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      Aspergillus Coinfection in a Hydatid Cyst Cavity of Lung in an Immunocompetent Host: A Case Report and Review of Literature


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          Aspergilloma (a saprophytic infection) typically colonizes lung cavities due to underlying diseases such as tuberculosis, bronchiectasis, cavitary lung cancer, sarcoidosis, and pulmonary infarctions. Rarely, aspergilloma has been noted within a hydatid cyst. Even if this was the case, it is more common to find the coexistence of aspergilloma and pulmonary echinococcal cysts in immunocompromised individuals. It is, however, very uncommon to find this coinfection in normal immune status individuals. Here, we report on the successfully treated case of a 30-year-old immunocompetent female from Western Nepal with histologically proven coinfection by these two pathogens. She had a prolonged history of exposure to domesticated dogs. She suffered from hemoptysis from time to time for 3 years with increased frequency in the last 30 days. She was misdiagnosed clinically during a past medical visit at a local health center. Her computed tomography (CT) scans showed well-defined nonenhancing cystic lesions in the anterior basal segment of the right lower lobe adjacent to the major fissure. She underwent enucleation of the cyst via right posterolateral thoracotomy. On further histopathological evaluation, laminated membranes of the ectocyst along with fungal elements were found, and periodic acid-Schiff (PAS) staining revealed Aspergillus in the form of septate hyphae and acute angle branching. Owing to patient's economic constraints and unavailability in our center, DNA testing and molecular characterization could not be performed which further highlights the essence of diagnosing and managing such cases in resource poor settings. Eventually, we reviewed 12 confirmed cases of this coinfection in immunocompetent individuals during a period of 7 years (2015–2022) comparing them to a systematic review of 22 confirmed cases of the same coinfection from 1995 to 2014.

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          Most cited references41

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          Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans.

          The earlier recommendations of the WHO-Informal Working Group on Echinococcosis (WHO-IWGE) for the treatment of human echinococcosis have had considerable impact in different settings worldwide, but the last major revision was published more than 10 years ago. Advances in classification and treatment of echinococcosis prompted experts from different continents to review the current literature, discuss recent achievements and provide a consensus on diagnosis, treatment and follow-up. Among the recognized species, two are of medical importance -Echinococcus granulosus and Echinococcus multilocularis - causing cystic echinococcosis (CE) and alveolar echinococcosis (AE), respectively. For CE, consensus has been obtained on an image-based, stage-specific approach, which is helpful for choosing one of the following options: (1) percutaneous treatment, (2) surgery, (3) anti-infective drug treatment or (4) watch and wait. Clinical decision-making depends also on setting-specific aspects. The usage of an imaging-based classification system is highly recommended. For AE, early diagnosis and radical (tumour-like) surgery followed by anti-infective prophylaxis with albendazole remains one of the key elements. However, most patients with AE are diagnosed at a later stage, when radical surgery (distance of larval to liver tissue of >2cm) cannot be achieved. The backbone of AE treatment remains the continuous medical treatment with albendazole, and if necessary, individualized interventional measures. With this approach, the prognosis can be improved for the majority of patients with AE. The consensus of experts under the aegis of the WHO-IWGE will help promote studies that provide missing evidence to be included in the next update. Copyright 2009 Elsevier B.V. All rights reserved.
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            Echinococcosis: a review.

            Echinococcosis in humans occurs as a result of infection by the larval stages of taeniid cestodes of the genus Echinococcus. In this review we discuss aspects of the biology, life cycle, etiology, distribution, and transmission of the Echinococcus organisms, and the epidemiology, clinical features, treatment, and effect of improved diagnosis of the diseases they cause. New sensitive and specific diagnostic methods and effective therapeutic approaches against echinococcosis have been developed in the last 10 years. Despite some progress in the control of echinococcosis, this zoonosis continues to be a major public health problem in several countries, and in several others it constitutes an emerging and re-emerging disease.
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              Cystic Echinococcosis.

              Echinococcosis is one of the 17 neglected tropical diseases (NTDs) recognized by the World Health Organization. The two major species of medical importance are Echinococcus granulosus and Echinococcus multilocularis. E. granulosus affects over 1 million people and is responsible for over $3 billion in expenses every year. In this minireview, we discuss aspects of the epidemiology, clinical manifestations, and diagnosis of cystic echinococcosis or cystic hydatid disease caused by E. granulosus.

                Author and article information

                Case Rep Infect Dis
                Case Rep Infect Dis
                Case Reports in Infectious Diseases
                14 July 2023
                : 2023
                : 6975041
                1Manang District Hospital, Chame, Nepal
                2Department of Internal Medicine, Piedmont Athens Regional, Athens, Georgia, USA
                3Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
                4Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu, Nepal
                5Department of Pathology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
                6Department of Radiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
                Author notes

                Academic Editor: Salim Surani

                Author information
                Copyright © 2023 Aayush Adhikari et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 27 March 2023
                : 16 June 2023
                : 21 June 2023
                Case Report

                Infectious disease & Microbiology
                Infectious disease & Microbiology


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