Teshon A, Reyes R, Schammel D P, Corso O, Schammel C, Kent P, Devane A M
1University of South Carolina School of Medicine Greenville, Greenville SC, USA.
2Pathology Associates, Greenville SC, USA.
Eur J Microbiol Immunol (Bp). 2024 May 13;14(3):296-307. doi: 10.1556/1886.2024.00043. Print 2024 Sep 11.
Acquired benign tracheoesophageal fistulas and bronchoesophageal fistulas (TEF) are typically associated with granulomatous mediastinal infections, 75% of which are iatrogenic. Candida albicans and Actinomyces are commonly occurring organisms, but are uncommon etiologies of TEF. Normal colonization and the slow growth characteristics of some species of these agents rarely result in infection, mycetoma, and broncholithiasis, and thus, delays in diagnosis and treatment are likely. Few reports describe C. albicans or Actinomyces spp. as the etiology of TEF or broncholithiasis. Herein, we report a case of benign acquired TEF secondary to coinfection of Candida and Actinomyces complicated by the formation of an actinomycetoma and broncholithiasis and a comprehensive literature review to highlight the unique nature of this presentation and offer a diagnostic algorithm for diagnosis and treatment of TEFs. Following a presentation of three months of productive cough, choking sensation, night sweats, and weight loss, a bronchoscopy revealed a fistulous connection between the esophagus and the posterior right middle lobe. Pathology identified a calcified fungus ball and a broncholith secondary to the co-infection of Candida and Actinomyces. This unique presentation of Candida and Actinomyces co-infection and the associated diagnostic algorithm are presented as education and a useful tool for clinicians.
获得性良性气管食管瘘和支气管食管瘘（TEF）通常与肉芽肿性纵隔感染有关，其中75%为医源性。白色念珠菌和放线菌是常见的病原体，但却是TEF不常见的病因。这些病原体的某些种类的正常定植和缓慢生长特性很少导致感染、足菌肿和支气管结石，因此，诊断和治疗可能会延迟。很少有报告将白色念珠菌或放线菌属描述为TEF或支气管结石的病因。在此，我们报告一例继发于念珠菌和放线菌合并感染的良性获得性TEF病例，该病例并发放线菌性足菌肿和支气管结石形成，并进行全面的文献综述，以突出这种表现的独特性质，并提供TEF诊断和治疗的诊断算法。在出现三个月的咳痰、哽咽感、盗汗和体重减轻症状后，支气管镜检查发现食管与右中肺叶后部之间存在瘘管连接。病理检查发现一个钙化的真菌球和一个继发于念珠菌和放线菌合并感染的支气管结石。念珠菌和放线菌合并感染的这种独特表现以及相关的诊断算法作为对临床医生的教育内容和有用工具呈现。
