Pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: incidence, risk factors, and outcome.

We describe a large series of patients with chronic obstructive pulmonary disease (COPD) and probable invasive pulmonary aspergillosis (IPA), and the risk factors and incidence of the disease in patients with isolation of Aspergillus from lower respiratory tract samples. From 2000 to 2007, we retrospectively studied all patients admitted with COPD and isolation of Aspergillus (239; 16.3/1000 admissions). Multivariate logistic regression and survival curves were used. Fifty-three patients had probable IPA (3.6 cases of IPA per 1000 COPD admissions). IPA affects at least 22.1% of patients with COPD and isolation of Aspergillus in culture. In 33 of the 53 patients with probable IPA, serum galactomannan was determined; in 14 (42.4%) of these, the result was positive. Five variables were independent predictors of IPA with statistical significance: admission to the intensive-care unit, chronic heart failure, antibiotic treatment received in the 3 months prior to admission, the accumulated dosage of corticosteroids equivalent to >700 mg prednisone received in the 3 months prior to admission, and the similar accumulated dosage of corticosteroids received from admission to the first clinical isolation of Aspergillus. Multivariate analysis gave an area under the curve of 0.925 (95% CI 0.888-0.962; p <0.001). The overall mean survival of the cohort was 64.1% (28.3% for IPA patients and 75.2% for non-IPA patients). The median number of days of survival was 48 (95% CI 33.07-62.92). However, we found statistically significant differences between patients with IPA (29 days; 95% CI 20.59-37.40) and patients without IPA (86 days; 95% CI 61.13-110.86) (log rank, p <0.001).

Workload and clinical significance of the isolation of zygomycetes in a tertiary general hospital.

Several reports of increases in invasive zygomycosis (IZ) at individual institutions across the USA and Europe have contributed to a generalized concept that IZ is an increasing problem and the overestimation of the clinical significance of the isolation of zygomycetes in microbiology departments. We assessed the workload and clinical significance of zygomycetes isolates recovered from clinical samples in our institution over a 19-year period (1988-2006). We retrospectively reviewed the charts of those patients from who isolates of zygomycetes were obtained and calculated the workload of its isolation, the incidence of IZ during this period and the positive predictive value (PPV) of a positive culture. Zygomycetes were recovered from 210 samples (176 patients), i.e., 0.086/1,000 clinical samples processed and 6.3/1,000 samples submitted for fungal isolation. Zygomycetes represented 0.6% of the total fungi recovered. The mean incidence of the disease was 1.2 cases/100,000 admissions (range 0-20). Only 16 of the samples which grew zygomycetes (7.6%) were from infected patients. The workload generated by zygomycetes in our institution and the PPV for IZ of their isolation in our laboratory were very low and the disease was not found to have significantly increased in recent years in our institution. Data from specific institutions cannot be generalized.

Zigomicetos y zigomicosis en la era de las nuevas terapias antifúngicas / Zygomycetes and zygomycosis in the new era of antifungal therapies

La zigomicosis o mucormicosis es la tercera infección fúngica invasora tras la candidiasis y la aspergilosis. Tradicionalmente se ha consideradouna enfermedad de adquisición comunitaria, pero se está convirtiendo en una infección de frecuente adquisición nosocomial. En los últimosaños, numerosos estudios en instituciones aisladas apuntan a un aumento del número de casos de zigomicosis invasora a raíz de las nuevasterapias antifúngicas e inmunosupresoras, y al aumento de la población inmunodeprimida. Por otro lado, el diagnóstico de la zigomicosismuchas veces es complicado, sobre todo en las formas pulmonares y diseminadas. Uno de los principales problemas que presenta el aislamientode zigomicetos de muestras clínicas en el laboratorio de microbiología es que con frecuencia los resultados tienen una difícil interpretación.Además, el aumento del número de micosis invasoras por hongos resistentes a los antifúngicos ha llevado al desarrollo de nuevasmoléculas con actividad antifúngica y diferentes perfiles de actividad frente a los zigomicetos(AU)

Zygomycosis or mucormycosis is the third most invasive fungal infection after candidiasis and aspergillosis. Traditionally, it has been considereda community-acquired disease, but it is becoming a frequent nosocomial-acquired disease. Recently, several publications from differentinstitutions have reported an increase in the number of cases of invasive zygomycosis as a result of the new antifungal and immunosuppresivetherapies and the emerging immunocompromised population. In addition, the diagnosis of zygomycosis is elusive, mainly in pulmonaryand disseminated forms. One of the main limitations in isolating Zygomycetes from clinical samples is the interpretation of results. The increasingnumber of invasive fungal infections caused by multiresistant fungi has led to the development of new antifungal drugs with variableactivity against Zygomycetes(AU)

[Zygomycetes and zygomycosis in the new era of antifungal therapies]. / Zigomicetos y zigomicosis en la era de las nuevas terapias antifúngicas.

Zygomycosis or mucormycosis is the third most invasive fungal infection after candidiasis and aspergillosis. Traditionally, it has been considered a community-acquired disease, but it is becoming a frequent nosocomial-acquired disease. Recently, several publications from different institutions have reported an increase in the number of cases of invasive zygomycosis as a result of the new antifungal and immunosuppresive therapies and the emerging immunocompromised population. In addition, the diagnosis of zygomycosis is elusive, mainly in pulmonary and disseminated forms. One of the main limitations in isolating Zygomycetes from clinical samples is the interpretation of results. The increasing number of invasive fungal infections caused by multiresistant fungi has led to the development of new antifungal drugs with variable activity against Zygomycetes.

[Incidence of anorexia nervosa in a community mental health services for children and adolescents]. / Incidencia de la anorexia nerviosa en una Unidad Pública de Salud Mental Infanto-Juvenil.

INTRODUCTION: In the last few years, a huge social importance is being given to eating disorders and specially to anorexia nervosa. Sometimes, the actual epidemiology doesn't correspond with that voice of alarm. MATERIAL AND METHODOLOGY: In this article are reviewed a sample of 3,849 clinical histories (aged 0 to 16 years) collected in 9 years in a public children and adolescents mental health unit.Objective. To see the incidence of the eating disorders (with their characteristics of sex and age) and the progression of cases of anorexia. RESULTS: Show that the percentage of eating disorders (including anorexia) compared with the rest of psychopathologies is very low, that the cases of eating disorders have risen in the last 4 years and that the cases of anorexia nervosa haven't risen in the last decade. DISCUSSION: Given the discrepancy with other authors who found several cases, we look for an interpretation of our data.

Incidencia de la anorexia nerviosa en una unidad pública de salud mental infanto-juvenil / Incidence of anorexia nervosa in a public children and adolescents mental health unit

Introducción. En los últimos años se está dando una enorme importancia social a los trastornos de la alimentación y especialmente a la anorexia nerviosa. A veces, la realidad epidemiológica no se corresponde con esa voz de alarma.Material y metodología. En este artículo se revisan un total de 3.849 historias clínicas (de 0 a 16 años de edad) recogidas a lo largo de 9 años en una Unidad Pública de Salud Mental Infanto-juvenil.Objetivos. Recoger la incidencia de los trastornos de la alimentación (con sus características de sexo y edad) y la progresión de casos de anorexia nerviosa.Resultados. Los resultados muestran que el porcentaje de trastornos de la alimentación (incluyendo la anorexia nerviosa) con relación al resto de patologías es muy bajo, que los casos de trastornos de la alimentación han aumentado a lo largo de los últimos 4 años y que los casos de anorexia nerviosa no se han incrementado a lo largo de la última década.Discusión. Dada la discrepancia con otros autores que encuentran un gran número de casos, buscamos una interpretación para nuestros datos. (AU)