RESUMEN
We describe a patient with community-acquired pneumonia due to Legionella pneumophila serogroup 6. This patient was found to have bronchoalveolar carcinoma of the lung by means of cytologic testing in 1 of 2 bronchoalveolar lavage samples, but no lesions were visible on bronchoscopy. Despite intravenous administration of azithromycin to the patient, repeat culture and polymerase chain reaction showed persistence of Legionella; the isolates remained susceptible to azithromycin. The patient did not respond to 14 doses of daily intravenously administered azithromycin. The poor outcome may have been partially due to the suspected underlying lung malignancy, as shown by cytologic examination, and by a delay in seeking medical attention.
Asunto(s)
Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Enfermedad de los Legionarios/tratamiento farmacológico , Neumonía Bacteriana/tratamiento farmacológico , Anciano , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/fisiopatología , Resultado Fatal , Femenino , Humanos , Legionella pneumophila/efectos de los fármacos , Legionella pneumophila/genética , Legionella pneumophila/aislamiento & purificación , Enfermedad de los Legionarios/diagnóstico por imagen , Enfermedad de los Legionarios/microbiología , Enfermedad de los Legionarios/fisiopatología , Pruebas de Sensibilidad Microbiana , Neumonía Bacteriana/diagnóstico por imagen , Neumonía Bacteriana/microbiología , Neumonía Bacteriana/fisiopatología , Radiografía , Insuficiencia del TratamientoRESUMEN
OBJECTIVE: To evaluate, for clinically normal dogs, results of Schirmer tear tests in eyes without topical anesthetic (STT) and to detect differences associated with breed, sex, age, day, and time of day in eyes in which STT was performed after use of topical anesthetic (STTa). ANIMALS: 41 Beagles, 43 Labrador Retrievers, 25 Golden Retrievers, 26 English Springer Spaniels, and 22 Shetland Sheepdogs. PROCEDURE: Beagles had STT and STTa values measured twice daily for 5 days. Client-owned dogs of 4 other breeds had STT and STTa values measured once. RESULTS: Mean +/- SD values of Beagles for STT and STTa were 20.2 +/- 2.5 and 3.8 +/- 2.7 mm/min. Mean values for STT and STTa were as follows: Labrador Retriever, 22.9 +/- 4.1 and 9.6 +/- 3.8 mm/min; English Springer Spaniel; 20.7 +/- 3.2 and 5.4 +/- 3.4 mm/min; Golden Retriever, 21.8 + 3.7 and 8.8 +/- 3.1 mm/min; and Shetland Sheepdog, 15.8 +/- 1.8 and 3.6 +/- 2.8 mm/min. Overall mean values for STT and STTa were 20.2 +/- 3.0 and 6.2 +/- 3.1 mm/min. Differences for STT and STTa were detected among breeds, but significant differences were not associated with sex or age within each breed or in overall values for all dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Results for the STT reported here compare favorably with reported values, except for results of Shetland Sheepdogs; however, results for the STTa differ dramatically from reported values. Clinicians should consider effects attributable to breed when evaluating results of STT and STTa in dogs.