When polymerase chain reaction does not help: cytomegalovirus pneumonitis associated with very low or undetectable viral load in both blood and bronchoalveolar lavage samples after lung transplantation.

Cytomegalovirus (CMV) pneumonitis occurs frequently among solid organ transplant recipients and is classically associated with significant viral replication in both blood and bronchoalveolar lavage (BAL) samples. We present a case of a 64-year-old lung transplant recipient who presented with CMV pneumonitis that was diagnosed based on the association of viral inclusion in the BAL sample, rapid response to ganciclovir, and absence of other infectious etiology. Surprisingly, we observed very low or undetectable viral load both in blood and BAL samples. Diagnosis of CMV pneumonitis should rely on the association of clinical, pathological, radiological, and microbiological signs, while quantitative nucleic acid amplification testing should be interpreted with caution.

[Complications of lung transplantation]. / Complications de la transplantation pulmonaire: complications médicales.

In 2009 lung transplantation is a valuable therapeutic option for a number of patients suffering from end-stage pulmonary diseases. Lung transplantation frequently offers a major improvement in quality of life; however, long-term survival is often limited by the development of the bronchiolitis obliterans syndrome, which is the equivalent of a chronic pulmonary graft rejection. As the bronchiolitis obliterans syndrome is the commonest cause of death in the medium- and long-terms, all patients receive intense immunosuppressive treatment in order to prevent or stabilize this complication. This treatment induces a number of potentially severe complications including metabolic complications, infections and malignancies. The most frequent metabolic complications are arterial hypertension, chronic renal insufficiency, hyperlipidaemia, diabetes and osteoporosis. Bacterial, viral and fungal infections are the second commonest cause of mortality. They are to be considered as medical emergencies and require urgent assessment and targeted therapy after microbiological specimens have been obtained. They should not under any circumstances be treated empirically and it should also be kept in mind that the lung transplant recipient may present several concomitant infections. The most frequent malignancies are post-transplant lymphoproliferative disorders, cutaneous neoplasias, Kaposi's sarcoma, some peculiar types of head and neck neoplasia, bronchogenic carcinomas and cancers of the digestive tract. The respiratory physician should recognize the symptoms and signs of specific complications induced by the immunosuppressive regimen and the goal of this report is to give a general overview of the most frequently encountered complications. Their assessment and treatment, though, will most often require the input of other specialists and a multidisciplinary approach.

[Medical complications of lung transplantation]. / Complications non chirurgicales de la transplantation pulmonaire.

In 2010, lung transplantation is a valuable therapeutic option for a number of patients suffering from of end-stage non-neoplastic pulmonary diseases. The patients frequently regain a very good quality of life, however, long-term survival is often hampered by the development of complications such as the bronchiolitis obliterans syndrome, metabolic and infectious complications. As the bronchiolitis obliterans syndrome is the first cause of death in the medium and long term, an intense immunosuppressive treatment is maintained for life in order to prevent or stabilize this complication. The immunosuppression on the other hand induces a number of potentially severe complications including metabolic complications, infections and malignancies. The most frequent metabolic complications are arterial hypertension, chronic renal insufficiency, diabetes, hyperlipidemia and osteoporosis. Bacterial, viral and fungal infections are the second cause of mortality. They are to be considered as medical emergencies and require urgent assessment and targeted therapy after microbiologic specimens have been obtained. They should not, under any circumstances, be treated empirically and it has also to be kept in mind that the lung transplant recipient may present several concomitant infections. The most frequent malignancies are skin cancers, the post-transplant lymphoproliferative disorders, Kaposi's sarcoma and some types of bronchogenic carcinomas, head/neck and digestive cancers. Lung transplantation is no longer an exceptional procedure; thus, the pulmonologist will be confronted with such patients and should be able to recognize the symptoms and signs of the principal non-surgical complications. The goal of this review is to give a general overview of the most frequently encountered complications. Their assessment and treatment, though, will most often require the input of other specialists and a multidisciplinary and transversal approach.

[Complications of lung transplantation: perioperative complications, acute and chronic rejection]. / Complications de la transplantation pulmonaire: complications péri-opératoires, rejet aigu et chronique.

In 2009 lung transplantation is a valuable therapeutic option for a spectrum of end-stage pulmonary diseases. To many patients who are dying, lung transplantation offers a new and normal life for several years. However, lung transplantation is a major surgical intervention associated with a significant early mortality. Moreover, matching according to the major human histocompatibilty antigens is impossible, exposing the recipient to an increased risk of acute and chronic rejection. Chronic rejection and its clinical corollary the bronchiolitis obliterans syndrome, is the main cause of death medium and long term. The immunosuppressive treatment administered in order to prevent or stabilize this complication induces a number of potentially severe complications including infection, malignancies, and cardio-vascular, metabolic and renal complications which not only limit autonomy and quality of life, but also cause death in a number of long term survivors. A better understanding of the precise mechanisms underlying the development of the bronchiolitis obliterans syndrome and the development of specific preventive or therapeutic strategies will be key elements for the improvement of long term survival. The control of this main cause of death will allow individual tailoring of the immunosuppressive therapy and decrease the incidence of infectious and metabolic complications.

Effects of low-dose dopamine on ventilation in patients with chronic obstructive pulmonary disease.

BACKGROUND: Dopamine plays an important role in the regulation of respiration and low-dose dopamine infusion is associated with a decreased respiratory drive response to hypoxia in animals and humans. The effects of dopamine on ventilation in patients with chronic obstructive pulmonary disease (COPD) is unknown. We tested the hypothesis that dopamine inhibits ventilation in patients with COPD. MATERIALS AND METHODS: In a double-blinded, cross-over, placebo-controlled, randomized study we studied nine patients with decompensated COPD, ventilated in the pressure support mode in the intensive care unit (ICU) and five ambulatory patients with stable COPD. All patients received 5 micro g kg(-1) min(-1) of dopamine or an equivalent volume of 5% glucose solution. RESULTS: In the mechanically ventilated COPD patients, there was no difference in the effects of dopamine compared with placebo on blood pressure, heart rate, minute ventilation (-0.5 +/- 1.1 vs. -0.2 +/- 0.9 L min(-1), P = 0.46, respectively), respiratory rate (-0.4 +/- 2.7 vs. -0.3 +/- 2.1 min(-1), P = 0.96), PaO(2) (-5 +/- 4 vs. -5 +/- 10 mmHg, P = 0.90, respectively), or PaCO(2) (-0.7 +/- 1.4 vs. -1.0 +/- 3.4 mmHg, P = 0.83, respectively). In spontaneously breathing stable patients, dopamine increased systolic blood pressure (P = 0.02) but did not influence other haemodynamic and respiratory variables. CONCLUSION: Although low-dose dopamine has been shown to depress ventilation in a variety of conditions, it does not compromise ventilation in COPD patients either breathing spontaneously or when weaned using pressure support ventilation.

Cloning of the antigen 85A from Mycobacterium gordonae and its use for the specific PCR identification of these mycobacteria.

The complete nucleotide sequence of 85A antigen of Mycobacterium gordonae was determined. This gene encodes 339 amino acids, including 43 amino acids for the signal peptide, followed by a mature protein of 296 amino acids. A polymerase chain reaction (PCR) assay for the rapid detection of M. gordonae DNA using two pairs of oligonucleotide primers, derived from our sequence, is described. This one-step PCR has been used successfully to amplify 38 strains of M. gordonae. Conversely, the primers did not amplify DNA from any of the 25 mycobacterial species tested. The results suggest that this PCR assay could be a good alternative to existing commercial assays for the specific identification of M. gordonae on early culture on solid medium or on early BACTEC broth culture.