[Atypical and opportunistic pulmonary infections after cardiac surgery]. / Zakazenia pluc wywolane patogenami atypowymi i oportunistycznymi u chorych po zabiegach kardiochirurgicznych.

BACKGROUND: New diseases and therapies that lead to marked immunocompromise, have brought to medicine so-called opportunistic infections, caused by pathogens that usually do not cause disease in the presence of a healthy immune system. First diagnosed in AIDS patients, opportunistic infections have appeared in many other situations, including transplant recipients, other immunosuppressed patients, and even in otherwise healthy patients undergoing major elective surgery. Among the most common pathogens causing atypical infections are: Pneumocistis jiroveci, Chlamydia, Mycoplasma and Legionella. The aim of this retrospective study was to assess the incidence of the above mentioned infections in cardiac surgical patients whose early postoperative period was complicated by respiratory distress. METHODS: The postoperative course of 5026 cardiac surgical patients was analysed retrospectively. In 196 cases (3.9%), important respiratory complications, defined as prolonged (>24h) requirement for mechanical ventilation, pulmonary oedema, atelectasis, pneumothorax, haemothorax, infiltrations present on chest x-ray, or ARDS, were detected. RESULTS: Positive atypical sputum cultures (Chlamydia pneumoniae, Mycoplasma pneumoniae or Pneumocistis jiroveci) were obtained from 27 patients (16%). Pneumocistis jiroveci was the most common pathogen identified. Legionella pneumoniae was never cultured. The average duration of mechanical ventilation in the study group was 253 h, and the mortality 18.5% (5 patients). CONCLUSIONS: Opportunistic infection with atypical pathogens should be suspected in the postoperative period when complicated by prolonged respiratory distress and difficulties with weaning from mechanical ventilation. Since these infections do not present with obvious symptoms, the diagnostic process should be extended and appropriate treatment introduced.

Lower respiratory tract infections in patients during hospital stay after heart transplantation.

A retrospective analysis was performed on the records of 95 pts who underwent heart transplantation at Dept. Of Cardiac Surgery & Transplantation in 1999 and 2000 y. In 34 pts lower respiratory tract infections were observed. In all cases bacterial factor was detected in sputum or bronchoalveolar lavage. In study population we analysed influence of such factors as age of the patients, the intensity and duration of immunosuppression, pre-existing diseases and timing after transplantation on the incidence of infection. Most often, in 43 pts gram negative stains bacteria was detected. Pseudomonas aeruginosa (15 pts), Acinetobacter baumanii (7 pts) and Enterobacter cloacae (6 pts) were predominant. Gram positive stains bacteria was detected only in two cases (Streptococcus pneumoniae and Staphylococcus aureus). In 1 pt we observed lung tuberculosis and in 2 pts Pneumocystis carinii pneumonia. Older recipient age was the only risk factor leading to occurrence of respiratory tract infections in patients after heart transplantation.

Possibility to treat lung tuberculosis without use of rifampicin in heart transplant recipients--two cases report.

Pulmonary infections remain the leading cause of death in patients after heart transplantation. Lung tuberculosis is more common in transplant recipients than in general population. Two cases of tuberculosis are presented in patients after heart transplantation. Regarding to influence of rifampicin on immunosuppressive therapy, those patients were treated with antimycobacterial drugs except rifampicin. A cure without recurrence can be achieved with a scheme of treatment regimes without rifampicin.