Management of pulmonary Scedosporium apiospermum infection by thoracoscopic surgery in an immunocompetent woman

The Scedosporium apiospermum complex is a group of emerging opportunistic fungal pathogens that affect both immunocompromised and immunocompetent individuals, most commonly via lung infection. Although they are resistant to many antifungal agents, this group of pathogens has a favorable susceptibility profile to azoles, especially voriconazole. Here, we describe the management of S. apiospermum infection in an otherwise healthy 44-year-old woman. She had exhibited intermittent hemoptysis for 2 years before admission to our hospital. Computed tomography revealed a thin-walled and well-circumscribed cavitary lesion in the left upper lobe; the lesion was filled with consolidative opacities. Fungal culture of bronchoalveolar lavage fluid specimens revealed grayish-white mold; lactophenol cotton blue staining revealed acute angle branched septate hyaline cylindrical hyphae, characteristic of S. apiospermum. Despite voriconazole 200 mg twice daily for 8 weeks, the patient showed no improvement; thus, her left upper lobe was removed via thoracoscopic surgery. Her symptoms immediately improved and chest radiography after surgical resection showed no evidence of radiological progression or reoccurrence. This report demonstrates that S. apiospermum lung infection may not respond well to voriconazole alone in immunocompetent hosts; thus, surgery could be curative for these patients.

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Status of pulmonary fungal pathogens among individuals with clinical features of pulmonary tuberculosis at Mbarara University Teaching Hospital in Southwestern Uganda

Therapeutic Advances in Infectious Disease ◽

10.1177/20499361211042477 ◽

2021 ◽

Vol 8 ◽

pp. 204993612110424

Author(s):

Israel Kiiza Njovu ◽

Benson Musinguzi ◽

James Mwesigye ◽

Kennedy Kassaza ◽

Joseph Turigurwa ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Clinical Features ◽

Fungal Pathogens ◽

Study Participant ◽

University Teaching ◽

Blue Staining ◽

Hiv Positive ◽

Fungal Culture ◽

Cross Sectional Survey ◽

Cross Sectional

Background: Pulmonary mycoses are important diseases of the respiratory tract caused by pulmonary fungal pathogens. These pathogens are responsible for significant morbidity and mortality rates worldwide; however, less attention has been paid to them. In this study we determined the prevalence of pulmonary fungal pathogens among individuals with clinical features of pulmonary tuberculosis at Mbarara Regional Referral Hospital. Method: This was a hospital based cross sectional survey. Sputum samples were collected from each study participant. For each sample, the following tests were performed: Sabouraud dextrose agar for fungal culture, GeneXpert for Mycobacteria tuberculosis (MTB) and potassium hydroxide for fungal screening. Filamentous fungal growth and yeasts were further examined with lactophenol cotton blue staining and germ tube respectively. Results: Out of 113 study participants, 80 (70.7%) had pulmonary fungal pathogens whilst those with pulmonary tuberculosis numbered five (4.4%). Candida albicans [21 (22.58%)] and Aspergillus species [16 (17.20%)] were the pathogens most identified among others. Two (1.7%) TB GeneXpert positive participants had fungal pathogens isolated from their sputum samples. We established a prevalence of 57 (71.3%) for pulmonary fungal pathogen (PFP) isolates, three (60.0%) for MTB in HIV positive patients and 18 (22.5%) for PFP, and zero (0.0%) for MTB in HIV negative patients. On the other hand, two (100%) HIV positive patients had both PFP isolates and MTB. Conclusion: Our findings highlight the diversity of neglected pulmonary fungal pathogens whose known medical importance in causing pulmonary mycoses cannot be overemphasised. Therefore this presents a need for routine diagnosis for pulmonary mycoses among TB suspects and set-up of antimicrobial profile for pulmonary fungal isolates to support clinical management of these cases.

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Comparison on Detection Results of Pathogen Nucleic Acids for Bronchoalveolar Lavage Fluid of Lung Infection Infants Between Uighur Nationality and Han Nationality

Journal of Advances in Medicine Science ◽

10.30564/jams.v3i1.1344 ◽

2020 ◽

Vol 3 (1) ◽

pp. 27

Author(s):

Linglong Lu

Keyword(s):

Influenza Virus ◽

Streptococcus Pneumoniae ◽

Bronchoalveolar Lavage ◽

Virus Type ◽

Bronchoalveolar Lavage Fluid ◽

Lavage Fluid ◽

Lung Infection ◽

Parainfluenza Virus ◽

Han Nationality ◽

Positive Rate

Objective: To analyze the detection results of pathogen nucleic acids for bronchoalveolar lavage fluid (BALF) of lung infection infants from Uighur nationality and Han nationality. Methods: A retrospective analysis was performed on the 318 infants with lung infection who were admitted to the hospital from April 2018 to April 2019. According to their nationality, they were divided into Uighur nationality group (190 cases) and Han nationality group (128 cases). The BALF specimens were collected to test pathogen nucleic acid. The distribution and positive rates of [respiratory syncytial virus (RSV), adenovirus (ADV), influenza virus A (IFA), influenza virus B (IFB), parainfluenza virus type 1 (PIV I), parainfluenza virus type 2 (PIV II), parainfluenza virus type 3 (PIV III)], bacteria (Streptococcus pneumoniae, Haemophilus influenzae, staphylococcus aureus, Pseudomonas aeruginosa, klebsiella pneumoniae), Mycoplasma pneumoniae (MP) and Chlamydia pneumoniae (CP) in both groups were observed and compared. Results: The virus detection for RSV, ADV and PIV III were on the top three in BALF from the children in both groups. The total positive rate of virus examination in Uighur nationality group was higher than that in Han nationality group (P<0.05). BALF in both groups was mainly on Streptococcus pneumoniae. The total positive rate of bacteria, MP and detection rate of chlamydia were higher in Uighur nationality group were higher than those in Han nationality group (P<0.05). Conclusion: The pathogen nucleic acid examination for bronchoalveolar lavage fluid in infants with lung viral infection is in the majority, mainly on RSV virus infection. The positive rates of virus, bacteria, MP and CP of children in Uighur nationality are high than those in Han nationality.

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ETIOLOGY OF DERMATOPHYTOSIS : A STUDY FROM SOUTH INDIA

10.36106/gjra/2700838 ◽

2021 ◽

pp. 20-22

Author(s):

G Aishwarya Reddy ◽

Mohammed Abdul Samad ◽

Karjigi Siddalingappa ◽

Kallappa C Herakal

Keyword(s):

Low Socioeconomic Status ◽

Fungal Infections ◽

Blue Staining ◽

Fungal Culture ◽

Test Results ◽

Low Socioeconomic ◽

Urease Test ◽

Cotton Blue ◽

Microscopic Features ◽

The Common

BACKGROUND: Dermatophytes are one of the most common fungal agents causing supercial skin infections. The prevalence of these infections varies from place to place and is more commonly associated with low socioeconomic status. AIMS AND OBJECTIVES: To isolate and identify the common dermatophytic species causing the infection and to know the efcacy of the antifungals commonly used against them. METHODS: One hundred and ten new cases, who consented for study were included. Skin scrapings were collected for direct microscopy by KOH and for fungal culture in Sabouraud 4% dextrose agar (SDA) with cycloheximide and dermatophyte test medium. Fungi were identied on the basis of their macroscopic and microscopic features with the help of lactophenol cotton blue staining and urease test. RESULTS: Of the 110 cases, 58 cases were KOH positive for fungal laments and culture positive for dermatophytes. Trichophyton was the predominant isolate (51 cases) with T. verrucosum being the commonest species (28 cases), followed by T. rubrum (16 patients), and T. mentagrophytes (7 cases). All species of Trichophyton were found to be most sensitive to systemic itraconazole and topical luliconazole amongst antifungals. CONCLUSIONS: Trichophyton species is the commonest organism causing fungal infections. Itraconazole and luliconazole are the most effective systemic and topical agents against them.

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Quantitative Multiplexed Detection of Common Pulmonary Fungal Pathogens by Labeled Primer Polymerase Chain Reaction

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2013-0592-oa ◽

2014 ◽

Vol 138 (11) ◽

pp. 1474-1480 ◽

Cited By ~ 8

Author(s):

Zhengming Gu ◽

Daelynn R. Buelow ◽

Ruta Petraitiene ◽

Vidmantas Petraitis ◽

Thomas J. Walsh ◽

...

Keyword(s):

Polymerase Chain Reaction ◽

Fungal Pathogens ◽

Bronchoalveolar Lavage Fluid ◽

Fungal Infections ◽

Lavage Fluid ◽

Quantitative Detection ◽

Target Sequence ◽

Chain Reaction ◽

Polymerase Chain ◽

Primer Polymerase Chain Reaction

Context Invasive fungal infections are an important cause of morbidity and mortality among immunocompromised patients. Objective To design and evaluate a multiplexed assay aimed at quantitative detection and differentiation of the 5 molds that are most commonly responsible for pulmonary infections. Design Using labeled primer polymerase chain reaction chemistry, an assay was designed to target the 5.8S and 28S ribosomal RNA genes of Aspergillus spp, Fusarium spp, Scedosporium spp, and members of the order Mucorales (Rhizopus oryzae, Rhizopus microsporus, Cunninghamella bertholletiae, Mucor circinelloides, Lichtheimia corymbifera, and Rhizomucor pusillus). This assay was split into 2 multiplexed reactions and was evaluated using both samples seeded with purified nucleic acid from 42 well-characterized clinical fungal isolates and 105 archived samples (47 blood [45%], 42 bronchoalveolar lavage fluid [40%], and 16 tissue [15%]) collected from rabbit models of invasive pulmonary fungal infections. Results Assay detection sensitivity was less than 25 copies of the target sequence per reaction for Aspergillus spp, 5 copies for Fusarium spp and Scedosporium spp, and 10 copies for the Mucorales. The assay showed quantitative linearity from 5 × 101 to 5 × 105 copies of target sequence per reaction. Sensitivities and specificities for bronchoalveolar lavage fluid, tissue, and blood samples were 0.86 and 0.99, 0.60 and 1.00, and 0.46 and 1.00, respectively. Conclusions Labeled primer polymerase chain reaction permits rapid, quantitative detection and differentiation of common agents of invasive fungal infection. The assay described herein shows promise for clinical implementation that may have a significant effect on the rapid diagnosis and treatment of patients' severe infections caused by these pulmonary fungal pathogens.

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Increased β-glucuronidase activity in bronchoalveolar lavage fluid of children with bacterial lung infection: A case-control study

Respirology ◽

10.1111/resp.12596 ◽

2015 ◽

Vol 20 (8) ◽

pp. 1248-1254 ◽

Cited By ~ 4

Author(s):

Evgenia C. Panagiotopoulou ◽

Sotirios Fouzas ◽

Konstantinos Douros ◽

Irene-Eva Triantaphyllidou ◽

Christina Malavaki ◽

...

Keyword(s):

Bronchoalveolar Lavage ◽

Bronchoalveolar Lavage Fluid ◽

Case Control Study ◽

Lavage Fluid ◽

Lung Infection ◽

Case Control ◽

Glucuronidase Activity ◽

Control Study

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747. Diagnostic Performance of Bronchoalveolar Lavage Fluid Galactomannan Assay in Patients with Negative Serum Galactomannan Assay Suspected with Invasive Pulmonary Aspergillosis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.937 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S421-S421

Author(s):

So Yun Lim ◽

Jinyeong Kim ◽

Sunghee Park ◽

Jiwon Jung ◽

Min Jae Kim ◽

...

Keyword(s):

Bronchoalveolar Lavage ◽

Diagnostic Performance ◽

Bronchoalveolar Lavage Fluid ◽

Diagnostic Yield ◽

Tertiary Care ◽

Invasive Pulmonary Aspergillosis ◽

Lavage Fluid ◽

Fungal Culture ◽

Care Hospital ◽

Pulmonary Aspergillosis

Abstract Background There are limited data in real clinical practice on the diagnostic value of BAL (bronchoalveolar lavage) fluid galactomannan (GM) assay in patients with suspected invasive pulmonary aspergillosis (IPA) who had negative serum GM results. Methods This study was performed at Asan Medical Center, a 2700 bed tertiary-care hospital in Seoul, South Korea between May 2008 and April 2019. All patients with suspected IPA whose serum GM assays revealed negative results and sequentially underwent BAL were enrolled in this study. Patients were classified as proven, probable, possible or not IPA by the revised 2019 EORTC/MSG definition. Results A total of 341 patients with suspected IPA including 4 proven IPA, 38 probable IPA, 107 possible IPA, and 192 not IPA were enrolled. Of these 341 patients, 107 (31%) with possible IPA were excluded from the final analysis. Of 42 patients with proven or probable IPA who had initial negative serum GM results, 24 (57%) revealed positive BAL GM results (n=24) or BAL fungal culture (n=8). Among the remaining 18 (43%), 2 (5%) were diagnosed as proven IPA by the histopathologic exam from transbronchial lung biopsy, 6 (14%) as probable IPA by subsequent sputum fungal culture, and 10 (24%) as probable IPA by repeated serum GM assay after BAL. Of 192 patients with not IPA, 14 (7%) revealed positive BAL GM results (n=14) or BAL fungal culture (n=8). The diagnostic performance of various tests is shown in Table 1. Table 1. Diagnostic performance of various diagnostic tests in patients with suspected IPA who had negative serum GM results Conclusion Sequential BAL in patients with suspected IPA who had initial negative serum GM results provided additional diagnostic yield in about half of patients. Disclosures All Authors: No reported disclosures

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Necrotizing Lung Infection Caused by the ProtozoanBalantidium coli

Canadian Journal of Infectious Diseases ◽

10.1155/2003/829860 ◽

2003 ◽

Vol 14 (3) ◽

pp. 163-166 ◽

Cited By ~ 15

Author(s):

Sat Sharma ◽

Godfrey Harding

Keyword(s):

Marked Improvement ◽

Bronchoalveolar Lavage Fluid ◽

Lavage Fluid ◽

Lung Infection ◽

Pig Manure ◽

Intestinal Infection ◽

Ciliated Protozoan ◽

Doxycycline Hyclate ◽

Balantidium Coli ◽

Large Numbers

Balantidium coli, a ciliated protozoan, is well known to cause intestinal infection in humans. Extraintestinal spread to the peritoneal cavity and genitourinary tract has rarely been reported. There have also been a few cases of lung involvement from this parasite. A case of B coli causing a thick-walled right upper lobe cavity in an organic farmer who had contact with aerosolized pig manure is reported. Bronchoalveolar lavage fluid examined for ova and parasite revealed trophozoites of B coli in large numbers. Treatment with doxycycline hyclate led to marked improvement. Necrotizing lung infection caused by the protozoanB colishould be considered in individuals who report contact with pigs.

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Utility of Routine Testing of Bronchoalveolar Lavage Fluid for Cryptococcal Antigen

Journal of Clinical Microbiology ◽

10.1128/jcm.36.10.3088-3089.1998 ◽

1998 ◽

Vol 36 (10) ◽

pp. 3088-3089 ◽

Cited By ~ 18

Author(s):

Stephen M. Kralovic ◽

Judith C. Rhodes

Keyword(s):

Cerebrospinal Fluid ◽

Positive Predictive Value ◽

Bronchoalveolar Lavage ◽

Predictive Value ◽

Bronchoalveolar Lavage Fluid ◽

Lavage Fluid ◽

Fungal Culture ◽

Routine Testing ◽

Cryptococcal Antigen ◽

Histological Results

All cryptococcal antigen (CrAg) testing performed at our institution between 1989 and 1994 was reviewed for utility of routinely testing of bronchoalveolar lavage fluid (BAL) for this antigen. Forty-two of 1,506 BAL specimens were positive. Seventeen of these were felt to represent false positives (sensitivity, 71%; positive predictive value, 0.59). The data on CrAg in cerebrospinal fluid and serum and the fungal culture and histological results of BAL specimens did not support continued, routine testing of BALs for CrAg to diagnose cryptococcosis.

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