Fungi ; Humans ; Lung Diseases, Fungal ; microbiology ; pathology

Coccidioidomycosis is an endemic disease found in the southwestern part of North America. Travellers who visit the endemic area may carry the infection. We report a case of pulmonary coccidioidomycosis in a 74-year-old woman. She was healthy before visiting Arizona, U.S.A twice. After returning home, she began to complain of intermittent dry coughing. The symptom was mild, however, and she was treated symptomatically. Later a chest radiograph, which was taken 4 years after the onset of the symptom, showed a solitary pulmonary nodule in the right upper lobe. By percutaneous needle aspiration, a few clusters of atypical cells were noted in the necrotic background. A right upper and middle lobectomy was done. A 1.5 x 1.5 x 1.2 cm sized tan nodule was present in otherwise normal lung parenchyma. Microscopically, the nodule consisted of aggregates of multiple solid granulomas inside of which was mostly necrotic. Neutrophils and nuclear debris were scattered along the periphery of the necrotic foci. Numerous multinucleated giant cells were associated with the granulomas. In the necrotic area, mature spherules of Coccidioides immitis, which were 30-100 microm in diameter, were present. They contained numerous endospores which ranged from 5 to 15 microm and were also noted in multinucleated giant cells. The diagnosis of coccidioidomycosis was made. She is doing well after the resection.
Aged ; Case Report ; Coccidioides* ; Coccidioidomycosis/pathology ; Coccidioidomycosis/microbiology* ; Female ; Human ; Korea ; Lung Diseases, Fungal/pathology ; Lung Diseases, Fungal/microbiology*

Adult ; Aspergillosis ; pathology ; Humans ; Lung Diseases, Fungal ; pathology ; Male ; Severe Acute Respiratory Syndrome ; pathology

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

OBJECTIVE: To improve the understanding of the clinical features of pulmonary cryptococcosis in non-human immunodeficiency virus (non-HIV) infection patients and reduce delay in diagnosis, or misdiagnosis. METHODS: The clinical features, imaging characteristics, laboratory examinations, treatment and prognosis of 34 cases of pulmonary cryptococcosis were retrospectively analyzed. The data were collected from Peking University First Hospital from June 1997 to June 2016. RESULTS: There were 34 cases diagnosed with pulmonary cryptococcosis, including 22 males and 12 females, aged from 20 to 75 years [average: (50.1±15.0) years]. There were 16 cases with host factors and (or) underlying diseases named immunocompromised group. In the study, 67.6% patients had clinical symptoms while 32.4% patients had no symptoms. The most common symptoms included cough, fever, chest pain, shortness of breath, and hemoptysis in sequence. Common chest imaging findings were patchy infiltrates, consolidation, single or multiple nodular or masses shadows. Among the 20 cases with cryptococcal capsular polysaccharide antigen detection, 19 were positive. Eleven cases underwent routine cerebrospinal fluid examination, and 3 cases complicated with central nervous system cryptococcal infection. At first visit, 24 cases were misdiagnosed, among which, 11 cases were misdiagnosed as lung cancer. The diagnosis of 15 cases was proved by percutaneous lung biopsy and 11 were confirmed by surgery, while 8 were diagnosed clinically. Then 11 cases were treated by surgical resection, and in median 4 years' followp, there was 1 case of recurrence. And 23 cases were treated with antifungal therapy, and in median 8 years' follow-up, 3 cases lost to the follow-up and 1 case of recurrence. Compared with normal immune group, immunocompromised patients had higher ages (P=0.017), more crackles (P=0.006) and more percentage of increase of peripheral white blood cells or neutrophils (P=0.003), but no significant difference in symptoms, imaging characteristics or hospitalization time. CONCLUSION There were no specific clinical symptoms and signs for pulmonary cryptococcosis in non-HIV patients. Diagnosis of pulmonary cryptococcosis depends on pathology. Percutaneous lung biopsy was mostly recommended for clinical highly suspected patients. Cryptoeoccal capsular polysaccharide antigen detection had a high sensitivity for the clinical diagnosis. Antifungal drug therapy was the major treatment, and the prognosis of the most patients was good.
Adult ; Aged ; Cryptococcosis/pathology* ; Delayed Diagnosis ; Diagnostic Errors ; Female ; Humans ; Lung Diseases ; Lung Diseases, Fungal/pathology* ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

OBJECTIVE: To determine the clinical characteristics, causes of pre-operative misdiagnosis and therapy of pulmonary cryptococcosis. METHODS: We retrospectively analyzed the clinical data of 28 patients suffering from pulmonary cryptococcosis from 2008 to 2013 in the Second Xiangya Hospital of Central South University. All patients were diagnosed pathologically. RESULTS: Of the 28 patients, 19 had no clear host factors. No patient was exposed to pigeons recently. The imaging findings showed that most patients had solitary, multiple nodules, masses, and patches. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) showed abnormal accumulation of fluorodeoxyglucose. Seven patients demonstrated malignancy and 1 demonstrated tuberculosis. None was considered as pulmonary fungus diseases. Microscopically, cryptococcosis granuloma formation was found in all patients and cryptococcosis neoformans were detected by Periodic acid-schiff and Grocott methenamine silver staining methods in the histopathological examination, respectively. Twenty-seven patients underwent lobectomy, and 1 had the medical antifungal drugs treatment. During the follow-up, symptoms in only 1 patient were not controlled. CONCLUSION Most pulmonary cryptococcosis patients have no evident immunocompromise. Clinical presentation of pulmonary cryptococcosis varies and is often related to the immune status of patients. Radiological manifestation of pulmonary cryptococcosis is indistinguishable from malignant tumor, and even 18F-FDG-PET imaging does not help to get a clear diagnosis. After surgical resection of the lung, systemic antifungal treatment is still necessary for special population. Systemic therapy of both fluconazole and itraconazole is classic choice for pulmonary cryptococcosis.
Cryptococcosis ; diagnosis ; pathology ; Fluorodeoxyglucose F18 ; Humans ; Lung ; microbiology ; pathology ; Lung Diseases, Fungal ; diagnosis ; pathology ; Positron-Emission Tomography ; Retrospective Studies ; Tomography, X-Ray Computed

OBJECTIVETo investigate the clinical characteristics of invasive pulmonary fungal infections (IPFI).

METHODSThe clinical data of 48 patients with confirmed IPFI at Peking Union Medical College Hospital from January 2004 to December 2008 were retrospectively analyzed. Patients were divided into primary IPFI group and secondary IPFI groups based on their disease courses.

RESULTSThe most commonly seen fungi were aspergillus species (37.5%) and cryptococcus species (37.5%), and community acquired infections accounted for 87.5%. The secondary IPFI accounted for 66.7% among all cases, in which the major pathogens were aspergillus species; in the primary IPFI group, the major pathogens were cryptococcus species. The symptoms of IPFI were non-specific and mostly presented as cough, fever, hemoptysis, and dyspnea. The common imaging features included multiple nodules, infiltrates and consolidations, or diffused lesions in bilateral lungs, and cavities were found in 11 patients (22.9%). The clinical symptoms and imaging findings were not significantly different between these two groups. A total of 46 patients (95.8%) received antifungal therapies or surgeries. Ten patients (20.8%; all from the secondary IPFI group) died, making the fatality rate significantly different between the primary IPFI group and secondary IPFI group (P=0.033).

CONCLUSIONSThe major pathogens of IPFI are aspergillus species and cryptococcus species, and most of them are community acquired. The secondary IPFI with aspergillus species tend to be highly fatal. The clinical symptoms and imaging features are non-specific. Early diagnosis with prompt antifungal therapies, or even with surgical intervention, may be beneficial for these patients.

Adolescent ; Adult ; Aged ; Female ; Humans ; Lung Diseases, Fungal ; microbiology ; mortality ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

OBJECTIVETo study the clinicopathologic characteristics of organizing pneumonia of the autopsies in elder and to analyze the possible underlying etiologic factors.

METHODSNinety-five cases of organizing pneumonia were found from 635 elderly autopsy reports of the Beijing Hospital since 1980. The morphologic and imaginal features were analyzed.

RESULTSThe foci of organizing pneumonia in our series were often small, patchy, scattered and adjacent to other lung lesion. There were, however, some variations in cases with different underlying conditions. The conditions associated with organizing pneumonia, as detected in our series, were: (1) 36 cases with suppurative inflammation, lung abscesses and chronic relapsing pneumonia; (2) 17 cases with fungal or viral infection; (3) 16 cases with aspiration pneumonia; (4) 5 cases with radiation pneumonia. We observed that it was not uncommon for organizing pneumonia coexisting with atelectasis and chronic pleuritis. The image of organizing pneumonia was varied.

CONCLUSIONSOrganizing pneumonia is a common finding in autopsies of the elder. It occurs in association with many diseases and the basic pathologic changes are similar. All of which represent secondary phenomenon. Possible etiologic factors include infection (due to bacteria, fungi or virus), aspiration and radiation. The possibility of organizing pneumonia should be considered if the shadow of lung is undisappeared in imagin.

Aged ; Cryptogenic Organizing Pneumonia ; etiology ; pathology ; Humans ; Lung ; diagnostic imaging ; pathology ; Lung Abscess ; complications ; pathology ; Lung Diseases, Fungal ; complications ; pathology ; Middle Aged ; Pneumonia, Aspiration ; complications ; pathology ; Radiography ; Retrospective Studies

Antifungal Agents ; therapeutic use ; Female ; Humans ; Lung ; microbiology ; pathology ; Lung Diseases, Fungal ; drug therapy ; etiology ; Middle Aged ; Schizophyllum ; drug effects ; pathogenicity ; Voriconazole ; therapeutic use

Diagnostic Errors ; Humans ; Lung Diseases, Fungal ; diagnosis ; drug therapy ; pathology ; Male ; Middle Aged ; Mucormycosis ; diagnosis ; drug therapy ; pathology ; Radiography, Thoracic ; Tomography, X-Ray Computed