Related Articles

Invasive Aspergillus infections in hospitalized patients with chronic lung disease.

Infect Drug Resist. 2013;6:33-9

Authors: Wessolossky M, Welch VL, Sen A, Babu TM, Luke DR

Abstract
BACKGROUND: Although invasive pulmonary aspergillosis (IPA) is more prevalent in immunocompromised patients, critical care clinicians need to be aware of the occurrence of IPA in the nontraditional host, such as a patient with chronic lung disease. The purpose of this study was to describe the IPA patient with chronic lung disease and compare the data with that of immunocompromised patients.
METHODS: The records of 351 patients with Aspergillus were evaluated in this single-center, retrospective study for evidence and outcomes of IPA. The outcomes of 57 patients with chronic lung disease and 56 immunocompromised patients were compared. Patients with chronic lung disease were defined by one of the following descriptive terms: emphysema, asthma, idiopathic lung disease, bronchitis, bronchiectasis, sarcoid, or pulmonary leukostasis.
RESULTS: Baseline demographics were similar between the two groups. Patients with chronic lung disease were primarily defined by emphysema (61%) and asthma (18%), and immunocompromised patients primarily had malignancies (27%) and bone marrow transplants (14%). A higher proportion of patients with chronic lung disease had a diagnosis of IPA by bronchoalveolar lavage versus the immunocompromised group (P < 0.03). The major risk factors for IPA were found to be steroid use in the chronic lung disease group and neutropenia and prior surgical procedures in the immunocompromised group. Overall, 53% and 69% of chronic lung disease and immunocompromised patients were cured (P = 0.14); 55% of chronic lung patients and 47% of immunocompromised patients survived one month (P = 0.75).
CONCLUSION: Nontraditional patients with IPA, such as those with chronic lung disease, have outcomes and mortality similar to that in the more traditional immunocompromised population.

PMID: 23761976 [PubMed]

Related Articles

Correlation between computed tomographic and magnetic resonance imaging findings of parenchymal lung diseases.

Eur J Radiol. 2013 Jun 10;

Authors: Barreto MM, Rafful PP, Rodrigues RS, Zanetti G, Hochhegger B, Souza AS, Guimarães MD, Marchiori E

Abstract
Computed tomography (CT) is considered to be the gold standard method for the assessment of morphological changes in the pulmonary parenchyma. Although its spatial resolution is lower than that of CT, MRI offers the advantage of characterizing different aspects of tissue based on the degree of contrast on T1-weighted image (WI) and T2-WI. In this article, we describe and correlate the MRI and CT features of several common patterns of parenchymal lung disease (air trapping, atelectasis, bronchiectasis, cavitation, consolidation, emphysema, ground-glass opacities, halo sign, interlobular septal thickening, masses, mycetoma, nodules, progressive massive fibrosis, reverse halo sign and tree-in-bud pattern). MRI may be an alternative modality for the collection of morphological and functional information useful for the management of parenchymal lung disease, which would help reduce the number of chest CT scans and radiation exposure required in patients with a variety of conditions.

PMID: 23763860 [PubMed - as supplied by publisher]

Sleep oxygen desaturation predicts survival in idiopathic pulmonary fibrosis.

J Clin Sleep Med. 2013;9(6):593-601

Authors: Kolilekas L, Manali E, Vlami KA, Lyberopoulos P, Triantafillidou C, Kagouridis K, Baou K, Gyftopoulos S, Vougas KN, Karakatsani A, Alchanatis M, Papiris S

Abstract
BACKGROUND: Recent studies suggest poor sleep quality in patients with idiopathic pulmonary fibrosis (IPF). However, so far, the impact of IPF-related sleep breathing disorders (SBDs) on survival has not been extensively studied.
METHODS: In a cohort of 31 (24 males) treatment-naïve, newly diagnosed consecutive IPF patients, we prospectively investigated the relationship of SBD parameters such as apnea-hypopnea index (AHI), maximal difference in oxygen saturation between wakefulness and sleep (maxdiff SpO2), and lowest sleep oxygen saturation (lowest SpO2) with clinical (survival, dyspnea, daytime sleepiness), pulmonary function, submaximal (6-min walk test [6MWT]) and maximal exercise variables (cardiopulmonary exercise test [CPET]), and right ventricular systolic pressure (RVSP).
RESULTS: Sleep oxygen desaturation exceeded significantly that of maximal exercise (p < 0.001). Maxdiff SpO2 was inversely related to survival, DLCO%, and SpO2 after 6MWT, and directly with dyspnea, AHI, and RVSP. The lowest SpO2 was directly related to survival and to functional (TLC%, DLCO%) as well as submaximal and maximal exercise variables (6MWT distance, SpO2 after 6MWT, peak oxygen consumption/kg, SpO2 at peak exercise), while an inverse association with dyspnea score, AHI, and RVSP was observed.
CONCLUSIONS: Our findings provide evidence that intermittent sleep oxygen desaturation significantly exceeds that of maximal exercise and is associated with survival in IPF patients. Furthermore, they imply the existence of a link between lung damage and apnea events resulting to the induction and severity of intermittent sleep oxygen desaturation that aggravate pulmonary arterial hypertension and influence IPF survival.
COMMENTARY: A commentary on this article appears in this issue on page 603. CITATION: Kolilekas L; Manali E; Vlami KA; Lyberopoulos P; Triantafillidou C; Kagouridis K; Baou K; Gyftopoulos S; Vougas KN; Karakatsani A; Alchanatis M; Papiris S. Sleep oxygen desaturation predicts survival in idiopathic pulmonary fibrosis. J Clin Sleep Med 2013;9(6):593-601.

PMID: 23772193 [PubMed - in process]