Pulmonary audavoxx.complications ser estar the most audavoxx.common reason of morbidity and mortality in immunoaudavoxx.compromised patients, quem lack of a basic mechanisms of moving defense. Nevertheless of the cause of a immunodeficiency, the most typical audavoxx.complications ser estar infections (bacterial, viroses or fungal). Among the fungal infections, aspergillosis is a most audavoxx.common (incidence, 1-9%; mortality, 55-92%) audavoxx.complying with organ transplant. Although pulmonary authorized is the most audavoxx.common form of aspergillosis, central nervous sistema involvement e sinusitis are not unaudavoxx.common. Top top CT scans, a halo authorize represents an area of short attenuation around ns nodule, revealing edema or hemorrhage. A gold standard para the diagnosis is the culture identification of ns fungus in sputum, BAL fluid or biopsy samples. Failing this identification, the detection that galactomannan, i m sorry is 1 of ns fungal wall surface audavoxx.components, has presented sensitivity and specificity the 89% e 98%, respectively. Amphotericin B, liposomal amphotericin B, caspofungin and, especially, voriconazole ~ ~ effective against ns fungus. Return Pneumocystis jirovecii pneumonia have the right to be fatal, a incidence that this condition has lessened due to a prophylactic usar of trimethoprim-sulfamethoxazole. In immunoaudavoxx.compromised patients presenting audavoxx.com dyspnea and hypoxemia, screening para fungi is indicated. A 14- to 21-day food of trimethoprim-sulfamethoxazole in audavoxx.combination audavoxx.com corticosteroids is audavoxx.commonly efficacious. Another rare fungal infection is disseminated candidiasis, i m sorry is caused by Candida spp.
Keywords: Pneumonia; Immunosuppression; Lung diseases, fungal.
As audavoxx.complicações pulmonares se constituem na maior razão de morbidade e mortalidade no hospedeiro imunoaudavoxx.comprometido, devido à deficiência nos mecanismos básicos de defesa. Independência ao vivo da razão da imunodepressão, infecções bacterianas, virais e fúngicas são as acrescido frequentes. Entre as infecções fúngicas, der aspergilose denominações a adicionar audavoxx.comum (incidência de 1-9% e humanidade de 55-92%) nos muitos tipos de transplantados. Embora a forma pneumônica isso é a acrescido frequente, lesões são de sistema indignação central e sinusite algum são raras. O assina do aur em TC de tórax representar uma áreas de baixo atenuação em volta do nódulo, revelando edema alternativamente hemorragia. O padrão ouro para emprego diagnóstico denominada a identificação dá fungo pela cultura de escarro, amostras de LBA alternativamente biópsia. Na deficiência dessa identificação, a detecção de galactomanana, um dos audavoxx.componentes da parede celular de Aspergillus sp., sim mostrado sensibilidade e especificidade de 89% e 98%, respectivamente. Anfotericina B, anfotericina ns lipossomal, caspofungina e voriconazol têm efeito sobre emprego fungo, abranger destaque para esse último. Naquela pneumonia por Pneumocystis jirovecii, que pode ser fatal, teve seus incidência reduzida pelo uso extra de sulfametoxazol/trimetoprima. Dispneia e hipoxemia em pacientes imunodeprimidos expressar a cobrar da inspeção de fungos. Ministérios uso de sulfametoxazol/trimetoprima através dos 14-21 dia associado alcançar corticosteroides costuma ser eficaz. Naquela candidíase disseminada excluir outra rara enfermidade fúngica causada através Candida spp.
Palavras-chave: Pneumonia; Imunossupressão; Pneumopatias fúngicas.IntroductionPulmonary audavoxx.complications ~ ~ the many audavoxx.common reason of morbidity and mortality in immunoaudavoxx.compromised patients. A multiple treatment options porque o patients audavoxx.com malignant diseases-especially a various chemotherapy regimens and the increasing usar of organ transplantation or hematopoietic cabinet transplantation-as fine as a increased survival of patients with autoimmune diseases, have significantly increased a number that immunoaudavoxx.compromised patients. This patients are characterized by susceptibility audavoxx.come infections resulted in by organisms whose virulence is low in habituais patients.Immunoaudavoxx.compromised patients are at a higher threat of emerging infection because they lack a basic mechanisms of cellular defense. Granulocytopenia, cabinet dysfunction (principally T lymphocyte dysfunction), congenital humor immunodeficiency, acquired pegue immunodeficiency, splenectomy e mechanical audavoxx.complications (especially early to the presence of catheters) are the principal factors the interfere with the defense of guts in immunoaudavoxx.compromised patients. This various types of defects ser estar more generally associated audavoxx.com certain microbe in the development the infections. The lack of pegue defense is most frequently associated with infection resulted in by Streptococcus pneumoniae; impaired cellular defense is most generally associated with infection brought about by mycobacteria; and granulocytopenia is most frequently associated with gram-negative bacteria and Staphylococcus aureus.(1)In children, immunological defects represent der major risk coeficiente for pulmonary involvement. Syndromes such together severe an unified immunodeficiency and the Wiskott-Aldrich syndrome cause high mortality in crianças who build pulmonary infection.Among adults, immunodeficiency is most frequently seen in patients audavoxx.com leukemia, lymphoma or AIDS, as well as in those it is registered to immunosuppressive therapy, associated or no to organ transplantation or bone marrow transplantation.In organ transplant recipients (principally liver transplant recipients e kidney transplant recipients), pneumonia occurs during uma of two phases. The o primeiro dia is a immediate phase, defined as the first month ~ transplantation, during which nosoaudavoxx.comial bacter pneumonia predominates. The second is a post-immediate phase, from the second to 6th months after ~ transplantation, i m sorry is identified by pulmonary infections led to by other agents, such as viruses, fungi, Pneumocystis jirovecii and mycobacteria.(1)The most audavoxx.common causal revendedor autorizado of fungal pneumonia are Aspergillus spp., which estão present in the localized e disseminated creates of a disease.The incidence that pneumocystosis among organ transplant recipients ranges from 2% audavoxx.come 4%, diminish after ns prophylactic use of the trimethoprim-sulfamethoxazole audavoxx.combination.In bone marrow transplant (BMT) recipients, porque o instance, pulmonary infection brought about by the various revendedor autorizado constitutes a most typical isolated audavoxx.complication.(2) Pulmonary infection is related to a immune condição of the recipient. Therefore, most species of bacterial e fungal pneumonia are diagnosed in the neutropenic period, before bone marrow engraftment. In addition to this major defect, troubles such as ns destruction of anatomical barriers (upper respiratory tract mucosa) and impairment of the cough reflex deserve to occur. One more serious problem is graft-versus-host disease (GVHD), which increases a risk that opportunistic infection with mechanisms that have yet to be audavoxx.completely defined.(1)Among ns GVHD-related causes of pneumonia, cytomegalovirus pneumonia e fungal epidemic (especially those caused by Aspergillus sp.) are the many noteworthy. This deserve to be attributed to impaired to move defense (mediated through T lymphocytes), and to deficiencies in ns number and function the macrophages.Although diagnostic resources are in consistent development and the accessibility of novo drugs (especially azole antifungal agents) is increasing, pulmonary infection continues to be as a most typical documented form of invasive epidemic in immunoaudavoxx.compromised patients.Aspergillosis is 1 of countless opportunistic fungal infections the principally affect a lungs. Ns incidence that aspergillosis in kidney transplant recipients, liver transplant recipients, BMT recipients e lung transplant recipients is, respectively, 1%, 2%, 7% and 9%. The mean mortality rate porque o this populace is 55-92%, which to represent 10-15% of ns deaths among all transplant recipients.(3)Regarding immune defense mechanisms, evidence shows that over there is innate immunity e immunity that creates through one evolutionary process during infection or disease. This last kind of immunity is recognized as adaptive immunity. For many years, cell-mediated immunity ser estar considered audavoxx.come be ns most effective, and humoral immunity was thought to it is in of secondary importance. However, that is currently accepted the cell-mediated immune is the gorjeta form the defense. Nevertheless, certain types of humor immune responses estão protective.In general, Th1-mediated immune is used porque o clearance of a fungal infection, conversely, Th2-mediated immunity habitually acts on ns susceptibility audavoxx.come infection.(4)A skilled cell-mediated defense requires an efficient contingent that lymphocytes: T-helper cells; T-suppressor cells; and effector lymphocytes.Many neoplastic diseases, particularly Hodgkin"s lymphomas, hairy cell leukemia and chronic lymphocytic leukemia, ~ ~ associated with the malfunctioning of a cell-mediated defense. Corticosteroid use, i m sorry is quite usual in these diseases, typically results in further impairment of moving immunity.In diagnostic terms, various aspects related to immunoaudavoxx.compromised patients in general, need to be taken right into consideration: first, an aggressive protocol the etiologic investigation is needed, since a delay in the diagnosis increases ns risk that death; second, if pulmonary infiltrate is determined early, fiberoptic bronchoscopy should be perform (fiberoptic bronchoscopy allows the identification or exclusion of an contagious etiology); and third, beforehand CT scans of the chest generally reveal lesions that are not checked out on routine chest X-rays.(5)Fungal pneumoniaDue audavoxx.come its incidence e morbidity, fungal pneumonia is 1 of a most severe infections in immunoaudavoxx.compromised patients, accounting for 30% of todos deaths among BMT recipients.(1)Pulmonary involvement habitually results a partir de systemic circulation of the fungus. Large-scale usar of antibiotics e prolonged periods of granulocytopenia, and corticosteroid therapy, ser estar extremely necessary factors para the event of fungal infection. Fungi of a genus Aspergillus ~ ~ the most usual causal agents. Other fungi, such together those of a genera Mucor, Fusarium, Rhizopus, Petriellidium, Cryptococcus, Histoplasma, Coccidioides and Candida, have also been identified as causal agents.Clinically, fungal pneumonia manifests as fever in patients who são de not respond to antibiotic therapy. However, the most significant finding is naquela focal lesion in a lung parenchyma, viewed on regimen chest X-rays and on CT scans of a chest.Blood culture, sputum culture and, particularly, BAL fluid society constitute the methods of identifying a fungi. Once these methods fail audavoxx.come detect ns etiologic agent, fine-needle aspiration is indicated. Fine-needle aspiration allows the characterization of the fungus in 50-67% of cases. The mean price of audavoxx.complications is 15%, e audavoxx.complications ~ ~ more typical in patient presenting with naquela platelet count of approximately 30,000/mm3.(6)AspergillosisInvasive aspergillosis is a most typical fungal infection amongst immunoaudavoxx.compromised neutropenic patients. In contrast to bacter infections, brought about by cytomegalovirus or by P. Jirovecii, in which prophylaxis has actually been displayed to reduce ns incidence of this diseases, ns number of cases of invasive aspergillosis has actually increased progressively. De acordo audavoxx.com to current studies, invasive aspergillosis affects 10-15% of BMT recipients. In most cases, aspergillosis affects somente the lungs. However, a significant part of patients build sinusitis e central nervous system infection. Ns most typical symptoms estão cough e dyspnea. However, pleuritic pain e hemoptysis can also occur.The lesions watched on regime chest X-rays incorporate single/multiple nodules, cavities e segmental/subsegmental consolidation. In a initial phase, ns most characteristic photo seen top top CT scans is the halo sign, an area of low attenuation that surrounds ns nodule and represents edema or hemorrhage (Figure 1). The halo sign ser estar described in an ext than 90% that neutropenic patients audavoxx.com invasive aspergillosis when HRCT scans to be taken in a initial step of the disease. At later stages, HRCT scans can concertos areas that necrosis and sequestration the lung tissue, which detaches itself from the neighboring parenchyma, resulting in the ar crescent sign.
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