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Histoplasmose pulmonar cavitária cr?nica simulando tuberculose
Unis, Gisela;Severo, Luiz Carlos;
Jornal Brasileiro de Pneumologia , 2005, DOI: 10.1590/S1806-37132005000400009
Abstract: objective: to evaluate cases of chronic pulmonary histoplasmosis diagnosed in recent years at the complexo hospitalar santa casa in porto alegre, in the state of rio grande do sul, brazil. methods: cases diagnosed at the santa casa hospital complex within the last 25 years were reviewed. four cases in which the diagnosis was made through histopathological analysis or culture and confirmed by with serologic testing are described. cases from the brazilian literature are also discussed. results: the principal clinical manifestations were cough, dyspnea, fever, anorexia and weight loss. among the radiological findings were emphysema, cystic cavities, bronchiectasis and pleural thickening. all patients had an epidemiological history of contact with chicken feces. one of the patients presented aspergillus fumigatus colonization of cavities. conclusion: chronic pulmonary histoplasmosis must be considered in patients with chronic obstructive pulmonary disease presenting cavitary lesions of the lung, sputum smear microscopy negative for acid-fast bacilli and negative tuberculin skin test. hemoptysis occurring in the presence of cured or fading pulmonary lesions is suggestive of aspergillus colonization.
Coexistência de coloniza??o fúngica intracavitária (bola fúngica) e tuberculose ativa
Unis, Gisela;Picon, Pedro Dornelles;Severo, Luiz Carlos;
Jornal Brasileiro de Pneumologia , 2005, DOI: 10.1590/S1806-37132005000200009
Abstract: background: although pulmonary tuberculosis is the principal predisposing factor for intracavitary fungal colonization, the coexistence of the two diseases is rare. simultaneity of fungal colonization and active mycobacteriosis in the same cavity (acid-fast bacilli found among hyphal masses) is highly unusual. objective: to describe clinical findings, diagnostic procedures, radiographic aspects, accompanying conditions and evolution in patients with tuberculosis and fungus ball. method: we reviewed, retrospectively, the records of 625 patients diagnosed with fungus ball between 1974 and 2002. all of the patients had been diagnosed through immunodiffusion or mycological study, or both. the inclusion criterion was positivity for acid-fast bacilli in sputum smear microscopy or histopathology. results: the charts of 14 patients were selected. all had presented hemoptysis, followed by productive cough, dyspnea, weight loss, fever, asthenia and chest pain. in one patient colonized by aspergillus niger and in another colonized by scedosporium apiospermum (teleomorph, pseudallescheria boydii), active tuberculosis was seen concomitant to the fungus ball. in the remaining cases, the mycobacteria were found in the adjacent parenchyma or in the contralateral lung. conclusion: this study corrobates the assertion that antagonism exists between mycobacterium tuberculosis and aspergillus fumigatus. the potential for fungal colonization and mycobacteriosis to occur concomitantly is demonstrated in other fungal agents, s. apiospermum (p. boydii) and a. niger in particular.
Microepidemia de histoplasmose em Blumenau, Santa Catarina
Oliveira, Flávio de Mattos;Unis, Gisela;Severo, Luiz Carlos;
Jornal Brasileiro de Pneumologia , 2006, DOI: 10.1590/S1806-37132006000400018
Abstract: acute pulmonary histoplasmosis is rarely diagnosed and is often confused with tuberculosis. most knowledge of the disease has been derived from descriptions of epidemics in which a number of individuals were exposed to the same source of infection. isolation of histoplasma capsulatum var. capsulatum from soil samples is conclusive evidence of an epidemic focus. this is the first report of an outbreak of histoplasmosis, in which two cases were reported and the fungus was isolated at the focus of the epidemic, in the state of santa catarina. further epidemiological studies are needed in order to determine the prevalence of the infection statewide.
Histoplasmose pulmonar aguda no Rio Grande do Sul
Unis, Gisela;Roesch, Eliane Wurdig;Severo, Luiz Carlos;
Jornal Brasileiro de Pneumologia , 2005, DOI: 10.1590/S1806-37132005000100010
Abstract: background: acute pulmonary histoplasmosis is a respiratory infection occurring when an otherwise healthy individual inhales a large quantity of fungal propagules. length of exposure determines disease severity. an epidemic is influenced by factors affecting the growth and transmission of histoplasma capsulatum var. capsulatum in nature. objective: to identify epidemiological and clinical aspects of patients with acute pulmonary histoplasmosis in the state of rio grande do sul (rs) and compare these aspects with those of other cluster outbreaks reported in brazil. method: the charts of 212 patients diagnosed with histoplasmosis over a 25-year period (1977-2002) were obtained from the archives of the laboratório de micologia from complexo hospitalar santa casa (santa casa hospital mycology laboratory), in the city of porto alegre (rs). in reviewing these patient charts, we identified and included in the study cases of acute pulmonary histoplasmosis in which there was a positive culture and/or histopathological findings consistent with the diagnosis. outbreaks were defined as one confirmed case or positive immunodifusion histoplasma capsulatum with compatible clinical history. all reported brazilian outbreaks were reviewed. results: of the 212 patient charts reviewed, 18 (8.5%) were selected for inclusion in the study. among those 18 patients, ages ranged from 8 to 63 years (median, 35.4), and 67% were male. epidemiological histories were suggestive of the disease in 11 patients (61%). the most common disease type, seen in 17 patients (95%), was primary acute pulmonary histoplasmosis, and there was a predominance of isolated cases. conclusion: the identification of isolated cases and the presence of cluster outbreaks demonstrate the abundance of h. capsulatum in the soil and, together with the occurrence of all forms of the disease, confirms the assumption that rio grande do sul is a hyperendemic region for histoplasmosis.
Histoplasmose disseminada e SIDA: importancia do meio de cultivo para o espécime clínico-broncoscópico
Unis, Gisela;Silva, Vanusa Barroso da;Severo, Luiz Carlos;
Revista da Sociedade Brasileira de Medicina Tropical , 2004, DOI: 10.1590/S0037-86822004000300008
Abstract: fiberoptic bronchoscopy is a useful procedure in the diagnosis of histoplasmosis, when the clinical material is adequately processed. ten cases of disseminated histoplasmosis in patients with aids are presented here, with a mycological evaluation in culture, mycosel? and sabouraud's chloramphenicol agar of clinical specimens obtained through fiberoptic bronchoscopy. the yield of mycosel? culture was 60%, while in sabouraud's chloramphenicol agar it was 20%, supporting the importance of selective medium in the isolation of histoplasma capsulatum var capsulatum from potentially contaminated clinical specimens, as well as the importance of clinical information for the laboratory as the key for a correct diagnosis.
Histoplasmoma pulmonar no Rio Grande do Sul
Unis, Gisela;Pêgas, Karla Lais;Severo, Luiz Carlos;
Revista da Sociedade Brasileira de Medicina Tropical , 2005, DOI: 10.1590/S0037-86822005000100003
Abstract: a retrospective analysis of sixteen patients with pulmonary nodules diagnosed as histoplasmoma by histopathologic evidence of histoplasma capsulatum var capsulatum was done in an endemic area for histoplasmosis. brazilian literature was reviewed. all patients were white, nine were men, mean age at diagnosis was 50.8 years. six (37.5%) patients had a relevant epidemiologic story. the pulmonary nodules were 0.7-2.7 cm in diameter, presenting as granulomatous lesions with caseous necrosis. twelve (75%) patients had solitary nodules. histoplasmoma as a rule is a solitary nodule of up to 3 cm in an asymptomatic patient. the diagnosis is made from histopathologic evidence of the fungus, which is accomplished using a special fungus stain, gomori-grocott methenamine silver. cultures or seromycology do not help the diagnosis.
Histoplasmose disseminada no Rio Grande do Sul
Unis, Gisela;Oliveira, Flávio de Mattos;Severo, Luiz Carlos;
Revista da Sociedade Brasileira de Medicina Tropical , 2004, DOI: 10.1590/S0037-86822004000600007
Abstract: this report describes epidemiological, clinical and laboratorial aspects of 111 cases of disseminated histoplasmosis from rio grande do sul over a 25-year period (1977-2002). aids and non-aids patients were analyzed was the predisposing disease in 63.1% of the patients. in both groups there were mostly men, whitout evidence of exposure to microfoci contaminated with histoplasma capsulatum. the main clinical features were systemic (fever and weight loss were present in 97.1 and 92.7% of aids and non-aids cases), followed by respiratory and mucocutaneous manifestations. seromycology (positive in 54.5% and 65.3% in aids and non-aids cases) was useful as a screening test. the high index of cutaneous involvement in aids patients (44.3%) compared with north american reports (p <0.01) suggests that different strains of histoplasma capsulatum may induce different clinical manifestations of the same disease.
Histoplasmoma pulmonar no Rio Grande do Sul
Unis Gisela,Pêgas Karla Lais,Severo Luiz Carlos
Revista da Sociedade Brasileira de Medicina Tropical , 2005,
Abstract: Foram revisados dezesseis prontuários de pacientes que apresentavam nódulo pulmonar à radiografia de tórax diagnosticados como histoplasmoma através de achado histopatológico demonstrando elementos fúngicos compatíveis com Histoplasma capsulatum var capsulatum no Rio Grande do Sul. Revisada a literatura brasileira. Todos os pacientes eram brancos, nove eram homens, a média de idade foi de 50,8 anos. Seis (37,5%) pacientes tinham história epidemiológica sugestiva de contato com fungo. Os nódulos variaram de 0,7 a 2,7 cm de diametro, apresentavam-se como granuloma com necrose caseosa. Doze (75%) pacientes apresentavam nódulo solitário. O histoplasmoma como regra se apresenta como nódulo solitário com até três centímetros de diametro em paciente assintomático. O diagnóstico é realizado por exame histopatológico com colora o especial para visualiza o do fungo, método de Gomori-Grocott com metenamina argêntica. Cultivo ou testes soromicológicos n o contribuem para o diagnóstico.
Histoplasmose disseminada e SIDA: importancia do meio de cultivo para o espécime clínico-broncoscópico
Unis Gisela,Silva Vanusa Barroso da,Severo Luiz Carlos
Revista da Sociedade Brasileira de Medicina Tropical , 2004,
Abstract: A fibrobroncoscopia é um procedimento útil no diagnóstico da histoplasmose, quando o material clínico é processado adequadamente. S o apresentados dez casos de histoplasmose disseminada em pacientes com SIDA, com avalia o micológica em cultivo, nos meios Mycosel e ágar-Sabouraud cloranfenicol de espécimes clínicos colhidos por fibrobroncoscopia. A positividade do cultivo em Mycosel foi de 60%, enquanto no ágar-Sabouraud cloranfenicol foi de 20%, evidenciando a importancia do meio seletivo no isolamento do Histoplasma capsulatum var capsulatum de espécimes clínicos potencialmente contaminados, bem como a importancia das informa es clínicas para o laboratório, sendo esta a chave para o diagnóstico correto.
Fungus ball in HIV-infected patients
Guazzelli, Luciana Silva;Unis, Gisela;Xavier, Melissa Orzechowski;Severo, Cecília Bittencourt;Picon, Pedro Dornelles;Severo, Luiz Carlos;
Revista do Instituto de Medicina Tropical de S?o Paulo , 2009, DOI: 10.1590/S0036-46652009000600007
Abstract: 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.
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