Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 469
Filtrar
1.
BMC Infect Dis ; 19(1): 764, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477038

RESUMO

BACKGROUND: Environmental bacteria, nontuberculous mycobacteria (NTM), are recognized as one of the major human infection pathogens. NTM are prone to be mistaken as multidrug-resistant Mycobacterium tuberculosis and challenge our fight against TB. In addition, treatment of NTM per se is intractable. Remarkably, the distribution of NTM pathogenic species is geographically specific. Thus, it is very important to summarize the prevalent features and clinical symptoms of NTM pulmonary disease. However, In Nanjing district, southeast China, there is no such a report. METHODS: Through investigating electronic medical records and analyzing data of clinical examination system (Lis), we retrospectively summarized the NTM species from 6012 clinical isolates from May 2017 to August 2018, and analyzed the association between NTM species and clinical symptoms. RESULTS: Of 6012 clinical specimens, 1461 (24.3%) could grow in the MGIT 960 broth. Among these positive isolates, 1213 (83%) were M. tuberculosis, 22 (1.5%) were M. bovis, and 226 (15.5%) were NTM. After deducting redundancy, those NTM specimens were confirmed from 154 patients, among which, 87 (56.5%) patients met the full ATS/IDSA NTM disease criteria. The most common etiologic agent was M. intracellulare (70.1%). NTM infection was associated with age, based on which 68.6% male patients and 77.8% female patients were over 50 years old. The older patients were more likely to have hemoptysis, but the younger patients were more likely to manifest chest congestion. Male patients were more likely to have shortness of breath and females were more likely to have hemoptysis. The most common radiographic presentation of NTM pulmonary disease was bronchiectasis, accounting for 39.1%. Remarkably, multiple and thin-walled cavities were outstanding. The most frequent comorbidity of NTM disease was previous tuberculosis (64%), followed by clinical bronchiectasis (19.5%), HIV (19.5%), and 6.9% chronic obstructive pulmonary disease (COPD). There was no association between NTM species and clinical symptoms. CONCLUSION: This study retrospectively investigated the prevalence of NTM pulmonary disease in Nanjing district, southeast China. Similar to Beijing area, north China, M. intracellulare was the major pathogenic NTM species. Clinical symptoms of the disease were not species-specific. Previous TB and HIV infection immensely enhanced risk of NTM disease.


Assuntos
Pneumopatias/diagnóstico , Pneumopatias/epidemiologia , Infecções por Micobactéria não Tuberculosa/diagnóstico , Infecções por Micobactéria não Tuberculosa/epidemiologia , Micobactérias não Tuberculosas/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Bronquiectasia/diagnóstico , Bronquiectasia/epidemiologia , Bronquiectasia/microbiologia , China/epidemiologia , Comorbidade , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/microbiologia , Humanos , Pneumopatias/microbiologia , Masculino , Pessoa de Meia-Idade , Infecções por Micobactéria não Tuberculosa/microbiologia , Micobactérias não Tuberculosas/classificação , Prevalência , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , Estudos Retrospectivos , Adulto Jovem
2.
Eur J Clin Microbiol Infect Dis ; 38(12): 2299-2304, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31471703

RESUMO

About 25% of the patients with bronchiectasis are likely to develop a chronic colonization with Pseudomonas aeruginosa. A better understanding of predictors of acquiring Pseudomonas within the patient population may facilitate future focused research. The aim of this retrospective observational study was to investigate predicting factors for P. aeruginosa colonization in patients with bronchiectasis. This was a single-center retrospective cohort study using a bronchiectasis database which consisted of 211 patients with bronchiectasis. Data were collected for demographic details, etiology, spirometry, microbiology data, maintenance medication use, exacerbation frequency, hospital admission rate, and FACED and Bronchiectasis Severity Index (BSI) score. Two hundred eleven patients were identified from our bronchiectasis database. Overall, 25% of the patients (n = 53) had a chronic colonization with P. aeruginosa. Seventeen patients (8%) died in a 5-year follow-up period of whom 7 (41%) had a chronic P. aeruginosa colonization (p > 0.05). After multiple regression analysis, P. aeruginosa-positive patients were significantly associated with an older age (> 55 years) (p = 0.004), the use of hypertonic saline (0.042), and inhalation antibiotics (< 0.001). Furthermore, the presence of PCD (p < 0.001) and post-infectious etiology (p < 0.001) as underlying causes were significantly associated with P. aeruginosa colonization. We observed that independent predictors for P. aeruginosa colonization were age > 55 years, hypertonic saline, and PCD, and post-infectious etiology as underlying causes of bronchiectasis. Since prevention of P. aeruginosa colonization is an important aim in the treatment of bronchiectasis, more attention could be directed to these groups at risk for Pseudomonas colonization.


Assuntos
Bronquiectasia/complicações , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/epidemiologia , Pseudomonas aeruginosa/isolamento & purificação , Idoso , Bronquiectasia/epidemiologia , Bronquiectasia/microbiologia , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infecções por Pseudomonas/microbiologia , Estudos Retrospectivos , Fatores de Risco
4.
J Med Microbiol ; 68(8): 1140-1147, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31274402

RESUMO

INTRODUCTION: Moraxella catarrhalis is an important but insufficiently studied respiratory pathogen. AIM: To determine antibiotic susceptibility and impact of recent antibiotics on M. catarrhalis from children with chronic endobronchial suppuration. METHODOLOGY: We cultured nasopharyngeal (NP) swabs and bronchoalveolar lavage (BAL) fluids collected from children who were prospectively enrolled in studies of chronic cough and had flexible bronchoscopy performed. Recent ß-lactam or macrolide antibiotic use was recorded. M. catarrhalis isolates stored at -80 °C were re-cultured and susceptibility determined to a range of antibiotics including the macrolide antibiotic erythromycin. RESULTS: Data from concurrently collected NP and BAL specimens were available from 547 children (median age 2.4 years) enrolled from 2007 to 2016. M. catarrhalis NP carriage was detected in 149 (27  %) children and lower airway infection (≥104 c.f.u. ml-1 BAL) in 67 (12  %) children. In total, 91  % of 222 M. catarrhalis isolates were ß-lactamase producers, and non-susceptibility was high to benzylpenicillin (98 %), cefaclor (39 %) and cotrimoxazole (38 %). Overall, >97  % isolates were susceptible to cefuroxime, chloramphenicol, erythromycin and tetracycline; three isolates were erythromycin-resistant (MIC >0.5 mg l-1). Recent macrolide antibiotics (n=152 children, 28 %) were associated with significantly reduced M. catarrhalis carriage and lower airway infection episodes compared to children who did not receive macrolides; odds ratios 0.19 (95  % CI 0.10-0.35) and 0.15 (0.04-0.41), respectively. CONCLUSION: Despite the frequent use of macrolides, few macrolide-resistant isolates were detected. This suggests a fitness cost associated with macrolide resistance in M. catarrhalis. Macrolide antibiotics remain an effective choice for treating M. catarrhalis lower airway infection in children with chronic endobronchial suppuration.


Assuntos
Bronquiectasia/tratamento farmacológico , Bronquiectasia/microbiologia , Macrolídeos/farmacologia , Macrolídeos/uso terapêutico , Infecções por Moraxellaceae/tratamento farmacológico , Infecções por Moraxellaceae/microbiologia , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bronquiectasia/patologia , Líquido da Lavagem Broncoalveolar/microbiologia , Pré-Escolar , Doença Crônica , Farmacorresistência Bacteriana , Feminino , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Infecções por Moraxellaceae/patologia , Nasofaringe/microbiologia , Supuração , beta-Lactamases/biossíntese
5.
BMC Infect Dis ; 19(1): 436, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101082

RESUMO

BACKGROUND: Information on non-tuberculosis mycobacterial (NTM) diseases remains limited in Singapore and other Southeast Asian countries. This study aimed to delineate epidemiological and clinical features of pulmonary NTM disease. METHODS: A retrospective review was performed on all NTM isolates identified in Singapore General Hospital from 2012 to 2016 using the 2007 ATS/IDSA diagnostic criteria. RESULTS: A total of 2026 NTM isolates from 852 patients were identified. M. abscessus-chelonae group (1010, 49.9%) was the most commonly isolated and implicated in pulmonary NTM disease. Pulmonary cases (352, 76%) had the highest prevalence among patients diagnosed with NTM diseases (465/852, 54.6%) with no gender difference. Male patients were older (68.5 years, P = 0.014) with a higher incidence of chronic obstructive pulmonary disease (COPD) (23.6%, P < 0.001) and recurrent cough with phlegm production (51.6%, P = 0.035). In contrast, more female patients had bronchiectasis (50%, P < 0.001) and haemoptysis (37.6%, P = 0.042). Age and COPD were associated with multiple NTM species isolation per patient. CONCLUSIONS: M. abscessus-chelonae group was the commonest NTM species isolated in Singapore. Pulmonary NTM infection has the highest frequency with male and female patients associated with a higher incidence of COPD and bronchiectasis respectively. Age and COPD were associated with multiple NTM species isolation per patient.


Assuntos
Pneumopatias/microbiologia , Infecções por Micobactéria não Tuberculosa/epidemiologia , Infecções por Micobactéria não Tuberculosa/etiologia , Micobactérias não Tuberculosas/isolamento & purificação , Idoso , Bronquiectasia/epidemiologia , Bronquiectasia/microbiologia , Comorbidade , Feminino , Hemoptise/epidemiologia , Hemoptise/microbiologia , Hospitais Gerais , Humanos , Incidência , Pneumopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Infecções por Micobactéria não Tuberculosa/microbiologia , Micobactérias não Tuberculosas/patogenicidade , Prevalência , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/microbiologia , Estudos Retrospectivos , Fatores Sexuais , Singapura/epidemiologia
6.
Am J Respir Crit Care Med ; 200(1): 33-41, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31109172

RESUMO

Rationale: The principal underlying inhaled antibiotic treatment in bronchiectasis is that airway bacterial load drives inflammation, and therefore antibiotic treatment will reduce symptoms. Objectives: To determine the relationship between bacterial load and clinical outcomes, assess the stability of bacterial load over time, and test the hypothesis that response to inhaled antibiotics would be predicted by baseline bacterial load. Methods: We performed three studies. Studies 1 and 2 were prospective studies including adults with bronchiectasis. Study 3 was a post hoc analysis of a randomized trial of inhaled aztreonam. A priori patients were divided into low (<105 cfu/g), moderate (105-106 cfu/g), and high bacterial load (≥107 cfu/g) using quantitative sputum culture. Measurements and Main Results: Bacterial load was a stable trait associated with worse quality of life and more airway inflammation in studies 1, 2, and 3. In study 3, patients with high bacterial load showed an improvement in the primary endpoint (Quality of Life-Bronchiectasis-Respiratory Symptoms Score at Week 4) in favor of aztreonam (mean difference of 9.7 points; 95% confidence interval, 3.4-16.0; P = 0.003). The proportion of patients who achieved an increase above the minimum clinically important difference was higher in the aztreonam group at Week 4 (63% vs. 37%; P = 0.01) and at Week 12 (62% vs. 38%; P = 0.01) only in high bacterial load patients. Conclusions: Improvement of quality of life with inhaled aztreonam was only evident in patients with high bacterial load. Bacterial load may be a useful biomarker of severity of disease and treatment response.


Assuntos
Antibacterianos/administração & dosagem , Aztreonam/administração & dosagem , Carga Bacteriana , Bronquiectasia/tratamento farmacológico , Escarro/microbiologia , Administração por Inalação , Idoso , Bronquiectasia/microbiologia , Bronquiectasia/fisiopatologia , Enterobacteriaceae , Feminino , Volume Expiratório Forçado , Haemophilus influenzae , Humanos , Inflamação/microbiologia , Masculino , Pessoa de Meia-Idade , Diferença Mínima Clinicamente Importante , Estudos Prospectivos , Pseudomonas aeruginosa , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Staphylococcus aureus , Streptococcus pneumoniae
7.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(4): 254-261, 2019 Apr 12.
Artigo em Chinês | MEDLINE | ID: mdl-30955282

RESUMO

Objective: To determine the pattern of respiratory pathogens at bronchiectasis exacerbation and its associations with disease severity. Methods: A total of 119 steady-state bronchiectasis patients [42 males, 77 females, age range 19 to 74 years, mean age (45±14)years], diagnosed by a compatible history combined with evidence of bronchial dilatation on high-resolution computed tomography (HRCT), were recruited prospectively from out-patient clinics in the First Affiliated Hospital of Guangzhou Medical University between September 2012 and March 2013. A comprehensive history taking, radiologic appearance, spirometry, sputum bacterial culture and 16 respiratory viruses in nasopharyngeal swabs and sputum samples by PCR assays were collected at steady-state bronchiectasis. All bronchiectasis patients were followed up one year and assessed for bacteriology, virology and systemic inflammatory indices [including white blood cell, C-reactive protein (CRP), interleukin-6, 8 and tumor necrosis factor-α] during bronchiectasis exacerbation. Results: Fifty-eight bronchiectasis patients [20 males, 38 females, age range 19 to 74 years, mean age (44±14) years] reported 100 exacerbations (1 to 5 exacerbation events per patient) during one year follow-up. Respiratory viruses were found more frequently in sputum and nasal swab during exacerbation [35.0% (35/100) and 39% (39/100)] than those during steady-state in bronchiectasis [sputum: 13.8% (8/58), nasal swab: 8.6% (5/58)] (χ(2)=8.33,χ(2)=13.51; respectively, all P<0.05). The rate of bacterial detection during exacerbation in sputum was 56% (56/100), which was not significantly different compared with those at steady-state (35/58, 60.3%;χ(2)=0.284, P=0.59). Of these respiratory infections, viral-bacterial co-infection accounted for 30% exacerbation events. The most common bacteria and viruses during exacerbation in mild bronchiectasis (n=18, with 25 exacerbation events) were Haemophilus parainfluenzae (4 cases) in sputum and influenza A in nasal swab or sputum (4 cases), respectively. In patients with moderate (n=17, with 29 exacerbation events)-severe bronchiectasis (n=23, with 46 exacerbation events), pseudomonas aeruginosa was the most common bacteria in sputum (35 cases), and the most common respiratory viruses were rhinovirus in nasal swab or sputum (11 cases). In these 100 exacerbation events, patients with bacterial and viral co-infection, pure bacteria infection, pure virus infection, no bacteria and virus infection accounted for 30, 29, 16 and 25 exacerbation events, respectively. And patients with co-infection had higher serum CRP (45±23) mg/L and IL-8 [9.0 (4.4-15.5) ng/L] (F=23.32, F=9.81,respectively; all P<0.05), and increased risk of hospitalization (30% vs. 0] compared with those in non-infectious group(χ(2)=9.0, P=0.003). Conclusions: Pseudomonas aeruginosa, rhinovirus and influenza A were common causative agents of exacerbation in bronchiectasis.In patients with moderate-severe bronchiectasis, pseudomonas aeruginosa was the most common bacterium in sputum, and the most common respiratory virus was rhinovirus in nasal swab or sputum, compared to Haemophilus parainfluenzae in sputum and influenza A in nasal swab or sputum in mild bronchiectasis. Patients with co-infection had more severe systemic inflammatory response and higher risk of hospitalization during exacerbation.


Assuntos
Bronquiectasia/fisiopatologia , Bronquiectasia/virologia , Pulmão/fisiopatologia , Pulmão/virologia , Infecções Respiratórias/microbiologia , Infecções Respiratórias/virologia , Escarro , Adulto , Idoso , Bronquiectasia/sangue , Bronquiectasia/microbiologia , China/epidemiologia , Feminino , Haemophilus influenzae , Humanos , Mediadores da Inflamação/sangue , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , Espirometria/métodos , Escarro/microbiologia , Escarro/virologia , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
Rev Esp Quimioter ; 32(3): 217-223, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-30924621

RESUMO

OBJECTIVE: Chronic colonisation/infection by Pseudomonas aeruginosa of the bronchiectasis is related to a faster deterioration of lung function, an increase in the number of exacerbations and a higher morbidity and mortality. Nebulised colistin decreases bacteria load. Therefore, a reduction in the number and in the severity of exacerbations and a delay of pulmonary decline is expected. The main objective is to evaluate if the treatment with nebulised colistin, for at least 6 months reduces the number of admissions and visits to the emergency department. METHODS: Observational, retrospective and non-interventionist study carried out in an organizational structure with an integrated management. Patients with non-cystic fibrosis bronchiectasis colonised / infected by P. aeruginosa, older than 18 years, were selected. Patients must have received nebulized colistin during at least 6 months. Clinical, microbiological and therapeutic data from the patients were collected from the SERGAS computerized clinical history (IANUS® v.4.20.0503) and the electronic prescription, which were divided into two time periods: 1) 6 months pre-treatment and during the treatment and 2) 12 months pre-treatment and during the treatment, in those who completed 1 year of treatment. RESULTS: Forty-four patients were included and of these, 29 (65.9%) had a follow-up of 12 months. The use of nebulized colistin decreased significantly the number of visits to the emergency (at 6 months), the frequency and duration of hospitalizations admissions (at 6 and 12 months), the antibiotic consumption (at 6 and 12 months) and the positive cultures. The treatment was well tolerated in almost all patients. CONCLUSIONS: The treatment with nebulised colistin during 6 and 12 months of non-cystic fibrosis bronchiectasis, colonised/infected by P. aeruginosa, seems beneficial for the patient, from the clinical and quality of life point of view, and could reduce the economic cost of the process.


Assuntos
Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Bronquiectasia/tratamento farmacológico , Bronquiectasia/microbiologia , Colistina/administração & dosagem , Colistina/uso terapêutico , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia , Administração por Inalação , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/efeitos adversos , Colistina/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nebulizadores e Vaporizadores , Pseudomonas aeruginosa/efeitos dos fármacos , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
11.
BMC Infect Dis ; 19(1): 263, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30885152

RESUMO

BACKGROUND: Mycobacterium avium complex lung disease (MAC-LD) can deteriorate rapidly to become fatal. Reported poor prognostic factors include radiographic findings, undernutrition, anemia and high inflammation test values. However, the association of these prognostic factors with the pathophysiology of the disease remains unknown. We aimed to clarify the pathophysiology of MAC-LD and develop a new biomarker that reflects the immune response to the disease. METHODS: We performed the cytokine panel analyses of serum from patients with MAC-LD and compared each cytokine level with clinically negative prognostic factors (radiographic disease type, body mass index, albumin, C-reactive protein and hemoglobin) and high-resolution CT scores. RESULTS: We analyzed 27 patients with MAC-LD, 6 with the fibrocavitary form and 21 with the nodular bronchiectatic form on high-resolution CT. Serum CXC motif ligand 10 (CXCL10) concentration was significantly elevated in patients with the fibrocavitary form (p = 0.008). CXCL10 levels correlated with body mass index (r = - 0.60, p = 0.0008), serum albumin concentration (r = - 0.45, p = 0.016) and high-resolution CT scores (r = 0.61, p = 0.0006). Among 14 patients initially untreated, antibiotic therapy was initiated for five during the study period. CXCL10 concentration was significantly higher in these patients (p = 0.046), and receiver operating characteristic analysis for CXCL10 concentration on treatment initiation produced an area under the curve of 0.844, with a sensitivity of 100%, specificity of 66.7%, and cut-off value of 366.5 pg/mL. CONCLUSION: We revealed cytokine profiles in patients with MAC-LD. Serum CXCL10 levels probably reflect the severity of MAC-LD. Our findings suggest that CXCL10 concentration may be a promising biomarker for managing treatment for patients with MAC disease of the lung.


Assuntos
Quimiocina CXCL10/sangue , Citocinas/sangue , Pneumopatias/imunologia , Complexo Mycobacterium avium , Infecção por Mycobacterium avium-intracellulare/imunologia , Idoso , Antibacterianos , Biomarcadores , Índice de Massa Corporal , Bronquiectasia/imunologia , Bronquiectasia/microbiologia , Feminino , Humanos , Pulmão , Pneumopatias/microbiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Sensibilidade e Especificidade
12.
Medicine (Baltimore) ; 98(13): e15048, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30921231

RESUMO

RATIONALE: Bronchiectasis results when inflammatory and infectious damage to the bronchial and bronchiolar walls leads to a vicious cycle of airway injury. On the basis of the classic characteristic, that is, permanent bronchial dilatation, bronchiectasis is generally considered irreversible in the adult population. PATIENT CONCERNS: A 21-year-old woman presented to our hospital with a 9-day history of productive cough and fever. DIAGNOSIS: Bronchiectasis after Mycoplasma pneumoniae pneumonia. INTERVENTIONS: The patient was treated with azithromycin for 7 days. OUTCOMES: The bronchial dilatation resolved as evidenced by sequential chest high-resolution computed tomography 7 days and 1 month later, respectively. LESSONS: Although complete disappearance is quite rare in adult, this case demonstrated that bronchial dilatation might resolve completely in such a fascinating short period of time if receiving adequate and timely regimens.


Assuntos
Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Bronquiectasia/tratamento farmacológico , Mycoplasma pneumoniae , Pneumonia por Mycoplasma/tratamento farmacológico , Bronquiectasia/microbiologia , Feminino , Humanos , Pneumonia por Mycoplasma/complicações , Resultado do Tratamento , Adulto Jovem
13.
BMC Pulm Med ; 19(1): 19, 2019 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-30665395

RESUMO

BACKGROUND: RGM medium is an agar-based, selective culture medium designed for the isolation of nontuberculous mycobacteria (NTM) from the sputum of patients with cystic fibrosis (CF). We evaluated RGM medium for the detection of NTM in patients with CF (405 samples), bronchiectasis (323 samples) and other lung diseases necessitating lung transplantation (274 samples). METHODS: In total, 1002 respiratory samples from 676 patients were included in the study. Direct culture on RGM medium, with incubation at two temperatures (30 °C and 37 °C), was compared with conventional culture of decontaminated samples for acid-fast bacilli (AFB) using both a solid medium (Löwenstein-Jensen medium) and a liquid medium (the Mycobacterial Growth Indicator Tube; MGIT). RESULTS: For all three patient groups, significantly more isolates of NTM were recovered using RGM medium incubated at 30 °C than by any other method (sensitivity: 94.6% vs. 22.4% for conventional AFB culture; P < 0.0001). Significantly more isolates of Mycobacterium abscessus complex were isolated on RGM at 30 °C than by AFB culture (sensitivity: 96.1% vs. 58.8%; P < 0.0001). The recovery of Mycobacterium avium complex was also greater using RGM medium at 30 °C compared to AFB culture (sensitivity: 83% vs. 70.2%), although this difference was not statistically significant and a combination of methods was necessary for optimal recovery (P = 0.21). CONCLUSIONS: In the largest study of RGM medium to date, we reaffirm its utility for isolation of NTM from patients with CF. Furthermore; we show that it also provides an effective tool for culture of respiratory samples from patients with bronchiectasis and other lung diseases.


Assuntos
Bronquiectasia/microbiologia , Fibrose Cística/microbiologia , Doenças Pulmonares Intersticiais/microbiologia , Infecções por Micobactéria não Tuberculosa/diagnóstico , Micobactérias não Tuberculosas/isolamento & purificação , Doença Pulmonar Obstrutiva Crônica/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Meios de Cultura , Técnicas de Cultura , Feminino , Humanos , Pneumopatias/microbiologia , Transplante de Pulmão , Masculino , Pessoa de Meia-Idade , Mycobacterium abscessus/isolamento & purificação , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Sensibilidade e Especificidade , Escarro , Adulto Jovem
14.
BMJ Case Rep ; 11(1)2018 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-30567079

RESUMO

This is the first case in the English language describing Achromobacter xylosoxidans in a patient with idiopathic bronchiectasis. A 66-year-old man with bronchiectasis presented with shortness of breath to the emergency department of our institution, a district hospital in the UK. His medications included long-term supplemental oxygen therapy and prophylactic azithromycin. Following 2 days admission to the respiratory unit, his saturations significantly deteriorated, and the patient was admitted to intensive care with type II respiratory failure. Following a week of intubation and ventilation, multidrug resistant A. xylosoxidans was isolated from the tracheal aspiration secretions. The patient recovered after receiving targeted intravenous antimicrobial therapy.


Assuntos
Achromobacter denitrificans , Bronquiectasia/microbiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Idoso , Antibacterianos/administração & dosagem , Bronquiectasia/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Humanos , Masculino
15.
Int J Mycobacteriol ; 7(4): 355-357, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30531034

RESUMO

Background: The use of imaging techniques is important for prompt diagnosis and treatment of atypical mycobacterial infections; it also reduces the burden of these infections. The purpose of the present study was to determine the association between computed tomography (CT) scan findings of pulmonary infection caused by atypical mycobacteria and bacillus count in sputum samples. Methods: This cross-sectional, observational, comparative study included 50 consecutive patients with pulmonary infection caused by atypical mycobacteria, who were hospitalized in Masih-Daneshvari Hospital of Tehran, Iran during 2012-2017. The association between CT scan findings of pulmonary infection caused by atypical mycobacteria and bacillus count in sputum samples was determined in these patients. Results: The results demonstrated that the presence of nodules smaller than 5 mm in diameter, consolidation, bronchiectasis, and pleural thickening were related to bacillus count in sputum samples (P < 0.05). Conclusion: Some CT scan findings, such as nodule diameter smaller than 5 mm, consolidation, bronchiectasis, and pleural thickening, may be indicators of atypical mycobacterial infection. Increased number of involved lobes with bronchiectasis can promote early diagnosis in patients with higher smear and culture grading.


Assuntos
Infecções por Micobactéria não Tuberculosa/diagnóstico , Micobactérias não Tuberculosas/isolamento & purificação , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Bronquiectasia/microbiologia , Bronquiectasia/patologia , Estudos Transversais , Humanos , Irã (Geográfico) , Pulmão/microbiologia , Pulmão/patologia , Infecções por Micobactéria não Tuberculosa/diagnóstico por imagem , Micobactérias não Tuberculosas/crescimento & desenvolvimento , Células-Tronco , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/microbiologia
16.
Drug Des Devel Ther ; 12: 4059-4066, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30568427

RESUMO

Non-cystic fibrosis bronchiectasis (NCFB) is a severe chronic illness characterized by irreversible dilation of airways and thickening of bronchial walls, chronic inflammation, repeated infections, and progressive obstruction of the airways. In contrast to cystic fibrosis bronchiectasis (CFB), which is a well-defined genetic disorder, NCFB is a heterogeneous disease caused by many different medical entities. Inhaled antibiotics are effective for patients with CFB, but their efficacy in NCFB has not been proven. The main pathogens involved in the colonization of patients with bronchiectasis are Haemophilus influenza, Moraxella catarrhalis, Staphylococcus aureus, and Pseudomonas aeruginosa. The latter is associated with increased morbidity and mortality. In addition, in NCFB, P. aeruginosa strains are frequently more resistant than those in CFB. At present, there are no approved inhaled antibiotic therapies for NCFB patients. Inhaled ciprofloxacin has been under investigation in the last few years. In two phase II randomized, double-blind, placebo-controlled trials, the use of inhaled ciprofloxacin was significantly associated with reduction in sputum bacterial density and greater eradication rates. In four phase III randomized, double-blind, placebo-controlled trials, the results regarding the time of the first exacerbation and the rate of exacerbations were inconsistent. Specifically, ORBIT-4 and RESPIRE-1 trials showed clinical benefit (prolongation of the time of the first exacerbation and reduced rate of exacerbations in the treatment group compared to the placebo group), whereas the ORBIT-3 and RESPIRE-2 failed to achieve their primary endpoints. The RESPIRE-1 was the first trial that examined the 14-days on/off course separate from the standard 28-days on/off regimen, which is based on CFB protocol treatments. The current data on the efficacy of inhaled ciprofloxacin are encouraging, but further evaluation is needed to determine the appropriate target group and the ideal duration of treatment.


Assuntos
Antibacterianos/administração & dosagem , Brônquios/efeitos dos fármacos , Bronquiectasia/tratamento farmacológico , Ciprofloxacino/administração & dosagem , Administração por Inalação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/efeitos adversos , Brônquios/microbiologia , Brônquios/patologia , Bronquiectasia/diagnóstico , Bronquiectasia/microbiologia , Bronquiectasia/mortalidade , Ciprofloxacino/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Escarro/microbiologia , Resultado do Tratamento , Adulto Jovem
18.
Sci Transl Med ; 10(464)2018 10 24.
Artigo em Inglês | MEDLINE | ID: mdl-30355797

RESUMO

Respiratory infections in mechanically ventilated patients caused by Gram-negative bacteria are a major cause of morbidity. Rapid and unequivocal determination of the presence, localization, and abundance of bacteria is critical for positive resolution of the infections and could be used for patient stratification and for monitoring treatment efficacy. Here, we developed an in situ approach to visualize Gram-negative bacterial species and cellular infiltrates in distal human lungs in real time. We used optical endomicroscopy to visualize a water-soluble optical imaging probe based on the antimicrobial peptide polymyxin conjugated to an environmentally sensitive fluorophore. The probe was chemically stable and nontoxic and, after in-human intrapulmonary microdosing, enabled the specific detection of Gram-negative bacteria in distal human airways and alveoli within minutes. The results suggest that pulmonary molecular imaging using a topically administered fluorescent probe targeting bacterial lipid A is safe and practical, enabling rapid in situ identification of Gram-negative bacteria in humans.


Assuntos
Corantes Fluorescentes/metabolismo , Bactérias Gram-Negativas/isolamento & purificação , Lipídeo A/metabolismo , Pulmão/microbiologia , Peptídeos/metabolismo , Animais , Bronquiectasia/microbiologia , Bronquiectasia/patologia , Humanos , Unidades de Terapia Intensiva , Pulmão/patologia , Macrófagos Alveolares/metabolismo , Polimixinas/farmacologia , Ovinos , Razão Sinal-Ruído , Relação Estrutura-Atividade
19.
Respirology ; 23(11): 1006-1022, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30207018

RESUMO

Interest in bronchiectasis has increased over the past two decades, as shown by the establishment of disease-specific registries in several countries, the publication of management guidelines and a growing number of clinical trials to address evidence gaps for treatment decisions. This review considers the evidence for defining and treating pulmonary exacerbations, the approaches for eradication of newly identified airway pathogens and the methods to prevent exacerbations through long-term treatments from a pragmatic practice-based perspective. Areas for future studies are also explored. Watch the video abstract.


Assuntos
Antibacterianos , Infecções Bacterianas , Bronquiectasia , Antibacterianos/classificação , Antibacterianos/farmacologia , Infecções Bacterianas/microbiologia , Infecções Bacterianas/fisiopatologia , Infecções Bacterianas/prevenção & controle , Bronquiectasia/diagnóstico , Bronquiectasia/microbiologia , Bronquiectasia/fisiopatologia , Bronquiectasia/terapia , Tomada de Decisão Clínica , Protocolos Clínicos , Progressão da Doença , Humanos , Exacerbação dos Sintomas
20.
Lancet ; 392(10150): 880-890, 2018 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-30215383

RESUMO

Bronchiectasis is characterised by pathological dilation of the airways. More specifically, the radiographic demonstration of airway enlargement is the common feature of a heterogeneous set of conditions and clinical presentations. No approved therapies exist for the condition other than for bronchiectasis caused by cystic fibrosis. The heterogeneity of bronchiectasis is a major challenge in clinical practice and the main reason for difficulty in achieving endpoints in clinical trials. Recent observations of the past 2 years have improved the understanding of physicians regarding bronchiectasis, and have indicated that it might be more effective to classify patients in a different way. Patients could be categorised according to a heterogeneous group of endotypes (defined by a distinct functional or pathobiological mechanism) or by clinical phenotypes (defined by relevant and common features of the disease). In doing so, more specific therapies needed to effectively treat patients might finally be developed. Here, we describe some of the recent advances in endotyping, genetics, and disease heterogeneity of bronchiectasis including observations related to the microbiome.


Assuntos
Bronquiectasia , Progressão da Doença , Doenças Autoimunes/complicações , Bronquiectasia/etiologia , Bronquiectasia/genética , Bronquiectasia/microbiologia , Bronquiectasia/fisiopatologia , Fibrose Cística/complicações , Predisposição Genética para Doença , Humanos , Imunocompetência , Microbiota , Mutação
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA