Rev Pneumol Clin
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Review Comparative Study
[American pulmonary histoplasmosis caused by Histoplasma capsulatum].
American pulmonary histoplasmosis is a deep mycosis imported from North America caused by the inhalation of Histoplasma capsulatum. It is endemic in several countries throughout the world and occasional cases have been reported in France, mainly imported from out lying French territories. The most frequent clinical forms observed in immunocompetent subjects are generally benign or silent and usually limited to a fortuitously discovered pulmonary nodule. ⋯ More often, the epidemiological context, clinical and radiological features, the elimination of differential diagnoses and, retrospectively, serology are sufficient for diagnosis. The clinical course is usually favorable. Itraconazole is the treatment of choice for symptomatic or complicated forms.
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Patients with hematology disease in post-chemotherapy medullary aplasia are susceptible to life-threatening bronchopulmonary mycoses, especially aspergillosis. Other less common pulmonary mycoses are also observed. We report 4 cases due to Penicillium purpurogenum, Acromonium strictum and Scedosporium apiospermum (n = 2) infections. ⋯ They have common ubiquitous, opportunistic and low pathogenicity characteristics in immunocompetent subjects. The major risk factor is neutropenia. Isolating one of these fungi in an immunodepressed patient modifies management protocols since certain unusual fungi such as Scedosporium are resistant to amphotericin B.
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The presence of D-dimers in the serum reflects fibrin formation and lysis. If the serum D-dimer level is lower than a threshold level which depends on the assay technique (usually 500 micrograms/l), pulmonary embolism can be excluded with a predictive value of 95%. ⋯ For routine practice, only ELISA tests have been validated for this indication, the sensitivity of latex tests being too low. D-dimer assay would be of little benefit for patients hospitalized for more than 24 for reasons other than suspected pulmonary embolism as specificity is very low in this population.