Ana Pando-Sandoval

T-cell profiling and the immunodiagnosis of latent tuberculosis infection in patients with inflammatory bowel disease.

Background:Factors associated with performance of interferon-&ggr; release assays (IGRA) and the tuberculin skin test (TST) in screening for latent tuberculosis infection in patients with inflammatory bowel diseases (IBD) are still poorly understood. The influence of peripheral T-cell subset counts on the results also remain unclear. Methods:Prospective single-center study in 205 patients with IBD. Latent tuberculosis infection screening included a chest radiograph, TST (retest if negative), and 2 IGRAs: QuantiFERON-TB Gold In-Tube (QFT-GIT) and TSPOT-TB (TSPOT). T-cell subpopulations were determined by flow cytometry. Results:Twenty-one (10.2%) patients had an abnormal chest radiograph, 55 (26.8%) had a positive TST, 16 (7.8%) had a positive QFT-GIT, and 25 (12.6%) had a positive TSPOT. TST positivity was lower in patients on ≥2 immunosuppressants compared with the controls (5-aminosalicylic acid treatment) (10.4% versus 38.2%, respectively) (P = 0.0057). No other drugs influenced TST or IGRA positivity. In patients on corticosteroid treatment, anti-TNF treatment, or ≥2 immunosuppressants, IGRAs detected 10 cases of latent tuberculosis infection not identified by TST. TSPOT and QFT-GIT increased yield by 56% and 22%, respectively. No significant differences in T-cell subpopulations were found between patients with positive or negative TST or TSPOT results. However, patients with positive QFT-GIT findings had more CD8+ T cells (mean, 883 ± 576 versus 484 ± 385 cells per microliter in patients with negative results) (P = 0.022). Conclusions:IGRAs can improve TST-based screening in patients with IBD on immunosuppressive therapy. A low CD8+ count can affect QFT-GIT results. We suggest combining TSPOT and TST screening in patients with IBD on immunosuppressants.

Transbronchial cryobiopsy in interstitial lung disease: experience in 106 cases – how to do it

Transbronchial biopsy using forceps (TBB) is the first diagnostic technique performed on patients with interstitial lung disease (ILD). However, the small size of the samples and the presence of artefacts in the tissue obtained make the yield variable. Our objectives were 1) to attempt to reproduce transbronchial cryobiopsy under the same conditions with which we performed conventional TBB, that is, in the bronchoscopy unit without intubating the patient and without fluoroscopy or general anaesthesia; 2) to describe the method used for its execution; and 3) to analyse the diagnostic yield and its complications. We carried out a prospective study that included 106 patients with clinical and radiological features suggestive of ILD who underwent cryo-transbronchial lung biopsy (cryo-TBB) under moderate sedation without endotracheal intubation, general anaesthesia or use of fluoroscopy. We performed the procedure using two flexible bronchoscopes connected to two video processors, which we alternated until obtaining the number of desired samples. A definitive diagnosis was obtained in 91 patients (86%). As for complications, there were five pneumothoraces (4.7%) and in no case was there severe haemorrhage or exacerbation of the underlying interstitial disease. Cryo-TBB following our method is a minimally invasive, rapid, safe and economic technique that can be performed in a bronchoscopy suite under moderate sedation without the need for intubating the patient or using fluoroscopy and without requiring general anaesthesia. Transbronchial cryobiopsy in interstitial lung disease http://ow.ly/jz1F309tMyf

Community-Acquired Moraxella catarrhalis Bacteremic Pneumonia: Two Case Reports and Review of the Literature

Moraxella (formerly Branhamella) catarrhalis was discovered at the end of the nineteenth century, and for many decades it was considered to be a harmless commensal of the upper respiratory tract. It is a Gram-negative, aerobic diplococcus considered to be the third most common pathogen isolated in childhood sinusitis and otitis media and in adult chronic lower respiratory disease, as well as an etiological agent of pneumonia in immunosuppressed patients or those with chronic obstructive pulmonary disease. Moraxella catarrhalis pneumonia is rarely associated with bacteremia. Here, we present two cases of community-acquired Moraxella catarrhalis bacteremic pneumonia.

Community-acquired bacteremic Streptomyces atratus pneumonia in an immunocompetent adult: a case report

IntroductionStreptomyces spp. are aerobic, Gram-positive bacteria of the order Actinomycetales, known for their ability to produce antimicrobial molecules such as streptomycin. Pneumonia due to Streptomyces is considered to be rare and limited to immunocompromised patients. Streptomyces spp. are only rarely associated with invasive systemic infections. To our knowledge, we report the first documented case of community-acquired Streptomyces atratus bacteremic pneumonia in an immunocompetent patient.Case presentationWe describe a case of Streptomyces atratus bacteremic pneumonia in an otherwise healthy, 77-year-old Spanish man. Streptomyces identified by 16S ribosomal RNA sequencing grew in multiple blood cultures and bronchoalveolar lavage cultures. The infection resolved completely after treatment with imipenem and amoxicillin/clavulanic acid for 2 months.ConclusionsThe majority of cases reported in the literature make reference to the difficulty of determining the pathogenic role of Streptomyces spp. Usually considered a contaminant, the pathogenic role of Streptomyces spp. is easier to confirm when the species is isolated from a catheter tip and, in the case of blood cultures, in more than one sample with a high count of colonies. To our knowledge, we report the first documented case of Streptomyces atratus bacteremic pneumonia in an immunocompetent patient. As the experience is limited, further studies are needed to better understand the interpretation of the isolates of the genus Streptomyces; the predisposing factors for infection; and the course, treatment, and evolution of these infections.

Community-Acquired Pneumonia and Empyema Caused by Citrobacter koseri in an Immunocompetent Patient

Citrobacter species, belonging to the family Enterobacteriaceae, are environmental organisms commonly found in soil, water, and the intestinal tracts of animals and humans. Citrobacter koseri is known to be an uncommon but serious cause of both sporadic and epidemic septicemia and meningitis in neonates and young infants. Most cases reported have occurred in immunocompromised hosts. The infections caused by Citrobacter are difficult to treat with usual broad spectrum antibiotics owing to rapid generation of mutants and have been associated with high death rates in the past. We believe this is the first case described in the literature of a community-acquired pneumonia and empyema caused by Citrobacter koseri in an immunocompetent adult patient.

Afectación pulmonar por ácido transretinoico en el tratamiento de la leucemia promielocítica aguda

limits its field of action to the tracheal and main bronchi. As this is a rigid instrument, it cannot be used with flexible bronchoscopy. It has been used in both malignant and benign lesions.2,3 The literature on this device has all been generated outside Spain, and there is no record of it having been used in the lower airway in this country. The main reason for choosing the microdebrider was that the patient presented an abnormal spirometry with a severe mixed pattern, and needed oxygen therapy at higher levels to maintain safe oxygen saturation. Thermo ablative endoscopic procedures (lasers, electrocautery, argon plasma) are known to require low FiO2 due to the risk of ignition. Moreover, the speed with which mechanical resection can be performed greatly reduces anesthesia time, which is an important factor in patients with low cardiorespiratory reserves. Our patient had a permanent pacemaker, preventing the use of bronchial electrocautery. Another alternative would have been cryotherapy, but this is not available in our hospital. In summary, we believe that mechanical debridement with this device offers new possibilities, and can be used when conventional thermoablation is either unavailable or unsafe. References

From cytology to histology: diagnosis of a relapsed mediastinal lymphoma by endobronchial ultrasound transbronchial histological needle.

Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) is highly accurate in diagnosing mediastinal lymphadenopathies of lung cancer and benign disorders, with the advantage that it is a minimally invasive technique, unlike open surgery and mediastinoscopy. However, the diagnostic accuracy of EBUS‐TBNA for the diagnosis of lymphoma in patients with mediastinal lymphadenopathy is not well defined. The lack of tissue architecture obtained by cytological needles decreases the diagnostic accuracy for diagnosis and subtyping of de novo and relapsed mediastinal lymphomas. We present the first described case in the literature of an anaplastic large cell lymphoma relapsed, diagnosed on tissue fragments obtained by EBUS‐TBNA with the particularity of using a histological needle.

Finger-in-glove sign in congenital bronchial atresia.

1Hospital Universitario Central de Asturias (HUCA). Instituto Nacional de Silicosis (INS). Area del Pulmon. Facultad de Medicina. Universidad de Oviedo. Oviedo. Espana; 2Hospital Universitario Central de Asturias (HUCA). Departamento de Radiologia. Oviedo, Espana. Correspondence: Dr Miguel Angel Ariza Prota, Instituto Nacional de Silicosis (INS), Area del Pulmon, Hospital Universitario Central de Asturias (HUCA), Facultad de Medicina, Universidad de Oviedo, Avenida Roma s/n, Oviedo, Asturias 33011, Spain. Telephone 34-69006806, e-mail arizamiguel@hotmail.com A 60-year-old woman was referred to the authors’ hospital in 2012, with a three-month history of nonproductive cough. She had no chest pain, night sweats or fever. She had no known toxic habits, nor surgical or medical background of interest. The chest x-ray showed loss of normal lung markings in the left upper lobe and a rounded, branching opacity mass lesion in the area of the left hilum (finger-in-glove sign) (Figure 1A). A computed tomography scan of the chest showed mucoid impactation, segmental hyperlucency and decreased vascularity of the left upper lobe (Figure 1B). Three-dimensional reconstruction of the bronchial tree revealed an atretic apicoposterior segmental bronchus of the left upper lobe confirming the diagnosis of congenital bronchial atresia (Figure 1C).

Tuberculosis miliar con afectación vertebral (mal de Pott)

Fig. 1. (A) Multiple uniform nodules, approximately 1 mm in size, with diffuse, bilateral, random distribution, predominantly in the upper lobes, with no pulmonary parenchymal distortion. (B) Circumferential soft tissue mass showing peripheral enhancement, containing areas of trapped fluid. The mass has a significant prevertebral component and a small anterior epidural component, causing slight compression of the medulla, but with no compressive myelopathy

Descripción de casos de derrame pleural secundario a Streptococcus milleri

In this study we analyzed the characteristics of patients with pleural effusion secondary to Streptococcus milleri studied retrospectively between January and March 2013 and found seven patients with a mean age of 60 years, 43% of which were smokers and 57% with a drinking habit. The most common associated factors were alcoholism, previous pneumonia and diabetes. Other bacteria were identified as Enterobacter aerogenes, Bacteroides and Prevotella intermedia capillosus in two patients. The mean duration of antibiotic therapy was 28 days; six patients underwent pleural drainage by chest tube and one patient needed surgery due to poor clinical progress. The mean duration of hospitalization was 30 days with satisfactory outcome in all cases, despite some changes in residual function.