ABSTRACT
Asthma, a chronic inflammatory lung disease affecting about 10 % of the population, involves both the general internist and the pulmonologist. The risk of over and underdiagnosis generates significant health costs and evitable clinical consequences. Improved screening through dedicated anamneses and questionnaires, as well as use of fractional exhaled nitric oxide (FeNO) may improve the diagnosis of asthma in general internal medicine.
L'asthme, maladie pulmonaire inflammatoire chronique affectant environ 10 % de la population, implique autant la médecine interne générale (MIG) que la pneumologie. Les risques de sous- et surdiagnostic engendrent d'importants coûts et conséquences cliniques évitables. Améliorer le dépistage lors de l'anamnèse avec l'utilisation de questionnaires dédiés et lors des examens fonctionnels par l'utilisation de la mesure de la fraction exhalée de l'oxyde nitrique pourrait être la clé d'un meilleur diagnostic de l'asthme en MIG.
Subject(s)
Asthma , Physicians , Humans , Asthma/diagnosis , Internal Medicine , Health Care Costs , PulmonologistsABSTRACT
Background: Blood culture-negative endocarditis (BCNE) is a significant condition associated with cardiac vegetation. It often occurs alongside sepsis, auto-immune diseases, or malignancies, posing a risk of vegetation and embolization. Notable pathogens include Haemophilus species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species. Case summary: A 60-year-old white male Belgian patient presented with worsening dyspnoea. His recent medical history included chronic infections over the past 6 months. Transthoracic echocardiography revealed severe aortic stenosis with an 18 × 12â mm vegetation. Despite normal inflammatory markers and negative blood tests, 18F-fluorodeoxyglucose positron emission tomography with computed tomography excluded malignancy but identified multiple bilateral septic lung emboli. Sputum cultures and tuberculosis polymerase chain reaction (PCR) were negative. Facing the high risk of cardiac embolization and the need for aortic valve replacement, surgery was scheduled with an intraoperative bronchoalveolar lavage (BAL) to investigate the lung lesions. Intraoperative findings confirmed valvular lesions, and a biological aortic valve was successfully implanted. The post-operative course was uneventful. Aortic valve cultures and eubacterial PCR results were negative, but BAL cultures were positive for Haemophilus influenzae, indicating a chronic infection. The patient showed favourable progress at 6 months post-surgery with ongoing antibiotherapy. Discussion: This case illustrates a rare BCNE associated with large vegetation and symptomatic H. influenzae chronic respiratory tract colonization (CRTC). For BCNE cases with negative sputum cultures and suspected bacterial CRTC, we recommend performing BAL cultures for accurate diagnosis.