A rare complication of chronic granulomatous disease in a child: constrictive aspergillus pericarditis.

A 3-year-old girl with the diagnosis of chronic granulomatous disease (CGD) was hospitalized for bronchopneumonia and congestive heart failure. Her medical history included methylprednisolone medication for autoimmune gastric outlet obstruction. Computed tomography revealed pneumonic infiltrations and pericardial thickening. A pulsed-wave Doppler recording revealed E/A >1. During a pericardiectomy, multiple islands of thick, firm-walled, fibrinous exudate-containing, small abscess formations were observed. Histopathological evaluation of pericardial tissue revealed granulomatous inflammation. Aspergillus fumigatus was cultured from the abscess. In conclusion, development of constrictive aspergillus pericarditis should be considered in patients with CGD because immediate initiation of antifungal management with aggressive surgical treatment is life-saving.

Endobronchial avium mycobacteria infection in an immunocompetent child.

A 12-month-old boy, with no medical history, was admitted for dyspnoea with no cough or fever. Chest auscultation revealed an expiratory wheezing with decreased right-sided breath sounds. Chest imaging revealed subcarinal adenopathy and a nodule in the right principal bronchus (RB). Bronchoscopy showed a major obstruction of the RB by a granuloma, and a smaller granuloma in the left principal bronchus. The granulation tissue was removed by laser section. Histological examination revealed a necrotising granulomatous inflammation, culture showed a Mycobacterium avium complex (MAC). Tests to rule out tuberculosis and immunodeficiency were negative. The diagnosis of an MAC endobronchial granuloma was ascertained and a multidrug therapy associating clarithromycin, rifampin and ethambutol was started. The clinical outcome was good after 3 months of treatment and the bronchoscopy normalised after 1 year. Although rare, the frequency of MAC respiratory infections in immunocompetent children can increase. Reporting these cases should help to optimise diagnosis and treatment.

Aspergillus fumigatus Bronchopneumonia in a Hellenic Shepherd Dog.

A 3 yr old intact female Hellenic shepherd dog was referred due to depression, partial anorexia, fever, and a mild productive cough of 2 mo duration. Thoracic radiographs showed increased opacity of all of the left lung lobes. Upon bronchoscopy, a sanguineous, purulent discharge was detected in the tracheal lumen with hyperplastic tissue narrowing the left main stem bronchus. Cultures were positive for bacteria (Bacillus spp. and Clostridium spp.) but negative for fungi. Due to the severity of the lesions, a complete left lung pneumonectomy was performed. Histopathological examination of the excised lung tissues revealed a severe granulomatous bronchopneumonia with numerous alveolar macrophages laden with structures stained positively by periodic acid-Schiff and Grocott stain that had morphology consistent with fungi. PCR and sequencing of internal transcribed spacer regions 1 and 2 from genetic material extracted from paraffin-embedded pulmonary tissue confirmed the presence of Aspergillus fumigatus. Itraconazole was administrated for 5.5 mo and the dog was clinically normal 26 mo after surgery.

[Paraoesophageal cyst revealed by repeated infections]. / Kyste para-oesophagien révélé par des broncho-pneumopathies récidivantes.

Paraoesophagial cyst is an extremely rare congenital malformation of the oesophagus often discovered incidentally in adults. We report the case of a paraoesophageal cyst in a 45 year old man revealed by recurrent chest infections and confirmed by examination at surgery.

Colheita do fluido brônquio-alveolar de bezerros através da traqueocentese transcutânea / Colection of bronchoalveolar fluid in calves by transcutaneous tracheocenthesis

Foi estudada uma técnica da traqueocentese transcutânea, praticada na regiäo cervical ventro-medial, para colheita de secreçäo brônquica de bezerros acometidos de broncopneumonia. Foram colhidas amostras de secreçäo nasal, através de "swabs" para comparaçäo da microflora da secreçäo brônquica, empregando-se a traqueocentese em 52 bezerros com diagnóstico clínico de broncopneumonia. A traqueocentese foi realizada em nível de campo, com material de fácil aquisiçäo e manipulaçäo, mostrando-se eficiente para colheita de secreçäo brônquica, facilmente exequível com o animal em estaçäo, sob contençäo mínima e sem necessidade de anestesia. A quantidade de secreçäo brônquica colhida foi suficiente para execuçäo dos exames bacteriológicos. Os exames demonstraram que a traqueocentese reduziu significativamente (P<0,01) o número de enterobactérias, possivelmente contaminantes, em relaçäo ao "swab" nasal

[Decanulation of tracheostomised children (author's transl)]. / Decanulación en ninños traqueotomizados

It is described eight tracheostomised patients, advising an early and gradual tracheal decanulation using silver tracheostomy tube with a window in the posterior curvature (fenestrated tube, Alder Hey pattern) and proper sedation at the moment of definitive decanulation. Decanulation techniques and the mechanical and functional difficulties that can occur and how to avoid them are described: Finally the tracheostomy tubes that have been used are mentioned.