RESUMEN
Treatment with an appropriate antimicrobial agent significantly decreases the bacterial burden and reduces the risk of a patient progressing to a more severe infection. When evaluating the use of antibiotics, practitioners should consider such factors as the local resistance patterns of common respiratory pathogens, the likelihood of infection with a resistant organism, and the potential for treatment failure. Recent antibiotic use is a risk factor for treatment failure. For patients with risk factors predictive of treatment failure, beta-lactams (usually in combination with a beta-lactamase inhibitor or a macrolide) and fluoroquinolones are most commonly recommended.
Asunto(s)
Antibacterianos/uso terapéutico , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Bronquitis Crónica/tratamiento farmacológico , Bronquitis Crónica/microbiología , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/microbiología , Esquema de Medicación , Monitoreo de Drogas , Utilización de Medicamentos/normas , Medicina Familiar y Comunitaria/métodos , Medicina Familiar y Comunitaria/normas , Humanos , Selección de Paciente , Neumonía/tratamiento farmacológico , Neumonía/microbiología , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Infecciones del Sistema Respiratorio/microbiología , Factores de Riesgo , Sinusitis/tratamiento farmacológico , Sinusitis/microbiología , Insuficiencia del TratamientoAsunto(s)
Colesterol , Granuloma de Cuerpo Extraño/diagnóstico , Enfermedades de los Senos Paranasales/diagnóstico , Seno Esfenoidal , Anciano , Diagnóstico Diferencial , Granuloma de Cuerpo Extraño/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Enfermedades de los Senos Paranasales/cirugía , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: To characterize the thin-section computed tomographic (CT) features of flock worker's lung (FWL) and to determine whether these features may be used to distinguish workers with FWL from flock workers who do not fulfill diagnostic criteria for FWL. MATERIALS AND METHODS: Thin-section CT images obtained in 43 flock workers (including 11 with FWL) were reviewed independently by radiologists blinded to occupational and clinical details. CT features recorded included ground-glass opacities, consolidation, micronodules, reticular abnormality, and septal thickening. Thirty-five of the CT scans (including nine obtained in patients with FWL) were also studied by using quantitative image analysis. The Student t test was used to compare mean lung attenuation between the workers with FWL and those without it. RESULTS: Every patient with FWL and 19 (59%) of the 32 exposed flock workers who did not meet criteria for the disease had an abnormal thin-section CT scan. The most common findings in FWL were ground-glass opacities and micronodules. Quantitative analysis showed a mean lung attenuation of -736.4 HU in patients with FWL, compared with -775.0 HU in workers without the disease (P <.05). CONCLUSION: While ground-glass opacities, micronodules, or both were found in all cases of FWL, these abnormalities were also present in a substantial proportion of symptomatic flock workers who did not satisfy current criteria for FWL. Although nonspecific, these findings should suggest the diagnosis of FWL in exposed individuals.