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Tropical lung, References: Kauffman, C. (2018). Diagnosis and treatment of…
Tropical lung
Pulmonary schistosomiasis
Risk factors
Exposure to fresh water contaminated with human feces infected by the parasite, due to domestic, occupational or recreational activities.
VIH
To be a woman
Main symptoms
Clinical manifestations of acute schistosomiasis syndrome include sudden onset of fever, urticaria and angioedema, chills, myalgia, arthralgia, dry cough, diarrhea, abdominal pain, and headache.
Symptoms of chronic infection often begin insidiously. The nature of the clinical manifestations depends on the tropism of the organs of the infecting species. Major organs potentially affected include the intestinal tract, liver, spleen, genitourinary tract, lungs, and central nervous system. Portal-pulmonary hypertension,
arterio-venous fistulas
Chest imaging findings
Radiographs may show dilated pulmonary arteries and arteriovenous abnormalities
Pulmonar infiltrate
The parasites that cause schistosomiasis live in certain types of freshwater snails. Seven species of schistosomes can cause infection in humans. The three main species are Schistosoma mansoni (Africa and South America), Schistosoma haematobium (Africa and the Middle East), and Schistosoma japonicum (East Asia)
Paragonimiasis
Risk factors
Aspects of the patient's habitat
Such as the presence of natural water sources with crabs
Poverty and cultural aspects
Main symptoms
Early start: Symptoms may include chest pain, dyspnea, cough, and malaise. Less common symptoms include low-grade fever and blood-streaked sputum.
Late infection: the second phase of infection refers to the period when the mature fins inhabit the lungs or ectopic sites; this phase can last for years, during which the worms induce inflammation and fibrosis at the sites. Clinical manifestations depend on the duration, intensity, and site of infection.
Chest imaging findings
Ring shadow lesions, due to the relative lucency of cystic cavities
Patchy pulmonary infiltrates, nodules, and/or calcifications
Pleural effusion
Irregular linear streaks, often adjacent to the ring shadows; these represent burrowing tracts of the flukes
Parenchymal mass lesions
Pleural thickening
X ray manifestations
The pulmonary lesions may be mistaken for tuberculosis [28] or malignancy.
Paragonimiasis lesions are located more peripherally and are much more common in the mid- and lower lung zones; tuberculous cavities are predominantly apical lesions.
On computed tomography (CT), focal fibrotic pleural thickening adjacent to a pulmonary nodule can be an important clue to the diagnosis of pleuropulmonary paragonimiasis
In addition, subpleural or subfissural nodules, often containing a necrotic low-attenuation area, may be observed.
Paragonimiasis is a trematode (fluke) infection transmitted predominantly through the consumption of raw or undercooked crab or crayfish. Nearly 50 species and subspecies of Paragonimus have been described, most of which are found in carnivorous animal hosts. Approximately 16 species have been reported to cause disease in humans, the most common of which is the eastern lung fluke, Paragonimus westermani.
Histoplasmosis
Chest imaging findings
Chest x-ray shows diffuse reticulonodular infiltrates involving all lung fields.
Chest radiographs usually show enlarged mediastinal or hilar lymph nodes with focal infiltrates but may be normal. Pulmonary infiltrates are usually patchy or nodular; Cavitation is rarely seen except in people with underlying obstructive pulmonary disease. Infiltrates may be diffuse after heavy exposure
Main symptoms
Acute pulmonary histoplasmosis:
Fever, chills, headache, myalgias, anorexia, cough, and chest pain usually develop two to four weeks after exposure
Generally, the symptomatology is milder and prolonged, between 3 and 6 months. Adimania and lethargy are the most frequent symptoms, accompanied by fever and, less frequently, by ulcers on the mucous membranes and lips. One third of these patients have hepatosplenomegaly with granulomatous hepatitis.
Risk factors
Activities at risk for developing histoplasmosis include cleaning poultry yards, attics, and barns, exploring caves, and soil removal and bridge cleaning activities
Histoplasmosis is a common endemic mycosis that is usually asymptomatic but occasionally results in severe disease. Histoplasmosis and its causative agent, Histoplasma capsulatum, are found throughout the world, but particularly in North and Central America.
Paracoccidiodomicosis
Risk factors
Origin from endemic area
Male sex
HIV infection
Lack of prophylaxis with cotrimoxazole
Main symptoms
Lymphadenopathy in the supraclavicular, cervical, and submandibular regions
Ulcerating lesions on the cheek and near the ear with a verrucous appearance resulting from hematologic dissemination
Papulonodular and ulcerating lesions resulting from hematologic dissemination.
Laboratory abnormalities
●Anemia – 90 percent
●Hypergammaglobulinemia – 89 percent
●Eosinophilia – 76 percent
●Hypoalbuminemia – 73 percent
●Hyperbilirubinemia – 44 percent
●Mildly elevated transaminases – 20 percent
Hepatosplenomegaly
Bone marrow dysfunction
Anemia, fever
Chest imaging findings
Bilateral perihilar infiltrates and inverted halo image
Interstitial lesions, radiopaque cotton-like images
Paracoccidioidomycosis is a systemic endemic mycotic disease caused by thermally dimorphic fungi of the genus Paracoccidioides, encompassing Paracoccidioides brasiliensis complex and Paracoccidioides lutzii.
Coccidiodomicosis
Risk factors
The risk of exposure within endemic regions is seasonal, typically being highest in dry periods following a rainy season. Periods of high incidence in Arizona range from May into July and then between October and early December. By contrast, the Central Valley in California, which rarely receives significant summer rain, has a single peak from late spring to late fall.
Black
Filipino ethnicity
HIV/AIDS
Having diabetes mellitus, being pregnant
Main symptoms
Primary coccidioidal pneumonia
Localized pneumonia
Diffuse lung disease
Generalized systemic symptoms, including fever, drenched night sweats, weight loss
Rheumatologic complaints (eg, arthralgia)
Cutaneous manifestations, such as erythema nodosum
Extrathoracic coccidioidomycosis
Osteoarticular involvement
Spinal infection
Chest imaging findings
In the most advanced cases
There are radiological findings of osteolysis, hypertrophic periostitis, purulent collections in the soft tissues and, finally, fistulization towards the skin, the mouths of these fistulas usually present reddish and protruding granulomas
Radiological manifestations of coccidioidomycosis
pulmonary are identical to those of tuberculosis. Nodules in apical regions and granulomatous organization
Pneumonia-like infiltrate
Coccidioidomycosis is caused by the dimorphic fungi of the genus Coccidioides. It is now recognized as consisting of two species, Coccidioides immitis and Coccidioides posadasii. However, there is no clinical or microbiologic distinction between these two species, and henceforth the organism will be referred to as Coccidioides.
References: Kauffman, C. (2018). Diagnosis and treatment of pulmonary histoplasmosis. UptoDate.
https://www-uptodate-com.bibliotecavirtual.udla.edu.ec/contents/diagnosis-and-treatment-of-pulmonary-histoplasmosis?search=Histoplasmosis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
