Isolated secondary fungal infections of pleural cavity

Abstract

Objectives: Pleural fungal infections are rare, but the incidence has been increasing with immunosuppressant diseases and use of immunosuppressive medications. In this report, we present 6 patients with pleural effusions that have been determined fungal infection. Methods: The medical records of patients with followed and treated due to fungal infection of the pleural were retrospectively reviewed. Result: The 6 cases whom was 58 of the value median for age were treated as surgical and medical due to fungal infection of the pleural cavity. Dyspnea, cough and chest pain were the most common symptoms. Fever, night sweats and expectoration are relatively rare. In 4 patients, the infections of pleural cavity developed on the bases of rheumatoid arthritis, tuberculosis, pleural mesothelioma and esophagopleural fistula. In two patients had isolated fungal infections. Cultural positivity was seen in 5 patients. Fungal hyphae were determined by cytopathology in all of the patients. As a surgical procedure, all of the patients underwent decortication or pleural biopsy and pleural irrigation. In all patients, antifungal agents were added to surgical procedures. Full recovery of infection was seen in 5 patients. One patient died. Conclusion: In immunosuppressive patients, the incidence of pleural effusions due to or associated with fungal infections are more common. Addition to culture of pleural fluid, histopathological evaluation of pleura will aid diagnosis. J Clin Exp Invest 2013; 4 (4): 443-446

Keywords

• Lung, fungal infection, pleural effusion

Plevral kavitenin izole sekonder mantar enfeksiyonları

Öz

Amaç: Plevral mantar enfeksiyonları nadirdir. İmmünsupresif hastalıkların ve immünsupresif tedavilerin artışı ile plevral mantar enfeksiyonlarının insidansı da artmaktadır. Bu klinik çalışmada, plevral mantar enfeksiyonuna bağlı plevral effüzyon izlenen hastalar literatür verileri eşliğinde gözden geçirildi. Yöntemler: Plevral mantar enfeksiyonu nedeniyle takip ve tedavi edilen hastalara ait medikal kayıtlar retrospektif olarak gözden geçirildi. Bulgular: Yaş median değeri 58 yıl olan 6 vaka plevral kavitenin mantar enfeksiyonu nedeni ile cerrahi ve medikal tedavi aldı. Radyolojik değerlendirmelerde tüm hastalarda değişik derecede plevral efüzyon izlendi. Hastalar sıklıkla dispne, öksürük ve göğüs ağrısı daha nadir ateş, gece terlemesi semptomlarına sahipti. Plevral mantar enfeksiyonu; 6 hastanın 4\'ünde romatoid artrit, tüberküloz, mezotelyoma ve özefagoplevral fistüle sekonder gelişmişti. İki hastada ise izole mantar enfeksiyonu saptandı. Hastaların tümünde plevral dokunun histopatolojik değerlendirilmesi ile fungal hifler rapor edildi. Mikrobiyolojik olarak mantar kültür pozitifliği 5 hastada bildirildi. Hastalara cerrahi işlem olarak dekortikasyon, plevral biopsi, primer özefagial onarım ile yaklaşıldı. Tüm hastalara cerrahi işlemin yanı sıra antifungal ajanlar parenteral tedaviye eklendi. Beş hastada tam bir iyileşme izlenirken, bir hasta kaybedildi. Sonuç: İmmünsupresif veya genel durumu bozuk hastalarda, mantar enfeksiyonlarına bağlı radyolojik tetkiklerde sıklıkla plevral efüzyon bulgusu izlenir. Plevral sıvının mikrobiyolojik kültürünün yanısıra plevranın histopatolojik olarak değerlendirilmesi tanıya yardımcı olacaktır.

Anahtar Kelimeler

• Akciğer, fungal enfeksiyonlar, plevral effüzyon

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