1/47. Aspergillus tracheobronchitis after allogeneic bone marrow transplantation.We describe a patient who developed Aspergillus tracheobronchitis after BMT. She complained of progressive dyspnea on day 165 and her respiratory function deteriorated rapidly. Although neither early chest x-rays nor CT scans were negative, bronchoscopy revealed formation of a pseudomembrane around the bronchial walls. Based upon pathological and microbiological examinations, she was diagnosed as having invasive Aspergillus tracheobronchitis. Retrospectively analyzed, the Aspergillus circulating antigen detection tests became positive before clinical symptoms developed, and may be beneficial for early diagnosis of Aspergillus tracheobronchitis. This form of aspergillosis should be regarded as one of the serious complications after BMT.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/47. aspergillus fumigatus isolated from blood samples of a patient with pulmonary aspergilloma after embolization.Aspergillus dna was detected by PCR in the serum sample of a 78-year-old man and galactomannan antigen of Aspergillus by sandwich ELISA was found. However, the infiltrative hyphae were not detected by the histopathologic examination of the lung. He developed hemoptysis, which required embolization of bronchial arteries. aspergillus fumigatus was isolated from blood samples after embolization by the lysis centrifugation method. To our knowledge, this is probably the first case in which Aspergillus spp. has been isolated from the systemic circulatory blood in a patient with pulmonary aspergilloma after embolization.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
3/47. Bilateral pulmonary aspergilloma caused by an atypical isolate of Aspergillus terreus.A case of bilateral pulmonary aspergilloma caused by an atypical isolate of Aspergillus terreus is described. The diagnosis was established by the presence of septate, dichotomously branched fungal elements in freshly collected bronchoalveolar lavage and sputum specimens and by repeated isolation of the fungus in culture. Specific precipitating antibodies against the A. terreus isolate were demonstrated in the patient's serum. The isolate was atypical as it failed to produce fruiting structures on routine mycological media, but it did so on extended incubation on potato flake agar and produced globose, relatively heavy-walled, hyaline accessory conidia (formerly termed aleurioconidia) on both vegetative and aerial mycelia. Also, it produced an intense yellow diffusing pigment in the medium. The report underscores the increasing importance of A. terreus in the etiology of pulmonary aspergillosis. It is suggested that A. terreus antigen be included in the battery of serodiagnostic reagents to facilitate the early diagnosis of infections caused by this species.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
4/47. Scopulariopsosis and hypersensitivity pneumonitis in an addict.Granulomatosis caused by fungal spores of a soil saprophyte is a newly recognized pulmonary complication of intravenous drug addiction. Brown, non-budding spores were histologically identified in necrotic tissue, inside giant cells of sarcoidlike granulomata, and in the vicinity of focal angiitic lesions. The fungus was identified by culture as the dematiaceous scopulariopsis brumptii. Cultural and histopathologic studies of lung biopsy specimens established the diagnosis. We showed precipitating antibodies to fungal antigen in the serum, prepared from the patient's isolate. Similar granulomatous pulmonary lesions were experimentally produced in mice by a single intravenous injection of spores of S. brumptii. The spores remained viable but did not show evidence of growth in the animal's tissue. Precipitating antibodies to fungal antigen and immediate wheal and late necrotizing type of skin reactions were shown in the challenged mice. The studies support the notion that pulmonary hypersensitivity to fungal spores was mediated by an Arthus'-type phenomenon.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
5/47. Pulmonary cryptococcosis in the immunocompetent host. Therapy with oral fluconazole: a report of four cases and a review of the literature.Isolated pulmonary cryptococcosis (IPC) is an infrequently diagnosed infection, the management of which is not well defined. In past years, IPC traditionally has not been treated in the immunocompetent host, given its perceived benign and self-limited course and the toxicity associated with amphotericin b. However, some patients manifest prominent and disabling symptoms, and infection occasionally may disseminate. fluconazole is active against cryptococcus neoformans, is easily administered, and has an excellent safety profile. We present four healthy hosts with IPC who were treated with oral fluconazole for 6 to 8 weeks. A review of the literature was conducted to identify other cases of IPC in healthy hosts who were also treated with fluconazole. Our results and the limited experience reported in the literature suggest that fluconazole may be an appropriate choice for the treatment of IPC in the immunocompetent host. Indications for treatment are not defined, but symptomatic patients, those with multiple nodules or extensive infiltrates on chest radiographs, and/or those testing positive for serum cryptococcal antigen might be potential candidates for therapy.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
6/47. Failure to detect circulating Aspergillus markers in a patient with chronic granulomatous disease and invasive aspergillosis.We report a patient with chronic granulomatous disease who developed invasive pulmonary aspergillosis and a subphrenic abscess. During treatment, high levels of Aspergillus antigen were detected in the abscess, but circulating antigen and Aspergillus dna were undetectable in the serum.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
7/47. Interstitial lung disease induced by endogenous candida albicans.We report on a 64-year old woman with an interstitial lung disease which had characteristics of hypersensitivity pneumonitis. Severe febrile attacks with impairment of ventilation and diffuse poorly defined radiodensities and ground glass opacities on chest x-ray occured repeatedly. Laboratory data showed hypoxemia, leukopenia and circulating candida albicans (C.a.)-antigen. Bronchoalveolar lavage revealed an increase in neutrophils. Transbronchial biopsies showed lymphocytic alveolitis, bronchiolitis obliterans and epitheloid cell granulomas. IgG and IgA and the lymphocyte proliferation assay were positive with C.a.-antigen. C.a. was detected in the feces. Intradermal skin test with C.a. showed a positive immediate and late phase reaction and inhalative provocation test with C.a.-antigen was positive. After antimycotic treatment the symptoms resolved completely and long-lasting. We conclude that the disease was induced by C.a.-antigen reaching the lungs from the intestinal tract via the bloodstream.- - - - - - - - - - ranking = 4keywords = antigen (Clic here for more details about this article) |
8/47. Successful unrelated cord blood transplantation in philadelphia chromosome positive acute lymphoblastic leukemia during pulmonary aspergillosis treated by anti-fungal therapy, granulocyte colony-stimulating factor-mobilized granulocytes and surgical resection: case report.A 3-year-old girl with philadelphia chromosome positive acute lymphoblastic leukemia developed pulmonary aspergillosis during severe neutropenia by re-induction therapy. She was treated by intravenous fluconazole, oral itraconazole with plasma level monitoring and surgical resection of the focus for 3 months after clinical diagnosis of fungal infection was made. Once she had recovered from surgery we attempted to induce remission with anti-fungal treatment. She developed fever and neutropenia and appeared unlikely to remit with conventional chemotherapy. Unrelated one-antigen-mismatched cord blood (CB) transplantation was performed 2 months after the induction therapy. Her pulmonary aspergillosis was reactivated during subsequent conditioning. Anti-fungal drugs were switched to amphotericin b and granulocyte colony-stimulating factor-mobilized granulocyte concentrates were transfused. She obtained engraftment and has maintained complete hematological and molecular remission without signs of aspergillus infection for 13 months so far after transplantation. Even very high-risk transplantation in pediatric patients could be successfully supported by carefully designed intense comprehensive medical care.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
9/47. Functioning adrenal black adenoma with pulmonary and cutaneous cryptococcosis: a case report and review of English literature.A 53-year-old woman experienced progressive general weakness and lumbago in the 2 years prior to a physical examination which disclosed cushingoid manifestations and a skin ulcer on the back of her right knee joint. Her plasma cortisol concentration ranged from 24.7 to 31.1 microg/dl, with an ACTH level <5 pg/ml. Urinary excretions of 17-hydroxycorticosteroid (17-OHCS) and 17-ketosteroid (17-KS) were 20.5 mg/day and 5.1 mg/day, respectively, and urinary cortisol was also increased (421 microg/day). Cortisol was not suppressed after the administration of 8 mg dexamethasone. Abdominal ultrasound sonography, computed tomography (CT) scan, and magnetic resonance imaging (MRI) studies demonstrated a left adrenal tumor and further, a chest X-ray examination showed a cavitary lesion containing a fungus ball-like mass in the left lower lung field. The serum cryptococcal antigen titer was positive at 1:128 and a bronchoalveolar lavage fluid culture yielded a growth of cryptococcus neoformans. A biopsy specimen of the skin ulcer also suggested cryptococcosis. As a result, a left adrenectomy was performed, and the excised specimen was shown to be an adenoma consisting of compact cells with abundant pigmentation (black adenoma). A diagnosis of functioning black adenoma of the adrenal gland, complicated with pulmonary and cutaneous cryptococcosis was made.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
10/47. Secondary cutaneous aspergillosis due to aspergillus flavus in an acute myeloid leukaemia patient following stem cell transplantation.In a 64-year-old man suffering from hypoblastic myelodysplastic syndrome a secondary acute myeloid leukaemia developed. After induction chemotherapy with resulting partial remission he received an allogenic (related) peripheral blood stem cell transplantation conditioned with 2 Gy total body irradiation. After haematopoietic reconstitution chest pain and dyspnoea appeared. Computer tomography revealed diffuse bilateral infiltrates which were considered to be suspicious for an invasive pulmonary aspergillosis of the left upper lobe. Respiratory and circulatory insufficiency occurred. In bronchoalveolar lavage fluid Aspergillus antigen was detected. In addition, aspergillus flavus was isolated on Sabouraud-dextrose agar. Ambisome (liposomal encapsulated amphotericin b) was applied in high dosages. On the skin of the sides and the back five livid red stained nodular lesions with haemorrhagic infarctions appeared. Pathohistologically, both in PAS (periodate acid Schiff) and Grocott-Gomori staining conglomerates of septated hyphae were detected in corium and subcutis. In addition, aspergillus flavus grew from skin tissue. Despite antifungal treatment the patient died from Aspergillus pneumonia and generalized aspergillosis with dissemination to heart, brain, and skin.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
| | Next -> |