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Vol. 36. Issue 1.
Pages 29-33 (January 2000)
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Vol. 36. Issue 1.
Pages 29-33 (January 2000)
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Factores pronósticos de la aspergilosis pulmonar invasiva en pacientes con neumopatía crónica
Prognostic factors in invasive pulmonary aspergillosis in patients with chronic respiratory disease
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J. Tárrega, F.R. Jerez, V. Plaza*
Departamento de Neumología. Hospital de la Santa Creu i de Sant Pau. Barcelona
T. Franqueta, F. Sánchezb, M. Gurguíc
a Servicio de Radiodiagnóstico, Hospital de la Santa Creu i de Sant Pau. Barcelona
b Servicio de Microbiología, Hospital de la Santa Creu i de Sant Pau. Barcelona
c Unidad de Enfermedades Infecciosas. Hospital de la Santa Creu i de Sant Pau. Barcelona
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Objetivos

a) Determinar en los enfermos con neumopatía crónica (NC) los factores de riesgo de fallecer por una aspergilosis pulmonar semiinvasiva e invasiva (APSI), y b) describir las características clínicas de la enfermedad en este tipo de pacientes.

Método

Se incluyeron en el estudio 21 enfermos con NC (9 EPOC, 2 asmáticos, 3 bronquiectasias, 5 secuelas tras tuberculosis y 2 con combinaciones de los anteriores) que fueron diagnosticados de APSI en nuestro hospital. El diagnóstico de infección pulmonar por Aspergillus se estableció cuando ante un cuadro clinicorradiológico compatible se aisló el hongo en secreciones bronquiales o muestras de parénquima pulmonar obtenidas en la necropsia.

Resultados

Los síntomas más frecuentes fueron el incremento de la disnea (81%), de la tos (67%) y de la expectoración (62%), habituales en el curso de las NC. Sólo el 14% de los casos presentó hemoptisis. Ocho pacientes fallecieron (38%) a consecuencia de la enfermedad. Al comparar este grupo con el grupo de pacientes que sobrevivió, encontramos diferencias estadísticamente significativas en las cifras de LDH y leucocitos, que fueron superiores, así como en las de proteínas totales en suero y plaquetas, que resultaron inferiores.

Conclusiones

a) Unas proteínas disminuidas, una LDH elevada y una leucocitosis con trombopenia son indicadores de mal pronóstico de la APSI en pacientes con NC, y b) estos pacientes no acostumbran presentar síntomas o signos que permitan sospechar el diagnóstico de APSI, pues son los propios de su neumopatía cuando se descompensa.

Palabras clave:
Aspergilosis pulmonar semiinvasiva-invasiva
Neumopatía crónica
Factores pronóstico
Objectives

a) To determine in patients with chronic respiratory disease the risk factors for death due to semi-invasive and invasive pulmonary aspergillosis (SIPA), and b) to describe the clinical features of SIPA in such patients.

Method

Twenty-one patients with chronic respiratory disease were enrolled (9 with chronic obstructive pulmonary disease, 2 asthmatics and 3 with bronchiectasis, 5 with posttubercular sequelae and 2 mixed cases). A diagnosis of SIPA was established in our hospital when, in a patient with a clinical picture consistent with such a diagnosis, the fungus was isolated in bronchial secretions or parenchymal pulmonary specimens were obtained during autopsy.

Results

The most common symptoms were dyspnea (81%), cough (67%) and expectoration (62%) increasing over the levels usual for patients with chronic respiratory disease. Hemoptysis was present in only 14%. Eight patients (38%) died as a result of SIPA. A comparison of those surviving and non-surviving patients revealed that the latter had significantly higher LDH levels and white cell counts, and significantly lower total plasma protein and platelet counts.

Conclusions

a) Low protein levels and high LDH levels and white cell counts with thrombopenia are indicators of poor prognosis in chronic respiratory disease patients with SIPA, and b) such patients do not usually present signs or symptoms that lead to a suspicion of SIPA given that such signs are typical of failing compensatory mechanisms in the disease itself.

Key words:
Semi-invasive and invasive pulmonary aspergillosis
Chronic respiratory disease
Prognostic factors
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