ABSTRACT
The aim of this study was to determine the significance of isolation of Aspergillus fumigatus from cultures of respiratory specimens in nongranulocytopenic patients. The medical records of patients with respiratory specimens positive for Aspergillus fumigatus who were admitted to an adult pneumology ward were reviewed during a 2-year period. A total of 80 respiratory specimens from 76 patients yielded Aspergillus fumigatus. Forty-eight patients were colonized with Aspergillus fumigatus, whereas the 28 (37%) remaining patients had pulmonary aspergillosis, manifest as aspergilloma ( n=19 patients), chronic necrotizing pulmonary aspergillosis ( n=7 patients), and bronchial aspergillosis ( n=2 patients). The presence of typical hyphae in direct examination of bronchoscopic specimens was more likely to be found in infected than in colonized patients ( P=0.04). No immunological test was positive in colonized patients, whereas anti- Aspergillus antibodies were detected in 55% of infected patients ( P<0.001). Pulmonary tuberculosis was the most common underlying lung disease in patients with aspergilloma, but it was not found in any patient with chronic necrotizing pulmonary aspergillosis ( P=0.006). Anti- Aspergillus antibodies were more likely to be detected in patients with aspergilloma (78%) than in patients with chronic necrotizing pulmonary aspergillosis (14%) ( P=0.007). The analysis of predisposing factors, in conjunction with immunological tests and examination of bronchoscopic specimens, is helpful in distinguishing between colonization and infection with Aspergillus fumigatus, as well as for differentiating between aspergilloma and chronic necrotizing pulmonary aspergillosis.
Subject(s)
Aspergillosis, Allergic Bronchopulmonary/diagnosis , Aspergillus fumigatus/isolation & purification , Immunocompetence , Lung Diseases, Fungal/diagnosis , Adult , Age Distribution , Aged , Aspergillosis, Allergic Bronchopulmonary/epidemiology , Aspergillosis, Allergic Bronchopulmonary/immunology , Bronchoscopy/methods , Cohort Studies , Colony Count, Microbial , DNA, Fungal/analysis , Female , France/epidemiology , Granulocytes , Humans , Incidence , Lung Diseases, Fungal/epidemiology , Lung Diseases, Fungal/immunology , Male , Middle Aged , Probability , Prognosis , Retrospective Studies , Risk Assessment , Sex Distribution , Sputum/microbiologyABSTRACT
VIRUSES AND BACTERIA: The fact that the airways are exposed to a large number of infectious agents could explain the frequency of respiratory infections and their causal effect in bronchial inflammation. Viruses are most often the causal agent, but the frequency of bacterial infections make them potential candidates in certain respiratory diseases. Chlamydia are particularly important due to their capacity to provoke immune dysfunction and chronic inflammation. EFFECT ON ASTHMA: It is not surprising to find biological evidence of Chlamydia pneumoniae infection in a large number of subjects who experience major degradation of their asthma because asthmatic subjects are particularly susceptible to respiratory infections and Chlamydia pneumoniae is a frequent cause of such infections. PATHOGENIC EFFECT: Finding Chlamydia pneumoniae as the causal agent in asthma is however much more surprising, with a much different consequence. There are however many epidemiological and clinical findings and case observations (Chlamydia pneumoniae asthma associations, prolonged favorable course in certain obstructive bronchial diseases after a short antibiotic regimen) as well as provocative pathophysiological data favoring this particular form of "infectious asthma". FURTHER INFORMATION: Large-scale studies with rigorous methodology remain to be performed. The would be needed to determine the exact relationship between Chlamydia pneumoniae infections and certain types of asthma, particularly when wheezing occurs after a respiratory infection and when chronic obstruction develops. The could also determine the role of anti-Chlamydia pneumoniae antibiotics in case of obstructive respiratory failure and also determine their efficacy on long-term outcome.
Subject(s)
Asthma/etiology , Chlamydophila Infections/complications , Chlamydophila pneumoniae , Adult , Age Factors , Anti-Bacterial Agents/therapeutic use , Asthma/diagnosis , Child , Chlamydophila Infections/diagnosis , Chlamydophila Infections/drug therapy , Chlamydophila pneumoniae/isolation & purification , Humans , Microbiological Techniques , Middle Aged , Time FactorsABSTRACT
BACKGROUND: It is uncommon for manifestations of cytomegalovirus infection to be limited to the small bowel in AIDS patients. CASE REPORTS: Two HIV-positive patients developed cytomegalovirus infection involving the small bowel with no other visceral localization. Recurrences were frequent despite medical therapy. DISCUSSION: The clinical manifestations, diarrhea, fever, vomiting and abdominal pain, suggest the diagnosis of cytomegalovirus enteritis in AIDS patients. Confirmation is obtained from the small bowel study and pathology examination of biopsy specimens. Treatment is generally based on medical and surgical management using intravenous anti-cytomegalovirus drugs and partial resection. Prognosis often remains less than satisfactory in this condition which is often diagnosed late.
