RESUMEN
Two mycobacteriophages were administered intravenously to a male with treatment-refractory Mycobacterium abscessus pulmonary infection and severe cystic fibrosis lung disease. The phages were engineered to enhance their capacity to lyse M. abscessus and were selected specifically as the most effective against the subject's bacterial isolate. In the setting of compassionate use, the evidence of phage-induced lysis was observed using molecular and metabolic assays combined with clinical assessments. M. abscessus isolates pre and post-phage treatment demonstrated genetic stability, with a general decline in diversity and no increased resistance to phage or antibiotics. The anti-phage neutralizing antibody titers to one phage increased with time but did not prevent clinical improvement throughout the course of treatment. The subject received lung transplantation on day 379, and systematic culturing of the explanted lung did not detect M. abscessus. This study describes the course and associated markers of a successful phage treatment of M. abscessus in advanced lung disease.
Asunto(s)
Bacteriófagos , Fibrosis Quística , Infecciones por Mycobacterium no Tuberculosas , Mycobacterium abscessus , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Bacteriófagos/genética , Fibrosis Quística/tratamiento farmacológico , Humanos , Pulmón , Masculino , Infecciones por Mycobacterium no Tuberculosas/terapia , Mycobacterium abscessus/fisiologíaRESUMEN
Peak expiratory flow (PEF) monitoring has long been a mainstay of asthma management, but controversy surrounds its efficacy in the pediatric population, and little published research exists on the subject. PEF is both effort and technique dependent and is not suitable for use in children under the age of 5 or with developmental disabilities. However, PEF is useful for monitoring airway changes if used properly, especially in that segment of the population labeled as "poor perceivers" of worsening symptoms. The authors review existing literature on the subject, including the newly revised National Heart, Lung, and Blood Institute (National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services. (2007). Expert panel report 3: Guidelines for the diagnosis and management of asthma-full report 2007. Retrieved June 17, 2008, from http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm) evidence-based guidelines.