New evidence in severe pneumonia: imipenem/ cilastatin/relebactam.

Imipenem combined with beta-lactamase inhibitor relebactam (IMI/REL) has an extensive bactericidal activity against Gram-negative pathogens producing class A or class C beta-lactamases, not active against class B and class D. The phase 3 clinical trial (RESTORE-IMI-2), double-blind, randomized, evaluated IMI/REL vs. piperacillin-tazobactam (PIP/TAZ) for treatment of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), demonstrated non-inferiority at all-cause mortality at 28 days (15.9% vs 21.3%), favorable clinical response at 7-14 days end of treatment (61% vs 59.8%) and with minor serious adverse effects (26.7% vs 32%). IMI/REL is a therapeutic option in HAP and VAP at approved dosage imipenem 500 mg, cilastatin 500 mg and relebactam 250 mg once every 6h, by an IV infusion over 30 min.

Depression and anxiety symptoms in Spanish adult patients with cystic fibrosis: associations with health-related quality of life.

BACKGROUND: Cystic fibrosis (CF) is a chronic disease with an impact on the quality of life. Self-reported symptoms of depression and anxiety were assessed in the Spanish cohort of the International Epidemiological Study on Depression and Anxiety in patients with CF (International Depression-Anxiety Epidemiological Study) and their relationship with health status and health-related quality of life (HRQoL) was evaluated. METHODS: This cross-sectional study recruited adult patients with CF at 10 Spanish centers. Patients completed the Hospital Anxiety and Depression Scale (HADS) and the Revised Cystic Fibrosis Questionnaire. Demographic and health data were recorded from medical charts. Logistic regression was used to determine the predictors of elevated symptoms of depression and anxiety (HADS≥8). RESULTS: Of the 336 participants recruited (mean age, 28.1years; 48.2% women), 41 (12.2%) had elevated depression-related scores, and 100 (29.7%) had elevated anxiety-related scores (HADS≥8). After adjusting for confounders, only less education, intravenous antibiotics, psychiatric medications and psychotherapy were significantly associated with elevated psychological symptoms. Specifically, regardless of lung function, patients who were depressed or anxious reported worse HRQoL. CONCLUSIONS: The prevalence of elevated symptoms of depression and anxiety was high in Spanish adult patients with CF, and these symptoms were associated with a decreased HRQoL.

Tobramycin inhalation powder (TOBI Podhaler) for the treatment of lung infection in patients with cystic fibrosis.

Cystic fibrosis (CF) is an autosomal recessive inherited disease secondary to a defect in the CF transmembrane conductance regulator gene (CFTR). Mortality in CF is associated with impairment of lung function in which bacterial infection plays a fundamental role. The microorganism Pseudomonas aeruginosa (P. aeruginosa) is a marker of poor prognosis. Tobramycin was the first parenteral antibiotic to be used as inhaled medication in CF. Owing to its beneficial effects; it was subsequently used in designed inhaled formulations. The first formulation was the inhalation solution, which improved lung function, lowered hospitalization rates, and reduced the courses of intravenous antibiotic. However, the high associated costs and time necessary to administer the medication negatively affected quality of life. The recent development of tobramycin inhalation powder has optimized treatment. The dry powder inhaler is a simple device that reduces administration time and improves adherence. As there is no risk of bacterial contamination, disinfection is unnecessary.

Reduced expression of galectin-1 and galectin-9 by leucocytes in asthma patients.

Accumulating evidence shows that galectins play roles in the initiation and resolution phases of inflammatory responses by promoting anti- or proinflammatory effects. This study investigated the presence of three members of the galectin family (galectin-1, -3 and -9) in induced sputum samples of asthma patients, as well as their possible implication in the immunopathogenesis of human asthma. Levels of interleukin (IL)-5, IL-13, and galectins were determined in leucocytes isolated from induced sputum samples by reverse transcription-polymerase chain reaction (RT-PCR) immunofluorescence and flow cytometry. High levels of IL-5 and IL-13 mRNA were detected in sputum cells from asthma patients. In parallel, immunoregulatory proteins galectin-1 and galectin-9 showed a reduced expression on macrophages from sputum samples compared with cells from healthy donors. In-vitro immunoassays showed that galectin-1 and galectin-9, but not galectin-3, are able to induce the production of IL-10 by peripheral blood mononuclear cells from healthy donors. These findings indicate that macrophages from sputum samples of asthma patients express low levels of galectin-1 and galectin-9, favouring the exacerbated immune response observed in this disease.

Mujer con pulmón del cuidador de aves / Women with bird breeder's lung

La neumonitis por hipersensibilidad o alveolitis alérgica extrínseca (AAE) se origina por una reacción de hipersensibilidad a antígenos inhalados sobre un pulmón con una susceptibilidad individual. En el caso del pulmón del cuidador de aves, son partículas que suelen encontrarse en el epitelio, el polvo que cubre las plumas o las heces de las aves. En la exploración física destacan los crepitantes inspiratorios a la auscultación pulmonar y los hallazgos en la radiografía de tórax pueden ser muy variables. La TC nos muestra diferentes patrones en función de la fase de la enfermedad en que nos encontremos. Respecto a las pruebas de función respiratoria, la mayoría de los pacientes presenta un patrón restrictivo. Un diagnóstico precoz será crucial en la evolución de la enfermedad, ya que la progresión puede conducir a una fibrosis pulmonar o una enfermedad pulmonar obstructiva crónica. Lo principal es eliminar la exposición a los antígenos, con ello muchos pacientes se recuperan (AU)

Hypersensitivity pneumonitis or extrinsic allergic alveolitis (EAA) originates from a hypersensitivity reaction to inhaled antigens on a lung with individual susceptibility. In the case of bird breeder's lung, they are particles that are generally found on the epithelium, dust that covers the feathers or stools of the birds. In the physical examination, the inspiratory crackling rales heard on pulmonary auscultations stand out and the findings on the chest X-ray may vary greatly. The CT scan shows us different patterns based on the disease phase in question. Regarding the pulmonary function tests, most of the patients have a restrictive pattern. Early diagnosis is crucial in the disease course since progression may lead to pulmonary fibrosis or chronic obstructive pulmonary disease. The most important is to eliminate exposition to the antigens, with which many patients recover (AU)

Paciente con esclerosis tuberosa y angiomiolipomas renales / No disponible

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Mujer joven con infecciones de repetición / Young women with recurrent infections

Resumen. La inmunodeficiencia común variable (CVID) es la inmunodeficiencia primaria que con más frecuencia encontramos en la práctica clínica. Clínicamente se define como la presencia de infecciones recurrentes y una reducción en suero de IgG (al menos 2 desviaciones estándar por debajo de los valores de referencia para su edad) y al menos otra de las Ig (IgA o IgM) y una reducción o ausencia de producción de títulos protectores de anticuerpos para vacunas de polisacáridos y antígenos proteicos. La clínica que presentan estos pacientes son múltiples infecciones sinopulmonares, infecciones bacterianas sistémicas y complicaciones gastrointestinales, siendo las infecciones sinopulmonares la manifestación clínica con que se presenta mayoritariamente. El pilar principal del tratamiento de la CVID es el tratamiento sustitutivo con inmunoglobulinas, junto con los antibióticos para las infecciones y el tratamiento adecuado de las complicaciones no infecciosas (AU)

Abstract. Common variable immunodeficiency (CVID) is the primary immunodeficiency frequently found in the clinical practice. Clinically, it is defined as the presence of recurrent infections and a reduction in IgG serum (at least 2 standard deviations before the reference values for the subject’s age) and at least another one of the Ig (IgA or IgM) and a reduction or absence of the production of antibody titers protectors for polysaccharide vaccines and protein antigens. The clinical manifestations of these patients are multiple sinopulmonary infections, systemic bacterial infections and gastrointestinal complications, the sinopulmonary infections being the clinical manifestations found most. The principal basis of the CVID treatment is the immunoglobulin replacement treatment, together with antibiotics for the infections and adequate treatment of the non-infectious complications (AU)

Aspergiloma pulmonar con buena respuesta a antifúngico / Pulmonary Aspergilloma with good response to an antifungal agent

Resumen. Aspergillus sp es una familia de hongos ubicuos que se adquieren mediante la inhalación de esporas y, en pacientes predispuestos, produce afectación pulmonar, siendo el aspergiloma la forma más común y mejor conocida. Se caracteriza por una bola fúngica constituida por hifas del hongo, células inflamatorias, fibrina, moco y restos titulares. Habitualmente, el aspergiloma se forma en una cavidad pre-existente del pulmón causada por diferentes patologías como tuberculosis, sarcoidosis, bronquiectasias, fibrosis quística, bullas, espondilitis anquilosante, neoplasias o infecciones pulmonares. Clínicamente los pacientes suelen estar asintomáticos o paucisintomáticos siendo la hemoptisis el síntoma más frecuente. El diagnóstico de la enfermedad se basa en la clínica y en los hallazgos de la radiografía, combinado con la serología y los cultivos microbiológicos. El tratamiento del aspergiloma es controvertido, dependiendo de varios factores. Presentamos dos casos de aspergiloma que han sido tratados con itraconazol con buena evolución (AU)

Abstract. Aspergillus sp is a ubiquitous family of fungi that are acquired through the inhalation of spores. Aspergilloma is the most common and best known of pulmonary involvement by Aspergillus. It is characterized by a ball made up of fungal hyphae, inflammatory cells, fibrin, mucus and debris holders. Typically, the Aspergilloma is forming in a pre-existing avity in the lung, caused by various diseases such as tuberculosis, sarcoidosis, bronchiectasis, cystic fibrosis, bullae, ankylosing spondylitis, tumors or lung infections. Clinically, patients are often asymptomatic being the hemoptisis the most common symptom. The diagnosis of the disease is based on clinical findings and in the radiography, combined with serology and microbiologic cultures. The treatment is controversial depending on several factors. We present two cases of Aspergilloma who have been treated with Itraconazole with good results (AU)

Neumotórax recidivante en paciente con fibrosis quística / Recurrent pneumothorax in patients with cystic fibrosis

La fibrosis quística (FQ) es una enfermedad multisistémica que afecta a glándulas sudoríparas, aparatos respiratorio, digestivo y reproductor, siendo la afectación de las vías respiratorias la principal causa de morbi-mortalidad. La frecuencia de aparición de neumotórax va aumentando con la edad del paciente, siendo la edad media de presentación de 21,9 años. El principal factor de riesgo para la producción de neumotórax es la obstrucción bronquial, originándose el 75% de los neumotórax en pacientes con un FEV1 menor del 40%. Entre otros factores que aumentan la probabilidad de padecer un neumotórax se han descrito: la colonización crónica por Pseudomonas aeruginosa, Burkholderia cepacia y Aspergillus, la aspergilosis broncopulmonar alérgica (ABPA), el recibir alimentación enteral por desnutrición, la hemoptisis masiva, la insuficiencia pancreática y la terapia con tobramicina o DNasa inhalada. Presentamos el caso de un paciente que ha sufrido 10 neumotórax en el transcurso de un año (AU)

Cystic fibrosis (CF) is a multisystem disease that affects sweat glands, respiratory, digestive and reproductive systems. The respiratory disease is the leading cause of morbidity and mortality. The frequency of occurrence of pneumothorax increases depending on the age of the patient being the average age of onset of 21.9 years. The main risk factor for the production of pneumothorax is chronic bronchial obstruction occur 75% of patients with a spirometry with a value in FEV1 less than 40% of the expected value. Among other factors that increase the likelihood of suffering a pneumothorax include colonization of patients by Pseudomonas aeruginosa, Burkholderia cepacia or Aspergillus, allergic bronchopulmonary aspergillosis (ABPA), enteral feeding for malnutrition, massive hemoptysis, pancreatic insufficiency and the therapy with inhaled tobramycin or dornase. We present the case of a patient who has undergone 10 pneumothorax in one year (AU)

Neumonía y masa de pared torácica / Pneumonia and thoracic wall mass

Los Actinomyces son bacterias anaerobias, que crecen formando racimos y filamentos y forman parte de la flora normal de la orofaringe, tracto gastrointestinal y genital femenino. Existen catorce especies de Actinomyces, siendo A. israeli la principal especie patógena en humanos. La mayoría de dichas infecciones son polimicrobianas, como en el caso que presentamos a continuación de una paciente con neumonía polimicrobiana y absceso cutáneo (AU)

Actinomyces are anaerobic bacteria, that grow forming clusters and filaments and form a part of the normal flora of the oropharynge, gastrointestinal tract and female genital tract. There are fourteen species of Actinomyces, A. israeli being the main pathogenic species in humans. Most of these infections are polymicrobial, as in the case we present herein of a female patient with polymicrobial pneumonia and cutaneous abscess (AU)

Lymphangioleiomyomatosis: a study of 72 patients from the Spanish registry.

BACKGROUND: Pulmonary lymphangioleiomyomatosis (LAM) is a rare lung disease that almost exclusively affects young women of childbearing age. The true incidence and prevalence of LAM are unknown. This study was conducted to evaluate the characteristics of lymphangioleiomyomatosis in Spain. METHODS: Over a 2-year period, a questionnaire designed for this study was collected. This questionnaire included sociodemograhic, clinical, radiological and functional data. Information about the study and this questionnaire were both sent by e-mail to all the participants of the interstitial disease registry of 2004. RESULTS: Seventy-two patients, all of whom were women, were included in the registry, with a mean age of 44.56 +/- 11.1 yr. Sixty-three patients (87.5%) presented the sporadic LAM and 9 (12.5%) presented LAM associated with tuberous sclerosis (LAM-TS). LAM diagnosis was confirmed with an open lung biopsy in 57 patients (79.2%) and was performed with thoracic HRCT compatible with LAM diagnosis in the other 15 cases. The most frequent symptom was dyspnoea (90%) followed by cough (44.4%). Almost 40% of patients presented renal angiomyolipomas in the study and the most frequent spirometric pattern was obstructive in more than half of the patients. Most patients with LAM-TS (88.8%) had renal angiomyolipomas compared with 31.7% in the sporadic LAM group. CONCLUSION: The characteristics of the Spanish population affected with LAM are similar to those of other countries. Most patients were symptomatic, had a history of previous pneumothorax and presented abnormal radiological findings and pulmonary function tests.

Aspergilosis bronopulmonar alérgica, diagnóstico previo de una fibrosis quística / Allergic bronchopulmonary aspergillosis, previous diagnosis of a cystic fibrosis

La aspergilosis broncopulmonar alérgica es una enfermedad pulmonar de base inmune frente a diversas especies de Aspergillus. En los pacientes con fibrosis quística, la aspergilosis broncopulmonar alérgica cursa con clínica respiratoria de tos, sibilancias, disnea de esfuerzo que no mejora tras tratamiento antibiótico, a lo que se suman alteraciones radiológicas como bronquiectasias o infiltrados y pruebas que muestran sensibilización al hongo. Presentamos a una paciente con aspergilosis broncopulmonar alérgica que posteriormente fue diagnosticada de fibrosis quística (AU)

The allergic bronchopulmonar aspergillosis is an immunology lung disease produced by Aspergillus. In cystic fibrosis patients, allergic bronchopulmonar aspergillosis deals with a respiratory clinic of cough, wheezes and dyspnea which do not improve after antibiotic treatment, and radiological alterations as bronchiectasis or infiltrators. We present a patient with allergic bronchopulmonar aspergillosis who was diagnosed as cystic fibrosis (AU

Fibrosis quística / Cystic fibrosis

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Pacientes con adenopatías calcificadas / Patient with calcified lymph nodes

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Paciente con bronquiectasias y litoptisis / Patient with bronchiectasis and lithoptysis

La broncolitiasis (cálculos bronquiales) es una afección rara. Se originan por la erosión bronquial de calcificaciones hiliares o parenquimatosas, que por lo general son secundarias a infecciones, como la tuberculosis o la histoplasmosis1. Presentamosel caso de una paciente con bronquiectasias bilaterales secundarias a tuberculosis y que durante el seguimientoha presentado varios episodios de litoptisis

The broncolithiasis (bronchial stones) is a rare affection. They are produced by the bronchial erosion of hili or parenchymatose calcifications, that are generally secondary to infections like the tuberculosis or histoplasmosis1. We report the case of a patient with bilateral bronchiectasis due to tuberculosis and that during the following she presented severalepisodes of lithoptysis (AU)

¿Está cambiando la etiología de las bronquiectasias? / Is the etiology of bronchiectasis changing?

Introducción: Las bronquiectasias (BQ) constituyen el estadio final de una heterogénea variedad de procesos patológicos.Objetivo: Valorar la etiología de las BQ de los pacientes derivados a una consulta monográfica de esta patología de un hospital terciario, durante el período comprendido entre julio 2002 a septiembre 2005.Pacientes y métodos: Se incluyeron todos los pacientes que fueron remitidos a la consulta con el diagnóstico de BQ mediante tomografía axial computarizada de tórax. Se les realizaron una historia clínica detallada, microbiología de esputo, espirometría, Mantoux y, en determinados casos, determinación de inmunoglobulinas IgE, IgG, IgA, IgM, IgG e IgE específicas a Aspergillus, proteinograma, anticuerpos antinucleares, test del sudor, estudio genético para fibrosis quística,radiografía de senos, espermiograma y estudio gastroduodenal.Resultados: Fueron evaluados 171 enfermos, 85 mujeres, con una edad media de 63,97 años (rango: 19-94). Presentaron una espirometría con porcentajes sobre el valor teórico de FVC: 69,83%, (19,92) y FEV1 67,01% (25,44). Se determinaron las siguientes etiologías causantes de las bronquiectasias: en el 38% fueron secundarias a tuberculosis, el 15,5%a enfermedad pulmonar obstructiva crónica, el 11,9% a asma, el 4,8% a enfermedad del tejido conectivo, el 4,2% a neumonía necrotizante, el 2,4% a enfermedad del cilio inmóvil, déficit de alfa 1 antitripsina y a inmunodeficiencias, el resto de las etiologías fueron inferiores al 2%. En 20 casos la etiología fue desconocida.Conclusión: Los protocolos diagnósticos de una consulta monográfica ayudan a establecer la causa primaria de las bronquiectasias. En nuestro medio las etiologías más frecuentes fueron la tuberculosis, la EPOC y asma

Objective: To evaluate the aetiology of bronchiectasis of patients from a monographic consult in an University hospital, from july 2002 to september 2005.Methods: All the patients with bronchiectasis diagnose confirmed by high resolution computed tomography (HRCT) were included. We made a clinical history, sputum microbiology, pulmonary function test, Mantoux test, and in certain cases: inmunoglobulins E, G, A, M, Aspergillus inmunoglobulins G and E, proteinogram, autoantibodies, sweat chloride test, CF genotyping, sinus radiology,spermiogram, and barium swallow/oesophageal imaging.Results: 171 patients were evaluated, 85 women, with a mean age of 63.97 years (range 19-94). They had a spirometry with FVC 69.83 % (19.92) and FEV 1 67.01 %(25.44). The causes of bronchiectasis ere: 38% due to tuberculosis, 15,5% to chronic obstructive pulmonary disease (COPD), 11.9% to asthma, 4.8% to collagen diseases, 4.2% to necrotizing pneumonia, 2.4% to inmotile cilia syndrome; other aetiologies were less than 2%. In 20 cases the aetiology was unknown.Conclusion: The diagnostic guidelines in a monographic consult help to determinate the mean cause of the bronchiectasis. In our area the most frequent causes were the tuberculosis, the COPD and the asthma

Derrame pleural izquierdo como primera manifestación de un quiste hidatídico / Left pleural effusion as first manifestation of a hydatid cyst

La hidatidosis es una parasitosis zoonótica causada por un cestodo del género Echinococcus. Las manifestaciones clínicas dependen de la localización, volumen y número de quistes. En el pulmón éstas se deben a las complicaciones (compresión, infección o ruptura), originando gran variedad de síntomas.Presentamos el caso de un paciente de 35 años con derrame pleural recidivante secundario a hidatidosis hepática

Hydatidosis is a zoonotic parasitosis caused by a cestode of the Echinococcus genus. The clinical manifestations depend on the location, volume and number of cysts. In the lung, they are due to complications (compression, infection or rupture) and cause a large variety of symptoms.We present the case of a 35 year old patient with recurrent pleural effusion secondary to hepatic hydatidosis

Diagnóstico de atresia bronquial en una mujer adulta / Diagnosis of bronchial atresia in an adult woman

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