomycin, antivirus drug, gamma-globulin and antifungal drug therapy. He came to our emergency center because of dyspnea due to right massive pleural effusion and peumothorax about two months after onset of neutropenia. His arterial blood gas showed severe hypoxia and the chest CT scan showed birateral pleural effusion and multiple intrapulmonary cavities. He was treated with chest tube drainage and intubated, but he died of progressive respiratory failure on admission day 3. Macroscopic and microbiologic findings of necroptic lung revealed the cavity with fistula in the middle lobe, which included debris with mucor and MRSA. The species of mucor identified as Absidia corymbifera as a result of analysis of BLAST with nested-PCR using the palafin-block.
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17
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Medarov BI, Tongia S, Rossoff LJ. Idiopathic pneumothorax, or not? Lancet Infect Dis 2004; 4:750. [PMID: 15567124 DOI: 10.1016/s1473-3099(04)01204-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Boris I Medarov
- Division of Pulmonary and Critical Care Medicine, Long Island Jewish Medical Centre, Albert Einstein School of Medicine, New Hyde Park, New York 11042, USA.
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18
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Bini A, Grazia M, Petrella F, Stella F, Bazzocchi R. Spontaneous biliopneumothorax (thoracobilia) following gastropleural fistula due to stomach perforation by nasogastric tube. Ann Thorac Surg 2004; 78:339-41. [PMID: 15223464 DOI: 10.1016/s0003-4975(03)01282-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2003] [Indexed: 11/28/2022]
Abstract
Gastropleural fistula may occur after pulmonary resection, perforated paraesophageal hernia, perforated malignant gastric ulcer at the fundus, or gastric bypass surgery for morbid obesity. We describe a case of gastropleural fistula after stomach perforation by a nasogastric tube in a patient who underwent Billroth II gastric resection for adenocarcinoma. Left biliopneumothorax occurred and was treated by thoracic drainage with -20 cm H2O aspiration. As gastropleural fistula persisted, laparotomy was repeated and gastric and diaphragmatic perforations were sutured. Gastropleural fistula is rare and, to our knowledge, this is the first reported case of gastropleural fistula and biliopneumothorax caused by gastric and diaphragmatic perforation by a nasogastric tube.
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Affiliation(s)
- Alessandro Bini
- Department of General and Thoracic Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Italy
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19
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Abramzon OM, Bukharin OV, Kurlaev PP. [Treatment of acute pyoinflammatory diseases of the lungs and pleura under control of microorganism persistence factors]. Vestn Khir Im I I Grek 2004; 163:13-6. [PMID: 15626066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Results of treatment of patients with acute pulmonary abscess, acute empyema of the pleura and pyopneumothorax were analyzed. The local treatment of the main group of patients consisting of 50 persons included oxitocin in combination with antiseptics and antibiotics which facilitated maximal reduction of the persistent potential of the pathogenic agent, its rapid elimination from the purulent focus and allowed to get better results using conservative therapy. The obtained clinical effect confirmed the experimental data on pronounced inhibition of persistent properties of the bacterial pathogens with the complexes "antibiotic-oxitocin".
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20
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Abramzon OM, Kirillov DA, Pan'kov AS, Perunova NB, Elagina NN, Valyshev AV, Bukharin OV. [Modifying action of oxytocin on the biological properties of the causative agents of anaerobic non-clostridial infection]. Zh Mikrobiol Epidemiol Immunobiol 2003:71-4. [PMID: 12966884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
In a number of in vitro experiments the effect of oxytocin on the antilysozyme and anticomplemental activity of Propiobacterium propionicum, Bacteroides fragilis, Prevotella melaninogenica and Peptostreprtococcus anaerobius, isolated from patients with acute pyoinflammatory pleuropulmonary diseases, was studied. Antibiotic resistance dynamics of the infective agents under study to lincomycin, clindamycin, thienam, vancomycin was also detected. The inhibiting activity of oxytocin on the persistence properties of B. fragilis, P. melanogenica and P. anaerobius was noted. Under the influence of the preparations used changes in the sensitivity of the strains to a number of antibiotics of the lincosamide, carbapenem and glycopeptide groups were found to occur. The data thus obtained were indicative of the possible mechanisms of action of oxytocin in the treatment of acute pyoinflammatory pleuropulmonary diseases of anaerobic nonclostridial etiology.
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Affiliation(s)
- O M Abramzon
- Institute of Cellular and Intracellular Symbiosis, Orenburg, Russia
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21
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Affiliation(s)
- Nan Shan Zhong
- Guangzhou Institute of Respiratory Disease, First Affiliated Hospital, Guangzhou Medical College, 51 Yanjiang Road, Guangzhou, China 510120.
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Kobayashi K, Yano S, Kato K, Saito S, Tokushima T. [A case of Mycobacterium avium pulmonary disease accompanied with pleural effusion]. Kekkaku 2002; 77:725-8. [PMID: 12494510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Nontuberculous mycobacterial infection is seldom complicated with pleural involvement. We report a very rare case of M. avium pulmonary disease accompanied with pleural effusion. A 76-year-old man was admitted to our hospital because of cough and low-grade fever. A chest radiograph and computed tomograph showed centrilobular nodules in the right middle lobe and left lingula, and right pleural effusion. The patient had had a right spontaneous pneumothorax 50 days before his admission. The sputum smear was negative for acid fast bacilli. The smear of pleural effusion was positive for acid fast bacilli, the level of adenosine deaminase in the effusion was markedly elevated, and pleural effusion was positive for M. avium as assessed by polymerase chain reaction (PCR). The pleural biopsy specimen showed fibrous change without granuloma, while the transbronchial biopsy specimen showed noncaseous epithelioid granulomas. We considered that the pneumothorax was caused by the spread of pulmonary M. avium infection to the visceral pleura with its perforation.
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Affiliation(s)
- Kanako Kobayashi
- Department of Pulmonary Medicine, National Matsue Hospital, 5-8-31, Agenogi, Matsue-shi, Shimane 690-8556, Japan
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23
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Abstract
OBJECTIVE The aim of this retrospective study was to review pleural and pericardial complications of patients with hydatid cysts and to analyze the management of therapy for these patients. METHODS Between 1991 and 2001, 43 (29.7%) of 145 patients presented with pleural and pericardial complications. These patients had spontaneous pneumothorax (6.2%), empyema (7.6%), pleural thickening (10.3%), hepatopleural fistula (2.8%), pericarditis (2.1%), and hepatobronchial fistula (0.7%). There were 22 male and 21 female patients, with a mean age of 30 years. RESULTS The most common symptom was chest pain (79.1%). In 37 (86.1%) of 43 patients, the cysts were unilateral. The ratio of ruptured cysts was 88.4%. In most of the patients, hydatid cysts developed in the right lung (62.9%) and the lower lobes of the lung (70.4%). Multiple cysts were found in 8 (18.6%) patients. The most common surgical techniques were cystotomy with capitonnage (55.7%) and decortication (69.8%). Radical lung resection was used in 14% of the patients. The morbidity rate was 16.3%, and the mortality rate was 2.3%. The mean follow-up was 19 months with no recurrence. CONCLUSIONS Although lung-preserving surgical interventions should be preferred, radical surgical procedures have been used more commonly in patients with pleural complications of hydatid cysts, and the postoperative morbidity rate was higher in these patients. Because of this, the surgical treatment should be carried out before the development of pleural complications. In addition, echinococcosis should be considered and included in the differential diagnosis of spontaneous pneumothorax and empyema.
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Affiliation(s)
- Olgun Kadir Aribas
- Department of Thoracic Surgery, Medical School of Selcuk University, 42080 Meram-Konya, Turkey.
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24
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Abstract
Pneumatoceles are cystic lesions of the lungs often seen in children with staphylococcal pneumonia and positive-pressure ventilation. Acinetobacter calcoaceticus is an aerobic, short immobile gram-negative rod, or coccobacillus, which is an omnipresent saprophyte. The variant anitratus is the most clinically significant pathogen in this family, usually presenting as a lower respiratory tract infection. Acinetobacter has been demonstrated to be one of the most common organisms found in the ICU. We present three critically ill surgery patients with Acinetobacter pneumonia, high inspiratory pressures, and the subsequent development of pneumatoceles. One of these patients died from a ruptured pneumatocele, resulting in tension pneumothorax. Treatment of pneumatoceles should center on appropriate intravenous antimicrobial therapy. This should be culture directed but is most often accomplished with Imipenem. Percutaneous, computed tomographic-guided catheter placement or direct tube thoracostomy decompression of the pneumatocele may prevent subsequent rupture and potentially lethal tension pneumothorax.
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Affiliation(s)
- J P Hunt
- Department of Surgery, Louisiana State University Medical Center, New Orleans 70112, USA
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25
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Affiliation(s)
- A Sharma
- Department of Pediatrics, Postgraduate Institute of Medical Science, Haryana, India
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Affiliation(s)
- L K Carlisle
- Department of Pediatrics, Louisiana State University Medical Center, New Orleans, USA
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Merino JM, Díaz MA, Ramírez M, Ruano D, Madero L. Complicated pulmonary aspergillosis with pneumothorax and pneumopericardium in a child with acute lymphoblastic leukemia. Pediatr Hematol Oncol 1995; 12:195-9. [PMID: 7626390 DOI: 10.3109/08880019509029555] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Invasive aspergillosis is a fungal infection that is being observed increasingly in immunocompromised patients due to the use of more aggressive chemotherapeutic regimens. To our knowledge, no case of pneumothorax and pneumopericardium associated with invasive pulmonary aspergillosis has been reported to date. High-dose amphotericin B (1 to 1.5 mg/kg/day) is the treatment of choice, although severe side effects, especially hypokalemia, are very common. Itraconazole is considered to be a therapeutic alternative for invasive pulmonary aspergillosis in immunocompromised patients. A rare combination of pneumothorax and pneumopericardium associated with systemic aspergillosis in a child with acute lymphoblastic leukemia is described. Treatment with low-dose amphotericin B and itraconazole achieved complete resolution of the foregoing complications.
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Affiliation(s)
- J M Merino
- Department of Pediatric Hematology and Oncology, Hospital Infantil Niño Jesús, Autonomous University of Madrid, Spain
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28
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Castagnola E, Fioredda F, Moroni C, Loy A, Viscoli C. Pneumothorax and Pneumocystis pneumonia in an infant with acquired immunodeficiency syndrome. Pediatr Infect Dis J 1992; 11:504. [PMID: 1608697 DOI: 10.1097/00006454-199206000-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Ezpeleta AI, Báez B, Villar M, Gato A, Ballesteros P, Gaspar G. [Spontaneous pneumothorax and Pneumocystis carinii pneumonia. Something more than a casual association?]. Rev Clin Esp 1992; 190:27-9. [PMID: 1546199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The association of spontaneous pneumothorax and Pneumocystis pneumonia is not frequent. The medical literature reports a ratio between 0 and 5.7%. In 18 patients admitted in our hospital, in the last two years, and diagnosed of AIDS and Pneumocystis pneumonia, we observed two cases of pneumothorax spontaneous. They represent the 11%. In one of them spontaneous pneumothorax was the first manifestation and in the other a complication of the illness. It was not possible to isolate an agent different from Pneumocystis carinii. Considering the lack of predisposition factors and the previous clinical history, we think that Pneumocystis carinii is by itself the agent responsible of this complication. In view of this possibility, spontaneous pneumothorax in a patient who belongs to an AIDS' risk group will alert the clinician to the possibility of infection with Pneumocystis carinii.
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Affiliation(s)
- A I Ezpeleta
- Servicio de Medicina Interna, Hospital Central de la Cruz Roja, Facultad de Medicina, Universidad Complutense, Madrid
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Rigg KM, Walker RW. Tension pneumothorax secondary to ruptured oesophageal diverticulum. Br J Clin Pract 1990; 44:528-9. [PMID: 2126452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- K M Rigg
- Royal Victoria Infirmary, Newcastle upon Tyne
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Abstract
A patient with antecedent coccidioidal pulmonary cavitary disease who developed an empyema due to Kingella kingae prompted our analysis of the literature regarding this unusual bacterial pathogen. Formerly classified among other genera and considered a nonpathogen, K. kingae has been increasingly recognized as a cause of human infection. While the most commonly diagnosed infections due to this organism are endocarditis and septic arthritis, there have also been isolated reports of bacteremia, diskitis, abscesses, meningitis, and oropharyngeal infections. The treatment of choice is penicillin, to which K. kingae strains are uniformly susceptible. Recognition of the potential pathogenicity of this microorganism in appropriate clinical settings will probably result in more prompt and specific therapy.
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Affiliation(s)
- V A Morrison
- Department of Medicine, University of Minnesota Health Sciences Center, Minneapolis 55455
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Lubin J, Poppiti R, Roen SA. Fine needle aspiration of the lung: a study of 53 consecutive cases. South Med J 1985; 78:1049-52. [PMID: 4035429 DOI: 10.1097/00007611-198509000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We reviewed our fine needle aspirations of the lung and chest on 53 consecutive patients from January 1979 through June 1982. Almost all of the patients had been studied by sputum and bronchial cytology and many by bronchial or transbronchial biopsy, but none of the patients had a definitive diagnosis. All of the lung aspirates were done in the department of radiology, using a 22 gauge Chiba disposable needle and the Wright-Giemsa stain. Twenty-four cases (45%) were diagnosed as malignant and ten cases (19%) were considered suggestive. Nineteen cases (36%) were read as negative for malignant cells, but in six of these cases (11% of total) we were able to make the diagnosis of an infectious process based on characteristic cytologic findings.
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Díaz Rojas F, Córdova Gutiérrez H, Aguirre Gas H. [Spontaneous pneumothorax associated to active pulmonary tuberculosis]. Prensa Med Mex 1978; 43:282-6. [PMID: 119959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This paper reviewed 8 cases of spontaneous pneumothorax, associated to pulmonary tuberculosis during a period of time of two years at the A.L.M. General Hospital of Toluca, Mex. The diagnosis was confirmed by clinical picture, radiology and bacteriology studies. Six males and two females proceding of the low class; farmers all of them. Their age ranged between 18 and 35 years. Two of the patients showed cavitary lesions, five had difusse fibrosis of the lung. We analized the clinical manifestations and reviewed the pathogenic mechanisms as well the medical and surgical treatment. No deaths ocurred en this series. We concluded that the direct relation between active pulmonary tuberculosis and spontaneous pneumothorax is not clear, but their association in this serie suggested further studies to stablished this. We emphasized the importance of this complication rare in the world literature.
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Miguérès J, Jover A, Didier J. [Role of respiratory viral infections and mycoplasma pneumoniae infection among the occasional factors in non-tuberculous spontaneous pneumothorax. Apropos of a serological inquiry into 91 cases]. Bronchopneumologie 1978; 28:12-8. [PMID: 228808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Randhawa HS, Pal M. Occurrence and significance of Cryptococcus neoformans in the respiratory tract of patients with bronchopulmonary disorders. J Clin Microbiol 1977; 5:5-8. [PMID: 319109 PMCID: PMC274521 DOI: 10.1128/jcm.5.1.5-8.1977] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Cryptococcus neoformans was cultured from 13 (3%) of 469 clinical specimens examined from the respiratory tract of patients with bronchopulmonary diseases. These isolations came from 5 (2%) of 207 patients; 11 isolates were from sputum and 1 each were from bronchoscopic aspirate and empyema pus. The fungus was not cultured from the oropharyngeal washings of 101 apparently healthy volunteers. Of the 5 patients, 3 had pulmonary tuberculosis, including one with pyopneumothorax and 2 with allergic bronchopulmonary aspergillosis as the underlying disease. In the tuberculosis patient with pyopneumothorax and C. neoformans in empyema pus, the fungus was presumably a tissue invader, whereas its role could not be unequivocally ascertained in the remaining 4 patients from whom it was isolated from sputum or bronchial aspirate on at least two consecutive occasions. The question of C. neoformans being a transient resident, commensal, or incitant of benign minimal lesions in the tracheobronchial tree is discussed. A comprehensive laboratory and clinical follow-up is warranted in patients from whose sputum or bronchial aspirate C. neoformans may be cultured even though definitive signs of cryptococcosis may be lacking.
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PIROLI G. [Observations on the bacteriological findings and on the antibiogram in 28 cases of empyema and pyopneumothorax]. Rass Int Clin Ter 1960; 40:60-7. [PMID: 14433224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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