[Pulmonary infection from Rhodococcus equi after renal transplantation. Review of the literature]. / Infection pulmonaire à Rhodococcus equi après transplantation rénale. Revue de la littérature.

Rhodococcus Equi, a strictly aerobic Gram positive coco-bacillus, is a pathogen for horses and foals. It may induce opportunistic infections and is described in AIDS infected patients. We report the case of a 47-year old man, breeder of horses, with kidney transplant who has presented, 8 years after his graft, an impairment of health, a fever and evidence of pulmonary disease. The pulmonary biopsy under scanner guidance and microbiology study, has displayed the diagnosis of Rhodococcus equi infection. The evolution has been favorable with double antibiotherapy (follow-up 27 months). Ten comparable observations have been published after organ transplantation: (kidney: 8; heart: 1; liver: 1). Pulmonary locations are widely predominant. The animal contact is found only in 30% of cases. The presentation of the sickness has been compared to pulmonary tuberculosis or to nocardiosis, pathologies often observed in this context of immunosuppression. The antibiotic treatment is difficult and should required two bactericidal antibiotics. A surgical lobectomy can be envisaged in case of relapse. The mortality is 30%.

Fluid shifts and endocrine responses during lower body negative pressure and dynamic arm exercise.

The use of lower body negative pressure (LBNP) is proposed as a means of reducing the effect of spaceflight on body water loss by stimulation of renin angiotensin aldosterone system (RAAS) activity. Seven subjects were successively submitted to LBNP exposure, arm cranking physical exercise, and to a combination of both procedures (LBNP + arm cranking) in order to check whether this combination enhances RAAS activity. The results showed that exposure to 40 min of LBNP to a level of -40 mm Hg was a more potent stimulus for renin secretion than submaximal and maximal arm cranking. The combination of LBNP with exercise does not further enhance the RAAS activity induced by LBNP alone. These data suggest that the fluid shift toward the lower body induced by LBNP counteracts triggering of renin secretion due to physical exercise.