Piggyback mycosis: pulmonary hydatid cyst with a mycotic co-infection

Abstract

The lungs are common sites for the occurrence of saprophytic or invasive mycosis as well as hydatid cysts. The two diseases seldom coexist, and the manifestation is seen as a fungal ball (usually aspergilloma) formed in the cavity left behind after hydatid cystectomy. Active invasion and proliferation of the fungi in the laminated ectocyst or sometimes the pericyst of the hydatid is very unusual. We report such a unique coexistence identified in two of the six surgically excised pulmonary hydatid cysts in the past 2 years. Both were immunocompetent males, who had presented with non-specific symptoms of cough, haemoptysis and chest pain. The septate slender hyphae of the invading fungus resembled those of Aspergillus.

A Rare Co-Existence of Aspergillosis and Pulmonary Hydatid Cyst in Immunocompetant Adults: Two Rare Case Reports and Review of the Literature

“…5,6,8 This is an expectable finding hence Aspergillus likes to colonize in post-infection cavities. The rest 17 cases were mixed infections without an operation history as in our two cases ( Table 1).…”

“…The incidence of Aspergillus colonization in hydatid cyst has variable ratios like 33% and 2% by Vaideswar et al and Kocer et al, respectively. 1,5 This difference may be associated with the limited number of the coexistence of hydatid cyst and Aspergillus. To our knowledge, 22 cases were reported in the literature.…”

“…Some authors suggest that fungi can invade outer aspect of laminated membrane and microorganisms settle into the cavity. 5,7 All cases reported in the literature were immunocompetant, except for three cases with diabetes mellitus (DM). 7,8,10 DM is generally a predisposing factor for pulmonary mycotic infections.…”

Aspergillus colonization of an echinococcal cyst cavity: case report

“…Bu tarzda, hidatik kist kavitesinde aspergillus ile uyumlu fungal kollonizasyon oldukça ender görülen bir durumdur. Bizim bildiğimiz kadarıyla literatürde sadece 9 yayın bulunmaktadır (3)(4)(5)(6)(7)(8)(9)(10)(11). Bildirilen olguların çoğu immün kompetandır, sadece 1'inde diabetes mellitus öyküsü vardır.…”

“…Bunlar arasında en sık görülen Aspergilloma; tüberküloz, sarkoidoz, bronşiektazi ve neoplazi gibi hastalıklara bağlı gelişen kaviter lezyonlarda görülür (1,2). Aspergilloma operasyon sonrası oluşan residü kaviter alanlarda da bildirilmekle birlikte hidatid kist kavitesinde kolonizasyon ender görülmektedir (3)(4)(5)(6)(7)(8)(9)(10)(11).…”