Cases reported "Aspergillosis"

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1/11. aspergillus fumigatus keratitis after laser in situ keratomileusis.

    PURPOSE: To report a case of aspergillus fumigatus keratitis after a laser in situ keratomileusis (LASIK) enhancement procedure. METHOD: Case report. RESULTS: A 56-year-old woman developed an ulcer in the flap 13 days after LASIK enhancement. A 4-week course of fortified antibiotics for a presumed bacterial infection followed. The ulcer progressed, causing 60% thinning of the corneal stroma. A biopsy was performed 5 weeks after onset of symptoms, and antifungal agents were initiated. Cultures showed A. fumigatus. Her cornea perforated after the biopsy, requiring cyanoacrylate and lamellar overlay sutures, but the infiltrate resolved on antifungal agents. CONCLUSION: This report is the first description of Aspergillus keratitis after LASIK. We hypothesize that the infection became established on the stromal bed during surgery and led to melting, anteriorly through the flap and posteriorly through the stroma. diagnosis was made by a corneal biopsy and inoculation of a wide array of media. This case demonstrates the need to consider atypical organisms, including fungi, in the differential diagnosis of post-LASIK infections when there is no response to therapy and highlights the role of corneal biopsy and flap lifting in the diagnosis of this condition.
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ranking = 1
keywords = bacterial infection
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2/11. Invasive fungal and bacterial infections of the temporal bone.

    OBJECTIVES/HYPOTHESIS: Objectives were to highlight the importance of surgical therapy in treating invasive polymicrobial infections of the temporal bone, to discuss the importance of antifungal therapy, and to review the differential diagnosis of ear canal granulomatous disorders. STUDY DESIGN: Retrospective case review at a tertiary care medical center. methods: A retrospective chart review of all patients diagnosed with invasive polymicrobial temporal bone infections was performed. Four patients were identified. All patients required surgical therapy for definitive management. All patients were followed for at least 1 year or until death. RESULTS: Three of four patients had invasive fungi as pathogens. One patient had an occult squamous cell carcinoma. At the time of writing, one patient was free of disease, two were dead of disease, and one was alive with disease. CONCLUSION: Invasive polymicrobial temporal bone infections can occur in immunocompromised patients and can possibly harbor an occult malignancy. Surgical debridement may be necessary to arrive at a correct diagnosis. Modified radical mastoidectomy with parenteral antibiotic therapy and other adjunctive measures may be necessary for disease resolution.
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ranking = 4
keywords = bacterial infection
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3/11. Bronchocentric granulomatosis: a complication of allergic bronchopulmonary aspergillosis.

    hypersensitivity to the fungal antigens of aspergillus fumigatus may result in a spectrum of immune injury collectively known as allergic bronchopulmonary aspergillosis (ABPA). This report describes a 14-yr-old boy who presented clinical findings consistent with ABPA,including a history of asthma, blood eosinophilia, serum precipitins, and IgE antibodies to aspergillus fumigatus. sputum Aspergillus, pulmonary infiltrates, and dual types I and III skin reactions to aspergillus fumigatus were observed also. pathology of the resected right upper lobe revealed severe bronchial destruction with the findings of bronchocentric granulomatosis. Noninvasive septate fungal hyphae compatible with Aspergillus were identified. Cultures from sputum and surgical specimens grew Aspergillus and Mycobacterium intracellulare avium. The PPD-B (purified protein derivative-Batty) intradermal skin test produced a 6 mm induration (PPD-S was negative). The patient's condition has been well controlled with prednisone and several antituberculous drugs. In addition, inflammatory and immunologic parameters have begun to return to normal. The relationship between ABa and the atypical mycobacterial infection is not clear. The association of ABPA with the severe bronchial destruction seen in bronchocentric granulomatosis is emphasized to alert physicans to this serious sequelae of ABa seen in the asthmatic.
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ranking = 1
keywords = bacterial infection
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4/11. Pulmonary oxalosis caused by aspergillus niger.

    A case report involving a pleuropulmonary mixed bacterial infection in association with aspergillus niger is described. The patient responded to a combination of antibiotics, aerosolized and intravenously administered amphotericin b, and surgery. aspergillus niger appeared to be a secondary invader and caused lung damage by the production of oxalic acid.
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ranking = 1
keywords = bacterial infection
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5/11. Antigenemia detected by radioimmunoassay in systemic aspergillosis.

    Because of difficulties in antemortem diagnosis of systemic aspergillosis, a radioimmunoassay to an aspergillus fumigatus carbohydrate was developed and evaluated in patients with mycotic or bacterial infections. Antigenemia was detected in sera obtained antemortem from four of seven patients with systemic aspergillosis and in pleural fluid from an Aspergillus empyema but not in control sera or pleural fluid from 43 patients or 27 normal donors. When characterized with reference to onset of disease, antigenemia was an early sign of infection. This study shows the usefulness of the Aspergillus antigen radioimmunoassay for early, specific immunodiagnosis of systemic aspergillosis.
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ranking = 1
keywords = bacterial infection
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6/11. Invasive rhinosino-orbital aspergillosis with precipitous visual loss.

    OBJECTIVE: To describe the clinicopathological and radiologic features in five cases of primary and secondary orbital aspergillosis. DESIGN: Case series. SETTING: ophthalmology department of a university hospital. patients: Five patients over 65 years of age with invasive rhinosino-orbital aspergillosis. RESULTS: Presenting features were abrupt onset of proptosis, ophthalmoplegia and blepharoptosis with precipitous visual loss. All had debilitating periorbital pain or headache, but none had orbital inflammatory signs or appeared "toxic." Predisposing causes included alcoholism, low-dose prednisone therapy and insulin-dependent diabetes mellitus. One patient, suspected of having mucormycosis based on tissue biopsy and results of potassium hydroxide preparations, harboured aspergillus fumigatus, which grew on culture. Secondary bacterial infections developed in three patients. Three patients died from their disease despite aggressive surgical treatment, including exenteration and sinus extirpation. The one patient with primary orbital aspergillosis survived after exenteration. CONCLUSIONS: Sinonasal aspergillosis with orbital extension and primary orbital aspergillosis have a precipitous clinical course that mimics that of mucormycosis and may be fatal despite early exenteration. Computed tomography and magnetic resonance imaging of the sinuses, orbit and head provide complementary diagnostic signs. While results of potassium hydroxide preparations and tissue biopsy guide treatment of fungal infection, definitive diagnosis requires fungal culture. Relatively good vision may be associated with massive orbital and secondary intracranial extension.
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ranking = 1
keywords = bacterial infection
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7/11. Fungal pulmonary abscess in an adult secondary to hyperimmunoglobulin E (Job's) syndrome.

    Job's syndrome is characterized by recurring bacterial infections of the skin and sinopulmonary tract. Laboratory evaluation reveals consistent elevation of circulating immunoglobulin e levels. The syndrome has been reported as a rare cause of bacterial pulmonary abscess and pneumatocele formation in childhood; here we present a case of cavitating fungal abscess in an adult with Job's syndrome.
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ranking = 1
keywords = bacterial infection
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8/11. Exogenous lipoid pneumonia complicated by mycobacterium fortuitum and aspergillus fumigatus infections.

    We report the case of a nonimmunocompromised female patient, who developed exogenous lipoid pneumonia with mycobacterium fortuitum infection at diagnosis, later followed by aspergillus fumigatus infection. The association of exogenous lipoid pneumonia with atypical mycobacterial infection is uncommon but well-recognized, but, to our knowledge, association with A. fumigatus infection has not previously been reported.
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ranking = 1
keywords = bacterial infection
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9/11. aspergillosis in systemic lupus erythematosus.

    Infection is the major cause of morbidity and mortality in systemic lupus erythematosus (SLE). Although various fungi account for a substantial number of these lethal infections, aspergillosis, an important opportunistic infection in immunosuppressed patients, is described rarely. Only 23 cases have been reported in the English-language medical literature. risk factors for acquiring aspergillosis in these patients were high grade disease activity, granulocytopenia, use of steroids and other immunosuppressive treatment and presence of bacterial infection. The diagnosis in most patients was delayed and they died. Here, we describe three SLE patients with invasive aspergillosis. Features of our patients' diseases were similar to those reported previously. aspergillosis appeared while they had active SLE treated with high dose corticosteroids. In 2 patients the fungal infection was systemic and diagnosed post mortem. Both were leukopenic and had concurrent bacterial infection and one received amphotericin b prior to death. In the third, the infection was localized to a transplanted kidney and was cured by nephrectomy. aspergillosis should be suspected in patients with active SLE, who are immunocompromised and sustain concomitant bacterial infections. The currently poor prognosis may be improved with more aggressive diagnostic investigation and treatment.
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ranking = 3
keywords = bacterial infection
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10/11. Saprophytic fungal infections and lung transplantation--revisited.

    BACKGROUND: Fungal infections cause serious morbidity and death in lung transplant recipients. Some centers exclude and others will prophylactically treat patients with evidence of Aspergillus colonization. methods: Of 126 patients undergoing lung transplantation at the University of north carolina since January 1990, five patients have died because of invasive Aspergillus and other saprophytic fungal infections. Those cases are reviewed looking for common predisposing factors, including any evidence of prior colonization. In addition, all preoperative and postoperative culture data on all transplant recipients were retrospectively examined to define the prevalence of preoperative and postoperative Aspergillus colonization in 121 patients with and without cystic fibrosis, none of whom had development of significant fungal disease. RESULTS: Fifty-two percent of 65 patients with cystic fibrosis were colonized with Aspergillus before operation, and 40% after operation at some time. None had development of significant Aspergillus infections, and none received prophylactic antifungal therapy. Most of the deaths from deep-seated fungal infections have been in patients without cystic fibrosis with no evidence of preoperative colonization. These patients had evidence of severe obliterative bronchiolitis, bacterial infections, persisting cytomegalovirus disease, or other major organ failure. CONCLUSION: The rationale for excluding patients or for giving amphotericin in the perioperative period in those patients who are colonized before surgery is questioned.
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ranking = 1
keywords = bacterial infection
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