Environmental exposures, the oral-lung axis and respiratory health: The airway microbiome goes on stage for the personalized management of human lung function.

The human respiratory system is constantly exposed to environmental stimuli, sometimes including toxicants, which can trigger dysregulated lung immune responses that lead to respiratory symptoms, impaired lung function and airway diseases. Evidence supports that the microbiome in the lungs has an indispensable role in respiratory health and disease, acting as a local gatekeeper that mediates the interaction between the environmental cues and respiratory health. Moreover, the microbiome in the lungs is intimately intertwined with the oral microbiome through the oral-lung axis. Here, we discuss the intricate three-way relationship between (i) cigarette smoking, which has strong effects on the microbial community structure of the lung; (ii) microbiome dysbiosis and disease in the oral cavity; and (iii) microbiome dysbiosis in the lung and its causal role in patients suffering chronic obstructive pulmonary disease (COPD), a leading cause of morbidity and mortality worldwide. We highlight exciting outcomes arising from recently established interactions in the airway between environmental exposures, microbiome, metabolites-functional attributes and the host, as well as how these associations have the potential to predict the respiratory health status of the host through an airway microbiome health index. For completion, we argue that incorporating (synthetic) microbial community ecology in our contemporary understanding of lung disease presents challenges and also rises novel opportunities to exploit the oral-lung axis and its microbiome towards innovative airway disease diagnostics, prognostics, patient stratification and microbiota-targeted clinical interventions in the context of current therapies.

A novel presentation of diaphragmatic flutter in a patient with obstructive sleep apnea and recurrent cerebellar hemangioblastoma.

We report a unique case of diaphragmatic flutter in a patient with obstructive sleep apnea who had no respiratory symptoms related to flutter and a history of recurrent cerebellar hemangioblastoma. The flutter was detected during a routine follow-up monitoring through the built-in software of the positive airway pressure device; the flow and pressure curves showed abnormal and curious oscillations. The ultrasound confirmed the diagnosis and ruled out other causes of abnormal diaphragmatic movements. This case report contributes to the scientific literature by presenting a novel case of diaphragmatic flutter associated with recurrent cerebellar hemangioblastoma. It also emphasizes the need for more research on the pathophysiology and treatment of this rare condition. CITATION: Ciorba C, Espinoza Perez JA, Alfonso Imizcoz M, Errasti Viader J, Cebollero Rivas P, De Vito EL. A novel presentation of diaphragmatic flutter in a patient with obstructive sleep apnea and recurrent cerebellar hemangioblastoma. J Clin Sleep Med. 2024;20(2):313-317.

Fungal infections following treatment with monoclonal antibodies and other immunomodulatory therapies / Infecciones fúngicas como consecuencia de tratamientos con anticuerpos monoclonales y otras terapias inmunomoduladoras

Tumor necrosis factor (TNF) is a proinflammatory cytokine involved in a wide range of important physiologic processes and has a pathologic role in some diseases. TNF antagonists (infliximab, adalimumab, etanercept) are effective in treating inflammatory conditions. Antilymphocyte biological agents (rituximab, alemtuzumab), integrin antagonists (natalizumab, etrolizumab and vedolizumab), interleukin (IL)-17A blockers (secukinumab, ixekizumab) and IL-2 antagonists (daclizumab, basiliximab) are widely used after transplantation and for gastroenterological, rheumatological, dermatological, neurological and hematological disorders. Given the putative role of these host defense elements against bacterial, viral and fungal agents, the risk of infection during a treatment with these antagonists is a concern. Fungal infections, both opportunistic and endemic, have been associated with these biological therapies, but the causative relationship is unclear, especially among patients with poor control of their underlying disease or who are undergoing steroid therapy. Potential recipients of these drugs should be screened for latent endemic fungal infections. Cotrimoxazole prophylaxis could be useful for preventing Pneumocystis jirovecii infection in patients over 65 years of age who are taking TNF antagonists, antilymphocyte biological agents or who have lymphopenia and are undergoing concomitant steroid therapy. As with other immunosuppressant drugs, TNF antagonists and antilymphocyte antibodies should be discontinued for patients with active infectious disease

El factor de necrosis tumoral (TNF) es una citocina proinflamatoria involucrada en una amplia gama de procesos fisiológicos importantes y desarrolla un papel en la patogenia de algunas enfermedades. Los antagonistas del TNF (infliximab, adalimumab, etanercept) son efectivos en el tratamiento de afecciones inflamatorias. Los agentes biológicos antilinfocitarios (rituximab, alemtuzumab), los antagonistas de la integrina (natalizumab, etrolizumab y vedolizumab), de la interleucina 17A (secukinumab, ixekizumab) o los antagonistas de la IL-2 (daclizumab, basiliximab) se usan ampliamente después del trasplante y en trastornos gastroenterológicos, reumatológicos, dermatológicos, neurológicos y hematológicos. Dado el papel relevante de estos elementos de defensa del huésped contra agentes bacterianos, virales y fúngicos, el riesgo de infección durante el tratamiento con estos antagonistas genera preocupación. Las infecciones por hongos, tanto oportunistas como endémicos, se han asociado con estas terapias biológicas, pero la relación causal no está clara, especialmente entre los pacientes con un control deficiente de su enfermedad subyacente o que están recibiendo terapia con esteroides. Los pacientes en tratamiento con estos medicamentos deben ser examinados para detectar infecciones micóticas endémicas latentes. La profilaxis con cotrimoxazol podría ser útil para prevenir la infección por Pneumocystis jirovecii en pacientes mayores de 65 años que estén tomando antagonistas de TNF, agentes biológicos antilinfocitarios, o tengan linfopenia y estén en tratamiento concomitante con esteroides. Al igual que con otros fármacos inmunosupresores, deben suspenderse los antagonistas de TNF y los anticuerpos antilinfocitarios en pacientes con enfermedad infecciosa activa hasta su control

Fungal infections following treatment with monoclonal antibodies and other immunomodulatory therapies.

Tumor necrosis factor (TNF) is a proinflammatory cytokine involved in a wide range of important physiologic processes and has a pathologic role in some diseases. TNF antagonists (infliximab, adalimumab, etanercept) are effective in treating inflammatory conditions. Antilymphocyte biological agents (rituximab, alemtuzumab), integrin antagonists (natalizumab, etrolizumab and vedolizumab), interleukin (IL)-17A blockers (secukinumab, ixekizumab) and IL-2 antagonists (daclizumab, basiliximab) are widely used after transplantation and for gastroenterological, rheumatological, dermatological, neurological and hematological disorders. Given the putative role of these host defense elements against bacterial, viral and fungal agents, the risk of infection during a treatment with these antagonists is a concern. Fungal infections, both opportunistic and endemic, have been associated with these biological therapies, but the causative relationship is unclear, especially among patients with poor control of their underlying disease or who are undergoing steroid therapy. Potential recipients of these drugs should be screened for latent endemic fungal infections. Cotrimoxazole prophylaxis could be useful for preventing Pneumocystis jirovecii infection in patients over 65 years of age who are taking TNF antagonists, antilymphocyte biological agents or who have lymphopenia and are undergoing concomitant steroid therapy. As with other immunosuppressant drugs, TNF antagonists and antilymphocyte antibodies should be discontinued for patients with active infectious disease.

Caracterización de las personas atendidas en cuidados paliativos en Atención Primaria de Salud en Cerro Navia, Chile / Characterization of people cared for in Primary Health Palliative Care in Cerro Navia, Chile

OBJETIVO: Describir características sociodemográficas y clínicas de las personas a las que se les brindan cuidados paliativos en Atención Primaria de Salud (APS) durante visitas domiciliarias en la comuna de Cerro Navia, a través de una investigación cuantitativa, obtenida de bases secundarias, durante el periodo de julio de 2017 a junio de 2018. MATERIAL Y MÉTODO: Investigación cuantitativa, diseño no experimental, transversal, descriptiva, con paradigma crítico. El estudio se realiza mediante la revisión de fuentes secundarias (registros de atenciones) de todas las personas atendidas en el Programa de Dependencia Severa en los distintos Centro de Salud Familiar (CESFAM) de Cerro Navia durante el periodo de julio de 2017 a junio de 2018. Se analizaron datos sociodemográficos y clínicos, tales como edad, sexo, ingreso económico, parentesco del cuidador/a y sexo, patologías y si el cuidado era a personas con enfermedades oncológicas o no. Para el análisis de información se utilizó una matriz en Microsoft Excel. RESULTADOS: Se revisaron las fichas de 539 personas, de las cuales 436 cumplieron con los criterios de inclusión, con una mediana de 78 años, dependencia severa del 61,5 %, con una mayor prevalencia de FONASA B (64,5 %). Los cuidadores eran mayormente de sexo femenino con 83,3 %, en donde el parentesco más frecuente fue "hija/o". Finalmente, del total de la población, el 85 % presentaba enfermedades crónicas como principal patología para ser atendida dentro del programa dependencia severa. CONCLUSIONES: Se identifi có que la población atendida en el programa de dependencia severa mayoritariamente posee patologías crónicas, por lo cual la entrega de CCPP debería extenderse a la población con enfermedades crónicas

OBJECTIVE: To describe the sociodemographic and clinical characteristics of the patients receiving palliative care in the primary health care (PHC) setting during home visits in the 'commune' of Cerro Navia through a quantitative research using secondary sources from July 2017 to June 2018. METHODS: A quantitative research using a non-experimental, cross-sectional, descriptive design within the critical paradigm. The study was carried out by reviewing secondary sources (care records) for the patients cared for within the Severe Dependence Program at the various CESFAM in Cerro Navia from July 2017 to June 2018. Patient sociodemographic and clinical data were analyzed, including age, gender, income, caregiver kinship and gender, disease, and cancer status (yes/no). A Microsoft Excel matrix was used to analyze information. RESULTS: A total of 539 records were collected, of which 436 met the inclusion criteria. Median age was 78 years. A total of 61.47 % had severe dependency, 64.45 % had FONASA B affiliation, 78.67 % had female caregivers, with "daughter" being the primary kinship, and 85 % had chronic diseases as primary condition qualifying to receive care within the Severe Dependence Program. CONCLUSIONS: The population cared for within the Severe Dependence Program was found to suffer mostly from chronic conditions, hence PC delivery should be extended to the population with chronic diseases

Colombian consensus on the diagnosis, treatment, and prevention of Candida Spp. disease in children and adults, / Consenso Colombiano Para el Diagnóstico, Tratamiento y Prevención de la Enfermedad por Candida Spp. en Niños y Adultos

Invasive Candidiasis (IC) and candidemia (as its most frequent manifestation) have become the main cause of opportunistic mycosis at hospital settings. This study, made by members of the Colombian Association of Infectious Diseases (ACIN), was aimed at providing a set of recommendations for the management, follow-up and prevention of IC / candidemia and mucous membrane candida infection in adult, pediatric and neonatal patients in a hospital setting, including the hemato-oncological and critical care units. All the data obtained through an exhaustive search were reviewed and analyzed in a comprehensive manner by all the members of the group, and the recommendations issued are being made after a careful review of the scientific literature available and the consensus of all specialists involved; the emergence of Candida Spp. problem is highlighted and a correct orientation to health professionals regarding the management of patients with candidiasis is provided in a rational and practical way, emphasizing patient evaluation, diagnostic strategies, prophylaxis, empirical treatment, directed treatment and preventative therapy.

La Candidiasis Invasora (CI) y la candidemia, como su manifestación más frecuente, se ha convertido en la principal causa de micosis oportunista a nivel hospitalario. Este manuscrito realizado por miembros de la Asociación Colombiana de Infectología (ACIN), tuvo como objetivo proporcionar un conjunto de recomendaciones para manejo, seguimiento y prevención de la CI/candidemia y de la infección candidiásica de mucosas, en población adulta, pediátrica y neonatal, en un entorno hospitalario, incluyendo las unidades hemato-oncológicas y unidades de cuidado crítico. Todos los datos obtenidos mediante una búsqueda exhaustiva, fueron revisados y analizados de manera amplia por todos los miembros del grupo, y las recomendaciones emitidas se elaboraron luego de la evaluación de la literatura científica disponible, y el consenso de todos los especialistas involucrados, reconociendo el problema de la emergencia de las infecciones por Candida Spp. y brindando una correcta orientación a los profesionales de la salud sobre el manejo de pacientes con enfermedad candidiásica, de una forma racional y práctica, enfatizando en la evaluación del paciente, estrategias de diagnóstico, profilaxis, tratamiento empírico, tratamiento dirigido y terapia preventiva.

La espirometría en la Neumología pública en Navarra. Análisis contrastado del estudio 3E / Spirometry in Public Hospitals in Navarre. A Comparative Analysis of the 3E Study

No disponible

Clinical and epidemiological characteristics and risk factors for mortality in patients with candidemia in hospitals from Bogotá, Colombia

Background: Bloodstream infection by Candida species has a high mortality in Latin American countries. The aim of this study was to describe the characteristics of patients with documented bloodstream infections caused by Candida species in third level hospitals and determine the risk factors for in-hospital-mortality. Methods: Patients from seven tertiary-care hospitals in Bogotá, Colombia, with isolation of a Candida species from a blood culture were followed prospectively from March 2008 to March 2009. Epidemiologic information, risk factors, and mortality were prospectively collected. Isolates were sent to a reference center, and fluconazole susceptibility was tested by agar-based E-test. The results of susceptibility were compared by using 2008 and 2012 breakpoints. A multivariate analysis was used to determinate risk factors for mortality. Results: We identified 131 patients, with a median age of 41.2 years. Isolates were most frequently found in the intensive care unit (ICU). Candida albicans was the most prevalent species (66.4% of the isolates), followed by C. parapsilosis (14%). Fluconazole resistance was found in 3.2% and 17.6% of the isolates according to the 2008 and 2012 breakpoints, respectively. Fluconazole was used as empirical antifungal therapy in 68.8% of the cases, and amphotericin B in 22%. Hospital crude mortality rate was 35.9%. Mortality was associated with age and the presence of shock at the time of Candida detection. Fluconazole therapy was a protective factor for mortality. Conclusions: Candidemia is associated with a high mortality rate. Age and shock increase mortality, while the use of fluconazole was shown to be a protective factor. A higher resistance rate with new breakpoints was noted. .

Clinical and epidemiological characteristics and risk factors for mortality in patients with candidemia in hospitals from Bogotá, Colombia.

BACKGROUND: Bloodstream infection by Candida species has a high mortality in Latin American countries. The aim of this study was to describe the characteristics of patients with documented bloodstream infections caused by Candida species in third level hospitals and determine the risk factors for in-hospital-mortality. METHODS: Patients from seven tertiary-care hospitals in Bogotá, Colombia, with isolation of a Candida species from a blood culture were followed prospectively from March 2008 to March 2009. Epidemiologic information, risk factors, and mortality were prospectively collected. Isolates were sent to a reference center, and fluconazole susceptibility was tested by agar-based E-test. The results of susceptibility were compared by using 2008 and 2012 breakpoints. A multivariate analysis was used to determinate risk factors for mortality. RESULTS: We identified 131 patients, with a median age of 41.2 years. Isolates were most frequently found in the intensive care unit (ICU). Candida albicans was the most prevalent species (66.4% of the isolates), followed by C. parapsilosis (14%). Fluconazole resistance was found in 3.2% and 17.6% of the isolates according to the 2008 and 2012 breakpoints, respectively. Fluconazole was used as empirical antifungal therapy in 68.8% of the cases, and amphotericin B in 22%. Hospital crude mortality rate was 35.9%. Mortality was associated with age and the presence of shock at the time of Candida detection. Fluconazole therapy was a protective factor for mortality. CONCLUSIONS: Candidemia is associated with a high mortality rate. Age and shock increase mortality, while the use of fluconazole was shown to be a protective factor. A higher resistance rate with new breakpoints was noted.

Evaluación de la utilización de una consulta de diagnóstico rápido de cáncer de pulmón. Tiempos de demora diagnóstica y terapéutica / Evaluation of the Use of a Rapid Diagnostic Consultation of Lung Cancer. Delay Time of Diagnosis and Therapy

Objetivo: Analizar los resultados conseguidos desde su creación hace 5 años en una consulta de diagnóstico rápido de cáncer de pulmón (CDR-CP) relacionados con el buen uso de la derivación, tiempos de demora diagnóstica y terapéutica, y días de estancia hospitalaria. Comparar las demoras diagnóstico-terapéuticas y estancias hospitalarias con las obtenidas en los pacientes evaluados mediante la sistemática habitual (NCDR-CP). Pacientes y método: Se ha incluido a todos los pacientes valorados en nuestra CDR-CP en los últimos 5 años. En los CP se han registrado las fechas de derivación al médico especialista, primera consulta, realización de pruebas diagnósticas, estadificación, inicio del tratamiento y días de hospitalización. Se han comparado estos mismos datos con los pacientes NCDR-CP diagnosticados en el periodo de octubre 2008 a octubre de 2010. Resultados: Se evaluaron 179 pacientes remitidos a CDR-CP que representan el 26,7% de las consultas ofertadas, siendo 166 (92,7%) las remisiones correctas, de las que el 44,5% correspondieron a un CP; en el 75,6% de ellos se realizó todo el estudio de forma ambulatoria y más del 85% de los casos cumplían con las recomendaciones existentes relacionadas con las demoras diagnóstico-terapéuticas. Al comparar estos datos con el grupo NCDR-CP (n=151), se encontraron diferencias relacionadas con los datos de hospitalización: menor porcentaje de ingresados (p<0,0001) y menos días de estancia (p<0,0001) en el grupo CDR-CP. No existieron diferencias entre ambos grupos en las demoras diagnósticas y terapéuticas. Conclusión: En nuestro medio la consulta de diagnóstico rápido de cáncer de pulmón permite realizar, en un gran porcentaje de casos, todos los estudios de forma ambulatoria y en plazos de tiempo acordes con las recomendaciones existentes. Pese a ello, hemos detectado una acusada infrautilización de las mismas(AU)

Objective: To analyze the results obtained in a lung cancer screening program since its inception five years ago regarding correct referrals, diagnostic and therapeutic delay times and days of hospitalization. To compare the diagnostic-therapeutic delays and hospital stays with those obtained in patients evaluated with the standard system. Patients and methods: Included for study were all those patients evaluated in our Lung Cancer Screening Program (LCSP) in the last five years. For the cases with LC, we recorded the dates the patients were referred to a specialist, the first consultation, diagnostic tests, stage, start of treatment and days of hospitalization. We compared these same data with lung cancer patients who did not partake in the LCSP and were diagnosed between October 2008 and October 2010. Results: We evaluated 179 patients remitted to the LCSP, which represented 26.7% of the consultations; 166 (92.7%) of the referrals were correct, out of which 44.5% were LC. In 75.6% of these, the entire study was completed in the outpatient setting, and more than 85% of the cases met the current recommendations related with diagnostic-therapeutic delays. When these results were compared with the non-LCSP group (n=151), differences were found in the data for hospitalizations: there was a lower percentage of hospitalizations (P<.0001) and shorter hospital stays (P<.0001) in the LCSP group. There were no differences between the two groups for diagnostic or therapeutic delays. Conclusion: In our setting, lung cancer screening programs allow for cancer studies to be carried out in the outpatient consultations in a large percentage of cases, and within the time periods recommended by current guidelines. In spite of this fact, we have detected that these programs are underused(AU)

Evaluation of the use of a rapid diagnostic consultation of lung cancer. Delay time of diagnosis and therapy.

OBJECTIVE: To analyze the results obtained in a lung cancer screening program since its inception five years ago regarding correct referrals, diagnostic and therapeutic delay times and days of hospitalization. To compare the diagnostic-therapeutic delays and hospital stays with those obtained in patients evaluated with the standard system. PATIENTS AND METHODS: Included for study were all those patients evaluated in our Lung Cancer Screening Program (LCSP) in the last five years. For the cases with LC, we recorded the dates the patients were referred to a specialist, the first consultation, diagnostic tests, stage, start of treatment and days of hospitalization. We compared these same data with lung cancer patients who did not partake in the LCSP and were diagnosed between October 2008 and October 2010. RESULTS: We evaluated 179 patients remitted to the LCSP, which represented 26.7% of the consultations; 166 (92.7%) of the referrals were correct, out of which 44.5% were LC. In 75.6% of these, the entire study was completed in the outpatient setting, and more than 85% of the cases met the current recommendations related with diagnostic-therapeutic delays. When these results were compared with the non-LCSP group (n=151), differences were found in the data for hospitalizations: there was a lower percentage of hospitalizations (P<.0001) and shorter hospital stays (P<.0001) in the LCSP group. There were no differences between the two groups for diagnostic or therapeutic delays. CONCLUSION: In our setting, lung cancer screening programs allow for cancer studies to be carried out in the outpatient consultations in a large percentage of cases, and within the time periods recommended by current guidelines. In spite of this fact, we have detected that these programs are underused.

Comparación de métodos de microdilución CLSI M27-A2 y EUCAST en aislamientos de Candida spp. en pacientes con cáncer / CLSI microdilution M27-A2 and EUCAST method comparison for Candida spp. in patients with cancer

Objetivo: comparar los métodos de referencia de microdilución en caldo de la CLSI M27-A2 y EUCAST, identificando la utilidad y las principales diferencias de cada uno de ellos para los agentes antifúngicos anfotericina B (1), fluconazol (FCZ) e itraconazol (ITZ), contra aislamientos clínicos de Candidaspp. de pacientes con cáncer. Materiales y métodos: se estudiaron 136 aislamientos de C. albicans, 36 de C. tropicalis y 17 de Candidaspp. Se utilizó el índice Kappa ponderado para medir el grado de acuerdo entre los dos métodos. Resultados: se estableció que el grado de concordancia entre los dos métodos para el total de los aislamientos fue alto con AB (κ: 1) y FCZ (κ: 0.74) y bajo al utilizar ITZ (κ: 0.49). La concordancia fue variable y especie-específica: para ITZ y FCZ en C. albicans fue de 0,45 y 0,64; en C. tropicalis, de 0,48 y 0,91; y en Candidaspp. de 0,73 y 0,87, respectivamente. Discusión: este estudio sugiere que las pruebas de sensibilidad antifúngica para los dos métodos son equivalentes en lo esencial. Deben considerarse las diferencias y discrepancias asociadas a la especie implicada, el tipo de antifúngico utilizado y los tiempos de incubación, que puede producir variaciones al interpretar los resultados obtenidos de acuerdo con la metodología empleada.

Objective: compare the broth microdilution testing reference standards CLSI M27-A2 and EUCAST, identifying the usefulness of each one of them and their main differences, against the antifungal agents amphotericin B (1), fluconazole (FCZ), and itraconazole (ITZ) using clinical isolates of Candidaspp. in cancer patients. Methods: isolates of C. albicans (n=136), C. tropicalis (n=36), and Candidaspp. (n=17) were tested by the two methods. The Kappa index was used to establish the degree of agreement between the methods. Results: the degree of agreement between the two methods was high for AB (κ: 1) and FCZ (κ: 0.74) and was low for ITZ (κ: 0.49). Agreement was variable and specific for the various species: for ITZ and FCZ in C. albicans, it was 0.45 and 0.64, respectively. In C. tropicalis, it was of 0.48 and 0.91, and in Candidaspp., it was 0.73 and 0.87 respectively. Discussion: this study suggests that antifungal susceptibility testing using both methods is equivalent. Attention should be focused on differences and discrepancies associated with the species tested, the type of antifungal agent, and the incubation times, which can cause variations at the moment of interpreting the results obtained.

Actualización en Aspergilosis con énfasis en Aspergilosis invasora / Aspergillosis update with focus in invasive aspergillosis

El género Aspergillus es ubicuo en la naturaleza y de distribución universal. Por esta razón, el contacto con este hongo incluye hospederos inmunocompetentes e inmunosuprimidos. La vía aérea es la forma más frecuente de adquirir este hongo y sus manifestaciones clínicas y localización topográfica se relacionan con la interacción del hongo y la capacidad inmunológica del hospedero. La principal manifestación clínica de este hongo es a nivel respiratorio, con un impacto muy importante en mortalidad y morbilidad, especialmente en el paciente inmunosuprimido. Los pacientes con tumores hematológicos, trasplantes de corazón, pulmón y con sida son más susceptibles de presentar invasión tisular y vascular por este hongo, que en tales casos se manifiesta como Aspergilosis Invasora (AI). La AI ofrece dificultades diagnósticas en el hospedero inmunosuprimido por lo que en este grupo de pacientes el uso de métodos de diagnóstico no invasores permite guiar el abordaje terapéutico. En la actualidad se dispone de medicamentos antifúngicos del grupo de los azoles (voriconazol) y de las equinocandinas (caspofungina) que han mejorado el resultado de la AI. En este artículo se actualiza la literatura en cuanto al diagnóstico y tratamiento de la AI.

The genus Aspergillus is ubiquitous in nature and has universal distribution; for this reason contact with this fungus includes immunocompetent and non-immunocompetent hosts. The most common form of acquiring this fungus is through air, and its clinical manifestations and topographic location correspond to the interaction of the fungus and its host's immune capacity. The main clinical manifestation of this fungus is a breathing condition and has a very significant impact on mortality and morbidity, especially in non-immunocompetent patients. Patients with haematological malignancies, heart or lung transplant surgeries, and AIDS are the most susceptible to present tissue and vascular invasion by this fungus in the form of invasive aspergillosis (IA). The IA presents diagnostic difficulties in non-immunocompetent hosts; therefore using non-invasive diagnosis methods for this group of patients offers therapeutic approach guidance. Antifungal drugs such as azoles (voriconazole) and echinocandins (caspofungin), that have improved the AI group results, are available nowadays. This article updates the literature on AI diagnosis and treatment.

Sensibilidad in vitro de hongos miceliales de aislamientos clínicos en pacientes con cáncer en el Instituto Nacional de Cancerología ESE / in vitro susceptibility of clinical isolates of filamentous fungi in patients with cancer in the Instituto Nacional de Cancerología

Introducción: la sensibilidad antifúngica in vitro en hongos filamentosos no ha tenido el mismo desarrollo que en levaduras. Se dispone de limitada información sobre la susceptibilidad en este tipo de aislamientos en Colombia. Materiales y métodos: se determinó la actividad in vitro de fluconazol, voriconazol, itraconazol, anfotericina B y caspofungina mediante el método de E-Test, de los géneros Aspergillus (36 A. fumigatus, 12 A. flavus, 9 A. niger, 6 A. terreus, 4 A. nidulans y 1 A. versicolor) e hifomicetes hialinos (9 Fusarium sp., 2 Geotrichum sp. y 2 Paecilomyces sp.), provenientes en su mayoría de lavados broncoalveolares (30%) y biopsias pulmonares (36%); 9% provenían de hemocultivos. Resultados: el perfil de resistencia general fue 28% para itraconazol, 15% para caspofungina, 14% para anfotericina B y 5% para voriconazol. En general, todos los aislamientos presentaron una sensibilidad disminuida para fluconazol e itraconazol. La mejor actividad farmacológica la presentaron voriconazol, caspofungina y anfotericina B. Fusarium sp. presentó una mayor actividad con el voriconazol. Se encontraron diferencias entre el tipo de micelio (Aspergillus vs no Aspergillus) y la susceptibilidad a voriconazol, anfotericina B y caspofungina. Conclusión: en general, los antimicóticos disponibles para el tratamiento de infecciones por miceliales muestran una sensibilidad disminuida in vitro en relación con el género y la especie identificada.

Introduction: fungal susceptibility against micelial fungi has not been developed at the same pace as susceptibility against yeasts. Scarce information is available about that kind of isolates in Colombia. Materials and methods: in vitro susceptibility against micelial isolates from patients with cancer was determined. The E-test method was used to find out susceptibility against fluconazole, voriconazole, itraconazole, amphotericin B, and caspofungin. Isolates of the genera Aspergillus (36 A. fumigatus, 12 A. flavus, 9 A. niger, 6 A. terreus, 4 A. nidulans and one A. versicolor isolate), Fusarium (n=9), Geotrichum and Paecilomyces (n=2 each one) obtained from patients with cancer were tested. These isolates were obtained from bronchoalveolar lavage (30%), pulmonary biopsies (36%) and bloodstream infections (9%). Results: The general pattern of resistance was 28% against intraconazole, 15% against caspofungin, 14% against amphotericin B, and 5% against voriconazole. In general, susceptibility against fluconazole and itraconazole showed a diminishing trend. Voriconazole, caspofungin, and amphotericin B showed the best pharmacologic potency. Fusarium sp. presented a higher activity level against voriconazole. There were differences in the susceptibility against voriconazole, anphotericin B, and caspofungin depending on the type of micelial isolate (Aspergillus vs. Non- Aspergillus). Conclusion: In general, the available antifungal treatments against mycelial fungi identified in the cancer center show diminished susceptibility.

Serum levels of soluble mesothelin-related peptides in malignant and nonmalignant asbestos-related pleural disease: relation with past asbestos exposure.

BACKGROUND: Malignant pleural mesothelioma (MPM) results from malignant transformation of mesothelial cells. Past asbestos exposure represents a major risk factor for MPM and other benign pleural disease. Soluble mesothelin-related peptides (SMRP) have been regarded as a promising serum biomarker for MPM. The aim of this study was to investigate serum levels of SMRP in malignant and nonmalignant asbestos-related pleural disease. PATIENTS: Four groups of patients were investigated: group 1 composed of 48 healthy subjects, group 2 composed of 177 patients with previous asbestos exposure and no pleural disease, group 3 composed of 36 patients with MPM, and group 4 composed of 101 patients with previous asbestos exposure and benign pleural disease. Serum SMRP levels were determined by ELISA. RESULTS: Serum SMRP levels were significantly higher among group 3 than the other three groups. There were no differences in SMRP concentrations between groups 2 and 4. Subjects exposed to asbestos had higher SMRP concentrations than normal control subjects regardless of the presence of pleural disease. The area under the receiver operating characteristic curve for SMRP values was 0.75 (95% confidence interval, 0.68-0.83). The SMRP level at 0.55 nmol/L/L was determined as the most optimal cutoff value with resulting sensitivity and specificity of 72% and 72% for the diagnosis of MPM. CONCLUSIONS: These data attest to good diagnostic sensitivity and specificity of SMRP for the diagnosis of malignant mesothelioma. We have also shown that serum SMRP levels might serve as a marker of asbestos exposure.