title: [Pulmonary paecilomycosis: Diagnosis and treatment].
abstract: OBJECTIVE
  To represent the advances of Russia and Uzbekistan in studying the problem of paecilomycosis. The goal of the investigation was to develop the diagnosis and treatment of pulmonary paecilomycosis (PP).
  
  
  METHODS
  Two hundred and twenty-five people, including 200 patients with bronchopulmonary infection with fungi of the Paecilomyces genus and 25 clinically healthy individuals (a control group), were examined. Clinico-anamnestic, laboratory diagnostic, mycological, and immunological studies were conducted; a lymphocyte antigen-binding test was used for differential diagnosis. Paecilomyces infection was diagnosed by microscopically examining the morphology of the fungi in the pathological material (blood, sputum) and by isolating the cultured fungi in the media (Sabouraud's and Czapek's ones). The severe complication of PP - atypical paecilomycosis-associated myocarditis (APAM) - was studied in 112 patients with helminthiasis-complicated paecilomycosis. These patients underwent using the conventional echocardiography.
  
  
  RESULTS
  Bronchopulmonary paecilomycosis resulting from primary and secondary infection with fungi of the Paecilomyces genus was clinically manifested as chronic obstructive bronchitis (11.5%), recurrent pneumonia (13.5%), exogenous allergic alveolitis (37%), and asthma (26%) complicated by helminthiasis (12%). Iodine deficiency promotes the prevalence of paecilomycosis and echinococcosis favors Paecilomycosis infection; moreover, the helminth capsule itself serves as a nutrient medium for the development of the mycelial form of the fungus. APAM is a severe complication of PP. Almost 50% of the patients with PP presented with carditis. The patients with APAM occasionally experienced fear and the most severe intermittent pain. The latter first occurred in the chest.and irradiated to the axilla, left hand, and its fingertips, paralyzing the arm. In some patients, the pain manifested itself in both arms with abdominal irradiation, by being accompanied by faints. Current analgesics (meloxicam, tizanidine, nimesulide, morphine, promedole) in combination with fluconazole provided a temporary positive effect.
  
  
  CONCLUSIONS
  Further investigations that must also include neurologists and anesthetists are required to work out effective pain relief regimens for APAM in patients with PP.
authors.affiliation: I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia.
authors.forename: A V
authors.initials: AV
authors.lastname: Strelyaeva
authors.affiliation: I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia.
authors.forename: A A
authors.initials: AA
authors.lastname: Svistunov
authors.affiliation: I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia.
authors.forename: R Al
authors.initials: RA
authors.lastname: Dzhomaa
authors.affiliation: I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia.
authors.forename: S A
authors.initials: SA
authors.lastname: Sapozhnikov
authors.affiliation: I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia.
authors.forename: N V
authors.initials: NV
authors.lastname: Chebyshev
authors.affiliation: Samarkand State Medical Institute, Samarkand, Republic of Uzbekistan.
authors.forename: A A
authors.initials: AA
authors.lastname: Ashurov
authors.affiliation: I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia.
authors.forename: M L
authors.initials: ML
authors.lastname: Maksimov
authors.affiliation: I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia.
authors.forename: N B
authors.initials: NB
authors.lastname: Lazareva
authors.affiliation: Samarkand State Medical Institute, Samarkand, Republic of Uzbekistan.
authors.forename: A K
authors.initials: AK
authors.lastname: Gabchenko
authors.affiliation: Samarkand State Medical Institute, Samarkand, Republic of Uzbekistan.
authors.forename: V M
authors.initials: VM
authors.lastname: Sadykov
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D007455:Iodine / Q000172:deficiency; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D009205:Myocarditis / Q000209:etiology / Q000382:microbiology / Q000503:physiopathology; D010143:Paecilomyces / Q000187:drug effects / Q000302:isolation & purification*; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D011859:Radiography; D012426:Russia; D013183:Sputum / Q000382:microbiology; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000378:metabolism / Q000503:physiopathology; D013963:Thyroid Hormones / Q000097:blood; D014610:Uzbekistan; D016277:Ventricular Function, Left
chemical_list: D000700:Analgesics; D000935:Antifungal Agents; D013963:Thyroid Hormones; D007455:Iodine