Isolated secondary fungal infections of pleural cavity

Year 2013, Volume: 4 Issue: 4, 468 - 471, 01.12.2013

Makbule Ergin Ali Yeğinsu Arife Zeybek Kürşat Gürlek

https://doi.org/10.5799/ahinjs.01.2013.04.0326

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

Abstract

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.

Keywords

Akciğer, fungal enfeksiyonlar, plevral effüzyon

References

• Wex P, Utta E, Drozdz W. Surgical treatment of pulmo- nary and pleura-pulmonary Aspergillus disease. Tho- rac Cardiovasc Surg 1993;41: 64-70.
• Light RW. Pleural effusion secondary to fungal ınfections, actinomycosis, and nocardiosis. In:RW Light editor. Pleural Diseases. Philedelphia;Lippincott Williams&Wilkins; 2001, 4th Edition. p. 196-197.
• Hillerdal G. Pulmonary aspergillus infection invading the pleura. Thorax 1981;36:745-751.
• CJM Namee. Toraksın mantar enfeksiyonları. In: Sug- arbaker DJ Editor. Erişkin Göğüs Cerrahisi. İstanbul . Nobel Tıp Kitabevleri; 2011. p.756-761.
• Moriyama B, Ditullio M, Wilson E, et al. Pharmacokinet- ics of antifungal agent in pleural fluid during the treat- ment of a patient with Candida empyema. Antimicrob Agents Chemother 2011;55:2478-2480.
• Baradkar VP, Marthur M, Kulkami SD, Kumar S. Tho- racic empyema due to Candida albicans. Indian J Pathol Microbiol 2008;51:286-288.
• SL Meyerson, DA Harpole. Mycotic and Actinomycotic infections of the lung. In; TW Shields Editor. General Thoracic Surgery. Philadelphia; Lippincott Williams &Wilkins;2009. p.1169-71.793-796.
• Ishiguro T, Takayanagi N, Ikeya T, et al. Isolation of Candida species is an important clue for suspecting gastrointestinal tract perforation as a cause of empy- ema. Intern Med 2010;49:1957-1964.
• Karthik RK, Sudarsanam TD. An unusual cause of em- pyema thoracic. Indian J Med Sci 2009;63:30-32.
• Goel MK, Juneja D, Jain SK, et al. A rare presentation of aspergillus infection as empyema thoracic. Lung In- dia 2010;27:27-29.
• Matsuda T, Koreeda Y, Mataki H, et al. A case of As- pergillus empyema successfully treated with combi- nation therapy of voriconazole and micafungin: excel- lent penetration of voriconazole and micafungin into pleural fluid. Intern Med 2010;49:1163-1169.
• Zhang W, Hu Y, Chen L, et al. Pleural aspergillosis complicated by recurrent pneumothorax: a case re- port. J Med Case Reports 2010;17:180.
• Torres CAO, Gomez JM. Tuberculous and fun- gal infections of the pleura. In;TW Shields editor. General Thoracic Surgery. Philadelphia; Lippincott Williams&Wilkins;2009. p. 793-796.
• Bonatti H, Lass-Floerl C, Angerer K, et al. Success- ful management of postpneumonectomy Aspergillus pleural empyema by combined surgical and anti- fungal treatment with voriconazole and caspofungin. Mycoses 2010;53:448-54.
• Gupta A, Mars T, Urquhart D, et al. Fungal pleural ef- fusion secondary to a rare cause of pancreatic pseu- docyst. Ped Pulmon 2009;44:616-618.
• Rajalingham S, Anshar FM. Chronic necrotizing pul- monary aspergillosis presenting as bilateral pleural ef- fusion: a case report. J Med Case Reports 2012;14:62.