ABSTRACT
[EXTRACTO] Chile es un país de 17 574 003 personas y durante el año 2020 hubo solo 141 donantes efectivos acorde al Sistema Integrado de Donación y Trasplante. En 2019, la tasa nacional de donantes fue de 10,4 por millón de habitantes, siendo inferior con respecto a países vecinos como Uruguay (22,86), Argentina (19,6) y Brasil (18); y más inferior aún a países como España (49,61) o Estados Unidos (36,88) (1). En los años 2020 y el 2021 los números continuaron deteriorándose y Chile reportó una tasa de donación de órganos de 7,2 y 7,4 por millón de habitantes respectivamente. Respecto a la mortalidad en lista de espera, datos chilenos muestran una mortalidad de 17% en pacientes esperando pulmón y hasta un 32% hígado (1). Esta mortalidad es elevada, y la cifra real podría ser incluso mayor si se consideran pacientes retirados de la lista de espera antes de fallecer (producto de la progresión de su enfermedad y la perdida de ventana de oportunidad para trasplante).
Subject(s)
LetterABSTRACT
Chronic eosinophilic pneumonia (CEP) is uncommon and predominantly seen in women. More than 6% of eosinophils in peripheral blood and more than 25% in bronchoalveolar lavage are diagnostic criteria. Secondary causes of hypereosinophilic pneumonia must be ruled out. We report a 72-year-old non-smoker man presenting in the emergency room with a history of cough, fever, and moderate dyspnea. He was not taking any medication. A chest-X ray showed a left lower lobe (LLL) consolidation, and was started on broad-spectrum antibiotics with a presumptive diagnosis of pneumonia. There was no improvement after therapy. A chest CT scan showed increased LLL consolidation and new left upper lobe ground glass opacities as well as a moderate left pleural effusion. Flexible bronchoscopy was performed and bronchoalveolar lavage showed 95% eosinophils, and had negative cultures. No parasites were identified. Transbronchial biopsies demonstrated eosinophil accumulation in alveoli and interstitium and pleural fluid was composed by 85% eosinophils. With the diagnosis of CEP, systemic corticosteroids were used with favorable clinical and radiological response.
Subject(s)
Pulmonary Eosinophilia/diagnosis , Aged , Biopsy , Chronic Disease , Humans , Male , Tomography, X-Ray ComputedABSTRACT
Chronic eosinophilic pneumonia (CEP) is uncommon and predominantly seen in women. More than 6% of eosinophils in peripheral blood and more than 25% in bronchoalveolar lavage are diagnostic criteria. Secondary causes of hypereosinophilic pneumonia must be ruled out. We report a 72-year-old non-smoker man presenting in the emergency room with a history of cough, fever, and moderate dyspnea. He was not taking any medication. A chest-X ray showed a left lower lobe (LLL) consolidation, and was started on broad-spectrum antibiotics with a presumptive diagnosis of pneumonia. There was no improvement after therapy. A chest CT scan showed increased LLL consolidation and new left upper lobe ground glass opacities as well as a moderate left pleural effusion. Flexible bronchoscopy was performed and bronchoalveolar lavage showed 95% eosinophils, and had negative cultures. No parasites were identified. Transbronchial biopsies demonstrated eosinophil accumulation in alveoli and interstitium and pleural fluid was composed by 85% eosinophils. With the diagnosis of CEP, systemic corticosteroids were used with favorable clinical and radiological response.
Subject(s)
Humans , Male , Aged , Pulmonary Eosinophilia/diagnosis , Biopsy , Tomography, X-Ray Computed , Chronic DiseaseABSTRACT
No disponible
Subject(s)
Humans , Lung Diseases, Interstitial/complications , Pleura/pathologySubject(s)
Lung Diseases, Interstitial/pathology , Pleura/pathology , Tomography, X-Ray Computed , Aged, 80 and over , Disease Progression , Elasticity , Female , Fibrosis , Forced Expiratory Volume , Humans , Lung Diseases, Interstitial/diagnostic imaging , Pleura/diagnostic imaging , Vital CapacityABSTRACT
Treatment failure in community-acquired pneumonia is defined as a clinical condition with inadequate response to antimicrobial therapy. Resistant and unusual microorganisms and noninfectious causes are responsible for treatment failure. Coccidioides immitis is a fungus that causes pneumonia in the northern hemisphere, especially in the United States and northern Mexico. We report a case of pulmonary coccidioidomycosis imported from Mexico to Chile. After a comprehensive study, histopathology was able to establish Coccidiodes immitis as the causative agent, achieving clinical and radiological improvement with antifungal therapy.
La neumonía de evolución tórpida son aquellas en que no se logra una respuesta clínica adecuada con el uso de terapia antimicrobiana. Existen múltiples causas a esta falta de respuesta: resistencia antimicrobiana, microorganismos no cubiertos o infecciones por microorganismos atípicos. Coccidioides immitis es un hongo causante de neumonía en el hemisferio norte, especialmente en E.U.A y norte de México. No existen reportes de casos pulmonares importados en Chile. Presentamos el caso de una mujer adulta con una neumonía que no respondió al tratamiento antimicrobiano habitual. Una vez realizado un estudio exhaustivo, se logró establecer mediante el estudio histopatológico la existencia de una coccidiodomicosis como entidad causal, logrando una respuesta clínica y radiológica favorable al tratamiento antifúngico.
Subject(s)
Female , Humans , Middle Aged , Coccidioidomycosis , Lung Diseases, Fungal , Antifungal Agents/therapeutic use , Chile , Coccidioidomycosis/diagnosis , Coccidioidomycosis/drug therapy , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Community-Acquired Infections/microbiology , Diagnosis, Differential , Lung Diseases, Fungal/diagnosis , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/microbiology , Mexico , Pneumonia/diagnosis , Travel , Treatment FailureABSTRACT
Treatment failure in community-acquired pneumonia is defined as a clinical condition with inadequate response to antimicrobial therapy. Resistant and unusual microorganisms and noninfectious causes are responsible for treatment failure. Coccidioides immitis is a fungus that causes pneumonia in the northern hemisphere, especially in the United States and northern Mexico. We report a case of pulmonary coccidioidomycosis imported from Mexico to Chile. After a comprehensive study, histopathology was able to establish Coccidiodes immitis as the causative agent, achieving clinical and radiological improvement with antifungal therapy.
Subject(s)
Coccidioidomycosis , Lung Diseases, Fungal , Antifungal Agents/therapeutic use , Chile , Coccidioidomycosis/diagnosis , Coccidioidomycosis/drug therapy , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Community-Acquired Infections/microbiology , Diagnosis, Differential , Female , Humans , Lung Diseases, Fungal/diagnosis , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/microbiology , Mexico , Middle Aged , Pneumonia/diagnosis , Travel , Treatment FailureABSTRACT
Legionella pneumophila is the second cause of severe community acquired pneumonia. In Chile, however, there are few reports of pneumonia caused by Legionella. We report eight patients (6 men, aged 42 to 72 years old) with community-acquired pneumonia caused by Legionella pneumophila serogroup 1, confirmed by the measurement of urinary antigen. Clinical presentation was characterized by fever or hypothermia (in one case), cough, dyspnea and neurological abnormalities in four patients. Cigarette smoking was the most frequently identified risk factor. All patients had at least one American Thoracic Society severity criteria. Complications observed were acute hypoxemic respiratory failure in seven patients, shock in four, renal failure in four and need for mechanical ventilation in three. No patient died.
