Coexistência de colonização fúngica intracavitária (bola fúngica) e tuberculose ativa

Abstract

Background: Although pulmonary tuberculosis is the principal predisposing factor for intracavitary fungal colonization, the coexistence of the two diseases is rare. Simultaneity of fungal colonization and active mycobacteriosis in the same cavity (acid-fast bacilli found among hyphal masses) is highly unusual.Objective: To describe clinical findings, diagnostic procedures, radiographic aspects, accompanying conditions and evolution in patients with tuberculosis and fungus ball.Method: We reviewed, retrospectively, the records of 625 patients diagnosed with fungus ball between 1974 and 2002. All of the patients had been diagnosed through immunodiffusion or mycological study, or both. The inclusion criterion was positivity for acid-fast bacilli in sputum smear microscopy or histopathology.Results: The charts of 14 patients were selected. All had presented hemoptysis, followed by productive cough, dyspnea, weight loss, fever, asthenia and chest pain. In one patient colonized by Aspergillus niger and in another colonized by Scedosporium apiospermum (Teleomorph, Pseudallescheria boydii), active tuberculosis was seen concomitant to the fungus ball. In the remaining cases, the mycobacteria were found in the adjacent parenchyma or in the contralateral lung. Conclusion:This study corrobates the assertion that antagonism exists between Mycobacterium tuberculosis and Aspergillus fumigatus. The potential for fungal colonization and mycobacteriosis to occur concomitantly is demonstrated in other fungal agents, S. apiospermum (P. boydii) and A. niger in particular.

Complex pulmonary aspergilloma treated by cavernostomy

“…Initially, the fungus adheres to the cavity wall, where it proliferates, but its own weight causes the detachment. Specific serology and cultures identify Aspergillus fumigatus in 98% of patients [5][6][7][16][17][18] . In our work, Aspergillus fumigatus was the etiologic agent in 16 cases and Aspergillus niger in one.…”

“…The presence of mycobacteria along with the fungal colonies is rare. Aspergillus fumigatus releases fumigalina, fumitoxin and gliotoxin, metabolites that inhibit the growth of Mycobacterium tuberculosis 5,6,9 . The most common clinical manifestation of the fungal ball is hemoptysis, of variable volume.…”

“…Several reports show that lung resections are associated with morbidity of 15%-78%, and mortality of 0%-44%. The discrepancies observed are mainly related to patient selection criteria, the extent of resection and the underlying lung disease [4][5][6][7] . Lung resection of a symptomatic intracavitary fungal ball is not always feasible in those with compromised pulmonary function and / or extensive bilateral pulmonary disease.…”