Rev Chil Infect 2005; 22 (2): 155-160
CASO CLÍNICONeumonía cavitada por Rhodococcus equi en paciente inmunocomprometido no infectado por virus de inmunodeficiencia humana. Caso clínico y revisión RICARDO RABAGLIATI B., ARTURO MORALES S., RENÉ BAUDRAND B., JORGE JORQUERA A., DAVID ODDÓ B., PATRICIA GARCÍA C., M. CECILIA CARMONA P., MARCELA CISTERNAS M. y ÁLVARO HUETE G.
Necrotizing pneumonia due to Rhodococcus equi in non HIV immunocompromised host. Case report and reviewRhodococcus equi, is a grampositive intracellular bacillus, that causes infection mainly in immunocompromised hosts. We report the case of a 52 years old woman, with a systemic lupus erythematosus and a progressive 10 months evolution with cough, dyspnea, mucous-purulent sputum, occasionally hemoptysis, intermittent fever, and weight loss of 10%. With partial response to antibiotic treatment, radiological evolution of thoracic scanners evidenced the development of multiple bilateral areas of consolidation, some of them nodular. Percutaneous thoracic biopsy showed characteristic histology and microbiological analysis yielded the identification of Rhodococcus equi in both bronchoalveolar lavage and pulmonary biopsy. She received prolonged bi-associated antibiotic treatment with good clinical and radiological response. This agent must be considered in the study of immunocompromised patients that present with a prolonged evolution of pneumonia.
Factores pronósticos y sobrevida a mediano plazo de una cohorte de pacientes con cáncer pulmonar atendidos en la red de salud de la Universidad Católica. Período Lung cancer is the leading cause of death from malignancy worldwide. In Chile the magnitude of the problem and the diagnosis-associated survival are unknown. Methods: We examined a cohort of 202 adult patients with lung cancer histologically confirmed in a single health network between January 2007 and December 2011. We accessed to medical records and images files of patients, recording the clinical, histological, imaging and staging data. Patients were followed until December 2013 to assess survival. Results: The mean age of the cohort was 68.1 ± 11.5 years, 53% were male and 86% had a smoking history. 82.2% of the cases were symptomatic at diagnosis, been cough the symptom most frequently reported. The predominant histological subtype was adenocarcinoma (42%), followed by squamous cell carcinoma (26.2%). In women, adenocarcinoma was the leading histology variety (56.4%), and in males it was adenocarcinoma (37%) and squamous cell carcinoma (33.3%). The majority of the patients were diagnosed at advanced stages of the disease. The 36-month survival rate was 46.1%. The mean survival according to clinical stage was 70.7 month in stage I, 60.3 in stage II, 47.1 in IIIA, 12.3 in IIIB and 11.7 month in stage IV. According to histological variety, the mean survival was 36.6 month in adenocarcinoma, 33.8 in squamous cell carcinoma, month in undifferentiated non small-cell carcinoma. There were no significant differences in survival by age or gender. Conclusion: The most common histological type was adenocarcinoma and short-term survival was related to the clinical staging and histological variants.
Bronchial thermoplasty is a tool used in the management
ACTUALIZACIÓN Introducciónel asma bronquial es una enfermedad pulmonar heterogénea, usualmente caracterizada por una inflamación crónica de la vía aérea. Está definida por la historia de síntomas respiratorios como sibilancias, disnea, sensación de pecho apretado y tos que varía en intensidad y en el tiempo, junto a limitación variable en el flujo de aire espiratorio 1 . el asma bronquial constituye una de las patologías respiratorias más prevalentes en la población 2 . Si bien la mayoría de los pacientes alcanzarán un buen control con corticoides inhalados y broncodilatadores, un pequeño porcentaje se mantendrá sintomático aún con el tratamiento estándar disponible. Se entiende por asma severo a aquel que requiere de tratamiento con dosis altas de corticoides inhalados más broncodilatadores β 2 -adrenérgicos de larga acción (LABA) para lograr su control, o asma que siga sin control a pesar de este tratamiento 1 . El asma severa representa un grupo heterogéneo de fenotipos (eosinofílico, paucinmune, granulocítico, entre otros) 3 , con diferencias fisiopatológicas detrás de cada uno de ellos, variando los elementos estructurales, celulares y moleculares. uno de los mecanismos responsables de la sintomatología de
Systemic inflammation among stable ex smokers with chronic obstructive pulmonary disease Background: Low-grade systemic inflammation is commonly observed in chronic obstructive pulmonary disease (COPD). Aim: To evaluate the extent of systemic inflammation in a group of ex-smokers with COPD in stable condition and its relation with pulmonary function and clinical manifestations. Patients and Methods: We studied 104 ex-smokers aged 69 ± 8 years (62 males) with mild to very severe COPD and 52 healthy non-smoker subjects aged 66 ± 11 years (13 males) as control group. High sensitivity serum C reactive protein (CRP), interleukin 6 (IL6), fibrinogen (F) and neutrophil count (Nc) were measured. Forced expiratory volume in the first minute (FEV 1), inspiratory capacity (IC), arterial blood gases, six minutes walking test, dyspnea and body mass index (BMI) were measured, calculating the BODE index. Health status was assessed using the Saint George Respiratory Questionnaire (SGRQ), the chronic respiratory questionnaire (CRQ), registering the number of acute exacerbations (AE) during the previous year and inhaled steroids's use. Systemic inflammation was considered present when levels of CRP or IL6 were above the percentile 95 of controls (7.98 mg/L and 3.42 pg/ml, respectively). Results: COPD patients had significantly higher CRP and IL6 levels than controls. Their F and Nc levels were within normal limits. Systemic inflammation was present in 56 patients, which had similar disease severity and frequency of inhaled steroid use, compared with patients without inflammation. Patients with systemic inflammation had more AE in the previous year; lower inspiratory capacity, greater dyspnea during the six minutes walk test and worse SGRQ and CRQ scores. Conclusions: Low-grade systemic inflammation was found in 56 of 104 ex-smokers with COPD. This group showed a greater degree of lung hyperinflation, dyspnea on exercise and poor quality of life.
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