TROPICAL LUNG

TROPICAL LUNG

1. Coccidiodomicosis

   • Microbiology
     • Epidemiology
       • Valley fever is an infection caused by the fungus Coccidioides.The scientific name for Valley fever is [ desert rheumatism[The southwestern United States and parts of Mexico and central and South America
     • Morphology
       • C. immitis is a dimorphic fungus that presents morphological variation in its mycelial and parasitic forms.It exists on the desert floor as a mold. As cells and become airborne. Arthrconidia undergo significant morphological changes after inhalation into the lung. Within living tissue, it typically swells into a large spherule containing numerous endospores
     • Coccidioides spp.
       • Coccidioides Immitis
       • Coccidioides posadsii
     • Reservoir
       • The reservoir is the earth, especially manure heaps and burrows, and the vehicle of transmission is the air through inhalation
   • Clinical Manifestations
     • Important
       • Symptomatic infection due to coccidioides most often presents similarly to community - acquired bacterial pneumonia (CAP), Symptoms occur approximately 7 to 21 days after exposure, which may or may not be obvious
     • Symtoms
       • Fatigue, Cough, fever,headache, night sweats, muscle or joint pain, dyspnoea, hemoptysis, erythema nodosum, arthralgia
     • It is estimated that as least 60 percent of all coccidioid infections do not receive medical attention because the primary infection is asymptomatic or minimally symtomatic
   • Diagnosis
     • Healthcare providers rely on your travel and medical history, symptoms, physical exams, and lab tests to diagnose Valley fever
     • Clinical, microbiological and serological diagnosis
       • Most outpatients with suspected coccidioidomycosis are evaluated with serologic tests
       • In patients with early disease repeat serological tests may be needed, as antibodies can take weeks to develop. Attempting to identify the organism by direct examination or by culture can also be helpful in this setting, especially in those with severe disease.
       • A coccidioid antigen test is available that can be positive with extrapulmonary disease.

2. Paracoccidiodes

   • Microbiology
     • Paracoccidioides brasiliensis
     • Epidemiology
       • People contract paracoccidioidomycosis after inhaling the Paracoccidioides fungus from the environment in certain parts of central and South America. Paracoccidioidomycosis is not spreas from person to person
     • Paracoccidioides lutzii
     • reservoir
       • soil
     • Morphology
       • Paracoccidioides brasilensis is a fungus filamentous or mycelial belonging to the phylum Ascomycota. It presents a dimorphic growth dependent on temperature. Grows as a filamentous saprophytic fungus in the soil and in cultivation at 18C - 23 C and as parasitic yeast in host tissues and in culture at 57C
   • Diagnosis
     • Healthcare providers use a patient´s symptoms, as well as laboratory tests and imaging tests, such as a chest X-ray, to diagnose paracoccidioidomycosis
     • X-rays and Tomography
       • They are not that specific but they can help us with the diagnosis.And find eosinophilic patterns
     • Microscopy
       • They yeast form of Paracoccidioides spp can be visualizad in sputum, abscess fluid, lymph node aspirates scrapings from skin lesions, and / or biopsy specimens of affected organs.
     • Serological tests
       • -P. brasiliensis:Detection of specific antibodies is used for the initial evaluation of patients with suspected P.brasiliensis infection. - Serological tests ca used to monitor response to therapy. - P.lutzii:Patients infected with P.lutzii may be negative by immunodiffusion test for antibodies to the gp43 antigen(36). However, a test for P.lutzii infection has been developed using a cell-free antigen preparation.
   • Clinical manifestations
     • Important
       • In adults, paracoccidioidomycosis usually affects the lungs and causes lesions in the mouth and throat.Children are more likely to have swollen lymph nodes and skin lesions
     • Symptoms
       • Mouth and throat injuries. weightloss, Swollen lymph nodes, Cough, Fever, Difficulty breathing, fatigue, enlarged liver and spleen.
     • Many people infected with paracoccidioides never develop symptoms. For people who develop symptoms, paracoccidioidomycosis usually affects the lungs and skin

3. Histoplasmosis

   • Microbiology
     • Histoplasma Capsulatum
       • Reservoir
         • H. capsulatum grows best in soils contaminated with bird or bat droppings. Sites commonly include chicken coops on farm buildings with large accumulation of bird droppings, abandoned buildings bird roosting sites, caves
       • Morphology
         • Histoplasma capsulatum var capsulatum Darling is a dimorphic, filamentous fungus at temperatures below 30 C but grows like yeast in mammalian cells or in special media at 35 - 37 C
       • lifecycle
         • The little light in the caves favors the sporulation of the fungus. It is frequently isolated from the ground of poultry pens, such as chicken coops, lofts, as well as the guano of caves or buildings where bats take refuge
       • Epidemiology
         • It is a fungal infection with a wide geographic distribution, affecting more than 60 countries, however. Its incidence is higher in America.Endemic areas are temperate, subtropical or humid tropical climates, close to fresh water courses
   • Clinical manifestations
     • Fever than 5 percent of exposed individuals develop symptomatic disease after a low level exposure to H. capsulatum
     • Symptoms
       • Fever, Shaking chills, Headache, Myalgia, Anorexy , Cough, chest pain (substernal, worse on deep inspiration), pleuritic pain may occur - Rales
     • Signs
       • Evidence of consolidation.Lobular or acinar bronchopneumonia, initially with neutrophilic infiltration.Recruitment of macrophages, Lymphocytes, and plasma cells, and the formation of granulomas
   • Diagnosis
     • Polymerase chain reaction 8PCR)
       • The role of the polymerase chain reaction (PCR) in the diagnosis of histoplasmosis is uncertain.
     • Antigen detection
       • Using the Histoplasma Antigen Detection Enzyme Immunoassay in the urine, blood, or BAL fluid or infected patients provides rapid diagnostic information and is particulary usefull in patients who are critically ill.
     • Histopathology and cytology:
       • Biopsy findings include granulomas, lymphohistiocytic aggregates, and diffuse mononuclear cell infiltrates. -Histopathological examination of lung tissue or mediastinal lymph nodes using special stains that highlight fungi.
     • Histopathology using fungal stains, cultures, antigen detection, and serologic tests for histoplasma -specific antibodies can help establish the diagnosis of pulmonary histoplasmosis.

4. PULMONARY SCHISTOSOMIASIS

   • Microbiology
     • pathogenic agent
       • Trematodes worms these are categorized into four distintc groups
         • S.Mansoni
         • S.Melongi
         • S. japonicum
         • S. intercalatum
     • reservoir
       • Live in freshwTER BODIES SUCH AS CANALS
   • Clinical manifestation
     • Symptoms
       • Chillas
       • Nausea
       • Abdominal pain
       • Myalgias
       • Urticarial
       • similar to serum sickness
       • Malaise
       • Fever
       • Blood in spetum
     • Living in places with poor sanitation and residing near contaminated water
     • Exposure to contaminated water with human feces infected
   • Diagnostic
     • Small pulmonary nodules ranging from 2 to 15 min and larger nodules with ground glass-opacity halo

5. PARAGONIMIASIS,

   • Microbiology
     • AGENT
       • More than 30 species of trematodes of the genus Paragonimus have been reported which infect animals and humans. Among the more than 10 species reported to infect humans, the most common is Pwestermani, the oriental lung fluke
     • factors
       • Speciality dishes in which shellfish are consumed raw or prepared only in vinegar, brine, or wine without cooking play a key role in the transmissions of paragonimiasis
   • Clinical manifestation
     • Symptoms
       • Abdominal pain
       • Caugh
       • Dyspnea
       • ulcers
       • swollen lymph nodes
   • Diagnostic
     • initial presentation with spontaneous left hydropneumothorax; subsequently developed bilateral pleural effusions, right upper lobe [infiltrate[, pleural thickening, and right hilar lymphadenopathy