Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2022; 32(01): 081-112
DOI: 10.1055/s-0042-1743418
Review Article

Imaging Approach to Pulmonary Infections in the Immunocompromised Patient

Shabnam Bhandari Grover 
1   Department of Radiology, VMMC and Safdarjung Hospital, New Delhi (Former and source of this work)
2   Department of Radiology and Imaging, Sharda School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India (Current)
,
Hemal Grover
3   Department of Radiology and Imaging, Icahn School of Medicine at Mount Sinai West, New York, New York, United States
,
Neha Antil
4   Department of Radiology and Imaging, Stanford University, California, United States
,
Sayantan Patra
5   Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
,
Manas Kamal Sen
6   Department of Pulmonary Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
,
Deepthi Nair
7   Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Pulmonary infections are the major cause of morbidity and mortality in immunocompromised patients and almost one-third of intensive care unit patients with pulmonary infections belong to the immunocompromised category. Multiple organisms may simultaneously infect an immunocompromised patient and the overwhelming burden of mixed infections further predisposes critically ill patients to acute hypoxemic respiratory failure. Notwithstanding that lung ultrasound is coming into vogue, the primary imaging investigation is a chest radiograph, followed by thoracic CT scan. This review based on our experience at tertiary care teaching hospitals provides insights into the spectrum of imaging features of various pulmonary infections occurring in immunocompromised patients. This review is unique as, firstly, the imaging spectrum described by us is categorized on basis of the etiological infective agent, comprehensively and emphatically correlated with the clinical setting of the patient. Secondly, a characteristic imaging pattern is emphasized in the clinical setting-imaging-pattern conglomerate, to highlight the most likely diagnosis possible in such a combination. Thirdly, the simulating conditions for a relevant differential diagnosis are discussed in each section. Fourthly, not only are the specific diagnostic and tissue sampling techniques for confirmation of the suspected etiological agent described, but the recommended pharmaco-therapeutic agents are also enumerated, so as to provide a more robust insight to the radiologist. Last but not the least, we summarize and conclude with a diagnostic algorithm, derived by us from the characteristic illustrative cases. The proposed algorithm, illustrated as a flowchart, emphasizes a diagnostic imaging approach comprising: correlation of the imaging pattern with clinical setting and with associated abnormalities in the thorax and in other organs/systems, which is comprehensively analyzed in arriving at the most likely diagnosis. Since a rapid evaluation and emergent management of such patients is of pressing concern not only to the radiologist, but also for the general physicians, pulmonologists, critical care specialists, oncologists and transplant surgery teams, we believe our review is very informative to a wide spectrum reader audience.

Keywords

immunocompromised patient - pulmonary infection - CT thorax - imaging pattern - tissue sampling - diagnostic algorithm


Publication History

Article published online:
27 May 2022

© 2022. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Vazquez Guillamet C, Hsu JL, Dhillon G, Vazquez Guillamet R. Pulmonary infections in immunocompromised hosts: Clinical. J Thorac Imaging 2018; 33 (05) 295-305
    CrossrefPubMedGoogle Scholar
  • 2 Oh YW, Effmann EL, Godwin JD. Pulmonary infections in immunocompromised hosts: the importance of correlating the conventional radiologic appearance with the clinical setting. Radiology 2000; 217 (03) 647-656
    CrossrefPubMedGoogle Scholar
  • 3 Vaillant A, Qurie A. Immunodeficiency [Internet]. Ncbi. nlm.nih.gov. 2020 [cited 14 July 2020]. Accessed January 30, 2022 from: https://www.ncbi.nlm.nih.gov/books/NBK500027/
    PubMedGoogle Scholar
  • 4 Peck K, Kim T, Lee M, Lee K, Han J. Pneumonia in immunocompromised patients: updates in clinical and imaging features. Precision Future Med 2018; 2 (03) 95-108
    CrossrefGoogle Scholar
  • 5 Bajaj SK, Tombach B. Respiratory infections in immunocompromised patients: lung findings using chest computed tomography. Radiol Infect Dis 2017; 4 (01) 29-37
    CrossrefPubMedGoogle Scholar
  • 6 Sarkar D, Jung MK, Wang HJ. Alcohol and the immune system. Alcohol Res 2015; 37 (02) 153-155
    Google Scholar
  • 7 Berbudi A, Rahmadika N, Tjahjadi AI, Ruslami R. Type 2 diabetes and its impact on the immune system. Curr Diabetes Rev 2020; 16 (05) 442-449
    CrossrefPubMedGoogle Scholar
  • 8 Syed-Ahmed M, Narayanan M. Immune dysfunction and risk of infection in chronic kidney disease. Adv Chronic Kidney Dis 2019; 26 (01) 8-15
    CrossrefPubMedGoogle Scholar
  • 9 França T, Ishikawa L, Zorzella-Pezavento S, Chiuso-Minicucci F, da Cunha M, Sartori A. Impact of malnutrition on immunity and infection. J Venom Anim Toxins Incl Trop Dis 2009; 15 (03) 374-390
    CrossrefGoogle Scholar
  • 10 Fuentes E, Fuentes M, Alarcón M, Palomo I. Immune system dysfunction in the elderly. An Acad Bras Cienc 2017; 89 (01) 285-299
    CrossrefPubMedGoogle Scholar
  • 11 Meidani M, Naeini AE, Rostami M, Sherkat R, Tayeri K. Immunocompromised patients: review of the most common infections happened in 446 hospitalized patients. J Res Med Sci 2014; 19 (Suppl. 01) S71-S73
    PubMedGoogle Scholar
  • 12 Ahuja J, Kanne JP. Thoracic infections in immunocompromised patients. Radiol Clin North Am 2014; 52 (01) 121-136
    CrossrefPubMedGoogle Scholar
  • 13 Azoulay E, Russell L, Van de Louw A. et al; Nine-i Investigators. Diagnosis of severe respiratory infections in immunocompromised patients. Intensive Care Med 2020; 46 (02) 298-314
    CrossrefPubMedGoogle Scholar
  • 14 Soldati G, Smargiassi A, Inchingolo R. et al. Proposal for international standardization of the use of lung ultrasound for patients with COVID-19: a simple, quantitative, reproducible method. J Ultrasound Med 2020; 39 (07) 1413-1419
    CrossrefPubMedGoogle Scholar
  • 15 Tanaka N, Kunihiro Y, Yanagawa N. Infection in immunocompromised hosts: imaging. J Thorac Imaging 2018; 33 (05) 306-321
    CrossrefPubMedGoogle Scholar
  • 16 Kunihiro Y, Tanaka N, Kawano R. et al. Differential diagnosis of pulmonary infections in immunocompromised patients using high-resolution computed tomography. Eur Radiol 2019; 29 (11) 6089-6099
    CrossrefPubMedGoogle Scholar
  • 17 Kulkarni AP, Sengar M, Chinnaswamy G. et al. Indian antimicrobial prescription guidelines in critically ill immunocompromised patients. Indian J Crit Care Med 2019; 23 (Suppl. 01) S64-S96
    PubMedGoogle Scholar
  • 18 Mahendra M, Jayaraj BS, Lokesh KS. et al. Antibiotic prescription, organisms and its resistance pattern in patients admitted to respiratory ICU with respiratory infection in Mysuru. Indian J Crit Care Med 2018; 22 (04) 223-230
    CrossrefPubMedGoogle Scholar
  • 19 Baldassarri RJ, Kumar D, Baldassarri S, Cai G. Diagnosis of infectious diseases in the lower respiratory tract: a cytopathologist's perspective. Arch Pathol Lab Med 2019; 143 (06) 683-694
    CrossrefPubMedGoogle Scholar
  • 20 Geake J, Hammerschlag G, Nguyen P. et al. Utility of EBUS-TBNA for diagnosis of mediastinal tuberculous lymphadenitis: a multicentre Australian experience. J Thorac Dis 2015; 7 (03) 439-448
    PubMedGoogle Scholar
  • 21 Murdoch DR, Werno AM, Jennings LC. Microbiological; diagnosis of respiratory illness: recent advances. In: Chernick V, Kendig E. eds. Kendig's Disorders of the Respiratory Tract in Children. 9th edition. New York: Elsevier; 2018: 396-405
    Google Scholar
  • 22 Washington JA. Principles of diagnosis. In: Baron S. ed. Medical Microbiology. 4th edition. Galveston (TX): University of Texas Medical Branch at Galveston; 1996. . Chapter 10. Accessed January 30, 2022 from: https://www.ncbi.nlm.nih.gov/books/NBK8014/
    Google Scholar
  • 23 Stanzani M, Sassi C, Lewis RE. et al. High resolution computed tomography angiography improves the radiographic diagnosis of invasive mold disease in patients with hematological malignancies. Clin Infect Dis 2015; 60 (11) 1603-1610
    CrossrefPubMedGoogle Scholar
  • 24 Chen C. (August 29th 2011). Gangrenous Lung Disease, Gangrene - Current Concepts and Management Options, Alexander Vitin, IntechOpen. DOI: 10.5772/22495 . Accessed January 30, 2022 from: https://www.intechopen.com/books/gangrene-current-concepts-and-management-options/gangrenous-lung-disease
    CrossrefGoogle Scholar
  • 25 Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008; 246 (03) 697-722
    CrossrefPubMedGoogle Scholar
  • 26 Okada F, Ando Y, Tanoue S. et al. Radiological findings in acute Haemophilus influenzae pulmonary infection. Br J Radiol 2012; 85 (1010): 121-126
    CrossrefPubMedGoogle Scholar
  • 27 Mane A, Gujar P, Gaikwad S. et al. Aetiological spectrum of severe community-acquired pneumonia in HIV-positive patients from Pune, India. Indian J Med Res 2018; 147 (02) 202-206
    CrossrefPubMedGoogle Scholar
  • 28 Miyashita N, Sugiu T, Kawai Y. et al. Radiographic features of Mycoplasma pneumoniae pneumonia: differential diagnosis and performance timing. BMC Med Imaging 2009; 9 (01) 7
    CrossrefPubMedGoogle Scholar
  • 29 Okada F, Ono A, Ando Y. et al. Thin-section CT findings in Pseudomonas aeruginosa pulmonary infection. Br J Radiol 2012; 85 (1020): 1533-1538
    CrossrefPubMedGoogle Scholar
  • 30 Musher DM, Thorner AR. Community-acquired pneumonia. N Engl J Med 2014; 371 (17) 1619-1628
    CrossrefPubMedGoogle Scholar
  • 31 Shindo Y, Ito R, Kobayashi D. et al. Risk factors for drug-resistant pathogens in community-acquired and healthcare-associated pneumonia. Am J Respir Crit Care Med 2013; 188 (08) 985-995
    CrossrefPubMedGoogle Scholar
  • 32 Sanivarapu R, Gibson J. Aspiration Pneumonia [Internet]. Ncbi. nlm.nih.gov. 2020 [cited 11 July 2020]. Accessed January 30, 2022 from: https://www.ncbi.nlm.nih.gov/books/NBK470459/
    PubMedGoogle Scholar
  • 33 Mandell LA, Niederman MS. Aspiration pneumonia. N Engl J Med 2019; 380 (07) 651-663
    CrossrefPubMedGoogle Scholar
  • 34 Chatha N, Fortin D, Bosma KJ. Management of necrotizing pneumonia and pulmonary gangrene: a case series and review of the literature. Can Respir J 2014; 21 (04) 239-245
    CrossrefPubMedGoogle Scholar
  • 35 Nachiappan AC, Rahbar K, Shi X. et al. Pulmonary tuberculosis: role of radiology in diagnosis and management. Radiographics 2017; 37 (01) 52-72
    CrossrefPubMedGoogle Scholar
  • 36 Bächler P, Baladron MJ, Menias C. et al. Multimodality imaging of liver infections: differential diagnosis and potential pitfalls. Radiographics 2016; 36 (04) 1001-1023
    CrossrefPubMedGoogle Scholar
  • 37 van Haren Noman S, Visser H, Muller AF, Limonard GJM. Addison's disease caused by tuberculosis: diagnostic and therapeutic difficulties. Eur J Case Rep Intern Med 2018; 5 (08) 000911 DOI: 10.12890/2018_00091.
    CrossrefGoogle Scholar
  • 38 Grover SB, Midha N, Gupta M, Sharma U, Talib VH. Imaging spectrum in disseminated histoplasmosis: case report and brief review. Australas Radiol 2005; 49 (02) 175-178
    CrossrefPubMedGoogle Scholar
  • 39 Sharma S, Singh P, Sahu KK, Rajwanshi A, Malhotra P, Naseem S. Histoplasmosis in pleural effusion in a 23-year-old man with mixed-phenotype acute leukemia. Lab Med 2017; 48 (03) 249-252
    CrossrefPubMedGoogle Scholar
  • 40 WHO Consolidated Guidelines on Tuberculosis. Module 4: Treatment - Drug-Resistant Tuberculosis Treatment [Internet]. Who.int. 2020 [cited 11 August 2020]. Accessed January 30, 2022 from: https://www.who.int/publications/i/item/9789240007048
    PubMedGoogle Scholar
  • 41 [Internet] Tbcindia.gov.in. 2020 [cited 11 August 2020]. Accessed January 30, 2022 from: https://tbcindia.gov.in/WriteReadData/NSP%20Draft%2020.02.2017%201.pdf
    PubMedGoogle Scholar
  • 42 Franquet T, Giménez A, Hidalgo A. Imaging of opportunistic fungal infections in immunocompromised patient. Eur J Radiol 2004; 51 (02) 130-138
    CrossrefPubMedGoogle Scholar
  • 43 Gopalakrishnan R, Nambi PS, Ramasubramanian V, Abdul Ghafur K, Parameswaran A. Histoplasmosis in India: truly uncommon or uncommonly recognised?. J Assoc Physicians India 2012; 60: 25-28
    PubMedGoogle Scholar
  • 44 George P, Nayak N, Anoop TM, Gopi N, Vikram HP, Sankar A. Pulmonary histoplasmosis mimicking carcinoma lung. Lung India 2015; 32 (06) 663-665
    CrossrefPubMedGoogle Scholar
  • 45 Truong J, Ashurst JV. Pneumocystis (Carinii) Jiroveci Pneumonia. Treasure Island, FL: Stat Pearls Publishing; 2020
    Google Scholar
  • 46 Li MC, Lee NY, Lee CC, Lee HC, Chang CM, Ko WC. Pneumocystis jiroveci pneumonia in immunocompromised patients: delayed diagnosis and poor outcomes in non-HIV-infected individuals. J Microbiol Immunol Infect 2014; 47 (01) 42-47
    CrossrefPubMedGoogle Scholar
  • 47 McBride JA, Gauthier GM, Klein BS. Clinical manifestations and treatment of blastomycosis. Clin Chest Med 2017; 38 (03) 435-449
    CrossrefPubMedGoogle Scholar
  • 48 Randhawa HS, Chowdhary A, Kathuria S. et al. Blastomycosis in India: report of an imported case and current status. Med Mycol 2013; 51 (02) 185-192
    CrossrefPubMedGoogle Scholar
  • 49 Greene R. The radiological spectrum of pulmonary aspergillosis. Med Mycol 2005; 43 (Suppl. 01) S147-S154
    CrossrefPubMedGoogle Scholar
  • 50 Kawashima A, Kuhlman JE, Fishman EK. et al. Pulmonary Aspergillus chest wall involvement in chronic granulomatous disease: CT and MRI findings. Skeletal Radiol 1991; 20 (07) 487-493
    CrossrefPubMedGoogle Scholar
  • 51 Franquet T, Müller NL, Lee KS, Oikonomou A, Flint JD. Pulmonary candidiasis after hematopoietic stem cell transplantation: thin-section CT findings. Radiology 2005; 236 (01) 332-337
    CrossrefPubMedGoogle Scholar
  • 52 Orlowski HLP, McWilliams S, Mellnick VM. et al. Imaging spectrum of invasive fungal and fungal-like infections. Radiographics 2017; 37 (04) 1119-1134
    CrossrefPubMedGoogle Scholar
  • 53 Davda S, Kowa XY, Aziz Z. et al. The development of pulmonary aspergillosis and its histologic, clinical, and radiologic manifestations. Clin Radiol 2018; 73 (11) 913-921
    CrossrefPubMedGoogle Scholar
  • 54 Althoff Souza C, Müller NL, Marchiori E, Escuissato DL, Franquet T. Pulmonary invasive aspergillosis and candidiasis in immunocompromised patients: a comparative study of the high-resolution CT findings. J Thorac Imaging 2006; 21 (03) 184-189
    CrossrefPubMedGoogle Scholar
  • 55 Georgiadou SP, Sipsas NV, Marom EM, Kontoyiannis DP. The diagnostic value of halo and reversed halo signs for invasive mold infections in compromised hosts. Clin Infect Dis 2011; 52 (09) 1144-1155
    CrossrefPubMedGoogle Scholar
  • 56 Maturu VN, Agarwal R. Reversed halo sign: a systematic review. Respir Care 2014; 59 (09) 1440-1449
    CrossrefPubMedGoogle Scholar
  • 57 Yeom SK, Kim HJ, Byun JH, Kim AY, Lee MG, Ha HK. Abdominal aspergillosis: CT findings. Eur J Radiol 2011; 77 (03) 478-482
    CrossrefPubMedGoogle Scholar
  • 58 Sherif R, Segal BH. Pulmonary aspergillosis: clinical presentation, diagnostic tests, management and complications. Curr Opin Pulm Med 2010; 16 (03) 242-250
    Google Scholar
  • 59 Jairam A, Dassi M, Chandola P, Lall M, Mukherjee D, Hooda AK. Pneumocystis jiroveci outbreak in a renal transplant center: Lessons learnt. Indian J Nephrol 2014; 24 (05) 276-279
    CrossrefPubMedGoogle Scholar
  • 60 Udwadia ZF, Doshi AV, Bhaduri AS. Pneumocystis carinii pneumonia in HIV infected patients from Mumbai. J Assoc Physicians India 2005; 53: 437-440
    PubMedGoogle Scholar
  • 61 Kanne JP, Yandow DR, Meyer CA. Pneumocystis jiroveci pneumonia: high-resolution CT findings in patients with and without HIV infection. AJR Am J Roentgenol 2012; 198 (06) W555-61 DOI: 10.2214/AJR.11.7329.
    CrossrefPubMedGoogle Scholar
  • 62 Bukamur HS, Karem E, Fares S, Al-Ourani M, Al-Astal A. Pneumocystis Jirovecii (carinii) pneumonia causing lung cystic lesions and pneumomediastinum in non-HIV infected patient. Respir Med Case Rep 2018; 25: 174-176
    CrossrefPubMedGoogle Scholar
  • 63 Nasnas R, Matta MY, El Helou G, Rizk N, Sarkis DK, Moussa R. Brain abscesses in HIV-positive patients due to Pneumocystis jiroveci. J Int Assoc Physicians AIDS Care (Chic) 2012; 11 (03) 169-171
    CrossrefPubMedGoogle Scholar
  • 64 Lum J, Abidi ZM, McCollister B, Henao-Martínez A. Miliary histoplasmosis in a patient with rheumatoid arthritis. Case Rep Med 2018; 2018: 1-6
    CrossrefPubMedGoogle Scholar
  • 65 Agrawal R, Yeldandi A, Savas H, Parekh ND, Lombardi PJ, Hart EM. Pulmonary mucormycosis: risk factors, radiologic findings, and pathologic correlation. Radiographics 2020; 40 (03) 656-666
    CrossrefPubMedGoogle Scholar
  • 66 Challa S, Uppin SG, Uppin MS, Paul RT, Prayaga AK, Rao MT. Pulmonary zygomycosis: a clinicopathological study. Lung India 2011; 28 (01) 25-29
    CrossrefPubMedGoogle Scholar
  • 67 Zhang Y, Li N, Zhang Y. et al. Clinical analysis of 76 patients pathologically diagnosed with pulmonary cryptococcosis. Eur Respir J 2012; 40 (05) 1191-1200
    CrossrefPubMedGoogle Scholar
  • 68 Saag MS, Graybill RJ, Larsen RA. et al; Infectious Diseases Society of America. Practice guidelines for the management of cryptococcal disease. Clin Infect Dis 2000; 30 (04) 710-718
    CrossrefPubMedGoogle Scholar
  • 69 Maini R, Ranjha S, Tandan N. et al. Pulmonary blastomycosis: a case series and review of unique radiological findings. Med Mycol Case Rep 2020; 28: 49-54
    CrossrefPubMedGoogle Scholar
  • 70 Franquet T. Imaging of pneumonia: trends and algorithms. Eur Respir J 2001; 18 (01) 196-208
    CrossrefPubMedGoogle Scholar
  • 71 Franquet T. Imaging of pulmonary viral pneumonia. Radiology 2011; 260 (01) 18-39
    CrossrefPubMedGoogle Scholar
  • 72 Moon JH, Kim EA, Lee KS, Kim TS, Jung KJ, Song JH. Cytomegalovirus pneumonia: high-resolution CT findings in ten non-AIDS immunocompromised patients. Korean J Radiol 2000; 1 (02) 73-78
    CrossrefPubMedGoogle Scholar
  • 73 Tan BH. Cytomegalovirus treatment. Curr Treat Options Infect Dis 2014; 6 (03) 256-270
    CrossrefPubMedGoogle Scholar
  • 74 Carotti M, Salaffi F, Sarzi-Puttini P. et al. Chest CT features of coronavirus disease 2019 (COVID-19) pneumonia: key points for radiologists. Radiol Med (Torino) 2020; 125 (07) 636-646
    CrossrefPubMedGoogle Scholar
  • 75 Apicella M, Campopiano MC, Mantuano M, Mazoni L, Coppelli A, Del Prato S. COVID-19 in people with diabetes: understanding the reasons for worse outcomes. Lancet Diabetes Endocrinol 2020; 8 (09) 782-792
    CrossrefPubMedGoogle Scholar
  • 76 Patel RH, Pella PM. COVID-19 in a patient with HIV infection. [published online ahead of print, 2020 May 22]. J Med Virol 2020; 92 (11) 2356-2357 DOI: 10.1002/jmv.26049.doi:10.1002/jmv.26049.
    CrossrefGoogle Scholar
  • 77 Pan F, Ye T, Sun P. et al. Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID-19) pneumonia.. Radiology 2020; 295: 715-721 https://doi.org/10.1148/radiol.2020200370
    CrossrefPubMedGoogle Scholar
  • 78 Prokop M, van WEverdingen, van TRees Vellinga. et al. CO-RADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19-Definition and Evaluation. Radiology 2020; 296 (02) -E97 E104
    CrossrefPubMedGoogle Scholar
  • 79 Dai WC, Zhang HW, Yu J. et al. CT imaging and differential diagnosis of COVID-19. Can Assoc Radiol J 2020; 71 (02) 195-200
    CrossrefPubMedGoogle Scholar
  • 80 [Internet] Mohfw.gov.in. 2020 [cited 11 August 2020]. Accessed January 30, 2022 from: http://www.mohfw.gov.in/pdf/UpdatedClinicalManagementProtocolforCOVID19dated03072020.pdf
    PubMedGoogle Scholar
  • 81 Garg D, Madan N, Qaqish O, Nagarakanti S, Patel V. Pulmonary toxoplasmosis diagnosed on transbronchial lung biopsy in a mechanically ventilated patient. Case Rep Infect Dis 2020; 2020: 97101825
    Google Scholar
  • 82 Velásquez JN, Ledesma BA, Nigro MG. et al. Pulmonary toxoplasmosis in human immunodeficiency virus-infected patients in the era of antiretroviral therapy. Lung India 2016; 33 (01) 88-91
    CrossrefPubMedGoogle Scholar
  • 83 Remington JS, Thulliez P, Montoya JG. Recent developments for diagnosis of toxoplasmosis. J Clin Microbiol 2004; 42 (03) 941-945
    CrossrefPubMedGoogle Scholar
  • 84 Nabeya D, Haranaga S, Parrott GL. et al. Pulmonary strongyloidiasis: assessment between manifestation and radiological findings in 16 severe strongyloidiasis cases. BMC Infect Dis 2017; 17 (01) 320
    CrossrefPubMedGoogle Scholar
  • 85 Bae K, Jeon KN, Ha JY, Lee JS, Na BK. Pulmonary strongyloidiasis presenting micronodules on chest computed tomography. J Thorac Dis 2018; 10 (08) E612-E615
    CrossrefPubMedGoogle Scholar
  • 86 Dogan C, Gayaf M, Ozsoz A. et al. Pulmonary Strongyloides stercoralis infection. Respir Med Case Rep 2014; 11: 12-15
    PubMedGoogle Scholar