ABSTRACT
Es poco común encontrar en la literatura casos de traqueobronquitis invasiva por aspergillus que se manifiesten como tumores endobronquiales que produzcan atelectasia pulmonar total. Aunque relatada en inmunocomprometidos, la morbimortalidad es considerable aun en pacientes sin enfermedad de base.
It is rare to find in the literature cases of invasive aspergillus tracheobronchitis that manifest as endobronchial tumors that produce total pulmonary atelectasis. Although reported in immunocompromised patients, morbidity and mortality are considerable even in patients without underlying disease.
ABSTRACT
Es poco común encontrar en la literatura casos de traqueobronquitis invasiva por aspergillus que se manifiesten como tumores endobronquiales que produzcan atelectasia pulmonar total. Aunque relatada en inmunocomprometidos, la morbimortalidad es considerable aun en pacientes sin enfermedad de base.
It is rare to find in the literature cases of invasive aspergillus tracheobronchitis that manifest as endobronchial tumors that produce total pulmonary atelectasis. Although reported in immunocompromised patients, morbidity and mortality are considerable even in patients without underlying disease.
ABSTRACT
Resumen La traqueobronquitis aspergilar es una forma poco frecuente de aspergilosis invasiva reportada excepcionalmente en el paciente inmunocompetente. Su diagnóstico es difícil, y los tratamientos propuestos hasta ahora son de escasa efectividad, todo lo cual constituye un verdadero problema para el equipo de salud. Presentamos el caso de una paciente de 28 años, inmunocompetente y sin antecedentes epidemiológicos, que desarrolló traqueobronquitis necrotizante por aspergilosis invasiva y recibió tratamiento con voriconazol con instilación local por broncoscopia con buena respuesta.
Abstract Aspergillus tracheobronchitis is a rare form of invasive aspergillosis reported exceptionally in the immunocompetent patient. Its diagnosis is difficult, and the treatments proposed so far are of little effectiveness, all of which constitute a real problem for the health team. We present the case of an immunocompetent 28 yearsold woman, with no epidemiological background, who developed necrotizing tracheobronchitis due to invasive aspergillosis and received voriconazole with local instillation by bronchoscopy with a good response.
Subject(s)
Humans , Female , Adult , Aspergillosis , Respiratory Tract Infections , Tracheitis , Bronchitis , Bronchoscopy , Antifungal AgentsABSTRACT
RESUMO As infecções do trato respiratório inferior associadas à ventilação mecânica são uma das complicações mais frequentes em pacientes em ventilação mecânica. Há muitos anos, a traqueobronquite associada à ventilação mecânica tem sido considerada uma doença que não demanda antibioticoterapia. Na última década, diversos estudos demonstraram que a traqueobronquite associada à ventilação mecânica deve ser considerada um processo intermediário que leva à pneumonia associada à ventilação mecânica, uma vez que apesar de ter impacto limitado sobre a mortalidade dos pacientes gravemente enfermos internados nas unidades de terapia intensiva, em contrapartida, demonstra associação significativa com o aumento dos custos hospitalares desses pacientes, assim como do tempo de internação na unidade de terapia intensiva e hospitalar, do uso de antibióticos, e da duração da ventilação mecânica. Embora ainda necessitemos de evidências científicas mais robustas, especialmente no que tange às modalidades terapêuticas, os dados atuais a respeito da traqueobronquite associada à ventilação mecânica salientam que há desfechos suficientemente importantes que exigem vigilância epidemiológica e controle clínico adequados.
ABSTRACT Ventilator-associated lower respiratory tract infection is one of the most frequent complications in mechanically ventilated patients. Ventilator-associated tracheobronchitis has been considered a disease that does not warrant antibiotic treatment by the medical community for many years. In the last decade, several studies have shown that tracheobronchitis could be considered an intermediate process that leads to ventilator-associated pneumonia. Furthermore, ventilator-associated tracheobronchitis has a limited impact on overall mortality but shows a significant association with increased patient costs, length of stay, antibiotic use, and duration of mechanical ventilation. Although we still need clear evidence, especially concerning treatment modalities, the present study on ventilator-associated tracheobronchitis highlights that there are important impacts of including this condition in clinical management and epidemiological and infection surveillance.
Subject(s)
Humans , Respiration, Artificial/adverse effects , Tracheitis/etiology , Bronchitis/etiology , Respiration, Artificial/methods , Respiratory Tract Infections/etiology , Respiratory Tract Infections/epidemiology , Tracheitis/epidemiology , Bronchitis/epidemiology , Pneumonia, Ventilator-Associated/epidemiology , Anti-Bacterial Agents/administration & dosageABSTRACT
Introducción: Las infecciones asociadas a ventilación mecánica son causa importante de morbimortalidad en el paciente crítico. La diferenciación entre traqueobronquitis y neumonía no es siempre fácil, y es controvertida. Algunos trabajos describen aumento de mortalidad, mayor estancia en Unidades de Cuidado Intensivo (UCI), mayor requerimiento de ventilación mecánica e incremento de costos en pacientes con traqueobronquitis asociada a ventilador (TAV), sin diferencias significativas en pacientes con neumonía asociada a ventilador (NAV). Estos estudios no describen el comportamiento clínico y epidemiológico de la TAV y la NAV como 2 entidades independientes, por lo que es necesario describirlo. Métodos: Estudio multicéntrico de cohorte prospectiva, de pacientes adultos que desarrollaron TAV o NAV durante su estancia en UCI, entre noviembre de 2013 y octubre de 2014. A cada una de las variables demográficas, clínicas, de laboratorio y de desenlace, como tiempo de ventilación mecánica, estancia hospitalaria y muerte, se le realizó análisis descriptivo; para evaluar las diferencias entre los grupos se utilizó test de chi cuadrado, t de Student o U de Mann Whitney. Resultados: Se incluyó a 143 pacientes, con edad promedio de 55 años, 57% eran hombres, de 6 países en Latinoamérica; 63% con NAV y 37% con TAV. Las comorbilidades más frecuentes fueron cardiovascular (44%) y neurológica (30%); esta última fue más frecuente en TAV (41,5 vs. 23%; p = 0,02). No se encontró diferencia en APACHE II de ingreso. El índice SOFA fue mayor en NAV (8 vs. 5; p = 0,02). No hubo diferencias en el aislamiento microbiológico, ni en los patrones de resistencia bacteriana entre las 2 entidades. Se observó mayor número de complicaciones cardiovasculares y SDRA en pacientes con NAV. No se encontró diferencia entre los 2 grupos en estancia en UCI, los días de ventilación mecánica ni en mortalidad. Conclusiones: La prevalencia de TAV fue mayor a lo descrito hasta ahora en la literatura. No se encontraron diferencias significativas en el aislamiento microbiológico, la resistencia bacteriana ni el esquema antibiótico utilizado en los 2 grupos. Aunque la NAV cursó con mayor proporción de complicaciones médicas asociadas, el hallazgo de una estancia hospitalaria, tiempo de ventilación mecánica y mortalidad similares sustenta la importancia clínica de la TAV.
Introduction: The infections associated with mechanical ventilation are a major cause of morbidity and mortality in critically ill patients. Limited studies report increased mortality and intensive care units (ICU) stays, requirements for mechanical ventilation and higher costs in ventilator-associated tracheobronchitis (TAV) in comparison to patients with ventilator-associated pneumonia (NAV). These studies do not describe the clinical and epidemiological behavior in the same population as independent entities, so it is necessary to describe the epidemiology of patients with TAV and NAV. Methods: Multicenter cross-sectional study of adult patients who developed TAV and/or NAV during their stay in the ICU in 2013 to 2014. A descriptive analysis was performed on each of the variables. For qualitative variables we assessed differences between groups using the Chi-squared test; for continuous variables, we used Student's t test or the Mann Whitney U test. Results: A total of 147 patients from 6 countries in Latin America were included; 63% with NAV and 37% with TAV. The average age was 55 years; 57% male. The most frequent comorbidity was cardiovascular (44%) and neurological (30%), the latter was more frequent in those with TAV (41.5 vs. 23%, P = .02). No differences were found in APACHE II on entry, but the difference appears in the SOFA index (8 vs. 5, P = .02). There were no differences in microbiological isolation, or bacterial resistance patterns between the 2 entities. A greater number of cardiovascular complications and ARDS were observed in patients with NAV. The ICU stay, days on mechanical ventilation and mortality were not different between the 2 groups. Conclusions: The TAV prevalence was higher than heretofore described in the literature. No significant differences were found in the microbiological isolation, bacterial resistance and antibiotic therapy used in the 2 groups, which might suggest that therapeutic approach be similar to that recommended for NAV. No differences were observed in clinical outcomes such as hospital stay, duration of mechanical ventilation and mortality, although NAV was associated with a greater proportion of medical complications.
Subject(s)
Humans , Male , Female , Middle Aged , Pneumonia , Critical Care , Bronchitis, Chronic , Respiration, Artificial , Epidemiology , Patient-Centered Care , Training Courses , Latin AmericaABSTRACT
We present the case of a 54-year-old male, who presented with respiratory complaints four months after he underwent renal transplantation. Bronchoscopy showed ulcerated mucosa of the left main bronchus and computed tomography (CT) of the thorax showed foci of air within the bronchial wall. A biopsy from the lesion showed septate fungal hyphae, dichotomously branching at acute angles. A locally invasive Aspergillus ulcerative tracheobronchitis with no parenchymal involvement is an important cause of tracheobronchitis in post-renal transplant patients. An early diagnosis and institution of appropriate treatment can improve the outcome. A combination treatment of caspofungin and voriconazole can be considered if patient is not responding to voriconazole alone.
Subject(s)
Antifungal Agents/administration & dosage , Aspergillosis/diagnosis , Aspergillosis/drug therapy , Aspergillosis/etiology , Aspergillosis/physiopathology , Biopsy , Bronchitis/diagnosis , Bronchitis/drug therapy , Bronchitis/etiology , Bronchitis/physiopathology , Bronchoscopy/methods , Early Diagnosis , Echinocandins/administration & dosage , Humans , Kidney Transplantation/adverse effects , Lung/pathology , Male , Middle Aged , Pyrimidines/administration & dosage , Tomography, X-Ray Computed , Tracheitis/diagnosis , Tracheitis/drug therapy , Tracheitis/etiology , Tracheitis/physiopathology , Treatment Outcome , Triazoles/administration & dosage , Ulcer/etiology , VoriconazoleABSTRACT
Introducción: las infecciones respiratorias bajas ocupan el primer lugar entre las infecciones relacionadas con el cuidado sanitario en unidades de cuidados intensivos. Objetivos: describir la incidencia y las consecuencias, sobre estadía y mortalidad, de la traqueobronquitis asociada a ventilación mecánica (TAVM) en UCI. Métodos: estudio multricéntrico, descriptivo, prospectivo y transversal, en 6 UCI de adultos. Se estudiaron 454 pacientes. Las variables de estudio fueron recogidas en 2 bases de datos. Resultados: tasa de incidencia de TAVM: 1,76 por ciento.Con respecto al número total de pacientes con factor de riesgo: 6,06 por ciento, Densidad de incidencia: 7,61 por ciento por 1 000 d con factor de riesgo. Estadía media, TAVM: 13,13 d, pacientes sin IRCS: 5,49 d (p=0,006). Mortalidad, TAVM: 25 por ciento, NAVM: 55,2 por ciento, pacientes sin IRCS: 14,9 por ciento(p=0,000). Conclusiones: la TAVM no es infrecuente en UCI. Su diagnóstico implica aumento de estadía y mortalidad en pacientes ventilados. Se justifica la implementación de medidas de vigilancia y prevención
Introduction: lower respiratory infections rank first among related infections in health care intensive care units. Objectives: to describe the incidence and consequences of stay and mortality of ventilator-associated tracheobronchitis (TAVM) in ICU. Methods: a multicenter, descriptive, prospective and cross-sectional study was conducted in 6 adult ICU. 454 patients were studied. The study variables were collected in two databases. Results: TAVM incidence rate: 1.76 percent, relative to the total number of patients with risk factor: 6.06 percent. Incidence density: 7.61 percent by 1000 d with risk factor. Average stay, TAVM: 13.13 d, patients without IRCS: 5.49 d (p = 0.006). Mortality, TAVM: 25 percent, VAP: 55.2 percent , patients without IRCS: 14.9 percent (p = 0.000). Conclusions: TAVM is not uncommon in ICU. Its diagnosis involves increased stay and its mortality in ventilated patients. The implementation of surveillance and prevention measures is requiered
Subject(s)
Humans , Ventilator-Induced Lung Injury/complications , Respiration, Artificial/adverse effects , Respiration, Artificial/methods , Cross-Sectional Studies , Epidemiology, Descriptive , Prospective Studies , Intensive Care Units/standardsABSTRACT
Invasive aspergillosis is a serious threat and a leading cause of death in immunocompromised patients. Aspergillus tracheobronchitis is an infrequent but severe form of invasive pulmonary aspergillos in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree. We report an extraordinary case of acute airway obstruction and respiratory failure due to Aspergillus tracheobronchitis in an immunocompromised patient. Fiberoptic bronchoscopy revealed extensive obstruction of both the main and lobar bronchus with yellowish nodules strongly adhered to the bronchial wall; both histologic examination and culture of these nodules revealed Aspergillus fumigatus. Even with early detection of an intraluminal growth of Aspergillus and prompt institution of antifungal therapy, the patient died of refractory hypoxemia a few days later. This report shows that Aspergillus tracheobronchitis should be considered in immunocompromised patients with suspected lung infection even when the main radiographic finding is atelectasis.
Subject(s)
Humans , Airway Obstruction , Hypoxia , Aspergillosis , Aspergillus , Aspergillus fumigatus , Bronchi , Bronchoscopy , Cause of Death , Immunocompromised Host , Lung , Pulmonary Atelectasis , Respiratory InsufficiencyABSTRACT
An influenza pandemic due to a novel influenza A/H1N1 virus occurred after April 2009. This virus has some characteristics that differentiate it from the seasonal influenza virus. The 2009 pandemic influenza A/H1N1 virus can frequently infect the lower respiratory tract, and it might cause acute tracheobronchitis as well as pneumonia. Viral-bacterial interaction is well known as an important mechanism of the pathogenesis of respiratory complications of influenza. Herein, we report on a case that presented with pseudomembranous tracheobronchitis complicated by coinfection with 2009 pandemic influenza A/H1N1 and Staphylococcus aureus. We also review the relevent literature.
Subject(s)
Bronchoscopes , Coinfection , Influenza, Human , Orthomyxoviridae , Pandemics , Pneumonia , Respiratory System , Seasons , Staphylococcus , Staphylococcus aureus , VirusesABSTRACT
A case of invasive aspergillosis caused by Aspergillus niger in a lung transplant recipient is described. The patient presented hyperglycemia starting postoperatively, with other complications such as cytomegalovirus infection. The associated predisposing factors and other implications are discussed. Aspergillus niger seems to be a fungal species of low virulence that requires the presence of a severely immunosuppressed host to cause invasive disease.
Descreve-se um caso de aspergilose invasiva causada por Aspergillus niger em um paciente transplantado de pulmão com quadros hiperglicêmicos desde o pós-operatório e outras complicações como infecção por citomegalovírus. Os fatores predisponentes associados e outras implicações são discutidos. Aspergillus niger parece ser uma espécie fúngica de baixa virulência, necessitando a presença de um hospedeiro gravemente imunodeprimido para causar doença invasiva.
Subject(s)
Female , Humans , Middle Aged , Aspergillosis/etiology , Aspergillus niger/isolation & purification , Bronchitis/microbiology , Lung Diseases, Fungal/microbiology , Lung Transplantation/adverse effects , Tracheitis/microbiology , Aspergillosis/diagnosis , Bronchitis/diagnosis , Fatal Outcome , Immunocompromised Host , Lung Diseases, Fungal/diagnosis , Tracheitis/diagnosisABSTRACT
Invasive aspergillus tracheobronchitis is uncommon manifestation of infection due to Aspergillus species, occurring in severely immunocompromised patients who are generally neutropenic with haematological diseases, AIDS, or after heart and lung transplantation. The pseudomembranous form is the most severe condition and is usually fatal despite treatment with antifungal agents. However, there are a few cases reported with no apparent severe compromise in the host defences. We encountered a pseudomembranous necrotizing bronchial aspergillosis in a 73-year old male patient, who was treated successfully with antifungal agents.
Subject(s)
Aged , Humans , Male , Antifungal Agents , Aspergillosis , Aspergillus , Heart , Immunocompromised Host , Lung TransplantationABSTRACT
The aspergillus tracheobronchitis is distinctive manifestation of invasive aspergillosis, in which infection is limited completely or predominantly to the tracheobronchial tree. It accounts for about 7 to 10 percent of cases of invasive disease. Grossly, such disease may take the mucosal exudate and obstruct partially the airway lumen or completely the occlusive mucous/fungus plugs. Microscopically, the superficial portion of the airway wall is acutely inflamed and contain fungal hyphae. However, infection is often limited to the mucosa. We report a case of aspergillus tracheobrochits in a 54 year-old man who presented cough, progressive dyspnea with wheezing, and mucus plug. Bronchoscopy showed mucosal exudate and plug.Bronchoscopic biopsy showed aspergillus hyphae and inflammation in the mucosa. He was successfully treated with itraconazole.
Subject(s)
Humans , Aspergillosis , Aspergillus , Biopsy , Bronchoscopy , Cough , Dyspnea , Exudates and Transudates , Hyphae , Inflammation , Itraconazole , Mucous Membrane , Mucus , Respiratory Sounds , TreesABSTRACT
PURPOSE: Causes of acute lower respiratory tract infections (ALRI) in children are diverse. But virus is the most common cause of ALRI, so it is important to understand the etiology and epidemiology of ALRI. This study was performed to investigate the etiologic organisms, age distribution, clinical manifestations and seasonal occurrence of ALRI in hospitalized children. METHODS: We confirmed viral etiologies using nasopharyngeal aspirates in 377 patients of the ages of 15 years or younger who were hospitalized for ALRI from March, 1996 to February, 1999 at Samsung Seoul Hospital, Seoul, Korea. Viral agents were detected by virus isolation and antigen detection by indirect immunofluorescent staining. RESULTS: The viral pathogens identified were influenza A (22.2%), influenza B (9.0 %), adenovirus (21.2%), parainfluenza virus type 1 (8.8%), type 2 (3.4%), type 3 (15.1%) and respiratory syncytial virus (RSV) (20.2%). The occurrence of ALRIs was high under 2 year old. The clinical patterns of viral ALRI include pneumonia (49.9%), croup (20.2%), bronchiolitis (22.0%), tracheobronchitis (8.0%). The specific viruses are frequently associated with specific clinical syndrome of ALRI. The respiratory agents and associated syndromes frequently have characteristic seasonal patterns. CONCLUSION: This study will help us to estimate the etiologic agents of ALRI, and to avoid inappropriate antibiotic therapy. An annual nationwide survey is necessary to understand the viral epidemiology associated with respiratory illness.
Subject(s)
Child , Child, Preschool , Humans , Adenoviridae , Age Distribution , Bronchiolitis , Child, Hospitalized , Croup , Epidemiology , Influenza, Human , Korea , Parainfluenza Virus 1, Human , Pneumonia , Respiratory Syncytial Viruses , Respiratory System , Respiratory Tract Infections , Seasons , SeoulABSTRACT
1. Twenty-seven cases of various forms of acute infection were treated with sulfathiazole2. The pneumonias, erysipelas, acute tracheo-bronchitis, acute cellulitis of the leg, puerperal fever, and a case of acute circumscribed inflammation of the auditory canal were favorably influenced by the drug. In acute gonorrhea, acute pleurisies, and in one case of facial cellulitis with abscess, sulfathiazole was a failure.3. The side-effects noted in my series were convulsion cyanosis in 3 cases, drug fever and diarrhea in another, and morbilliform rashes in 3. All of these patients were of ages ranging from 1.5 months to 5 years. None of my adult patients developed any toxic manifestations4. Sulfathiazole seems to be a useful therapeutic agent in the treatment of the pneumonias, acute tracheo-bronchitis, acute cellulitis, erysipelas, puerperal fever, and in beginning acute circumscribed inflammation of the auditory tube.(Summary and Conclusion)
ABSTRACT
The tracheobronchial histopathologic findings in 7 healthy cats used with high frequency oscillation ventilation (HFOV) were compared with those in 6 cats used with conventional mechanical ventilation (CMV). 4-point, 9-variable scoring system was used to evaluate the injury in the trachea, right & left main bronchi and parenchyma. The following results were obtained; 1) The tracheobronchial tree received HFOV had no significant damage compared with CMV (P>0.05). 2) Intraepithelial mucus loss and emphysema were slightly more prominent in CMV groups. As above results; the tracheobronchial histopathologic difference was not prominent between CMV and HFOV groups received with relatively short period, however, the cellular of function and barotrauma may be more prominent in CMV groups. From now on, as causes of tracheobronchial injury in HFV, interaction between humidification and mechanical trauma considers further study.