Histopatologia, sorologia e cultivo no diagnóstico da criptococose

Cryptococcosis is one of the most common opportunistic fungal infections in patients with acquired immunodeficiency syndrome (AIDS). We report 13 cases of cryptococcal infection based on histopathology, serology and cultures. Epidemiological analysis, histochemical techniques of hematoxilin and eosin (HE) and Grocot's silver (GMS), as well special histochemical techniques such as Mayer's mucicarmine (MM) and Fontana-Masson (FM), cryptococcal antigen test (CrAg) and isolation on fungal media: Sabouraud's (SAB), brain-heart infusion agar (BHI) and canavanine-glycine-bromothymol blue (CGB) agar were analyzed. Unsatisfactory staining results by MM stain associated to negative titers by CrAg test, which FM stain confirmed that capsule-deficient Cryptococcus infections were observed in four cases. Eight isolated cases were identified as follows: six cases were infection with Cryptococcus neoformans and two cases were Cryptococcus gattii.A criptococose é a mais comum infecção fúngica oportunística observada em pacientes com síndrome da imunodeficiência adquirida (AIDS). Relatamos 13 casos da infecção baseados no diagnóstico histopatológico, sorológico e cultivo. Foram analisadas: a epidemiologia, as técnicas histoquímicas básicas de hematoxilina-eosina (HE) e coloração pela prata (GMS), bem como as técnicas histoquímicas especiais de mucicarmim de Mayer (MM) e Fontana-Masson (FM), o teste do antígeno criptocóccico (CrAg) e o isolamento em cultivos em ágar-Sabouraud (SAB), ágar infusão de cérebro-coração (BHI) e meio com canavanina azul de bromotimol (CGB). Em quatro casos, resultados tintoriais insatisfatórios pela coloração de MM associados a títulos negativos pelo teste do CrAg, a coloração de FM confirmou a infecção pelo Cryptococcus deficiente de cápsula. Oito isolados foram identificados: seis casos apresentaram a infecção por Cryptococcus neoformans e dois casos apresentaram a infecção por Cryptococcus gattii

Fungemia por Cryptococcus gattii: relato de um caso com lesões cerebrais e pulmonares nos achados radiológicos mimetizando câncer

Homem branco de 64 anos, aparentemente imunocompetente, desenvolveu lesões pulmonares e cerebrais por criptococose disseminada. Os achados radiológicos foram similares àqueles encontrados em pacientes com câncer de pulmão e metástase no sistema nervoso central. C. gattii foi isolado de cultivos de lavado broncoalveolar, biópsia cerebral e sangue. O mesmo fungo foi encontrado em fragmentos pulmonares e cerebrais obtidos da autópsia. Testes de antígeno no soro e no líquido cefalorraquidiano foram diagnóstico no nosso caso e devem ser incluídos na avaliação diagnóstica de lesões pulmonares e cerebrais indefinidas. Pesquisa na literatura mostrou poucos relatos de fungemia por esta espécie de Cryptococcus, contrastando com C. neoformans.A 64-year-old apparently immunocompetent white man developed lung and brain lesions of disseminated cryptococcosis. The radiologic features mimicked those of lung cancer metastatic to the central nervous system. C. gattii was recovered from cultures of bronchoalveolar lavage fluid, brain biopsy, and blood. The same fungus was recovered from pulmonary and brain specimens at autopsy. Serum and cerebrospinal fluid cryptococcal antigen tests were diagnostic in our case and should be included in the diagnostic evaluation of unexplained pulmonary and cerebral lesions. A literature search showed few reports of fungemia by this species of Cryptococcus, contrasting to C. neoformans

Nocardiose disseminada por Nocardia farcinica diagnosticada através do cultivo de abscesso da tireóide

A previously healthy 75-year-old white male dentist presented with a 6-month history of low-back pain treated with chronic steroid therapy had a Nocardia farcinica infection diagnosed by aspirate of thyroid abscess and six blood cultures. Despite the treatment with parenteral combination of trimethoprim/sulfamethoxazole, the patient failed to respond and died after two days of therapy. Autopsy revealed disseminated nocardiosis, involving lungs with pleural purulent exudate in both sides, heart, thyroid, kidneys, brain, bones, and lumbosacral soft tissue with destruction of L2-L4.Paciente previamente hígido, homem de 75 anos, branco, dentista, apresentou história de seis meses de dor lombar, fez uso crônico de corticoterapia e teve diagnóstico de infecção por Nocardia farcinica através do aspirado de abscesso da tireóide e seis hemocultivos positivos. Apesar do tratamento com a combinação de sulfametoxazol/trimetoprim, o paciente não respondeu indo a óbito dois dias após. A necropsia revelou nocardiose disseminada, envolvendo ambos os pulmões, empiema bilateral, coração, tireóide, rins, cérebro, ossos, e tecidos moles lombossacrais, com destruição da L2-L4

PARASITOSES INTESTINAIS EM CRIANÇAS DE CRECHES/ESCOLAS DE PORTO ALEGRE: PREVALÊNCIA E PROFILAXIA

UNIVERSIDADE FEDERAL DE CIENCIAS DA SAÚDE DE PORTO ALEGR

Bola fúngica em pacientes HIV-infectados

Aspergillus is a phagocyte opportunistic fungus that causes aspergillosis, an unusual disease in patients with AIDS. Six cases of fungal ball in patients with AIDS are reported here. In this group, all patients had hemoptysis and tuberculosis as the underlying lung disease. The diagnosis of pulmonary fungus ball was based on the clinical and radiographic feature, combined with serological and mycological evidence of Aspergillus fumigatus.Os fungos filamentosos são oportunistas de fagócitos, motivo pelo qual aspergilose é incomum em pacientes com Aids. A apresentação clínica depende do estado imune, tamanho do inóculo fúngico e doença de base. São relatados neste trabalho seis casos de bola fúngica em pacientes com Aids. Neste grupo, todos tiveram tuberculose como doença de base e hemoptise foi o principal sintoma. O diagnóstico da bola fúngica foi através da apresentação clínica, achados radiológicos combinados com imunodifusão radial dupla, exame micológico direto e cultivo do material do trato respiratório, sendo A. fumigatus o agente isolad

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

Variability in Galactomannan detection by platelia Aspergillus EIA™ according to the Aspergillus species

Here we investigate the extent to which different Aspergillus species release galactomannan (GM) in vitro. Marked variability was observed in GM reactivity between and within Aspergillus species, with A. terreus strains showing the highest GM indexes. The in vivo significance of these findings remains to be determined.O estudo objetivou investigar a liberação in vitro de galactomanana (GM) em distintas espécies patogênicas de fungos do gênero Aspergillus. Grande variabilidade foi detectada tanto intra quanto inter espécies, sendo as cepas da espécie A. terreus relacionadas aos maiores índices de GM detectados. O significado in vivo destes achados permanece em aberto, porém merece investigação

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