Allergic bronchopulmonary aspergillosis, a complication of patients with cystic fibrosis : Report of two cases and review of the literature

ABSTRACT: Allergic bronchopulmonary aspergillosis (ABPA) is a lung disease resulting from hypersensitivity to Aspergillus, which leads to impaired mucociliary clearance, mucus impaction with obstruction of the airway, and pulmonary infiltration. Clinically it is characterized by dyspnea, wheezing, fever, malaise, brown or black expectoration, and poor clinical response to the standard therapy for exacerbations in patients with chronic lung disease. In patients with cystic fibrosis (CF) it may be difficult to establish the diagnosis of ABPA due to the overlapping of clinical, radiological and immunological features and to the high frequency of pulmonary bacterial infections. Therefore, annual monitoring of these patients is recommended by measuring the level of total immunoglobulin E (IgE); according to its result and to the clinical context, the diagnosis and treatment of ABPA with steroids should be considered. Such treatment leads to improvement of symptoms, lung function, quality of life and prognosis. We report two pediatric patients diagnosed with CF who were difficult to control; the diagnosis of ABPA was established and their pulmonary symptoms improved with the use of steroids.RESUMEN: La aspergilosis broncopulmonar alérgica (ABPA) es la enfermedad pulmonar resultante de hipersensibilidad a Aspergillus, que lleva a alteración de la depuración mucociliar, impactación mucosa con obstrucción de la vía aérea e infiltración pulmonar. Se caracteriza clínicamente por disnea, sibilancias, fiebre, malestar general y expectoración de color marrón o negro, y por la mala respuesta clínica al tratamiento habitual instaurado para las exacerbaciones en pacientes con enfermedad pulmonar crónica. En los pacientes con fibrosis quística (FQ) puede ser difícil establecer el diagnóstico de ABPA debido a la superposición de las características clínicas, radiológicas e inmunológicas de las dos enfermedades y a la presencia frecuente de infecciones bacterianas pulmonares. Por ello, se recomienda que en el seguimiento de dichos pacientes se haga medición anual de la inmunoglobulina E (IgE) sérica total y, según su resultado y el contexto clínico, se plantee el diagnóstico de ABPA y se haga el tratamiento oportuno con esteroides con el cual mejoran los síntomas, la función pulmonar, la calidad de vida y el pronóstico. Presentamos dos pacientes pediátricos con diagnóstico de FQ de difícil control, en quienes se hizo el diagnóstico de ABPA y cuya sintomatología pulmonar mejoró con el tratamiento esteroide

Epidemiological, clinical and laboratory findings of children younger than 15 years with diabetic ketoacidosis admitted at San Vicente Fundación University Hospital in Medellín, Colombia, between January 2001 and December 2010

ABSTRACT: Diabetic ketoacidosis (DKA) is the most important acute complication in children with diabetes mellitus. Our objective was to determine the clinical and epidemiological characteristics, and the laboratory findings in the pediatric population with DKA at a third-level hospital in Medellín, Colombia. Methodology: A descriptive, retrospective study of DKA in children under 15 years. Information was obtained from the clinical records and analyzed with descriptive statistics. Results: 98 episodes of DKA in 77 patients were included. Average age of patients was 8.7 years, 57.1% were girls, and 23.4% had no health security coverage. In 53.1%, DKA was the presenting manifestation of DM. Out of those with previous DM1 diagnosis, 64.4% had not adhered to treatment. On admission, 42.8% had infections. Time between the onset of symptoms and the consultation was 41 hours in those with previous DM1 diagnosis, and 120 hours in the ones diagnosed de novo. Severe DKA was the predominant one: 41.8%. On admission, pH was 7.1 (SD: 0.12). During treatment, 28.6% developed hypoglycemia and 5.1%, cerebral edema. Two patients died. Conclusions: Clinical and laboratory characteristics of our patients with DKA are similar to those reported by other authors. Lack of adherence to treatment and infections may be important and avoidable causes of decompensation.RESUMEN: La cetoacidosis diabética (CAD) es la complicación aguda más importante en los niños con diabetes mellitus. Nuestro objetivo fue determinar las características epidemiológicas y clínicas y los hallazgos de laboratorio de nuestra población pediátrica con CAD. Metodología: estudio descriptivo retrospectivo, de episodios de CAD en menores de 15 años, admitidos entre 2001 y 2010 al Hospital Universitario San Vicente Fundación (Medellín, Colombia). Se obtuvo la información en las historias clínicas y se la analizó usando estadística descriptiva. Resultados: se incluyeron 98 episodios de CAD en 77 pacientes con edad promedio de 8,7 años, 57,1% de ellos, niñas y 23,4% sin afiliación al Sistema de Seguridad Social en Salud; 53,1% debutaron como CAD. De aquellos con diagnóstico previo de DM1, 64,4% no habían tenido adherencia al tratamiento. Al admitirlos, 42,8% tenían infección. El tiempo transcurrido entre el inicio de los síntomas y la consulta fue de 41 horas en los que tenían diagnóstico previo de DM1 y de 120 horas en los diagnosticados de novo. Predominó la CAD grave: 41,8%. El pH al ingreso fue 7,12 (DE: 0,12). Durante el tratamiento 28,6% desarrollaron hipoglicemia y 5,1%, edema cerebral; la mortalidad fue 2%. Conclusiones: las características clínicas y de laboratorio de nuestros pacientes con CAD son similares a las reportadas en otros estudios. La falta de adherencia al tratamiento y las infecciones pueden ser una causa importante y evitable de descompensación

Epidemiological, clinical and laboratory findings of children fewer than 15 years with diabetic ketoacidosis admitted at San Vicente Fundación Hospital in Medellín, Colombia, between January 2001 and December 2010 = Características epidemiológicas y clínicas y hallazgos de laboratorio de los niños menores de 15 años con cetoacidosis diabética atendidos en el Hospital Universitario San Vicente Fundación en Medellín, Colombia, entre enero de 2001 y diciembre de 2010

Introduction: Diabetic ketoacidosis (DKA) is the most important acute complication in children with diabetes mellitus. There are several publications regarding the characteristics of children with DKA admitted to hospital care in developed countries, however, in our population there is no information concerning the characteristics of these children. Our aim is to determinate these characteristics. Methods: Retrospective study of DKA events in children fewer than 15 years admitted to HUSVF between 2001 and 2010. The information was collected from medical records and characteristics are depicted by descriptive statistics. Results: We included 98 events of DKA in 77 patients, 64.3% were women, uninsured 23.5%. DKA was the debut of the disease in 53.1%, the average age was 8.7 years (DE 4.35). Patients with known diagnosis didn’t have treatment adherence in 57%, 42,8 % of patients had urinary tract, gastrointestinal, respiratory or another febrile illness at admission. The time between the onset of symptoms and admission was 109 hours (1-720 hours). Ketoacidosis was mild in 29.5%, moderate in 28.7% and severe in 41.8%. The pH at admission was 7,12 (SD 0,12). It took 12.6 hours (SD 8,98) to reach pH 7,30. 14.4% showed hypokalemia, hyponatremia 28.6%, 28.6% hypoglycemia, 5% had cerebral edema and mortality was 2%. Conclusions: Clinical and laboratory characteristics of our population are similar to those reported in other studies. Lack of adherence can be an important and preventable cause of decompensation