Category Archives: Respiratory Failure : Part 4

Respiratory Failure Caused by Adiaspiromycosis: Discussion (Part 3)

To diagnose adiaspiromycosis is still difficult. The increased number of lymphocytes and eosinophils recovered from the bronchoalveolar lavage fluid might not suggest a specific pathologic condition. Further, the presence of adiaconidia could not be proven by direct visualization or by cultures. The negative skin-test of haplosporangin was difficult to interpret: not only was the antigen prepared by Emmons extracted from the parvum variety—and the antigenic relationship with the crescens variety has not been well studied, but also, the sensitivity and specificity of the test has not been high in animal or human studies. As cross reactions between antigens prepared from Emmonsia parvum, Coccidioides immitis, Histoplasma capsulatum, and not so consistently, P hrasiliensis have already been demonstrated, the finding of false positive results in serologic tests might be expected, but obviously do not point at a specific disorder. Thus, the diagnosis of both presented cases rested essentially on lung histopathologic examination, either by open lung or by transbronchial route. birth control pills Continue reading

Respiratory Failure Caused by Adiaspiromycosis: Discussion (Part 2)

In addition to both cases presented here, two new cases of symptomatic disease were submitted to a regional Congress held in Brazil, one of them evolving to fatal respiratory failure. Unfortunately, beyond histopathologic analysis, very few clinical data were available.
To the best of our knowledge, all cases of human adiaspiromycosis have been ascribed to Emmonsia crescens (or Chrysosporium parvum var crescens). The other variation of the fungus, Emmonsia parvum (or Chrysosporium parvum var parvum), was found only among wild animals. In both presented cases, the adiaconidia in lung sections were compatible with the crescens variety, reaching diameters about 200 mm (Fig 3). ventolin inhalers Continue reading

Respiratory Failure Caused by Adiaspiromycosis: Discussion (Part 1)

Respiratory Failure Caused by Adiaspiromycosis: Discussion (Part 1)Adiaspiromycosis is a pulmonary disease affecting primarily small wild mammals. By inhaling the elements of the saprophytic stage of the fungus that lives for long periods in soil substrates, man may become an accidental link of the saproparatrophic circulation of the agent. After reaching the human or host alveoli, the infecting cells—or conidia—are converted into the elements of the parasitic stage— adiaconidia—which increase their volume by an estimated factor of 10^6, achieving diameters of 400 to 700 mm. Continue reading

Respiratory Failure Caused by Adiaspiromycosis: Case Reports (Part 5)

Multiple nodular granulomas were distributed throughout lung tissue resembling miliary tuberculosis. The granulomas had a predominantly interstitial localization, with compression of adjacent blood vessels and small bronchi. Differing from previous descriptions of the disease, a considerable amount of necrosis, caseation, and degenerated inflammatory cells were found (Fig 3, upper). A solitary round adiaconidium occupied the center of some granulomas and multinucleated giant cells of the foreign-body type surrounded the surface of these adiaconidia. Continue reading

Respiratory Failure Caused by Adiaspiromycosis: Case Reports (Part 4)

Repeated examinations and cultures of sputum revealed no acid-fast bacilli or fungi. Tuberculin, histoplasmin, coccidioidin, paracoccidioidin, sporotrichin and haplosporangin skin tests were negative. The DNCB skin test was positive. A transbronchial biopsy was performed, showing a granulomatous process with an unidentified organism in the center of the granulomas. An open chest biopsy was then performed, aimed at a better characterization of the organism. Continue reading

Respiratory Failure Caused by Adiaspiromycosis: Case Reports (Part 3)

Respiratory Failure Caused by Adiaspiromycosis: Case Reports (Part 3)Case 2
A 29-year-old white man was well until progressive dyspnea developed. One month before entry, he began to develop coryza, myalgia, anorexia, fever, and headache. Two weeks prior to admission, a nonproductive cough developed.
He was a carpenter who had been restoring a factory roof in Sao Paulo, closed down for several years. A large amount of dust was kicked up while working on the stuffy roof.
On admission, the patient appeared well, with mild dyspnea. Temperature was 38.3°C, pulse was 90 beats per minute, and respirations were 20/min. Blood pressure was 100/70 mm Hg. Inspiratory crackles were heard in both lung bases. Buy Asthma Inhalers Online Continue reading

Respiratory Failure Caused by Adiaspiromycosis: Case Reports (Part 2)

Repeated examinations and cultures of the bronchoalveolar lavage or sputum revealed no acid-fast bacilli, fungi, or pathogenic bacteria. Serologic tests for Paracoccidioides brasiliensis, Histoplasina capsu-latum, Aspergillus fumigatus and Candida albicans revealed negative immunodiffusion, weakly positive counterimmunoelectropho-resis for A fumigatus, and positive complement-fixing antibodies in titers 1:16 (micromethod), for all the above species. Tuberculin, histoplasmin, paracoccidioidin and haplosporangin (prepared from antigens of Eminonsia parvum) skin tests were negative. Cotrimoxa-zole, 1600 mg/day was started, with little improvement. buy prednisone Continue reading

Respiratory Failure Caused by Adiaspiromycosis: Case Reports (Part 1)

Case 1
A 42-year-old white man was well up to two months before, when he began to suffer from progressive dyspnea, fatigue, fever and night sweats. He was a peasant and had been working at some farms in Sao Paulo. Four months before entry, he had been cleaning a shed for a whole week. This shed had been closed for over a year, and a great number of rodent remains and bats were found inside it. Besides coughing bouts caused by the large dust clouds kicked up, he had no further complaints then, nor in the subsequent two months. Six weeks before admission, he was treated during a month for a suspected miliary tuberculosis, but his symptoms worsened. Continue reading

Respiratory Failure Caused by Adiaspiromycosis

Respiratory Failure Caused by AdiaspiromycosisAdiaspiromycosis is a recently recognized disease, most frequently caused by the fungus Emmonsia crescens (now preferably designated Chrysosporium parvum var parvum). Despite its ubiquitous occurrence in rodents and small wild mammals throughout the world, the disease rarely affects man. buy ampicillin
The first established human case was diagnosed in France, in 1964, reported as a localized process. Since then, however, five cases of massive human infestation, leading to a disseminated granulomatous pulmonary process have been reported from Czechoslovakia, Union of Soviet Socialist Republics, Guatemala, and France. Continue reading

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