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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;156:143-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Cuestiones por resolver en el tratamiento con glucocorticoides de la infección COVID-19" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "143" "paginaFinal" => "144" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Unresolved questions about the treatment of COVID-19 with corticosteroids" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1756 "Ancho" => 2500 "Tamanyo" => 433707 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Forest plot</span> de la reducción en mortalidad, de acuerdo con la gravedad en la COVID-19 tras el uso de glucocorticoides.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luis Corral-Gudino, Jesica Abadía-Otero, Julia Gómez-Barquero" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Luis" "apellidos" => "Corral-Gudino" ] 1 => array:2 [ "nombre" => "Jesica" "apellidos" => "Abadía-Otero" ] 2 => array:2 [ "nombre" => "Julia" "apellidos" => "Gómez-Barquero" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020620306410" "doi" => "10.1016/j.medcle.2020.10.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620306410?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S002577532030765X?idApp=UINPBA00004N" "url" => "/00257753/0000015600000003/v1_202101240617/S002577532030765X/v1_202101240617/es/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Acute isolated appendicitis caused by aspergillus in a patient suffering from severe aplastic anemia" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "144" "paginaFinal" => "146" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Yaoying Long, Lin Liu, Xiaoqiong Tang" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Yaoying" "apellidos" => "Long" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] ] ] 1 => array:3 [ "nombre" => "Lin" "apellidos" => "Liu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] ] ] 2 => array:4 [ "nombre" => "Xiaoqiong" "apellidos" => "Tang" "email" => array:1 [ 0 => "tlscqmu@126.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Hematopathology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Apendicitis aislada aguda causada por aspergillus en un paciente con anemia aplásica grave" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1696 "Ancho" => 1000 "Tamanyo" => 347806 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Aspergilus colonies in the appendix were observed by Histological examination. (a) Hematoxylin and eosin(H & E) staining showed fungal spores(arrows). (b) Periodic acid–Schiff (PAS) staining revealed fungal hyphae with acute-angle branching (arrows). (c) Gomori methenamine silver (GMS) staining showed fungal spores (arrows).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Fungal infection is an uncommon disease of appendicitis. The fungal appendicitis occurs in 1.15% of autopsy cases. The incidence of aspergillus appendicitis is even lower, just 0.01%.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> This infection is seen primarily in patients with hematologic malignancies or transplantation who suffer from neutropenia, and also in immunodeficiency patients such as infected with human immunodeficiency virus (HIV). Clinical manifestations are diverse and nonspecific. Definitive diagnosis may require histopathologic evidence of fungal invasion of tissue, but this is not always feasible.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Early recognition is important to prevent complications or death. Although experience evaluating treatment strategies is limited, a combined medical and surgical approach is usually necessary.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a case of primary Aspergillus appendicitis diagnosed by histologic examination in a neutropenic patient with severe aplastic anemia. After persisting fever, he developed lower right quadrant abdominal pain. Abdominal computed tomography revealed enlargement with enhancing thicken wall of appendix and mild periappendiceal fat reticulation without evidence of wall disruption. These findings were consistent with acute appendicitis with secondary inflammation. The patient was taken up for emergency surgery after transfusion with platelets. Laparotomy revealed an inflamed, edematous appendix without appendiceal perforation and a large amount of pus moss adhered to the appendix surface. Histologically, the appendix was congestive and edematous, with degeneration, necrosis and exfoliation of some mucosa. Interstitial lymphoid connective tissue is hyperplasia and inflammatory cell infiltration could be seen on serosal surface. Fungal hyphae with acute-angle branching were observed, which suggested Aspergillus infection (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Voriconazole treatment was maintained after surgery, and no aspergillosis relapse or other invasive fungal infections were observed. The patient was admitted for stem cell transplantation successfully. Follow up to now, the prognosis of the patient is good.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Studies demonstrated that immunosuppressed populations who have chemotherapy or immunosuppressive therapy are at risk for fungal infection of appendix. Direct colonization from the appendix is likely to occur in aspergillus appendicitis. It has been reported that patients with neutropenia may develop intestinal mucositis during chemotherapy.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Different from the path of invasion of Aspergillus in the lungs, the entrance of Aspergillus may be intestinal in patients with severe intestinal mucositis. The mucedine penetrates the intestinal wall, invades the mesentery, and forms hyphae in the lumen, leading to Aspergillus infection of appendix.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Simultaneous bacterial and fungal infection may be another possible pathogenesis of fungal appendicitis. Our patient had persisting fever who was in a state of low immunity with neutropenia. Antibacterial therapy alone could not effectively control body temperature, which indicates the presence of a serious bacterial infection or a concomitant infection with other pathogens.</p><p id="par0020" class="elsevierStylePara elsevierViewall">As fungal infection has high mortality and tends to involve other organs or systems, it is necessary to diagnose and treatment early. However, diagnosis of Aspergillus appendicitis can be challenging. The diagnostic methods of fungal infections mainly include serology, microbiology and pathology. Serologic methods are viewed as being clinically useful but not specific for Aspergillus. Although the microbiological methods are excellent specificity, it is time-consuming, insensitive and easily disturbed by the external environment. Histopathological examination of biopsy is the gold standard, but this is not always feasible due to require testing of invasively collected specimens.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Early treatment of suspected appendicitis of aspergillus has been proved related to improve prognosis. It is necessary to perform empirical antifungal therapy in patients with neutropenia associated with fever. Voriconazole or amphotericin B is recommended if Aspergillus infection is suspected.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Recent studies have reported that antifungal therapy can be initiated based on the results of continuous screening for aspergillosis (such as galactomannan and 1–3-β-<span class="elsevierStyleSmallCaps">d</span>-glucan). It's called preemptive therapy and is an early treatment strategy, which has been proposed as an alternative to empirical therapy. In addition, the degree of immunosuppression should be reduced as much as possible as an adjunct to antifungal therapy. Aspergillus appendicitis, except for antifungal treatment, is recommended for surgery to remove necrotic appendix.</p><p id="par0030" class="elsevierStylePara elsevierViewall">This highlights the need to consider fungal appendicitis as the differential diagnosis early in immunosuppressed patients with fever that cannot be controlled by antibiotics., especially with the presentation of ambiguous clinical symptoms and signs, including persistent fever and abdominal pain. Besides, it is very important to complete laboratory and imaging examinations in time. Early diagnosis and prompt surgery with medical treatment are associated with a survival advantage.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethics approval and consent to participate</span><p id="par0035" class="elsevierStylePara elsevierViewall">This study was approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University and was performed according to the Declaration of Helsinki.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Author contributions</span><p id="par0040" class="elsevierStylePara elsevierViewall">Conceived and designed the case report: Yaoying Long, Lin Liu and Xiaoqiong Tang. Literature search, eligibility determination, and data extraction: Yaoying Long and Lin Liu. Analyzed the data: Yaoying Long, Lin Liu and Xiaoqiong Tang. Wrote the manuscript: Yaoying Long. Critical revision of intellectual content and proofreading of manuscript: Xiaoqiong Tang. All authors approved of the content of this manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Patient consent for publication</span><p id="par0050" class="elsevierStylePara elsevierViewall">Patient has provided informed consent for publication of the case.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethics approval and consent to participate" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Author contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Patient consent for publication" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Contributed equally.</p>" "identificador" => "fn0005" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1696 "Ancho" => 1000 "Tamanyo" => 347806 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Aspergilus colonies in the appendix were observed by Histological examination. (a) Hematoxylin and eosin(H & E) staining showed fungal spores(arrows). (b) Periodic acid–Schiff (PAS) staining revealed fungal hyphae with acute-angle branching (arrows). (c) Gomori methenamine silver (GMS) staining showed fungal spores (arrows).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristic clinical features of Aspergillus appendicitis: case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Gjeorgjievski" 1 => "M.B. Amin" 2 => "M.S. Cappell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3748/wjg.v21.i44.12713" "Revista" => array:6 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2015" "volumen" => "21" "paginaInicial" => "12713" "paginaFinal" => "12721" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26640349" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intra-abdominal fungal infections" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Rebolledo" 1 => "J.C. Sarria" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.qco.0000433309.21148.f7" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Infect Dis" "fecha" => "2013" "volumen" => "26" "paginaInicial" => "441" "paginaFinal" => "446" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23982234" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary invasive aspergillosis of the digestive tract: report of two cases and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Eggimann" 1 => "J.C. Chevrolet" 2 => "M. Starobinski" 3 => "P. Majno" 4 => "M. Totsch" 5 => "B. Chapuis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s15010-006-5660-0" "Revista" => array:6 [ "tituloSerie" => "Infection" "fecha" => "2006" "volumen" => "34" "paginaInicial" => "333" "paginaFinal" => "338" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17180588" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary gastrointestinal aspergillosis after autologous peripheral blood progenitor cell transplantation: an unusual presentation of invasive aspergillosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. González-Vicent" 1 => "M.A. Díaz" 2 => "I. Colmenero" 3 => "J. Sevilla" 4 => "L. Madero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1399-3062.2007.00288.x" "Revista" => array:6 [ "tituloSerie" => "Transpl Infect Dis" "fecha" => "2008" "volumen" => "10" "paginaInicial" => "193" "paginaFinal" => "196" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18069930" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.F. Patterson" 1 => "G.R. Thompson 3rd" 2 => "D.W. Denning" 3 => "J.A. Fishman" 4 => "S. Hadley" 5 => "R. Herbrecht" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/ciw326" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2016" "volumen" => "63" "paginaInicial" => "e1" "paginaFinal" => "e60" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27365388" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00257753/0000015600000003/v1_202101240617/S0025775320300427/v1_202101240617/en/main.assets" "Apartado" => array:4 [ "identificador" => "66430" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas al Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00257753/0000015600000003/v1_202101240617/S0025775320300427/v1_202101240617/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320300427?idApp=UINPBA00004N" ]
