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Journal of Fungi (Basel, Switzerland) Feb 2023, the etiological agent for histoplasmosis, is a dimorphic fungus that grows as a mold in the environment and as a yeast in human tissues. The areas of highest... (Review)
Review
, the etiological agent for histoplasmosis, is a dimorphic fungus that grows as a mold in the environment and as a yeast in human tissues. The areas of highest endemicity lie within the Mississippi and Ohio River Valleys of North America and parts of Central and South America. The most common clinical presentations include pulmonary histoplasmosis, which can resemble community-acquired pneumonia, tuberculosis, sarcoidosis, or malignancy; however, certain patients can develop mediastinal involvement or progression to disseminated disease. Understanding the epidemiology, pathology, clinical presentation, and diagnostic testing performance is pivotal for a successful diagnosis. While most immunocompetent patients with mild acute or subacute pulmonary histoplasmosis should receive therapy, all immunocompromised patients and those with chronic pulmonary disease or progressive disseminated disease should also receive therapy. Liposomal amphotericin B is the agent of choice for severe or disseminated disease, and itraconazole is recommended in milder cases or as "step-down" therapy after initial improvement with amphotericin B. In this review, we discuss the current epidemiology, pathology, diagnosis, clinical presentations, and management of pulmonary histoplasmosis.
PubMed: 36836350
DOI: 10.3390/jof9020236 -
Forensic Science, Medicine, and... Sep 2018Although death from food is not an uncommon finding in forensic facilities worldwide, the range of underlying lethal mechanisms and associated conditions that should be... (Review)
Review
Although death from food is not an uncommon finding in forensic facilities worldwide, the range of underlying lethal mechanisms and associated conditions that should be sought at the time of autopsy is quite disparate. Deaths may occur from i) infectious agents including bacteria, viruses, protozoa, cestodes, nematodes and prions; ii) natural toxins including amanita toxins, tetrodotoxin, ciguatera and scombroid; iii) anaphylaxis; iv) poisoning; v) mechanical issues around airway and gut obstruction and/or perforation; and vi) miscellaneous causes. Food-related deaths are important in terms of global mortality, and thus autopsies need to be comprehensive with full ancillary testing. Medicolegal matters may involve issues concerning likely exposure to infectious agents, possible foods ingested, the declared content and possible components of food, the significance of toxicological analyses, and aspects of duty of care in cases of café coronary syndrome and gastroenteritis while in care.
Topics: Airway Obstruction; Anaphylaxis; Esophageal Perforation; Food; Food Hypersensitivity; Food Microbiology; Foodborne Diseases; Forensic Medicine; Humans; Mediastinal Diseases; Obesity; Pica; Prader-Willi Syndrome
PubMed: 28710688
DOI: 10.1007/s12024-017-9899-9 -
Open Forum Infectious Diseases May 2024This study aimed to characterize the demographics, microbiology, management and treatment outcomes of mediastinitis according to the origin of the infection.
BACKGROUND
This study aimed to characterize the demographics, microbiology, management and treatment outcomes of mediastinitis according to the origin of the infection.
METHODS
This retrospective observational study enrolled patients who had mediastinitis diagnosed according to the criteria defined by the Centers for Disease Control and Prevention and were treated in Strasbourg University Hospital, France, between 1 January 2010 and 31 December 2020.
RESULTS
We investigated 151 cases, including 63 cases of poststernotomy mediastinitis (PSM), 60 cases of mediastinitis due to esophageal perforation (MEP) and 17 cases of descending necrotizing mediastinitis (DNM). The mean patient age (standard deviation) was 63 (14.5) years, and 109 of 151 patients were male. Microbiological documentation varied according to the origin of the infection. When documented, PSM cases were mostly monomicrobial (36 of 53 cases [67.9%]) and involved staphylococci (36 of 53 [67.9%]), whereas MEP and DNM cases were mostly plurimicrobial (38 of 48 [79.2%] and 8 of 12 [66.7%], respectively) and involved digestive or oral flora microorganisms, respectively. The median duration of anti-infective treatment was 41 days (interquartile range, 21-56 days), and 122 of 151 patients (80.8%) benefited from early surgical management. The overall 1-year survival rate was estimated to be 64.8% (95% confidence interval, 56.6%-74.3%), but varied from 80.1% for DNM to 61.5% for MEP.
CONCLUSIONS
Mediastinitis represents a rare yet deadly infection. The present cohort study exhibited the different patterns observed according to the origin of the infection. Greater insight and knowledge on these differences may help guide the management of these complex infections, especially with respect to empirical anti-infective treatments.
PubMed: 38751899
DOI: 10.1093/ofid/ofae225 -
Current Health Sciences Journal 2017Cysts of the mediastinum, which are benign masses, are usually detected by chance, and constitute a small but important diagnose group, representing 7 to 18% of all...
INTRODUCTION
Cysts of the mediastinum, which are benign masses, are usually detected by chance, and constitute a small but important diagnose group, representing 7 to 18% of all primary mediastinal tumors. Pleuropericardial cysts, located most frequently in the left anterior and inferior mediastinum, are identified in the fourth or fifth decade of life affecting females more than males with a sex ratio of 8:4.
MATERIAL AND METHOD
We present the case of a 52 year old woman diagnosed with pericardial cyst located in the left cardiophrenic angle. CPP was rather big and was initially diagnosed as encysted pleurisy. Ultrasound guided exploratory thoracentesis was performed evacuating 300 ml "water spring" like fluid very scarce in cells. We further investigated our patient for differential diagnosis but the patient refused surgery and she is now managed conservatively with a close follow-up.
CONCLUSIONS
A pericardial cyst should always be suspected when a cystic lesion is detected in the mediastinum. Pleuropericardial cysts are usually suspected after an abnormal chest X-ray is obtained. If the patient is asymptomatic and the information provided by CT indicates a benign tumoral process suggestive for a pleuropericardial cyst, conservative management with careful follow-up is justified.
PubMed: 30595860
DOI: 10.12865/CHSJ.43.01.13 -
European Journal of Case Reports in... 2020The serological prevalence of Epstein-Barr virus (EBV) among young adults exceeds 90% worldwide. Even though EBV primary infection is usually benign, severe...
UNLABELLED
The serological prevalence of Epstein-Barr virus (EBV) among young adults exceeds 90% worldwide. Even though EBV primary infection is usually benign, severe complications can occur in adolescents and young adults and so the disease must be promptly diagnosed. The development of an oropharyngeal abscess leading to a descending necrotizing mediastinitis (DNM) is exceptional and potentially lethal, so early diagnosis with a CT scan, appropriate antibiotics and surgery are essential. The authors present a case where DNM was associated with reactive hemophagocytic syndrome as a result of infectious mononucleosis, as well as a review of similar cases in the English literature.
LEARNING POINTS
The incidence of serious complications in Epstein-Barr virus (EBV) primary infection increases with age.Respiratory symptoms (e.g., pleuritic pain, dyspnoea) and unusually prolonged fever (>10 days) in patients with infectious mononucleosis could be 'red flags' for life-threatening complications such as empyema and descending necrotizing mediastinitis.The threshold for performing cervical and chest computed tomography in septic patients with infectious mononucleosis should be low.
PubMed: 33194856
DOI: 10.12890/2020_001829 -
Seminars in Interventional Radiology Dec 2012Infectious, traumatic, or neoplastic processes in the chest often result in fluid collections within the pleural, parenchymal, or mediastinal spaces. The same... (Review)
Review
Infectious, traumatic, or neoplastic processes in the chest often result in fluid collections within the pleural, parenchymal, or mediastinal spaces. The same fundamental principles that guide drainages of the abdomen can be applied to the chest. This review discusses various pathologic conditions of the thorax that can result in the abnormal accumulation of fluid or air, and their management using image-guided methods.
PubMed: 24293797
DOI: 10.1055/s-0032-1330058 -
Infection and Drug Resistance 2018Deep sternal wound infection (DSWI), also known as mediastinitis, is a serious and potentially fatal condition. The diagnosis and treatment of DSWI are challenging. In... (Review)
Review
Deep sternal wound infection (DSWI), also known as mediastinitis, is a serious and potentially fatal condition. The diagnosis and treatment of DSWI are challenging. In this current narrative review, the epidemiology, risk factors, diagnosis, and surgical and antimicrobial management of DSWI are discussed. Ideally, the management of DSWI requires early and sufficient surgical debridement and appropriate antibiotic therapy. When foreign material is present, biofilm-active antibiotic therapy is also needed. Because DSWI is often complex, the management requires the involvement of a multidisciplinary team consisting of cardiothoracic surgeons, plastic surgeons, intensivists, infectious disease specialists, and clinical microbiologists.
PubMed: 30038509
DOI: 10.2147/IDR.S130172 -
Respirology (Carlton, Vic.) Jul 2019
Topics: Endoscopic Ultrasound-Guided Fine Needle Aspiration; Humans; Lymphadenopathy; Polymerase Chain Reaction; Tuberculosis, Lymph Node
PubMed: 30897268
DOI: 10.1111/resp.13536 -
Lung India : Official Organ of Indian... 2022To identify specific characteristics, distribution and associated findings of lesions causing secondary spontaneous pneumothorax (SSP).
OBJECTIVES
To identify specific characteristics, distribution and associated findings of lesions causing secondary spontaneous pneumothorax (SSP).
METHODS
Computed tomography (CT) chest of 37 patients (between October 2011 and January 2020) was evaluated by two radiologists. They were classified into 'Infectious' and 'Non-infectious' groups, based on cause of pneumothorax. A scoring system (score 0-10) was proposed based on parameters which were statistically significant.
RESULTS
Out of 37 patients with pneumothorax, 18 could be attributed to infectious aetiology and remaining 19 were due to noninfectious causes. The most common infectious cause of spontaneous pneumothorax was tuberculosis and noninfectious cause was chronic obstructive airway disease (COAD). Statistically significant difference was found for lesion wall thickness and presence of solid component between these two groups. No significant difference was found between both groups when comparing age, gender, lesion size and lesion distribution. The presence of pleural thickening, consolidation and mediastinal lymphadenopathy were statistically significant. Pleural effusion was never present in the noninfectious group. The area under receiver operating characteristic for differentiating patients in the two groups was 0.931 (standard error, 0.038; 95% CI, 0.856-1.000), and optimal threshold score for identifying patients with infectious causes was 4.5, with 77.8% sensitivity and 89.5% specificity.
CONCLUSION
Pneumothorax is almost equally common due to infectious and noninfectious causes. The most common infectious cause of spontaneous pneumothorax was tuberculosis and noninfectious cause was COAD. Based on certain CT findings, we have proposed a scoring system to differentiate between these two groups.
PubMed: 35848662
DOI: 10.4103/lungindia.lungindia_282_21