Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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High-resolution computed tomography findings of pulmonary tuberculosis in lung transplant recipients

Achados de tuberculose pulmonar na tomografia computadorizada de alta resolução em transplantados de pulmão

Irai Luis Giacomelli, Roberto Schuhmacher Neto, Carlos Schuller Nin, Priscilla de Souza Cassano, Marisa Pereira, José da Silva Moreira, Douglas Zaione Nascimento, Bruno Hochhegger

J Bras Pneumol.2017;43(4):270-273

Abstract PDF PT PDF EN Portuguese Text

Objective: Respiratory infections constitute a major cause of morbidity and mortality in solid organ transplant recipients. The incidence of pulmonary tuberculosis is high among such patients. On imaging, tuberculosis has various presentations. Greater understanding of those presentations could reduce the impact of the disease by facilitating early diagnosis. Therefore, we attempted to describe the HRCT patterns of pulmonary tuberculosis in lung transplant recipients. Methods: From two hospitals in southern Brazil, we collected the following data on lung transplant recipients who developed pulmonary tuberculosis: gender; age; symptoms; the lung disease that led to transplantation; HRCT pattern; distribution of findings; time from transplantation to pulmonary tuberculosis; and mortality rate. The HRCT findings were classified as miliary nodules; cavitation and centrilobular nodules with a tree-in-bud pattern; ground-glass attenuation with consolidation; mediastinal lymph node enlargement; or pleural effusion. Results: We evaluated 402 lung transplant recipients, 19 of whom developed pulmonary tuberculosis after transplantation. Among those 19 patients, the most common HRCT patterns were ground-glass attenuation with consolidation (in 42%); cavitation and centrilobular nodules with a tree-in-bud pattern (in 31.5%); and mediastinal lymph node enlargement (in 15.7%). Among the patients with cavitation and centrilobular nodules with a tree-in-bud pattern, the distribution was within the upper lobes in 66.6%. No pleural effusion was observed. Despite treatment, one-year mortality was 47.3%. Conclusions: The predominant HRCT pattern was ground-glass attenuation with consolidation, followed by cavitation and centrilobular nodules with a tree-in-bud pattern. These findings are similar to those reported for immunocompetent patients with pulmonary tuberculosis and considerably different from those reported for AIDS patients with the same disease.

 


Keywords: Lung transplantation; Diagnostic imaging; Mycobacterium infections; Thoracic diseases; Tomography, X-Ray computed/methods; Tuberculosis, pulmonary.

 


Functional improvement in patients with idiopathic pulmonary fibrosis undergoing single lung transplantation

Melhora funcional em portadores de fibrose pulmonar idiopática submetidos a transplante pulmonar unilateral

Adalberto Sperb Rubin1,2, Douglas Zaione Nascimento1, Letícia Sanchez1, Guilherme Watte2, Arthur Rodrigo Ronconi Holand1, Derrick Alexandre Fassbind1, José Jesus Camargo1,2

J Bras Pneumol.2015;41(4):299-304

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Objective: To evaluate the changes in lung function in the first year after single lung transplantation in patients with idiopathic pulmonary fibrosis (IPF). Methods: We retrospectively evaluated patients with IPF who underwent single lung transplantation between January of 2006 and December of 2012, reviewing the changes in the lung function occurring during the first year after the procedure. Results: Of the 218 patients undergoing lung transplantation during the study period, 79 (36.2%) had IPF. Of those 79 patients, 24 (30%) died, and 11 (14%) did not undergo spirometry at the end of the first year. Of the 44 patients included in the study, 29 (66%) were men. The mean age of the patients was 57 years. Before transplantation, mean FVC, FEV1, and FEV1/FVC ratio were 1.78 L (50% of predicted), 1.48 L (52% of predicted), and 83%, respectively. In the first month after transplantation, there was a mean increase of 12% in FVC (400 mL) and FEV1 (350 mL). In the third month after transplantation, there were additional increases, of 5% (170 mL) in FVC and 1% (50 mL) in FEV1. At the end of the first year, the functional improvement persisted, with a mean gain of 19% (620 mL) in FVC and 16% (430 mL) in FEV1. Conclusions: Single lung transplantation in IPF patients who survive for at least one year provides significant and progressive benefits in lung function during the first year. This procedure is an important therapeutic alternative in the management of IPF.

 


Keywords: Pulmonary fibrosis; Respiratory function tests; Lung transplantation.

 


Extracorporeal membrane oxygenation in an awake patient as a bridge to lung transplantation

Oxigenação por membrana extracorpórea em paciente acordado como ponte para o transplante pulmonar

Spencer Marcantonio Camargo1,a, Stephan Adamour Soder1,b, Fabiola Adelia Perin1,c, Douglas Zaione Nascimento1,d, Sadi Marcelo Schio1,e

J Bras Pneumol.2018;44(1):69-70

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Community-acquired staphylococcal pneumonia

Pneumonia estafilocócica adquirida na comunidade

José Wellington Alves dos Santos, Douglas Zaione Nascimento, Vinicius André Guerra, Vanessa da Silva Rigo, Gustavo Trindade Michel, Tiago Chagas Dalcin

J Bras Pneumol.2008;34(9):683-689

Abstract PDF PT PDF EN Portuguese Text

Objective: Staphylococcal pneumonia typically presents high rates of morbidity and mortality. It typically occurs in cases of influenza (airborne transmission) or during episodes of bacteremia (blood-borne transmission). Methods: A retrospective and descriptive study was conducted in patients admitted to our hospital between January of 1992 and December of 2003. All of he patients included had been diagnosed with community-acquired pneumonia caused by Staphylococcus aureus. All were older than 14 years of age, and none were intravenous drug users. Results: Community-acquired pneumonia was identified in 332 cases, of which 24 (7.3%) were identified as cases of staphylococcal pneumonia. Age ranged from 14 to 89 years. Fifteen patients were male, and nine were female. Twelve patients met the criteria for severe pneumonia. Chest X-rays showed unilateral consolidation in 14 cases, bilateral consolidation in 10, pleural effusion in 15, rapid radiological progression of pulmonary lesions in 14, cavitation in 6 and pneumothorax in 1. Most of the patients presented comorbidities, of which diabetes mellitus was the most common. Twelve patients presented complications such as empyema and septic shock. Four patients died, translating to a mortality rate of 16.6% in our sample. Conclusions: The clinical presentation of pneumonia caused by S. aureus is similar to that of pneumonia caused by other etiological agents. Radiological findings, epidemiological data and risk factors provide important clues to the diagnosis. These factors are important for clinical suspicion, since S. aureus is not typically addressed in empirical treatment.

 


Keywords: Staphylococcal pneumonia; Staphylococcal infections; Community-acquired infections.

 


 

 


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