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PubMed2002

Scedosporium apiospermum fungemia in a lung transplant recipient.

Scedosporium apiospermum, the asexual anamorph of the cosmopolitan fungus Pseudallescheria boydii, is emerging as an important cause of disseminated infection in immunocompromised patients. We present our experience with the first reported case of S apiospermum fungemia in a lung transplant patient. Disseminated infection resulted in sepsis, multiorgan failure, and death. Review of the literature highlights the diagnostic difficulties related to the similarities between S. apiospermum and Aspergillus sp. This superficial resemblance has a significant impact on clinical outcomes considering the inherent resistance of Scedosporium to amphotericin B, the traditional antifungal of choice for disseminated hyalohyphomycoses.

Aspergillosis↗
PubMed2003

Aspergillus infection in lung transplant recipients with cystic fibrosis: risk factors and outcomes comparison to other types of transplant recipients.

STUDY OBJECTIVES: To characterize Aspergillus infections in lung transplant recipients with cystic fibrosis (CF). DESIGN: A retrospective analysis of 32 consecutive lung transplant recipients with CF who underwent bilateral lung transplant at the University of Wisconsin from 1994 to 2000 to determine the incidence, risk factors, and consequences of Aspergillus infection. The findings were compared to 101 non-CF recipients of lung transplants (93) and heart-lung transplants (8) for other transplant indications. SETTING: A university hospital. PATIENTS OR PARTICIPANTS: Lung transplant recipients with CF or other indications for transplantation. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Seventeen of 32 CF recipients (53%) had Aspergillus fumigatus isolated from their respiratory secretions prior to undergoing transplantation. Ten of these 17 (59%) recipients had A fumigatus persistently found in their respiratory secretions posttransplant vs 6 of 15 CF patients (40%) who had not been colonized pretransplant and 28 of 101 of the non-CF recipients (28%). Four of the preoperatively colonized CF recipients developed tracheobronchial aspergillosis (TBA) just distal to the bronchial anastomoses, and one recipient had dehiscence of the involved anastomosis. None of the CF recipients developed disseminated aspergillosis or pneumonia. Prophylactic antifungal therapy did not prevent TBA, and IV amphotericin B therapy was required to clear the infection in all four patients, with endobronchial debridement of necrotic tissue required in two of them. In contrast, 10 of the non-CF (10%) recipients developed Aspergillus infections posttransplant (TBA, 4 recipients; pneumonitis, 6 recipients), and only 3 patients had successful treatment and long-term survival (TBA, 2 patients; pneumonia, 1 patient). Donor lung ischemia time, cytomegalovirus infection or pneumonia, or pretransplant mechanical ventilation did not increase the risk of developing TBA in CF recipients. CONCLUSIONS: The risk of TBA for patients receiving lung transplants for CF warrants early surveillance bronchoscopy to detect TBA, particularly in recipients with pretransplant colonization.

Adult↗
PubMed1975

Immediate operative treatment for massive hemoptysis.

A series of 15 patients with life threatening, massive hemoptysis is reported. Thirteen of these patients underwent immediate operative treatment with only three deaths. One died after bronchoscopic identification of the bleeding site while awaiting elective thoracotomy. The other patient left the hospital against medical advice. Immediate identification of the site of bleeding by bronchoscopy followed by thoracotomy with resection of the bleeding source, is the preferred method of managing such patients, except when there are specific contraindications to resection.

Adult↗
PubMed1975

Transbronchial forceps lung biopsy through the fiberoptic bronchoscope. tdiagnosis of diffuse pulmonary disease.

Transbronchial forceps biopsy through the fiberoptic bronchoscope was performed in 37 patients. Tissue was technically inadequate for examination in two cases. A pathologic diagnosis was obtained in 26 (72 percent) and in five additional critically ill patients, direct histologic examination of lung tissue allowed exclusion of certain entities, thus significantly influencing therapy. Overall, the procedure was of value in 31 of 35 patients (90 percent). There was no significant hemorrhage and there was one 15 percent pneumothorax. The safety and high diagnostic yield of this technique in the diagnosis of diffuse lung disease is proved.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1976

Aspergilloma within a malignant pulmonary cavity.

The simultaneous appearance of both bronchogenic carcinoma and aspergilloma with the typical radiographic appearance of a mycetoma emphasizes the importance of consistent suspicion for malignancy in any pulmonary lesion. This is apparently the first reported case in which allergic phenomena (asthma-like symptoms and eosinophilia) are associated with an aspergilloma occurring within a cavitary bronchogenic carcinoma.

Aged↗
PubMed1980

Pulmonary infiltrates in leukemia.

We reviewed the inpatient records of 139 adult patients with leukemia to determine the incidence of opportunistic infections in immunocompromised patients and the pattern of roentgenographic involvement of such infections. There were 98 parenchymal infiltrates identified, including 43 episodes of local disease and 55 episodes of diffuse disease. The causes of the infiltrates were determined from biopsies of tissue and autopsies whenever possible. If roentgenographic resolution after therapy with an antibiotic or diuretic agent was documented, the cause was considered determined; however, this did not identify a specific bacterial or viral agent. Parenchymal infiltrates (17 episodes) appearing in the period before treatment or within 72 hours of initiating therapy were not opportunistic. Local disease during treatment was infectious in 23 (74 percent) of 31 cases and was bacterial in 20 (87 percent) of 23 cases. Opportunistic organisms caused only 13 percent of the local infectious episodes. Diffuse disease was noninfectious in 26 (65 percent) of 40 episodes; while in the 14 episodes of infectious disease identified, 13 (93 percent) were caused by opportunistic organisms. We conclude that procedures for biopsy to document opportunistic infection are of little value in local or diffuse disease before treatment, are of modest value in local disease during treatment, and are of greatest value in diffuse disease during treatment if little clinical evidence for noninfectious causes exists.

Acute Disease↗
PubMed1980

Invasive aspergillosis with massive fatal hemoptysis in patients with neoplastic disease.

Two patients had fatal episodes of massive hemoptysis secondary to invasive aspergillosis, complicating in one with acute leukemia and in the other with lung carcinoma. Review of the literature reveals that these cases are among the very few in which invasive aspergillosis has been documented as the etiology of massive hemoptysis in cancer patients. Both patients had been previously treated with corticosteroids and/or other immunosuppressive agents. In one of the two patients, the diagnosis was made ante mortem and antifungal therapy instituted, but dissemination progressed despite treatment.

Adenocarcinoma↗
PubMed1989

Pulmonary infiltrates in immunocompromised patients. Diagnostic value of telescoping plugged catheter and bronchoalveolar lavage.

The usefulness of telescoping plugged catheter (TPC) together with bronchoalveolar lavage (BAL) in the same bronchoscopic act in the diagnosis of pulmonary infiltrates was studied in 113 fiberoptic bronchoscopic examinations performed on 96 immunocompromised patients. The TPC cultures detected pulmonary bacterial infections in 25 (22 percent) cases but showed a high frequency of false positive results (12 microorganisms, 27 percent). Bronchoalveolar lavage had an overall diagnostic yield of 49 percent (53 of 113 cases). Combining TPC and BAL diagnostic values, 78 of 113 pulmonary infiltrates (69 percent) were diagnosed. The results obtained by both techniques allowed us to modify the treatment in 35 (31 percent) cases. Combined, TPC and BAL show a good diagnostic yield in immunocompromised patients with pulmonary infiltrates. Both techniques should be performed as the first approach in the evaluation of these patients, and be done in the same bronchoscopic procedure.

Bacteria↗
PubMed2004

[Human adiaspiromycosis: cicatricial lesions in mediastinal lymph nodes].

Chest roentgenogram of a sixty-year-old male patient, revealed a tumoral mass in the right lung, that was later demonstrated by transbronchial biopsy, to be a bronchogenic adenocarcinoma. There was no tomographic evidence of distant metastasis, however, in order to assess the mediastinal involvement for staging of the tumor, biopsies from the regional lymph nodes were obtained. Microscopic examination of the sample tissues failed to show any metastatic lesion, but, unexpectedly, revealed the presence of cicatricial granulomas in an advanced stage of fibrosis. They contained a few round, empty and collapsed corpuscles, limited by a thick PAS-positive, membrane. These structures were identified as adiaconidia of Emmonsia crescens, the etiological agent of human adiaspiromycosis. In the tissue sections, a large amount of carbon dust (anthracosis) was also seen.

Chrysosporium↗
PubMed2001

A double fistula, broncho-cavitary-cutaneous communication caused by cancer invasion.

Pulmonary infection with cavitation causes severe respiratory symptoms if the cavity has a communication with main bronchus, through which fluid flows out into trachea. In this report a young male with lung cancer invading an adjacent pre-existent fungus cavitary lesion is presented. Cancer invasion led to broncho-cavitary communication and caused massive intrabronchial aspiration. Subsequently, the cancer destroyed the thoracic wall, and a cavitary-cutaneous fistula developed which relieved symptoms as if treated with open drainage.

Adult↗
PubMed2006

Pulmonary cryptococcosis within a pulmonary carcinoma-review of reported cases.

An asymptomatic 71-year-old man was admitted for evaluation of a pulmonary tumor. Chest computed tomography revealed a cavitary tumor in the apical segment of the right lung. Histopathological examination of the resected lung revealed pulmonary cryptococcosis within a papillary adenocarcinoma. Macroscopic and histopathological findings speculated that papillary adenocarcinoma preceded pulmonary cryptococcosis.

Adenocarcinoma, Papillary↗
PubMed1978

A specially designed cutting aspiration needle for lung biopsy.

The results of 166 lung biopsy procedures performed on 151 patients using a specially designed cutting aspiration needle are summarized. Excellent tissue cores and fragments of tissue were obtained providing a pathologic diagnosis in 85.5% of attempts. A correspondingly low overall complication rate of 12.7% was obtained.

Adenocarcinoma, Papillary↗