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[Clinical features of 32 cases of fungal pneumonia]
M Fujishita1, R Kataoka, M Kobayashi
1Department of Internal Medicine, Kochi Heart Clinic, Japan.
Abstract:
A total of 32 patients with mycoses other than cavity-formed aspergilloma were reviewed. The main pathogenic fungi were Aspergillus in 14, Candida in 8, Cryptococcus in 4, Trichosporon in 4 and Mucor in 2. Coinfection by two species was detected in 3 cases: Trichosporon and Aspergillus in 2 and Aspergillus and Candida in 1. The underlying diseases were hematologic malignancies in all cases except 1 case of lung cancer. The hematologic malignancies were mostly leukemias of various types. Cryptococcosis developed in patients given long-term corticosteroid treatment but not in leukemic patients. All cases of aspergillosis, candidiasis and mucormycosis were due to nosocomial infection. On the other hand, 3 of 4 cases of cryptococcosis or trichosporonosis were attributable to community-acquired infection. Two of 4 trichosporonosis cases were considered to have been acquired during 2-day home stays. The diagnosis of pulmonary mycosis was made pathologically in 18 and clinically in 14 cases. Of the latter, 6 cases had an air-crescent sign on chest X-ray films and 8 cases were culture-positive. Extrapulmonary involvement was seen in all 16 cases of candidiasis, cryptococcosis and trichosporonosis but not in 10 of 14 aspergillosis cases. Severe granulocytopenia was present in all cases except 4 cases of cryptococcosis and 3 cases of aspergillosis. Chest X-ray findings of aspergillosis were of two types: one was an air-crescent sign which was noted in the recovery phase from leukopenia and the other was gradually enlarging consolidation which was bound by the interlobar fissure and progressed to lobar penumonia. A diffuse granular shadow was not characteristic of any fungus species.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
This study reviews 32 patients with fungal infections, identifying Aspergillus and Candida as common pathogens, often linked to hematologic malignancies and hospital-acquired infections. Community-acquired fungal infections were also noted.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Pulmonology
Background:
- Fungal infections (mycoses) pose significant risks, particularly in immunocompromised patients.
- Understanding the spectrum of fungal pathogens and their origins is crucial for effective management.
Purpose of the Study:
- To analyze the characteristics of various fungal infections in a cohort of 32 patients.
- To differentiate between hospital-acquired and community-acquired mycoses.
- To correlate underlying conditions and clinical findings with specific fungal agents.
Main Methods:
- Retrospective review of 32 patients diagnosed with mycoses (excluding cavity-formed aspergilloma).
- Identification of primary fungal pathogens: Aspergillus, Candida, Cryptococcus, Trichosporon, and Mucor.
- Analysis of underlying diseases, infection sources (nosocomial vs. community-acquired), diagnostic methods, and clinical manifestations.
Main Results:
- Aspergillus (14 cases) and Candida (8 cases) were the most frequent pathogens, often associated with hematologic malignancies.
- Aspergillosis, candidiasis, and mucormycosis were predominantly nosocomial, while cryptococcosis and trichosporonosis had community-acquired origins.
- Extrapulmonary involvement was common in candidiasis, cryptococcosis, and trichosporonosis, but less so in aspergillosis.
- Chest X-ray findings for aspergillosis included air-crescent signs during leukopenia recovery and progressive consolidation.
Conclusions:
- Hematologic malignancies are a primary risk factor for invasive fungal infections.
- Distinguishing between nosocomial and community-acquired fungal infections is vital for epidemiological control.
- Clinical and radiological findings aid in diagnosing pulmonary mycoses, with specific patterns associated with Aspergillus.