RESUMEN
The case history of a HIV patient with a pulmonary infect of Rhodococcus equi is presented. He recovered after prolonged treatment with antibiotics and lobectomy. The Rhodococcus equi infection was the presenting symptom of his impaired immune status caused by HIV infection.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Infecciones por VIH/diagnóstico , Neumonía Bacteriana/microbiología , Rhodococcus equi/aislamiento & purificación , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico por imagen , Infecciones Oportunistas Relacionadas con el SIDA/terapia , Adulto , Antibacterianos , Antivirales/uso terapéutico , Quimioterapia Combinada/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , VIH-1/aislamiento & purificación , Humanos , Masculino , Neumonectomía , Neumonía Bacteriana/diagnóstico por imagen , Neumonía Bacteriana/terapia , Radiografía , Resultado del TratamientoAsunto(s)
Budesonida/efectos adversos , Glucocorticoides/efectos adversos , Enfermedades Pulmonares Obstructivas/tratamiento farmacológico , Anciano , Aspergilosis/inducido químicamente , Budesonida/administración & dosificación , Femenino , Glucocorticoides/administración & dosificación , Humanos , Enfermedades Pulmonares Fúngicas/inducido químicamente , Enfermedades Pulmonares Obstructivas/complicaciones , Masculino , Persona de Mediana Edad , Infecciones por Mycobacterium no Tuberculosas/inducido químicamente , Infecciones Oportunistas/inducido químicamenteRESUMEN
In four patients, men of 64, 66 and 69 years old and a woman of 65 years, who suffered from chronic obstructive pulmonary disease (COPD) and used inhalation corticosteroids in a relatively high dose (800-1600 micrograms of budesonide per day), a pulmonary infection was diagnosed caused by Mycobacterium malmoense (the first two patients) and Aspergillus (the other two) respectively. Inhalation corticosteroids are of great importance in the treatment of asthmatic patients. Their place in the treatment of patients with COPD is much less clear. The patients did not have an immunological deficiency or anatomical pulmonary or bronchial deformation which could have explained the occurrence of these infections. The high dosages of inhalation corticosteroids may have been involved in the cause of these infections by suppressing the T-cell response locally. In view of this, longterm inhalation corticosteroid treatment should be prescribed in COPD patients only if the efficacy of the medication has been proved in the individual patient involved.
Asunto(s)
Enfermedades Pulmonares Obstructivas/tratamiento farmacológico , Infecciones Oportunistas/etiología , Infecciones del Sistema Respiratorio/etiología , Administración por Inhalación , Corticoesteroides/administración & dosificación , Corticoesteroides/efectos adversos , Anciano , Aspergilosis/diagnóstico , Femenino , Humanos , Enfermedades Pulmonares Obstructivas/complicaciones , Masculino , Persona de Mediana Edad , Infecciones por Mycobacterium no Tuberculosas/diagnósticoRESUMEN
An analysis was carried of relations between PEF measurements and FEV1 values and between PEF and FEF25-75 in 130 patients with COLD (48 females and 82 males). PEF was assessed using the Wright peak flow meter, while FEV1 and FEF25-75 from the spirographic curve. A positive linear correlation was found between PEF and FEV1 in absolute values, % predicted and standardised residuals (r = 0.91, r = 0.87, p < 0.001). Diagnostic sensitivity of PEF in detecting bronchial obstruction was 82%, while the specificity was 85%. The weakest correlation was found between PEF and FEV1 in standardised residuals of 41 patients with PEF between 50% and 79% predicted (r = 0.41, p < 0.05). In this subgroup of patients, twenty one (51%) had normal FEV1, and twenty (49%) low FEV1 values. Measurements of PEF despite a strong correlation with FEF25-75 did not allow to single out cases without small airway involvement, because in 28% of the patients with PEF 100% predicted lowered FEF25-75 were noted. In 97% of patients with PEF values 80% predicted abnormal low FEF25-75 were demonstrable.