Lower respiratory tract infections caused by Haemophilus influenzae: clinical features and predictors of outcome.

BACKGROUND: We studied clinical features and predictors of outcome of lower respiratory tract infections caused by Haemophilus influenzae in hospitalized adults in a general hospital. MATERIAL/METHODS: Medical records of hospitalized adults with H. influenzae lower respiratory tract infections during the period 1996 to 2002 were retrospectively reviewed using a standardized questionnaire. RESULTS: Eleven female (24%) and 34 male (76%) patients were identified. Median age was 68 years (range 28-86 years). Most patients had a smoking history (n=37; 82%) and an underlying medical condition, with chronic obstructive pulmonary disease being the most common (n=28; 62%). Pneumonia was diagnosed in 34 patients (76%). Among them, 10 (29%) showed lobar and 24 (71%) showed segmental opacification on chest radiograph. Parapneumonic pleural effusion was observed in 10 patients (22%). Fifteen patients (33%) had positive blood cultures for H. influenzae. Based on results of sputum, blood, and pleural cultures, empirical antibiotic regimens were appropriate in 40 patients (89%). Nonserotypeable H. influenzae accounted for the majority of cases (n=26; 58%). Thirty-six (80%) H. influenzae isolates were resistant to amoxicillin. Forty patients (89%) with infection had a favorable outcome. All 5 patients who died had pneumonia with respiratory failure and underlying disease. Linear logistic regression analysis revealed leukocytosis and cancer as independent risk factors of death. CONCLUSIONS: H. influenzae lower respiratory tract infections were observed mainly in elderly patients with severe comorbidities. Pneumonia was associated with high mortality, especially in patients with underlying malignancy and H. influenzae isolates resistant to amoxicillin.

Th1/Th2 cytokine pattern in bronchoalveolar lavage fluid and induced sputum in pulmonary sarcoidosis.

BACKGROUND: Sarcoidosis is thought to be a T-helper type 1 cytokine (Th2 cytokine) mediated disorder. Induced sputum (IS) has been proposed as a useful non-invasive method, mainly for the assessment of the airway diseases. The aim of this study was to explore induced sputum (IS) CD4+ Th1 T-lymphocyte subpopulation and to compare them with those of bronchoalveolar lavage fluid (BALF) in patients with sarcoidosis. METHODS: We studied prospectively 21 patients (12 female, 9 male) of median age 46 yr (range, 25-65) with sarcoidosis and 10 normal subjects (5 female, 5 male) of median age 39 yr (range, 26-60). IS was performed with hypertonic saline solution using an ultrasonic nebulizer. BALF was performed within 10 days of IS. After stimulation of sputum lymphocytes with phorbol-myristate-acetate, we used double immunocytochemical methods to identify CD4+ IFN-gamma positive and IL-4 positive cells (Th1 and Th2, respectively). RESULTS: Sarcoidosis patients had an increased number of CD4+ -IFN-gamma producing cells in IS (p = 0.003) and BALF (p = 0.01) in comparison with normal subjects. No significant differences were detected between CD4+ -IL-4 cells in BALF (p = 0.053, NS) and IS (p = 0.46, NS) between sarcoidosis patients and healthy controls. The ratio of Th1 to Th2 cells in BALF and IS was statistically different in sarcoidosis when compared with normal subjects (p = 0.007 in BALF and IS). A significant correlation was found between CD4+ IFN-gamma positive cells in IS and those in BALF in sarcoidosis patients (r = 0.685, p = 0.0006). CONCLUSION: These data suggests that a Th1-like cytokine pattern can be observed in CD4+ T-lymphocytes in IS in patients with pulmonary sarcoidosis. Further studies are needed to explore the value of IS vs BALF in the follow-up of these patients.

Perforin expression and cytotoxic activity of sputum CD8+ lymphocytes in patients with COPD.

BACKGROUND: Previous studies have shown that the inflammatory response to cigarette smoking differs between smokers who acquire COPD and those who do not, and the CD8(+) T- lymphocytes have been identified as a key player in this response. OBJECTIVE: To investigate the cytotoxic activity and perforin expression of CD8(+) lymphocytes in the airway lumen of patients with COPD. METHODS: Thirty-six male smokers with COPD, 25 male smokers without COPD, and 10 healthy nonsmokers participated in the study. T-lymphocytes of induced sputum samples were labeled with appropriate monoclonal antibodies and measured using flow cytometry. The cytotoxic activity of CD8(+) cells was defined by incubating them with specific target cells (K562). RESULTS: The percentage and the total number of CD8(+) lymphocytes were significantly higher in COPD smokers compared to non-COPD smokers (p = 0.01 and p = 0.005, respectively) or to healthy nonsmokers (p = 0.02 and p = 0.01, respectively). Perforin expression in CD8(+) cells was significantly higher in smokers with COPD compared to the other two groups (p = 0.001). Increased cytotoxic activity of T cells was also observed in induced sputum of patients with COPD in comparison to the other two groups. CONCLUSION: CD8(+) cells are not only increased in number in sputum samples of smokers with COPD but are highly activated, expressing high levels of perforin. These findings suggest that CD8(+) T-lymphocytes play a significant role in the inflammatory process of COPD.

Comparison of sputum induction with bronchoalveolar lavage cell differential counts in patients with sarcoidosis.

BACKGROUND AND AIM: Induced sputum (IS) has been proposed as a useful non-invasive method mainly for the assessment of airway diseases. The aim of this study was to evaluate IS cellular composition and T-lymphocyte subpopulations and to compare them with those of bronchoalveolar lavage fluid (BALF) in patients with sarcoidosis. METHODS: We studied prospectively 20 patients (12 female, 8 male) of median age 46 yr (range 25-65) with sarcoidosis and 10 normal subjects (5 female, 5 male) of median age 39 yr (range 26-60). IS was performed with hypertonic saline solution using an ultrasonic nebulizer (De Vilbis 2000). BALF was performed by conventional procedure using fiberoptic bronchoscopy. May-Giemsa-Grunewald stained preps were differentially counted and T-lymphocyte subsets were analyzed by flow activated cell sorter (FACS). RESULTS: The percentage of macrophages was significantly lower in IS than in BALF (p < 0.0001), the percentage of neutrophils was significantly lower in BALF than in IS (p < 0.0001), while there was no difference in the percentage of lymphocytes (p = 0.693) and eosinophils (p = 0.25) in IS vs BALF in patients with sarcoidosis. A significant correlation was found between BALF and IS lymphocyte counts (r = 0.61, p = 0.004), macrophages (r = 0.51, p = 0.02), and CD4+/CD8+ ratio (r = 0.700, p = 0.001). CONCLUSIONS: These results suggest that the inflammation in sarcoidosis could be effectively and non-invasively determined by the analysis of cell differential counts and T-lymphocyte subsets in IS. Further studies are needed to explore the role of IS vs BALF in the follow-up of these patients.