Fundación Valle del Lili, Cali, Colombia.
Universidad Icesi, Cali, Colombia.
J Investig Med High Impact Case Rep. 2023 Jan-Dec;11:23247096231175443. doi: 10.1177/23247096231175443.
Infection by covers a broad clinical spectrum, including invasive pulmonary aspergillosis (IPA) and its disseminated extrapulmonary form, invasive aspergillosis (IA). It typically occurs in severely immunocompromised hosts, but it sometimes affects the immunocompetent population, especially patients with acute diseases being treated at the intensive care unit (ICU) and less often those with chronic conditions. In this article, we report the case of a 50-year-old male, with diabetes mellitus (DM) as the only risk factor, treated for IPA and IA with cardiac and central nervous system (CNS) involvement at a high complexity institution in Cali-Colombia. Clinical presentation and radiological findings are unspecific and require a high level of suspicion. To confirm the case, histological or cytological of the fungus is required; histopathological examination of lung tissue is the gold standard, but it is difficult to perform due to respiratory compromise and high risk of bleeding, so bronchoscopy and bronchoalveolar lavage (BAL) plays an essential role in the diagnostic process. A diagnostic algorithm that includes risk assessment, symptoms, imaging findings, and isolation in cultures is essential to allow the diagnosis and initiation of treatment promptly, which includes a combination of surgery and antifungal medications for long periods, even life-long treatment.
曲霉属感染涵盖广泛的临床谱,包括侵袭性肺曲霉病(IPA)及其播散性肺外形式,侵袭性曲霉病(IA)。它通常发生在严重免疫功能低下的宿主中,但有时也会影响免疫功能正常的人群,特别是在重症监护病房(ICU)接受治疗的急性疾病患者,较少见于患有慢性疾病的患者。在本文中,我们报告了一例 50 岁男性患者的病例,他患有糖尿病(DM)这一唯一的危险因素,在哥伦比亚卡利的一家高复杂度机构中接受 IPA 和 IA 的治疗,合并心脏和中枢神经系统(CNS)受累。临床表现和影像学表现缺乏特异性,需要高度怀疑。为了确诊,需要真菌的组织学或细胞学检查;肺组织的组织病理学检查是金标准,但由于呼吸窘迫和高出血风险,难以进行,因此支气管镜检查和支气管肺泡灌洗(BAL)在诊断过程中起着至关重要的作用。一个包括风险评估、症状、影像学发现和培养物分离的诊断算法对于及时诊断和开始治疗至关重要,治疗包括手术和抗真菌药物的联合使用,治疗时间长,甚至可能需要终身治疗。