Síndrome de Lady Windermere como causa de tos crónica. A propósito de un caso

Nontuberculous mycobacteria are rarely recognized in the world today; their prevalence is increasing due to suspicion in immunocompromised patients or in those suffering from chronic illnesses such as cystic fibrosis. A case with of Lady Windermere Syndrome diagnosis that originally started with chronic cough is presented. Tomography showed bilateral bronchiectasis in the left lingual segment and in the middle and lower right lobe. Mycobacterium avium-intracellulare complex was isolated using bronchoscopy. The lack of suspicion of nontuberculous mycobacteria in patients without risk factors and chronic cough leads to diagnosis delay and clinical deterioration of the patient.Las micobacterias no tuberculosas son poco reconocidas hoy en el mundo, incrementándose su prevalencia a punto de partida de su sospecha en inmunodeprimidos o en enfermedades crónicas, como la fibrosis quística. Se presenta el caso de una paciente con diagnóstico de síndrome de Lady Windermere a punto de partida de un cuadro de tos crónica. Se realizó tomografía computarizada donde se evidenciaron bronquiectasias en el segmento lingular del pulmón izquierdo y en los lóbulos medio e inferior del derecho. Mediante la broncoscopia se aisló el complejo Mycobacterium avium-intracellulare. La falta de sospecha de micobacterias atípicas en pacientes sin factores predisponentes, con un cuadro de tos crónica, conduce al retraso en el diagnóstico y el deterioro clínico del paciente

Comportamiento de variables predictivas de exacerbaciones de la EPOC en el Hospital Neumológico de Cuba

La utilización de variables predictoras de exacerbaciones de la EPOCno es una práctica generalizada en nuestro medio, por lo que no podemos caracterizar los pacientes exacerbadores ni diseñar estrategias para su manejo integral. Se realizó un estudio descriptivo prospectivo correlacionar en pacientes con diagnóstico de EPOC del Hospital Neumológico de Cuba, con el objetivo de determinar la asociación entre variables clínicas, funcionales e imagenológicas y la frecuencia de exacerbaciones al año. La población estuvo constituida por pacientes con diagnóstico clínico de EPOC y la muestra por aquellos pacientes con diagnóstico confirmado que cumplieran los criterios de inclusión. La correlación entre las variables se realizó mediante el Coeficiente de Correlación de Pearson con un intervalo de Confianza del 95% y la prueba t de student con un nivel de significación (p) menor de 0.05.El 81.82% de los pacientes muy graves son agudizadores con enfisema. El 75% de los pacientes con índice de la arteria pulmonar/ aorta tienen más de dos exacerbaciones al año. El 84.61% de los pacientes agudizadores presentaron grado cuatro de la disnea. La presión media de la arteria pulmonar junto al VEF1 constituyeron los mejores predictores de exacerbaciones en el grupo de pacientes estudiados.</p

Adjuvant interferon gamma in patients with pulmonary atypical Mycobacteriosis: A randomized, double-blind, placebo-controlled study

<p>Abstract</p> <p>Background</p> <p>High antibiotic resistance is described in atypical Mycobacteriosis, mainly by <it>Mycobacterium avium </it>complex (MAC).</p> <p>Methods</p> <p>A randomized, double-blind, placebo-controlled clinical trial was carried out in two hospitals to evaluate the effect of interferon (IFN) gamma as immunoadjuvant to chemotherapy on patients with atypical mycobacteria lung disease. Patients received placebo or 1 × 10⁶IU recombinant human IFN gamma intramuscularly, daily for one month and then three times per week up to 6 months as adjuvant to daily oral azithromycin, ciprofloxacin, ethambutol and rifampin. Sputum samples collection for direct smear observation and culture as well as clinical and thorax radiography assessments were done during treatment and one year after. Cytokines and oxidative stress determinations were carried out in peripheral blood before and after treatment.</p> <p>Results</p> <p>Eighteen patients were included in the IFN group and 14 received placebo. Groups were homogeneous at entry; average age was 60 years, 75% men, 84% white; MAC infection prevailed (94%). At the end of treatment, 72% of patients treated with IFN gamma were evaluated as complete responders, but only 36% in the placebo group. The difference was maintained during follow-up. A more rapid complete response was obtained in the IFN group (5 months before), with a significantly earlier improvement in respiratory symptoms and pulmonary lesions reduction. Disease-related deaths were 35.7% of the patients in the placebo group and only 11.1% in the IFN group. Three patients in the IFN group normalized their globular sedimentation rate values. Although differences in bacteriology were not significant during the treatment period, some patients in the placebo group converted again to positive during follow-up. Significant increments in serum TGF-beta and advanced oxidation protein products were observed in the placebo group but not among IFN receiving patients. Treatments were well tolerated. Flu-like symptoms predominated in the IFN gamma group. No severe events were recorded.</p> <p>Conclusion</p> <p>These data suggest that IFN gamma is useful and well tolerated as adjuvant therapy in patients with pulmonary atypical Mycobacteriosis, predominantly MAC. Further wider clinical trials are encouraged.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN70900209.</p

Síndrome de Lady Windermere como causa de tos crónica. A propósito de un caso

Nontuberculous mycobacteria are rarely recognized in the world today; their prevalence is increasing due to suspicion in immunocompromised patients or in those suffering from chronic illnesses such as cystic fibrosis. A case with of Lady Windermere Syndrome diagnosis that originally started with chronic cough is presented. Tomography showed bilateral bronchiectasis in the left lingual segment and in the middle and lower right lobe. Mycobacterium avium-intracellulare complex was isolated using bronchoscopy. The lack of suspicion of nontuberculous mycobacteria in patients without risk factors and chronic cough leads to diagnosis delay and clinical deterioration of the patient.Las micobacterias no tuberculosas son poco reconocidas hoy en el mundo, incrementándose su prevalencia a punto de partida de su sospecha en inmunodeprimidos o en enfermedades crónicas, como la fibrosis quística. Se presenta el caso de una paciente con diagnóstico de síndrome de Lady Windermere a punto de partida de un cuadro de tos crónica. Se realizó tomografía computarizada donde se evidenciaron bronquiectasias en el segmento lingular del pulmón izquierdo y en los lóbulos medio e inferior del derecho. Mediante la broncoscopia se aisló el complejo Mycobacterium avium-intracellulare. La falta de sospecha de micobacterias atípicas en pacientes sin factores predisponentes, con un cuadro de tos crónica, conduce al retraso en el diagnóstico y el deterioro clínico del paciente