Cavitary pulmonary coccidioidomycosis: pathologic and clinical correlates of disease.
ABSTRACT Cavitary pulmonary coccidioidomycosis is a difficult diagnosis to establish due to the poor sensitivity of serological tests and rarity of culture from sputum. A pathologic and clinical analysis was performed of 21 consecutive patients with surgically resected cavities that proved to be coccidioidomycosis. Ten patients (48%) had serological evidence of Coccidioides infection, and 1 patient cultured Coccidioides spp. from sputum. The definitive diagnosis of coccidioidomycosis was made in the remaining 10 patients (48%) upon microscopic examination of tissue. The pleura showed fibrous pleuritis in 7 patients (33%) and eosinophilic pleuritis in 4 cases (19%); granulomas without microorganisms were demonstrated in 4 cases (19%). The cavity wall showed chronic inflammation and occasional giant cells but no granulomas and no microorganisms. The cavity contents included a mycetoma in 6 cases (28%); the cavity lining showed neutrophils and caseous necrosis; Coccidioides hyphae were present in 13 (62%) and spherules in 16 (76%) cases but often were rare. Adjacent lung showed lymphoid hyperplasia with chronic bronchiolitis in all cases; satellite granulomas with diagnostic spherules were variably present. The histopathology of cavitary coccidioidomycosis is strikingly variable depending on what area is sampled by biopsy, and microorganisms may be rare. This may explain the high rate of failure of diagnosis by fine needle aspiration and bronchoalveolar lavage. Pathologists in nonendemic areas must be aware of these findings, as this disease is now diagnosed worldwide.
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Article: Cavitary pulmonary disease.[Show abstract] [Hide abstract]
ABSTRACT: A pulmonary cavity is a gas-filled area of the lung in the center of a nodule or area of consolidation and may be clinically observed by use of plain chest radiography or computed tomography. Cavities are present in a wide variety of infectious and noninfectious processes. This review discusses the differential diagnosis of pathological processes associated with lung cavities, focusing on infections associated with lung cavities. The goal is to provide the clinician and clinical microbiologist with an overview of the diseases most commonly associated with lung cavities, with attention to the epidemiology and clinical characteristics of the host.Clinical microbiology reviews 05/2008; 21(2):305-33, table of contents. · 16.00 Impact Factor
Article: Coccidioidal pulmonary cavitation.[Show abstract] [Hide abstract]
ABSTRACT: 1.1. Seventy-seven cases of coccidioidal pulmonary cavitation have been summarized.2.2. Cavitation is found in about 1 to 3 per cent of hospitalized patients with coccidioidomycosis, or about 0.1 per cent of all patients with this disease.3.3. Fifty-eight per cent of the group were asymptomatic and the condition was detected on routine chest x-ray films.4.4. Eighty-six per cent of patients had a single cavity and 14 per cent had multiple cavities. Fifty-eight per cent were in the right lung, 42 per cent in the left lung, and three patients had bilateral cavities.5.5. Only 57 per cent of the patients in the present series had positive coccidioidin skin tests. Sixty-four per cent had positive complement fixation antibodies in varying degrees.6.6. Non-surgical and surgical management of coccidioidal pulmonary cavities has been compared. In the former group, half of the cavities closed spontaneously. Most patients were asymptomatic but 22 per cent of this group had bleeding, usually slight, at some time. No new cavities developed.7.7. In the surgical group most were asymptomatic, although 30 per cent gave a history of bleeding. There were no deaths but in 29 per cent of the patients with resection, bronchopleural fistulas with empyema developed and twenty additional surgical procedures were required. Furthermore, new cavities appeared postoperatively in 20 per cent of the patients who underwent resection.8.8. On the basis of the aforementioned data, a conservative, non-surgical regimen appears most desirable for coccidioidal pulmonary cavity unless (1) the cavity is over 4 cm. in diameter, (2) the cavity is enlarging significantly or (3) there are recurrent, severe hemoptyses.The American Journal of Medicine 01/1959; 25(6):890-7. · 5.30 Impact Factor
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