Pulmonary mycobacteriosis caused by mycobacterium kansasii as a precede to the chronic pulmonary aspergillosis: case report
| Autor: | Boris Vrga |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Mycobacterium kansasii
biology business.industry Chronic pulmonary aspergillosis medicine antifungalni tretman Aspergillus fumigatus kronična pulmonalna kavitarna aspergiloza kronična plućna aspergiloza General Medicine antifungal treatment chronic cavitary pulmonary aspergillosis chronic pulmonary aspergillosis biology.organism_classification medicine.disease business Microbiology |
| Zdroj: | Medicina Fluminensis : Medicina Fluminensis Volume 55 Issue 1 |
| ISSN: | 1848-1868 1847-6864 1848-820X |
| DOI: | 10.21860/medflum2019_216324 |
| Popis: | Aim: To present a patient suffering from chronic pulmonary aspergillosis and in whom a prolonged use of corticosteroids due to chronic obstructive pulmonary disease represented a serious risk factor in the development and progression of the infection. Case report: We present a case of a 52-year-old cachectic, HIV seronegative potator and smoker who, having recovered from pulmonary mycobacteriosis caused by Mycobacterium kansasii, developed a chronic cavitary pulmonary aspergillosis (CCPA) which was confirmed by radiological, microbiological (positive culture findings on Aspergillus fumigatus in sputum samples, bronchial aspirate and bronchoalveolar lavage) and blood findings (IgG antibodies and a positive galactomannan antigen for Aspergillus).Granulomatous reaction without a hyphal invasion was confirmed by transbronchial lung biopsy. Despite being treated with peroral and intravenous antifungal medicines, the patient died, most probably due to the development of a more invasive form of pulmonary aspergillosis. Conclusion: Due to the lack of unambiguous diagnostic and therapeutic criteria, chronic pulmonary aspergillosis poses a considerable challenge to the clinician, because it is the case of a continuous disease which shows different forms of clinical and radiological presentation in its evolution. Its relatively high morbidity and mortality rate , despite targeted antifungal therapy, proves the need for further researches, particularly those which refers to the identification of certain presentations of the disease and efficacy of therapeutic methods. Cilj: Prikazati pacijenta koji boluje od kronične plućne aspergiloze i kod kojega je dugotrajna primjena kortikosteroida zbog kronične opstruktivne plućne bolesti predstavljala važan faktor rizika u nastanku i razvoju infekcije. Prikaz slučaja: Prikazujemo slučaj 52-godišnjeg pacijenta, kahektičnog, HIV seronegativnog potatora i pušača, koji je nakon preboljele plućne mikobakterioze uzrokovane Mycobacterium kansasii zadobio kroničnu kavitarnu aspergilozu pluća koja je dokazana na temelju radioloških, mikrobioloških (pozitivne kulture Aspergillus fumigatusa u uzorcima sputuma, aspiratu bronha i bronhoalveolarnom lavatu) i krvnih nalaza (IgG protutijela i pozitivan galaktomananski antigen na Aspergillus). Transbronhalnom biopsijom pluća dokazana je granulomska reakcija bez hifalne invazije. Unatoč tretmanu peroralnim i intravenskim antifungicima slučaj je završio letalnim ishodom, najvjerojatnije zbog razvoja invazivnije forme plućne aspergiloze. Zaključak: Zbog nedostatka nedvosmislenih dijagnostičkih i terapijskih kriterija, kronična plućna aspergiloza predstavlja nemali izazov za neposrednog kliničara, tim više što je riječ o kontinuiranoj bolesti koja u svojoj evoluciji iskazuje različite oblike kliničke i radiološke prezentacije. Njen relativno visok morbiditet i mortalitet, unatoč ciljanoj antifungalnoj terapiji, ukazuje na potrebu daljnjih proučavanja, prioritetno onih koji se odnose na identifikaciju pojedinih prezentacija bolesti i efikasnost terapijskih postupaka. |
| Databáze: | OpenAIRE |
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