Endobronchial fungal infection (EBFI)

1. Endobronchial Fungal Infection (EBFI)
D R . M D . S H A F I Q U L I S L A M D E WA N
R E S I D E N T ( P U L M O N O L O G Y )
D E PA RT M E N T O F R E S P I R ATO RY M E D I C I N E
D H A K A M E D I C A L C O L L E G E H O S P I TA L

2. Introduction
Endobronchial fungal infection (EBFI) is a rare form of pulmonary fungal
infection that especially affects immunocompromised patients.
EBFI resulting in obstruction of the main bronchus is extremely rare.
With the development of bronchoscopic techniques, rare cases of EBFI have
been reported.
Bronchoscopic findings in EBFI vary from mild mucosal inflammation to central
airway obstruction.
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 2

3. Fungi causing EBFI
•Aspergillosis
•Coccidioidomycosis
•Mucormycosis
•Candidiasis
•Cryptococcosis
•Histoplasmosis
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 3

4. Lesions in EBFI
•Lesions predominantly involved the lobar and segmental bronchi.
•Unilateral involvement is common than bilateral and tracheal involvement is
uncommon.
•The characteristics of the lesions included_
• Yellowish-white necrotic plaques
• Irregular-sessile nodules
• Granulomatous lesions
• EB masses (hemorrhagic or non-hemorrhagic)
• Hyperemic mucosa
• Bronchial stenosis and anastomotic infection, especially in transplant patients.
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 4

5. Specimen for diagnosis
•Bronchial washings and/or brushings
•Bronchoalveolar lavage (BAL)
•Endobronchial biopsy of the lesion
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 5

6. Bronchoscopic/pathological description (Aspergillosis)
•Bronchial stenosis
•Yellowish-white necrotic material-
plaques
•Pseudomembranous plaques
•Yellowish exudative material
•White-colored nodules
•Broken sutures
•Edematous irregular mucosa
•Ulcerative appearance
•Grayish mucous plaque
•Friable brownish material
•Dehiscence
•Dark-black pigmentation
•Mucosal irregularity
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 6

7. Bronchoscopic View (Aspergillosis)
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 7

8. Bronchoscopic/pathological description (Coccidioidomycosis)
•Irregular nodules
•Sessile nodules
•Submucosal nodules
•Granular lesions
•Mass-like lesion
•Friable mass
•Polypoid mass
•Hyperemic patches
•Papillary excrescences
•Cobble-stoned view
•White nodular raised lesions
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 8

9. Bronchoscopic View (Coccidioidomycosis)
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 9

10. Bronchoscopic/pathological description (Mucormycosis)
•Mass-like lesion
•Gray white fibrinous plug
•Inflammation
•Granular lesion
•Slough of mucosa
•Ulcer
•Stenosis
•Green pseudo-membrane
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 10

11. Bronchoscopic View (Mucormycosis)
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 11

12. Bronchoscopic/pathological description (Candida)
•Anastomotic site infection
•Pseudo-membrane
•Multiple, large, firmly adherent plaques
•Hemorrhage
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 12

13. Bronchoscopic View (Candida)
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 13

14. Bronchoscopic/pathological description (Cryptococcosis)
•Hemorrhagic mass
•White mass-like lesion
•Infiltrative mucosal lesion
•Gelatinous mass
•Soft, reddish, broad-based nodule
•Ulcerative lesion
•Pseudomembranous appearance
•White mucous plaque
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 14

15. Bronchoscopic View (Cryptococcosis)
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 15

16. Bronchoscopic/pathological description (Histoplasmosis)
•Hyperemic mucosa
•Broncho-esophageal fistula
•Friable mass
•Hemorrhage
•Mass
•Broncholithiasis
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 16

17. Bronchoscopic View (Histoplasmosis)
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 17

18. DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 18
“Fungal infection should be in the differential diagnosis
of any type of EB lesion, particularly in an
immunocompromised patient”

19. DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 19
Thank You