RESUMO
Coinfection of SARS-CoV-2/Mycobacterium tuberculosis (MTB) in patients with HIV/AIDS has not been previously reported. Here, we present two cases of coinfection of SARS-CoV-2 and MTB in patients with HIV. The first case is a 39-year-old patient who was admitted with a 7-day history of fever, myalgia, headache, and cough. The second patient is a 43-year-old man who had a 1-month history of cough with hemoptoic sputum, evolving to mild respiratory distress in the last 7 days. Both patients already had pulmonary tuberculosis and subsequently developed SARS-CoV-2 infection during the 2020 pandemic. Nonadherence to antiretroviral treatment may have been a factor in the clinical worsening of the patients.
Assuntos
Infecções por Coronavirus/microbiologia , Tosse/microbiologia , Infecções por HIV/microbiologia , Cooperação do Paciente/psicologia , Pneumonia Viral/microbiologia , Síndrome do Desconforto Respiratório/microbiologia , Tuberculose Pulmonar/microbiologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Betacoronavirus/patogenicidade , COVID-19 , Coinfecção , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Tosse/tratamento farmacológico , Tosse/imunologia , Tosse/virologia , HIV/patogenicidade , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Infecções por HIV/virologia , Humanos , Masculino , Mycobacterium tuberculosis/patogenicidade , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Síndrome do Desconforto Respiratório/tratamento farmacológico , Síndrome do Desconforto Respiratório/imunologia , Síndrome do Desconforto Respiratório/virologia , SARS-CoV-2 , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/imunologia , Tuberculose Pulmonar/virologiaRESUMO
The cough reflex is a protective mechanism of the airway; it avoids bronchoaspiration and its complications and, when it is altered, it can appear as a hypersensitivity syndrome; cough per se is the most common symptom for which medical consultation is sought. Chronic cough represents a public health problem with a high degree of morbidity; It represents a syndrome by itself, regardless of the underlying condition. Recent evidence suggests an abnormal and altered neurophysiologic process. Recent literature and new therapeutic mechanisms were reviewed. We are in the process of understanding the cough syndrome.
El reflejo de la tos es un mecanismo de protección de la vía respiratoria, evita la broncoaspiración y sus complicaciones; cuando está alterado puede manifestarse como un síndrome de hipersensibilidad. La tos per se es el síntoma más común por el que se consulta en la práctica médica. La tos crónica representa un problema de salud pública, con alto grado de morbilidad; representa un síndrome por sí mismo, sin importar la condición subyacente. Evidencia reciente sugiere un proceso neurofisiológico anormal y alterado. Se revisó literatura especializada y acerca de los nuevos mecanismos terapéuticos. Estamos en proceso de comprender el síndrome de la tos.
Assuntos
Tosse/imunologia , Hipersensibilidade/complicações , Doença Crônica , Tosse/diagnóstico , Tosse/fisiopatologia , Tosse/terapia , Humanos , Reflexo , SíndromeRESUMO
A 55-year-old woman presented 18 months after a trip to Ecuador with night sweat, malaise, and an unclear lesion of the lung. Computed tomography of the lung showed a nodular lesion of 14 mm. Antibodies against Histoplasma capsulatum were detected in the complement fixation text (CFT) and IgG western blot. Re-examination of a formalin fixed paraffin embedded (FFPE) lung-biopsy revealed yeasts after silver staining, compatible with H. capsulatum , which was verified by extraction and amplification of DNA from FFPE. After therapy with itraconazole 400 mg/day, the patient showed an uneventful clinical recovery without regression of the lung lesion. The serological follow-up examination after 17 months showed CFT without pathological findings.
Assuntos
Artrite/prevenção & controle , Exantema/prevenção & controle , Febre de Causa Desconhecida/prevenção & controle , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Viagem , Antifúngicos/uso terapêutico , Artrite/diagnóstico , Artrite/imunologia , Testes de Fixação de Complemento , Tosse/diagnóstico , Tosse/imunologia , Tosse/prevenção & controle , Equador , Exantema/diagnóstico , Exantema/imunologia , Feminino , Febre de Causa Desconhecida/diagnóstico , Febre de Causa Desconhecida/imunologia , Histoplasmose/imunologia , Humanos , Itraconazol/uso terapêutico , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Common variable immunodeficiency is characterized by defective antibody production and recurrent pulmonary infections. Intravenous immunoglobulin is the treatment of choice, but the effects of Intravenous immunoglobulin on pulmonary defense mechanisms are poorly understood. OBJECTIVE: The aim of this study was to verify the impact of intravenous immunoglobulin on the physical properties of the sputum and on inflammatory alterations in the airways of patients with Common variable immunodeficiency associated with bronchiectasis. METHOD: The present study analyzed sputum physical properties, exhaled NO, inflammatory cells in the sputum, and IG titers in 7 patients with Common variable immunodeficiency and bronchiectasis with secretion, immediately before and 15 days after Intravenous immunoglobulin. A group of 6 patients with Common variable immunodeficiency and bronchiectasis but no sputum was also studied for comparison of the basal IgG level and blood count. The 13 patients were young (age=36+/-17 years) and comprised predominantly of females (n=11). RESULTS: Patients with secretion presented significantly decreased IgG and IgM levels. Intravenous immunoglobulin was associated with a significant decrease in exhaled NO (54.7 vs. 40.1 ppb, p<0.05), sputum inflammatory cell counts (28.7 vs. 14.6 cells/mm(3), p<0.05), and a significant increase in respiratory mucus transportability by cough (42.5 vs. 65.0 mm, p < 0.05). CONCLUSION: We concluded that immunoglobulin administration in Common variable immunodeficiency patients results in significant improvement in indexes of inflammation of the airways with improvement in the transportability of the respiratory mucus by cough.
Assuntos
Bronquiectasia , Imunodeficiência de Variável Comum , Imunoglobulinas Intravenosas/uso terapêutico , Depuração Mucociliar/fisiologia , Infecções Respiratórias , Escarro , Adulto , Bronquiectasia/tratamento farmacológico , Bronquiectasia/imunologia , Bronquiectasia/fisiopatologia , Contagem de Células , Imunodeficiência de Variável Comum/tratamento farmacológico , Imunodeficiência de Variável Comum/imunologia , Imunodeficiência de Variável Comum/fisiopatologia , Tosse/imunologia , Tosse/fisiopatologia , Feminino , Humanos , Imunoglobulina G/análise , Imunoglobulina M/análise , Masculino , Muco/fisiologia , Óxido Nítrico/análise , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/imunologia , Infecções Respiratórias/fisiopatologia , Escarro/citologia , Escarro/efeitos dos fármacos , Escarro/imunologia , Estatísticas não Paramétricas , Fatores de TempoRESUMO
INTRODUCTION: Common variable immunodeficiency is characterized by defective antibody production and recurrent pulmonary infections. Intravenous immunoglobulin is the treatment of choice, but the effects of Intravenous immunoglobulin on pulmonary defense mechanisms are poorly understood. OBJECTIVE: The aim of this study was to verify the impact of intravenous immunoglobulin on the physical properties of the sputum and on inflammatory alterations in the airways of patients with Common variable immunodeficiency associated with bronchiectasis. METHOD: The present study analyzed sputum physical properties, exhaled NO, inflammatory cells in the sputum, and IG titers in 7 patients with Common variable immunodeficiency and bronchiectasis with secretion, immediately before and 15 days after Intravenous immunoglobulin. A group of 6 patients with Common variable immunodeficiency and bronchiectasis but no sputum was also studied for comparison of the basal IgG level and blood count. The 13 patients were young (age=36±17 years) and comprised predominantly of females (n=11). RESULTS: Patients with secretion presented significantly decreased IgG and IgM levels. Intravenous immunoglobulin was associated with a significant decrease in exhaled NO (54.7 vs. 40.1 ppb, p<0.05), sputum inflammatory cell counts (28.7 vs. 14.6 cells/mm³, p<0.05), and a significant increase in respiratory mucus transportability by cough (42.5 vs. 65.0 mm, p < 0.05). CONCLUSION: We concluded that immunoglobulin administration in Common variable immunodeficiency patients results in significant improvement in indexes of inflammation of the airways with improvement in the transportability of the respiratory mucus by cough.
Assuntos
Adulto , Feminino , Humanos , Masculino , Bronquiectasia , Imunodeficiência de Variável Comum , Imunoglobulinas Intravenosas/uso terapêutico , Depuração Mucociliar/fisiologia , Infecções Respiratórias , Escarro , Bronquiectasia/tratamento farmacológico , Bronquiectasia/imunologia , Bronquiectasia/fisiopatologia , Contagem de Células , Imunodeficiência de Variável Comum/tratamento farmacológico , Imunodeficiência de Variável Comum/imunologia , Imunodeficiência de Variável Comum/fisiopatologia , Tosse/imunologia , Tosse/fisiopatologia , Imunoglobulina G/análise , Imunoglobulina M/análise , Muco/fisiologia , Óxido Nítrico/análise , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/imunologia , Infecções Respiratórias/fisiopatologia , Estatísticas não Paramétricas , Escarro/citologia , Escarro/efeitos dos fármacos , Escarro/imunologia , Fatores de TempoRESUMO
Chronic cough is a common complaint in children and its relationship with asthma is controversial. The aim of the present study was to determine the pattern of airway inflammation in atopic and nonatopic children with chronic cough, and to investigate whether atopy is a predictive factor for eosinophilic inflammation in cough. Bronchoalveolar lavage (BAL; three aliquots of 1 ml/kg saline) was performed in the right middle lobe of 24 (11 atopic and 13 nonatopic) children with persistent cough (8 females, 16 males), mean age 4.7 years (range: 1-11). Atopy was defined as an elevated total serum IgE or a positive RAST test. Both atopic and nonatopic children with persistent cough had an increase in total cells/ml in BAL (atopic: median 39 x 10(4), range: 20-123; nonatopic: median 22 x 10(4), range: 17-132) compared to nonatopic controls (median 11 x 10(4), range 9-30). The increases were mainly in neutrophils (atopic: median 17%, range 2.5-88.5%; nonatopic: median 6%, range 1.0-55.0%) compared to controls (median 1.55%, range 0.5-7.0%; atopics vs. controls, P < 0.005). There were no significant increases in eosinophils, lymphocytes, epithelial cells, or mast cells. Eosinophils were elevated in only 5/11 atopic and none of the nonatopic children. The increased percentage of neutrophils in the BAL fluid of atopic and nonatopic children with persistent cough could be due to an underlying inflammatory process driving the cough, or even conceivably, due to the effect of coughing itself. In this highly selected series, the absence of eosinophilic inflammation in the majority suggests that most would be predicted not to respond to inhaled corticosteroid therapy. This study underscores the need to be cautious about treating coughing children with inhaled corticosteroids, even in the context of a tertiary referral practice.