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1.
Medicine (Baltimore) ; 98(41): e17535, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593129

RESUMO

Scedosporium genus as a significant emerging opportunist causes a broad spectrum of disease in not only immunosuppressed but also immunocompetent patients. The lung is one of the most commonly encountered sites of Scedosporium infection. Due to its very high levels of antifungal resistance, surgery has been recommended as an important part in the treatment of pulmonary Scedosporium spp infection, even in immunocompetent cases. However, whether lung surgery could help to reduce the risk of death in immunocompetent patients is not clear.We retrospectively retrieved the records of pulmonary infections with Scedosporium species in immunocompetent patients through a comprehensive literature search. The association of surgery on all-cause mortality was explored using binary logistic regression (BLR). Receiver operating characteristic (ROC) curve analysis was carried out to evaluate the capability of the model.The comprehensive searching strategy yielded 33 case reports and 3 case series in total, with 40 individual patients being included. The overall mortality was 12.50%. The fatality rate was 9.09% (2/22) in cases with surgery and 16.67% (3/18) in cases without surgery (odds ratio, 0.50; 95% confidence interval, 0.07-3.38; P = .48). Consistently, BLR analysis identified no statistical association between surgery and reduced mortality (odds ratio, 1.19; 95% confidence interval, 0.09-15.64; P = .89), after adjusting for age, gender, and antifungal chemotherapy. The area under the ROC curve was 0.88.For immunocompetent patients with pulmonary Scedosporium spp infection, surgical therapy may not be associated with reduced mortality. Surgical excision could be considered but is not imperative in this group of patients.


Assuntos
Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/cirurgia , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/cirurgia , Scedosporium/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Farmacorresistência Fúngica/fisiologia , Feminino , Humanos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Pneumopatias Fúngicas/microbiologia , Pneumopatias Fúngicas/mortalidade , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Micoses/tratamento farmacológico , Micoses/epidemiologia , Micoses/microbiologia , Micoses/mortalidade , Estudos Observacionais como Assunto , Cuidados Pós-Operatórios , Infecções Respiratórias/microbiologia , Infecções Respiratórias/mortalidade , Estudos Retrospectivos , Scedosporium/isolamento & purificação , Voriconazol/administração & dosagem , Voriconazol/uso terapêutico
2.
Respir Res ; 20(1): 126, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208426

RESUMO

BACKGROUND: Viral respiratory infection (VRI) is a common contraindication to elective surgery. Asymptomatic shedding among pediatric surgery patients (PSPs) could potentially lead to progression of symptomatic diseases and cause outbreaks of respiratory diseases. The aim of this study is to investigate the incidence of infection among mild symptomatic PSP group and asymptomatic PSP group after surgical procedure. METHODS: We collected the induced sputum from enrolled 1629 children (under 18 years of age) with no respiratory symptom prior to pediatric surgery between March 2017 and February 2019. We tested 16 different respiratory virus infections in post-surgery mild symptomatic PSP group and asymptomatic PSP group using a quantitative real-time reverse transcriptase polymerase chain reaction (qRT-PCR) assay panel. We analyzed symptom data and quantitative viral load to investigate the association between viruses, symptoms and viral quantity in qRT-PCR-positive PSPs. RESULTS: Out of 1629 children enrolled, a total of 204 respiratory viruses were present in 171 (10.50%) PSPs including 47 patients with mild symptoms and 124 with no symptoms after surgery. Commonly detected viruses were human rhino/enterovirus (HRV/EV, 42.19%), parainfluenza virus 3 (PIV3, 24.48%), coronavirus (CoV NL63, OC43, HKU1, 11.46%), and respiratory syncytial virus (RSV, 9.9%). PIV3 infection with a higher viral load was frequently found in PSPs presenting with mild symptoms, progressing to pneumonia with radiographic evidence after surgery. HRV/EV were the most commonly detected pathogens in both asymptomatic and mild symptomatic PSPs. CoV (OC43, HKU1) infections with a higher viral load were mostly observed in asymptomatic PSPs progressing to alveolar or interstitial infiltration. CONCLUSIONS: Our study suggested that PIV3 is a new risk factor for VRI in PSPs. Employing a more comprehensive, sensitive and quantitative method should be considered for preoperative testing of respiratory viruses in order to guide optimal surgical timing.


Assuntos
Infecções Respiratórias/diagnóstico , Infecções Respiratórias/cirurgia , Escarro/virologia , Viroses/diagnóstico , Viroses/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Viroses/epidemiologia
3.
Laryngoscope ; 129(9): 1993-1997, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31059600

RESUMO

OBJECTIVES/HYPOTHESIS: To describe recurrence patterns in patients with recurrent respiratory papillomatosis (RRP) following surgical intervention. STUDY DESIGN: Single-center, retrospective, longitudinal case series. METHODS: Initial and follow-up laryngoscopic examinations of seven previously untreated adult-onset RRP patients were reviewed. Patients were followed longitudinally for periods ranging from 3 months to 7 years. Lesion locations were recorded using a twenty-one region laryngeal schematic, and maps were generated to illustrate the distribution of disease before and after cold-knife or potassium-titanyl-phosphate laser intervention. Univariate and multivariate analyses were employed to examine variables affecting recurrence patterns. RESULTS: Across all patients, a statistically significant correlation between initial distribution and primary recurrence was observed. Seventy-five percent of new lesions were adjacent to regions with preexisting disease; 83% of new glottic lesions were adjacent to preexisting glottic lesions, and 66% of supraglottic lesions were adjacent to preexisting supraglottic regions. No statistically significant differences in recurrence rate were observed across sites. CONCLUSIONS: In previously untreated patients with adult-onset recurrent respiratory papillomatosis, lesions tended to recur either in the same regions or regions adjacent to those affected at the time of initial surgery. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:1993-1997, 2019.


Assuntos
Glote/patologia , Infecções por Papillomavirus/patologia , Infecções Respiratórias/patologia , Adulto , Feminino , Glote/cirurgia , Humanos , Laringoscopia , Laringe/patologia , Laringe/cirurgia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Infecções por Papillomavirus/cirurgia , Infecções Respiratórias/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
4.
Otolaryngol Clin North Am ; 52(3): 537-557, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30922560

RESUMO

With fiber-based lasers that may be passed via the working channel of a flexible laryngoscope, in-office laser laryngeal surgery has become possible. The potassium-titanyl-phosphate laser has several features that make it ideal for laryngeal surgery, and it is now the laser of choice for in-office management of a variety of laryngeal lesions. Its applications have expanded significantly since its introduction, with reports of new indications continuing to appear in the literature. This article provides a comprehensive review of the indications and technical details of in-office potassium-titanyl-phosphate laser laryngeal surgery, and a summary of the existing literature regarding outcomes of these procedures.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Doenças da Laringe/cirurgia , Laringe/cirurgia , Terapia a Laser , Humanos , Lasers de Estado Sólido/uso terapêutico , Infecções por Papillomavirus/cirurgia , Infecções Respiratórias/cirurgia
6.
Auris Nasus Larynx ; 46(5): 772-778, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30765273

RESUMO

OBJECTIVE: The fiber-guided carbon dioxide (CO2) laser is a useful device for laryngopharyngeal surgery. The flexible CO2 wave-guide laser has been developed and commercially available for several years. However, the transnasal use of CO2 flexible wave-guided laser surgery through the instrument channel of a flexible endoscope (CO2 TNFLS) is not permitted in Japan. This feasibility study aimed to assess the value and the safety of an in-office CO2 TNFLS procedure. METHODS: Patients with small laryngopharyngeal diseases were enrolled from June 2015. Eligible patients had indications with lesions generally localized superficial lesions such as the benign tumor, leukoplakia, and premalignant lesion-like carcinoma in situ (CIS). Patients were locally well anesthetized using xylocaine. After removing as much of the lesion(s) as possible with flexible forceps, the remainder of the lesions were evaporated using CO2 TNFLS through the instrument channel of a flexible endoscope under local anesthesia. RESULTS: Eighteen surgeries involving 13 patients, including 9 papilloma (7 recurrent respiratory papilloma [RRP]), 2 carcinoma in situ, 1 leukoplakia, and 1 large epiglottic cyst), were performed. Four patients with RRP required multiple surgeries. Except for 3 patients with RRP, all patients achieved disease control without additional intervention. All procedures were completed with no severe adverse events. CONCLUSION: Office-based CO2 TNFLS is safe and feasible for patients with laryngopharyngeal pathologies. It is especially valuable for RRP patients with small lesions to avoid surgery under general anesthesia.


Assuntos
Carcinoma in Situ/cirurgia , Neoplasias Laríngeas/cirurgia , Terapia a Laser/métodos , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Infecções por Papillomavirus/cirurgia , Neoplasias Faríngeas/cirurgia , Infecções Respiratórias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios , Anestesia Local , Cistos/cirurgia , Epiglote/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Doenças da Laringe/cirurgia , Lasers de Gás/uso terapêutico , Leucoplasia/cirurgia , Masculino , Pessoa de Meia-Idade , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural , Doenças Faríngeas/cirurgia , Resultado do Tratamento
7.
Eur Arch Otorhinolaryngol ; 276(3): 801-803, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30806807

RESUMO

OBJECTIVE: To evaluate the efficacy of MMR vaccine in the treatment of juvenile-onset recurrent respiratory papillomatosis as adjuvant therapy by experimental research. METHODS: Thirty-one children with RRP were enrolled and assigned randomly to intervention group or control group. Fifteen subjects in intervention group were treated with local application MMR vaccine on the lesion after surgery; sixteen subjects in the control group were treated with surgical excision alone. The quantity of virus of positive specimens was measured by fluorescence quantitative polymerase chain reaction. RESULTS: After treatment with MMR vaccine, viral load of intervention group was (9.56 ± 11.03) × 108  copies/ml, that of control group was (22.01 ± 17.78) × 108 copies/ml, and there was significant difference between the two groups (P = 0.040). CONCLUSIONS: Local application MMR vaccine as adjuvant therapy can reduce HPV viral load significantly. It is suggested that the MMR vaccine may inhibit replication of HPV DNA, but the curative effect needs further confirmation.


Assuntos
Adjuvantes Imunológicos/uso terapêutico , Vacina contra Sarampo-Caxumba-Rubéola/uso terapêutico , Infecções por Papillomavirus/terapia , Infecções Respiratórias/terapia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Vacina contra Sarampo-Caxumba-Rubéola/imunologia , Infecções por Papillomavirus/cirurgia , Infecções por Papillomavirus/virologia , Cuidados Pós-Operatórios , Infecções Respiratórias/cirurgia , Infecções Respiratórias/virologia , Carga Viral
9.
J Infect Dis ; 219(7): 1016-1025, 2019 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-30358875

RESUMO

BACKGROUND: Recurrent respiratory papillomatosis is a benign condition caused by human papillomavirus (HPV). Surgery is the mainstay of treatment, but numerous adjuvant therapies have been applied to improve surgical outcome. Recently, HPV vaccination has been introduced, but only smaller studies of its effect have been published. The present meta-analysis is intended as a possible substitute for a proposed but not yet realized multicenter randomized controlled trial. METHODS: A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. PubMed, Embase, and Cochrane were systematically searched. All retrieved studies (n = 593) were reviewed and qualitatively assessed. In addition, 2 previously unpublished data sets were included. The systematic review included 11 studies, comprising 133 patients, of whom 63 patients from 5 studies were eligible for meta-analysis. A random-effects meta-analysis was conducted for the mean difference in number of surgical procedures per month before and after vaccination. RESULTS: The number of surgical procedures per month was significantly reduced after HPV vaccination compared with before vaccination (estimated mean, 0.06 vs 0.35). The mean intersurgical interval increased from 7.02 months (range, 0.30-45 months) before to 34.45 months (2.71-82 months) after HPV vaccination. CONCLUSION: The present study supports the continued use of the HPV vaccine as an adjuvant treatment for recurrent respiratory papillomatosis.


Assuntos
Infecções por Papillomavirus/terapia , Vacinas contra Papillomavirus/uso terapêutico , Infecções Respiratórias/terapia , Humanos , Infecções por Papillomavirus/cirurgia , Infecções Respiratórias/cirurgia , Fatores de Tempo
11.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 53(11): 825-829, 2018 Nov 07.
Artigo em Chinês | MEDLINE | ID: mdl-30453401

RESUMO

Objective: To observe the clinical course of children with juvenile-onset recurrent respiratory papillomatosis (JORRP) until 14 years old. Methods: The clinical data of one hundred and twenty cases treated between Januray 1, 2002 and September 30, 2017 in Beijing Tongren Hospital were analyzed retrospectively. Excluding the deaths and the lost, patients who could be ≥ 5 years without recurrence, were defined as the cured group, and < 5 years with recurrence defined as the recurrent group. Furthermore, using statistical methods to analyze the differences of the age of initial operation, total number of operations, invasive lesion, HPV infection, tracheotomy, airway dissemination after tracheotomy and time of tube wear between the two groups. Results: One hundred and three cases were followed up, except for the six deaths.Numbers of operations in eight cases were ≤2, and ≥3 in eighty nine cases.Peak of the primary surgical age were about 4.5 years old, while the self-healing trend occurred at nine years old. In the cured group, forty three cases were cured, with a curative rate of 41.7% (43/103), and there were all fifty four survivors in the recurrent group.The total number of operations, invasive cases, HPV positive cases and the G score of hoarseness in the recurrent group were higher than those in the cured group (F=13.02, χ(2)=13.04, χ(2)=17.37, Z=-4.59, P<0.05). The number of tracheal dissemination caused by tracheotomy in the recurrent group (66.7%, 27.8%)was more than that in the cured group (χ(2)=16.01, P<0.05). Compared with the time of wearing a tracheostomy tube in cured group, the recurrent group was longer ((3.4±3.1) years vs (8.3±6.7) years, χ(2)=7.19, P<0.05). Conclusions: 41.7% of the patients had no relapse for at least five years.There exsisted differences between the cured and recurrent group in the following aspects: the total numbers of surgery, the agression of the lesions, tracheal intratracheal dissemination after tracheotomy, the time of tracheotomy, the HPV typing and the G grading of hoarseness.


Assuntos
Infecções por Papillomavirus/cirurgia , Infecções Respiratórias/cirurgia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Seguimentos , Humanos , Infecções por Papillomavirus/mortalidade , Complicações Pós-Operatórias/etiologia , Recidiva , Infecções Respiratórias/mortalidade , Estudos Retrospectivos , Fatores de Tempo , Traqueotomia/efeitos adversos , Traqueotomia/instrumentação , Resultado do Tratamento
12.
Int J Pediatr Otorhinolaryngol ; 115: 120-124, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30368371

RESUMO

OBJETIVES: To describe our experience in reconstructive laryngeal surgery in patients with recurrent respiratory papillomatosis (RRP). INTRODUCTION: RRP is a rare laryngeal disease requiring multiple surgical endoscopic interventions during its course. These interventions may cause secondary lesions that may compromise airway patency. Open larynx reconstructive surgery, as tracheostomy, is a procedure considered to potentially favor extralaryngeal papilloma dissemination. In patients with RRP, the use of endoscopic posterior cricoid split and rib grafting has not been previously described. METHODS: The clinical charts of 230 patients with RRP seen between 1996 and 2017 were reviewed. All patients who underwent airway expansion procedures either by open or endoscopic approach were included in the study. RESULTS: Four patients with RRP underwent laryngeal surgery for laryngeal stenosis were included. A double-stage open approach was used in two patients and a single-stage endoscopic approach in the remaining two. The two tracheostomized patients were decannulated while tracheostomy was avoided in the two patients who underwent a single-stage endoscopic procedure. Two patients had active papillomatous lesions limited to the larynx at the time of surgery; no dissemination was observed during follow-up (cases 1 and 3). One patient had extralaryngeal disseminated papilomatosis; surgery did not lead to an increased lesion load compared to presurgical lesions (case 4). The patient who did not have active lesions did not have recurrence (case 2). CONCLUSIONS: Reconstructive laryngeal surgery is a safe and effective option in the management of stenotic sequelae resulting from the surgical treatment of RRP, allowing for decannulation or avoiding tracheostomy.


Assuntos
Laringoplastia/métodos , Laringoestenose/cirurgia , Infecções por Papillomavirus/cirurgia , Infecções Respiratórias/cirurgia , Criança , Pré-Escolar , Endoscopia/métodos , Feminino , Humanos , Lactente , Laringoplastia/efeitos adversos , Laringoestenose/etiologia , Laringe/cirurgia , Masculino , Recidiva Local de Neoplasia/cirurgia , Infecções por Papillomavirus/complicações , Infecções Respiratórias/complicações , Estudos Retrospectivos
13.
JAMA Otolaryngol Head Neck Surg ; 144(9): 831-837, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30098151

RESUMO

Importance: Recurrent respiratory papillomatosis (RRP) is a viral-induced disease caused by human papillomavirus and the second leading cause of dysphonia in children; however, neither a cure nor a definitive surgical treatment is currently available for RRP. Although laser therapy is often used in the treatment of RRP, the lack of real-time laser-tissue interaction feedback undermines the ability of physicians to provide treatments with low morbidity. Therefore, an intraoperative tool to monitor and control laser treatment depth is needed. Objective: To investigate the potential of combining optical coherence tomography (OCT) with laser therapy for patient-tailored laryngeal RRP treatments. Design, Setting, and Participants: This in vivo study was performed at the Massachusetts Eye and Ear Infirmary from February 1, 2017, to September 1, 2017. Three-dimensional OCT images were acquired before, during, and after photoangiolytic laser therapy in 10 pediatric patients with a history of papilloma growth who presented with lesions and hoarseness. Main Outcomes and Measures: Whether intraoperative OCT monitoring of changes in optical scattering and absorption provides quantitative information to control thermal damage in tissue. Results: Among the 10 pediatric patients (age range, 4-11 years; 6 male) included in the study, high-resolution OCT images revealed epithelial hyperplasia with clear RRP lesion margins. Images acquired during therapy indicated coagulation deep in tissue, and posttherapy images showed the ability to quantify the amount of tissue ablated by the photoangiolytic laser. Conclusions and Relevance: Concurrent use of OCT imaging and laser therapy may improve postoperative outcomes for patients with RRP by delivering an optimal, patient-tailored treatment. Additional studies investigating the correlation between optical properties with vocal outcomes are required.


Assuntos
Lasers de Estado Sólido/uso terapêutico , Monitorização Intraoperatória/métodos , Infecções por Papillomavirus/cirurgia , Infecções Respiratórias/cirurgia , Cirurgia Assistida por Computador/métodos , Tomografia de Coerência Óptica , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Humanos , Masculino , Infecções por Papillomavirus/diagnóstico por imagem , Infecções Respiratórias/diagnóstico por imagem , Resultado do Tratamento
14.
Artigo em Chinês | MEDLINE | ID: mdl-29757556

RESUMO

Objective:To observe the outcomes of Traditional Chinese Medicine combined with CO_2 laser surgery on the clinical course and serum immunological indexes of Adult onset Recurrent Respiratory Papillomatosis.Method:69 cases of adult recurrent respiratory papilloma patients who enrolled in Beijing Tongren Hospital from September 2014 to March 2016 were divided randomly into two groups.The Chinese medicine surgery group were treated with traditional Chinese medicine combined with CO_2 laser surgery and the surgery group were treated with CO_2 laser surgery alone.All patients were followed up for more than one year.Relapse time and Derkay score were examed and analyzed between two groups before and after treatment.The detection of aperipheral blood immunoglobulin,T cell subsets,percentage of B cell and NK cell and IgG subtype examed every six month.Result:There was no significant difference between two group in Derkay score,lesion recurrence time and the index of immunology before the treatment(P>0.05).However,the recurrence time after treatment [(14.11±1.57)months]prolonged than before treatment[(10.85±2.33)months]in the experimental group.The examination of IgG [(1 539.84±388.20)mg/dl],percentage of total T lymphocytes[(85.14±22.24)%],Th cells[(47.34±19.07)%],B lymphocytes[(12.55±5.26)%]in treatment of traditional Chinese medicine was higher than that before treatment of serum IgG [(1 225.14±260.27)mg/dl],T cells [(69.68±11.12)%],Th [(41.97±10.92)%],B lymphocytes[(10.30±5.45)%].The difference was statistically significant(P<0.01).Conclusion:The curative effect of traditional Chinese medicine combined with laser surgery for the treatment of adult recurrent respiratory papillomatosis,can effectively prolong the recurrence time of patients,improve their immune cell antiviral ability and be worthy of clinical popularization and application.


Assuntos
Terapia a Laser , Medicina Tradicional Chinesa , Infecções por Papillomavirus/tratamento farmacológico , Infecções Respiratórias/tratamento farmacológico , Adulto , Humanos , Recidiva Local de Neoplasia , Infecções por Papillomavirus/imunologia , Infecções por Papillomavirus/cirurgia , Infecções Respiratórias/imunologia , Infecções Respiratórias/cirurgia
15.
Rev. esp. quimioter ; 31(2): 146-151, abr. 2018. tab
Artigo em Inglês | IBECS | ID: ibc-174510

RESUMO

The clinical and microbiological characteristics of pleuro-pulmonary infection (PPI) caused by Streptococcus intermedius is described, including 6 cases in the literature and 9 cases handled at the present centre. Out of the 15 patients, 12 were male; mean age at diagnosis was 62.06 ± 15 years. Twelve had risk factors for S. intermedius infection such as alcoholism in 5 (35.7%) patients, periodontal disease in 3 (24.6%) cases, chronic obstructive pulmonary disease in 3 (24.6%), and diabetes mellitus in 2 (14.2%). Cough was present in 12 (80%) patients and chest pain and dyspnea in 9 (60%). The mean diagnosis interval was 34 days. The diagnosis was obtained from pleural fluid aspirate in 13 (86.6%) cases and from biopsy/tissue samples in 2. The most frequently antimicrobials used for treatment were ceftriaxone + levofloxacin. Ten patients cured with a combination of medical and surgical treatment and 2 patients died as a consequence of infection. The incidence of PPI caused by S. intermedius is increasing in our health area; drainage along with antibiotic therapy is recommended for treatment


Se describen las características clínicas y microbiológicas de la infección pleuro-pulmonar producida por Streptococcus intermedius , incluyendo 6 casos de la literatura y 9 casos diagnosticados en nuestro centro. De los 15 pacientes, 12 eran varones; la media de edad al diagnóstico fue de 62,02 ± 15 años. Doce tenían factores de riesgo para la infección por S. intermedius , tales como alcoholismo en 5 (35,7%) pacientes, enfermedad periodontal en 3 (24,6%) casos, enfermedad pulmonar obstructiva crónica en 3 (24,6%), y diabetes mellitus en 2 (14,2%). Se presentó tos en 12 (80%) pacientes y dolor torácico y disnea en 9 (60%). La media del intervalo diagnóstico fue de 34 días. El diagnóstico se obtuvo de aspirado de líquido pleural en 13 (86,6%) casos y de muestras de biopsia/tejido en 2. Los antimicrobianos más frecuentemente utilizados fueron ceftriaxona + levofloxacino. Diez pacientes curaron con una combinación de tratamiento médico y quirúrgico y dos pacientes fallecieron como consecuencia de la infección. La incidencia de infección pleuro-pulmonar causada por S. intermedius se ha incrementado en nuestra área de salud; el tratamiento recomendado es el drenaje junto con la terapia antibiótica


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Pneumopatias/tratamento farmacológico , Pneumopatias/microbiologia , Doenças Pleurais/tratamento farmacológico , Doenças Pleurais/microbiologia , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/microbiologia , Streptococcus intermedius , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia , Antibacterianos/uso terapêutico , Terapia Combinada , Pneumopatias/cirurgia , Doenças Pleurais/cirurgia , Infecções Respiratórias/cirurgia , Fatores de Risco
16.
Rev Esp Quimioter ; 31(2): 146-151, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29565100

RESUMO

The clinical and microbiological characteristics of pleuro-pulmonary infection (PPI) caused by Streptococcus intermedius is described, including 6 cases in the literature and 9 cases handled at the present centre. Out of the 15 patients, 12 were male; mean age at diagnosis was 62.06 ± 15 years. Twelve had risk factors for S. intermedius infection such as alcoholism in 5 (35.7%) patients, periodontal disease in 3 (24.6%) cases, chronic obstructive pulmonary disease in 3 (24.6%), and diabetes mellitus in 2 (14.2%). Cough was present in 12 (80%) patients and chest pain and dyspnea in 9 (60%). The mean diagnosis interval was 34 days. The diagnosis was obtained from pleural fluid aspirate in 13 (86.6%) cases and from biopsy/tissue samples in 2. The most frequently antimicrobials used for treatment were ceftriaxone + levofloxacin. Ten patients cured with a combination of medical and surgical treatment and 2 patients died as a consequence of infection. The incidence of PPI caused by S. intermedius is increasing in our health area; drainage along with antibiotic therapy is recommended for treatment.


Assuntos
Pneumopatias/tratamento farmacológico , Pneumopatias/microbiologia , Doenças Pleurais/tratamento farmacológico , Doenças Pleurais/microbiologia , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/microbiologia , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia , Streptococcus intermedius , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Terapia Combinada , Feminino , Humanos , Incidência , Pneumopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Doenças Pleurais/cirurgia , Derrame Pleural/microbiologia , Infecções Respiratórias/cirurgia , Fatores de Risco , Resultado do Tratamento
17.
Asian Cardiovasc Thorac Ann ; 26(2): 120-126, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29383943

RESUMO

Background Infectious lung cavities are a common entity for the respiratory physician. Sometimes these lesions require surgical treatment, but surgery is challenging, and complications are common. Methods Patients with infectious lung cavities amenable to surgical treatment were included in a case-control study. The control group included patients with no complications. The cases group comprised patients with any of the following complications up to 90 days after surgery: death, persistence of hemoptysis, empyema, operative blood loss > 500 mL, vascular lesion requiring repair, massive transfusion (>5 units of packed red blood cells per 48 h) or reoperation for bleeding, postoperative mechanical ventilation, intensive care unit stay > 48 h, prolonged air leak, and persistent atelectasis. The potential risk factors for complications analyzed were demographic data, exposure to contaminants, comorbidities, preoperative embolization, surgical indication, spirometry results, and sputum test positive for Mycobacterium tuberculosis. Results Forty-five patients were included in the study and divided into 24 cases and 21 controls. We found a significant difference in the time to removal of chest tubes in favor of the noncomplicated cases (6.45 vs. 4.05 days, p = 0.030), and persistent active infection at the time of surgery tended to be a risk factor for complications (odds ratio = 6.6, 95% confidence interval: 0.7-60, p = 0.061). Conclusion The presence of persistent active infection at the time of surgery could be a risk factor for complications in resection surgery for infectious lung cavities.


Assuntos
Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Infecções Respiratórias/cirurgia , Perda Sanguínea Cirúrgica , Distribuição de Qui-Quadrado , Empiema Pleural/etiologia , Transfusão de Eritrócitos/efeitos adversos , Feminino , Hemoptise/etiologia , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pneumonectomia/mortalidade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Hemorragia Pós-Operatória/etiologia , Atelectasia Pulmonar/etiologia , Respiração Artificial/efeitos adversos , Infecções Respiratórias/complicações , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/mortalidade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
20.
Artigo em Inglês | MEDLINE | ID: mdl-29296080

RESUMO

Background: Endoscopic lung volume reduction (eLVR) is a therapeutic option for selected patients with COPD and severe emphysema. Infectious exacerbations are serious events in these vulnerable patients; hence, prophylactic antibiotics are often prescribed postinterventionally. However, data on the microbiological airway colonization at the time of eLVR are scarce, and there are no evidence-based recommendations regarding a rational antibiotic regimen. Objective: The aim of this study was to perform a clinical and microbiological analysis of COPD patients with advanced emphysema undergoing eLVR with endobronchial valves at a single German University hospital, 2012-2017. Patients and methods: Bronchial aspirates were obtained prior to eLVR and sent for microbiological analysis. Antimicrobial susceptibility testing of bacterial isolates was performed, and pathogen colonization was retrospectively compared with clinical parameters. Results: At least one potential pathogen was found in 47% (30/64) of patients. Overall, Gram-negative bacteria constituted the most frequently detected pathogens. The single most prevalent species were Haemophilus influenzae (9%), Streptococcus pneumoniae (6%), and Staphylococcus aureus (6%). No multidrug resistance was observed, and Pseudomonas aeruginosa occurred in <5% of samples. Patients without microbiological airway colonization showed more severe airflow limitation, hyperinflation, and chronic hypercapnia compared to those with detected pathogens. Conclusion: Microbiological airway colonization was frequent in patients undergoing eLVR but not directly associated with poorer functional status. Resistance testing results do not support the routine use of antipseudomonal antibiotics in these patients.


Assuntos
Bactérias/isolamento & purificação , Pulmão/microbiologia , Doença Pulmonar Obstrutiva Crônica/microbiologia , Enfisema Pulmonar/microbiologia , Infecções Respiratórias/microbiologia , Idoso , Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Bactérias/crescimento & desenvolvimento , Broncoscopia , Farmacorresistência Bacteriana , Feminino , Alemanha , Hospitais Universitários , Humanos , Pulmão/cirurgia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Pneumonectomia/métodos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/cirurgia , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/cirurgia , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/cirurgia , Estudos Retrospectivos
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