The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology
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Review Case Reports
M. Kansasii pulmonary disease in idiopathic CD4+ T-lymphocytopenia.
Cases of patients with markedly depressed CD4+ T-lymphocyte counts, with or without opportunistic infections, in the absence of any evidence of human immunodeficiency virus (HIV) have been described in recent years. In 1992, the definition of "idiopathic CD4+ T-lymphocytopenia" was formulated by the Centers for Disease Control and Prevention (CDC) of Atlanta (USA). The present case illustrates the occurrence of an unexplained Mycobacterium kansasii pneumonia in a white HIV-negative subject with a persistent depletion of CD4+ T-lymphocytes and suppression of cell-mediated immunity. To our knowledge, this is the first observation of idiopathic CD4+ T-lymphocytopenia with pulmonary mycobacteriosis due to Mycobacterium kansasii, and the sixth case of this kind of immunodeficiency described in Italy.
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Pulmonary involvement is a clinically important form of visceral Kaposi's sarcoma in immunocompromised patients. Recently, herpesvirus-like deoxyribonucleic acid (DNA) sequences, defining a new herpesvirus termed "human herpesvirus 8" (HHV8) or "Kaposi's sarcoma-associated herpesvirus" (KSHV), were detected in Kaposi's sarcoma of acquired immune deficiency syndrome (AIDS) and non-AIDS patients. We describe the successful detection of HHV8 DNA in the bronchoalveolar lavage (BAL) fluid of patients with pulmonary Kaposi's sarcoma. ⋯ In addition, HHV8 DNA could be detected in the skin biopsy tissue, lymph node, and peripheral blood mononuclear cells of these patients. Our data show that human herpesvirus 8 deoxyribonucleic acid can be detected in the bronchoalveolar lavage fluid of patients with pulmonary Kaposi's sarcoma. If further studies reveal a high specificity for human herpesvirus 8 deoxyribonucleic acid detection, this test will improve the tools for the diagnosis of pulmonary Kaposi's sarcoma without further need of biopsies.
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Comparative Study
Protected bronchoalveolar lavage in the diagnosis of ventilator-associated pneumonia.
The aim of this study was to evaluate the diagnostic efficacy of protected bronchoalveolar lavage (PBAL) in ventilator-associated pneumonia (VAP), and to determine the effect of antibiotic therapy on its microbiological and cytological results. We prospectively studied 102 episodes of suspected VAP in 93 patients. Subsequent follow-up confirmed VAP in 35 of the 102 (34%) cases. ⋯ The sensitivity of protected bronchoalveolar lavage quantitative cultures was 87% and the specificity 91%. The sensitivity of cytological analysis for intracellular organisms was 75% and the specificity 98%. According to our results, if the patient is already on antibiotics, the direct examination of protected bronchoalveolar lavage fluid is less reliable, although still helpful.
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Nocturnal nasal intermittent positive pressure ventilation (NIPPV) is an effective means of normalizing awake blood gases in patients with respiratory insufficiency due to neuromuscular or chest wall dysfunction. However, little attention has been paid to the effects of long-term ventilation on spontaneous breathing during sleep in such patients. The purpose of this study was to determine whether spontaneous breathing during sleep improved after long-term nasal ventilation. ⋯ Minimum Sa,O2 during REM sleep similarly improved from a mean value of 49 +/- 14% during the diagnostic night to 73 +/- 10% at review follow-up (p < 0.001). In 12 patients, transcutaneous carbon dioxide was measured continuously during sleep on both occasions and demonstrated significantly less CO2 retention during follow-up compared to control studies both in NREM (p < 0.003) and REM sleep states (p < 0.004). Long-term nocturnal ventilation produces improved respiratory drive both asleep and awake and improved arousal responses to abnormal blood gases.