Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713


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Association between paracoccidioidomycosis and cancer

Associação entre paracoccidioidomicose e câncer

Gustavo da Silva Rodrigues, Cecília Bittencourt Severo, Flávio de Mattos Oliveira, José da Silva Moreira, João Carlos Prolla, Luiz Carlos Severo

J Bras Pneumol.2010;36(3):-

Abstract PDF PT PDF EN Portuguese Text

Objective: To analyze the association between paracoccidioidomycosis (Pcm) and cancer in a series of 25 cases and to review the literature on this topic. Methods: A retrospective review of 25 cases diagnosed with Pcm and cancer, retrieved from a series of 808 consecutive adult patients diagnosed with Pcm based on tests conducted in the Mycology Laboratory of the Santa Casa Complexo Hospitalar, in the city of Porto Alegre, Brazil, between 1972 and 2007. The diagnosis of Pcm was confirmed by means of direct microscopic examination, histopathological examination or immunodiffusion test. All cancer cases were confirmed by histopathological or cytopathological examination. Results: Respiratory symptoms were the principal complaints of the patients evaluated. Pulmonary involvement predominated, followed by skin and lymph node involvement. The most prevalent tumor was bronchial carcinoma, in 15 patients, followed by other types of carcinoma, and 1 patient had Hodgkin's lymphoma. In 16 patients (64%), the site of the Pcm was the same as that of the tumor. In most cases, Pcm treatment consisted of the isolated administration of sulfanilamide, sulfamethoxazole-trimethoprim, ketoconazole, itraconazole or amphotericin B. The most common treatment for cancer was surgery, followed by radiotherapy and chemotherapy. Of the 25 patients, 12 were cured of Pcm, and 4 died. In 9 patients, the final outcome was unknown. In the general population of the area under study, the prevalence of lung cancer was significantly higher in smokers with Pcm than in smokers without Pcm (p < 0.001). Conclusions: A diagnosis of Pcm appears to increase the risk of lung cancer.


Keywords: Paracoccidioides; Paracoccidioidomycosis; Neoplasms.


Aspergillus fumigatus fungus ball in the pleural cavity

Bola fúngica por Aspergillus fumigatus em cavidade pleural

Luciana Silva Guazzelli, Cecília Bittencourt Severo, Leonardo Santos Hoff, Geison Leonardo Fernandes Pinto, José Jesus Camargo, Luiz Carlos Severo

J Bras Pneumol.2012;38(1):125-132

Abstract PDF PT PDF EN Portuguese Text

Objective: To report the cases of 6 patients with fungus ball caused by Aspergillus fumigatus (aspergilloma) in the pleural cavity. Methods: Between 1980 and 2009, 391 patients were diagnosed with aspergilloma at the Santa Casa Hospital Complex in Porto Alegre, Brazil. The diagnosis of aspergilloma in the pleural cavity was made through imaging tests revealing effusion and pleural thickening with air-fluid level; direct mycological examination revealing septate hyphae, consistent with Aspergillus sp.; and positive culture for A. fumigatus in the surgical specimen from the pleural cavity. Results: Of the 391 patients studied, 6 (2%) met the established diagnostic criteria. The mean age of those 6 patients was 48 years (range, 29-66 years), and 5 (83%) were male. The most common complaints were cough, expectoration, and hemoptysis. Four patients (67%) had a history of tuberculosis that had been clinically cured. All of the patients were submitted to surgical removal of the aspergilloma, followed by intrapleural instillation of amphotericin B, in 4; and 2 received systemic antifungal treatment p.o. There was clinical improvement in 5 patients, and 1 died after the surgery. Conclusions: In adult patients with a history of cavitary lung disease or pleural fistula, a careful investigation should be carried out and fungal infection, especially aspergilloma, should be taken into consideration. In such cases, laboratory testing represents the most efficient use of the resources available to elucidate the diagnosis.


Keywords: Aspergillus fumigatus; Tuberculosis; Empyema, pleural; Pleural effusion.


Aspergillus fumigatus fungus ball in the native lung after single lung transplantation

Bola fúngica por Aspergillus fumigatus no pulmão nativo após transplante unilateral de pulmão

Fernando Ferreira Gazzoni, Bruno Hochhegger, Luiz Carlos Severo, José Jesus Camargo

J Bras Pneumol.2013;39(3):-

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Chapter 1 - Laboratory diagnosis of pulmonary mycoses

Capítulo 1 - Diagnóstico laboratorial das micoses pulmonares

Melissa Orzechowski Xavier, Flávio de Mattos Oliveira, Luiz Carlos Severo

J Bras Pneumol.2009;35(9):907-919

Abstract PDF PT PDF EN Portuguese Text

In this era of immunosuppression and transplantation, it is imperative that laboratory scientists remain in close communication with physicians. In patients receiving immunosuppressive therapy, the diagnosis of mycoses must be rapid, which is complicated, requiring the cooperation and collaboration of a number of professionals from various fields of expertise. In this paper, the laboratory diagnosis of pulmonary fungal infection is reviewed. The following topics are included: host factors such as immunological response and predisposing anatomical features; collection, transport and storage of specimens; laboratory processing of samples; direct microscopy; staining techniques, culture and identification of fungi; laboratory biosafety; tissue tropism and reactions; serology; and antigen detection.


Keywords: Mycology; Laboratories, hospital; Diagnostic techniques and procedures; Lung diseases, fungal.


Chapter 3 - Pulmonary cryptococcosis

Capítulo 3 - Criptococose pulmonar

Cecília Bittencourt Severo, Alexandra Flávia Gazzoni, Luiz Carlos Severo

J Bras Pneumol.2009;35(11):1136-1144

Abstract PDF PT PDF EN Portuguese Text

Cryptococcosis is a systemic mycosis caused by two species of the encapsulated basidiomycetes, Cryptococcus neoformans and C. gattii, which, respectively, cause infection in immunocompromised individuals and in immunologically normal hosts. Patients with T-cell deficiencies are more susceptible to this infection. The spectrum of the disease ranges from asymptomatic pulmonary lesions to disseminated infection with meningoencephalitis. The medical relevance of cryptococcosis increased dramatically as a consequence of the AIDS epidemic and organ transplants.


Keywords: Cryptococcus neoformans; Pneumonia; Acquired immunodeficiency syndrome; Amphotericin B; Fluconazole.


Chapter 7 - Zygomycosis

Capítulo 7 - Zigomicose

Cecília Bittencourt Severo, Luciana Silva Guazzelli, Luiz Carlos Severo

J Bras Pneumol.2010;36(1):134-141

Abstract PDF PT PDF EN Portuguese Text

Zygomycosis (mucormycosis) is a rare but highly invasive infection caused by fungi belonging to the order Mucorales, which includes the genera Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Saksenaea, Cunninghamella, Cokeromyces and Syncephalastrum. This type of infection is usually associated with hematologic diseases, diabetic ketoacidosis and organ transplantation. The most common form of presentation is rhinocerebral mucormycosis, with or without pulmonary involvement. Pulmonary zygomycosis is more common in patients with profound, prolonged neutropenia and can present as segmental or lobar infiltrates, isolated nodules, cavitary lesions, hemorrhage or infarction. The clinical and radiological manifestations are often indistinguishable from those associated with invasive aspergillosis. This article describes the general characteristics of pulmonary zygomycosis, emphasizing laboratory diagnosis, and illustrates the morphology of some lesions.


Keywords: Zygomycosis; Diagnostic techniques and procedures; Mucormycosis.


Coexistence of intracavitary fungal colonization (fungus ball) and active tuberculosis

Coexistência de colonização fúngica intracavitária (bola fúngica) e tuberculose ativa

Gisela Unis, Pedro Dornelles Picon, Luiz Carlos Severo

J Bras Pneumol.2005;31(2):139-143

Abstract PDF PT PDF EN Portuguese Text

Background: Although pulmonary tuberculosis is the principal predisposing factor for intracavitary fungal colonization, the coexistence of the two diseases is rare. Simultaneity of fungal colonization and active mycobacteriosis in the same cavity (acid-fast bacilli found among hyphal masses) is highly unusual. Objective: To describe clinical findings, diagnostic procedures, radiographic aspects, accompanying conditions and evolution in patients with tuberculosis and fungus ball. Method: We reviewed, retrospectively, the records of 625 patients diagnosed with fungus ball between 1974 and 2002. All of the patients had been diagnosed through immunodiffusion or mycological study, or both. The inclusion criterion was positivity for acid-fast bacilli in sputum smear microscopy or histopathology. Results: The charts of 14 patients were selected. All had presented hemoptysis, followed by productive cough, dyspnea, weight loss, fever, asthenia and chest pain. In one patient colonized by Aspergillus niger and in another colonized by Scedosporium apiospermum (Teleomorph, Pseudallescheria boydii), active tuberculosis was seen concomitant to the fungus ball. In the remaining cases, the mycobacteria were found in the adjacent parenchyma or in the contralateral lung. Conclusion: This study corrobates the assertion that antagonism exists between Mycobacterium tuberculosis and Aspergillus fumigatus. The potential for fungal colonization and mycobacteriosis to occur concomitantly is demonstrated in other fungal agents, S. apiospermum (P. boydii) and A. niger in particular.


Keywords: Key words: Aspergillosis. Aspergillus fumigatus. Aspergillus niger. Pseudallescheria. Mycobacterium tuberculosis. Scedosporium apiospermum.


Acute pulmonary histoplasmosis in the state of Rio Grande do Sul, Brazil

Histoplasmose pulmonar aguda no Rio Grande do Sul

Gisela Unis, Eliane Wurdig Roesch, Luiz Carlos Severo

J Bras Pneumol.2005;31(1):-

Abstract PDF PT PDF EN Portuguese Text

Background: Acute pulmonary histoplasmosis is a respiratory infection occurring when an otherwise healthy individual inhales a large quantity of fungal propagules. Length of exposure determines disease severity. An epidemic is influenced by factors affecting the growth and transmission of Histoplasma capsulatum var. capsulatum in nature. Objective: To identify epidemiological and clinical aspects of patients with acute pulmonary histoplasmosis in the state of Rio Grande do Sul (RS) and compare these aspects with those of other cluster outbreaks reported in Brazil. Method: The charts of 212 patients diagnosed with histoplasmosis over a 25-year period (1977-2002) were obtained from the archives of the Laboratório de Micologia from Complexo Hospitalar Santa Casa (Santa Casa Hospital Mycology Laboratory), in the city of Porto Alegre (RS). In reviewing these patient charts, we identified and included in the study cases of acute pulmonary histoplasmosis in which there was a positive culture and/or histopathological findings consistent with the diagnosis. Outbreaks were defined as one confirmed case or positive immunodifusion Histoplasma capsulatum with compatible clinical history. All reported Brazilian outbreaks were reviewed. Results: Of the 212 patient charts reviewed, 18 (8.5%) were selected for inclusion in the study. Among those 18 patients, ages ranged from 8 to 63 years (median, 35.4), and 67% were male. Epidemiological histories were suggestive of the disease in 11 patients (61%). The most common disease type, seen in 17 patients (95%), was primary acute pulmonary histoplasmosis, and there was a predominance of isolated cases. Conclusion: The identification of isolated cases and the presence of cluster outbreaks demonstrate the abundance of H. capsulatum in the soil and, together with the occurrence of all forms of the disease, confirms the assumption that Rio Grande do Sul is a hyperendemic region for histoplasmosis.


Keywords: Key words - Histoplasmosis/epidemiology. Histoplasmosis/diagnostic. Histoplasma. Medical records. Retrospective studies.


Chronic pulmonary histoplasmosis mimicking tuberculosis

Histoplasmose pulmonar cavitária crônica simulando tuberculose

Gisela Unis, Luiz Carlos Severo

J Bras Pneumol.2005;31(4):318-324

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate cases of chronic pulmonary histoplasmosis diagnosed in recent years at the Complexo Hospitalar Santa Casa in Porto Alegre, in the state of Rio Grande do Sul, Brazil. Methods: Cases diagnosed at the Santa Casa Hospital Complex within the last 25 years were reviewed. Four cases in which the diagnosis was made through histopathological analysis or culture and confirmed by with serologic testing are described. Cases from the Brazilian literature are also discussed. Results: The principal clinical manifestations were cough, dyspnea, fever, anorexia and weight loss. Among the radiological findings were emphysema, cystic cavities, bronchiectasis and pleural thickening. All patients had an epidemiological history of contact with chicken feces. One of the patients presented Aspergillus fumigatus colonization of cavities. Conclusion: Chronic pulmonary histoplasmosis must be considered in patients with chronic obstructive pulmonary disease presenting cavitary lesions of the lung, sputum smear microscopy negative for acid-fast bacilli and negative tuberculin skin test. Hemoptysis occurring in the presence of cured or fading pulmonary lesions is suggestive of Aspergillus colonization.


Keywords: Histoplasmosis/diagnosis; Histoplasmosis/drug therapy; Histoplasma/isolation & purification; Tuberculosis, pulmonary/diagnosis; Itraconazole/drug therapy; Sputum/microbiology; Diagnosis, Differential


Histoplasmosis mimicking primary lung cancer or pulmonary metastases

Histoplasmose simulando neoplasia primária de pulmão ou metástases pulmonares

Aline Gehlen Dall Bello, Cecilia Bittencourt Severo, Luciana Silva Guazzelli, Flavio Mattos Oliveira, Bruno Hochhegger, Luiz Carlos Severo

J Bras Pneumol.2013;39(1):63-68

Abstract PDF PT PDF EN

Objective: To describe the main clinical and radiological characteristics of patients with histoplasmosis mimicking lung cancer. Methods: This was a retrospective descriptive study based on the analysis of the medical records of the 294 patients diagnosed with histoplasmosis between 1977 and 2011 at the Mycology Laboratory of the Santa Casa Sisters of Mercy Hospital of Porto Alegre in the city of Porto Alegre, Brazil. The diagnosis of histoplasmosis was established by culture, histopathological examination, or immunodiffusion testing (identification of M or H precipitation bands). After identifying the patients with macroscopic lesions, as well as radiological and CT findings consistent with malignancy, we divided the patients into two groups: those with a history of cancer and presenting with lesions mimicking metastases (HC group); and those with no such history but also presenting with lesions mimicking metastases (NHC group). Results: Of the 294 patients diagnosed with histoplasmosis, 15 had presented with lesions mimicking primary neoplasia or metastases (9 and 6 in the HC and NHC groups, respectively). The age of the patients ranged from 13 to 67 years (median, 44 years). Of the 15 patients, 14 (93%) presented with pulmonary lesions at the time of hospitalization. Conclusions: The clinical and radiological syndrome of neoplastic disease is not confined to malignancy, and granulomatous infectious diseases must therefore be considered in the differential diagnosis.


Keywords: Histoplasmosis; Multiple pulmonary nodules; Solitary pulmonary nodule.


Pulmonary Rhodococcus equi infection: report of the first two Brazilian cases

Infecção pulmonar por "Rhodococcus equi": relato dos dois primeiros casos brasileiros

Luiz Carlos Severo, Patricia Ritter, Victor Flávio Petrillo, Cícero Armídio Gomes Dias, Nelson da Silva Porto

J Bras Pneumol.2001;27(3):-

Abstract PDF PT

Rhodococcus equi, the principal agent of rhodococcosis, is a pleomorphic, gram-positive, aerobic coccus bacillus that infects humans by inhalation or through a transcutaneous route. It is clinically manifested as a pulmonary abscess. The first two Brazilian cases of rhodococcosis are reported on. Both patients were immunocompromised and showed pulmonary infection. The first patient had AIDS and cavitating pneumonia in the left upper lobe, that was fatal. The second case presented Goodpasture syndrome and was under chronic corticotherapy. He displayed a cavitating nodular lesion in the right upper lobe, that was successfully treated with sulfametoxazol-trimethoprim.


Keywords: Actinomycetal infections. Pulmonary tuberculosis. Acquired immunodeficiency syndrome. Goodpasture syndrome. Brazil.


An outbreak of histoplasmosis in the city of Blumenau, Santa Catarina

Microepidemia de histoplasmose em Blumenau, Santa Catarina

Flávio de Mattos Oliveira, Gisela Unis, Luiz Carlos Severo

J Bras Pneumol.2006;32(4):375-378

Abstract PDF PT PDF EN Portuguese Text

Acute pulmonary histoplasmosis is rarely diagnosed and is often confused with tuberculosis. Most knowledge of the disease has been derived from descriptions of epidemics in which a number of individuals were exposed to the same source of infection. Isolation of Histoplasma capsulatum var. capsulatum from soil samples is conclusive evidence of an epidemic focus. This is the first report of an outbreak of histoplasmosis, in which two cases were reported and the fungus was isolated at the focus of the epidemic, in the state of Santa Catarina. Further epidemiological studies are needed in order to determine the prevalence of the infection statewide.


Keywords: Histoplasmosis/diagnosis; Histoplasmosis/epidemiology; Histoplasma/isolation & purification; Lung disases, fungal; Disease outbreaks; Case reports [publication type]


The halo sign: HRCT findings in 85 patients

Sinal do halo: achados de TCAR em 85 pacientes

Giordano Rafael Tronco Alves1, Edson Marchiori1, Klaus Irion2, Carlos Schuler Nin3, Guilherme Watte3, Alessandro Comarú Pasqualotto3, Luiz Carlos Severo3, Bruno Hochhegger1,3

J Bras Pneumol.2016;42(6):435-439

Abstract PDF PT PDF EN Portuguese Text

Objective: The halo sign consists of an area of ground-glass opacity surrounding pulmonary lesions on chest CT scans. We compared immunocompetent and immunosuppressed patients in terms of halo sign features and sought to identify those of greatest diagnostic value. Methods: This was a retrospective study of CT scans performed at any of seven centers between January of 2011 and May of 2015. Patients were classified according to their immune status. Two thoracic radiologists reviewed the scans in order to determine the number of lesions, as well as their distribution, size, and contour, together with halo thickness and any other associated findings. Results: Of the 85 patients evaluated, 53 were immunocompetent and 32 were immunosuppressed. Of the 53 immunocompetent patients, 34 (64%) were diagnosed with primary neoplasm. Of the 32 immunosuppressed patients, 25 (78%) were diagnosed with aspergillosis. Multiple and randomly distributed lesions were more common in the immunosuppressed patients than in the immunocompetent patients (p < 0.001 for both). Halo thickness was found to be greater in the immunosuppressed patients (p < 0.05). Conclusions: Etiologies of the halo sign differ markedly between immunocompetent and immunosuppressed patients. Although thicker halos are more likely to occur in patients with infectious diseases, the number and distribution of lesions should also be taken into account when evaluating patients presenting with the halo sign.


Keywords: Tomography, X-ray computed; Aspergillosis; Lung neoplasms.




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