Allergic bronchopulmonary aspergillosis as presenting sign of cystic fibrosis in an elderly man

Clinical significance of microbial infection and adaptation in cystic fibrosis

A select group of microorganisms inhabit the airways of individuals with cystic fibrosis. Once established within the pulmonary environment in these patients, many of these microbes adapt by altering aspects of their structure and physiology. Some of these microbes and adaptations are associated with more rapid deterioration in lung function and overall clinical status, whereas others appear to have little effect. Here we review current evidence supporting or refuting a role for the different microbes and their adaptations in contributing to poor clinical outcomes in cystic fibrosis.

The experience of receiving a diagnosis of cystic fibrosis after age 20: implications for social work

Using the phenomenological approach of Van Manen, this study explored the lived experience of receiving a diagnosis of cystic fibrosis as an adult. Ten essential themes were generated from the stories of 36 participants: Awareness of Death, Change, Difference, Distraction, Family Indifference, Intrusion, Isolation, Normalizing, Time, and Uncertainty. Themes associated with gender, illness severity, and medical care were also developed. Although themes were similar to those in the chronic illness literature, late-diagnosis of CF was found to be a unique experience. Participants sought personal relationships with caregivers and educational materials targeted to their needs. Implications for social work are discussed.

Communicating a diagnosis of cystic fibrosis to an adult: what physicians need to know

Ten percent of cystic fibrosis (CF) diagnoses are confirmed in adults. No disease-specific research is available to guide nonpediatricians in communicating these diagnoses or to determine whether prevalent bad-news guidelines apply. In this phenomenological study, the author asked 36 individuals to describe their adult-diagnosis experiences, reactions, and preferences. Data analysis revealed that most respondents were satisfied with their diagnosis interviews. Participants described different physician styles in delivering the diagnosis and a range of reactions on learning that they had CF. They urged that physicians appreciate the impact of a CF diagnosis on adults, assess the personal characteristics that could affect individuals' responses, and develop relevant patient-education techniques. Interactions of disease characteristics with individuals' personal situations appeared to be more important than physicians' approaches in determining how participants experienced and responded to the diagnosis. That no typical interview emerged rendered a one-fits-all guideline unrealistic for communicating CF diagnoses to adults.

Sinobronchial allergic mycosis: the SAM syndrome

We contend that the presence of concomitant allergic fungal sinusitis (AFS) and allergic bronchopulmonary mycosis in the same patient represents an expression of the same process of fungal hypersensitivity in the upper and lower airways. We have termed this process the SAM syndrome, an acronym for sinobronchial allergic mycosis. Diagnostic criteria have been established for the SAM syndrome, and the clinical characteristics of one previously unreported and four previously reported patients have been tabulated. Patients with the SAM syndrome have chronic sinusitis involving multiple sinuses, asthma, immediate cutaneous reactivity to fungal allergens, peripheral eosinophilia, and radiographic evidence of bronchiectasis. Total serum IgE levels are usually elevated as well. A variety of chest radiographic abnormalities may occur, ranging from mass lesions to diffuse pulmonary infiltrates and even normal findings on chest radiographs. Patients present for an evaluation of either sinus or lung disease and, at that time, demonstrate no clinical features that distinguish them from patients with isolated sinus or lung disease. All patients reported to date have had clinical responses to therapy with corticosteroids. We postulate that SAM is underdiagnosed in patients with AFS, a disease recently reported from medical centers in the southeastern and western United States. Moreover, since our patient had a mutation in the cystic fibrosis transmembrane conductor regulator (CFTR) gene, we further hypothesize that CFTR gene mutations may play an important role in the pathogenesis of the SAM syndrome.