Coinfection of Pulmonary Hydatid Cyst and Aspergilloma: Case Report and Systematic Review

Abstract

Aspergilloma infection consists of a mass of fungal hyphae, inflammatory cells, fibrin, mucus, and tissue debris and can colonize lung cavities due to underlying diseases such as tuberculosis, sarcoidosis, bronchiectasis, cavitary lung cancer, neoplasms, ankylosing spondylitis, bronchial cysts, and pulmonary infarction. Here we report coinfection of pulmonary hydatid cyst and aspergilloma in a 34-year-old female who had had history of minor thalassemia and suffered from chest pain, dyspnea, non-productive cough for at least five months, and hemoptysis for 20 days. Radiographic sign showed a large cavitary lesion (5 × 6 × 6 cm) involving left lower lobe (LLL). Dichotomous septate hyphae were observed in bronchoalveolar lavage and biopsy specimens from LLL. The patient subsequently improved after combined anti-helminth therapies with albendazole (400 mg/bd) and lobectomy. According to morphological and molecular characterization, Aspergillus niger was confirmed. In vitro antifungal susceptibility tests revealed that the MIC values for the antifungals used in this case in increasing order were posaconazole (0.125 µg/ml), itraconazole and voriconazole (0.5 µg/ml), and amphotericin B (1 µg/ml). The minimum effective concentration for caspofungin was 0.125 µg/ml. Subsequently, we systematically reviewed 22 confirmed cases of pulmonary hydatid cyst and aspergilloma during a period of 19 years (1995-2014) and discussed the epidemiology, clinical features, and treatment of this disease.

Cystic echinococcosis: An attraction for fungal and bacterial pulmonary infections

“…Currently, there is no generally accepted duration of antifungal treatment in cases of coexisting aspergilloma and pulmonary HC with no surgical treatment (19). This is partially due to the fact that majority of reported cases are diagnosed retrospectively after surgical removal of the cyst (7,8,17,20). Further reporting of similar coinfected, surgically untreatable cases will contribute to a better management of these patients.…”

Coexistencia de aspergilosis e hidatidosis pulmonar. Reporte de un caso

“…En un estudio de 100 casos con diagnóstico de quiste hidatídico, solamente en dos pacientes presentaron esta coexistencia (8) . En Perú es el primer caso documentado; se han hecho reportes de la coexistencia de aspergilosis en casos de tuberculosis pulmonar (7,(9)(10)(11) ; como el reportado por Arce en 14 pacientes con tuberculosis en la región de Ica (9) . En el reporte se tuvieron dos resultados positivos de Western blot dado que la paciente tenía hidatidosis hepática y pulmonar.…”

“…Aspergillus es un hongo saprofítico, se han identificado alrededor de 200 especies, sin embargo, muy pocas especies causan enfermedad en humanos, el Aspergillus fumigatus es la especie patógena más común. La presencia de lesiones cavitarias en el pulmón es un factor predisponente para la infección por Aspergillus, que tiende a crecer en áreas con tejido desvitalizado y sus factores predisponentes son la inmunodeficiencia y alteraciones en el sistema pulmonar (7,8) .…”

“…La infección consiste en una masa de hifas fúngicas, células inflamatorias, fibrina, moco y restos de tejido y puede colonizar el pulmón debido a enfermedades subyacentes tales como tuberculosis, sarcoidosis, bronquiectasias, bullas, cáncer de pulmón cavitario, neoplasias, espondilitis anquilosante, quistes bronquiales, infarto pulmonar, etc. (7) . El hígado y los pulmones son los sitios más comunes de esta infección.…”

Invasive Pulmonary Aspergillosis in Patients with Non-Decompensated Liver Cirrhosis: A Case Report

“…Subsequently, molecular tests were performed for accurate identification of Aspergillus fumigatus. Briefly, DNA was extracted from the colony using homogenization by glass beads followed by phenol-chloroform purification, as described previously (5,6). Polymerase chain reaction (PCR) amplification of the β-tubulin gene was performed using the primers B2a (5'-GGTAACCAAATCGGTGCTTTC-3') and B2b ('5-ACCCTCAGTGTAGTGACCCTTGGC-3') with cycles of five minutes at 94°C for primary denaturation, followed by 35 cycles at 94°C (60 seconds), 58°C (30 seconds), and 72°C (80 seconds), with a final seven-minutes extension step at 72°C.…”