Adhikari Aayush, Khanal Surendra, Magar Sagar Rana, Thapa Srijana, Khati Srijana, Lamichhane Rajan, Marasini Kundan
Manang District Hospital, Chame, Nepal.
Department of Internal Medicine, Piedmont Athens Regional, Athens, Georgia, USA.
Case Rep Infect Dis. 2023 Jul 14;2023:6975041. doi: 10.1155/2023/6975041. eCollection 2023.
Aspergilloma (a saprophytic infection) typically colonizes lung cavities due to underlying diseases such as tuberculosis, bronchiectasis, cavitary lung cancer, sarcoidosis, and pulmonary infarctions. Rarely, aspergilloma has been noted within a hydatid cyst. Even if this was the case, it is more common to find the coexistence of aspergilloma and pulmonary echinococcal cysts in immunocompromised individuals. It is, however, very uncommon to find this coinfection in normal immune status individuals. Here, we report on the successfully treated case of a 30-year-old immunocompetent female from Western Nepal with histologically proven coinfection by these two pathogens. She had a prolonged history of exposure to domesticated dogs. She suffered from hemoptysis from time to time for 3 years with increased frequency in the last 30 days. She was misdiagnosed clinically during a past medical visit at a local health center. Her computed tomography (CT) scans showed well-defined nonenhancing cystic lesions in the anterior basal segment of the right lower lobe adjacent to the major fissure. She underwent enucleation of the cyst via right posterolateral thoracotomy. On further histopathological evaluation, laminated membranes of the ectocyst along with fungal elements were found, and periodic acid-Schiff (PAS) staining revealed Aspergillus in the form of septate hyphae and acute angle branching. Owing to patient's economic constraints and unavailability in our center, DNA testing and molecular characterization could not be performed which further highlights the essence of diagnosing and managing such cases in resource poor settings. Eventually, we reviewed 12 confirmed cases of this coinfection in immunocompetent individuals during a period of 7 years (2015-2022) comparing them to a systematic review of 22 confirmed cases of the same coinfection from 1995 to 2014.
曲菌球（一种腐生性感染）通常因潜在疾病（如肺结核、支气管扩张、空洞性肺癌、结节病和肺梗死）而在肺空洞中定植。曲菌球很少出现在包虫囊肿内。即便如此，在免疫功能低下的个体中，曲菌球与肺棘球蚴囊肿并存更为常见。然而，在免疫功能正常的个体中发现这种混合感染非常罕见。在此，我们报告一例来自尼泊尔西部的30岁免疫功能正常女性的成功治疗病例，其经组织学证实同时感染了这两种病原体。她有长期接触家养犬的病史。她间歇性咯血3年，在过去30天内咯血频率增加。她在当地卫生中心的一次既往就诊中被临床误诊。她的计算机断层扫描（CT）显示右下叶前基底段靠近主裂处有边界清晰的无强化囊性病变。她通过右后外侧开胸手术进行了囊肿摘除术。进一步的组织病理学评估发现，外囊的分层膜以及真菌成分，过碘酸希夫（PAS）染色显示曲霉菌呈分隔菌丝和锐角分支形式。由于患者经济受限且我院无法进行相关检测，未能进行DNA检测和分子特征分析，这进一步凸显了在资源匮乏地区诊断和管理此类病例的重要性。最终，我们回顾了7年（2015 - 2022年）期间12例免疫功能正常个体的这种混合感染确诊病例，并将其与1995年至2014年22例相同混合感染确诊病例的系统评价进行比较。
