RESUMO
We report a case of disseminated infection by Rhodococcus equi as the inaugural manifestation of idiopathic T-CD4+ lymphopenia. We aim to demonstrate our diagnostic and therapeutic approach and focus on the major dilemmas arising from the lack of scientific evidence regarding best clinical practice of this infection in humans.
Assuntos
Infecções por Actinomycetales/microbiologia , Linfopenia/diagnóstico , Pneumonia Necrosante/diagnóstico , Rhodococcus equi/isolamento & purificação , Infecções por Actinomycetales/complicações , Infecções por Actinomycetales/diagnóstico , Infecções por Actinomycetales/patologia , Administração Intravenosa , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Antibióticos Antituberculose/administração & dosagem , Antibióticos Antituberculose/uso terapêutico , Biópsia por Agulha/métodos , Lavagem Broncoalveolar/métodos , Broncoscopia/métodos , Linfócitos T CD4-Positivos , Tosse/diagnóstico , Tosse/etiologia , Quimioterapia Combinada , Serviço Hospitalar de Emergência , Febre/diagnóstico , Febre/etiologia , Humanos , Levofloxacino/administração & dosagem , Levofloxacino/uso terapêutico , Linfopenia/etiologia , Masculino , Pneumonia Necrosante/tratamento farmacológico , Pneumonia Necrosante/etiologia , Rifampina/administração & dosagem , Rifampina/uso terapêutico , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
UNLABELLED: Suberosis is an occupational lung disease of cork workers associated with repeated exposure to mouldy cork dust in the cork industry, usually presenting as an interstitial lung disorder (Extrinsic Allergic Alveolitis). However, Occupational Asthma can also be associated with cork dust exposure and demonstrated by serial peak expiratory flow changes. AIM: To investigate broncho-alveolar inflammation in patients with cork work-related occupational asthma, evaluated by Broncho-alveolar fluid cellular profiles and serial peak expiratory flow (PEF) rates monitoring. RESULTS: We studied 14 patients with respiratory symptoms associated with occupational exposure in the cork industry. Positive PEF monitoring occurred in 7 cases (Occupational Asthma-OA), and in 7 (Non-occupational asthmatics-NOA) PEF records were negative. There were no differences in age, lung function (FEV1%, RV%), bronchial hyperresponsiveness, years of exposure, and atopy between the two patients groups. However, patients with work-related asthma had higher BAL eosinophil counts than NOA (1.9 +/- 2.6% versus 0.2 +/- 0.3%; p < 0.05, Wilcoxon test). CONCLUSIONS: Cork worker's asthma, demonstrated by work related changes in serial PEF recordings, is associated with eosinophilic lung inflammation as described in other forms of occupational asthma.