[Pulmonary infection with Mycobacterium malmoense. Difficulties in diagnosis and treatment]. / Infection pulmonaire à Mycobacterium malmoense. Difficultés diagnostiques et de thérapeutiques.

INTRODUCTION: Pulmonary infection due to Mycobacterium malmoense can be difficult to diagnose. These difficulties can be responsible for a delay in the implementation of optimal treatment. Moreover, the treatment is not standardized. OBSERVATION: We report the case of a 56-year-old patient who developed a Mycobacterium malmoense pulmonary infection whose diagnosis was delayed due to initial suspicion of pulmonary Mycobacterium tuberculosis infection. Once the diagnosis was confirmed, the patient was treated empirically with rifampicin, ethambutol, and clarithromycin for 12 months after culture conversion, giving a total of 15 months. The clinical and radiological outcomes were favorable. DISCUSSION: This clinical case highlights the difficulties of diagnosing pulmonary atypical mycobacterial infection according to the American Thoracic Society criteria, particularly Mycobacterium malmoense, a non-tuberculous mycobacterium (NTM) quite uncommon in France. Currently, there are new diagnostic techniques such as GenoType Mycobacteria Direct®. The second issue is the poorly standardized treatment of this NTM and many others, that are based on the recommendations of the British Thoracic Society. A national register has been set up by the MycoMed network, based essentially on the work of microbiologists but this register is unfortunately not exhaustive. CONCLUSION: A more systematic reporting strategy could allow cohort studies and therefore provide us with data on the most efficient drugs in the treatment of the rarest NTM infections.

Effectiveness of bacteriophages in the sputum of cystic fibrosis patients.

Bacteriophages have been shown to be effective for treating acute infections of the respiratory tract caused by antibiotic-resistant bacteria in animal models, but no evidence has yet been presented of their activity against pathogens in complex biological samples from chronically infected patients. We assessed the efficacy of a cocktail of ten bacteriophages infecting Pseudomonas aeruginosa following its addition to 58 sputum samples from cystic fibrosis (CF) patients collected at three different hospitals. Ten samples that did not contain P. aeruginosa were not analysed further. In the remaining 48 samples, the addition of bacteriophages led to a significant decrease in the levels of P. aeruginosa strains, as shown by comparison with controls, taking two variables (time and bacteriophages) into account (p = 0.024). In 45.8% of these samples, this decrease was accompanied by an increase in the number of bacteriophages. We also tested each of the ten bacteriophages individually against 20 colonies from each of these 48 samples and detected bacteriophage-susceptible bacteria in 64.6% of the samples. An analysis of the clinical data revealed no correlation between patient age, sex, duration of P. aeruginosa colonization, antibiotic treatment, FEV1 (forced expiratory volume in the first second) and the efficacy of bacteriophages. The demonstration that bacteriophages infect their bacterial hosts in the sputum environment, regardless of the clinical characteristics of the patients, represents a major step towards the development of bacteriophage therapy to treat chronic lung infections.

[Inadequate secretion of ß-human chorionic gonadotropin in lung cancer]. / Sécrétion d'hormone chorionique gonadotrope ß au cours des cancers bronchiques.

INTRODUCTION: The inadequate secretion of ß-human chorionic gonadotropin (ß-HCG) during non-small cell lung cancer (NSCLC) is rare and quite ignored. The dosage of ß-HCG is probably not systematically realized in women who are in age of pregnancy and who need chemotherapy (CT) despite the descriptions of cases of prescription of CT against lung cancer in women who were pregnant. The incidence of NSCLC cancer is increasing and the risk to prescribe a CT in a woman who is pregnant is also increasing. CASES REPORTS: We describe the cases of two women and one man who had an augmentation of the ß-HCG plasmatic level before the prescription of CT against lung cancer. In women, the differential diagnostic between inadequate secretion of ß-HCG and pregnancy has been a problem. CONCLUSION: The inadequate secretion of ß-HCG during NSCLC is probably not so rare. The dosage of this hormone before each infusion of CT should be systematic to avoid the realization of CT during pregnancy. This raises the question of the method for differential diagnostic between pregnancy and inadequate secretion of ß-HCG in young women who suffer from NSCLC, especially when a small level of ß-HCG is measured.

[Anti-angiogenic agents in the treatment of lung cancer: indications and toxicities]. / Thérapeutiques antiangiogéniques dans le cancer bronchique: indications et toxicités.

Lung cancer is the leading cause of cancer-related death. Targeting the vascular endothelial growth factor (VEGF) pathways in combination with standard chemotherapy can improve response rate and survival in non-small cell lung cancer. Since October 2006, a new class of drugs targeting angiogenesis has been introduced for the treatment of advanced lung cancer. Bevacizumab, an antibody directly targeting VEGF was the first agent to be approved. Other small molecule tyrosine kinase inhibitors targeting the VEGF receptor are also active in the treatment of advanced lung cancer and are currently under development. Most of these new drugs are well tolerated though potentially significant toxicities such as haemoptysis and hypertension have been observed. This article will review these new-targeted anti-angiogenic agents with a focus on their use in lung cancer and on their important side effects.

[Do all cryptogenic organizing pneumonias require lung biopsy and steroid treatment?]. / Pneumopathie organisée cryptogénique : biopsie et corticoïdes sont-ils constamment utiles ?

INTRODUCTION: Diagnostic guidelines recommend a lung biopsy to make the diagnosis of cryptogenic organizing pneumonia (COP). However, in some cases, in the presence of a typical clinical picture, the diagnosis can be made without histological proof: the combination of a "reversed halo sign" and migratory areas of patchy alveolar consolidation on the CT-scan is strongly suggestive. Steroids are the recommended treatment, but relapses and complications of steroids occur frequently whereas the morbidity of COP is usually low and the evolution is often the same with or without treatment. CASE REPORT: We report the case of a 51 year old woman with mild COP. The diagnosis was made according to the clinico-radiological criteria that we propose, without any formal histological proof. Treatment consisted of a short course of steroids, which led to spectacular clinical and radiological improvement but was withdrawn due to poor tolerance. The patient refused further treatment but clinical progress was favourable. After a follow-up period of 2.5 years a CT-scan showed evidence of a radiological relapse but the patient remained asymptomatic. CONCLUSION: In this article, we do not attempt to prove that lung biopsy and steroid treatment are unnecessary in the management of COP, but we would like to propose that, in some situations with the coexistence of a "reversed halo sign" and migratory areas of patchy consolidation on the CT-scan, in the context of a typical clinical presentation and mild symptoms, the usefulness of lung biopsy and steroid treatment is debatable.