Bronquiectasias y macrólidos / Bronchiectasis and macrolides

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Neumonía por citomegalovirus en paciente con inmunodeficiencia asociada a timoma / Cytomegalovirus pneumonia in a patient with thymoma-associated immunodeficiency

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Risk factors for nosocomial pneumonia in critically ill trauma patients.

OBJECTIVE: To determine risk factors for nosocomial pneumonia in critically ill trauma patients. DESIGN: Prospective cohort study. SETTING: The trauma intensive care unit (ICU) of a 1500-bed tertiary-care hospital. PATIENTS: All critically ill trauma patients (n = 103) admitted consecutively between November 1995 and October 1996. INTERVENTIONS: A comparison of data recorded at the time of ICU admission and during the clinical evolution in patients with (n = 23) and without (n = 80) nosocomial pneumonia was made. Data referred mainly to possible risk factors were recorded; they also included factors related to pneumonia etiology and evolutive factors. Predictors of nosocomial pneumonia were assessed by logistic regression analysis. MEASUREMENTS AND MAIN RESULTS: The presence of significant growth on quantitative cultures of the protected specimen brush (> or = 103 colony forming units/mL) was required to accept pneumonia as microbiologically proven, as well as the concurrence of a cohort of clinical and radiologic signs. Twenty-three (22.3%) patients developed nosocomial pneumonia. The mean age of these patients was 41.7 yrs; 18 of them (78.3%) were men. The microorganisms isolated in significant concentrations were Acinetobacter baumanii (ten cases), Staphylococcus aureus (11 cases), Pseudomonas aeruginosa (five cases), Haemophilus influenzae (two cases), and Klebsiella pneumoniae, Citrobacter freundii, Serratia marcescens, Enterococcus spp., Enterobacter spp., coagulase-negative Staphylococcus, and Streptococcus intermedius (one case each one). Risk factors for pneumonia by univariate analysis included nasogastric tube; continuous enteral feeding; prolonged mechanical ventilation (>1 day); use of H2-receptor antagonist, sucralfate, muscle relaxants, corticosteroids, barbiturates, and inotropic agents; positive end-expiratory pressure; intense sedation; re-intubation; tracheotomy; urgent brain computed tomography (CT) scan; craniotomy; iatrogenic event; and hyperventilation. The mortality rate was 43.5% (10 of 23) in the nosocomial pneumonia group and 18.8% in patients without nosocomial pneumonia (p =.02). Also, the mean stay in the ICU, the therapeutic charge (measured with total and mean punctuation of the Therapeutic Intervention Scoring System) and the complications, infectious and noninfectious, of the clinical evolution were significantly more frequent in patients with nosocomial pneumonia than in those without pneumonia (p <.05). In the multivariate analysis, continuous enteral feeding, craniotomy, prolonged mechanical ventilation (>24 hrs), use of positive end-expiratory pressure, and corticotherapy were independent predictors of nosocomial pneumonia. CONCLUSIONS: It seems that factors related to the patient's clinical course, rather than variables registered on the first days of ICU admission, are those that would exert an influence on the development of nosocomial pneumonia in critically ill trauma patients. In this way, from our point of view, in our study the main risk factors are the use of prolonged mechanical ventilation (>4 hrs) and positive end-expiratory pressure. At the same time, we can conclude that the reduction of this infection incidence could decrease the mean stay in the ICU, the therapeutic charge, and the prognosis in terms of mortality and morbidity.

Toxicidad de las quinolonas / Quinolone toxicity

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Infección por Chlamydia pneumoniae y patología respiratoria / Chlamydia pneumoniae infection and respiratory pathology

Este artículo incluye una revisión sobre la relación entre Chlamydia pneumoniae y diferentes enfermedades respiratorias, tales como bronquitis, neumonía, sinusitis, faringitis y asma (AU)

[Intrabronchial foreign body in adults: usefulness of computerized tomography]. / Cuerpo extraño intrabronquial en adultos: utilidad de la tomografía computarizada.

The diagnosis of intrabronchial solid foreign body is recorded less often in adults than in children and becomes increasingly difficult to make as time passes after aspiration. Three cases of intrabronchial foreign body in adults with no history of loss of consciousness are reported. Clinical and radiological features are discussed, with special mention of the diagnostic role of computed tomography, a technique that has not often been mentioned in the literature on foreign body aspiration, but that is more sensitive and specific than the simple X-ray. In patients with symptoms inconsistent with X-ray images, computed tomography can be a useful, noninvasive technique for guiding diagnosis and assessing the need for bronchoscopy.

[Fulminant pneumonia caused by Streptococcus milleri: rare or not diagnosed?]. / Neumonía de curso fulminante causada por Streptococcus milleri: infrecuente o no diagnosticada?

Streptococcus milleri is increasingly isolated in laboratory samples and is worthy of consideration as a differential diagnosis in pyogenic infections, particularly in adults with underlying infections. We describe a well-documented case of pleuropulmonary infection in a young man with no known risk factors. We analyze the diversity of microbiological features of these bacteria in culture, as well as their clinical importance as pathogens.

[Pulmonary fibrosis as a presentation form of the Jo-1 syndrome]. / Fibrosis pulmonar como forma de presentación del síndrome Jo-1.

Jo-1 syndrome is a disease recently described, included on the list of connective tissue diseases. Its clinical features are myositis and/or pulmonary fibrosis associated to the presence of precipitant antibodies against intracellular enzyme call histidine T-RNA synthetase. This antibody is related to pulmonary fibrosis associated to myositis and some scientist gave predictive value on the onset of pulmonary fibrosis in patients with myositis. However, isolated association of pulmonary fibrosis have been exceptionally described. A patient with severe interstitial pulmonary affliction and positive Jo-1 antibody without myositis is presented. The actual knowledge of the disease and its association is reviewed.

[Gammagraphy with gallium-67 citrate in the diagnosis of pulmonary tuberculosis]. / La gammagrafía con citrato de galio-67 en el diagnóstico de la tuberculosis pulmonar.

The reception of Gallium Citrate 67 (C. de Ga-67) has been studied in 27 patients with active pulmonary TBC shown bacteriologically. The findings of the gammagraphy with C. de Ga-67 have been compared with those of the simple thorax radiology. We have objectified 96% sensitivity in the examination of the tuberculous lesions by isotopic techniques. These have shown, as well, a high performance in the detection of active tuberculous areas at hiliar, mediatinic and extrathoracic level, greater than that of the simple radiography, as well as to evaluate the activity of apparently residual lesions in the thorax radiography. We conclude that the gammagraphy with C. de Ga-67 is a bloodless method which complements radiology in the diagnosis of activity, extension and location of pulmonary tuberculosis.

[Usefulness of total and specific IgE in the diagnosis of respiratory allergy]. / Utilidad de la IgE total y específica en el diagnóstico de la alergia respiratoria.

We studied 500 patients with an average age of 36.25 +/- 14.27 years and did the following tests: Intradermoreaction and prick tests, total IgE by PRIST and specific IgE by RAST. The antigens used for the study were the following: Lolium Perenne, Dermatophagoides pteronyssinus, and house dust. Of de 500 patients studied, 104 had a negative skin test and RAST. They also had a negative history of allergy. The other 396 patients presented a clinical history compatible with the diagnosis of allergy and were positive to skin test and/or RAST. A correlative study between the different techniques utilized in the diagnosis of these patients was undertaken. We observed significant higher levels of total IgE in the allergic than in the non-allergic group (p less than 0.001). The normal levels of total IgE in our environment were equal or inferior to 263.33 UI/ml. In the group of allergic patients, levels higher than 263.33 UI/ml were found in 49.27% of RAST positive patients and 46.35% in skin test positive patients. In the 295 patients studied with intradermoreaction, the correlation coefficients (r) were as follows: Lolium perenne r: 0.90; Dermatophagoides Pteronyssinus r: 0.54; house dust r: 0.14. The correlation coefficients (r) in the 101 patients studied with prick tests were the following; Lolium perenne r: 0.86; Dermatophagoides Pteronyssinus r: 0.82; house dust r: 0.48. As can be observed the prick tests gave overall better results than the intradermoreaction. On comparing the skin and RAST tests qualitatively we observed that in those patients studied by prick tests, 86.79% were pollen-positive in both trials.(ABSTRACT TRUNCATED AT 250 WORDS)

[Study of helper T lymphocytes and suppressor T lymphocytes in respiratory allergy and their modifications in relation to symptomatology]. / Estudio de linfocitos T facilitadores y T supresores en alergia respiratoria y sus modificaciones en relación a la sintomatología.

In has been assumed that in allergic disease there is a primary disorder in the lymphocyte subpopulation with decrease suppressor activity responsible for the pathological increase in IgE. Other authors have found secondary disorder in T lymphocyte subpopulations in relation to the clinical manifestations of the type I hypersensitivity reaction. We have studied the T lymphocyte subpopulations in 152 patients affected with bronchial asthma and/or extrinsic allergic rhinitis (without immunotherapy) in which 72 were male and 80 female with an average age of 26.49 +/- 12.05 years. Monoclonal antibody techniques were used (OKT4 for helpers and OKT8 for suppressors). The results were compared with 30 healthy controls; 60 males and 14 females with an average age of 32.52 +/- 14.23 years. We also studied the T lymphocyte subpopulations in relation to the symptomatology presented by the patients. The results were as follows: Significant decrease in helper and suppressor lymphocytes in allergic patients as compared to controls (p less than 0.001). No significant differences were found between the groups in relation to symptomatology (p greater than 0.05). In our study we found an important and significant decrease in helper T lymphocytes in peripheral blood in patients with respiratory allergy as compared to the control group, such as that found by Hsieh who also observed a deficient OKT4 function. Other authors have also observed a significant decrease in helper T lymphocytes parallel to the symptomatology of the type I hypersensitivity reaction, a finding that we have been unable to confirm in our study since no significant changes were observed between the symptomatic and asymptomatic patients.(ABSTRACT TRUNCATED AT 250 WORDS)