IFITM3 and severe influenza virus infection. No evidence of genetic association.

Influenza virus infection (IVI) is typically subclinical or causes a self-limiting upper respiratory disease. However, in a small subset of patients IVI rapidly progresses to primary viral pneumonia (PVP) with respiratory failure; a minority of patients require intensive care unit admission. Inherited and acquired variability in host immune responses may influence susceptibility and outcome of IVI. However, the molecular basis of such human factors remains largely elusive. It has been proposed that homozygosity for IFITM3 rs12252-C is associated with a population-attributable risk of 5.4 % for severe IVI in Northern Europeans and 54.3 % for severe H1N1pdm infection in Chinese. A total of 148 patients with confirmed IVI were considered for recruitment; 118 Spanish patients (60 of them hospitalized with PVP) and 246 healthy Spanish individuals were finally included in the statistical analysis. PCR-RFLP was used with confirmation by Sanger sequencing. The allele frequency for rs12252-C was found to be 3.5 % among the general Spanish population. We found no rs12252-C homozygous individuals in our control group. The only Spanish patient homozygous for rs12252-C had a neurological disorder (a known risk factor for severe IVI) and mild influenza. Our data do not suggest a role of rs12252-C in the development of severe IVI in our population. These data may be relevant to recognize whether patients homozygous for rs12252-C are at risk of severe influenza, and hence require individualized measures in the case of IVI.

Utilización del factor VII activado en lavado bronco alveolar en un caso de hemorragia pulmonar / Use of recombinant activated factor VII in bronchoalveolar lavage in a case of pulmonary

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Empiema causado por Streptococcus constellatus / Emphyema by Streptococcus constellatus

We presented a case of patient with bipolar disorder that he was admitted in the respiratory unit of our hospital by empyema produced by Streptococcus constellatus (S. constellatus). S. constellatus can produce lung infections, specially patients with airway manipulation. The response to treatment with penicillin usually are good (AU)

Presentamos el caso de un paciente diagnosticado de trastorno bipolar que ingresa en el servicio de neumología de nuestro hospital por un empiema producido por Streptococcus constellatus (S. constellatus). El S. constellatus puede producir infecciones pulmonares, especialmente en pacientes con una manipulación previa de la vía aérea. La respuesta al tratamiento con penicilinas suele ser buena (AU)

Pacientes con adenopatías calcificadas / Patient with calcified lymph nodes

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¿Está cambiando la etiología de las bronquiectasias? / Is the etiology of bronchiectasis changing?

Introducción: Las bronquiectasias (BQ) constituyen el estadio final de una heterogénea variedad de procesos patológicos.Objetivo: Valorar la etiología de las BQ de los pacientes derivados a una consulta monográfica de esta patología de un hospital terciario, durante el período comprendido entre julio 2002 a septiembre 2005.Pacientes y métodos: Se incluyeron todos los pacientes que fueron remitidos a la consulta con el diagnóstico de BQ mediante tomografía axial computarizada de tórax. Se les realizaron una historia clínica detallada, microbiología de esputo, espirometría, Mantoux y, en determinados casos, determinación de inmunoglobulinas IgE, IgG, IgA, IgM, IgG e IgE específicas a Aspergillus, proteinograma, anticuerpos antinucleares, test del sudor, estudio genético para fibrosis quística,radiografía de senos, espermiograma y estudio gastroduodenal.Resultados: Fueron evaluados 171 enfermos, 85 mujeres, con una edad media de 63,97 años (rango: 19-94). Presentaron una espirometría con porcentajes sobre el valor teórico de FVC: 69,83%, (19,92) y FEV1 67,01% (25,44). Se determinaron las siguientes etiologías causantes de las bronquiectasias: en el 38% fueron secundarias a tuberculosis, el 15,5%a enfermedad pulmonar obstructiva crónica, el 11,9% a asma, el 4,8% a enfermedad del tejido conectivo, el 4,2% a neumonía necrotizante, el 2,4% a enfermedad del cilio inmóvil, déficit de alfa 1 antitripsina y a inmunodeficiencias, el resto de las etiologías fueron inferiores al 2%. En 20 casos la etiología fue desconocida.Conclusión: Los protocolos diagnósticos de una consulta monográfica ayudan a establecer la causa primaria de las bronquiectasias. En nuestro medio las etiologías más frecuentes fueron la tuberculosis, la EPOC y asma

Objective: To evaluate the aetiology of bronchiectasis of patients from a monographic consult in an University hospital, from july 2002 to september 2005.Methods: All the patients with bronchiectasis diagnose confirmed by high resolution computed tomography (HRCT) were included. We made a clinical history, sputum microbiology, pulmonary function test, Mantoux test, and in certain cases: inmunoglobulins E, G, A, M, Aspergillus inmunoglobulins G and E, proteinogram, autoantibodies, sweat chloride test, CF genotyping, sinus radiology,spermiogram, and barium swallow/oesophageal imaging.Results: 171 patients were evaluated, 85 women, with a mean age of 63.97 years (range 19-94). They had a spirometry with FVC 69.83 % (19.92) and FEV 1 67.01 %(25.44). The causes of bronchiectasis ere: 38% due to tuberculosis, 15,5% to chronic obstructive pulmonary disease (COPD), 11.9% to asthma, 4.8% to collagen diseases, 4.2% to necrotizing pneumonia, 2.4% to inmotile cilia syndrome; other aetiologies were less than 2%. In 20 cases the aetiology was unknown.Conclusion: The diagnostic guidelines in a monographic consult help to determinate the mean cause of the bronchiectasis. In our area the most frequent causes were the tuberculosis, the COPD and the asthma

Impact of initial antibiotic choice on mortality from pneumococcal pneumonia.

To determine the impact of initial antimicrobial choice on 30-day mortality rate in patients with community-acquired pneumonia due to Streptococcus pneumoniae (CAP-SP), a prospective, observational study was conducted in 35 Spanish hospitals. A total of 638 patients with CAP-SP were identified. Antimicrobials were chosen by the attending physician. Patients were grouped into the following categories: beta-lactam monotherapy (n = 251), macrolide monotherapy (n = 37), beta-lactam plus macrolide (n = 198), levofloxacin alone/combination (n = 48), and other combinations (n = 104). The reference category was beta-lactam+macrolide. The 30-day survival probability was 84.9%. Using multivariate survival analysis, factors related to mortality in the entire population were: bilateral disease, suspected aspiration, shock, HIV infection, renal failure and pneumonia severity index (PSI) score Class IV versus I-III and categories V versus I-III. The association of beta-lactams+macrolides was not better than the use of beta-lactams alone. The current authors analysed the different groups of patients with significant mortality/morbidity: intensive care unit, PSI Class >III, renal failure, chronic lung disease and bacteraemia. Only in patients with PSI Class >III, who had undergone initial antimicrobial choice classified as other combinations, were associated with higher mortality. In conclusion, the current authors have not demonstrated an independent association between initial antimicrobial regimen and 30-day mortality in community-acquired pneumococcal pneumonia patients, except for those with a higher pneumonia severity index score.

Bronchoalveolar lavage in smokers: quantification of alveolar macrophages and neutrophils as markers of bronchial obstruction.

Increased concentrations of neutrophils and alveolar macrophages are recovered in the bronchoalveolar lavage (BAL) of smokers compared with non-smokers. We designed a study to determine the relationship between neutrophils and alveolar macrophages recovered by BAL and the degree of air-flow obstruction, measured by spirometry (chronic air-flow obstruction was defined as: FEV1 < 80% of predicted and FEV1/FVC ratio < 70% of predicted) in healthy smokers. We found a significant correlation between spirometric values and the number of neutrophils and alveolar macrophages in BAL fluid obtained from healthy smokers. Our findings suggest that counts of 13-15x1000 neutrophils/ml and/or 430-450x1000 alveolar macrophages/ml in BAL fluid could be used as markers of air-flow obstruction in smokers.