Tsukamurella tyrosinosolvens - An unusual case report of bacteremic pneumonia after lung transplantation

<p>Abstract</p> <p>Background</p> <p>Lung transplant recipients have an increased risk for actinomycetales infection secondary to immunosuppressive regimen.</p> <p>Case presentation</p> <p>A case of pulmonary infection with bacteremia due to <it>Tsukamurella tyrosinosolvens </it>in a 54-year old man who underwent a double lung transplantation four years previously is presented.</p> <p>Conclusion</p> <p>The identification by conventional biochemical assays was unsuccessful and <it>hsp </it>gene sequencing was used to identify <it>Tsukamurella tyrosinosolvens</it>.</p

Intermediate-term results after en bloc double-lung transplantation with bronchial arterial revascularization

AbstractObjective: Between May 1990 and January 1994, 18 patients underwent en bloc double-lung transplantation with tracheal anastomosis and bronchial arterial revascularization. Because at that time it was already suggested that chronic ischemia could be a contributing factor in occurrence of obliterative bronchiolitis, the purpose of this study was to evaluate, with a follow-up ranging from 22 to 69 months, the midterm effects of bronchial arterial revascularization on development of obliterative bronchiolitis. Results: Results were assessed according to tracheal healing, functional results, rejection, infection, and incidence of obliterative bronchiolitis. There were no intraoperative deaths or reexplorations for bleeding related to bronchial arterial revascularization, but there were three hospital deaths and five late deaths, two of them related to obliterative bronchiolitis. According to the criteria previously defined, tracheal healing was assessed as grade I, IIa, or IIb in 17 patients and grade IIIa in only one patient. Early angiography (postoperative days 20 to 40) demonstrated a patent graft in 11 of the 14 patients in whom follow-up information was obtained. Ten patients are currently alive with a 43-month mean follow-up. Among the 15 patients surviving more than 1 year, functional results have been excellent except in five in whom obliterative bronchiolitis has developed and who had an early or late graft thrombosis. Furthermore, those patients had a significantly higher incidence of late acute rejection (p < 0.02), cytomegalovirus disease (p < 0.006), and bronchitis episodes (p < 0.0008) than patients free from obliterative bronchiolitis. Conclusion: We conclude that besides its immediate beneficial effect on tracheal healing, long-lasting revascularization was, at least in this small series, associated with an absence of obliterative bronchiolitis, thus suggesting but not yet proving the possible role of chronic ischemia in this multifactorial disease. (J THORAC CARDIOVASC SURG 1996;112:1292-300

Major Role for Amphotericin B–Flucytosine Combination in Severe Cryptococcosis

BACKGROUND: The Infectious Diseases Society of America published in 2000 practical guidelines for the management of cryptococcosis. However, treatment strategies have not been fully validated in the various clinical settings due to exclusion criteria during therapeutic trials. We assessed here the optimal therapeutic strategies for severe cryptococcosis using the observational prospective CryptoA/D study after analyzing routine clinical care of cryptococcosis in university or tertiary care hospitals. METHODOLOGY/PRINCIPAL FINDINGS: Patients were enrolled if at least one culture grew positive with Cryptococcus neoformans. Control of sterilization was warranted 2 weeks (Wk2) and 3 months (Mo3) after antifungal therapy onset. 208 HIV-positive or -negative adult patients were analyzed. Treatment failure (death or mycological failure) at Wk2 and Mo3 was the main outcome measured. Combination of amphotericin B+flucytosine (AMB+5FC) was the best regimen for induction therapy in patients with meningoencephalitis and in all patients with high fungal burden and abnormal neurology. In those patients, treatment failure at Wk2 was 26% in the AMB+5FC group vs. 56% with any other treatments (p<0.001). In patients treated with AMB+5FC, factors independently associated with Wk2 mycological failure were high serum antigen titer (OR [95%CI] = 4.43[1.21-16.23], p = 0.025) and abnormal brain imaging (OR = 3.89[1.23-12.31], p = 0.021) at baseline. Haematological malignancy (OR = 4.02[1.32-12.25], p = 0.015), abnormal neurology at baseline (OR = 2.71[1.10-6.69], p = 0.030) and prescription of 5FC for less than 14 days (OR = 3.30[1.12-9.70], p = 0.030) were independently associated with treatment failure at Mo3. CONCLUSION/SIGNIFICANCE: Our results support the conclusion that induction therapy with AMB+5FC for at least 14 days should be prescribed rather than any other induction treatments in all patients with high fungal burden at baseline regardless of their HIV serostatus and of the presence of proven meningoencephalitis

Development of a Multivariate Prediction Model for Early-Onset Bronchiolitis Obliterans Syndrome and Restrictive Allograft Syndrome in Lung Transplantation.

Chronic lung allograft dysfunction and its main phenotypes, bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS), are major causes of mortality after lung transplantation (LT). RAS and early-onset BOS, developing within 3 years after LT, are associated with particularly inferior clinical outcomes. Prediction models for early-onset BOS and RAS have not been previously described. LT recipients of the French and Swiss transplant cohorts were eligible for inclusion in the SysCLAD cohort if they were alive with at least 2 years of follow-up but less than 3 years, or if they died or were retransplanted at any time less than 3 years. These patients were assessed for early-onset BOS, RAS, or stable allograft function by an adjudication committee. Baseline characteristics, data on surgery, immunosuppression, and year-1 follow-up were collected. Prediction models for BOS and RAS were developed using multivariate logistic regression and multivariate multinomial analysis. Among patients fulfilling the eligibility criteria, we identified 149 stable, 51 BOS, and 30 RAS subjects. The best prediction model for early-onset BOS and RAS included the underlying diagnosis, induction treatment, immunosuppression, and year-1 class II donor-specific antibodies (DSAs). Within this model, class II DSAs were associated with BOS and RAS, whereas pre-LT diagnoses of interstitial lung disease and chronic obstructive pulmonary disease were associated with RAS. Although these findings need further validation, results indicate that specific baseline and year-1 parameters may serve as predictors of BOS or RAS by 3 years post-LT. Their identification may allow intervention or guide risk stratification, aiming for an individualized patient management approach

Sarcoïdose grave & thalidomide (à propos d'une observation)

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Quand le pneumologue doit-il envisager la greffe pulmonaire pour un de ses patients ? Critères d’inscription en liste d’attente : mucoviscidose, HTAP et maladies systémiques (sarcoïdose, histiocytose langerhansienne, lymphangioleïomyomatose et connectivites)

National audienceIntroduction Placing a patient on the national lung transplant waiting list remains a difficult matter, and is more a question of timing than selection of the candidate according to disease-specific criteria. Back-ground The listing criteria for cystic fibrosis are FEV1 less than 30% of the predicted value, hypoxaemia with a PaO2 less than 55 mm Hg and hypercapnia with a PaCO2 over 50 mm Hg. The rate of decline of FEV1, increasing antibiotic requirements and life threatening complications can all accelerate the listing procedure. For primary pulmonary hypertension the criteria are persistent dyspnoea, NYHA grade III or IVA, despite epoprostenol treatment and a 6 minute walk test of less than 250 metres. Sarcoidosis, lymphangioleiomyomatosis, histiocytosis X and connective tissue diseases are rare indications for which the listing criteria are similar to those for the more usual respiratory diseases. View points Further therapeutic advances, increased numbers of available organs and changes in the allocation rules will necessitate periodical updates of these selection and listing criteria. Conclusion The optimal time for placing lung transplantation patients who have been referred early in the course of their disease on the waiting list will be determined by clinical experience and individual patient follow-up.Introduction L’inscription d’un patient sur la liste nationale d’attente de transplantation pulmonaire reste une question délicate non tant par les critères de sélection des candidats que par le choix du moment. État des connaissances Les critères d’inscription pour la mucoviscidose sont définis par un VEMS inférieur à 30 % de la valeur théorique, une hypoxémie inférieure à 55 mmHg et une hypercapnie supérieure à 50 mmHg. La vitesse du déclin du VEMS, l’antibiodépendance et une complication mettant en jeu le pronostic vital accélèrent l’inscription. Les contre-indications restent relatives. Ceux de l’hypertension artérielle pulmonaire sont une dyspnée stade III ou IV NHYA persistante après traitement par époprosténol et un périmètre de marche inférieur à 250 mètres. La sarcoïdose, la lymphangioleïomyomatose, l’histiocytose et les connectivites sont des indications rares dont les critères d’inscription rejoignent ceux des autres pathologies respiratoires plus classiques. Perspectives Les innovations thérapeutiques, l’augmentation des greffons disponibles et les changements des règles d’allocations des greffons devront faire réévaluer les critères de sélection des patients et d’inscription sur la liste d’attente. Conclusion L’expérience clinique et le suivi de chaque patient restent des éléments primordiaux pour juger du moment opportun d’inscription sur liste de transplantation de patients adressés suffisamment tôt aux centres spécialisés

La greffe pulmonaire et ses traitements.

La transplantation pulmonaire offre aux malades atteints d’insuffisance respiratoire terminale l’espoir d’une durée de vie augmentée, mais aussi d’une meilleure qualité de vie et d’une autonomie plus grande. Après la greffe, les patients doivent bénéficier d’une prise en charge rigoureuse et accepter de prendre un traitement à vie. En cela, le suivi après la transplantation constitue une véritable “nouvelle maladie chronique” à laquelle ils devront s’adapter.A lung transplant offers patients with terminal respiratory failure the hope of a longer life expectancy, as well as a better quality of life and greater autonomy. After the transplant, patients must receive rigorous care and accept that they will have to take medication for the rest of their lives. In this respect, the post-transplant follow-up constitutes a ‘new chronic condition’ to which they must adapt

Nitrogen monoxide and carbon monoxide transfer interpretation: state of the art.

Just a few clinicians routinely measure the subcomponents of the lung diffusing capacity for Carbone monoxide (DL ). This is because the measurement of membrane and blood conductances for CO (Dm and Db  = θ  × V , respectively) by the classic Roughton and Forster method is complicated and time consuming. In addition, it mistakenly assumes a close relationship between alveolar oxygen partial pressure (PAO ) and mean intracapillary oxygen partial pressure (PcapO ) which is the true determinant of specific conductance of haemoglobin for CO (θ ). Besides that, the critical multistep oxygenation method along with different linear equations relating 1/θ to PcapO gave highly scattered Dm and V values. The Dm and V can also be derived from a simultaneous measurement of DL and DL with the blood resistance for NO assumed to be negligible. However, recent in vitro and in vivo experiments point towards a finite value of θ (about 4·5 ml  × ml  × min  × mmHg ). Putting together the arguments and our clinical data allows us to report here the state of the art in partitioning the CO diffusing capacity into its constitutive components, with the goal to encourage further studies examining the sensitivity of Dm and V to alterations observed in parenchymal diseases

Clonal population of flucytosine-resistant Candida tropicalis from blood cultures, Paris, France

Candida tropicalis is a diploid ascomycetes yeast responsible for 4%-24% of candidemia. Resistance to flucytosine is rarely described for this species but was observed for 45 (35%) of 130 C. tropicalis isolates recovered from blood cultures in the Paris area in a 4-year survey. The aims of this study were to test the hypothesis that the flucytosine-resistant isolates could represent a subgroup and to determine the relationship between epidemiologic and genomic data. Epidemiologic data and gene sequences were analyzed, and molecular typing was performed. Our results suggest that a clone of flucytosine-resistant isolates, associated with malignancies and a lower mortality than that for other C. tropicalis isolates, is widespread in the Paris area. We propose the analysis of 2 polymorphic microsatellite markers coupled with URA3 sequencing to track the clone