Search Results (32)

Background: Scar carcinoma represents a distinct subtype of lung malignancy developing in areas of chronic pulmonary fibrosis, inflammation, and structural remodeling, frequently associated with previous pulmonary tuberculosis (TB). The present study aimed to evaluate the radiological, clinical, inflammatory, and histopathological characteristics associated with the scar carcinoma phenotype in patients with lung cancer (LC) and previous TB-related pulmonary abnormalities. Methods: A retrospective observational cohort study conducted between February 2020 and December 2025 included 844 patients diagnosed with lung cancer. The scar carcinoma phenotype was operationally defined by the coexistence of: (1) confirmed lung cancer, (2) post-tuberculous structural pulmonary abnormalities on thoracic imaging, and (3) clinical history compatible with prior pulmonary TB. Associations between the scar carcinoma phenotype and clinicopathological variables were evaluated using Pearson’s Chi-square and Fisher’s exact tests. Binary logistic regression analysis was performed to identify independent predictive factors associated with scar carcinoma. Receiver operating characteristic (ROC) curve and precision–recall curve analyses were additionally performed. Results: Post-TB sequelae were identified in 58.2% of patients, while active TB was present in 7.8% of cases. Adenocarcinoma represented the predominant histopathological subtype (63.3%). Fibrotic/interstitial/bronchial abnormalities (67.7%), cavitary/destructive lesions (69.0%), atelectatic/retractile changes (65.4%), and infectious/inflammatory pulmonary abnormalities (60.4%) were highly prevalent. Significant associations were identified between scar carcinoma and TB sequelae (χ² = 811.850, p < 0.001), adenocarcinoma histology (χ² = 655.545, p < 0.001), infectious/inflammatory changes (χ² = 635.168, p < 0.001), cavitary/destructive lesions (χ² = 508.347, p < 0.001), fibrotic/interstitial abnormalities (χ² = 539.895, p < 0.001), and atelectatic/retractile changes (χ² = 597.346, p < 0.001). Logistic regression identified haemoptysis (OR = 0.651 (95% CI: 0.486–0.871), p = 0.005) and pulmonary opacities and/or condensation (OR = 1.343 (95% CI: 1.014–1.779), p = 0.040) as independent predictive factors. ROC analysis demonstrated moderate predictive performance (AUC = 0.703). Conclusions: TB-associated pulmonary remodeling was strongly associated with the scar carcinoma phenotype, consistent with an associative role of chronic inflammation, fibrosis, and post-TB structural damage in lung carcinogenesis; however, causal inferences cannot be drawn from this retrospective observational design. Full article

Animal tuberculosis caused by mycobacteria of the Mycobacterium tuberculosis complex (MTBC) represents a significant challenge to both public and animal health. Although eradication programs focus predominantly on cattle, small ruminants, especially goats, may play a relevant role as reservoirs. This study aimed to characterize tuberculosis cases in small ruminants in Portugal diagnosed at the national reference laboratory for Tuberculosis (Instituto Nacional de Investigação Agrária e Veterinária) over the period from April 2012 to July 2023. In this study, samples from 79 animals suspected of TB (64 goats and 15 sheep) were analyzed by integrating histopathology; bacteriology; and, when applicable, PCR results, thereby allowing the distribution by species to be described, MTBC agents to be identified, and diagnostic agreement to be assessed. Of these samples, 29 positive cases (36.7%) were identified, all of them in goats (45.3% of goats tested), whereas no cases were confirmed in sheep. Mycobacterium caprae was the most frequently identified species (89.7%), followed by Mycobacterium bovis (10.3%). Geographic distribution was concentrated in the Alentejo (48.3%) and Norte (44.8%) regions, where 93.1% of cases occurred. Topographical analysis of lesions revealed respiratory tract involvement (lung and/or thoracic lymph nodes) in 82.7% of positive cases, with gross patterns including caseous/caseocalcified lesions (n = 11), necrosis (n = 9), and nodular granulomatous lesions (n = 10). Agreement between histopathology and bacteriology was 81.5%. Parasitic coinfections were observed in 24.1% of positive cases, complicating histopathological interpretation. The results of this study indicate goats, as opposed to sheep, as non-negligible reservoirs of TB, suggesting species-level differences that warrant targeted investigation. The predominance of respiratory lesions and the detection of extensive cavitary forms indicate potential aerogenous transmission with implications for multi-host systems. Diagnostic discordance and parasitic interference reinforce the need for combined testing methodologies. It is therefore advisable to consider the integration of goats into tuberculosis surveillance and control programs, with greater relevance in Alentejo and Norte. Full article

Pulmonary tuberculosis (TB) remains a global health threat, with individual genetic determinants like Toll-like receptor 2 (TLR2) gene variations potentially modulating immune responses to Mycobacterium tuberculosis. This systematic review evaluates the role of TLR2 polymorphisms in influencing susceptibility to and clinical manifestations of pulmonary TB. Following PRISMA guidelines, a comprehensive search of PubMed, Scopus, and ScienceDirect was conducted through July 2024 for observational studies investigating TLR2 single-nucleotide polymorphisms (SNPs) and active TB. Risk of bias was assessed using the Newcastle–Ottawa Scale. Of 8878 identified articles, 32 studies met the inclusion criteria. The most frequently investigated variants, Arg753Gln (rs5743708), −196 to −174 del, and rs3804099, were consistently associated with increased TB susceptibility, particularly in Asian and African populations. Furthermore, specific polymorphisms correlated with greater disease severity, including cavitary lesions and aggressive clinical progression. In conclusion, TLR2 genetic polymorphisms significantly increase the risk of developing pulmonary TB and contribute to more severe clinical outcomes. These findings emphasize the potential of genetic profiling in enhancing TB control strategies and developing personalized diagnostic or therapeutic approaches. Full article

Background and Clinical Significance: Cladosporium cladosporioides is a ubiquitous dematiaceous mold that is rarely implicated in invasive human diseases and often considered a saprophyte and plant pathogen. Case Presentation: We report an extremely rare case of C. cladosporioides fungemia in a 61-year-old man with mantle cell lymphoma undergoing chemotherapy. The patient developed fever, dry cough and cavitary pulmonary lesions in the setting of profound immunosuppression. Blood cultures yielded slow-growing dark pigmented mold after prolonged incubation and species identification was achieved using MALDI-TOF mass spectrometry with an alternative fungal database, supported by microscopic morphology. Serum 1,3-β-D-glucan levels were markedly elevated, while galactomannan antigen testing was negative. Antifungal susceptibility testing demonstrated activity of triazoles and targeted therapy with voriconazole led to clinical improvement. A review of the literature identified only five previously reported cases of invasive C. cladosporioides infections worldwide, involving primarily pulmonary and central nervous system disease. Conclusions: To the best of our knowledge, this is the first documented case of fungemia caused by this species. The current report highlights the pathogenic potential of C. cladosporioides in immunocompromised hosts, the diagnostic challenges posed by slow-growing dematiaceous fungi, the importance of prolonged culture incubation, fungal biomarkers and advanced identification techniques for timely diagnosis and management. Full article

Background and Clinical Significance: Cutaneous aspergillosis caused by Aspergillus flavus is rare and coinfection with Klebsiella pneumoniae was reported only in pulmonary disease. Case Presentation: We describe a 57-year-old woman with no prior comorbidities who developed septic shock requiring intensive care, broad-spectrum antibiotics, corticosteroids, and renal replacement therapy. Six days after discharge, she was readmitted with fever, leukopenia, thrombocytopenia, cavitary lung lesions, and multiple erythematous nodules on the limbs and mammary regions. Bronchial aspirate cultures detected K. pneumoniae, while progressive cutaneous lesions required surgical debridement. Histopathology revealed angioinvasive septate hyphae, and MALDI-TOF identified A. flavus. The K. pneumoniae strain was extensively drug resistant; A. flavus was susceptible only to azoles. Despite targeted therapy, lesions progressed requiring bilateral mastectomy. Conclusions: This case illustrates a previously unreported scenario in which secondary immunosuppression after severe sepsis led to concurrent cutaneous A. flavus infection and extensively drug-resistant (XDR) K. pneumoniae. Early recognition of mixed fungal–bacterial infections is essential for appropriate management. Full article

Background/Objectives: This study aims to identify baseline imaging parameters, across various imaging modalities, that can predict the response to bleomycin sclerotherapy in patients with head and neck lymphatic–venous malformations (LVMs). Methods: A retrospective analysis of 80 patients (85 lesions) treated at a tertiary care center between January 2018 and December 2022 was conducted. Imaging modalities, including CT, MRI, ultrasonography, and dynamic digital radiographic images, were reviewed for lesion characteristics. Factors including lesion type, volume, morphology, location, and contrast opacification patterns were analyzed for their association with treatment response, defined as a >50% reduction in lesion size and symptom improvement. Univariable and multivariable logistic regression analyses were performed. Results: Of 85 lesions, 45 (52.9%) responded to treatment. Univariable analysis showed that pure lymphatic malformations (OR = 6.12, p = 0.004), macrocystic components (OR = 10, p = 0.016), cavitary morphology on dynamic digital radiographic images (OR = 8.90, p < 0.001), neck location (OR = 4, p = 0.03), and deep-seated lesions (OR = 3.69, p = 0.03) were significantly associated with better outcomes. Multivariable analysis identified cavitary morphology as the strongest predictor (p = 0.04). A combination of cavitary morphology, macrocystic components, and pure LM type yielded the highest predictive accuracy (AUC = 0.80, p = 0.03). Conclusions: The presence of lymphatic channels or large cystic venous spaces—such as macrocystic features on imaging or cavitary morphology—along with neck or deep-seated lesion location, predicts a favorable response to bleomycin sclerotherapy in head and neck LVMs. Full article

Background and Objectives: The role of adenosine deaminase (ADA) in pulmonary tuberculosis (PTB) remains insufficiently defined in advanced forms of disease. Likewise, the systemic immune inflammatory index (SII) has not been validated in severe PTB. This 6-year prospective observational study aims to evaluate biomarker signatures of serum ADA and SII. Materials and Methods: According to the PTB case definition, 232 adult patients were divided into group 1, with a positive bacteriologic exam (n = 168), and group 2, without bacteriological confirmation (n = 64). ADA serum levels were compared by age, gender, nutritional status, morphologic and bacteriological pattern of PTB lesions, survival status, along with serum levels of other inflammatory biomarkers. All patients with comorbidities, interfering with the level of ADA, were excluded to avoid bias. Results: A total cohort of 208 PTB adults, aged 54.37 ± 14.365 years, included 156 males. The overall mortality was 11.53%. Death occurred after a mean interval of 1.63 ± 3.228 months after PTB diagnosis. ADA serum mean levels were 32.94 ± 9.146 IU/L, significantly higher in G1 (p = 0.002), in patients with delayed diagnosis of PTB (p = 0.000), with lung cavitation (p = 0.003), and death as a poor outcome (p ˂ 0.02). SII had a mean value of 1752.226 ± 2704.150, significantly increased in bacteriologically confirmed PTB cases (p = 0.018), delayed diagnosis (p = 0.002), cavitary advanced pulmonary tuberculosis (APT) (p = 0.002), and deceased (p = 0.003). Both an ADA cut-off elevated risk value of over 30 IU/L and SII of over 902 were fulfilled by 73 patients, with 2.10 higher risk of advanced PTB (p = 0.006) and 4.49 higher risk of mortality (p = 0.000). Conclusions: Serum ADA and SII are recommended as predictors of advanced and severe pulmonary TB. These findings indicate that ADA and SII, when elevated together, delineate a high-risk PTB phenotype with greater disease severity and early mortality. The combination offers a pragmatic, biomarker-based approach to risk stratification in PTB. Full article

Background: Interstitial lung diseases (ILDs) are a heterogeneous group of conditions that can cause fibrosis of the lung interstitium, resulting in respiratory failure and death. Patients with an ILD, particularly idiopathic pulmonary fibrosis (IPF) or connective tissue disease-associated ILDs (CTD-ILDs), are prone to develop chronic pulmonary infections such as tuberculosis (TB) and non-tuberculous mycobacterial pulmonary disease (NTM-PD). Methods: This case series examines the management of three ILD patients with a usual interstitial pneumonia (UIP) pattern and concomitant NTM-PD or TB at National Institute for Infectious Diseases “Lazzaro Spallanzani” in Rome, Italy, over three years (2019–2022). Results and Conclusions: Multi-disciplinary discussion (MDD) was crucial to define the therapeutic approach due to the increased risk of side effects and drug interactions. Our work underscored how a comprehensive diagnostic evaluation, enriched by MDD, is useful for optimizing the management and reducing drug-related adverse effects and interactions in ILD patients with cavitary lesions. Full article

Administering intraluminal fluid can improve the acoustic window for the visualization of the lumen and wall layers in the cavitary organs. Microbubbles in ultrasound contrast agents can also be used for intracavitary applications to enhance visualization of the lesion in human patients. However, there was no literature extending the clinical application of intraluminal contrast-enhanced ultrasonography (CEUS) to patients with naturally occurring diseases in veterinary medicine. This case series aims to describe the detailed application and diagnostic value of intraluminal CEUS in six clinical cases with naturally occurring gastrointestinal (GI) and urinary tract diseases. Full article

Pulmonary vasculitis identifies a heterogeneous group of diseases characterized by inflammation, damage and necrosis of the wall of pulmonary vessels. The most common approach to classify vasculitis is according to etiology, therefore dividing them into primary and secondary, with a further sub-classification of primary vasculitis based on the size of the affected vessels (large, medium, and small). Pulmonary involvement is frequently observed in patients with systemic vasculitis and radiological presentation is not pathognomonic, but may vary between diseases. The main findings using high-resolution computed tomography (HRCT) include small vessel wall thickening, nodular lesions, cavitary lesions, reticular opacities, ground-glass opacities (GGO), consolidations, interlobular septal thickening, tracheobronchial stenosis, and aneurysmal dilatation of pulmonary arteries, with or without pleural effusion. Radiological diagnosis alone is difficult since signs and symptoms of lung vessel involvement are often non-specific and might overlap with other conditions such as infections, connective tissue diseases and neoplasms. Therefore, the aim of this review is to describe the most common radiological features of lung involvement in pulmonary vasculitis so that, alongside detailed clinical history and laboratory tests, a prompt diagnosis can be performed. Full article

Toxocariasis is an uncommon cause of multiple cavitary lung lesions and an ill-defined liver lesion. We herein report a patient with lung and liver toxocariasis, which mimicked metastatic lesions of colon cancer on ¹⁸F-FDG PET–CT and chest and abdominal CT performed for cancer staging after diagnosis of colon cancer. The patient was diagnosed with lung and liver toxocariasis by a positive enzyme-linked immunosorbent assay. Lung toxocariasis may occur as multiple cavitary lung lesions, and liver toxocariasis may appear as a solitary ill-defined nodule, which may be misdiagnosed as metastatic tumors. Clinicians should consider toxocariasis when multiple cavitary lung lesions and a solitary ill-defined focal liver lesion are detected, especially in a patient with cancer. Full article

In this work, we propose a CAD (computer-aided diagnosis) system using advanced deep-learning models and computer vision techniques that can improve diagnostic accuracy and reduce transmission risks using the YOLOv7 (You Only Look Once, version 7) object detection architecture. The proposed system is capable of accurate object detection, which provides a bounding box denoting the area in the X-rays that shows some possibility of TB (tuberculosis). The system makes use of CNNs (Convolutional Neural Networks) and YOLO models for the detection of the consolidation of cavitary patterns of the lesions and their detection, respectively. For this study, we experimented on the TBX11K dataset, which is a publicly available dataset. In our experiment, we employed class weights and data augmentation techniques to address the data imbalance present in the dataset. This technique shows a promising improvement in the model’s performance and thus better generalization. In addition, it also shows that the developed model achieved promising results with a mAP (mean average precision) of 0.587, addressing class imbalance and yielding a robust performance for both obsolete pulmonary TB and active TB detection. Thus, our CAD system, rooted in state-of-the-art deep-learning and computer vision methodologies, not only advances diagnostic accuracy but also contributes to the mitigation of TB transmission risks. The substantial improvement in the model’s performance and the ability to handle class imbalance underscore the potential of our approach for real-world TB detection applications. Full article

Introduction: Hafnia alvei is a Gram-negative, facultative anaerobic bacillus that is most often found as an enteric commensal. It is seldom considered to be pathogenic in immunocompetent individuals. Case report: We describe a case of a 23-year-old, previously healthy male, who presented to the emergency department with a two-day history of hemoptysis, mild dyspnea, pleuritic chest pain, fevers, and chills. Bloods revealed leukocytosis and elevated C-reactive protein. Chest X-ray and CT of the thorax revealed a cavitating lesion in the right upper lobe. He was commenced on empiric antibiotic treatment with amoxicillin/clavulanate and clarithromycin for community-acquired pneumonia in accordance with local guidelines. He subsequently underwent a bronchoscopy, and the bronchoalveolar lavage sample revealed a heavy growth of H. alvei. Despite the widely documented natural resistance of H. alvei to penicillin, the patient demonstrated complete resolution of his symptoms and initial raised inflammatory markers. Conclusions: We present a case of community-acquired cavitary pneumonia in a previously healthy young adult with H. alvei isolated from bronchoalveolar lavage samples. Parallels are drawn between our case and other cases of H. alvei respiratory isolates in our discussion of its clinical significance. Full article

Blastomycosis is caused by a thermally dimorphic fungus that thrives in moist acidic soil. Blastomyces dermatitidis is the species responsible for most infections in North America and is especially common in areas around the Great Lakes, the St. Lawrence Seaway, and in several south-central and southeastern United States. Other Blastomyces species have more recently been discovered to cause disease in distinct geographic regions around the world. Infection almost always occurs following inhalation of conidia produced in the mold phase. Acute pulmonary infection ranges from asymptomatic to typical community-acquired pneumonia; more chronic forms of pulmonary infection can present as mass-like lesions or cavitary pneumonia. Infrequently, pulmonary infection can progress to acute respiratory distress syndrome that is associated with a high mortality rate. After initial pulmonary infection, hematogenous dissemination of the yeast form of Blastomyces is common. Most often this is manifested by cutaneous lesions, but osteoarticular, genitourinary, and central nervous system (CNS) involvement also occurs. The diagnosis of blastomycosis can be made by growth of the mold phase of Blastomyces spp. in culture or by histopathological identification of the distinctive features of the yeast form in tissues. Detection of cell wall antigens of Blastomyces in urine or serum provides a rapid method for a probable diagnosis of blastomycosis, but cross-reactivity with other endemic mycoses commonly occurs. Treatment of severe pulmonary or disseminated blastomycosis and CNS blastomycosis initially is with a lipid formulation of amphotericin B. After improvement, therapy can be changed to an oral azole, almost always itraconazole. With mild to moderate pulmonary or disseminated blastomycosis, oral itraconazole treatment is recommended. Full article

Background and Objectives: Endobronchial ultrasound transbronchial lung biopsy with guide sheath (EBUS-GS-TBLB) has been regarded as a reasonable diagnostic method with an acceptable diagnostic yield. In addition, EBUS-GS-TBLB is considered safer and less invasive compared to percutaneous needle biopsy and thoracoscopic surgery. However, we encountered a case of life-threatening procedure-related fatal infection, which was successfully managed. Case presentation: A 61-year-old man with a 30 pack-year smoking history was referred to our clinic with a necrotic lung mass in the right middle lobe on a chest computed tomography scan. EBUS-GS-TBLB was performed for a pathological diagnosis without immediate complications. Eight days after the procedure, the patient visited the hospital with sudden hemoptysis and severe dyspnea with fever. A chest computed tomography revealed a ruptured lung abscess and pneumonia, developed after EBUS-GS-TBLB. Extracorporeal membrane oxygenation (ECMO) and mechanical ventilation were initiated to manage refractory hypoxia. While maintaining ECMO, video-assisted thoracoscopic surgery was performed at the patient’s bedside in the intensive care unit. After surgery, the patient’s vital signs gradually improved, and a chest computed tomography revealed a reduction in the extent of the lung abscess. Results: Although EBUS-GS-TBLB is minimally invasive and relatively safe when used for the diagnosis of peripheral lung lesions, pulmonary physicians should be aware of this rare but critical complication. Conclusions: We suggest that the careful prescription of prophylactic antibiotics before EBUS-GS-TBLB would be wise if the mass featured a necrotic, cavitary, or cystic lesion. Full article