Paracoccidioidomycosis molecular diagnosis associated with tuberculosis in sputum samples

Introdução: A paracoccidioidomicose (PCM) é uma micose sistêmica endêmica causada pelo fungo Paracoccidioides spp. O objetivo deste estudo foi determinar a associação entre tuberculose (TB) e PCM em pacientes com exame micológico negativo. Métodos: Estudo prospectivo de diagnóstico molecular de amostras de escarro, com resultado positivo para bacilo álcool ácido resistente (BAAR) e negativo no exame direto e cultivo micológico. Resultados: A aplicação de técnicas moleculares resultou em 18,4% de pacientes coinfectados com PCM e TB. Conclusão: O conhecimento das diferenças clínicas, epidemiológicas e laboratoriais da PCM quando associada à TB é importante para prevenir a disseminação da doença, complicações e o aumento da letalidade.Introduction: Paracoccidioidomycosis (PCM) is a systemic endemic mycosis caused by Paracoccidioides spp. The aim of this study was to determine the association between tuberculosis (TB) and PCM in patients with negative mycological examination results. Methods: Prospective study of molecular diagnosis of sputum samples, with positive results for bacilli resistant acid (BAAR) and negative results on direct examination and mycological culture. Results: The application of molecular techniques resulted in 18.4% of patients co-infected with PCM and TB. Conclusion: The knowledge of clinical, epidemiological, and laboratory differences of PCM when associated with TB is important to prevent the spread of disease, complications, and increased mortality

Characteristics of Actinomyces spp. and Nocardia spp. simulating neoplasia

Introduction: Actinomyces and Nocardia are filamentous bacteria that can simulate neoplastic diseases, mainly in lungs.Methods: A retrospective study based on the analysis of the medical records of five cases of actinomycosis and nocardiosis, which has been primarily misdiagnosed as lung cancer according to their radiographic findings. Cases were selected from a sample of 38 patients diagnosed with actinomycosis and 29 patients diagnosed with nocardiosis at the Mycology Laboratory of Irmandade de Misericórdia Santa Casa de Porto Alegre (state of Rio Grande do Sul, Brazil) between January 1977 to December 2012. The diagnosis was established by culture and histological examination. The literature was also critically reviewed.Results: We reported data of three cases of nocardiosis and two cases of actinomycosis that was primary diagnosed as lung cancer. The patients’ mean age was 50.6 (ranged from 43-63), four were male and 80% (4/5) of patients were immunocompetent. In more than 50% of patients, diagnosis and also treatment of lesions required surgical intervention. Conclusions: The complete knowledge of disease manifestations accelerates diagnosis and treatment and decreases unnecessary surgical interventions and morbidity and mortality rates, which are high in these infections.  

Histoplasmose simulando neoplasia primária de pulmão ou metástases pulmonares

OBJECTIVE: To describe the main clinical and radiological characteristics of patients with histoplasmosis mimicking lung cancer. METHODS: This was a retrospective descriptive study based on the analysis of the medical records of the 294 patients diagnosed with histoplasmosis between 1977 and 2011 at the Mycology Laboratory of the Santa Casa Sisters of Mercy Hospital of Porto Alegre in the city of Porto Alegre, Brazil. The diagnosis of histoplasmosis was established by culture, histopathological examination, or immunodiffusion testing (identification of M or H precipitation bands). After identifying the patients with macroscopic lesions, as well as radiological and CT findings consistent with malignancy, we divided the patients into two groups: those with a history of cancer and presenting with lesions mimicking metastases (HC group); and those with no such history but also presenting with lesions mimicking metastases (NHC group). RESULTS: Of the 294 patients diagnosed with histoplasmosis, 15 had presented with lesions mimicking primary neoplasia or metastases (9 and 6 in the HC and NHC groups, respectively). The age of the patients ranged from 13 to 67 years (median, 44 years). Of the 15 patients, 14 (93%) presented with pulmonary lesions at the time of hospitalization. CONCLUSIONS: The clinical and radiological syndrome of neoplastic disease is not confined to malignancy, and granulomatous infectious diseases must therefore be considered in the differential diagnosis.Objetivo: Descrever as principais características clínico-radiológicas de pacientes com histoplasmose simulando câncer de pulmão. Métodos: Estudo descritivo e retrospectivo baseado na análise dos prontuários médicos de 294 pacientes diagnosticados com histoplasmose no Laboratório de Micologia da Irmandade Santa Casa de Misericórdia de Porto Alegre, em Porto Alegre (RS) entre 1977 e 2011. O diagnóstico de histoplasmose foi estabelecido por cultura, exame histopatológico ou identificação de bandas M ou H por imunodifusão. Após identificar os pacientes com lesões macroscópicas e com achados compatíveis de malignidade em radiografia ou TC de tórax, os pacientes foram divididos em dois grupos: pacientes com história de câncer e lesões simulando metástases (grupo HC) e pacientes sem história de câncer com lesão simulando neoplasia primária (SHC). Resultados: Dos 294 pacientes com histoplasmose, 15 apresentaram lesões simulando neoplasia primária ou metástases (9 e 6 nos grupos HC e SHC, respectivamente). A idade dos pacientes variou de 13 a 67 anos (mediana, 44 anos) Dos 15 pacientes, 14 (93%) apresentaram lesões pulmonares no momento da internação. Conclusões: A síndrome clínica e radiológica da doença neoplásica não se limita a malignidade, e, portanto, as doenças infecciosas granulomatosas devem ser consideradas no diagnóstico diferencial

Histoplasmose apresentando múltiplos nódulos pulmonares. Um caso simulando características radiológicas de metástase pulmonar

Apresentamos caso de histoplasmose com múltiplos nódulos pulmonares em paciente com história de melanoma. Este caso simula malignidade, incluindo o sinal de vaso nutridor que ocorre na metástase pulmonar. Enfatizamos a necessidade de considerar esta infecção em áreas onde a histoplasmose é endêmica.We present a case of histoplasmosis with multiple pulmonary nodules in a patient with a history of melanoma. This case closely simulated malignancy, including the presence of feeding vessel sign, which occurs in pulmonary metastasis. We emphasize the need to be aware of this infection in areas where histoplasmosis is endemic

Characteristics of Actinomyces spp. and Nocardia spp. simulating neoplasia

Introduction: Actinomyces and Nocardia are filamentous bacteria that can simulate neoplastic diseases, mainly in lungs. Methods: A retrospective study based on the analysis of the medical records of five cases of actinomycosis and nocardiosis, which has been primarily misdiagnosed as lung cancer according to their radiographic findings. Cases were selected from a sample of 38 patients diagnosed with actinomycosis and 29 patients diagnosed with nocardiosis at the Mycology Laboratory of Irmandade de Misericórdia Santa Casa de Porto Alegre (state of Rio Grande do Sul, Brazil) between January 1977 to December 2012. The diagnosis was established by culture and histological examination. The literature was also critically reviewed. Results: We reported data of three cases of nocardiosis and two cases of actinomycosis that was primary diagnosed as lung cancer. The patients’ mean age was 50.6 (ranged from 43-63), four were male and 80% (4/5) of patients were immunocompetent. In more than 50% of patients, diagnosis and also treatment of lesions required surgical intervention.  Conclusions: The complete knowledge of disease manifestations accelerates diagnosis and treatment and decreases unnecessary surgical interventions and morbidity and mortality rates, which are high in these infections

Histoplasmosis presenting with multiple pulmonary nodules. A case mimicking radiological features of pulmonary metastasis

We present a case of histoplasmosis with multiple pulmonary nodules in a patient with a history of melanoma. This case closely simulated malignancy, including the presence of feeding vessel sign, which occurs in pulmonary metastasis. We emphasize the need to be aware of this infection in areas where histoplasmosis is endemic

Retrospective and prospective evaluation of mycosis and actinomycetous infections simulating neoplasia

O estudo trata de infecções fúngicas por Histoplasma, Cryptococcus gattii e Paracoccidioides e por Actinomyces e Nocardia que simularam neoplasia a partir de achados radiológicos. O objetivo deste trabalho é demonstrar, através de casos do banco de dados do Laboratório de Micologia da Irmandade Santa Casa de Misericórdia de Porto Alegre, a importância de um diagnóstico diferencial destas infecções com doenças neoplásicas. Identificamos os aspectos epidemiológicos e clínico-laboratoriais desses pacientes e revisamos criticamente a literatura. A casuística foi constituída por 83 casos, extraídos de uma população de 1.368 pacientes, de 1981 a 2012. As características clínicas e radiológicas de neoplasia foram observadas principalmente na histoplasmose, pela formação de histoplasmoma, na criptococose por C. gattii pela capacidade de formar criptococoma; na actinomicose e na nocardiose pela produção de massas. O que reforça o fato de que a síndrome clínica não é patognomônica da doença neoplásica e que as doenças infecciosas, especialmente granulomatosas devem ser consideradas no diagnóstico diferencial.The study comes to infections by Histoplasma, Cryptococcus gattii, Paracoccidioides, and also Actinomyces and Nocardia simulating neoplasia from radiological findings. The objective of this study is to demonstrated, through case database of Mycology Laboratory of Irmandade Santa Casa de Misericordia de Porto Alegre, the importance of a differential diagnosis of these infections with neoplastic disease. We identified the epidemiological, clinical and laboratorial datas of these cases and review the literature critically. The casuistic consisted of 83 cases, drawn from a population of 1,368 patients, from 1981-2012. The clinical and radiological features of malignancy were observed mainly in histoplasmosis by manifestation as histoplasmoma, in cryptoccosis by C.gattii to the ability to form crytococcoma; actinomycosis and nocardiosis by the production of masses. This fact emphasizes that the clinical syndrome is not pathognomonic of neoplastic diseases and that infectious diseases, especially granulomatous, should be considered in the differential diagnosis

AVALIAÇÃO RETROSPECTIVA E PROSPECTIVA DE INFECÇÕES FÚNGICAS E ACTINOMICETOSES QUE SIMULAM NEOPLASIAS.

1

AVALIAÇÃO RETROSPECTIVA E PROSPECTIVA DE INFECÇÕES FÚNGICAS E ACTINOMICETOSES QUE SIMULAM NEOPLASIAS.

1