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Baran E, D'Ascenzo MV, Bosia JD, Montaña P. Abdominal ultrasound findings in adult patients with cystic fibrosis. Rev Gastroenterol Mex (Engl Ed) 2024; 89:19-24. [PMID: 35882591 DOI: 10.1016/j.rgmxen.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 05/18/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION AND AIMS Cystic fibrosis (CF) is a genetic disease whose gastrointestinal compromise mainly involves the pancreas, bile ducts, and liver. Our aim was to analyze abdominal ultrasound findings. METHODS A retrospective, descriptive study was conducted on adults (patients ≥ 16 years of age) diagnosed with CF, within the time frame of 2006-2019. Clinical and genetic parameters, body mass index, forced expiratory volume in one second, pancreatic insufficiency, CF-related diabetes, cirrhosis secondary to CF, and abdominal ultrasound images were analyzed. RESULTS Seventy patients, 39 of whom were men (55.8%), had a mean age of 27 years and a mean body mass index of 21.3 ± 2.8 kg/m2 (r: 17-30.9). Forty-seven (67.1%) presented with pancreatic insufficiency, 6 (8.5%) with cirrhosis secondary to CF, and 21 (30%) had CF-related diabetes. Median forced expiratory volume in one second was 47% and the F508del mutation was found in 56.1%. Images of the pancreas: no pathologic findings in 49 (70%), increased echogenicity in 18 (25.7%), and cysts in 3 (4.3%). Gallbladder images: microgallbladder in 3 (4.2%), biliary sludge in 2 (2.8%), gallstones in 7 (10%), and a history of cholecystectomy in 4 (5.8%). Liver and spleen images: no pathologic findings in 47 (67.2%), homogeneous hepatomegaly with splenomegaly in 2 (2.8%), a heterogeneous pattern of the parenchyma in 11 (15.8%), increased echogenicity in 4 (5.7%), and heterogeneous echo patterns, lobulated liver contour, and splenomegaly in 6 (8.5%). CONCLUSION Abdominal ultrasound is a safe, low-cost technique that enables the identification of some degree of chronic liver and pancreatic diseases, improving the approach and follow-up decisions in adult patients with CF.
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Affiliation(s)
- E Baran
- Unidad de Adultos con Fibrosis Quística, Servicio de Neumonología, Hospital Rodolfo Rossi, La Plata, Buenos Aires, Argentina.
| | - M V D'Ascenzo
- Unidad de Adultos con Fibrosis Quística, Servicio de Gastroenterología, Hospital Rodolfo Rossi, La Plata, Buenos Aires, Argentina
| | - J D Bosia
- Unidad de Adultos con Fibrosis Quística, Servicio de Gastroenterología, Hospital Rodolfo Rossi, La Plata, Buenos Aires, Argentina
| | - P Montaña
- Servicio de Imágenes, Hospital Rodolfo Rossi, La Plata, Buenos Aires, Argentina
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Nieto Royo R, Durán Barata D, Barrios Barreto D, Briceño Franquiz W, Máiz Carro L. [Safety and effectiveness of treatment with elexacaftor, tezacaftor and ivacaftor in adults with cystic fibrosis]. Med Clin (Barc) 2023; 161:338-341. [PMID: 37474394 DOI: 10.1016/j.medcli.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Cystic fibrosis (CF) is a disease caused by mutations in the gene located on chromosome 7 that encodes the CF transmembrane conductance regulator protein. Several trials have demonstrated the efficacy and safety of the ELE/TEZ/IVA combination in patients who have at least one F508del mutation. The main objective of the study was to evaluate the safety at 3 and 6 months of treatment with ELE/TEZ/IVA in adult patients with CF. METHODS This is a real-life, prospective, single-center, cross-sectional study that included adult patients from the CF multidisciplinary unit. The demographic and clinical characteristics of all patients were recorded. During the time of the study, 3 visits were carried out (baseline, at 3 and at 6 months). Side effects were recorded during the follow-up time. RESULTS 3 months after the start of treatment, a statistically significant improvement was observed. of lung function, BMI, pulmonary exacerbations and energy level, as well as in all the categories of the CFQ-R questionnaire except in the digestive domain. This improvement was maintained, but not increased at 6 months in all variables, except BMI, where differences were observed between 3 and 6 months of treatment. CONCLUSIONS In the cohort studied, treatment with ELE/TEZ/IVA has a good safety profile. and produces an early improvement in lung function, BMI, quality of life and the "energy level" of adult patients with CF, which is maintained at 6 months of treatment.
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Affiliation(s)
- Rosa Nieto Royo
- Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, España; Departamento de Medicina, Universidad de Alcalá, Madrid, España.
| | - Diego Durán Barata
- Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, España; Departamento de Medicina, Universidad de Alcalá, Madrid, España
| | - Deisy Barrios Barreto
- Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, España; Departamento de Medicina, Universidad de Alcalá, Madrid, España
| | - Winnifer Briceño Franquiz
- Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, España; Departamento de Medicina, Universidad de Alcalá, Madrid, España
| | - Luis Máiz Carro
- Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, España; Departamento de Medicina, Universidad de Alcalá, Madrid, España
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Diab Cáceres L, Zamarrón de Lucas E. Cystic fibrosis: Epidemiology, clinical manifestations, diagnosis and treatment. Med Clin (Barc) 2023:S0025-7753(23)00362-7. [PMID: 37558605 DOI: 10.1016/j.medcli.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 08/11/2023]
Abstract
Cystic fibrosis is a genetic and multisystemic disease. The main comorbidity in adulthood is respiratory involvement, with the presence of bronchiectasis, chronic bronchial infection and airflow obstruction. Until a decade ago, treatments were aimed at favoring secretion drainage, reducing respiratory exacerbations, controlling chronic bronchial infection and slowing functional deterioration, but with the advent of cystic fibrosis transmembrane conductance regulator (CFTR) modulators, the cystic fibrosis paradigm has changed. This novel treatment goes a step further in the management of this disease, it is able to improve the production of defective CFTR protein and increase its expression on the cell surface, thus achieving a better functioning of ion exchange, fluidizing respiratory secretions and reducing airflow obstruction. In addition, there are currently different lines of research aimed at correcting the genetic defect that causes cystic fibrosis.
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Affiliation(s)
- Layla Diab Cáceres
- Unidad de Fibrosis Quística, Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - Ester Zamarrón de Lucas
- Unidad de Fibrosis Quística, Servicio de de Neumología, Hospital Universitario La Paz, Madrid
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Mangas-Sánchez C, Garriga-García M, Serrano-Nieto MJ, Garcia-Romero R, Álvarez Beltrán M, Crehuá-Gaudiza E, Vicente-Santamaría S, Martínez-Costa C, Díaz-Martín JJ, Bousoño-García C, González-Jiménez D. Safety and efficacy of a new supplementation protocol in patients with cystic fibrosis and vitamin D deficiency. An Pediatr (Barc) 2023; 98:257-266. [PMID: 36932016 DOI: 10.1016/j.anpede.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/23/2022] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVES Based on the European and American Cystic Fibrosis (CF) consensus recommendations, an increase in vitamin D (VD) supplementation in patients with CF and insufficient or defficient levels was proposed. The objective of our study was to determine the safety and efficacy of this new protocol. MATERIAL AND METHODS Multicentre nonrandomized uncontrolled experimental study. Patients with insufficient levels (<30 ng/mL) received increasing doses of VD (between 800 and 10 000 IU/day). Patients were followed up for 12 months, during which their vitamin and nutritional status, pulmonary function and calcium and phosphate metabolism were assessed. STATISTICAL ANALYSIS t test for paired data and multivariate logistic regression analysis. RESULTS Thirty patients aged 1-39 years (median, 9.1) completed the follow-up. Two patients were dropped from the study on account of 25-OH VD levels greater than 100 ng/mL at 3 months without clinical or laboratory signs of hypercalcaemia. At 12 months, we observed an increase of 7.6 ng/mL (95% CI, 4.6-10 ng/mL) in the mean 25-OH VD level and an improvement in vitamin status: 37% achieved levels of 30 ng/mL or greater, 50% levels between 20 and 30 ng/mL and 13% remained with levels of less than 20 ng/mL. We found no association between improved VD levels and pulmonary function. CONCLUSIONS The proposed protocol achieved an increase in serum VD levels and a decrease in the percentage of patients with VD insufficiency, although it was still far from reaching the percentages of sufficiency recommended for this entity.
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Affiliation(s)
- Carmen Mangas-Sánchez
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Central de Asturias, Oviedo, Spain.
| | | | | | - Ruth Garcia-Romero
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Miguel Servet, Zaragoza, Spain
| | - Marina Álvarez Beltrán
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Vall d'Hebron. Barcelona, Spain
| | - Elena Crehuá-Gaudiza
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Cecilia Martínez-Costa
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Juan José Díaz-Martín
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Central de Asturias, Oviedo, Spain
| | - Carlos Bousoño-García
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Central de Asturias, Oviedo, Spain
| | - David González-Jiménez
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Central de Asturias, Oviedo, Spain
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Escudero García J, Martín Rivada Á, Uribe Posada A, Sanz Santiago V, Argente J, Martos-Moreno GÁ. Carbohydrate metabolism impairment in children and adolescents with cystic fibrosis. ENDOCRINOL DIAB NUTR 2022; 69:576-583. [PMID: 36347795 DOI: 10.1016/j.endien.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/06/2021] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Development of cystic fibrosis-related diabetes (CFRD) is associated with worsening of nutritional status and lung function, as well as increased mortality. The relevance of diagnosing the «pre-diabetic» status in these patients has not been addressed and the utility of HbA1c measurement in these patients is under discussion. AIM To study and characterise the different categories of carbohydrate metabolism impairment in paediatric patients with cystic fibrosis. PATIENTS AND METHODS A transversal study for characterisation of carbohydrate metabolism impairment according to clinical and anthropometric status and genetic background in 50 paediatric patients with cystic fibrosis (CF) was undertaken. Oral glucose tolerance tests (OGTT) for determination of glucose and insulin levels measurement and continuous subcutaneous glucose monitoring (CSGM) were performed. RESULTS 6% of patients presented with CFRD, 26% impaired glucose tolerance, 10% an indeterminate glucose alteration and 2% impaired fasting glucose. The severity of glycaemic impairment correlated positively with age and negatively with standardised height (p < 0.05) with intergroup differences in HbA1c levels (p < 0.01), with the latter correlating with the duration of hyperglycaemia throughout CSGM. No intergroup differences in mutation prevalence, pulmonary function test, nutritional status or disease exacerbations in the previous year were found. The daily enzyme replacement dose correlated with the glucose area under the curve (AUC, p < 0.05) but not with insulin-AUC. CONCLUSIONS An older age and greater enzyme replacement need are correlated with more severe carbohydrate metabolism impairment and lower standardized height in paediatric CF patients, with HbA1c correlating with the duration of hyperglycaemia. The study of the full glucose/insulin AUCs throughout the OGTT affords no additional information compared to glucose determination at 120 min in these patients.
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Affiliation(s)
- Janire Escudero García
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Madrid, Spain
| | - Álvaro Martín Rivada
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Madrid, Spain
| | - Amalia Uribe Posada
- Sección de Neumología, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Jesús Argente
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Madrid, Spain; Departamento de Pediatría, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; IMDEA Food Institute, CEIUAM+CSIC, Madrid, Spain
| | - Gabriel Ángel Martos-Moreno
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Madrid, Spain; Departamento de Pediatría, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
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Chiner-Vives E, Cordovilla-Pérez R, de la Rosa-Carrillo D, García-Clemente M, Izquierdo-Alonso JL, Otero-Candelera R, Pérez-de Llano L, Sellares-Torres J, de Granda-Orive JI. Short and Long-Term Impact of COVID-19 Infection on Previous Respiratory Diseases. Arch Bronconeumol 2022; 58 Suppl 1:39-50. [PMID: 35501222 PMCID: PMC9012323 DOI: 10.1016/j.arbres.2022.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/30/2022] [Indexed: 02/07/2023]
Abstract
On March 11, 2020, the World Health Organization declared Coronavirus Disease 2019 (COVID-19) a pandemic. Till now, it affected 452.4 million (Spain, 11.18 million) persons all over the world with a total of 6.04 million of deaths (Spain, 100,992). It is observed that 75% of hospitalized COVID-19 patients have at least one COVID-19 associated comorbidity. It was shown that people with underlying chronic illnesses are more likely to get it and grow seriously ill. Individuals with COVID-19 who have a past medical history of cardiovascular disorder, cancer, obesity, chronic lung disease, diabetes, or neurological disease had the worst prognosis and are more likely to develop acute respiratory distress syndrome or pneumonia. COVID-19 can affect the respiratory system in a variety of ways and across a spectrum of levels of disease severity, depending on a person's immune system, age and comorbidities. Symptoms can range from mild, such as cough, shortness of breath and fever, to critical disease, including respiratory failure, shock and multi-organ system failure. So, COVID-19 infection can cause overall worsening of these previous respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease, etc. This review aims to provide information on the impact of the COVID-19 disease on pre-existing lung comorbidities.
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Affiliation(s)
- Eusebi Chiner-Vives
- Multidisciplinary Sleep Unit, Respiratory Department, Sant Joan University Hospital, Sant Joan d'Alacant, Alicante, Spain
| | - Rosa Cordovilla-Pérez
- Respiratory Department, Salamanca University Hospital, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | | | - Marta García-Clemente
- Lung Management Area, HUCA, Institute for Health Research of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
| | - José Luis Izquierdo-Alonso
- Department of Medicine and Medical Specialties, University of Alcalá, Madrid, Spain; Respiratory Medicine, University Hospital of Guadalajara, Guadalajara, Spain
| | | | - Luis Pérez-de Llano
- Respiratory Department, Lucus Augusti University Hospital, EOXI Lugo, Monforte, CERVO, Lugo, Spain
| | - Jacobo Sellares-Torres
- Interstitial Lung Diseases Working Group, Respiratory Department, Clinic-University Hospital-IDIBAPS, Barcelona, Spain
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López-Valdez JA, Aguilar-Alonso LA, Gándara-Quezada V, Ruiz-Rico GE, Ávila-Soledad JM, Reyes AA, Pedroza-Jiménez FD. Cystic fibrosis: current concepts. Bol Med Hosp Infant Mex 2021; 78:584-596. [PMID: 34934215 DOI: 10.24875/bmhim.20000372] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cystic fibrosis is an autosomal recessive genetic disease, mainly in Caucasian children and young adults. It is caused by pathogenic variants in the CFTR (cystic fibrosis transmembrane conductance regulator) gene, which results in increased viscosity and difficult mucus clearance. The main organ affected is the lung, the pancreas, sweat glands, intestine, liver, nasal mucosa, salivary glands, and reproductive tract. The clinical manifestations vary, ranging from the most frequent pulmonary symptoms of obstructive disease to gastrointestinal manifestations relatection of pathogenic variants in the CFTR gene allow the diagnosis to be integrated. Cystic fibrosis management consists of three main strategies: firstly, to keep the airway free of secretion; secondly, to keep the airway free of infection; and finally, to maintain an optimal nutritional status. Therapies that seek to correct alterations in the CFTR gene are focused on avoiding a pathogenic nonsense variant, correcting folding, increasing trafficking to the plasma membrane, or increasing the function of the CFTR channel. Other therapies still under development include gene therapy, genome editing, and antisense oligonucleotides to modify the expression of this gene.
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Affiliation(s)
- Jaime A López-Valdez
- Centro de Ciencias de la Salud, Universidad Autónoma de Aguascalientes, Aguascalientes, Aguascalientes, Mexico
| | - Luis A Aguilar-Alonso
- Centro de Ciencias de la Salud, Universidad Autónoma de Aguascalientes, Aguascalientes, Aguascalientes, Mexico
| | - Vanessa Gándara-Quezada
- Centro de Ciencias de la Salud, Universidad Autónoma de Aguascalientes, Aguascalientes, Aguascalientes, Mexico
| | - Gabriel E Ruiz-Rico
- Centro de Ciencias de la Salud, Universidad Autónoma de Aguascalientes, Aguascalientes, Aguascalientes, Mexico
| | - Juana M Ávila-Soledad
- Centro de Ciencias de la Salud, Universidad Autónoma de Aguascalientes, Aguascalientes, Aguascalientes, Mexico
| | - Adriana A Reyes
- Centro de Ciencias de la Salud, Universidad Autónoma de Aguascalientes, Aguascalientes, Aguascalientes, Mexico
| | - Fernando D Pedroza-Jiménez
- Centro de Ciencias de la Salud, Universidad Autónoma de Aguascalientes, Aguascalientes, Aguascalientes, Mexico
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Viñado C, Girón RM, Ibáñez E, García-Ortega A, Pérez I, Polanco D, Pemán J, Solé A. Filamentous fungi in the airway of patients with cystic fibrosis: Just spectators? Rev Iberoam Micol 2021; 38:168-174. [PMID: 34535388 DOI: 10.1016/j.riam.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/17/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There are important advances in the management of bacterial infection in patients with cystic fibrosis (CF), but there are many gaps in the field of fungal infections. AIMS The aim of this study was to analyse whether chronic respiratory filamentous fungal colonization had clinical impact and whether antifungal treatment can change the disease. METHODS The prospective, bicentric and descriptive study was carried out within a 3-year follow-up period, with four-month periodicity medical controls. Adult patients from two CF units of tertiary hospitals were included. Clinical, microbiological, analytical and spirometric variables were collected. Quality of life was evaluated in a subgroup, using the Spanish version of the Revised Cystic Fibrosis Quality of Life Questionnaire (CFQ-R). To statistically analyze the evolution of forced expiratory along time (volume of air blown out in 1 second -FEV1-) and the forced vital capacity (FVC), mixed linear models were carried out. RESULTS From the ninety-eight patients under study, 40 suffered chronic filamentous fungal colonization. The presence of filamentous fungi in airway was associated to an annual fall of FEV1 and FVC of 0.029 and 0.017 litres, respectively (p<0.001). In addition, worse quality of life based on CFQ-R, significant when concerning physical condition and emotional state, was also linked with the fungal colonization. Protocolized antifungal therapy, nebulized or oral, improved FEV1 in 0.023 and 0.024 litres per year, respectively (p<0.001). CONCLUSIONS Chronic filamentous fungal colonization in patients with CF is associated with a significant annual decline of lung function that persists over time. Chronic antifungal therapy slows down this progression, mainly in the patient with more advanced disease.
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Affiliation(s)
- Clara Viñado
- Servicio de Neumología del Hospital de Barbastro, Spain.
| | - Rosa María Girón
- Unidad de Fibrosis Quística del Hospital Universitario de la Princesa de Madrid, Spain
| | - Elisa Ibáñez
- Servicio de Microbiología del Hospital Universitario y Politécnico La Fe de Valencia, Spain
| | - Alberto García-Ortega
- Unidad de Fibrosis Quística y Trasplante Pulmonar del Hospital Universitario y Politécnico La Fe de Valencia, Spain
| | - Inés Pérez
- Unidad de Fibrosis Quística y Trasplante Pulmonar del Hospital Universitario y Politécnico La Fe de Valencia, Spain
| | - Dinora Polanco
- Servicio de Neumología del Hospital Universitario Arnau de Vilanova de Lleida, Spain
| | - Javier Pemán
- Servicio de Microbiología del Hospital Universitario y Politécnico La Fe de Valencia, Spain
| | - Amparo Solé
- Unidad de Fibrosis Quística y Trasplante Pulmonar del Hospital Universitario y Politécnico La Fe de Valencia, Spain
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Blanco-Orive P, Del Corral T, Martín-Casas P, Ceniza-Bordallo G, López-de-Uralde-Villanueva I. Quality of life and exercise tolerance tools in children/adolescents with cystic fibrosis: Systematic review. Med Clin (Barc) 2021; 158:519-530. [PMID: 34507821 DOI: 10.1016/j.medcli.2021.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This systematic review aims to analyze the validity and reliability of available tools to assess health-related quality of life (HRQoL) and exercise tolerance in children and adolescents with cystic fibrosis (CF). MATERIALS AND METHODS A review of observational studies studying the validity and reliability of the tools was conducted. The COSMIN (COnsesus-based Standards for the selection of health Measurements INstruments) guide was followed to analyze the quality of these tools. RESULTS A total of 18 studies were selected. Of the eight HRQoL tools, five generic and three specific, analyzed in 14 studies, the Cystic Fibrosis Questionnaire-Revised (CFQ-R) presents the best properties. Of the four tools analyzed to assess exercise tolerance, cycle ergometry and the modified shuttle test are the most valid and reliable. CONCLUSIONS The CFQ-R, cycloergometry and the modified shuttle test have the best properties for the assessment of children with CF, but more studies are needed.
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Affiliation(s)
- Paula Blanco-Orive
- Programa de doctorado en Cuidados en Salud, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España
| | - Tamara Del Corral
- Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España
| | - Patricia Martín-Casas
- Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España.
| | - Guillermo Ceniza-Bordallo
- Programa de doctorado en Cuidados en Salud, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España
| | - Ibai López-de-Uralde-Villanueva
- Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España
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Arrudi-Moreno M, García-Romero R, Samper-Villagrasa P, Sánchez-Malo MJ, Martin-de-Vicente C. Neonatal cystic fibrosis screening: Analysis and differences in immunoreactive trypsin levels in newborns with a positive screen. An Pediatr (Barc) 2021; 95:11-17. [PMID: 34140271 DOI: 10.1016/j.anpede.2020.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/09/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Neonatal cystic fibrosis (CF) screening has enabled the disease to be diagnosed early, and is a determining factor in the increase in survival of these patients. Its main disadvantage is its low specificity and elevated number of false positives. The aim of this study is to analyse the differences in immunoreactive trypsin (IRT) between the different groups of newborns (NB) with a positive neonatal screen depending on whether they were healthy, healthy carriers, affected by CF, or CFSPID (Cystic Fibrosis Screen Positive, Inconclusive Diagnosis). MATERIAL Retrospective analytical study of the concentrations of IRT in NB with a positive neonatal screen for CF born in a tertiary hospital during an 8-year period. RESULTS A total of 790 NB with a positive neonatal screen for CF were analysed. Of these 86.3% were term, 53% girls, and 11.8% were admitted. The mean IRT value was 79.16 ng/mL (range 60-367). Significantly higher concentrations of IRT were found in those affected by CF compared to the other groups (P < .001). There were higher levels in large prematures (P = .007) and admitted patients (P = .002). There were no differences as regards gender or season. There was a direct correlation of 64% (P = .001) between IRT and sweat test in those affected by CF and CFSPID. A cut-off value of IRT for the diagnosis of CF was calculated from the ROC curve (76.2 ng/mL (S = 95.7%, Sp = 64.5%). CONCLUSIONS NB with CF have significantly higher levels of IRT than healthy ones, or carriers and CFSPID. Prematurity and hospital admission may also have an influence. A higher IRT value is associated with a higher level in the sweat test.
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Affiliation(s)
| | - Ruth García-Romero
- Unidad de Gastroenterología Pediátrica, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Steffanowski C, Papalia M, Iriarte A, Langleib M, Galanternik L, Gutkind G, Cooper V, Ramírez MS, Radice M. Full characterization of plasmids from Achromobacter ruhlandii isolates recovered from a single patient with cystic fibrosis (CF). Rev Argent Microbiol 2021; 54:3-8. [PMID: 33896603 DOI: 10.1016/j.ram.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/24/2020] [Accepted: 01/24/2021] [Indexed: 10/21/2022] Open
Abstract
In the last decade Achromobacter spp. has been associated with chronic colonization in patients with cystic fibrosis (CF). Although Achromobacter xylosoxidans is the most frequent species recovered within this genus, other species such as A. ruhlandii have also been reported in these patients. Descriptions of mobile elements are scarce in Achromobacter and none of them have been originated in A. ruhlandii. The aim of this study was to report the full characterization of a plasmid which was maintained in four clonally related A. ruhlandii isolates. Between 2013 and 2015, nine A. ruhlandii isolates were recovered from a pediatric patient with CF at a hospital in Buenos Aires. Four selected clonally related isolates were sequenced by Illumina MiSeq, annotated using RAST and manually curated. The presence of a unique plasmid of 34096-bp and 50 CDS was observed in the four isolates, displaying only 1 nucleotide substitution translated into one amino acid change among them. These plasmids have a class 1 integron containing the aac-(6')-Ib gene, a mercury resistance operon region and the relE/stbE toxin/antitoxin system. Plasmids showed 79% similarity and 99% identity with pmatvim-7 from Pseudomonas aeruginosa. This is the first full description and characterization of a plasmid from A. ruhlandii which was maintained over time.
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Affiliation(s)
- Carla Steffanowski
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, IbaViM, Argentina
| | - Mariana Papalia
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, IbaViM, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Andrés Iriarte
- Laboratorio de Biología Computacional, Departamento de Desarrollo Biotecnológico, Instituto de Higiene, Facultad de Medicina, Montevideo, Uruguay
| | - Mauricio Langleib
- Laboratorio de Biología Computacional, Departamento de Desarrollo Biotecnológico, Instituto de Higiene, Facultad de Medicina, Montevideo, Uruguay
| | | | - Gabriel Gutkind
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, IbaViM, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Vaughn Cooper
- University of Pittsburgh, Department of Microbiology and Molecular Genetics, Pittsburgh, United States
| | - María Soledad Ramírez
- California State University, Fullerton, Department of Biological Science, Fullerton, United States
| | - Marcela Radice
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, IbaViM, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina.
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12
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Páez-Velásquez JS, Romero-Uribe IE, Castilla-Peón MF, Lezana-Fernández JL, Chávez-López A. SARS-CoV-2 infection in a pediatric patient with cystic fibrosis. Bol Med Hosp Infant Mex 2021; 78:29-33. [PMID: 33661877 DOI: 10.24875/bmhim.20000216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Cystic fibrosis (CF) is a potentially mortal disease characterized by a chronic pulmonary disease with persistent airway infection. Children with this disease are more susceptible to respiratory infections due to the limitation in mucociliary transport and anatomical disruption of the bronchial tree. SARS-CoV-2 causes COVID-19, a respiratory illness related to exacerbations of chronic pulmonary pathologies in children, such as CF and asthma. There are not enough case reports on pediatric patients with SARS-CoV-2 infection and CF, for which we share our experience. Case report A 22-month-old male patient diagnosed with CF presented in the hospital with cough, fever, and increased respiratory work. The patient received supplemental oxygen and antibiotic and antiviral therapy. Positive results for type B influenza and RT-PCR (reverse transcription-polymerase chain reaction) for SARS-CoV-2 were obtained. Due to the persistence of respiratory difficulty, high-flow therapy was initiated, with a good response. After an episode of hypoxemia, bradycardia, and increased respiratory work secondary to accumulated secretions, orotracheal intubation and invasive mechanical ventilation were performed. The patient evolved with clinical and gasometric improvement. After 10 days of in-hospital antibiotic management with adequate clinical evolution, the patient was discharged to complete oral treatment and home isolation. Conclusions We present a case of chronic respiratory disease and SARS-CoV-2 infection with severity criteria in a pediatric patient. The evolution was favorable with timely support management and antibiotic therapy in a third-level hospital.
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Affiliation(s)
| | - Ilse E Romero-Uribe
- Servicio de Terapia Intensiva. Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - María F Castilla-Peón
- Dirección de Investigación. Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | - Adrián Chávez-López
- Servicio de Terapia Intensiva. Hospital Infantil de México Federico Gómez, Mexico City, Mexico
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13
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Berardinelli EM, Lopardo HA. [Development of a simple medium for the selective isolation of bacteria belonging to the Streptococcus anginosus group]. Rev Argent Microbiol 2021; 53:277-280. [PMID: 33674170 DOI: 10.1016/j.ram.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/14/2020] [Accepted: 12/10/2020] [Indexed: 11/18/2022] Open
Abstract
Bacteria of the Streptococcus anginosus group (SAG) have recently been recognized as contributors of bronchopulmonary disease in cystic fibrosis (CF). Routine detection and quantification are limited by current CF microbiology protocols. The development of the CHROMagar™ StrepB chromogenic medium modified by the addition of plasma, nalidixic acid, colistin and sulfadiazine to make it selective for SAG bacteria is described. This medium could be used as a diagnostic tool to detect SAG in respiratory samples from patients suffering from chronic lung disease.
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Affiliation(s)
- Elena M Berardinelli
- Hospital General de Agudos Dr. Abel Zubizarreta, Ciudad Autónoma de Buenos Aires, Argentina; Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Horacio A Lopardo
- Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina; Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Argentina
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Diab Cáceres L, Girón Moreno RM, García Castillo E, Pastor Sanz MT, Olveira C, García Clemente M, Nieto Royo R, Prados Sánchez C, Caballero Sánchez P, Olivera Serrano MJ, Padilla Galo A, Nava Tomas E, Esteban Peris A, Fernández Velilla M, Torres MI, Ancochea Bermúdez J. Effect of Sex Differences on Computed Tomography Findings in Adults With Cystic Fibrosis: A Multicenter Study. Arch Bronconeumol 2020; 57:256-263. [PMID: 32107115 DOI: 10.1016/j.arbres.2019.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/28/2019] [Accepted: 12/30/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND The survival of women with cystic fibrosis (CF) is lower than that of men by approximately 5 years. While various factors have been put forward to account for this discrepancy, no specific reasons have been established. Our hypothesis was that anatomical-structural involvement is more pronounced in women with CF than in men and that this is reflected in thoracic HRCT findings. MATERIAL AND METHODS We performed a prospective multicentre study, in which adult patients were consecutively included over 18 months. Chest HRCT was performed, and findings were scored by 2 thoracic radiologists using the modified Bhalla system. We also studied respiratory function, applied the CFQR 14+ questionnaire, and collected clinical variables. RESULTS Of the 360 patients followed up in the participating units, 160 were eventually included. Mean age was 28 years, and 47.5% were women. The mean±SD global score on the modified Bhalla score was 13.7±3.8 in women and 15.2±3.8 in men (p=0.024). The highest scores were observed for sacculations, bronchial generations, and air trapping in women. Women had lower BMI, %FEV1, %FVC, and %DLCO. Similarly, the results for the respiratory domain in CFQR 14+ were worse in women, who also had more annual exacerbations. CONCLUSIONS This is the first study to provide evidence of the implication of sex differences in HRCT findings in patients with CF. Women with CF present a more severe form of the disease that results in more frequent exacerbations, poorer functional and nutritional outcomes, deterioration of quality of life, and greater structural damage.
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Affiliation(s)
| | | | | | | | - Casilda Olveira
- Pulmonology Service, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Rosa Nieto Royo
- Pulmonology Service, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Martín-Gómez MT. Taking a look on fungi in cystic fibrosis: More questions than answers. Rev Iberoam Micol 2020; 37:17-23. [PMID: 31928888 DOI: 10.1016/j.riam.2019.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/21/2019] [Accepted: 10/30/2019] [Indexed: 02/07/2023] Open
Abstract
Cystic fibrosis (CF) is one of the most frequent recessive inherited diseases in western countries. Advances in medical care have led to a substantial increase in the life expectancy of CF patients. Survival beyond adolescence has permitted to see fungi not only as late colonizers, but also as potential pathogens responsible of allergic reactions and chronic infections related to lung function deterioration. The role of fungi, nevertheless, has been overlooked until recently. As a result, a number of questions on their epidemiology, clinical significance, or diagnosis, among others, remain unanswered. Besides more in depth studies about the extent of the deleterious effect of fungi on the CF host, new technologies may provide the key to understand its pathogenic role, its interaction with other microbial components of the respiratory microbiota, and should pave the way to define subsets of patients at risk who would benefit from specific therapy. This review is intended to provide a quick overview on what we know about the presence of fungi in the CF airway and its repercussion in the host, and to point out some of the many knowledge gaps needed to understand and advance in the management of fungi in the airway of CF subjects.
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Papalia M, Steffanowski C, Traglia G, Almuzara M, Martina P, Galanternik L, Vay C, Gutkind G, Ramírez MS, Radice M. Diversity of Achromobacter species recovered from patients with cystic fibrosis, in Argentina. Rev Argent Microbiol 2019; 52:13-18. [PMID: 31253503 DOI: 10.1016/j.ram.2019.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/06/2019] [Accepted: 03/18/2019] [Indexed: 11/16/2022] Open
Abstract
Different phenotype-based techniques and molecular tools were used to describe the distribution of different Achromobacter species in patients with cystic fibrosis (CF) in Argentina, and to evaluate their antibiotic resistance profile. Phenotypic identification was performed by conventional biochemical tests, commercial galleries and MALDI-TOF MS. Genetic approaches included the detection of A. xylosoxidans specific marker blaoxa-114, the amplification and sequencing of the 16S rRNA gene, nrdA and blaOXA complete sequence, and MLST analysis. Phenotypic approaches, even MALDI-TOF, rendered inconclusive or misleading results. On the contrary, concordant results were achieved with the nrdA sequencing or sequence type (ST) analysis, and the complete blaOXA sequencing, allowing a reliable discrimination of different Achromobacter species. A. xylosoxidans accounted for 63% of Achromobacter infections and A. ruhlandii accounted for 17%. The remaining species corresponded to A. insuavis, A. dolens, A. marplatensis and A. pulmonis. Antimicrobial susceptibilities were determined by the agar dilution method according to CLSI guidelines. Piperacillin, piperacillin/tazobactam and carbapenems were the most active antibiotics. However, the emergence of carbapenem-resistant isolates was detected. In conclusion, prompt and accurate identification tools were necessary to determine that different Achromobacter species may colonize/infect the airways of patients with CF. Moreover, antimicrobial therapy should be administered based on the susceptibility profile of individual Achromobacter sp. isolates.
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Affiliation(s)
- Mariana Papalia
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Microbiología, Laboratorio de Resistencia Bacteriana, Ciudad Autónoma de Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Carla Steffanowski
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Microbiología, Laboratorio de Resistencia Bacteriana, Ciudad Autónoma de Buenos Aires, Argentina
| | - Germán Traglia
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Departamento de Bioquímica Clínica, Laboratorio de Bacteriología Clínica, Ciudad Autónoma de Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Marisa Almuzara
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Departamento de Bioquímica Clínica, Laboratorio de Bacteriología Clínica, Ciudad Autónoma de Buenos Aires, Argentina
| | - Pablo Martina
- Universidad Nacional De Misiones, Instituto de Biología Subtropical, Misiones, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Laura Galanternik
- Hospital de Niños Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
| | - Carlos Vay
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Departamento de Bioquímica Clínica, Laboratorio de Bacteriología Clínica, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gabriel Gutkind
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Microbiología, Laboratorio de Resistencia Bacteriana, Ciudad Autónoma de Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - María Soledad Ramírez
- California State University, Fullerton, Department of Biological Science, Fullerton, United States; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Marcela Radice
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Microbiología, Laboratorio de Resistencia Bacteriana, Ciudad Autónoma de Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina.
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Erro Iribarren M, Girón Moreno RM, Diab Cáceres L, Pastor Sanz MT, Buendía Moreno B, Alarcón Cavero T, Granja Torrecillas S, Zurita Cruz ND, Ancochea Bermúdez J. Study of a Cohort of Patients With Cystic Fibrosis and Isolation of Scedosporium spp. Arch Bronconeumol 2019; 55:559-564. [PMID: 31178266 DOI: 10.1016/j.arbres.2019.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/22/2019] [Accepted: 02/14/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In recent years an increase in the prevalence of colonization and infection by Scedosporium spp. in patients with cystic fibrosis (CF) has been observed. In this article, we study the frequency of isolation of Scedosporium spp. in an adult CF Unit, analyzing characteristics of the patients and predisposing factors. METHODS A retrospective observational study was conducted in 87 adult CF patients in whom the presence of positive culture for Scedosporium spp. was tested for a 5-year period (January 2012-July 2017). We recorded the following clinical variables: age, sex, body mass index, genotype, presence of pancreatic insufficiency, bacterial colonization, lung function, other complications, exacerbations and treatment, and the modified Bhalla score from the last high-resolution computed tomography. Results were analyzed with IBM SPSS Statistics Version 22.0 software. RESULTS Scedosporium spp. was isolated in 25.3% of patients. In the bivariate analysis, these patients showed a higher rate of Pseudomonas aeruginosa infection, worse score in the Bhalla classification (highlighting the following items: bronchiectasis, mucus plugs and bronchial generations), a slight decrease in the lung diffusion capacity and more frequently received inhaled antibiotics. In the logistic regression multivariate analysis, only the bronchial generations item was significant. CONCLUSION Scedosporium spp. must be considered an emerging opportunistic pathogen in patients with CF whose clinical involvement, risk factors or need for treatment is unknown.
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Affiliation(s)
- Marta Erro Iribarren
- Servicio de Neumología, Hospital Universitario de la Princesa, Madrid, España; Instituto de Investigación Sanitaria de la Princesa, Madrid, España.
| | - Rosa María Girón Moreno
- Servicio de Neumología, Hospital Universitario de la Princesa, Madrid, España; Instituto de Investigación Sanitaria de la Princesa, Madrid, España
| | - Layla Diab Cáceres
- Servicio de Neumología, Hospital Universitario de la Princesa, Madrid, España; Instituto de Investigación Sanitaria de la Princesa, Madrid, España
| | - María Teresa Pastor Sanz
- Servicio de Neumología, Hospital Universitario de la Princesa, Madrid, España; Instituto de Investigación Sanitaria de la Princesa, Madrid, España
| | - Buenaventura Buendía Moreno
- Instituto de Investigación Sanitaria de la Princesa, Madrid, España; Servicio de Microbiología y Parasitología, Hospital Universitario de la Princesa, Madrid, España
| | - Teresa Alarcón Cavero
- Instituto de Investigación Sanitaria de la Princesa, Madrid, España; Servicio de Microbiología y Parasitología, Hospital Universitario de la Princesa, Madrid, España
| | - Silvia Granja Torrecillas
- Instituto de Investigación Sanitaria de la Princesa, Madrid, España; Servicio de Microbiología y Parasitología, Hospital Universitario de la Princesa, Madrid, España
| | - Nelly Daniela Zurita Cruz
- Instituto de Investigación Sanitaria de la Princesa, Madrid, España; Servicio de Microbiología y Parasitología, Hospital Universitario de la Princesa, Madrid, España
| | - Julio Ancochea Bermúdez
- Servicio de Neumología, Hospital Universitario de la Princesa, Madrid, España; Instituto de Investigación Sanitaria de la Princesa, Madrid, España
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Diab-Cáceres L, Girón-Moreno RM, Pastor-Sanz MT, Quintana-Gallego E, Delgado-Pecellín I, Blanco-Aparicio M, Maiz L, García-Clemente MM, Luna-Paredes C, Mondéjar-López P, Ruiz-de-Valbuena M, Fernández O, Barrio M, González M, López-Neyra A, Cols-I-Roig M, Palou-Rotger A, Gómez-de-Terreros-Caro FJ. Compassionate Use of Lumacaftor/Ivacaftor in Cystic Fibrosis: Spanish Experience. Arch Bronconeumol 2018; 54:614-618. [PMID: 30518496 DOI: 10.1016/j.arbres.2018.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 04/09/2018] [Accepted: 05/01/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The most common cystic fibrosis (CF)-causing mutation is deltaF508 (F508del), which is present in 28% of CF Spanish patients. While the literature based on real-life studies on CF patients homozygous F508del treated with lumacaftor/ivacaftor is limited, it demonstrates the need for better strategies to prevent related adverse events (AEs) as well as the development of newer drugs. METHODS We conducted a multicenter, retrospective, observational study to describe the effects of lumacaftor/ivacaftor treatment in real-life in Spain. 20 CF patients were included, all aged 6 and upwards and presented with ppFEV1<40%, chosen from CF units country-wide. For the purposes of the study, they were treated with lumacaftor/ivacaftor 200/125mg two tablets twice a day on a compassionate use programme throughout 2016. The primary endpoint was measured in all of the sample patients. Data were analysed from ppFEV1 at baseline and was measured every 6 months. RESULTS The mean age was 26.65 (range of 10-45), while the mean ppFEV1 before the treatment was 32.4% and mean BMI was 19.9kg/m2. We analysed the changes in ppFEV1 and BMI from baseline during the treatment with lumacaftor/ivacaftor, but no differences were found. However, a moderate association between days of intravenous antibiotic needed and the use of lumacaftor/ivacaftor (p=0.001) was established. Indeed, under the lumacaftor/ivacaftor, patients required 5.8 days of intravenous antibiotic treatment compared to 14.9 days prior to study. Also, severe pulmonary exacerbations requiring hospitalisation were statistically fewer under lumacaftor/ivacaftor treatment (p=0.003). Finally, 75% of the sample presented with AEs, which led 35% of the subjects to discontinue the treatment. CONCLUSIONS While treatment with lumacaftor/ivacaftor resulted in an improvement in the number of pulmonary severe exacerbations, no improvement in ppFEV1 or BMI was found.
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Affiliation(s)
| | | | | | - Esther Quintana-Gallego
- Hospital Universitario Virgen del Rocío, Sevilla, Spain. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Delgado-Pecellín
- Hospital Universitario Virgen del Rocío, Sevilla, Spain. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Luis Maiz
- Hospital Ramón y Cajal, Respirology, Madrid, Spain
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Delgado Pecellín I, Pérez Ruiz E, Álvarez Ríos AI, Delgado Pecellín C, Yahyaoui Macías R, Carrasco Hernández L, Marcos Luque I, Caro Aguilera P, Moreno Valera MJ, Quintana Gallego ME. Results of the Andalusian Cystic Fibrosis Neonatal Screening Program, 5 Years After Implementation. Arch Bronconeumol 2018; 54:551-558. [PMID: 29983195 DOI: 10.1016/j.arbres.2018.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/23/2018] [Accepted: 03/27/2018] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Cystic fibrosis neonatal screening (CFNS), based on double determination of immunoreactive trypsinogen ([IRT] [IRT1/IRT2]), has been available in Andalusia since May 2011. If screening is positive, a sweat test is performed, and if that is positive or inconclusive, genetic testing is requested. OBJECTIVE To analyze CFNS, based on results from the first 4.5 years of the program. MATERIALS AND METHODS Prospective descriptive study of neonates undergoing CFNS. IRT levels, sweat chloride, and mutations were recorded. Statistical analysis was performed using SPSS 12.0. RESULTS Between May 2011 and December 2016, 474,953 neonates underwent CFNS. Of these, 1,087 (0.23%) had elevated IRT2. Since CFNS was introduced, 73 cases of cystic fibrosis were diagnosed; 60 were diagnosed by positive CFNS, and 13 were diagnosed by other means. In one case, the patient developed a typical clinical picture of cystic fibrosis, but had not undergone CFNS at the decision of the parents; the remaining 12 had a negative CFNS (false negatives). Of these, one patient was diagnosed before symptoms developed, as his twin brother had a positive CFNS result; another had chloride at the upper limit of normal, and was subsequently diagnosed with genetic testing before symptoms appeared; and 10 patients developed clinical signs and symptoms. Excluding patients with meconium ileus, sensitivity and specificity of the CFNS program were 85.71% and 99.78%, respectively. The incidence of the disease in Andalusia is 1/6,506 live births. CONCLUSION These results are a basis for reflection on possible areas for improvement of the CFNS algorithm, and thought may be given to the introduction of genetic studies to increase sensitivity and reduce false positives.
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Affiliation(s)
- Isabel Delgado Pecellín
- Unidad de Fibrosis Quística, Hospital Universitario Virgen del Rocío, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España.
| | - Estela Pérez Ruiz
- Hospital Materno-Infantil, Hospital Regional Universitario de Málaga, IBIMA, España
| | - Ana Isabel Álvarez Ríos
- Servicio de Bioquímica Clínica, Sección de Metabolopatías, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Carmen Delgado Pecellín
- Servicio de Bioquímica Clínica, Sección de Metabolopatías, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Raquel Yahyaoui Macías
- UGC Laboratorio, Sección de Metabolopatías, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), España
| | - Laura Carrasco Hernández
- Unidad de Fibrosis Quística, Hospital Universitario Virgen del Rocío, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
| | - Irene Marcos Luque
- Departamento de Medicina Materno-Fetal, Genética y Reproducción, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Sevilla, España
| | - Pilar Caro Aguilera
- Hospital Materno-Infantil, Hospital Regional Universitario de Málaga, IBIMA, España
| | - María José Moreno Valera
- Unidad de Neumología y Alergia Pediátricas, Hospital Universitario Virgen del Rocío, Sevilla, España; Unidad de Gestión Clínica de Neonatal, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - María Esther Quintana Gallego
- Unidad de Fibrosis Quística, Hospital Universitario Virgen del Rocío, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
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Sánchez-Bautista A, Rodríguez-Díaz JC, Garcia-Heredia I, Luna-Paredes C, Alcalá-Minagorre PJ. Airway microbiota in patients with paediatric cystic fibrosis: Relationship with clinical status. Enferm Infecc Microbiol Clin 2018; 37:167-171. [PMID: 30827333 DOI: 10.1016/j.eimc.2018.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/08/2018] [Accepted: 05/02/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION New massive sequencing techniques make it possible to determine the composition of airway microbiota in patients with cystic fibrosis (CF). However, the relationship between the composition of lung microbiome and the clinical status of paediatric patients is still not fully understood. MATERIAL AND METHODS A cross-sectional observational study was conducted on induced sputum samples from children with CF and known mutation in the CFTR gene. The bacterial sequences of the 16SrRNA gene were analyzed and their association with various clinical variables studied. RESULTS Analysis of the 13 samples obtained showed a core microbiome made up of Staphylococcus spp., Streptococcus spp., Rothia spp., Gemella spp. and Granulicatella spp., with a small number of Pseudomonas spp. The cluster of patients with less biodiversity were found to exhibit a greater number of sequences of Staphylococcus spp., mainly Staphylococcus aureus (p 0.009) and a greater degree of lung damage. CONCLUSION An airway microbiome with greater biodiversity may be an indicator of less pronounced disease progression, in which case new therapeutic interventions that prevent reduction in non-pathogenic species of the airway microbiota should be studied.
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Affiliation(s)
- Antonia Sánchez-Bautista
- Department of Microbiology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Juan Carlos Rodríguez-Díaz
- Department of Microbiology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | - Inmaculada Garcia-Heredia
- Department of Microbiology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Carmen Luna-Paredes
- Pediatric Cystic Fibrosis Unit, Department of Pediatrics, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Pedro J Alcalá-Minagorre
- Department of Pediatrics, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
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Jauregui A, Deu M, Romero L, Roman A, Moreno A, Armengol M, Solé J. Lung Transplantation in Cystic Fibrosis and the Impact of Extracorporeal Circulation. Arch Bronconeumol 2018; 54:313-9. [PMID: 29534846 DOI: 10.1016/j.arbres.2018.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Lung disease is the major cause of death among cystic fibrosis (CF) patients, affecting 80% of the population. The impact of extracorporeal circulation (ECC) during transplantation has not been fully clarified. This study aimed to evaluate the outcomes of lung transplantation for CF in a single center, and to assess the impact of ECC on survival. METHODS We performed a retrospective observational study of all trasplanted CF patients in a single center between 1992 and 2011. During this period, 64 lung transplantations for CF were performed. RESULTS Five- and 10-year survival of trasplanted patients was 56.7% and 41.3%, respectively. Pre-transplantation supplemental oxygen requirements and non-invasive mechanical ventilation (NIMV) do not seem to affect survival (P=.44 and P=.63, respectively). Five- and 10-year survival among patients who did not undergo ECC during transplantation was 75.69% and 49.06%, respectively, while in those did undergo ECC during the procedure, 5- and 10-year survival was 34.14% and 29.87%, respectively (P=.001). PaCO2 is an independent risk factor for the need for ECC. CONCLUSIONS The survival rates of CF patients undergoing lung transplantation in our hospital are similar to those described in international registries. Survival is lower among patients receiving ECC during the procedure. PaCO2 is a risk factor for the need for ECC during lung transplantation.
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Clemente León M, Bilbao Gassó L, Moreno-Galdó A, Campos Martorrell A, Gartner Tizzano S, Yeste Fernández D, Carrascosa Lezcano A. Oral glucose tolerance test and continuous glucose monitoring to assess diabetes development in cystic fibrosis patients. ACTA ACUST UNITED AC 2017; 65:45-51. [PMID: 29137964 DOI: 10.1016/j.endinu.2017.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/18/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Patients with cystic fibrosis (CF) undergo a slow and progressive process toward diabetes. Oral glucose tolerance test (OGTT) is recommended to diagnose impaired glucose levels in these patients. Continuous glucose monitoring (CGM) measures glucose profiles under real-life conditions. OBJECTIVE To compare OGTT and CGM results in CF patients. METHODS Paired OGTT and 6-day CGM profiles (146.2±9.1h/patient) were performed in 30 CF patients aged 10-18 years. RESULTS According to OGTT, 14 patients had normal glucose tolerance (NGT), 14 abnormal glucose tolerance (AGT), and two cystic fibrosis-related diabetes (CFRD). In 27 patients (13 NGT, 13 AGT, 1 CFRD), CGM showed glucose values ranging from 140 to 200mg/dL during similar monitoring times (2%-14% with NGT, 1%-16.9% with AGT, and 3% with CFRD). Glucose peak levels ≥200mg/dL were seen in seven patients (3 NGT, 3 AGT, 1 CFRD). According to CGM, two patients had all glucose values under 140mg/dL (1 NGT, 1 AGT). Seventeen patients had glucose levels ranging from 140 to 200mg/dL (10 NGT, 6 AGT, 1 CFRD). Ten patients (3 NGT, 7 AGT) had glucose values ≥200mg/dL for ≤1% of the monitoring time and one (CFRD) for >1% of the monitoring time. CONCLUSIONS OGTT results did not agree with those of the CGM. CGM allows for diagnosis of glucose changes not detected by OGTT. Such changes may contribute to optimize pre-diabetes management in CF patients.
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Affiliation(s)
- María Clemente León
- Unidad de Endocrinología, Servicio de Pediatría, Hospital Vall d'Hebron, Grupo de Investigación Crecimiento y Desarrollo, Instituto Investigación Vall d'Hebron (VHIR), CIBER de Enfermedades Raras, Instituto Salud Carlos III, Universitat Autònoma de Barcelona, Spain.
| | - Laura Bilbao Gassó
- Unidad de Endocrinología, Servicio de Pediatría, Hospital Vall d'Hebron, Spain
| | - Antonio Moreno-Galdó
- Sección de Alergia Pediátrica, Neumología Pediátrica y Fibrosis quística, Hospital Vall d'Hebron, Grupo de Investigación Crecimiento y Desarrollo, Instituto Investigación Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, Spain
| | - Ariadna Campos Martorrell
- Unidad de Endocrinología, Servicio de Pediatría, Hospital Vall d'Hebron, Grupo de Investigación Crecimiento y Desarrollo, Instituto Investigación Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, Spain
| | - Silvia Gartner Tizzano
- Sección de Alergia Pediátrica, Neumología Pediátrica y Fibrosis quística, Hospital Vall d'Hebron, Grupo de Investigación Crecimiento y Desarrollo, Instituto Investigación Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, Spain
| | - Diego Yeste Fernández
- Unidad de Endocrinología, Servicio de Pediatría, Hospital Vall d'Hebron, Grupo de Investigación Crecimiento y Desarrollo, Instituto Investigación Vall d'Hebron (VHIR), CIBER de Enfermedades Raras, Instituto Salud Carlos III, Universitat Autònoma de Barcelona, Spain
| | - Antonio Carrascosa Lezcano
- Unidad de Endocrinología, Servicio de Pediatría, Hospital Vall d'Hebron, Grupo de Investigación Crecimiento y Desarrollo, Instituto Investigación Vall d'Hebron (VHIR), CIBER de Enfermedades Raras, Instituto Salud Carlos III, Universitat Autònoma de Barcelona, Spain
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Cipolla L, Rocca F, Martinez C, Aguerre L, Barrios R, Prieto M. Prevalence of Burkholderia cepacia complex species in cystic fibrosis patients in Argentina during the period 2011-2015. Enferm Infecc Microbiol Clin 2018; 36:431-4. [PMID: 29055510 DOI: 10.1016/j.eimc.2017.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/29/2017] [Accepted: 09/05/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Burkholderia cepacia (B. cepacia) complex is composed of 20 phylogenetically closely related bacterial species. Some species have emerged as opportunistic pathogens in immunocompromised patients and are responsible for nosocomial outbreaks. The B. cepacia complex is a recognized respiratory pathogen in patients with cystic fibrosis. Burkholderia cenocepacia and Burkholderia multivorans (B. multivorans) are the most prevalent species in the world, according to the literature. However, research groups in Argentina have described a particular local epidemiology, with prevalence of Burkholderia contaminans (B. contaminans). METHODS A total of 68 isolates of B. cepacia complex recovered of 46 cystic fibrosis patients attended at 14 hospitals distributed in 9 provinces of the country were studied. Identification was carried out by conventional phenotypic methods and was confirmed by recA gene sequencing. Sequences were analysed using the BLASTN program and comparing with B. cepacia complex type strains sequences deposited in GenBank. Antibiotic susceptibility tests were performed on isolates of the most prevalent species according to CLSI M45 guidelines. RESULTS The prevalent specie was B. contaminans (49%, n = 33) followed by B. cenocepacia (25%; n = 17). The remaining species were Burkholderia seminalis (B. seminalis) (7%, n = 5), B. cepacia (7%, n = 5), B. multivorans (6%, n = 4), Burkholderia vietnamensis (5%, n=3) and Burkholderia pyrrocinia (1%; n = 1). The 46% of B. contaminans isolates were resistant to SXT and 76% sensitive to MIN, MEM and CAZ. The isolates of B. cenocepacia were 100% resistant to SXT and MIN and 47% to CAZ and MEM. B. seminalis showed high levels of resistance to TMS (80%), CAZ (60%) and MIN (60%), and 60% of the isolates showed intermediate sensitivity to MEM. CONCLUSION Previous reports have described the prevalence of B. contaminans isolation from cystic fibrosis patients in Argentina, Spain and Portugal, and a case of two patients with cystic fibrosis in Ireland has recently been reported. Due to the high frequency with which B. contaminans is isolated in our country, it is necessary to promote the investigation of possible sources of infection and to understand the factors and mechanisms involved in the apparent greater transmissibility of this species. Different antimicrobial resistance profiles were detected between the species.
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Bueno J, Flors L. The role of imaging in the diagnosis of bronchiectasis: the key is in the distribution. Radiologia (Engl Ed) 2018; 60:39-48. [PMID: 28781148 DOI: 10.1016/j.rx.2017.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/20/2017] [Accepted: 06/20/2017] [Indexed: 11/22/2022]
Abstract
Diseases that involve the medium caliber airways (segmental and subsegmental bronchi) are common and present clinically with nonspecific respiratory symptoms such as cough, recurrent respiratory infections and occasionally, hemoptysis. The abnormal and irreversible dilation of bronchi is known as "bronchiectasis". The diagnosis can be challenging and the analysis of the regional distribution of the bronchiectasis is the most useful diagnostic guide. The objective of this manuscript is to describe the main imaging findings of bronchiectasis and their classification, review the diseases that most commonly present with this abnormality, and provide an approach to the diagnosis based on their imaging appearance and anatomic distribution. Bronchiectasis is a frequent finding that may result from a broad range of disorders. Imaging plays a paramount role in diagnosis, both in the detection and classification, and in the diagnosis of the underlying pathology.
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Zurbano L, Zurbano F. [What the family doctor must know about lung transplant (Part 1)]. Semergen 2017; 43:457-462. [PMID: 28129961 DOI: 10.1016/j.semerg.2016.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/29/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
Abstract
Lung transplant is a therapeutic, medical-surgical procedure indicated for pulmonary diseases (except lung cancer), that are terminal and irreversible with current medical treatment. More than 3,500 lung transplants have been performed in Spain, with a rate of over 6 per million and increasing. In this review, an analysis is made of the types of transplants, their indications and contraindications, the procedures, immunosuppressive treatments, their side effects and medical interactions, current prophylaxis. A list of easily accessible literature references is also include, the majority being by national authors.
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Affiliation(s)
- L Zurbano
- Unidad de Trasplante Pulmonar, Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - F Zurbano
- Unidad de Trasplante Pulmonar, Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander, España.
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Prieto CI, Palau MJ, Martina P, Achiary C, Achiary A, Bettiol M, Montanaro P, Cazzola ML, Leguizamón M, Massillo C, Figoli C, Valeiras B, Perez S, Rentería F, Diez G, Yantorno OM, Bosch A. [Cystic Fibrosis Cloud database: An information system for storage and management of clinical and microbiological data of cystic fibrosis patients]. Rev Argent Microbiol 2016; 48:27-37. [PMID: 26895996 DOI: 10.1016/j.ram.2015.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 11/03/2015] [Accepted: 11/22/2015] [Indexed: 11/29/2022] Open
Abstract
The epidemiological and clinical management of cystic fibrosis (CF) patients suffering from acute pulmonary exacerbations or chronic lung infections demands continuous updating of medical and microbiological processes associated with the constant evolution of pathogens during host colonization. In order to monitor the dynamics of these processes, it is essential to have expert systems capable of storing and subsequently extracting the information generated from different studies of the patients and microorganisms isolated from them. In this work we have designed and developed an on-line database based on an information system that allows to store, manage and visualize data from clinical studies and microbiological analysis of bacteria obtained from the respiratory tract of patients suffering from cystic fibrosis. The information system, named Cystic Fibrosis Cloud database is available on the http://servoy.infocomsa.com/cfc_database site and is composed of a main database and a web-based interface, which uses Servoy's product architecture based on Java technology. Although the CFC database system can be implemented as a local program for private use in CF centers, it can also be used, updated and shared by different users who can access the stored information in a systematic, practical and safe manner. The implementation of the CFC database could have a significant impact on the monitoring of respiratory infections, the prevention of exacerbations, the detection of emerging organisms, and the adequacy of control strategies for lung infections in CF patients.
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Affiliation(s)
- Claudia I Prieto
- CINDEFI, CONICET-CCT La Plata, Centro de Biotecnología Aplicada, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Buenos Aires, Argentina
| | - María J Palau
- Sala de Microbiología, Hospital de Niños «Sor María Ludovica», La Plata, Buenos Aires, Argentina
| | - Pablo Martina
- CINDEFI, CONICET-CCT La Plata, Centro de Biotecnología Aplicada, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Buenos Aires, Argentina
| | - Carlos Achiary
- Infocom S.A., Ciudad Autónoma de Buenos Aires, Argentina
| | - Andrés Achiary
- Infocom S.A., Ciudad Autónoma de Buenos Aires, Argentina
| | - Marisa Bettiol
- Sala de Microbiología, Hospital de Niños «Sor María Ludovica», La Plata, Buenos Aires, Argentina
| | | | - María L Cazzola
- Sala de Bacteriología, Hospital HIGA, La Plata, Buenos Aires, Argentina
| | - Mariana Leguizamón
- CINDEFI, CONICET-CCT La Plata, Centro de Biotecnología Aplicada, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Buenos Aires, Argentina
| | - Cintia Massillo
- CINDEFI, CONICET-CCT La Plata, Centro de Biotecnología Aplicada, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Buenos Aires, Argentina
| | - Cecilia Figoli
- CINDEFI, CONICET-CCT La Plata, Centro de Biotecnología Aplicada, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Buenos Aires, Argentina
| | - Brenda Valeiras
- CINDEFI, CONICET-CCT La Plata, Centro de Biotecnología Aplicada, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Buenos Aires, Argentina
| | - Silvia Perez
- Sala de Bacteriología, Hospital HIGA, La Plata, Buenos Aires, Argentina
| | - Fernando Rentería
- Servicio de Neumonología, Hospital de Niños «Sor María Ludovica», La Plata, Buenos Aires, Argentina
| | - Graciela Diez
- Servicio de Neumonología, Hospital de Niños «Sor María Ludovica», La Plata, Buenos Aires, Argentina
| | - Osvaldo M Yantorno
- CINDEFI, CONICET-CCT La Plata, Centro de Biotecnología Aplicada, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Buenos Aires, Argentina
| | - Alejandra Bosch
- CINDEFI, CONICET-CCT La Plata, Centro de Biotecnología Aplicada, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Buenos Aires, Argentina.
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Galaviz-Ballesteros MDJ, Acosta-Rodríguez-Bueno CP, Consuelo-Sánchez A, Franco-Álvarez I, Olalla-Mera OI, Vázquez-Frias R. [Pseudo-Bartter syndrome as manifestation of cystic fibrosis with DF508 mutation]. Bol Med Hosp Infant Mex 2016; 73:331-334. [PMID: 29384126 DOI: 10.1016/j.bmhimx.2016.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/11/2016] [Accepted: 04/18/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pseudo Bartter syndrome (PBS) is defined as hypokalaemic hypochloraemic metabolic alkalosis in the absence of renal tubular pathology. Children with cystic fibrosis (CF) are at risk of developing electrolyte abnormalities and even PBS may occur. CASE REPORT 5 months old female infant with a history of two events of dehydration with vomit, refusal to eat, chronic cough, polyuria, malnutrition, metabolic alkalosis, hypokalemia, hyponatremia, hypochloremia and acute renal failure. Chronic cough study was performed, discarding pulmonary tuberculosis, gastroesophageal reflux disease and impaired swallowing. PBS was diagnosed due to hypokalaemic hypochloraemic metabolic alkalosis in the absence of renal tubular pathology. CF was corroborated by electrolytes in sweat and through molecular analysis of the delta F508 mutation. This is one of the few reported cases linking PBS and this mutation. CONCLUSIONS In patients with hyponatremic dehydration episodes with hypokalaemic hypochloraemic metabolic alkalosis, PBS should be considered as differential diagnosis. CF could be presented as PBS, mainly in patients younger than 2 years.
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Affiliation(s)
| | | | - Alejandra Consuelo-Sánchez
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Isidro Franco-Álvarez
- Departamento de Nefrología, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Odilo Iván Olalla-Mera
- Departamento de Nefrología, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Rodrigo Vázquez-Frias
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México.
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Cano Megías M, Guisado Vasco P, González Albarrán O, Lamas Ferreiro A, Máiz Carro L. Association of the relative change in weight and body mass index with lung function in teenagers and adults with cystic fibrosis: Influence of gender and diabetes. ACTA ACUST UNITED AC 2015; 62:422-9. [PMID: 26311609 DOI: 10.1016/j.endonu.2015.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 06/20/2015] [Accepted: 06/25/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Nutritional status is a prognostic factor in cystic fibrosis. Prevention of nutritional impairment and weigh loss are major clinical objectives because they are associated with worsening of lung function and increased mortality. OBJECTIVE To identify a potential relationship of clinical nutrition parameters, and their relative changes, with lung function (FEV1%) in a cohort of adolescent and adult patients with CF. METHODS A retrospective analysis of 64 patients older than 14years. Weight, height, BMI, and lung function data were collected at a period of disease stability, both in the year of the first abnormal oral glucose tolerance test (OGTT) and in the previous year. Relative changes in weight and BMI, and their relationship with FEV1%, were determined by linear regression and ANOVA tests; influence of gender and diabetes was also assessed. RESULTS Mean age of the series (28 females and 36 males) was 26.8years. Normal glucose tolerance (NGT) was found in 26.7%, while 18.3% had diabetes without impaired fasting glucose (CFRD without FPG). Mean BMI was 20.32, with a mean weight of 53.53kg; 32.8% had BMI<18.5, and only 4.7% were overweight. Overall, a positive relative change in weight (≥6%) was associated with an increase in FEV1% (9.31%), as compared to those with a greater weight loss (at least 2%), who had a 12.09% fall in FEV1. Patients with CFRD without FPG had poorer lung function if they had a negative relative change in weight by at least 2% as compared to NGT. CONCLUSIONS In patients with CF, a relative weight gain is positively associated to FEV1%, while a relative weight loss of at least 2% has a significant negative impact on lung function.
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Affiliation(s)
- Marta Cano Megías
- Servicio de Endocrinología y Nutrición, Hospital Universitario Ramón y Cajal, Madrid, España.
| | | | - Olga González Albarrán
- Servicio de Endocrinología y Nutrición, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Adelaida Lamas Ferreiro
- Servicio de Pediatría, Unidad de Fibrosis Quística, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Luis Máiz Carro
- Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, España
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Del Corral T, Percegona J, López N, Valiente A, Garriga M, Seborga M, Vilaró J. Validity of a Spanish Version of the Leicester Cough Questionnaire in Children With Cystic Fibrosis. Arch Bronconeumol 2015; 52:63-9. [PMID: 26163742 DOI: 10.1016/j.arbres.2015.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 01/05/2015] [Accepted: 01/28/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) patients present chronic cough as one of the main symptoms, which has an important effect on quality of life and social relations. Our goal was to validate the Spanish version of the Leicester Cough Questionnaire (LCQ) in a group of children and teenagers with CF. METHODS After adapting to Spanish by standardized translation and retro-translation methodology, a sample of 58 stable CF patients from 7 to 18 years were recruited from three CF specialized centers in Spain. The questionnaire was administered twice; the second administration (LCQ2) was performed between 2-4 weeks later than the first one (LCQ1), in order to analyse the reliability and validity of the Spanish version. To correlate results with health related quality of life (HRQoL) we used the Cystic Fibrosis Questionnaire-Revised (CFQ-R). RESULTS Population was composed by 62% male, age 11.7 ± 3.1 years and body mass index (BMI) 19 ± 3 kg/m(2). Total scores from LCQ were: LCQ1 19 (17.75-21) vs LCQ2 19 (16-21) (P=.199). Cronbach's Alpha coefficient was 0.83 for the LCQtotal and for each specific domain was: 0.82 LCQphysical; 0.74 LCQpsychological and 0.62 LCQsocial. Intraclass correlation coefficient was: 0.69 LCQphysical; 0.59 LCQpsychological; 0.45 LCQsocial and 0.71 LCQtotal (good reliability). Relations with CFQ-R showed moderated and significant results: for the LCQtotal: respiratory symptom domain r = 0,51 (P<.001) and physical capacity domain r = 0,62 (P<.05). CONCLUSION The Spanish version of the Leicester Cough Questionnaire is reliable and valid for children and adolescents with CF and it has good relations with health related quality of life in this population.
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Affiliation(s)
- Tamara Del Corral
- Asociación Madrileña de Fibrosis Quística, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España
| | - Janaína Percegona
- Máster en Medicina Respiratoria, Universitat de Barcelona y Universitat Pompeu Fabra, Barcelona, España
| | - Núria López
- Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | - Andrea Valiente
- Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | | | - Melisa Seborga
- Asociación Madrileña de Fibrosis Quística, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España
| | - Jordi Vilaró
- FCS Blanquerna, Grup de Recerca en Salut, Activitat Física i Esport (SAFE), Universitat Ramon Llull, Barcelona, España.
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Llorca Otero L, Girón Moreno R, Buendía Moreno B, Valenzuela C, Guiu Martínez A, Alarcón Cavero T. Achromobacter xylosoxidans infection in an adult cystic fibrosis unit in Madrid. Enferm Infecc Microbiol Clin 2015; 34:184-7. [PMID: 26139304 DOI: 10.1016/j.eimc.2015.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 04/07/2015] [Accepted: 05/18/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Achromobacter xylosoxidans is an emerging pathogen in cystic fibrosis (CF). Although the rate of colonization by this microorganism is variable, prevalence is increasing in CF units. METHODS A microbiological/clinical study was conducted on of adult CF patients harboring A. xylosoxidans. Identification and susceptibility testing were performed using MicroScan (Siemens). Decline in lung function was assessed using the variable, annual percentage loss of FEV1 (forced expiratory volume in 1s). RESULTS A. xylosoxidans was isolated in 18 (19.8%) of 91 patients over a 14-year period. Mean age was 26.6 years (18-39 years). Nine patients (9.8%) were chronically colonized. Piperacillin/tazobactam and imipenem were the most active antibiotics. Mean annual decline in lung function in chronically colonized patients was 2.49%. CONCLUSIONS A. xylosoxidans is a major pathogen in CF. A decreased lung function was observed among patients who were chronically colonized by A. xylosoxidans. Antibiotic therapy should be started early in order to prevent chronic colonization by this microorganism.
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Affiliation(s)
- Laura Llorca Otero
- Department of Microbiology, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Diego de León, 62, Madrid, Spain.
| | - Rosa Girón Moreno
- Department of Pulmonology, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Diego de León, 62, Madrid, Spain
| | - Buenaventura Buendía Moreno
- Department of Microbiology, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Diego de León, 62, Madrid, Spain
| | - Claudia Valenzuela
- Department of Pulmonology, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Diego de León, 62, Madrid, Spain
| | - Alba Guiu Martínez
- Department of Microbiology, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Diego de León, 62, Madrid, Spain
| | - Teresa Alarcón Cavero
- Department of Microbiology, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Diego de León, 62, Madrid, Spain
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Abstract
Cystic fibrosis is the most common life-shortening recessively inherited disorder in the Caucasian population. The genetic mutation that most frequently provokes cystic fibrosis (ΔF508) appeared at least 53,000years ago. For many centuries, the disease was thought to be related to witchcraft and the "evil eye" and it was only in 1938 that Dorothy H. Andersen characterized this disorder and suspected its genetic origin. The present article reviews the pathological discoveries and diagnostic and therapeutic advances made in the last 75 years. The review ends with some considerations for the future.
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Affiliation(s)
- Salvador Navarro
- Consultor sénior jubilado, Servicio de Gastroenterología, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Barcelona, España.
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32
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Cantón R, Máiz L, Escribano A, Olveira C, Oliver A, Asensio O, Gartner S, Roma E, Quintana-Gallego E, Salcedo A, Girón R, Barrio MI, Pastor MD, Prados C, Martínez-Martínez MT, Barberán J, Castón JJ, Martínez-Martínez L, Poveda JL, Vázquez C, de Gracia J, Solé A. Spanish consensus on the prevention and treatment of Pseudomonas aeruginosa bronchial infections in cystic fibrosis patients. Arch Bronconeumol 2015; 51:140-50. [PMID: 25614377 DOI: 10.1016/j.arbres.2014.09.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 09/22/2014] [Indexed: 01/22/2023]
Abstract
Pseudomonas aeruginosa is the main pathogen in bronchopulmonary infections in cystic fibrosis (CF) patients. It can only be eradicated at early infection stages while reduction of its bacterial load is the therapeutic goal during chronic infection or exacerbations. Neonatal screening and pharmacokinetic/pharmacodynamic knowledge has modified the management of CF-patients. A culture based microbiological follow-up should be performed in patients with no infection with P.aeruginosa. At initial infection, inhaled colistin (0,5-2MU/tid), tobramycin (300mg/bid) or aztreonam (75mg/tid) with or without oral ciprofloxacin (15-20mg/kg/bid, 2-3weeks) are recommended. In chronic infections, treatment is based on continuous administration of colistin or with a 28-day on-off regimen with tobramycin or aztreonam. During mild-moderate exacerbations oral ciprofloxacin (2-3weeks) can be administered while serious exacerbations must be treated with intravenous combination therapy (beta-lactam with an aminoglycoside or a fluoroquinolone). Future studies will support antibiotic rotation and/or new combination therapies. Epidemiological measures are also recommended to avoid new P.aeruginosa infections and "patient-to-patient transmission" of this pathogen.
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Affiliation(s)
- Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Madrid, España; Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, España.
| | - Luis Máiz
- Unidad de Bronquiectasias y Fibrosis Quística, Servicio de Neumología, Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Madrid, España
| | - Amparo Escribano
- Unidad de Neumología Pediátrica y Fibrosis Quística, Servicio de Pediatría, Hospital Clínico Universitario, Universidad de Valencia, Valencia, España
| | - Casilda Olveira
- Unidad de Gestión Clínica de Enfermedades Respiratorias, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, España
| | - Antonio Oliver
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, España; Servicio de Microbiología y Unidad de Investigación, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Palma de Mallorca, España
| | - Oscar Asensio
- Unidad de Neumología y Alergia Pediátrica, Hospital Universitario de Sabadell. Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | - Silvia Gartner
- Unidad de Neumología Pediátrica y Fibrosis Quística, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Eva Roma
- Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Esther Quintana-Gallego
- Unidad de Fibrosis Quística, Servicio de Neumología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Antonio Salcedo
- Unidad de Fibrosis Quística Interhospitalaria Niño Jesús-Gregorio Marañón, Madrid, España
| | - Rosa Girón
- Unidad de Bronquiectasias y Fibrosis Quística, Hospital Universitario La Princesa, Instituto La Princesa de Investigación Sanitaria, Madrid, España
| | - María Isabel Barrio
- Sección de Neumología Pediátrica y Unidad de Fibrosis Quística, Hospital Universitario La Paz, Madrid, España
| | - María Dolores Pastor
- Unidad de Neumología Pediátrica y Fibrosis Quística, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Concepción Prados
- Unidad de Fibrosis Quística y Bronquiectasias, Servicio de Neumología, Hospital Universitario La Paz, Madrid, España
| | | | - José Barberán
- Departamento de Medicina Interna, Hospital Montepríncipe, Universidad CEU San Pablo, Madrid, España
| | - Juan José Castón
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Luis Martínez-Martínez
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, España; Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL y Departamento de Biología Molecular, Universidad de Cantabria, Santander, España
| | - José Luis Poveda
- Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Carlos Vázquez
- Unidad de Neumología Pediátrica y Fibrosis Quística, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | - Javier de Gracia
- Servicio de Neumología y CIBER en Enfermedades Respiratorias (CibeRES), Hospital Universitari Vall d'Hebron, Universidad Autónoma, Barcelona, España
| | - Amparo Solé
- Unidad de Trasplante Pulmonar y Fibrosis Quística, Hospital Universitario y Politécnico la Fe, Valencia, España.
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Chacón CF, Vicente R, Ramos F, Porta J, Lopez Maldonado A, Ansotegui E. [Nocardia farcinica lung infection in a patient with cystic fibrosis and a lung transplant]. ACTA ACUST UNITED AC 2015; 62:161-4. [PMID: 25443661 DOI: 10.1016/j.redar.2014.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 04/13/2014] [Accepted: 04/26/2014] [Indexed: 11/21/2022]
Abstract
Patients with cystic fibrosis have a higher risk of developing chronic respiratory infectious diseases. The Nocardia farcinica lung infection is rare in this group of patients, and there are limited publications about this topic. Its diagnosis is complex, due to the clinical and the radiology signs being non-specific. Identification of the agent responsible in the sputum culture is occasionally negative. It is a slow growing organism and for this reason treatment is delayed, which can lead to an increase in complications, hospitable stays, and mortality. A case is reported on a 26 year-old woman with cystic fibrosis and chronic lung colonization by Nocardia farcinica and Aspergillus fumigatus, on long-term treatment with ciprofloxacin, trimethoprim-sulfamethoxazole, and posaconazole, who was admitted to ICU after bilateral lung transplantation. The initial post-operative progress was satisfactory. After discharge, the patient showed a gradual respiratory insufficiency with new chest X-ray showing diffuse infiltrates. Initially, the agent was not seen in the sputum culture. Prompt and aggressive measures were taken, due to the high clinical suspicion of a Nocardia farcinica lung infection. Treatment with a combination of amikacin and meropenem, and later combined with linezolid, led to the disappearance of the lung infiltrates and a clinical improvement. In our case, we confirm the rapid introduction of Nocardia farcinica in the new lungs. The complex identification and the delay in treatment increased the morbimortality. There is a special need for its eradication in patients with lung transplant, due to the strong immunosuppressive treatment.
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34
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Casas Maldonado F, Alfageme Michavila I, Barchilón Cohen VS, Peis Redondo JI, Vargas Ortega DA. [Pneumococcal vaccine recommendations in chronic respiratory diseases]. Semergen 2014; 40:313-25. [PMID: 25107494 DOI: 10.1016/j.semerg.2014.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 06/22/2014] [Indexed: 11/30/2022]
Abstract
Community-acquired pneumonia is an acute respiratory infectious disease which has an incidence of 3-8 cases/1,000 inhabitants, and increases with age and comorbidities. The pneumococcus is the organism most frequently involved in community-acquired pneumonia in the adult (30-35%). Around 40% of patients with community-acquired pneumonia require hospital admission, and around 10% need to be admitted to an intensive care unit. The most serious forms of pneumococcal infection include invasive pneumococcal disease (IPD), which covers cases of bacteremia (associated or not to pneumonia), meningitis, pleuritis, arthritis, primary peritonitis and pericarditis. Currently, the biggest problem with the pneumococcus is the emergence of resistance to antimicrobial agents, and its high morbimortality, despite the use of appropriate antibiotics and proper medical treatment. Certain underlying medical conditions increase the risk of IPD and its complications, especially, from the respiratory diseases point of view, smoking and chronic respiratory diseases. Pneumococcal disease, according to the WHO, is the first preventable cause of death worldwide in children and adults. Among the strategies to prevent IPD is vaccination. WHO considers that its universal introduction and implementation against pneumococcus is essential and a priority in all countries. There are currently 2 pneumococcal vaccines for adults: the 23 serotypes polysaccharide and conjugate 13 serotypes. The scientific societies represented here have worked to develop some recommendations, based on the current scientific evidence, regarding the pneumococcal vaccination in the immunocompetent adult with chronic respiratory disease and smokers at risk of suffering from IPD.
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Affiliation(s)
- F Casas Maldonado
- Asociación de Neumología y Cirugía Torácica del Sur (NEUMOSUR), España.
| | | | | | - J I Peis Redondo
- Sociedad Española de Médicos de Atención Primaria (SEMERGEN-Andalucía), España
| | - D A Vargas Ortega
- Sociedad Española de Médicos Generales y de Familia (SEMG-Andalucía), España
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35
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Lerín M, Prados C, Martínez MT, Maíz L, Girón R, Solé A, Cabanillas JJ, Alvarez-Sala R. Cystic fibrosis in adult age. Rev Clin Esp 2014; 214:289-95. [PMID: 24948579 DOI: 10.1016/j.rce.2014.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/01/2014] [Accepted: 05/03/2014] [Indexed: 11/28/2022]
Abstract
AIM To know the prevalence of the patients diagnosed of cystic fibrosis (CF) older than 18 years old of five specific Spanish Units and to analyze their clinical, genetic and microbiological characteristics. PATIENTS AND METHODS Observational, cross-sectional, descriptive study of patients diagnosed with CF at age or older than 18 years. The variables analyzed were: current age, age at diagnosis, sex, nationality, lung function parameters, pathologies presented at diagnosis, microbiological features and genetic findings. RESULTS Eigthy nine patients (14.8% of the total of 600 CF patients followed at the participating units), of which 45 patients were female (50.6%) and 44 were males (49.4%), were included with a mean age at diagnosis of 36.4 years. Eigthy one patients (91%) were Spaniards. The sweat test was diagnostic in 77 (86.5%) of the patients studied. The sweat test was diagnostic in 77 of the 89 patients studied (86.5%). The most frequently detected mutations were F508del/other and G542X/other, and the most frequent clinical findings at diagnosis were the presence of bronchiectasis in 33 patients (37.1%) followed by sterility in 12 patients (13.5%). The most common colonizing organisms were meticillin-sensitive Staphylococcus aureus (S.aureus) (23.6%) and Pseudomonas aeruginosa (P. aeruginosa) (13.5%). Most patients presented a mild obstructive ventilatory defect and had no pancreatic involvement. The sweat test used to be indeterminate. CONCLUSIONS CF is also a disease which diagnosis can be in adulthood. CF patients diagnosed in adulthood have a mild lung function and lower incidence of pancreatic involvement, so their prognosis tends to be favorable.
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Affiliation(s)
- M Lerín
- Unidad de Fibrosis quística, Servicio de Neumología, Hospital Universitario La Paz, Madrid, España
| | - C Prados
- Unidad de Fibrosis quística, Servicio de Neumología, Hospital Universitario La Paz, Madrid, España.
| | - M T Martínez
- Unidad de Fibrosis quística, Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, España
| | - L Maíz
- Unidad de Fibrosis quística, Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - R Girón
- Unidad de Fibrosis quística, Servicio de Neumología, Hospital Universitario La Princesa, Madrid, España
| | - A Solé
- Unidad de Fibrosis quística, Servicio de Neumología, Hospital Universitario La Fe, Valencia, España
| | - J J Cabanillas
- Unidad de Fibrosis quística, Servicio de Neumología, Hospital Universitario La Paz, Madrid, España
| | - R Alvarez-Sala
- Unidad de Fibrosis quística, Servicio de Neumología, Hospital Universitario La Paz, Madrid, España
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Girón Moreno RM, Fernandes Vasconcelos G, Cisneros C, Gómez-Punter RM, Segrelles Calvo G, Ancochea J. Presence of anxiety and depression in patients with bronchiectasis unrelated to cystic fibrosis. Arch Bronconeumol 2013; 49:415-20. [PMID: 24008154 DOI: 10.1016/j.arbres.2013.01.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 01/25/2013] [Accepted: 01/26/2013] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Patients with chronic bronchiectasis (BQ) may suffer from psychological disorders. The objective of this study was to assess the presence of anxiety and depression in patients from a specialised BQ Unit, using validated questionnaires. PATIENTS AND METHODS We included patients consecutively diagnosed with BQ (unrelated to cystic fibrosis) by high resolution computed tomography in the study. Patients were clinically stable in the previous three weeks and voluntarily completed the Beck Depression Inventory, State-Trait Anxiety Inventory and St. George's Respiratory Questionnaire, after signing the informed consent. They were classified according to their scores on the psychological screening questionnaires, and their results were compared with the clinical, radiological and functional parameters and Quality of Life. RESULTS Seventy patients were included, 48 women and 22 men, with a mean age of 64.19years. Thirty-four percent (34%) of patients showed symptoms of depression, and around 55% had scores above the 50th percentile in trait and state anxiety. The amount of sputum was associated with trait anxiety. Bacterial colonization was related to anxiety (trait and state), especially Pseudomonas aeruginosa colonization. Female patients showed a higher risk of depression. There was no relationship between the Quality of Life scores and the established classifications of anxiety and depression. CONCLUSIONS A high percentage of patients with BQ presented anxiety (trait and state) and depression. The daily sputum production and bacterial colonization (especially with P. aeruginosa) were the variables most related to anxiety; depression was more common in women. We believe that the presence of psychological disorders should be evaluated, especially in patients with this profile.
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Affiliation(s)
- Rosa María Girón Moreno
- Servicio de Neumología, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, España.
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López-Cantero M, Grisolía AL, Vicente R, Moreno I, Ramos F, Porta J, Torregrosa S. [Extracorporeal membrane oxygenation in primary graft dysfunction in a paediatric double lung transplant: presentation of a case]. ACTA ACUST UNITED AC 2014; 61:205-8. [PMID: 23731837 DOI: 10.1016/j.redar.2013.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 03/26/2013] [Accepted: 03/27/2013] [Indexed: 11/20/2022]
Abstract
Primary graft dysfunction is a leading cause of morbimortality in the immediate postoperative period of patients undergoing lung transplantation. Among the treatment options are: lung protective ventilatory strategies, nitric oxide, lung surfactant therapy, and supportive treatment with extracorporeal membrane oxygenation (ECMO) as a bridge to recovery of lung function or re-transplant. We report the case of a 9-year-old girl affected by cystic fibrosis who underwent double-lung transplantation complicated with a severe primary graft dysfunction in the immediate postoperative period and refractory to standard therapies. Due to development of multiple organ failure, it was decided to insert arteriovenous ECMO catheters (pulmonary artery-right atrium). The postoperative course was satisfactory, allowing withdrawal of ECMO on the 5th post-surgical day. Currently the patient survives free of rejection and with an excellent quality of life after 600 days of follow up.
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Correa-Ruiz A, Girón R, Buendía B, Medina-Pascual MJ, Valenzuela C, López-Brea M, Sáez-Nieto JA. Burkholderia cepacia complex infection in an Adult Cystic Fibrosis unit in Madrid. Enferm Infecc Microbiol Clin 2013; 31:649-54. [PMID: 23528342 DOI: 10.1016/j.eimc.2012.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 11/30/2012] [Accepted: 12/04/2012] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Burkholderia cepacia complex have emerged as significant pathogens in cystic fibrosis (CF) patients due to the risk of cepacia syndrome and the innate multi-resistance of the microorganisms to antibiotics. The aim of this study was to describe the antimicrobial susceptibility profiles, the genotypes and subtypes of BCC, and the clinical evolution of CF patients with BCC. METHODS The lung function and Brasfield and Shwachman score were assessed in 12 patients. BCC were identified and susceptibility was studied by MicroScan (Siemens). Species and genospecies of BCC were confirmed by molecular methods in a Reference Centre (Majadahonda). RESULTS BCC were identified in 12 of 70 patients (17.1%) over a ten year period. The mean age to colonization by BCC was 24.4 years (SD: 7.71). B. cenocepacia was isolated in 4 patients (33.3%), B. contaminans was isolated in 3 patients (25%), both B. vietnamiensis and B. stabilis were isolated in 2 patients (16.7%), and B. cepacia, B. multivorans and B. late were isolated in one patient (8.3%). Among the B. cenocepacia, subtype IIIa was identified in two strains, and subtype IIIb was identified in the other two strains. There was susceptibility to meropenem in 90% of BCC, 80% to cotrimoxazole, 60% to minocycline, 50% to ceftazidime, and 40% to levofloxacin. CONCLUSIONS B. cenocepacia was the most prevalent species among the BCC isolated in CF adult patients, and subtypes IIIa and IIIb were identified in the 50% of the strains. Meropenem and cotrimoxazole showed the best activity.
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Affiliation(s)
- Ana Correa-Ruiz
- Servicio de Microbiología, Instituto de Investigación Sanitaria, Hospital de La Princesa, Madrid, Spain.
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