Situación inmune en el anciano con neumonía durante el episodio agudo y tras el alta / Immune status in the elderly with pneumonia during the acute episode and after discharge

Objetivo: analizar la situación inmunológica básica de la neumonía en el anciano (NEA) durante el ingreso y a los 6 meses tras el alta, y su relación con la mortalidad. Material y métodos: estudio prospectivo en pacientes mayores de 65 años con NEA que ingresaron en el Servicio de Medicina Interna en el Hospital Virgen del Camino (Pamplona) en 2 años. Se estudian los datos epidemiológicos, clínicos, etiológicos, analíticos y antropométricos en el ingreso, y la evolución de la NEA al año del alta. Se determinan linfocitos totales, linfocitos T CD4, CD8, CD4/CD8, inmunoglobulinas, complemento (C3, C4, CH50), anticuerpos antinucleares (ANA), factor reumatoide e interleucina 6 (IL-6) en sangre periférica, así como multitest durante el ingreso. A los 6 meses del alta se estudian: linfocitos totales, linfocitos T, CD4, CD8, CD4/CD8 e IL-6. Para realizar las comparaciones entre los diversos parámetros, se aplica un nivel de significación de p < 0,05. Resultados: en el período estudiado se admitió a 125 pacientes con una edad media de 77,9 años (65-95). Fallecieron 11 pacientes (8,8%) durante el ingreso. En el seguimiento ambulatorio durante un año falleció un 30%. Los pacientes que fallecieron tuvieron menos linfocitos totales (p = 0,01), linfocitos T (p = 0,005), CD4 (p = 0,002), C3 (p = 0,001) y C4 (p = 0,001) que los que sobrevivieron. Los ANA estaban presentes en mayor proporción entre los fallecidos (p = 0,017). No se encontraron relaciones evidentes entre los parámetros inmunológicos estudiados y la mortalidad ambulatoria. Los linfocitos totales, linfocitos T, CD4 y los CD8 se recuperan significativamente a los 6 meses tras el alta. En cambio, los valores de IL-6 disminuyen a los 6 meses respecto al ingreso (p = 0,009). Conclusiones: las variables relacionadas con mayor mortalidad durante la NEA fueron: linfocitos totales, linfocitos T, CD4, CD8, C3, C4 y ANA. Se describe un aumento significativo de los valores de inmunidad celular a los 6 meses del alta

Objective: to analyze immune status in elderly patients with pneumonia during admission and at 6 months after discharge, as well as its association with mortality. Material and methods: we performed a prospective study in patients aged > 65 years old with pneumonia admitted to the Internal Medicine Department of the Hospital Virgen del Camino (Pamplona) over a 2-year period. Epidemiological, etiological, laboratory and anthropometric data were studied at admission and 1 year after discharge. Total lymphocytes, T lymphocytes, CD4, CD8, CD4/CD8, immunoglobulins, complement (C3, C4, CH50), antinuclear antibodies (ANA), rheumatoid factor and interleukin-6 (IL-6) in peripheral blood, as well as the multitest during admission, were studied. The following variables were studied 6 months after discharge: total lymphocytes, T lymphocytes, CD4, CD8, CD4/CD8, and IL-6. For the comparison of variables, a significance level of p < 0.05 was set. Results: during the study period, 125 patients with a mean age of 77.9 years (65-95) were admitted. Eleven patients (8.8%) died during admission. During the 1-year outpatient follow-up, 30% died. Patients who died had lower total lymphocyte (p = 0.01), T lymphocyte (p = 0.005), CD4 (p = 0.002), C3 (p = 0.001) and C4 (p = 0.001) levels than those who survived. Higher ANA concentrations were found among patients who died (p = 0.017). No clear associations were found between the immunological parameters studied and outpatient mortality. Levels of total lymphocytes, T lymphocytes, CD4 and CD8 were significantly increased at 6 months after discharge. In contrast, IL-6 levels were lower at 6 months after discharge than on admission (p = 0.009). Conclusions: the variables related to higher mortality in pneumonia in the elderly were total lymphocytes, T-lymphocytes, CD4, CD8, C3, C4 and ANA. Values of cellular immunity were significantly increased 6 months after discharge

Carmine (E-120)-induced occupational asthma revisited.

BACKGROUND: Occupational asthma (OA) caused by carmine (E-120) has been reported. OBJECTIVE: We sought to evaluate the prevalence of sensitization and OA at a natural dye processing factory in which 2 workers had been given a diagnosis of carmine-induced OA 6 years previously. METHODS: The 24 current employees and one worker who had recently left work because of asthma completed a questionnaire and underwent skin testing (carmine, cochineal, carminic acid, curcuma, annato, and chlorophyll), carmine IgE dot-blot analysis, and methacholine inhalation testing. Workers exhibiting positive occupational skin test responses, work-related asthma, or bronchial hyperresponsiveness underwent specific inhalation challenge and serial peak expiratory flow rate recording. RESULTS: Positive skin test responses to carmine (41.7%), cochineal (29.2%), and carminic acid (4.2%) were observed. Carmine IgE dot-blot results were positive in 4 subjects. No difference in atopy or smoking was observed between occupationally sensitized and nonsensitized subjects. Among the 5 employees reporting work-related asthma, 2 had positive skin test responses, and 4 had bronchial hyperresponsiveness. Five subjects underwent specific inhalation challenges: 2 workers had early asthma responses to carmine and cochineal challenges, and the remaining subjects did not have suggestive peak expiratory flow recordings. The subject who had left his job was given a diagnosis of carmine-induced OA. CONCLUSION: The prevalence of sensitization and OA caused by carmine was 41.6% and 8.3%, respectively. When the 3 workers who had left their jobs were included, the cumulative incidence of sensitization and OA was 48.1% and 18.5%, resembling the healthy worker effect. Prevention programs to establish the permissible levels of airborne allergen should be implemented.