Issues

Journal & Issues

Volume 70 (2021): Issue 2 (September 2021)

Volume 70 (2021): Issue 1 (June 2021)

Volume 69 (2020): Issue 4 (December 2020)

Volume 69 (2020): Issue 3 (December 2020)

Volume 69 (2020): Issue 2 (December 2020)

Volume 69 (2020): Issue 1 (June 2020)

Volume 68 (2019): Issue 4 (December 2019)

Volume 68 (2019): Issue 3 (December 2019)

Volume 68 (2019): Issue 2 (October 2019)

Volume 68 (2019): Issue 1 (June 2019)

Journal Details
Format
Journal
eISSN
2247-059X
First Published
31 Jan 1951
Publication timeframe
1 time per year
Languages
English

Search

Volume 70 (2021): Issue 1 (June 2021)

Journal Details
Format
Journal
eISSN
2247-059X
First Published
31 Jan 1951
Publication timeframe
1 time per year
Languages
English

Search

11 Articles
Open Access

Summary

Published Online: 28 May 2022
Page range: 1 - 2

Abstract

Open Access

Tuberculosis in Romania during COVID-19. Some new concerns. Some new answers.

Published Online: 28 May 2022
Page range: 3 - 4

Abstract

Keywords

  • tuberculosis
  • COVID-19
Open Access

Side effects induced by using the protective equipment and tips for avoiding them

Published Online: 28 May 2022
Page range: 5 - 10

Abstract

Abstract

Severe acute respiratory distress syndrome (SARS)-CoV-2, the cause of Coronavirus disease 2019 (COVID-19), has caused a global pandemic with worldwide morbidity, mortality and disruptions to society. Undoubtedly, the global spread of the COVID-19 pandemic had warranted universal precautions to slow the rate of infection. Hand hygiene, social distancing, regular disinfection of surfaces and avoidance of touching one’s face are some of the measures which have been used in an attempt to decrease exponential disease spread. The epidemiology of SARS-CoV-2 had indicated that most infections were spread by respiratory droplets, through exposure to an infected individual at close range. For this reason, healthcare professionals are mandated to wear personal protective equipment (PPE) for a prolonged period of time when caring for COVID-19 patients. On the other hand, the COVID-19 pandemic has led to an increased use of face protection such as surgical masks and eye protection not only amongst healthcare workers but also now the general public. Prolonged use of N95 and surgical masks by healthcare professionals during COVID-19 has caused adverse effects such as headaches, rash, acne, skin breakdown and impaired cognition. This review delves into various adverse effects of prolonged mask use and provides recommendations to ease the burden on healthcare professionals. The magnitude of this condition is clinically significant and might worsen if the current outbreak further continues to spread widely and stays for a longer time, affecting the work performance of healthcare workers. Perhaps better strategies are needed for designing various PPE and reducing the duration for which healthcare workers are required to use them.

Keywords

  • COVID-19
  • personal protective equipment
  • adverse effects
Open Access

SARS-CoV-2 epidemiological surveillance of healthcare professionals working in an inpatient rehabilitation facility

Published Online: 28 May 2022
Page range: 11 - 17

Abstract

Abstract

Background: Healthcare Workers (HCW) represent one of the most vulnerable subject groups to be infected by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2).

Aims: Between March 2020 and May 2020, we decided to implement a surveillance programme for HCW that aimed to (1) strengthen the safety of the employees; (2) estimate the punctual prevalence of SARS-CoV-2 infection in asymptomatic operators; (3) use the results to train personnel and to strengthen surveillance for applying and validating preventive strategies; and (4) compare the observed prevalence and the infection characteristics with a real-life (RL) sample from non-healthcare settings.

Methods: A nasopharyngeal (NP) swab in HCW, representative of all mansions, and RL subjects was performed after informed consent signing (T0), then after 6 d ± 24 h (T1) and after 12 d ± 24 h (T2). The presence of SARS-CoV-2 mRNA was tested by commercially available real-time PCR.

Results: A total of 219 HCW and 100 RL subjects were enrolled; and among all the subjects, only 1 HCW resulted positive at the swab testing throughout the study period. The positive subject was an asymptomatic nurse without any comorbidities or risk factors.

Conclusions: Our experience supports the utility of implementing dedicated surveillance programmes for the HCW. The efficiency in keeping low the number of the infection, maintaining the psychological well-being of the personnel and the availability of a tool which in case of infection may allow the early identification of clusters are critical issues which encourage the planning and implementation of such programmes NIH clinicaltrials.gov (NCT04913701).

Keywords

  • SARS-CoV-2
  • COVID-19 nucleic acid testing
  • healthcare workers
  • surveillance
  • prevalence
  • prevention
Open Access

COVID-19 disease in the pulmonology unit of a dedicated COVID-19 hospital – our experience

Published Online: 28 May 2022
Page range: 18 - 25

Abstract

Abstract

Background: The Coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) has led to a global health care crisis. We report profiles of cases admitted to our hospital.

Methods: We conducted this study at the pulmonology unit of a Dedicated COVID Hospital (DCH) of Western India. This is a prospective observational study which analysed the demographical data, clinical parameters, comorbidities, complications and laboratory and outcome parameters.

Results: Our study included 101 patients. The mean age was 43 years; 64 (63.3%) were men and 37 (36.7%) women. Out of 101, 6 (6%) had mild, 30 (30%) had moderate and 65 (64%) had severe COVID-19 disease. Severity increased with age and comorbidities. Ninety-four (94%) had pneumonia. Of these 94, 65 (69%) patients had acute respiratory distress syndrome (ARDS). Twenty-one (21%) were mild, 20 (31%) moderate and 24 (37%) severe ARDS. ARDS severity increased with age and in men. Thirty-six (36%) required oxygenation only and 29 (29%) required additional ventilatory management – mostly non-invasive ventilation (NIV). The laboratory values analysis revealed elevation of D-dimers level in 66 (65.3%) and IL6 in 68 (67.3%). Diabetes mellitus (DM) and hypertension (HT) were the common comorbidities. Totally three (2.97%) patients died due to COVID-19 infection. Mortality was associated with HT and myocarditis. Mean duration of hospital stay was 15 days, and it increased with increasing severity of disease and ARDS.

Conclusion: COVID-19 is common in the adult with male preponderance. The majority recovered with a good outcome. Comorbidities affected outcome adversely.

Keywords

  • COVID-19
  • comorbidities
  • outcome
Open Access

Multidrug-resistant tuberculosis and diabetes mellitus as a problem of modern medicine

Published Online: 28 May 2022
Page range: 26 - 33

Abstract

Abstract

Aims: To carry out a comprehensive retrospective assessment of the prevalence, features and course of treatment of patients with multidrug-resistant tuberculosis (MDR-TB) and diabetes mellitus (DM).

Materials and Methods: Our study is based on a retrospective analysis of statistical data obtained from 762 current and former MDR-TB patients (74% of patients with resistance only to first-line drugs – isoniazid (H) and rifampin (R); 36% with resistance to H, R and second-line drugs) included in the register of tuberculosis (TB) patients from different regions of Ukraine and the Grodno region of the Republic of Belarus between 2015 and 2019.

Results and Discussion: In both groups of the study recurrent TB prevailed: 49 cases (55.7%) of relapse TB compared to 39 cases (44.3%) of primary TB in the main group; 363 cases (53.9%) of relapse TB compared to 311 (46.1%) primary TB in the control group (P < 0.05). The rate of successful treatment in the control group is higher than in the main group (64.7% vs. 61.4%; P < 0.05). A significant difference between the two groups was observed owing to the difference in frequency of treatment, which in the main group has recorded 27.3%, as against 40.3% in the control group (almost two times lower; P < 0.05).

Conclusions: The association between TB and DM increases the morbidity, chemoresistance and proportion of recurrences. Pulmonary TB developed significantly more often in middle-aged patients with type 2 DM with moderate and severe states, with subcompensated form and with a complicated course.

Keywords

  • multidrug resistance
  • diabetes mellitus
  • hydrocarbon metabolism
  • treatment
  • epidemiology
Open Access

Brain metastases revealing primary pulmonary soft part sarcoma

Published Online: 28 May 2022
Page range: 34 - 39

Abstract

Abstract

Alveolar soft part sarcoma (ASPS) is a rare mesenchymal soft-tissue tumour. It commonly arises in the lower extremities in adults and the head and neck in children. Primary pulmonary involvement, without evidence of soft tissue tumour elsewhere, is very rare. We present the seventh case ever reported in the literature of primary ASPS of the lung, which was revealed by brain metastases in a 28-year-old male patient. The parietal brain tumour was resected. The radiological and histological study led to the diagnosis: metastasis of an alveolar sarcoma. The patient then had brain radiotherapy and chemotherapy. Using this case as a starting point, we reviewed the characteristics and the main therapeutic options in these uncommon neoplasms.

Keywords

  • Alveolar soft part sarcoma
  • brain tumour
Open Access

Case of severe treatment resistant cryptogenic organising pneumonia

Published Online: 28 May 2022
Page range: 40 - 44

Abstract

Abstract

Cryptogenic organising pneumonia (COP) is a rare interstitial lung disease with different onset of symptoms, which responds rapidly to glucocorticoid treatment. We present a case of COP which manifested as progressive 3-year dyspnoea that has led ultimately to acute respiratory failure. Moreover, treatment with prednisone for this patient exhibits slow onset of the effect.

Keywords

  • organising pneumonia
  • acute respiratory failure
  • prednisone therapy
Open Access

COVID-19 complicated by multiple germs infection -case report and short literature review

Published Online: 28 May 2022
Page range: 45 - 50

Abstract

Abstract

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is characterised by a varied clinical picture. In some cases the evolution may be unfavourable, progressing to pneumonia and acute respiratory distress syndrome.

Clinical case: A 70-years-old woman, with multiple comorbidities, was admitted for low-grade fever, dry cough and loss of appetite, symptoms that started 4 days prior to hospitalisation. She was initially diagnosed with mild coronavirus disease 2019 (COVID-19). On the 18th day of illness, there was an increase in inflammatory markers, progression of radiological lesions and SpO2 dropped to 88% room air. Treatment with tocilizumab, remdesivir and high-flow oxygen therapy was initiated. Chest Computed tomography with pulmonary artery angiography ruled out suspected pulmonary embolism, but revealed a new pneumonic process and right pleural effusion, therefore antibiotic therapy was started. Imaging reassessment revealed excavation of the pneumonic process and persistence of pleural effusion. Reverse transcription polymerase chain reaction (RT-PCR) retesting for SARSCOV2 was negative and the patient was transferred to another hospital to undergo bronchoscopy and continue the treatment. Bacteriological examination of the induced sputum revealed the presence of Stenotrophomonas maltophilia, and in the bronchial aspirate was isolated Legionella pneumophilla; whereas the pharyngeal exudate highlighed the presence of Candida glabrata. Finally, the evolution was favorable. The patient was discharged with the recommendation to continue antibiotic therapy at home.

Conclusions: The evolution of SARS-CoV-2 infection may be unpredictable, the superinfection with other pathogens may influence the prognosis and progression of the disease.

Keywords

  • COVID-19 pneumonia
  • superinfection
  • Legionella pneumophilla
  • Stenotrophomonas maltophilia
Open Access

The unpredictable diagnosis of pulmonary nodules

Published Online: 28 May 2022
Page range: 51 - 54

Abstract

Abstract

Pulmonary nodules are single or multiple rounded opacities with a size of minimum 1 cm diameter visualised in the lung parenchyma. From an anatomopathological point of view, they can be benign or malignant. Most often, these nodules are asymptomatic or with minimal symptoms. Now, we present the case of a 62-year-old patient, a smoker, with exposure to occupational respiratory noxious (cellulose industry – 10 years and printing industry – 30 years) without significant personal respiratory pathological history. He has dyspnoea on moderate exertion, irritable cough, myalgia, arthralgia and physical asthenia. The physical examination reveals the presence of a right bayonet sign. Biologically, an inflammatory syndrome was present, the urine test shows no pathological changes, but the imaging is intriguing. On the other side, the imagistic workup [chest X-ray and computed tomography (CT) scan] was quite surprising: micro/macronodular opacities with variable wall thickness, irregular contours and a tendency to confluence at the bilateral lower lobes level. A bronchoscopy was also performed with bronchioloalveolar lavage (BAL) in the right upper lobe (RUL) and bronchial biopsy at the level of the right upper ventral. The hypotheses are multiple: pulmonary rheumatoid nodules, polyangiitis with granulomatosis, lymphangitis carcinomatosis and tuberculosis. Thoracic surgery determined the diagnosis.

Keywords

  • Pulmonary nodule
  • ‘bayonet sign’
  • cavity
  • adenocarcinoma
Open Access

Is the allergic reaction to Aspergillus a contraindication for biological therapy in severe asthma?

Published Online: 28 May 2022
Page range: 55 - 58

Abstract

Abstract

Introduction: According to the available speciality data, a study from the Netherlands has proven that 24% of patients are in Stage 4–5 of the Global Initiative for Asthma guide (GINA) treatment. Among them, 17% have difficult-to-treat asthma and only 3.7% have severe asthma. Patients with severe asthma have a poor prognosis, with numerous exacerbations that are usually severe. Therefore, add-on biological treatments used for eligible patients may change the outcome.

Case report: A 56-year-old female patient, diagnosed 10 years ago with asthma, without professional exposure, treated at home with maximal inhalation treatment, with multiple exacerbations and therefore multiple admissions to the hospital, one of which in the intensive care unit where she received endotracheal intubation and mechanical ventilation, is admitted to the hospital for persistent dyspnoea at rest, wheezing and chest tightness. Investigations revealed obstructive ventilatory dysfunction with a decreased value of forced expiratory volume (FEV1) by 37.57% and a reversibility ratio of 156%. Radiography results indicated absence of acute pleuropulmonary lesions; white blood cells (WBC) at 13,550 and eosinophils at 5566/µL; and 4.107% confirmed immunoglobulin E (IgE)-mediated allergy. The score for asthma control test (ACT) taken on 26 April 2018 was −8 and total IgE was 513 UI/L. Allergology evaluation results did not indicate allergies at prick test. Specific IgE was done for allergy for cat epithelium, guinea pig, rabbit, Penicillium notatum, Cladosporium herbarum and Aspergillus fumigates. Negative fungal test after bronchoscopy was performed to exclude pulmonary Aspergillosis. Omalizumab at 900 mg/month treatment was started. The outcome after 1 year showed no exacerbations, no admissions and no systemic corticotherapy usage.

Discussion: Allergic reaction to Aspergillus does not overlap with the diagnosis of pulmonary Aspergillosis; the condition is rather associated with immunosuppression and with a poor outcome. Severe asthma with prolonged progression and multiple risk factors must be treated with maximal therapy.

Keywords

  • severe asthma
  • Aspergillus
  • biologic therapy
11 Articles
Open Access

Summary

Published Online: 28 May 2022
Page range: 1 - 2

Abstract

Open Access

Tuberculosis in Romania during COVID-19. Some new concerns. Some new answers.

Published Online: 28 May 2022
Page range: 3 - 4

Abstract

Keywords

  • tuberculosis
  • COVID-19
Open Access

Side effects induced by using the protective equipment and tips for avoiding them

Published Online: 28 May 2022
Page range: 5 - 10

Abstract

Abstract

Severe acute respiratory distress syndrome (SARS)-CoV-2, the cause of Coronavirus disease 2019 (COVID-19), has caused a global pandemic with worldwide morbidity, mortality and disruptions to society. Undoubtedly, the global spread of the COVID-19 pandemic had warranted universal precautions to slow the rate of infection. Hand hygiene, social distancing, regular disinfection of surfaces and avoidance of touching one’s face are some of the measures which have been used in an attempt to decrease exponential disease spread. The epidemiology of SARS-CoV-2 had indicated that most infections were spread by respiratory droplets, through exposure to an infected individual at close range. For this reason, healthcare professionals are mandated to wear personal protective equipment (PPE) for a prolonged period of time when caring for COVID-19 patients. On the other hand, the COVID-19 pandemic has led to an increased use of face protection such as surgical masks and eye protection not only amongst healthcare workers but also now the general public. Prolonged use of N95 and surgical masks by healthcare professionals during COVID-19 has caused adverse effects such as headaches, rash, acne, skin breakdown and impaired cognition. This review delves into various adverse effects of prolonged mask use and provides recommendations to ease the burden on healthcare professionals. The magnitude of this condition is clinically significant and might worsen if the current outbreak further continues to spread widely and stays for a longer time, affecting the work performance of healthcare workers. Perhaps better strategies are needed for designing various PPE and reducing the duration for which healthcare workers are required to use them.

Keywords

  • COVID-19
  • personal protective equipment
  • adverse effects
Open Access

SARS-CoV-2 epidemiological surveillance of healthcare professionals working in an inpatient rehabilitation facility

Published Online: 28 May 2022
Page range: 11 - 17

Abstract

Abstract

Background: Healthcare Workers (HCW) represent one of the most vulnerable subject groups to be infected by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2).

Aims: Between March 2020 and May 2020, we decided to implement a surveillance programme for HCW that aimed to (1) strengthen the safety of the employees; (2) estimate the punctual prevalence of SARS-CoV-2 infection in asymptomatic operators; (3) use the results to train personnel and to strengthen surveillance for applying and validating preventive strategies; and (4) compare the observed prevalence and the infection characteristics with a real-life (RL) sample from non-healthcare settings.

Methods: A nasopharyngeal (NP) swab in HCW, representative of all mansions, and RL subjects was performed after informed consent signing (T0), then after 6 d ± 24 h (T1) and after 12 d ± 24 h (T2). The presence of SARS-CoV-2 mRNA was tested by commercially available real-time PCR.

Results: A total of 219 HCW and 100 RL subjects were enrolled; and among all the subjects, only 1 HCW resulted positive at the swab testing throughout the study period. The positive subject was an asymptomatic nurse without any comorbidities or risk factors.

Conclusions: Our experience supports the utility of implementing dedicated surveillance programmes for the HCW. The efficiency in keeping low the number of the infection, maintaining the psychological well-being of the personnel and the availability of a tool which in case of infection may allow the early identification of clusters are critical issues which encourage the planning and implementation of such programmes NIH clinicaltrials.gov (NCT04913701).

Keywords

  • SARS-CoV-2
  • COVID-19 nucleic acid testing
  • healthcare workers
  • surveillance
  • prevalence
  • prevention
Open Access

COVID-19 disease in the pulmonology unit of a dedicated COVID-19 hospital – our experience

Published Online: 28 May 2022
Page range: 18 - 25

Abstract

Abstract

Background: The Coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) has led to a global health care crisis. We report profiles of cases admitted to our hospital.

Methods: We conducted this study at the pulmonology unit of a Dedicated COVID Hospital (DCH) of Western India. This is a prospective observational study which analysed the demographical data, clinical parameters, comorbidities, complications and laboratory and outcome parameters.

Results: Our study included 101 patients. The mean age was 43 years; 64 (63.3%) were men and 37 (36.7%) women. Out of 101, 6 (6%) had mild, 30 (30%) had moderate and 65 (64%) had severe COVID-19 disease. Severity increased with age and comorbidities. Ninety-four (94%) had pneumonia. Of these 94, 65 (69%) patients had acute respiratory distress syndrome (ARDS). Twenty-one (21%) were mild, 20 (31%) moderate and 24 (37%) severe ARDS. ARDS severity increased with age and in men. Thirty-six (36%) required oxygenation only and 29 (29%) required additional ventilatory management – mostly non-invasive ventilation (NIV). The laboratory values analysis revealed elevation of D-dimers level in 66 (65.3%) and IL6 in 68 (67.3%). Diabetes mellitus (DM) and hypertension (HT) were the common comorbidities. Totally three (2.97%) patients died due to COVID-19 infection. Mortality was associated with HT and myocarditis. Mean duration of hospital stay was 15 days, and it increased with increasing severity of disease and ARDS.

Conclusion: COVID-19 is common in the adult with male preponderance. The majority recovered with a good outcome. Comorbidities affected outcome adversely.

Keywords

  • COVID-19
  • comorbidities
  • outcome
Open Access

Multidrug-resistant tuberculosis and diabetes mellitus as a problem of modern medicine

Published Online: 28 May 2022
Page range: 26 - 33

Abstract

Abstract

Aims: To carry out a comprehensive retrospective assessment of the prevalence, features and course of treatment of patients with multidrug-resistant tuberculosis (MDR-TB) and diabetes mellitus (DM).

Materials and Methods: Our study is based on a retrospective analysis of statistical data obtained from 762 current and former MDR-TB patients (74% of patients with resistance only to first-line drugs – isoniazid (H) and rifampin (R); 36% with resistance to H, R and second-line drugs) included in the register of tuberculosis (TB) patients from different regions of Ukraine and the Grodno region of the Republic of Belarus between 2015 and 2019.

Results and Discussion: In both groups of the study recurrent TB prevailed: 49 cases (55.7%) of relapse TB compared to 39 cases (44.3%) of primary TB in the main group; 363 cases (53.9%) of relapse TB compared to 311 (46.1%) primary TB in the control group (P < 0.05). The rate of successful treatment in the control group is higher than in the main group (64.7% vs. 61.4%; P < 0.05). A significant difference between the two groups was observed owing to the difference in frequency of treatment, which in the main group has recorded 27.3%, as against 40.3% in the control group (almost two times lower; P < 0.05).

Conclusions: The association between TB and DM increases the morbidity, chemoresistance and proportion of recurrences. Pulmonary TB developed significantly more often in middle-aged patients with type 2 DM with moderate and severe states, with subcompensated form and with a complicated course.

Keywords

  • multidrug resistance
  • diabetes mellitus
  • hydrocarbon metabolism
  • treatment
  • epidemiology
Open Access

Brain metastases revealing primary pulmonary soft part sarcoma

Published Online: 28 May 2022
Page range: 34 - 39

Abstract

Abstract

Alveolar soft part sarcoma (ASPS) is a rare mesenchymal soft-tissue tumour. It commonly arises in the lower extremities in adults and the head and neck in children. Primary pulmonary involvement, without evidence of soft tissue tumour elsewhere, is very rare. We present the seventh case ever reported in the literature of primary ASPS of the lung, which was revealed by brain metastases in a 28-year-old male patient. The parietal brain tumour was resected. The radiological and histological study led to the diagnosis: metastasis of an alveolar sarcoma. The patient then had brain radiotherapy and chemotherapy. Using this case as a starting point, we reviewed the characteristics and the main therapeutic options in these uncommon neoplasms.

Keywords

  • Alveolar soft part sarcoma
  • brain tumour
Open Access

Case of severe treatment resistant cryptogenic organising pneumonia

Published Online: 28 May 2022
Page range: 40 - 44

Abstract

Abstract

Cryptogenic organising pneumonia (COP) is a rare interstitial lung disease with different onset of symptoms, which responds rapidly to glucocorticoid treatment. We present a case of COP which manifested as progressive 3-year dyspnoea that has led ultimately to acute respiratory failure. Moreover, treatment with prednisone for this patient exhibits slow onset of the effect.

Keywords

  • organising pneumonia
  • acute respiratory failure
  • prednisone therapy
Open Access

COVID-19 complicated by multiple germs infection -case report and short literature review

Published Online: 28 May 2022
Page range: 45 - 50

Abstract

Abstract

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is characterised by a varied clinical picture. In some cases the evolution may be unfavourable, progressing to pneumonia and acute respiratory distress syndrome.

Clinical case: A 70-years-old woman, with multiple comorbidities, was admitted for low-grade fever, dry cough and loss of appetite, symptoms that started 4 days prior to hospitalisation. She was initially diagnosed with mild coronavirus disease 2019 (COVID-19). On the 18th day of illness, there was an increase in inflammatory markers, progression of radiological lesions and SpO2 dropped to 88% room air. Treatment with tocilizumab, remdesivir and high-flow oxygen therapy was initiated. Chest Computed tomography with pulmonary artery angiography ruled out suspected pulmonary embolism, but revealed a new pneumonic process and right pleural effusion, therefore antibiotic therapy was started. Imaging reassessment revealed excavation of the pneumonic process and persistence of pleural effusion. Reverse transcription polymerase chain reaction (RT-PCR) retesting for SARSCOV2 was negative and the patient was transferred to another hospital to undergo bronchoscopy and continue the treatment. Bacteriological examination of the induced sputum revealed the presence of Stenotrophomonas maltophilia, and in the bronchial aspirate was isolated Legionella pneumophilla; whereas the pharyngeal exudate highlighed the presence of Candida glabrata. Finally, the evolution was favorable. The patient was discharged with the recommendation to continue antibiotic therapy at home.

Conclusions: The evolution of SARS-CoV-2 infection may be unpredictable, the superinfection with other pathogens may influence the prognosis and progression of the disease.

Keywords

  • COVID-19 pneumonia
  • superinfection
  • Legionella pneumophilla
  • Stenotrophomonas maltophilia
Open Access

The unpredictable diagnosis of pulmonary nodules

Published Online: 28 May 2022
Page range: 51 - 54

Abstract

Abstract

Pulmonary nodules are single or multiple rounded opacities with a size of minimum 1 cm diameter visualised in the lung parenchyma. From an anatomopathological point of view, they can be benign or malignant. Most often, these nodules are asymptomatic or with minimal symptoms. Now, we present the case of a 62-year-old patient, a smoker, with exposure to occupational respiratory noxious (cellulose industry – 10 years and printing industry – 30 years) without significant personal respiratory pathological history. He has dyspnoea on moderate exertion, irritable cough, myalgia, arthralgia and physical asthenia. The physical examination reveals the presence of a right bayonet sign. Biologically, an inflammatory syndrome was present, the urine test shows no pathological changes, but the imaging is intriguing. On the other side, the imagistic workup [chest X-ray and computed tomography (CT) scan] was quite surprising: micro/macronodular opacities with variable wall thickness, irregular contours and a tendency to confluence at the bilateral lower lobes level. A bronchoscopy was also performed with bronchioloalveolar lavage (BAL) in the right upper lobe (RUL) and bronchial biopsy at the level of the right upper ventral. The hypotheses are multiple: pulmonary rheumatoid nodules, polyangiitis with granulomatosis, lymphangitis carcinomatosis and tuberculosis. Thoracic surgery determined the diagnosis.

Keywords

  • Pulmonary nodule
  • ‘bayonet sign’
  • cavity
  • adenocarcinoma
Open Access

Is the allergic reaction to Aspergillus a contraindication for biological therapy in severe asthma?

Published Online: 28 May 2022
Page range: 55 - 58

Abstract

Abstract

Introduction: According to the available speciality data, a study from the Netherlands has proven that 24% of patients are in Stage 4–5 of the Global Initiative for Asthma guide (GINA) treatment. Among them, 17% have difficult-to-treat asthma and only 3.7% have severe asthma. Patients with severe asthma have a poor prognosis, with numerous exacerbations that are usually severe. Therefore, add-on biological treatments used for eligible patients may change the outcome.

Case report: A 56-year-old female patient, diagnosed 10 years ago with asthma, without professional exposure, treated at home with maximal inhalation treatment, with multiple exacerbations and therefore multiple admissions to the hospital, one of which in the intensive care unit where she received endotracheal intubation and mechanical ventilation, is admitted to the hospital for persistent dyspnoea at rest, wheezing and chest tightness. Investigations revealed obstructive ventilatory dysfunction with a decreased value of forced expiratory volume (FEV1) by 37.57% and a reversibility ratio of 156%. Radiography results indicated absence of acute pleuropulmonary lesions; white blood cells (WBC) at 13,550 and eosinophils at 5566/µL; and 4.107% confirmed immunoglobulin E (IgE)-mediated allergy. The score for asthma control test (ACT) taken on 26 April 2018 was −8 and total IgE was 513 UI/L. Allergology evaluation results did not indicate allergies at prick test. Specific IgE was done for allergy for cat epithelium, guinea pig, rabbit, Penicillium notatum, Cladosporium herbarum and Aspergillus fumigates. Negative fungal test after bronchoscopy was performed to exclude pulmonary Aspergillosis. Omalizumab at 900 mg/month treatment was started. The outcome after 1 year showed no exacerbations, no admissions and no systemic corticotherapy usage.

Discussion: Allergic reaction to Aspergillus does not overlap with the diagnosis of pulmonary Aspergillosis; the condition is rather associated with immunosuppression and with a poor outcome. Severe asthma with prolonged progression and multiple risk factors must be treated with maximal therapy.

Keywords

  • severe asthma
  • Aspergillus
  • biologic therapy

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