Rhodococcus equi infection as inaugural manifestation of idiopathic CD4+ lymphopenia: A rare entity and a therapeutic challenge

We report a case of disseminated infection by Rhodococcus equi as the inaugural manifestation of idiopathic T-CD4⁺ lymphopenia. We aim to demonstrate our diagnostic and therapeutic approach and focus on the major dilemmas arising from the lack of scientific evidence regarding best clinical practice of this infection in humans.

Broncho-alveolar inflammation in cork worker's asthma

Suberosis is an occupational lung disease of cork workers associated with repeated exposure to mouldy cork dust in the cork industry, usually presenting as an interstitial lung disorder (Extrinsic Allergic Alveolitis). However, Occupational Asthma can also be associated with cork dust exposure and demonstrated by serial peak expiratory flow changes.

AIM

To investigate broncho-alveolar inflammation in patients with cork work-related occupational asthma, evaluated by Broncho-alveolar fluid cellular profiles and serial peak expiratory flow (PEF) rates monitoring.

RESULTS

We studied 14 patients with respiratory symptoms associated with occupational exposure in the cork industry. Positive PEF monitoring occurred in 7 cases (Occupational Asthma-OA), and in 7 (Non-occupational asthmatics-NOA) PEF records were negative. There were no differences in age, lung function (FEV1%, RV%), bronchial hyperresponsiveness, years of exposure, and atopy between the two patients groups. However, patients with work-related asthma had higher BAL eosinophil counts than NOA (1.9 +/- 2.6% versus 0.2 +/- 0.3%; p < 0.05, Wilcoxon test).

CONCLUSIONS

Cork worker's asthma, demonstrated by work related changes in serial PEF recordings, is associated with eosinophilic lung inflammation as described in other forms of occupational asthma.

Monitoring of peak expiratory flow rates in cork workers' occupational asthma

Suberosis is an occupational lung disorder of cork industry workers usually presenting as an extrinsic allergic alveolitis, but airway involvement in some cases makes the diagnostic approach complex. We assessed peak expiratory flow rates (PEF) in 17 cork workers with asthma symptoms that worsened at work, comparing three methods of PEF graph analysis. Complete agreement (three observers) was found in 12 of 17 cases (70.6%) with the visual inspection of mean daily values and in 11 of 17 cases (64.7%) with the minimum, maximum, and mean daily values (without any consensus in two cases). According to the mean PEF graph, there were eight positive readings (47%), five negative readings (29%), and four dubious readings (24%); with the other graphic analysis, two of the dubious cases were reclassified as negative. When we analyzed daily variability >20%, we found only three positive results, one of which was in absolute disagreement with the visual analysis. Our results suggest that it is possible to demonstrate occupational asthma in cork work exposure. The visual inspection of PEF monitoring shows a greater number of positive results than the index of daily variability; however, the latter may help to sort out dubious cases.

[Pleural effusion infected with Salmonella enteridis]

The authors describe the case of a 49 year-old caucasian male with left pleural effusion. The etiology of the effusion was exsudative with a preponderance of neutrophils. Ten days after admission and on empirical antibiotic therapy, the patient still had fever and the pleural effusion that became purulent. The thoracic echography and computerized tomography showed a subcapsular splenic abcess. The diagnosis was established by the culture of the pleural effusion and the isolation of Salmonella enteritidis enteritidis serotype. According to the antibiogram, a treatment with cotrimoxazole was established with clinical improvement. A splenectomy was performed.