I've spoken about my fungal pneumonia in prior posts but I thought I'd consolidate that information and provide more reference information with it.
MY DIAGNOSIS
Early September 7th I went to the ER with a small bowel obstruction. After admission to the ER and getting treated with pain and nausea meds the ER doc ordered a series of tests to verify my suspicion of a bowel obstruction. This included urine and blood tests but also an abdominal CT scan. This is what the radiologist said about CT scan:
IMPRESSION:
1. Findings suggest partial small bowel obstruction.
2. There is induration/inflammation around the ileocolonic anastomosis in the right abdomen but there is no discrete abscess in this area.
3. Small fluid collection in the anterior abdomen deep to the midline wound. This contains no gas bubbles. It could be sterile or infected.
4. Potentially significant abnormality in both lung bases where there are new nodular infiltrates. These are only partially included on the study. A CT scan of the chest with intravenous contrast is suggested for further evaluation.
Based upon this CT scan (and a blood test which indicated I was fighting infection), the ER doc admitted me to the hospital. They also ordered a chest CT scan. The radiologist said this about the chest CT scan:
IMPRESSION:
1. Multifocal pulmonary consolidation, consistent with pneumonia.
2. A subcentimeter cavitary nodule is present in the right middle lobe.
3. If the patient is immunosuppressed, one should consider opportunistic infection.
I later learned that I had 20 or more "spots" in my lungs. Later I read that the "cavitary nodule" usually indicates necrotic (aka dead) tissue.
Based upon my taking both Imuran (immuno-suppressant) and Prednisone (also considered immuno-suppressant), the doctors did consider me to be immuno-compromised. So they began a battery of tests which eventually included more than 30 tests, most of them blood tests.
After one of the antibody tests indicated exposure to Cryptococcus Neoformans, they began treating me for that and they elected to perform a broncoscopy. They also tested the material the collected from my lungs in the broncoscopy (a washing, a brushing, and a biopsy). The washing and brushing were both clear of organisms but the culture of the biopsy also showed C. Neoformans and restesting my blood for C. Neoformans verified the diagnosis.
Cryptococcus neoformans is the fungus that causes this disease. It is usually found in soil. If you breathe it in, it infects your lungs. The infection may go away on its own, remain in the lungs only, or spread throughout the body (disseminate).
This infection is most often seen in people with a weakened immune system, such as those with HIV infection, taking high doses of corticosteroid medications, cancer chemotherapy, or who have Hodgkin's disease.
It can be found all over the world.
Because I displayed no symptoms of the central nervous system (to indicate encephalitis or meningitis), they elected to not perform a lumbar puncture for testing by cerebral-spinal fluid (CSF). To this date (10/7), I still do not display central nervous system (CNS) symptoms, cross your fingers that this remains true because if this gets into my CNS the prognosis is terrible. Most people die and of those that survive, nearly all of them suffer some amount of brain damage.
Note, the results of some of my cultures are still not back yet (mostly the mycobacterium cultures). So it is possible that I am suffering from another infection - I'm sincerely hoping that I'm not. I've got plenty to worry about already.
This process was complicated by the fact that I was asymptomatic for the fungal infection. I'm not sure whether this was because I still had prednisone and Imuran in my system and my immune system was ignoring the infection or because we caught it too early for it to cause major symptoms.
I fear that the former is true. I fear this because of the 20+ spots they found on the CT scan.
TREATMENT
Treatment of Cryptococcus by Medscape says to treat mild to moderate C. Neoformans infections with 400 mg / day Diflucan or Itraconazole for 6 to 12 months.
People with a high chance of reinfection/relapse can be treated with 200 mg/day of Diflucan, perhaps for the rest of their life. If I still require IV Remicade after we resolve the original infection, then I will probably use this treatment regimen.
PROGNOSIS
Now that this condition has been diagnosed and treatment has begun, my prognosis is excellent. Even if I have to stop taking my current anti-fungal drug, there are enough alternatives that I'll be able to kill this infection. Also I've stopped taking any drugs which can compromise my immune system and it should be able to help much more than it was previously.
I am really hoping that this does not prevent me from taking the Remicade and as I near the end of my C. Neoformans treatment, I'm hoping that I can get my Infectious Diseases doc and GI doc to agree to a treatment plan which both includes Remicade or equivalent and prevents a re-occurrence of the fungal pneumonia.
MY DIAGNOSIS
Early September 7th I went to the ER with a small bowel obstruction. After admission to the ER and getting treated with pain and nausea meds the ER doc ordered a series of tests to verify my suspicion of a bowel obstruction. This included urine and blood tests but also an abdominal CT scan. This is what the radiologist said about CT scan:
IMPRESSION:
1. Findings suggest partial small bowel obstruction.
2. There is induration/inflammation around the ileocolonic anastomosis in the right abdomen but there is no discrete abscess in this area.
3. Small fluid collection in the anterior abdomen deep to the midline wound. This contains no gas bubbles. It could be sterile or infected.
4. Potentially significant abnormality in both lung bases where there are new nodular infiltrates. These are only partially included on the study. A CT scan of the chest with intravenous contrast is suggested for further evaluation.
Based upon this CT scan (and a blood test which indicated I was fighting infection), the ER doc admitted me to the hospital. They also ordered a chest CT scan. The radiologist said this about the chest CT scan:
IMPRESSION:
1. Multifocal pulmonary consolidation, consistent with pneumonia.
2. A subcentimeter cavitary nodule is present in the right middle lobe.
3. If the patient is immunosuppressed, one should consider opportunistic infection.
I later learned that I had 20 or more "spots" in my lungs. Later I read that the "cavitary nodule" usually indicates necrotic (aka dead) tissue.
Based upon my taking both Imuran (immuno-suppressant) and Prednisone (also considered immuno-suppressant), the doctors did consider me to be immuno-compromised. So they began a battery of tests which eventually included more than 30 tests, most of them blood tests.
After one of the antibody tests indicated exposure to Cryptococcus Neoformans, they began treating me for that and they elected to perform a broncoscopy. They also tested the material the collected from my lungs in the broncoscopy (a washing, a brushing, and a biopsy). The washing and brushing were both clear of organisms but the culture of the biopsy also showed C. Neoformans and restesting my blood for C. Neoformans verified the diagnosis.
Cryptococcus neoformans is the fungus that causes this disease. It is usually found in soil. If you breathe it in, it infects your lungs. The infection may go away on its own, remain in the lungs only, or spread throughout the body (disseminate).
This infection is most often seen in people with a weakened immune system, such as those with HIV infection, taking high doses of corticosteroid medications, cancer chemotherapy, or who have Hodgkin's disease.
It can be found all over the world.
Because I displayed no symptoms of the central nervous system (to indicate encephalitis or meningitis), they elected to not perform a lumbar puncture for testing by cerebral-spinal fluid (CSF). To this date (10/7), I still do not display central nervous system (CNS) symptoms, cross your fingers that this remains true because if this gets into my CNS the prognosis is terrible. Most people die and of those that survive, nearly all of them suffer some amount of brain damage.
Note, the results of some of my cultures are still not back yet (mostly the mycobacterium cultures). So it is possible that I am suffering from another infection - I'm sincerely hoping that I'm not. I've got plenty to worry about already.
This process was complicated by the fact that I was asymptomatic for the fungal infection. I'm not sure whether this was because I still had prednisone and Imuran in my system and my immune system was ignoring the infection or because we caught it too early for it to cause major symptoms.
I fear that the former is true. I fear this because of the 20+ spots they found on the CT scan.
TREATMENT
Treatment of Cryptococcus by Medscape says to treat mild to moderate C. Neoformans infections with 400 mg / day Diflucan or Itraconazole for 6 to 12 months.
People with a high chance of reinfection/relapse can be treated with 200 mg/day of Diflucan, perhaps for the rest of their life. If I still require IV Remicade after we resolve the original infection, then I will probably use this treatment regimen.
PROGNOSIS
Now that this condition has been diagnosed and treatment has begun, my prognosis is excellent. Even if I have to stop taking my current anti-fungal drug, there are enough alternatives that I'll be able to kill this infection. Also I've stopped taking any drugs which can compromise my immune system and it should be able to help much more than it was previously.
I am really hoping that this does not prevent me from taking the Remicade and as I near the end of my C. Neoformans treatment, I'm hoping that I can get my Infectious Diseases doc and GI doc to agree to a treatment plan which both includes Remicade or equivalent and prevents a re-occurrence of the fungal pneumonia.
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