Lung Nodules Due to in a Person with Cystic Fibrosis

Overview

Journal BMJ Case Rep

Specialty General Medicine

Date 2022 Jan 1

PMID 34972773

Authors

Mary Bryson Piechowiak

Anne Whitney Brown

Shambhu Aryal

Shalika Basnayake Katugaha

Affiliations

Soon will be listed here.

Abstract

We present the first reported case of pulmonary infection presenting as lung nodules. The patient is a 31-year-old man with cystic fibrosis (CF) colonised with multidrug-resistant and increased frequency of pulmonary exacerbations in the preceding months. While on intravenous antibiotics for a pulmonary exacerbation, he developed bilateral pulmonary nodules. Bronchoalveolar lavage cultures grew He was initially treated with dual antifungal therapy, voriconazole and micafungin. Discontinuation of voriconazole due to transaminitis resulted in the development of new nodules, and isavuconazonium was added. Repeat imaging revealed no progression of disease. Micafungin was eventually discontinued. Monotherapy with isavuconazonium is planned for 1 year post lung transplant. In the CF population, may be an opportunistic pathogen. The case highlights that frequent CF exacerbations and antibiotic exposure increase the risk for opportunistic infections including species and the implications for lung transplantation in this setting.

References

Baser S, Onn A, Lin E, Morice R, Duvic M . Pulmonary manifestations in patients with cutaneous T-cell lymphomas. Cancer. 2007; 109(8):1550-5. DOI: 10.1002/cncr.22567. View

Loverdos K, Fotiadis A, Kontogianni C, Iliopoulou M, Gaga M . Lung nodules: A comprehensive review on current approach and management. Ann Thorac Med. 2019; 14(4):226-238. PMC: 6784443. DOI: 10.4103/atm.ATM_110_19. View

Pfaller M, Diekema D, Rinaldi M, BARNES R, Hu B, Veselov A . Results from the ARTEMIS DISK Global Antifungal Surveillance Study: a 6.5-year analysis of susceptibilities of Candida and other yeast species to fluconazole and voriconazole by standardized disk diffusion testing. J Clin Microbiol. 2005; 43(12):5848-59. PMC: 1317207. DOI: 10.1128/JCM.43.12.5848-5859.2005. View

Jha B, Dey S, Tamang M, Joshy M, Shivananda P, Brahmadatan K . Characterization of Candida species isolated from cases of lower respiratory tract infection. Kathmandu Univ Med J (KUMJ). 2008; 4(3):290-4. View

Gungor O, Tamay Z, Guler N, Erturan Z . Frequency of fungi in respiratory samples from Turkish cystic fibrosis patients. Mycoses. 2012; 56(2):123-9. DOI: 10.1111/j.1439-0507.2012.02221.x. View

PAINTER B, ISENBERG H . Isolation of Candida parapsilosis: report of two cases. Am J Clin Pathol. 1973; 59(1):62-5. DOI: 10.1093/ajcp/59.1.62. View

Gibson R, Burns J, Ramsey B . Pathophysiology and management of pulmonary infections in cystic fibrosis. Am J Respir Crit Care Med. 2003; 168(8):918-51. DOI: 10.1164/rccm.200304-505SO. View

Govender N, Patel J, Magobo R, Naicker S, Wadula J, Whitelaw A . Emergence of azole-resistant Candida parapsilosis causing bloodstream infection: results from laboratory-based sentinel surveillance in South Africa. J Antimicrob Chemother. 2016; 71(7):1994-2004. DOI: 10.1093/jac/dkw091. View

Ahuja T, Fong K, Louie E . Combination antifungal therapy for treatment of prosthetic valve endocarditis and utility of T2Candida Panel®: A case series. IDCases. 2019; 15:e00525. PMC: 6441745. DOI: 10.1016/j.idcr.2019.e00525. View

10.

Trofa D, Gacser A, Nosanchuk J . Candida parapsilosis, an emerging fungal pathogen. Clin Microbiol Rev. 2008; 21(4):606-25. PMC: 2570155. DOI: 10.1128/CMR.00013-08. View

11.

Pfaller M, Rhomberg P, Messer S, Jones R, Castanheira M . Isavuconazole, micafungin, and 8 comparator antifungal agents' susceptibility profiles for common and uncommon opportunistic fungi collected in 2013: temporal analysis of antifungal drug resistance using CLSI species-specific clinical breakpoints.... Diagn Microbiol Infect Dis. 2015; 82(4):303-13. DOI: 10.1016/j.diagmicrobio.2015.04.008. View

12.

Chotirmall S, ODonoghue E, Bennett K, Gunaratnam C, ONeill S, McElvaney N . Sputum Candida albicans presages FEV₁ decline and hospital-treated exacerbations in cystic fibrosis. Chest. 2010; 138(5):1186-95. DOI: 10.1378/chest.09-2996. View

13.

Delhaes L, Touati K, Faure-Cognet O, Cornet M, Botterel F, Dannaoui E . Prevalence, geographic risk factor, and development of a standardized protocol for fungal isolation in cystic fibrosis: Results from the international prospective study "MFIP". J Cyst Fibros. 2018; 18(2):212-220. DOI: 10.1016/j.jcf.2018.10.001. View

14.

Cuthbertson L, Felton I, James P, Cox M, Bilton D, Schelenz S . The fungal airway microbiome in cystic fibrosis and non-cystic fibrosis bronchiectasis. J Cyst Fibros. 2020; 20(2):295-302. PMC: 8048771. DOI: 10.1016/j.jcf.2020.05.013. View

15.

Pfaller M, Diekema D, Turnidge J, Castanheira M, Jones R . Twenty Years of the SENTRY Antifungal Surveillance Program: Results for Species From 1997-2016. Open Forum Infect Dis. 2019; 6(Suppl 1):S79-S94. PMC: 6419901. DOI: 10.1093/ofid/ofy358. View

16.

Rex J, Walsh T, Sobel J, Filler S, Pappas P, Dismukes W . Practice guidelines for the treatment of candidiasis. Infectious Diseases Society of America. Clin Infect Dis. 2000; 30(4):662-78. DOI: 10.1086/313749. View

17.

Pinhati H, Casulari L, Souza A, Siqueira R, Damasceno C, Colombo A . Outbreak of candidemia caused by fluconazole resistant Candida parapsilosis strains in an intensive care unit. BMC Infect Dis. 2016; 16(1):433. PMC: 4992558. DOI: 10.1186/s12879-016-1767-9. View

18.

Weems Jr J . Candida parapsilosis: epidemiology, pathogenicity, clinical manifestations, and antimicrobial susceptibility. Clin Infect Dis. 1992; 14(3):756-66. DOI: 10.1093/clinids/14.3.756. View

19.

Katragkou A, McCarthy M, Meletiadis J, Hussain K, Moradi P, Strauss G . In vitro combination therapy with isavuconazole against Candida spp. Med Mycol. 2017; 55(8):859-868. DOI: 10.1093/mmy/myx006. View