ABSTRACT
We report the case of a patient who has been hospitalized for dyspnea. Investigations revealed airway obstruction, eosinophilia, elevated IgE and elevated exhaled nitric oxide. Patient improved with oral corticosteroids (OCS). However, the patient presented two exacerbations requiring OCS during the next twelve months. Chest CT scan revealed two multiloculated parenchymal lesions. Lab test was positive for Echinococcus and Western-Blot confirmed infection with Echinococcus granulosus. Bronchoalveolar lavage confirmed the presence of 6 % eosinophils. Echinococcus granulosis is a zoonotic larval infection caused by a tapeworm larva. Patients with this disease may be asymptomatic for years. Early identification and management, in a multidisciplinary team, are essential and rely mainly on surgical intervention and antiparasitic treatments. This article presents the case of a young patient with pulmonary echinococcosis.
Nous rapportons le cas d'un patient ayant été hospitalisé dans un contexte d'obstruction bronchique, avec une légère éosinophilie, une élévation des IgE et du monoxyde d'azote dans l'air exhalé, qui a évolué favorablement sous corticostéroïdes oraux (CSO). L'évolution est marquée par deux exacerbations d'asthme d'évolution favorable sous CSO dans les douze mois de suivi. Une tomodensitométrie thoracique révèle la présence de deux lésions pulmonaires kystiques. Les sérologies infectieuses mettent en évidence une positivité pour l'espèce -Echinococcus et une confirmation pour l'Echinococcus granulosus. Le lavage broncho-alvéolaire retrouve une hyperéosinophilie à 6 %. L'échinococcose kystique est une infection larvaire zoonotique causée par une larve de taenia. Les patients atteints de cette maladie peuvent être asymptomatiques pendant de nombreuses années. Une identification précoce et une prise en charge adéquate, en équipe pluridisciplinaire, sont primordiales et reposent essentiellement sur une intervention chirurgicale et des traitements anti-parasitaires. Cet article présente le cas d'un jeune patient atteint d'une échinococcose kystique pulmonaire.
Subject(s)
Asthma , Echinococcus granulosus , Eosinophilia , Animals , Humans , Eosinophilia/complications , Asthma/complications , Asthma/diagnosis , Eosinophils , Zoonoses/complicationsABSTRACT
OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and high symptom burden that interferes with physical activity and results in a vicious cycle of inactivity and symptom worsening. The aim of this multicenter, observational study was to determine the prevalence and severity of morning, daytime and night-time symptoms as well as patterns of physical activity levels (PALs) and their interrelation in Belgian COPD patients, enrolled in the multinational SPACE study (NCT03031769). METHODS: Socio-demographic, socio-economic and disease characteristics data were collected from patients' medical records as part of a routine visit to their primary care practice or pulmonologist. Dedicated questionnaires were used to evaluate respiratory symptoms for each part of the day. PAL was assessed by means of self- and interview-reported tools, and physician's judgment. Patients were also classified according to GOLD recommendations 2013 and 2017. RESULTS: Overall, 102 Belgian patients participated in the study (mean age 67 years, 60.8% males). Over 85% of patients experienced respiratory symptoms throughout the day and about one-third were considered as 'active' (PAL ≥150 minutes/week). Physician-assessed PALs were higher than self-reported PALs, categorizing fewer patients as 'inactive' (17.6% versus 42.2%, respectively). PALs and symptoms were weakly interrelated. Inactive patients were present in all GOLD classification groups. CONCLUSION: Stable Belgian COPD patients enrolled in the SPACE study presented 24-hour respiratory symptoms and insufficient PALs. Physicians tended to overestimate patients' physical activity. Inactive patients were present across all GOLD classification groups. New approaches are deemed necessary to objectively identify and activate sedentary patients.
Subject(s)
Pulmonary Disease, Chronic Obstructive , Aged , Exercise/physiology , Female , Humans , Lung , Male , Pulmonary Disease, Chronic Obstructive/epidemiology , Severity of Illness Index , Surveys and QuestionnairesABSTRACT
PURPOSE: Bronchial carcinogenesis is a multistep process characterized by accumulation of genetic and molecular abnormalities, which precedes and accompanies the preinvasive lesions known as dysplasia and carcinoma in situ (CIS). We hypothesized that the level of accumulated molecular abnormalities in dysplasia assessed by immunohistochemical markers might reflect the severity of the carcinogenic process, thus allowing for risk assessment in smokers. EXPERIMENTAL DESIGN: We performed a prospective analysis of bronchial biopsies in 48 former smokers who had at least one area of metaplasia. Twenty-two of the patients had a previous history of lung cancer. Eighty bronchial lesions were recorded at baseline, including 31 metaplasia, 12 mild dysplasia, 9 moderate dysplasia, 9 severe dysplasia, and 19 CISs. Forty-one percent of the patients had multiple preinvasive lesions. Immunohistochemical analysis of P53, cyclin D1, cyclin E, Bax, and Bcl2 was performed. Aberrant expression of one of these proteins as compared with normal bronchi was recorded as one molecular alteration. RESULTS: After 18 months, 17 patients were diagnosed with lung cancer. No isolated parameter, including dysplastic grade or any isolated molecular alteration, was significantly associated with cancer occurrence at 18 months follow-up, using a logistic regression statistical analysis. In contrast, considering CIS and cancer as end point, more than two immunohistochemical abnormalities were associated with cancer or CIS occurrence (P = 0.02). CONCLUSIONS: We concluded that the cumulative index of immunohistochemical abnormalities in a random dysplasia is associated with CIS or lung cancer in the cancerization field of symptomatic smokers, independently of the histopathological grade of dysplasia. This set of histopathological biomarkers might be useful in risk assessment and provide intermediate end points for chemopreventive trials.
