Chronic necrotizing pulmonary aspergillosis (CNPA) is an unusual form of pulmonary aspergillosis arising in the setting of mildly immune compromised state or altered local defense system. CNPA rarely shows histological findings mimicking bronchocentric granulomatosis (BCG), which is characterized by peribronchiolar granulomatous destruction. We describe a case representing CNPA with elements of BCG. A-64 year-old woman was admitted because of atypical pneumonia with multi-focal variable sized consolidations and cavitary lesions on high-resolution computed tomography (HRCT). The open lung biopsy specimen showed large areas of necrotizing pneumonia with some scattered aspergillus hyphae within the lung parenchyma. Some terminal bronchioles were found to be destroyed and were replaced by peribronchiolar granulomatous inflammation. There was no evidence of angioinvasion by aspergillus or aspergillous emboli. Despite vigorous antifungal agent and steroid treatment, she died of acute airway obstruction by bronchial casts on the thirty-fourth hospital day.
Aspergillosis/etiology/*pathology ; Case Report ; Chronic Disease ; Female ; Granuloma/etiology/pathology ; Human ; Lung Diseases, Fungal/etiology/*pathology ; Middle Age ; Necrosis

Aspergillosis ; drug therapy ; etiology ; pathology ; Aspergillus flavus ; isolation & purification ; Dermatomycoses ; drug therapy ; etiology ; pathology ; Female ; Humans ; Middle Aged ; Skin Ulcer ; etiology

BACKGROUNDCritically ill chronic obstructive pulmonary disease (COPD) patients admitted to an intensive care unit (ICU) due to respiratory failure are at particularly high risk of Aspergillus infection. The serum galactomannan index (GMI) has proven to be one of the prognostic criteria for invasive pulmonary aspergillosis (IPA) in classical immunocompromised patients. However, the prognostic value of serum GMI in critically ill COPD patients needs evaluation. The purpose of this study is to investigate the prognostic value of serum GMI in patients with severe COPD.

METHODSIn this single-center prospective cohort study, serum samples for GMI assay were collected twice a week from the first day of ICU admission to the day of the patients' discharge or death. Patients were divided into two groups according to their clinical outcome on the 28th day of their ICU admission. Univariate analysis and survival analysis were tested in these two groups.

RESULTSOne hundred and fifty-three critically ill COPD patients were included and were divided into survival group (106 cases) and non-survival group (47 cases) according to their outcome. Univariate analysis showed that the highest GMI level during the first week after admission (GMI-high 1st week) was statistically different between the two groups. Independent prognostic factors for poor outcome in severe COPD patients were: GMI-high 1st week >0.5 (RR: 4.04, 95% CI: 2.17-7.51) combined with accumulative dosage of corticosteroids >216 mg before the RICU admission (RR: 2.25, 95% CI: 1.11-4.56) and clearance of creatinine (Ccr) ≤ 64.31 ml/min (RR: 2.48, 95% CI: 1.22 ± 5.07).

CONCLUSIONSThe positive GMI-high 1st week (>0.5) combined with an accumulative dosage of corticosteroids >216 mg before the ICU admission and a low Ccr may predicate a poor outcome of critically ill COPD patients.

Aged ; Aged, 80 and over ; Critical Illness ; Female ; Humans ; Invasive Pulmonary Aspergillosis ; blood ; complications ; pathology ; Male ; Mannans ; blood ; Middle Aged ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive ; blood ; etiology ; pathology

OBJECTIVE: Although rare, invasive rhino-orbital-skull base aspergillosis usually is fatal and necessitates prompt diagnosis, surgical intervention and antifungal treatment. METHOD: A case series of 5 patients, with review of treatments and outcomes. RESULT: Five patients initially presented with orbital apex syndrome without apparent rhino-sinus disease. Histologic examination revealed invasive aspergillosis. Four patients underwent transnasal endoscopic surgical exploration of rhino-orbital-skull base, and three of them simultaneously underwent optic nerve decompression. One patient underwent the rhinopharyngeal biopsy. Following surgical debridement and antifungal drug, Two patients achieved various degree of recovery, 1 patient (case 5) showed vision improvement, from counting fingers to 0.1 and symptom-free during 65 months follow-up. One patient (case 1) showed no recovery of vision from no light perception, but symptom-free during 43 months follow-up. Other three patients respectively died of massive intracranial spread (case 3), postoperative brainstem hemorrhage (case 2) and sepsis (case 4). CONCLUSION Invasive sino-orbital-skull base aspergillosis often may resemble inflammatory conditions. Early diagnosis and surgical intervention are required to improve vision and survival. The endoscopic surgical exploration and biopsy often are necessary to rule out fungal sinus infection before considering steroid use, especially in immunocompromised individuals. The patients with invasive rhino-orbital-skull base aspergillosis usually have a poor prognosis.
Adult ; Aged ; Aspergillosis ; pathology ; Female ; Humans ; Male ; Middle Aged ; Orbit ; microbiology ; Orbital Diseases ; etiology ; metabolism ; Retrospective Studies ; Sinusitis ; microbiology ; Skull Base ; microbiology

Aged, 80 and over ; Aspergillus ; isolation & purification ; Fever of Unknown Origin ; etiology ; Humans ; Invasive Pulmonary Aspergillosis ; complications ; microbiology ; pathology ; Length of Stay ; Long-Term Care ; Lung Diseases, Interstitial ; complications ; pathology ; Male ; Pulmonary Alveoli ; pathology ; Respiratory Distress Syndrome, Adult ; complications ; pathology

The objective of this study was to evaluate the etiological factors, diagnosis and therapy of pulmonary fungal infection in hematological malignancies, 14 cases of malignant hematological disease with pulmonary fungal infection were collected and analyzed. The results showed that 11 out of 14 cases had the respiratory manifestations, sputum was sticky and difficult to be expectorated in 7 cases, X rays in chests showed shadows with features of stigma and sheet in 11 cases, Candida albicans and aspergillus infection were observed in 10 and 2 cases respectively, the numbers of neutrophil were below 0.5 x 10(9)/L in 8 cases and below 1.0 x 10(9)/L in 3 cases respectively, fluconazole was used for 12 cases and clinical symptoms of 11 cases were improved within two weeks. In conclusion, the occurrence of pulmonary fungal infection in malignant hematological diseases is associated with intensive chemotherapy, decrease of neutrophil counts and using of broad-spectrum antibiotics, the diagnosis at early stage is difficult and clinicians should pay more attention to its clinical and laboratory examinations, and give them therapy in time.
Adolescent ; Adult ; Aged ; Antifungal Agents ; therapeutic use ; Aspergillosis ; complications ; diagnosis ; drug therapy ; Candidiasis ; complications ; diagnosis ; drug therapy ; Female ; Fluconazole ; therapeutic use ; Hematologic Neoplasms ; drug therapy ; etiology ; pathology ; Humans ; Lung Diseases, Fungal ; complications ; diagnosis ; drug therapy ; Male ; Middle Aged ; Treatment Outcome

A 69-year old man presented to us with decreased vision in his right eye and a relative afferent pupillary defect. Under the presumption that he was suffering from retrobulbar optic neuritis or ischemic optic neuropathy, visual field tests were performed, revealing the presence of a junctional scotoma. Imaging studies revealed tumorous lesions extending from the sphenoid sinus at the right superior orbital fissure, with erosion of the right medial orbital wall and optic canal. Right optic nerve decompression was performed via an endoscopic sphenoidectomy, and histopathologic examination confirmed the presence of aspergillosis. The patient did not receive any postoperative antifungal treatment; however, his vision improved to 20 / 40, and his visual field developed a left congruous superior quadrantanopsia 18 months postoperatively. A junctional scotoma can be caused by aspergillosis, demonstrating the importance of examining the asymptomatic eye when a patient is experiencing a loss of vision in one eye. Furthermore, damage to the distal optic nerve adjacent to the proximal optic chiasm can induce unusual congruous superior quadrantanopsia.
Aged ; Antifungal Agents/therapeutic use ; Aspergillosis/*complications/diagnosis ; Decompression, Surgical/methods ; Diagnosis, Differential ; Endoscopy/methods ; Eye Infections, Fungal/*complications/diagnosis/therapy ; Follow-Up Studies ; Hemianopsia/*complications/diagnosis/therapy ; Humans ; Magnetic Resonance Imaging ; Male ; Optic Nerve/pathology ; Scotoma/diagnosis/*etiology/therapy ; Sphenoid Bone/surgery ; Visual Acuity ; Visual Fields