Pub Date : 2019-05-01DOI: 10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6876
L. Bushmann, M. Reddy, M. Srour, S. Maughan, N. Malhotra
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Pub Date : 2019-05-01DOI: 10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6881
R. Neupane, M. Sharma, D. Sharma, R. Thachil, M. Krishnamurthy, Gerald F. Lowman
Primary pulmonary histoplasmosis is found worldwide, and is particularly endemic in some areas of the North America, usually those surrounding the Ohio and Mississippi river valleys. It is not common in the East Coast of the United States, and is in fact, reportable in Pennsylvania. It has been rarely described in immunocompetent individuals residing in a non-endemic region. We present a case of a previously healthy middle-aged male, a Pennsylvania resident, who presented with mid-sternal chest discomfort, fatigue, chills and mild shortness of breath, and was diagnosed with primary pulmonary histoplasmosis. Introduction Histoplasma capsulatum is a thermally dimorphic fungus that is particularly found in environments with soil containing the droppings of birds or bats that are often decaying or decayed. When there is any disruption, it can cause the release of the fungal particles with subsequent inhalation by a potential host. Thus, it primarily affects the lungs, but other organs can also be affected. Primary pulmonary histoplasmosis is found worldwide, and is particularly endemic in some areas of the North America, usually those surrounding the Ohio and Mississippi river valleys (1). Baddley et al. found that per 100,000 populations in the United States, 3.4 cases of histoplasmosis were present in older adults more than 65 years of age. (2). It is a problem in patients who have compromised immunity from infections like HIV/AIDS and is more prevalent in areas where anti-retro viral treatment is not widely available (3). Histoplasmosis is not common in the East Coast of the US. In Pennsylvania, it is in fact a reportable disease. We present an infrequent occurrence of pulmonary histoplasmosis in a middleaged immunocompetent male living in a non-endemic area. Case Report A 50-year-old physically active man presented to our hospital with mid-sternal chest discomfort, fatigue, chills and mild shortness of breath that started about a week prior and became progressively worse. He also complained of extreme diaphoresis. Vital signs showed temperature of 99.1°F, heart rate 67 bpm/regular, respiratory rate 18/m, blood pressure 144/90 mmHg and saturation 98% on room air. He was awake, alert and oriented to time, place and person. His neck was supple with no carotid bruits noted. Lung exam revealed occasional bibasilar coarse crackles, cardiac examination revealed normal rate and rhythm, normal S1 and S2 with no murmurs/rubs or gallops. Abdomen, skin, extremities and neurology examination were normal. A cc ep te d pa pe r Three sets of troponin I were negative and electrocardiogram showed normal sinus rhythm with no significant ST-T segment changes. Chest x-ray on admission showed multiple nodules with a shaggy and therefore inflammatory appearance mainly in the upper and mid lung fields bilaterally (Figure 1). D-dimers were elevated at 1190 nanograms/milliliter (normal range 0-399). Patient underwent a Computed Tomography Angiography (CTA) of the chest wh
原发性肺组织胞浆菌病在世界各地都有发现，在北美的一些地区尤其流行，通常是在俄亥俄和密西西比河流域周围。它在美国东海岸并不常见，事实上，在宾夕法尼亚州是可以报告的。在居住在非流行地区的具有免疫能力的个体中很少有描述。我们提出一个病例，以前健康的中年男性，宾夕法尼亚州居民，谁提出胸骨中部胸部不适，疲劳，寒战和轻度呼吸短促，并被诊断为原发性肺组织胞浆菌病。荚膜组织原体是一种热二态真菌，特别发现于含有鸟类或蝙蝠粪便的土壤环境中，这些土壤经常腐烂或腐烂。当有任何破坏时，它可能导致真菌颗粒释放，随后被潜在宿主吸入。因此，它主要影响肺部，但其他器官也可能受到影响。原发性肺组织胞浆菌病在世界各地都有发现，在北美的一些地区尤其流行，通常是在俄亥俄和密西西比河流域周围(1)。Baddley等人发现，在美国每10万人中，65岁以上的老年人中有3.4例组织胞浆菌病。(2)这是一个对HIV/AIDS等感染免疫低下的患者的问题，在抗逆转录病毒治疗不广泛的地区更为普遍(3)。组织胞浆菌病在美国东海岸并不常见。在宾夕法尼亚州，这实际上是一种需要报告的疾病。我们提出一个罕见的肺组织浆菌病发生在中年男性免疫正常生活在一个非流行地区。病例报告一名50岁体力活动男性，约一周前开始出现胸骨中部胸部不适、疲劳、寒战和轻度呼吸短促，病情逐渐加重。他还抱怨自己极度出汗。生命体征显示体温99.1°F，心率67 bpm/常规，呼吸频率18/m，血压144/90 mmHg，室内空气饱和度98%。他很清醒，很警觉，对时间、地点和人都很有方向感。他的脖子很柔软，没有颈动脉硬块。肺部检查偶见双基底动脉粗裂，心脏检查显示心率和节律正常，S1和S2正常，无杂音/摩擦或跳动。腹部、皮肤、四肢、神经检查正常。3组肌钙蛋白I阴性，心电图显示窦性心律正常，ST-T段无明显改变。入院时胸部x线片显示双侧肺上野和中野多发结节，结节呈毛糙状，因此呈炎症样(图1)。d -二聚体升高至1190纳克/毫升(正常范围0-399)。患者接受了胸部计算机断层血管造影(CTA)，肺栓塞呈阴性。报告了许多双侧肺结节，最大的左肺结节大小为1.3×0.8厘米，同时有一个隆突周围淋巴结大小为1.5×1.2厘米(图1)。考虑到吸烟史超过20年，人们对肺部转移性疾病的担忧增加。经一位肺病专家进一步详细评估后，发现他最近访问了波多黎各的一个蝙蝠居住的洞穴，洞穴的地板上覆盖着蝙蝠的鸟粪。病人显然还得把鞋里的东西拿掉。这次访问大约是在这次演讲前三周。患者胸痛不明显为胸膜炎性质，核应激试验和二维经胸超声心动图正常。血、尿组织浆抗原阳性。我们没有订购针对组织浆抗原的抗体，因为产生抗体需要2个月左右的时间。患者口服伊曲康唑，负荷剂量为200mg，每日3次，连用3天，随后每日200 mg，连用3个月。采用标准推荐剂量。未进行治疗药物监测。患者报告治疗后症状有明显改善。如果出现与肺组织浆菌病一致的新症状，从流行地区返回的旅行者需要高度的临床怀疑。该疾病本身具有非常广泛的表现，使临床诊断同样具有挑战性。误诊或延误诊断的可能性很高，特别是生活在非流行地区的免疫功能正常的患者。对于那些患有急性发热性肺病的人，必须询问他们在住院期间参与的活动和他们去过的地方。 根据美国疾病控制与预防中心的报告，组织胞浆菌病在以下州和美国领土报告:阿肯色州、特拉华州、伊利诺伊州、印第安纳州、肯塔基州、密歇根州、明尼苏达州、内布拉斯加州、宾夕法尼亚州、波多黎各和威斯康星州。因此，在像宾夕法尼亚州这样的地区，诊断很容易被遗漏或延迟(2,4)。正如我们在案例研究中观察到的那样，由于肺部结节的恶性肿瘤，最初的计划是进行肺活检或正电子发射断层扫描(PET)扫描。第二次检查和关于患者旅行和特定地点访问的更详细的历史有助于确定诊断。因此，必须有很高的临床怀疑指数。它极大地改变了管理层的发展。组织浆菌病的诊断方法有多种，包括真菌染色、培养、抗原检测和组织浆菌特异性抗体的血清学检测。用不涉及培养的方法诊断组织胞浆菌病仍然是非常准确的。Wheat等人的研究表明，在体液中可以检测到组织浆体的多糖抗原。血清和尿液中抗原的存在增加了诊断的准确性(5,6)。有许多零星病例报告显示，该病类似原发性肺癌、淋巴瘤、头颈癌和肺转移，患者接受了不必要的广泛侵入性检查。组织胞浆菌病的延迟治疗导致了非常严重的疾病表现(7,8)。如果这些病例发展为慢性，可能会出现严重的进行性肺功能丧失，死亡率高达30%(9)。治疗应根据疾病的临床表现量身定制。大多数病例是自限性的，但那些症状严重或持续超过四周的患者需要治疗。伊曲康唑是轻中度疾病的首选药物，而两性霉素B用于中重度至重度感染(10,11)。结论及时准确诊断原发性肺组织浆菌病是避免严重后遗症的必要措施。这类病例在非流行地区免疫力完好的居民中很容易被遗漏，因为初级临床怀疑程度较低。近期接触组织浆抗原的详细病史很重要。血清和尿液抗原检测是一种简单、快速和准确的诊断方法。及时治疗有助于实现完全康复。参考文献1。Manos NE, Ferebee SH, Kerschbaum WF。组织浆蛋白敏感性患病率的地理差异。说胸部。1956年6月,29(6):649 - 68。2. Baddley JW, Winthrop KL, Patkar NM, Delzell E, Beukelman T，谢峰，等。美国老年人地方性真菌感染的地理分布。新兴传染病。2011年9月17日(9):1664-9。3.Haddad NE, Powderly WG。艾滋病毒/艾滋病患者真菌病的变化。艾滋病读本2001;11:365-8, 75 - 8。4. 疾病预防控制中心。2008年从萨尔瓦多-宾夕法尼亚州和弗吉尼亚州返回的旅行者中组织胞浆菌病的爆发。MMWR。2008年12月19日;57(50): 1349 - 53年5。施华森特鲁伯，罗氏，等。急性肺组织浆菌病的抗原检测诊断。临床感染病2009;49 (12) 1878-1882麦丽娟。侵袭性真菌感染的非培养诊断方法。传染病报告2007;9 (6) 465-471Bello, A. G. D, Severo, C. B, Guazzelli, L. S, Oliveira, F. M, Hochhegger, B.， and Severo, L. C.(2013)。组织胞浆菌病模拟原发性肺癌或肺转移。巴西肺学杂志:巴西肺学与组织学官方学会，39(1)，63 - 68。8. Antonello VS, Zaltron VF, Vial M, Oliveira FM, Severo LC。口咽组织浆体病11例报告并文献复习。中华医学杂志，2011;44(1):26-29。9. Goodwin RA Jr, Owens FT, Snell JD，等。慢性肺组织胞浆菌病。医学(巴尔的摩)1976;55:413。10. Johnson PC, Wheat LJ, Cloud GA，等。脂质体两性霉素B与常规两性霉素B诱导治疗艾滋病患者组织浆菌病的安全性和有效性比较。Ann Intern Med 2002;137:105。11. Dismukes WE, Bradsher RW Jr .， Cloud GC，等。伊曲康唑
{"title":"An Unusual Infection in an Immunocompetent Male of a Non-Endemic Area: Lessons from a Vacation","authors":"R. Neupane, M. Sharma, D. Sharma, R. Thachil, M. Krishnamurthy, Gerald F. Lowman","doi":"10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6881","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6881","url":null,"abstract":"Primary pulmonary histoplasmosis is found worldwide, and is particularly endemic in some areas of the North America, usually those surrounding the Ohio and Mississippi river valleys. It is not common in the East Coast of the United States, and is in fact, reportable in Pennsylvania. It has been rarely described in immunocompetent individuals residing in a non-endemic region. We present a case of a previously healthy middle-aged male, a Pennsylvania resident, who presented with mid-sternal chest discomfort, fatigue, chills and mild shortness of breath, and was diagnosed with primary pulmonary histoplasmosis. Introduction Histoplasma capsulatum is a thermally dimorphic fungus that is particularly found in environments with soil containing the droppings of birds or bats that are often decaying or decayed. When there is any disruption, it can cause the release of the fungal particles with subsequent inhalation by a potential host. Thus, it primarily affects the lungs, but other organs can also be affected. Primary pulmonary histoplasmosis is found worldwide, and is particularly endemic in some areas of the North America, usually those surrounding the Ohio and Mississippi river valleys (1). Baddley et al. found that per 100,000 populations in the United States, 3.4 cases of histoplasmosis were present in older adults more than 65 years of age. (2). It is a problem in patients who have compromised immunity from infections like HIV/AIDS and is more prevalent in areas where anti-retro viral treatment is not widely available (3). Histoplasmosis is not common in the East Coast of the US. In Pennsylvania, it is in fact a reportable disease. We present an infrequent occurrence of pulmonary histoplasmosis in a middleaged immunocompetent male living in a non-endemic area. Case Report A 50-year-old physically active man presented to our hospital with mid-sternal chest discomfort, fatigue, chills and mild shortness of breath that started about a week prior and became progressively worse. He also complained of extreme diaphoresis. Vital signs showed temperature of 99.1°F, heart rate 67 bpm/regular, respiratory rate 18/m, blood pressure 144/90 mmHg and saturation 98% on room air. He was awake, alert and oriented to time, place and person. His neck was supple with no carotid bruits noted. Lung exam revealed occasional bibasilar coarse crackles, cardiac examination revealed normal rate and rhythm, normal S1 and S2 with no murmurs/rubs or gallops. Abdomen, skin, extremities and neurology examination were normal. A cc ep te d pa pe r Three sets of troponin I were negative and electrocardiogram showed normal sinus rhythm with no significant ST-T segment changes. Chest x-ray on admission showed multiple nodules with a shaggy and therefore inflammatory appearance mainly in the upper and mid lung fields bilaterally (Figure 1). D-dimers were elevated at 1190 nanograms/milliliter (normal range 0-399). Patient underwent a Computed Tomography Angiography (CTA) of the chest wh","PeriodicalId":296268,"journal":{"name":"D59. FUNGAL INFECTION CASE REPORTS","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132476398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2019.199.1_MEETINGABSTRACTS.A6871
M. Eltayeb, S. Asad, A. Malik, Yen-Ting Cao, Wen-Ya Yu, Annie Hong
{"title":"Fluconazole Non Susceptible Disseminated Coccidioidomycosis in a Critically Ill Patient Without Known Immunosuppression","authors":"M. Eltayeb, S. Asad, A. Malik, Yen-Ting Cao, Wen-Ya Yu, Annie Hong","doi":"10.1164/AJRCCM-CONFERENCE.2019.199.1_MEETINGABSTRACTS.A6871","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2019.199.1_MEETINGABSTRACTS.A6871","url":null,"abstract":"","PeriodicalId":296268,"journal":{"name":"D59. FUNGAL INFECTION CASE REPORTS","volume":"187 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132576645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6874
N. Achamallah, L. Kuklinski, M. Miller, S. Hosea
{"title":"Disseminated Cocci Packs a Punch","authors":"N. Achamallah, L. Kuklinski, M. Miller, S. Hosea","doi":"10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6874","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6874","url":null,"abstract":"","PeriodicalId":296268,"journal":{"name":"D59. FUNGAL INFECTION CASE REPORTS","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116440746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6886
F. Lim, Z. Solangi, K. Eneh
{"title":"A Tale of Exotic Lizard Induced Respiratory Tract Infection from Candida in a Healthy Young Female","authors":"F. Lim, Z. Solangi, K. Eneh","doi":"10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6886","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6886","url":null,"abstract":"","PeriodicalId":296268,"journal":{"name":"D59. FUNGAL INFECTION CASE REPORTS","volume":"27 12","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121010455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6864
Y. Zafar, E. Tylski, A. Gohar
{"title":"Pulmonary Mucormycosis Presenting as Bronchial Mass","authors":"Y. Zafar, E. Tylski, A. Gohar","doi":"10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6864","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6864","url":null,"abstract":"","PeriodicalId":296268,"journal":{"name":"D59. FUNGAL INFECTION CASE REPORTS","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121276877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6856
K. Pennington, C. Kennedy, S. Peters, M. Brutinel, J. Scott, H. Sekiguchi, S. Blackmon, M. Wylam
{"title":"Aspergilloma in Lung Transplant Recipient 8 Years Post-Transplant: Should Prolonged Anti-Fungal Prophylaxis Be Re-Visited?","authors":"K. Pennington, C. Kennedy, S. Peters, M. Brutinel, J. Scott, H. Sekiguchi, S. Blackmon, M. Wylam","doi":"10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6856","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6856","url":null,"abstract":"","PeriodicalId":296268,"journal":{"name":"D59. FUNGAL INFECTION CASE REPORTS","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133698427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6869
Elizabeth Au, K. Modi
{"title":"A ‘Mass’ Caused by Dust: Disseminated and Severe Coccidioidomycosis in an Immunocompetent Person","authors":"Elizabeth Au, K. Modi","doi":"10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6869","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6869","url":null,"abstract":"","PeriodicalId":296268,"journal":{"name":"D59. FUNGAL INFECTION CASE REPORTS","volume":"95 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131927357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6862
F. Zeba, N. Nassikas, J. Aliotta
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