RESUMEN
We report the case of a patient with a febrile acute respiratory failure associated with alveolar opacities localized in the left upper lobe on chest-X-ray. Diagnosis was related to pulmonary embolism with overflow pulmonary edema. Complete recovery was obtained after mechanical ventilation, anticoagulation and a short course of intra venous dobutamine.
Asunto(s)
Edema Pulmonar/etiología , Embolia Pulmonar/complicaciones , Embolia Pulmonar/patología , Insuficiencia Respiratoria/etiología , Anciano , Anticoagulantes/uso terapéutico , Diagnóstico Diferencial , Fiebre , Humanos , Masculino , Alveolos Pulmonares/patología , Edema Pulmonar/diagnóstico por imagen , Embolia Pulmonar/diagnóstico por imagen , Radiografía Torácica , Respiración ArtificialRESUMEN
We report a case of acute respiratory failure due to Toxoplasma gondii mimicking pneumocystosis in an AIDS patient. Empirical antibiotic therapy with cotrimoxazole is discussed. Active research and identification of pathogens with adapted laboratory tests is mandatory.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Antiinfecciosos/uso terapéutico , Antiinflamatorios/uso terapéutico , Enfermedades Pulmonares Parasitarias/complicaciones , Enfermedades Pulmonares Parasitarias/tratamiento farmacológico , Metilprednisolona/uso terapéutico , Insuficiencia Respiratoria/etiología , Toxoplasmosis/complicaciones , Toxoplasmosis/tratamiento farmacológico , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Enfermedad Aguda , Adulto , Diagnóstico Diferencial , Humanos , Enfermedades Pulmonares Parasitarias/diagnóstico , Masculino , Toxoplasmosis/diagnósticoRESUMEN
We report a case of Candida albicans fungemia complicated by a pulmonary localization in a non-immunocompromised patient. Complete recovery was obtained after a long course of high-dose fluconazole in spite of in vitro resistance of the Candida to fluconazole. The usefulness of fluconazole therapy, the best dosage regimen and the in vitro and in vivo correlations are discussed.
Asunto(s)
Antifúngicos/uso terapéutico , Candidiasis/tratamiento farmacológico , Candidiasis/etiología , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/etiología , Fluconazol/uso terapéutico , Fungemia/tratamiento farmacológico , Fungemia/etiología , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Enfermedades Pulmonares Fúngicas/etiología , Adulto , Antibacterianos/efectos adversos , Candidiasis/microbiología , Cateterismo Venoso Central/efectos adversos , Infección Hospitalaria/microbiología , Farmacorresistencia Microbiana , Femenino , Fungemia/microbiología , Humanos , Enfermedades Pulmonares Fúngicas/microbiología , Nutrición Parenteral Total/efectos adversos , Factores de Riesgo , Tomografía Computarizada por Rayos XRESUMEN
To describe the epidemiologic and microbial aspects of ventilator-associated pneumonia (VAP) in patients with acute respiratory distress syndrome (ARDS), we prospectively evaluated 243 consecutive patients who required mechanical ventilation (MV) for > or = 48 h, 56 of whom developed ARDS as defined by a Murray lung injury score > 2.5. We did this with bronchoscopic techniques when VAP was clinically suspected, before any modification of existing antimicrobial therapy. For all patients, the diagnosis of pneumonia was established on the basis of culture results of protected-specimen brush (PSB) (> or = 10(3) cfu/ml) and bronchoalvelolar lavage fluid (BALF) (> or = 10(4) cfu/ml) specimens, and direct examination of cells recovered by bronchoalveolar lavage (BAL) (< or = 5% of infected cells). Thirty-one (55%) of the 56 patients with ARDS developed VAP for a total of 41 episodes, as compared with only 53 (28%) of the 187 patients without ARDS for a total of 65 episodes (p = 0.0005). Only 10% of first episodes of VAP in patients with ARDS occurred before Day 7 of MV, as compared with 40% of the episodes in patients without ARDS (p = 0.005). All but two patients with ARDS who developed VAP had received antimicrobial treatment (mostly with broad-spectrum antibiotics) before the onset of infection, as compared with only 35 patients without ARDS (p = 0.004). The organisms most frequently isolated from patients with ARDS and VAP were methicillin-resistant Staphylococcus aureus (23%), nonfermenting gram-negative bacilli (21%), and Enterobacteriaceae (21%). These findings confirm that microbiologically provable VAP occurs far more often in patients with ARDS than in other ventilated patients. Because these patients are often treated with antibiotics early in the course of the syndrome, the onset of VAP is frequently delayed after the first week of MV, and is then caused mainly by methicillin-resistant S. aureus and other multiresistant microorganisms.
Asunto(s)
Infección Hospitalaria/etiología , Neumonía Bacteriana/etiología , Respiración Artificial/efectos adversos , Síndrome de Dificultad Respiratoria/complicaciones , Anciano , Líquido del Lavado Bronquioalveolar/microbiología , Broncoscopía , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía Bacteriana/diagnóstico , Neumonía Bacteriana/microbiología , Estudios Prospectivos , Síndrome de Dificultad Respiratoria/mortalidad , Síndrome de Dificultad Respiratoria/terapia , Tasa de SupervivenciaRESUMEN
The authors report a case of Neisseria sicca endocarditis presenting with multiple organ failure in a 33 year old intravenous drug user. The diagnosis was confirmed by transthoracic and transoesophageal echocardiography showing vegetations on the aortic valve and three blood cultures positive for Neisseria Sicca. Massive aortic regurgitation occurred on the 4th day. The patient died of complications of intracerebral haematomas before surgical intervention. Contrary to pathogenic Neisseria gonorrhoeae and meningitides, saprophytic Neisseria, including Neisseria sicca, are commensal organisms of the upper respiratory tract. They are exceptionally rare causes of endocarditis. A review of the literature from the era of antibiotic therapy, found about thirty cases of saprophytic Neisseria endocarditis of which only five were due to Neisseria sicca. The clinical characteristics were the young age, the mainly left heart valve disease and the high incidence of cerebrovascular accidents. The originality of this case was the exceptionally rare involvement of this organism and the multiplicity of the extracardiac manifestations, especially renal and neurological.
Asunto(s)
Endocarditis Bacteriana/complicaciones , Insuficiencia Multiorgánica/etiología , Neisseria/aislamiento & purificación , Infecciones por Neisseriaceae/complicaciones , Adulto , Ecocardiografía Transesofágica , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/terapia , Resultado Fatal , Humanos , Masculino , Insuficiencia Multiorgánica/mortalidad , Insuficiencia Multiorgánica/terapia , Infecciones por Neisseriaceae/terapia , Choque Séptico/etiología , Abuso de Sustancias por Vía Intravenosa/complicacionesRESUMEN
The aim of this study was to assess the value of echocardiographic contrast in measuring systolic pulmonary artery pressures. Thirty-four patients with an average age of 61 +/- 15 years undergoing right heart catheterisation had a simultaneous measurement of systolic pulmonary artery pressures by catheter and colour-coded Doppler echocardiography under basal conditions and after injection of 5% dextrose agitated with 1 cm3 of air to form microcavitations. The Doppler echocardiographic measurements were performed after withdrawal of the catheter into the inferior vena cava before and after injection of contrast. Patients were divided into two groups according to the pulmonary artery pressures at catheterisation: Group I, comprising 11 patients with systolic pulmonary artery pressures of less than 35 mmHg; Group II, comprising 23 patients with systolic pulmonary artery pressures of over 35 mmHg; The injection of contrast significantly increased the number of patients in whom systolic pulmonary artery pressures could be calculated from the Doppler signal of tricuspid regurgitation (TR) in Group I (control: 18%; contrast: 100%, p < 0.01) and Group II (control: 65%; contrast: 96%, p < 0.05). There was a close correlation between the catheter and Doppler measurements of the trans-tricuspid valve pressure gradients before and after injection of contrast in Group I (n = 11, r = 0.85, p = 0.001, with an estimated standard error (ESE) = 3.8 mmHg) and in Group II (control: n = 15, r = 0.89, p = 0.001, ESE = 10.5 mmHg, and after contrast: n = 22, .r = 0.90, p = 0.001, ESE = 7.95 mmHg) with the catheter in the right ventricle.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Presión Sanguínea , Ecocardiografía Doppler , Cardiopatías/fisiopatología , Arteria Pulmonar , Anciano , Cateterismo Cardíaco , Ecocardiografía Doppler/métodos , Cardiopatías/diagnóstico por imagen , Hemodinámica , Humanos , Persona de Mediana Edad , Sístole , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/fisiopatologíaAsunto(s)
Amrinona/farmacología , Dobutamina/farmacología , Hemodinámica/efectos de los fármacos , Hipertensión Pulmonar/tratamiento farmacológico , Enfermedades Pulmonares Obstructivas/tratamiento farmacológico , Anciano , Amrinona/uso terapéutico , Dobutamina/uso terapéutico , Femenino , Humanos , Hipertensión Pulmonar/etiología , Enfermedades Pulmonares Obstructivas/complicaciones , Masculino , Persona de Mediana EdadRESUMEN
We report a case of deficient anti-diuretic hormone masked by an associated deficiency of the corticotrophine due to hypophysial metastasis from a small cell carcinoma of the bronchus. Steroid therapy used as an anti-emetic revealed the diabetes insipidus. There was a favourable outcome to chemotherapy.