[Infections due to Mycobacterium simiae]. / Infecciones por Mycobacterium simiae.

Mycobacterium simiae is a slow-growing photochromogenic environmental mycobacterium, first described in 1965. Rarely associated with human infections, possibly due to its limited pathogenicity, it mainly produces lung infection in immunocompetent elderly patients with underlying lung disease, and in disseminated infections in immunosuppressed young patients with AIDS. A microbiological culture is needed to confirm the clinical suspicion, and genetic sequencing techniques are essential to correctly identify the species. Treating M. simiae infections is complicated, owing to the multiple resistance to tuberculous drugs and the lack of correlation between in vitro susceptibility data and in vivo response. Proper treatment is yet to be defined, but must include clarithromycin combined with other antimicrobials such as moxifloxacin and cotrimoxazole. It is possible that M. simiae infections are undiagnosed.

CPAP titration: Different methods for similar clinical results.

BACKGROUND: Continuous positive airway pressure (CPAP) is the main treatment for obstructive sleep apnea-hypopnea syndrome (OSAHS). Polysomnography (PSG) is the gold standard for CPAP titration. However, alternative methods have been sought to titrate CPAP at less expense in terms of time and resources. The aim of this study was to analyze CPAP success in controlling OSAHS symptoms and adverse effects by two titration methods. METHODS: This was a retrospective, observational cohort study in which 200 CPAP-naive patients who had been referred to our sleep laboratory and diagnosed with OSAHS were evaluated on two consecutive visits. During the first visit, an initial CPAP pressure was established either by split-night PSG or by using a mathematical formula. On the second visit, 1 month later, symptom persistence and adverse effects of CPAP treatment were assessed. RESULTS: Patients included were 157 males (78.5%) and 43 females (21.5%) aged 56+/-10 years. 87 patients (43.5%) were titrated by PSG and 113 (56.5%) using the formula. At the second visit, symptoms had improved significantly for both groups with no significant differences in the presence of adverse effects. The initial pressure had to be readjusted in five patients. CONCLUSIONS: This study suggests that formula titration can control symptoms as effectively as split-night titration. A prompt evaluation of the patient is advisable in order to ensure compliance with treatment and to correct possible adverse effects.

Infecciones por Mycobacterium simiae / Infections due to Mycobacterium simiae

Mycobacterium simiae es una micobacteria ambiental de crecimiento lento, fotocromógena, descrita por primera vez en 1965. Se asocia raramente a infecciones humanas, posiblemente por su limitada patogenicidad, principalmente a infección pulmonar en pacientes inmunocompetentes de edad avanzada con enfermedad pulmonar subyacente, e infección diseminada en pacientes jóvenes inmunodeprimidos con sida. El cultivo microbiológico es necesario para confirmar la sospecha clínica, y las técnicas de secuenciación genética son indispensables para identificar la especie. El tratamiento de las infecciones por M. simiae es complicado por su multirresistencia a los fármacos antituberculosos y por la falta de correlación de los datos de sensibilidad in vitro con la respuesta in vivo. El tratamiento adecuado aún está por definir, pero debe incluir claritromicina asociada a otros antimicrobianos, como moxifloxacino y cotrimoxazol. Es posible que las infecciones por M. simiae estén infradiagnosticadas

Mycobacterium simiae is a slow-growing photochromogenic environmental mycobacterium, first described in 1965. Rarely associated with human infections, possibly due to its limited pathogenicity, it mainly produces lung infection in immunocompetent elderly patients with underlying lung disease, and in disseminated infections in immunosuppressed young patients with AIDS. A microbiological culture is needed to confirm the clinical suspicion, and genetic sequencing techniques are essential to correctly identify the species. Treating M. simiae infections is complicated, owing to the multiple resistance to tuberculous drugs and the lack of correlation between in vitro susceptibility data and in vivo response. Proper treatment is yet to be defined, but must include clarithromycin combined with other antimicrobials such as moxifloxacin and cotrimoxazole. It is possible that M. simiae infections are undiagnosed

Endoscopic sealing of bronchopleural fistulas with submucosal injection of a tissue expander: a novel technique.

The occurrence of a bronchopleural fistula (BPF) continues to represent a challenging management problem, and is associated with high morbidity and mortality. A novel and successful technique that uses submucosal injection of a tissue expander for bronchoscopic occlusion of BPFs has been designed. This method may be used either alone or in combination with bronchoscopic instillation of n-butyl-cyanoacrylate glue. The occlusion technique is described, with a presentation of two patients who were successfully treated with this method. The submucosal injection of a tissue expander is an effective, economical and minimally invasive technique for managing BPFs.

[Characteristics of tuberculosis in patients older than 65 years in the sanitary area of Cadiz (Spain)]. / Características de la tuberculosis en pacientes mayores de 65 años en el área sanitaria de Cádiz (España).

BACKGROUND: Tuberculosis in the elderly is an increasing public health problem. AIM: To describe the epidemiological, clinical and microbiological characteristics of tuberculosis in patients over 65 years old, as compared to younger patients. MATERIAL AND METHODS: We reviewed the case histories of tuberculosis, microbiologically diagnosed by Ziehl-Neelsen/auramine smear and Löwenstein-Jensen culture, in patients over 65 years old, in the sanitary area of Cadiz (Spain). RESULTS: We detected 49 new cases (37 males) of tuberculosis in elderly subjects. The infection rate in this age group (16.3/100,000 inhabitants) is lower than in people younger than 65 years old (21.1/100,000 inhabitants). The most common symptoms were cough (44.9%), fever (40.8%) and dyspnea (44.9%). Neither of them were infected by the human immunodeficiency virus nor were parenteral drug abusers. Thirty seven percent of cases had a history of previous tuberculosis, and in 75.5% the disease location was pulmonary. The Ziehl-Neelsen/auramine smear was negative in 53.1% of the samples. CONCLUSIONS: The number of patients older than 65 years old with tuberculosis has increased in the sanitary area of Cadiz (Spain). This group of patients shows different epidemiological and clinical characteristics than younger patients.

Características de la tuberculosis en pacientes mayores de 65 años en el área sanitaria de Cádiz (España) / Characteristics of tuberculosis in patients older than 65 years in the sanitary area of Cadiz (Spain)

Background : Tuberculosis in the elderly is an increasing public health problem. Aim: To describe the epidemiological, clinical and microbiological characteristics of tuberculosis in patients over 65 years old, as compared to younger patients. Material and methods: We reviewed the case histories of tuberculosis, microbiologically diagnosed by Ziehl-Neelsen/auramine smear and L÷wenstein-Jensen culture, in patients over 65 years old, in the sanitary area of Cadiz (Spain). Results: We detected 49 new cases (37 males) of tuberculosis in elderly subjects. The infection rate in this age group (16.3/100.000 inhabitants) is lower than in people younger than 65 years old (21.1/100.000 inhabitants). The most common symptoms were cough (44.9 percent), fever (40.8 percent) and dyspnea (44.9 percent). Neither of them were infected by the human immunodeficiency virus nor were parenteral drug abusers. Thirty seven percent of cases had a history of previous tuberculosis, and in 75.5 percent the disease location was pulmonary. The Ziehl-Neelsen/auramine smear was negative in 53.1 percent of the samples. Conclusions: The number of patients older than 65 years old with tuberculosis has increased in the sanitary area of Cadiz (Spain). This group of patients shows different epidemiological and clinical characteristics than younger patients (Rev MÚd Chile 2004; 132: 325-30).