Gustavo Trindade Michel

Diretrizes brasileiras para pneumonia adquirida na comunidade em adultos imunocompetentes - 2009

Community-acquired pneumonia continues to be the acute infectious disease that has the greatest medical and social impact regarding morbidity and treatment costs. Children and the elderly are more susceptible to severe complications, thereby justifying the fact that the prevention measures adopted have focused on these age brackets. Despite the advances in the knowledge of etiology and physiopathology, as well as the improvement in preliminary clinical and therapeutic methods, various questions merit further investigation. This is due to the clinical, social, demographical and structural diversity, which cannot be fully predicted. Consequently, guidelines are published in order to compile the most recent knowledge in a systematic way and to promote the rational use of that knowledge in medical practice. Therefore, guidelines are not a rigid set of rules that must be followed, but first and foremost a tool to be used in a critical way, bearing in mind the variability of biological and human responses within their individual and social contexts. This document represents the conclusion of a detailed discussion among the members of the Scientific Board and Respiratory Infection Committee of the Brazilian Thoracic Association. The objective of the work group was to present relevant topics in order to update the previous guidelines. We attempted to avoid the repetition of consensual concepts. The principal objective of creating this document was to present a compilation of the recent advances published in the literature and, consequently, to contribute to improving the quality of the medical care provided to immunocompetent adult patients with community-acquired pneumonia.Community-acquired pneumonia continues to be the acute infectious disease that has the greatest medical and social impact regarding morbidity and treatment costs. Children and the elderly are more susceptible to severe complications, thereby justifying the fact that the prevention measures adopted have focused on these age brackets. Despite the advances in the knowledge of etiology and physiopathology, as well as the improvement in preliminary clinical and therapeutic methods, various questions merit further investigation. This is due to the clinical, social, demographical and structural diversity, which cannot be fully predicted. Consequently, guidelines are published in order to compile the most recent knowledge in a systematic way and to promote the rational use of that knowledge in medical practice. Therefore, guidelines are not a rigid set of rules that must be followed, but first and foremost a tool to be used in a critical way, bearing in mind the variability of biological and human responses within their individual and social contexts. This document represents the conclusion of a detailed discussion among the members of the Scientific Board and Respiratory Infection Committee of the Brazilian Thoracic Association. The objective of the work group was to present relevant topics in order to update the previous guidelines. We attempted to avoid the repetition of consensual concepts. The principal objective of creating this document was to present a compilation of the recent advances published in the literature and, consequently, to contribute to improving the quality of the medical care provided to immunocompetent adult patients with community-acquired pneumonia.

Asymptomatic presentation of chronic pulmonary paracoccidioidomycosis: case report and review

Asymptomatic presentations of chronic pulmonary paracoccidiodomycosis have beenreported since 1959, usually published in case series of paracoccidiodomycosis. Incidental radiographic findings on chest roentgenogram led to diagnostic evaluation in these cases. An unusual case in a female patient is described, and 24 previously reported cases are reviewed.

An unusual presentation of paracoccidioidomycosis in an AIDS patient: A case report

A case of paracoccidioidomycosis presenting as a solitary pulmonary nodular lesion in a patient with acquired immunodeficiency syndrome (AIDS) is presented. This case illustrates that restricted lung lesions can also be found and diagnosed in immunodeficient patients.

Histoplasmose pulmonar cavitária crônica

Histoplasmosis is a systemic mycosis caused by the thermally dimorphic fungus Histoplasma capsulatum, which can be isolated from soil contaminated with droppings from birds or bats. Chronic cavitary pulmonary histoplasmosis is one of the rarest clinical presentations of this disease. The differential diagnosis with tuberculosis should be made in patients presenting with cavitated lesions in upper lung segments. We report the case of a female patient with chronic cavitary pulmonary histoplasmosis who had presented with progressive dyspnea and worsening of the radiological pattern over a four-year period.

Poliangeíte microscópica com hemorragia alveolar difusa

Poliangeite microscopica e uma forma de vasculite sistemica de pequenos vasos, associada aos anticorpos anticitoplasma de neutrofilos, que preferencialmente acomete venulas, capilares e arteriolas, e que pode, entretanto, envolver arterias e veias. Esta entre as vasculites sistemicas primarias de pequenos vasos mais frequentes, e pode ter apresentacao clinica indistinguivel da granulomatose de Wegener e da sindrome de Churg-Strauss. Estas vasculites de pequenos vasos sao histologicamente semelhantes e podem ser diferenciadas pela presenca de granulomas na granulomatose de Wegener, ou de quadro clinico-funcional de asma na sindrome de Churg-Strauss. Relata-se o caso de um paciente do sexo masculino de 66 anos com poliangeite microscopica com hemorragia alveolar difusa como forma de apresentacao clinica, com enfase no diagnostico diferencial com outras vasculites pulmonares de pequenos vasos.

Granulomatose broncocêntrica idiopática em jovem não asmática

Bronchocentric granulomatosis is histopathologically defined as being characterized by necrotizing granulomatous inflammation centered in the bronchi or bronchioles, which can be idiopathic or associated with infectious, immunologic or neoplastic diseases. This paper reports the case of a 26 year old nonasthmatic young woman with a 1-month history of chest pain, fever and productive cough. Chest radiography and computerized tomography were performed, and an open-lung biopsy was submitted to histological analysis. Radiographs and tomographs revealed consolidation and cavitation in the lingula. Transbronchial needle aspiration showed nonspecific inflammatory lesions, and no etiologic agent was identified. Histological examination of the specimen obtained by open-lung biopsy was consistent with idiopathic bronchocentric granulomatosis. The patient responded positively to prednisone therapy, and no relapse was documented.