Respiratory viral infections before the COVID-19 in Portugal: A single center study.

Objectives: We aimed to describe the respiratory viruses (RV) found in respiratory samples from patients admitted to Hospital de São Bernardo, Setúbal, Portugal, between October 2019 and March 2020, and to correlate these with clinical features. Design: This retrospective study explored 948 fresh frozen naso/oropharyngeal swabs, tested by reverse transcription-polymerase chain reaction. Results: Rhinovirus/enterovirus, influenza, and respiratory syncytial virus (hRSV) were the most prevalent RV. Half of the patients fulfilled the acute respiratory infection (ARI) and/or influenza-like illness (ILI) criteria, with increasing age significantly reducing the risk of ARI and/or ILI. Hospital admission was more frequently observed in symptomatic patients, but the length of stay and mortality were significantly lower. Most (96.5 %) patients had a main respiratory diagnosis. In adults, the most prevalent was pneumonia, which particularly affected older patients, while in children, the most common was bronchiolitis. The number of hospital admissions was high. Sudden onset, shortness of breath, older age, and hRSV detection significantly increased the risk of hospital admission overall. In bronchiolitis, female gender significantly increased the risk of hospital admission, while older age significantly reduced this risk. Twenty patients died within the first month of sampling, and all were older adults. Older age and male gender significantly increased the risk of death. Conclusions: Respiratory viral infections can have a significant clinical impact, particularly in young infants with bronchiolitis and older adults with pneumonia. This study provides the first snapshot of the respiratory viral infections just before the outbreak of SARS-CoV-2 in Portugal, providing relevant clinical insights.

Characterization and management of elderly and very elderly patients with non-small cell lung cancer.

OBJECTIVES: Despite non-small cell lung cancer (NSCLC) high prevalence and increasing incidence, evidence specific to the elderly and very elderly is sparse. To retrospectively compare characterization and approach of NSCLC patients (pts) aged 70-79 and ≥80 years. METHODS: We performed a retrospective analysis of 297 adult NSCLC pts who registered and initiated NSCLC management in our Pulmonology Oncology Unit from January 2013 to December 2016 corresponding to 38.2% of all NSCLC patients (n = 778). Demographic data and lung cancer management were analysed. RESULTS: Pts were categorized as elderly (n = 211, 71.0%) and very elderly (n = 86, 29.0%). Very elderly pts had worse Eastern Cooperative Oncology Group performance status (P = 0.047), higher Charlson age comorbidity index (P < 0.001) and the majority had stage IV cancer (66.3%, P = 0.04). The first management option in very elderly pts was chemotherapy (CTX) (30.2%, P = 0.37) and in elderly pts was multimodal therapy (30.3%, P ≤ 0.001). Support therapy and first-line targeted (EGFR or ALK-positive) were more common in the very elderly (23.6%, P = 0.01; 17.4% P = 0.002, respectively). Curative radiation or surgery rates did not differ between groups. Reasons for premature first-line CTX stop, toxicity and hospitalization did not differ. Death rate (69.7% vs 63.5% for very elderly and elderly, respectively) and mean survival since diagnosis (11.5 vs 11.6 months for very elderly and elderly, respectively) did not differ. CONCLUSIONS: There were significant differences in pts characteristics having the very elderly more multimorbidity and advanced state of disease. First management options were significantly different with respect to multimodal, targeted and support therapy.

A Rare Case of Granulomatous Pneumonitis Due to Intravesical BCG for Bladder Cancer.

Granulomatous pneumonitis is a rare complication of bacillus Calmette-Guerin immunotherapy following intravesical administration of bacillus Calmette-Guerin. The authors present an unusual case of a 67-year-old man who developed mild and non-specific symptoms, following intravesical bacillus Calmette-Guerin instillations. Examinations revealed features of miliary tuberculosis and granuloma suggestive of mycobacterial infection. Anti-tuberculosis treatment resulted in a remarkable improvement in his symptoms and gradually upgrading of radiological appearance. The symptoms were less severe than some others described but this case provides evidence that, even in some cases, specific treatment may be necessary. We highlight the importance of recognizing miliary Mycobacterium bovis as a probable complication of bacillus Calmette-Guerin immunotherapy. The clinical disease course can be mild, despite extensive bilateral miliary nodules on primary presentation.

A pneumonite granulomatosa é uma complicação rara da imunoterapia com bacillus Calmette-Guerin após administração intravesical de bacillus Calmette-Guerin. Os autores apresentam um caso incomum de um homem de 67 anos de idade que desenvolveu sintomas ligeiros e inespecíficos, após instilações de bacillus Calmette-Guerin intravesical. Os xames revelaram características da tuberculose miliar e granuloma sugestivo de infeção por micobactérias. O tratamento antibacilar resultou numa melhoria notável na sua sintomatologia e na melhoria progressiva das alterações radiológicas. Os sintomas foram de menor gravidade comparativamente a outros casos relatados na literatura, mas este caso fornece evidências de que, mesmo em algumas situações, um tratamento específico pode ser necessário. Destacamos a importância de reconhecer o Mycobacterium bovis disseminado como uma provável complicação da imunoterapia a bacillus Calmette-Guerin. O curso clínico da doença pode ser ligeiro, apesar da extensa disseminação miliar bilateral na apresentação primária.

A rare case of Actinomyces meyeri empyema: Still a challenging entity to manage.

Actinomyces meyeri is a rare pathogen and an infrequent cause of human actinomycosis. Less than ten cases were reported in the English-literature to date concerning A. meyeri empyema. We herein report a case to promote the awareness and adequate management of the disease. A 44-year-old immunocompetent male with known pulmonary disease was diagnosed with an A. meyeri empyema. He underwent chest tube drainage and a short-term treatment with clindamycin for 4 months. This is the first report of a patient with structural pulmonary disease with an A. meyeri empyema treated with 4-month of clindamycin and chest tube drainage. In comparison to previous reports, our case was diagnosed early, empyema was effectively drained with one chest tube and symptoms and radiological findings were rapidly improved. Short-term antibiotic treatment can be well succeeded if an early diagnosis is made, there is no evidence of dissemination and adequate management is promptly instituted.