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A Red Flag for Community-Acquired Pneumonia in the Elderly.

Panchabhai TS, Bandyopadhyay D, Arrossi V, Brizendine KD, Ahmad M - J Glob Infect Dis (2015 Jul-Sep)

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland, Ohio, USA.

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Sir, Advanced age is associated with defects in innate and adaptive immunity, called immunosenescence... We describe an elderly female patient who presented with community-acquired pneumonia, which posed a considerable diagnostic challenge, leading to significant delay in appropriate intervention... An 84-year-old Caucasian female presented with nonproductive cough, decreased appetite, and malaise of 2 months’ duration... She was initially diagnosed as right middle lobe pneumonia and had received three courses of antibiotics... Therapy with intraconazole was initiated for the diagnosis of acute diffuse histoplasmosis... Her symptoms improved remarkably, and her oxygen was weaned down... Treatment is indicated in the elderly with acute pulmonary histoplasmosis if symptoms persist for longer than a month or in case of a severe disease burden... Chronic progressive pulmonary histoplasmosis should be treated, even if it is minimally symptomatic... The clinical outcome of fungal infections is also likely to be worse in elderly patients because they are less able to cope with the burden of endemic mycosis, owing to age-related changes in innate and adaptive immunity... A high index of suspicion should be harbored for acute pulmonary histoplasmosis in elderly patients presenting with atypical features of community-acquired pneumonia.

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Related in: MedlinePlus

(a) Transbronchial biopsy showing focal interstitial pneumonitis(black arrow), H&E, 4× (b) Infiltrating histiocytes with vague non-necrotizing granuloma formation with a multinucleated giant cell (arrow)shown H&E, 10×
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Figure 2: (a) Transbronchial biopsy showing focal interstitial pneumonitis(black arrow), H&E, 4× (b) Infiltrating histiocytes with vague non-necrotizing granuloma formation with a multinucleated giant cell (arrow)shown H&E, 10×

Mentions: The patient underwent bronchoscopy with normal airway examination, and bronchoalveolar lavage (BAL) and transbronchial biopsies (TBBx) were performed from the right middle and lower lobes, respectively. The BAL cultures were negative. The TBBx demonstrated interstitial pneumonitis with histiocytic infiltrates and vaguely formed non-necrotizing granulomas [Figure 2a and b]. The hematoxylin-andeosin (H&E) and Gomori's methenamine-silver (GMS) stains showed several yeasts morphologically consistent with Histoplasma species within the cytoplasm of the infiltrating histiocytes [Figure 3a and b]. The patient's serum fungal battery for histoplasma antibody and urinary histoplasma antigen were later reported as positive. Therapy with intraconazole was initiated for the diagnosis of acute diffuse histoplasmosis. Her symptoms improved remarkably, and her oxygen was weaned down. A follow-up chest X-ray at 8 weeks showed complete resolution of the lesion.


A Red Flag for Community-Acquired Pneumonia in the Elderly.

Panchabhai TS, Bandyopadhyay D, Arrossi V, Brizendine KD, Ahmad M - J Glob Infect Dis (2015 Jul-Sep)

(a) Transbronchial biopsy showing focal interstitial pneumonitis(black arrow), H&E, 4× (b) Infiltrating histiocytes with vague non-necrotizing granuloma formation with a multinucleated giant cell (arrow)shown H&E, 10×
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4557142&req=5

Figure 2: (a) Transbronchial biopsy showing focal interstitial pneumonitis(black arrow), H&E, 4× (b) Infiltrating histiocytes with vague non-necrotizing granuloma formation with a multinucleated giant cell (arrow)shown H&E, 10×
Mentions: The patient underwent bronchoscopy with normal airway examination, and bronchoalveolar lavage (BAL) and transbronchial biopsies (TBBx) were performed from the right middle and lower lobes, respectively. The BAL cultures were negative. The TBBx demonstrated interstitial pneumonitis with histiocytic infiltrates and vaguely formed non-necrotizing granulomas [Figure 2a and b]. The hematoxylin-andeosin (H&E) and Gomori's methenamine-silver (GMS) stains showed several yeasts morphologically consistent with Histoplasma species within the cytoplasm of the infiltrating histiocytes [Figure 3a and b]. The patient's serum fungal battery for histoplasma antibody and urinary histoplasma antigen were later reported as positive. Therapy with intraconazole was initiated for the diagnosis of acute diffuse histoplasmosis. Her symptoms improved remarkably, and her oxygen was weaned down. A follow-up chest X-ray at 8 weeks showed complete resolution of the lesion.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland, Ohio, USA.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir, Advanced age is associated with defects in innate and adaptive immunity, called immunosenescence... We describe an elderly female patient who presented with community-acquired pneumonia, which posed a considerable diagnostic challenge, leading to significant delay in appropriate intervention... An 84-year-old Caucasian female presented with nonproductive cough, decreased appetite, and malaise of 2 months’ duration... She was initially diagnosed as right middle lobe pneumonia and had received three courses of antibiotics... Therapy with intraconazole was initiated for the diagnosis of acute diffuse histoplasmosis... Her symptoms improved remarkably, and her oxygen was weaned down... Treatment is indicated in the elderly with acute pulmonary histoplasmosis if symptoms persist for longer than a month or in case of a severe disease burden... Chronic progressive pulmonary histoplasmosis should be treated, even if it is minimally symptomatic... The clinical outcome of fungal infections is also likely to be worse in elderly patients because they are less able to cope with the burden of endemic mycosis, owing to age-related changes in innate and adaptive immunity... A high index of suspicion should be harbored for acute pulmonary histoplasmosis in elderly patients presenting with atypical features of community-acquired pneumonia.

No MeSH data available.


Related in: MedlinePlus