1/45. Primary pulmonary sporotrichosis.A case of pulmonary sporotrichosis is described with secondary involvement of the rectum which was misdiagnosed as tuberculosis for a number of years. The authors suggest that every nondiagnosed chronic cavitary disease in the lung should include appropriate tests for sporotrichosis.- - - - - - - - - - ranking = 1keywords = tuberculosis (Clic here for more details about this article) |
2/45. Unusual pulmonary manifestations of disseminated penicillium marneffei infection in three AIDS patients.penicillium marneffei is a rare fungal pathogen which can cause human infections in people predominantly living in South-east asia and the southern portion of china. We report three cases of systemic P. marneffei infection in patients infected with hiv who lived in or had travelled to endemic areas. The clinical manifestation includes high fever, chills, weight loss, general malaise, chronic cough, haemoptysis, multiple skin lesions, abnormal liver function, etc. Chest X-ray showed single or multiple cavitary lesions with smooth or irregular thin wall. P. marneffei is cultured from blood, sputum, skin biopsy, sono-guide aspiration and bronchoscopic biopsy. After antifungal therapy with intravenous amphotericin b or oral fluconazole, skin lesions resolved completely within 2 weeks and cavitary lesions in the lungs changed to chronic fibrotic and interstitial processes after several months to a few years later. Our two cases had been treated as either pulmonary tuberculosis or suspected malignancy. A definite diagnosis and early treatment are important because this fungal infection is a marker of AIDS in South-east asia.- - - - - - - - - - ranking = 1keywords = tuberculosis (Clic here for more details about this article) |
3/45. Chronic pulmonary histoplasmosis in the State of Rio de Janeiro, brazil.Three cases of chronic pulmonary histoplasmosis affecting aged patients with chronic obstructive pulmonary disease are reported. They had a history of recurrent episodes of respiratory infection and presented radiological lung lesions inducing a misdiagnosis of chronic pulmonary tuberculosis of the adults. The diagnosis of histoplasmosis, suggested by the immunodiffusion test and the detection of yeastlike cells in smeared and stained sputum, was confirmed by the isolation and identification of histoplasma capsulatum var. capsulatum in selective media. The treatment was carried out with amphothericin B and ketoconazole or itraconazole. Clinical, radiologic, mycologic and serologic improvement was obtained in all the patients. However, relapses occurred within a period of 1 to 18 months after the interruption of the treatment. Mycological diagnosis and the difficulties observed in the treatment were discussed. In addition data on the epidemiology of histoplasmosis in the state of Rio de Janeiro, brazil, were presented.- - - - - - - - - - ranking = 1keywords = tuberculosis (Clic here for more details about this article) |
4/45. Diagnostic dilemma: aspergillosis.Two cases of varied forms of Aspergillosis are reported who were being diagnosed and treated on different lines. One case, who was treated on lines of allergic bronchitis, had very high total eosinophil count and, fleeting pulmonary infiltrates over a period of 5 years along with history of cough, fever and weight loss. aspergillus fumigatus was grown on sputum culture. On the background of a long standing history of bronchial asthma with evidence of peripheral as well as central eosinophilia, fleeting pulmonary infiltrates and A. fumigatus grown on sputum culture, we kept the diagnosis of Allergic Bronchopulmonary aspergillosis (ABPA) and put the patient on steroids and itraconazole. Patient showed good response to therapy. Another case, a 50 year old male, presented to us with clinical picture of subacute myelitis. Being a known case of ABPA and on steroid therapy for long duration, we kept the diagnosis of invasive aspergillosis. growth of aspergillus fumigatus on sputum culture on three occasions and MR imaging of spine further supported our view. Aspergillosis of the lung do not have characteristic clinico-radiological features of permit the diagnosis and should be considered in the differential diagnosis of tuberculosis, pneumonia, bronchiectasis, lung abscess and bronchial asthma.- - - - - - - - - - ranking = 1keywords = tuberculosis (Clic here for more details about this article) |
5/45. Colonization with schizophyllum commune of localized honeycomb lung with mucus.We report a surgical case involving localized honeycomb lung with mucus, caused by colonization of a schizophyllum commune, which displayed a tumorous shadow in the right upper mediastinum. A 74-year-old male with a history of tuberculosis in the 1970s was referred to Chiba University Hospital (Chiba, japan) with an abnormal shadow evident in the chest roentgenogram. A transbronchial biopsy failed to yield a definite diagnosis. We resected the right upper lobe, which was found to contain a consolidative lesion filled with viscous mucus in the right upper lobe adjacent to the right upper mediastinum. Microscopic examination revealed a honeycomb lung formation with mucus in the destroyed space. culture of the mucus yielded a whitish filamentous fungus, positively identified as S. commune. This is the first report of S. commune leading to a deposit of mucus and the formation of a consolidative lesion in the destroyed lung.- - - - - - - - - - ranking = 1keywords = tuberculosis (Clic here for more details about this article) |
6/45. pleural effusion from blastomycetes in an adult Nigerian: a case report.A 37 year old hide and skin trader in Northern nigeria, presented with massive right sided purulent pleural effusion. This started with cough, chest pain and fever for 5 weeks following endotracheal intubation. He had chest tube inserted and was treated with antituberculous drugs for 10 weeks without improvement. Fungal studies on the sputum, and pleural fluid yielded Blastomycetes dermatitidis which responded excellently to ketoconazole and saline pleural lavage. This experience underscores the need for early suspicion of systemic mycosis in suspected cases of tuberculosis with poor or no response to treatment. This will reduce morbidity, mortality and cost of treatment.- - - - - - - - - - ranking = 1keywords = tuberculosis (Clic here for more details about this article) |
7/45. Roentgenology of sporotrichosis.Localized cutaneous as well as unifocal and multifocal systemic sporotrichosis may all produce roentgenographic findings. Localized cutaneous nodules may occasionally extend to the bone below producing a locally erosive lesion similar to those more commonly found in blastomycosis. More frequently, sporotrichosis involves the joints, either alone or with accompanying skin nodules. The joint changes are those of a pyogenic arthritis of the knees, elbows, hands, or feet which is difficult to distinguish from pyarthrosis produced by other organisms. The pulmonary findings depend upon whether or not the lung is the only site of infection. If there are no other areas of involvement, the pulmonary findings may be indistinguishable from those of secondary tuberculosis. However, if the skin on joints are also involved, small nodules appear and apparently do not proceed to cavitation.- - - - - - - - - - ranking = 1keywords = tuberculosis (Clic here for more details about this article) |
8/45. The primary pulmonary lymph node complex of crytptococcosis.A cryptococcal primary pulmonary lymph node complex has been demonstrated at autopsy or after thoracotomy in 1% of the cases of cryptococcosis. Stepwise microscopic examination of hilar lymph nodes should reveal a more frequent incidence of this rare but now well-documented complex. Nine examples of the cryptococcal complex are extant, including three herewith reported from the files of the Armed Forces Institute of pathology. Four of these complexes developed in apparently normal persons and five in those hypersusceptible to infection because of neutropenia, diabetes, renal insufficiency, or corticosteroid therapy. The complexes in the normal persons were circumscribed granulomas and represented first-infection cryptococcosis similar to first-infection tuberculosis. There was a chronic course and a good prognosis with surgical resection. The complexes in the compromised hosts were predominantly acute diffuse pneumonias and large diffuse lesions of the lymph nodes, and were interpreted as first-infection cryptococcosis with massive spread facilitated by the compromised state. All these compromised patients died within a few weeks.- - - - - - - - - - ranking = 1keywords = tuberculosis (Clic here for more details about this article) |
9/45. Cases from the Osler Medical Service at Johns Hopkins University. scedosporium apiospermum mycetoma of the lung.PRESENTING FEATURES: A 42-year-old man was admitted with a chief complaint of cough and night sweats of 2 months' duration. The cough produced brown sputum but no blood. He also reported drenching sweats every night for the last several weeks before admission. He attributed his cough to exposure to dust while working on demolishing a funeral home 2 months ago; he denied any history of respiratory symptoms before this recent job. The patient smoked less than one pack of cigarettes per week during the previous year. He had no history of tuberculosis or contact with infected persons. He denied a history of severe lung infection, asthma, sinus disease, or overseas travel, as well as behaviors that are risk factors for human immunodeficiency virus (hiv) infection, such as intravenous drug use or multiple sexual partners.His physical examination was notable for a temperature of 101.4 degrees F and an oxygen saturation of 98% on room air. In general, he was thin, although well in appearance, and not visibly short of breath. His lungs were clear to auscultation. Laboratory studies and urinalysis were normal.A chest radiograph showed a 3-cm by 2-cm mass with a surrounding cavity in the right upper lobe (Figure 1). A subsequent chest computed tomographic scan showed a 5-cm by 4-cm cavity in the right upper lobe, with surrounding infiltrates as well as a mass within the cavity suspicious for a fungus ball (Figure 2). Patchy infiltrates were also seen in the left and right lower lobes.What is the diagnosis?- - - - - - - - - - ranking = 1keywords = tuberculosis (Clic here for more details about this article) |
10/45. invasive pulmonary aspergillosis soon after therapy with infliximab, a tumor necrosis factor-alpha-neutralizing antibody: a possible healthcare-associated case?BACKGROUND: Infliximab is a chimeric monoclonal antibody against tumor necrosis factor (TNF)-alpha, used for the treatment of Crohn's disease and rheumatoid arthritis. Recently, an increased risk of infection due to mycobacterium tuberculosis and rare cases of invasive fungal disease have been reported following infliximab therapy. CASE REPORT: A 73-year-old woman with chronic rheumatoid arthritis who had been treated with methotrexate, leflunomide, and prednisone was given the first of three doses of infliximab in June 2001. In July 2001, she presented with cough, and in August, she had a right upper lobe infiltrate that was treated with levofloxacin without improvement. In October, the patient had right upper and middle lobe infiltrates on a chest X-ray and computed tomography scan. At bronchoscopy, an endobronchial mass was biopsied, which demonstrated Aspergills fumigatus. Our patient had frequently accompanied her daughter on visits to another medical center following a stem cell transplant, where her daughter was instructed to wear a mask during all visits because of extensive building construction. We postulate that our patient may have acquired pulmonary aspergillosis during this period. literature reviews on granulomatous diseases following infliximab therapy and hospital-acquired aspergillosis are presented. CONCLUSION: The temporal relationship between the administration of infliximab and A. fumigatus infection in this patient suggests a causal relationship and possible healthcare-associated acquisition. These data underscore the importance of both patient and family education on prevention strategies when potent immune-modulating medications such as infliximab have been prescribed.- - - - - - - - - - ranking = 1keywords = tuberculosis (Clic here for more details about this article) |
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