Micosis pulmonar causada por Penicillium spp: reporte de caso en paciente con fibrosis quística / Pulmonary mycosis caused by Penicillium spp: case report in a patient with cystic fibrosis

Se presenta el caso de un paciente masculino de 15 años con diagnóstico de fibrosis quística. Este desarrolló una sintomatología caracterizada por tos húmeda, no cianozante ni emetizante, sin un patrón temporal específico. Asociado a esto, nuevas lesiones nodulares bilaterales fueron identificadas en una tomografía de tórax. El abordaje diagnóstico incluyó una broncoscopia y la toma de un lavado broncoalveolar, que identificó la presencia de un microorganismo micótico poco común: Penicillium spp. Se inició tratamiento con voriconazol oral durante 14 días, resultando en una mejora clínica y radiológica significativa. El cultivo de expectoración posterior mostró un resultado negativo para Penicillium spp. Aunque la incidencia de exacerbaciones pulmonares causadas por agentes micóticos en pacientes con fibrosis quística es relativamente baja, se observa un incremento gradual, posiblemente relacionado con el uso prolongado de antimicrobianos de amplio espectro. La importancia de reportar este caso radica en el papel incierto que estos microorganismos juegan en la progresión del daño pulmonar, subrayando la necesidad de un seguimiento a mediano y largo plazo en estos pacientes.

This report discusses a 15-year-old male patient diagnosed with cystic fibrosis who developed clinical symptoms characterized by productive cough, not associated with cyanosis or vomiting, and without a specific time pattern. Associated with these symptoms, new bilateral nodular lesions were identified in a chest CT scan. Diagnostic approach included bronchoscopy and bronchoalveolar lavage, which identified a rare fungal organism: Penicillium spp. Treatment with oral voriconazole for 14 days was initiated, resulting in significant clinical and radiological improvement. Subsequent sputum culture showed a negative result for Penicillium spp. Although the incidence of pulmonary exacerbations caused by fungal agents in patients with cystic fibrosis is relatively low, there is a gradual increase, possibly related to the prolonged use of broad-spectrum antimicrobials. The importance of reporting this case lies in the uncertain role these organisms play in the progression of lung damage, highlighting the need for medium and long-term follow-up in these patients.

Validating Reference Equations for Impulse Oscillometry in Healthy Mexican Children.

BACKGROUND: The impulse oscillometry system (IOS) measures the impedance (Z) of the respiratory system, but proper interpretation of its results requires adequate reference values. The objectives of this work were: (1) to validate the reference equations for the IOS published previously by our group and (2) to compare the adjustment of new available reference equations for the IOS from different countries in a sample of healthy children. METHODS: Subjects were healthy 4-15-y-old children from the metropolitan area of Mexico City, who performed an IOS test. The functional IOS parameters obtained were compared with the predicted values from 12 reference equations determined in studies of different ethnic groups. The validation methods applied were: analysis of the differences between measured and predicted values for each reference equation; correlation and concordance coefficients; adjustment by Z-score values; percentage of predicted value; and the percentage of patients below the lower limit of normality or above the upper limit of normality. RESULTS: Of the 224 participants, 117 (52.3%) were girls, and the mean age was 8.6 ± 2.3 y. The equations that showed the best adjustment for the different parameters were those from the studies by Nowowiejska et al (2008) and Gochicoa et al (2015). The equations proposed by Frei et al (2005), Hellinckx et al (1998), Kalhoff et al (2011), Klug and Bisgaard (1998), de Assumpção et al (2016), and Dencker et al (2006) overestimated the airway resistance of the children in our sample, whereas the equation of Amra et al (2008) underestimated it. In the analysis of the lower and upper limits of normality, Gochicoa et al equation was the closest, since 5% of subjects were below or above percentiles 5 and 95, respectively. The study found that, in general, all of the equations showed greater error at the extremes of the age distribution. CONCLUSIONS: Because of the robust adjustment of the present study reference equations for the IOS, it can be recommended for both clinical and research purposes in our population. The differential adjustment of other equations underlines the need to obtain local reference values.