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Santos J, Aguilar L, García-Méndez E, Siquier B, Custardoy J, García-Rey C, Pallarés R, Blanquer R, Caminero J, Dal-Ré R, Durán J, Gil-Aguado A, Grau I, Ibáñez D, Llorca E, Martínez J, Molinos L, Mensa J, Moreno S, Palacios R, Vidal J. Clinical Characteristics and Response to Newer Quinolones inLegionellaPneumonia: A Report of 28 Cases. J Chemother 2013; 15:461-5. [PMID: 14598938 DOI: 10.1179/joc.2003.15.5.461] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Twenty-eight (11.6%) out of 241 Spanish patients enrolled in an international phase III clinical trial of mild to moderate community-acquired pneumonia (CAP) comparing gemifloxacin vs. trovafloxacin were diagnosed of Legionnaires' disease. A definite diagnosis was established by seroconversion in 13 patients of whom only 2 had a positive Legionella urinary antigen. The remaining 15 patients were possible Legionella infections based on a single elevated IgG titer (> or = 1:512). All patients had a radiologically confirmed diagnosis of pneumonia, 5 (19%) patients were older than 65, comorbidity was present in 9 (33%), and 10 (36%) had to be hospitalized. Fifteen patients were treated with oral gemifloxacin (320 mg/day) and 13 with oral trovafloxacin (200 mg/day). Overall, clinical success occurred in 25 (89.3%) patients after 7 days of treatment and only 1 patient needed a 14-day treatment. There were only one adverse event withdrawal and one clinical failure, and no patients died. In light of the favorable clinical outcome, the use of newer fluoroquinolones seems adequate for the treatment of suspected or proven Legionella pneumonia.
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Affiliation(s)
- J Santos
- Infectious Diseases Unit, Hospital Virgen de la Victoria, Málaga, Spain
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Sologuren I, Boisson-Dupuis S, Pestano J, Vincent QB, Fernández-Pérez L, Chapgier A, Cárdenes M, Feinberg J, García-Laorden MI, Picard C, Santiago E, Kong X, Jannière L, Colino E, Herrera-Ramos E, Francés A, Navarrete C, Blanche S, Faria E, Remiszewski P, Cordeiro A, Freeman A, Holland S, Abarca K, Valerón-Lemaur M, Gonçalo-Marques J, Silveira L, García-Castellano JM, Caminero J, Pérez-Arellano JL, Bustamante J, Abel L, Casanova JL, Rodríguez-Gallego C. Partial recessive IFN-γR1 deficiency: genetic, immunological and clinical features of 14 patients from 11 kindreds. Hum Mol Genet 2011; 20:1509-23. [PMID: 21266457 PMCID: PMC3115578 DOI: 10.1093/hmg/ddr029] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 01/19/2011] [Indexed: 11/13/2022] Open
Abstract
We report a series of 14 patients from 11 kindreds with recessive partial (RP)-interferon (IFN)-γR1 deficiency. The I87T mutation was found in nine homozygous patients from Chile, Portugal and Poland, and the V63G mutation was found in five homozygous patients from the Canary Islands. Founder effects accounted for the recurrence of both mutations. The most recent common ancestors of the patients with the I87T and V63G mutations probably lived 1600 (875-2950) and 500 (200-1275) years ago, respectively. The two alleles confer phenotypes that are similar but differ in terms of IFN-γR1 levels and residual response to IFN-γ. The patients suffered from bacillus Calmette-Guérin-osis (n= 6), environmental mycobacteriosis (n= 6) or tuberculosis (n= 1). One patient did not suffer from mycobacterial infections but had disseminated salmonellosis, which was also present in two other patients. Age at onset of the first environmental mycobacterial disease differed widely between patients, with a mean value of 11.25 ± 9.13 years. Thirteen patients survived until the age of 14.82 ± 11.2 years, and one patient died at the age of 7 years, 9 days after the diagnosis of long-term Mycobacterium avium infection and the initiation of antimycobacterial treatment. Up to 10 patients are currently free of infection with no prophylaxis. The clinical heterogeneity of the 14 patients was not clearly related to either IFNGR1 genotype or the resulting cellular phenotype. RP-IFN-γR1 deficiency is, thus, more common than initially thought and should be considered in both children and adults with mild or severe mycobacterial diseases.
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Affiliation(s)
| | - Stéphanie Boisson-Dupuis
- Laboratory of Human Genetics of Infectious Diseases, Necker Faculty, INSERM U980, Necker Medical School, University Paris Descartes, Paris, France
- St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - Jose Pestano
- Department of Biochemistry, Molecular Biology, Physiology, Genetics and Immunology
| | - Quentin Benoit Vincent
- Laboratory of Human Genetics of Infectious Diseases, Necker Faculty, INSERM U980, Necker Medical School, University Paris Descartes, Paris, France
| | - Leandro Fernández-Pérez
- Department of Clinical Sciences-Pharmacology Unit, Molecular and Translational Endocrinology Group and
| | - Ariane Chapgier
- Laboratory of Human Genetics of Infectious Diseases, Necker Faculty, INSERM U980, Necker Medical School, University Paris Descartes, Paris, France
| | - María Cárdenes
- Department of Immunology
- Canarian Institute for Cancer Research, La Laguna, Santa Cruz de Tenerife, Spain
| | - Jacqueline Feinberg
- Laboratory of Human Genetics of Infectious Diseases, Necker Faculty, INSERM U980, Necker Medical School, University Paris Descartes, Paris, France
| | | | - Capucine Picard
- Laboratory of Human Genetics of Infectious Diseases, Necker Faculty, INSERM U980, Necker Medical School, University Paris Descartes, Paris, France
- Study Center of Primary Immunodeficiencies and
| | | | - Xiaofei Kong
- St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - Lucile Jannière
- Laboratory of Human Genetics of Infectious Diseases, Necker Faculty, INSERM U980, Necker Medical School, University Paris Descartes, Paris, France
| | - Elena Colino
- Department of Pediatrics, Unit of Infectious Diseases
| | | | | | - Carmen Navarrete
- Department of Immunology, Hospital de Niños Roberto del Río, Santiago de Chile, Chile
| | - Stéphane Blanche
- Pediatric Immunology and Hematology Unit, Assistance Publique Hôpitaux de Paris, Necker Hospital, Paris, France
| | | | - Paweł Remiszewski
- IIIrd Department of Lung Diseases, National Tuberculosis and Chest Diseases Research Institute, Warsaw, Poland
| | - Ana Cordeiro
- Department of Medicine, Coimbra Pediatric Hospital, Coimbra, Portugal
| | - Alexandra Freeman
- Laboratory of Clinical Infectious Diseases, National Institutes of Health, Bethesda, MA, USA
| | - Steven Holland
- Laboratory of Clinical Infectious Diseases, National Institutes of Health, Bethesda, MA, USA
| | - Katia Abarca
- Department of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | | | - José Gonçalo-Marques
- Department of Pediatric Infectious Diseases, Santa Maria-Centro Hospitalar Lisboa Norte Hospital, Lisbon, Portugal and
| | - Luisa Silveira
- Department of Pediatrics, Santo Espirito de Angra do Heroísmo EPE Hospital, Angra do Heroìsmo, Portugal
| | - José Manuel García-Castellano
- Laboratory of Molecular Oncology, Research Unit and
- Department of Orthopedic Surgery, Insular-Materno Infantil Hospital, Las Palmas de Gran Canaria, Spain
| | - José Caminero
- Department of Respiratory Diseases, Gran Canaria Dr Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | - José Luis Pérez-Arellano
- Department of Medical and Surgical Sciences, School of Medicine, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Department of Infectious Diseases
| | - Jacinta Bustamante
- Laboratory of Human Genetics of Infectious Diseases, Necker Faculty, INSERM U980, Necker Medical School, University Paris Descartes, Paris, France
| | - Laurent Abel
- Laboratory of Human Genetics of Infectious Diseases, Necker Faculty, INSERM U980, Necker Medical School, University Paris Descartes, Paris, France
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Faculty, INSERM U980, Necker Medical School, University Paris Descartes, Paris, France
- St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
- Pediatric Immunology and Hematology Unit, Assistance Publique Hôpitaux de Paris, Necker Hospital, Paris, France
| | - Carlos Rodríguez-Gallego
- Department of Immunology
- Department of Medical and Surgical Sciences, School of Medicine, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Canarian Institute for Cancer Research, La Laguna, Santa Cruz de Tenerife, Spain
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Casan P, Togores B, Giner J, Nerin I, Drobnic F, Borderias L, Caminero J, Duce F, Agusti AG. Lack of effects of moderate-high altitude upon lung function in healthy middle-aged volunteers. Respir Med 1999; 93:739-43. [PMID: 10581664 DOI: 10.1016/s0954-6111(99)90042-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study investigates the effects of moderate-high altitude on lung function and exercise performance in 46 volunteers (19 females, 27 males), with a mean age of 42.4 +/- 1.4 years (+/- SEM) and varying smoking and exercise habits, who were not previously acclimatized. Measures obtained in the base camp (1140 m) and at altitude (2630 m), in random order, included forced spirometry, maximal voluntary ventilation, maximal inspiratory and expiratory pressures, arterial oxygen saturation and capillary lactate concentration after a standardized exercise test. The smoking history, Fagerström test and degree of habitual physical activity were also recorded for each participant. The percentage of smokers was similar in males (19%) and females (21%) (P = n.s.). Mean habitual physical activity index was 8.2 +/- 0.2 (range, 5.88-11.63). At the base camp, all lung function variables were within the normal range. Lactate concentration after exercise averaged 3.7 +/- 0.3 mm l-1. No significant change was observed at altitude, except for a higher heart rate and a lower arterial oxygen saturation (SaO2) (both at rest and after inspiratory manoeuvres). The smoking history and the degree of physical activity did not influence lung function or exercise performance at altitude. The results of this study show that in middle-aged, healthy, not particularly well-trained individuals, lung function is not significantly altered by moderate-high altitude, despite the absence of any acclimatization period and independent of their smoking history and previous exercise habits.
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Affiliation(s)
- P Casan
- Servicio de Neumología of Hospital Santa Creu i de Sant Pau, Barcelona, Spain
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Abstract
We review our experience of transbronchial fine needle aspiration (TBFNA) over a 3-year period. A total of 112 TBFNAs were performed on 95 patients. Four aspirates were from peripheral lung lesions, 20 from non-ulcerated submucosal infiltrative lesions, 19 from mediastinal abnormalities close to the tracheobronchial tree, and the remaining 69 were for staging of bronchogenic carcinoma with apparent mediastinal lymph node spread, evaluated by chest computed tomography (CT). In the 20 submucosal lesions TBFNA reached a sensitivity of 82.3%, providing the only evidence of a malignant process in five cases. With respect to the 19 mediastinal lesions arising in close proximity to the central airways, TBFNA permitted a diagnosis in cases that would otherwise have required more invasive procedures, although the diagnostic sensitivity of the technique in this group of patients was poor (26%). In the mediastinal staging group, the sensitivity was 76.9%, with no false positive results. Complete sensitivity of TBFNA for the detection of disease was 65.8%. We conclude that TBFNA is a reliable and low risk procedure.
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Affiliation(s)
- F Rodríguez de Castro
- Sección de Neumologia, Hospital Ntra. Sra. del Pino, Facultad de Ciencias de la Salud, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
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Rodríguez de Castro F, Molero T, Acosta O, Julià-Serdà G, Caminero J, Cabrera P, Carrillo T. Value of DNA analysis in addition to cytological testing in the diagnosis of malignant pleural effusions. Thorax 1994; 49:692-4. [PMID: 8066565 PMCID: PMC475059 DOI: 10.1136/thx.49.7.692] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Aneuploidy appears to be a highly specific marker for cancer, and measurement of cellular DNA content by flow cytometry is rapid and reliable. This study was undertaken to determine if the addition of DNA analysis improved the sensitivity of cytological diagnosis of malignancy in pleural fluid. METHODS Pleural effusions from 92 patients were studied by cytological examination and flow cytometry. RESULTS In 41 patients the final diagnosis was malignancy, there were 40 cases of benign effusions including 22 with pleural tuberculosis, and in the remaining 11 patients with biopsy proven cancer the presence of malignant cells was not found by cytological and histological means in the pleural fluid. Aneuploidy and cytological malignancy were found in 14 samples. There were seven cases with abnormal flow cytometry and negative cytological results. In 12 patients the cytological test results were positive but DNA analysis was normal. Thirty six samples of fluid were both diploid and cytologically negative. Of the 22 tuberculous effusions seven contained aneuploid cells. The sensitivity of DNA and cytological analysis was 51.2% and 63.4%, respectively. The specificity of DNA analysis was 74.5%. CONCLUSIONS DNA analysis of cells in malignant pleural effusions is both less sensitive and specific than the cytological diagnosis. Flow cytometric analysis is not recommended for routine use in the diagnosis of pleural effusions.
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Affiliation(s)
- F Rodríguez de Castro
- Section of Pulmonary Diseases, Hospital Universitario Ntra. Sra. del Pino, Facultad de Ciencias de la Salud, Universidad de Las Palmas, Gran Canaria, Spain
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