RESUMEN
BACKGROUND: Recent studies report very low adherence of practitioners to ATS/IDSA recommendations for the treatment of nontuberculous mycobacteria pulmonary disease (NTM-PD), as well as a great variability of practices. Type of management could impact prognosis. METHODS: To evaluate management and prognosis of patients with NTM-PD cases with respect to ATS recommendations, we conducted a multicenter retrospective cohort study (18 sentinel sites distributed throughout France), over a period of six years. We collected clinical, radiological, microbiological characteristics, management and outcome of the patients (especially death or not). RESULTS: 477 patients with NTM-PD were included. Respiratory comorbidities were found in 68% of cases, tuberculosis sequelae in 31.4% of patients, and immunosuppression in 16.8% of cases. The three most common NTM species were Mycobacterium avium complex (60%), M. xenopi (20%) and M. kansasii (5.7%). Smear-positive was found in one third of NTM-PD. Nodulobronchiectatic forms were observed in 54.3% of cases, and cavitary forms in 19.1% of patients. Sixty-three percent of patients were treated, 72.4% of patients with smear-positive samples, and 57.5% of patients with smear-negative samples. Treatment was in adequacy with ATS guidelines in 73.5%. The 2-year mortality was 14.4%. In the Cox regression, treatment (HR = 0.51), age (HR = 1.02), and M. abscessus (3.19) appeared as the 3 significant independent prognostic factors. CONCLUSION: These findings highlight the adequacy between French practices and the ATS/IDSA guidelines. Treatment was associated with a better survival.
Asunto(s)
Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/microbiología , Infecciones por Mycobacterium/epidemiología , Infecciones por Mycobacterium/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Francia/epidemiología , Adhesión a Directriz/estadística & datos numéricos , Humanos , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/terapia , Masculino , Persona de Mediana Edad , Mycobacterium/aislamiento & purificación , Infecciones por Mycobacterium/diagnóstico por imagen , Infecciones por Mycobacterium/terapia , Pronóstico , Estudios Retrospectivos , Distribución por Sexo , Adulto JovenRESUMEN
Chronic necrotizing or semi-invasive aspergillosis represents a disease commonly occurred in patients with mild immunodeficiency. We report a case of chronic necrotizing pulmonary aspergillosis in immunocompetent patient without underlying disease. The discovery of the disease was made accidentally, by finding a nodular opacity on a routine chest X-ray. The diagnostic was confirmed by pathological and bacteriological examination. With specific antifungal treatment, no complete eradication was obtained and the patient has a slow evolution with many relapses.
Asunto(s)
Antifúngicos/uso terapéutico , Inmunocompetencia , Hallazgos Incidentales , Aspergilosis Pulmonar Invasiva/diagnóstico por imagen , Aspergilosis Pulmonar Invasiva/patología , Adulto , Caspofungina , Diagnóstico Diferencial , Quimioterapia Combinada , Equinocandinas/uso terapéutico , Femenino , Humanos , Aspergilosis Pulmonar Invasiva/tratamiento farmacológico , Aspergilosis Pulmonar Invasiva/cirugía , Itraconazol/uso terapéutico , Lipopéptidos , Pronóstico , Pirimidinas/uso terapéutico , Radiografía , Enfermedades Raras , Recurrencia , Cirugía Torácica Asistida por Video , Factores de Tiempo , Resultado del Tratamiento , Triazoles/uso terapéutico , VoriconazolRESUMEN
The authors report a case of a 19-year-old man with alveolar rhabdomyosarcoma with an unusual clinical presentation. The diagnosis was established on lymph node biopsy performed on admission of the patient in a context simulating leukaemia. The patient achieved complete remission in response to high-dose chemotherapy. A recurrence in the form of an intratesticular metastasis demonstrated a periorbital tumour that was probably the primary tumour. The authors present the radiological and histological findings and a molecular biology study of the testicular metastasis, eliminating a primary testicular tumour.
