Browsing by Author "Jimenez, Carlos"
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Item Fungal empyema thoracis in cancer patients(Elsevier, 2016) Nigo, Masayuki; Vial, Macarena; Munita, José; Jiang, Ying; Tarrand, Jeffrey; Jimenez, Carlos; Kontoyiannis, DimitriosOBJECTIVES: Fungal empyema thoracis (FET) is a rare life-threatening infection. We sought to describe the clinical characteristics of FET in a large academic cancer center. METHODS: We conducted a retrospective chart review of all cancer patients who had a fungal isolate from the pleural fluid culture between 1/2005 and 8/2013. RESULTS: A total of 106 fungal isolates were identified in 97 patients. Yeasts accounted for 62% of the isolates whereas 38% were identified as molds. The most frequent pathogens were Candida spp. (58%) and Aspergillus spp. (12%). All patients with Aspergillus and 83% with Candida met criteria for proven fungal disease. Compared to the Aspergillus group, Candida FET was associated with recent abdominal or thoracic surgical procedures (44% vs. 0%, p = 0.01). Overall, 6-week mortality was high, with no significant differences between Candida and Aspergillus (31% vs. 45%, respectively [p = 0.48]). Only 1 out of 11 patients with uncommon molds died at 6 weeks, despite only 2 of them received appropriate antifungal therapy. CONCLUSIONS: Development of FET carries a high mortality in cancer patients. A history of a recent surgical procedure is a risk factor for FET due to Candida. Isolation of uncommon molds is likely to represent a contamination of the pleural fluid.Item Needle fracture during endobronchial ultrasound-guided transbronchial needle aspiration(American Thoracic Society, 2016) Vial, Macarena; O’Connell, John; Grosu, Horiana; Ost, David; Eapen, George; Jimenez, CarlosA 57-year-old man with new-onset hoarseness and markedly enlarged left paratracheal lymphadenopathy underwent an endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) that revealed non–small cell carcinoma. During the procedure, the needle broke inside the lymph node, and after several unsuccessful attempts to remove it, the procedure was terminated without any additional lymph node staging. The patient then self-referred to our institution, where he underwent a positron emission tomography–computed tomography scan and another EBUS-TBNA for completion of mediastinal staging.