Pulmonary hydatid disease with coexistent aspergillosis: An incidental finding (original) (raw)
2013, Indian Journal of Medical Microbiology
cyst was made. Patient underwent surgery and specimen was sent for histopathological examination. Grossly, we received a cut open cystic structure measuring 8 8 cm devoid of contents [Figure 2a]. Histopathological examination of cyst wall revealed the laminated membrane of hydatid cyst along with Echinococcus hooklets and infi ltration of its wall with septate fungal hyphae with acute angle branching, consistent with aspergillosis [Figure 2b]. These fungal hyphae were positive with periodic acid-Schiff and Grocotts methenamine silver. Culture studies were positive for Aspergillus fumigatus. Discussion Hydatid cyst is a zoonotic disease most commonly caused by Echinococcus granulosus, while Echinococcus multilocularis is the most common cause of pulmonary involvement. Human beings acquire the disease by ingesting the parasite eggs and are the intermediate hosts. Liver and lungs are most commonly affected organ; however, infection can occur in any organ of the body. [2] Aspergillosis is a saprophytic fungal infection most commonly caused by A. fumigatus. Aspergillus may cause allergic pulmonary aspergillosis, aspergilloma, and semi-invasive and invasive aspergillosis. [3] Typically, aspergilloma develop in cavities formed as a result of tuberculosis, sarcoidosis, bronchiectasis and lung abscess. Immune suppression and structural pulmonary defects may predispose to this infection. There are only a few case reports in the literature on the coexistence of aspergillosis and echinococcosis. [4-8] Aspergillus tends to invade the blood vessels; therefore, the most common symptom in pulmonary aspergillosis is haemoptysis which was present in our patient as well. Such a coexistence of hydatid cyst with fungi resembling Aspergillus is extremely rare and has been documented in only few case reports till date. It is important that we do not confuse this condition with colonisation sometimes seen after hydatid cystectomy that is no different from aspergilloma forming in preformed lung cavities. [9] The pathogenesis of this association remains unknown, but the cavity needs to be in communication with the airways so that fungal spores can colonise the cavity space. Although patients with immune defi ciencies are prone to aspergillosis, the coexistence of Aspergillus and hydatid
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