Francisco Arancibia

Instituto Nacional del Tórax

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Antoní Torres

Centro de Investigación Biomédica en Red de Enfermedades Respiratorias

MÁ

Miguel Ángel Martínez‐García

Hospital Universitari i Politècnic La Fe

Rodrigo Abensur Athanazio

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Santiago Ewig

Augusta-Kranken-Anstalt

Josep Mensa

Consorci Institut D'Investigacions Biomediques August Pi I Sunyer

David de la Rosa

Hospital de Sant Pau

Samia Zahi Rached

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Casilda Olveira

Instituto de Investigación Biomédica de Málaga

Mauricio Ruiz

Hospital Clínico de la Universidad de Chile

Torsten Bauer

Helios Klinikum Emil von Behring

Cooperative Institutions

University of Chile

Instituto Nacional del Tórax

Instituto de Salud Carlos III

Universitat de Barcelona

Pontificia Universidad Católica de Chile

Medizinische Hochschule Hannover

Centro de Investigación Biomédica en Red de Enfermedades Respiratorias

University of Turin

Consorci Institut D'Investigacions Biomediques August Pi I Sunyer

Sociedad de Biología de Chile

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Treatment of Community-Acquired Pneumonia in Immunocompromised Adults

CHEST Journal (2020)

Julio A. Ramírez Daniel M. Musher Scott E. Evans Charles S. Dela Cruz Kristina Crothers

10.1016/j.chest.2020.05.598

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Citations (147)

Understanding the Burden of Respiratory Syncytial Virus in Older Adults in Latin America: An Expert Perspective on Knowledge Gaps

Pulmonary Therapy (2024)

Ricardo de Amorim Corrêa Francisco Arancibia Renato de Ávila Kfouri Alberto Chebabo Gabriel García

Respiratory syncytial virus (RSV) is a significant global health concern and major cause of hospitalization, particularly among infants and older adults. The clinical impact of RSV is well characterized in infants; however, in many countries, the burden and risk of RSV in older populations are overlooked. In Latin America, there are limited data on RSV epidemiology and disease management in older adults. Therefore, the impact of RSV in this region needs to be addressed. Here, current insights on RSV infections in older populations in Latin America, including those with underlying health conditions, are discussed. We also outline the key challenges limiting our understanding of the burden of RSV in Latin America in a worldwide context and propose an expert consensus to improve our understanding of the burden of RSV in the region. By so doing, we aim to ultimately improve disease management and outcomes of those at risk and to alleviate the impact on healthcare systems.A graphical plain language summary is available with this article.

10.1007/s41030-024-00253-3

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Citations (5)

Transcriptomic signature on Hantavirus Cardiopulmonary Syndrome patients, reveals an increased interferon response as a hallmark of critically ill patients

medRxiv (Cold Spring Harbor Laboratory) (2021)

Grazielle Esteves Ribeiro Eduardo Durán-Jara Ruth Pérez Analía Cuiza Luis León

Abstract New World hantaviruses are important human pathogens that can cause a severe zoonotic disease called hantavirus cardiopulmonary syndrome (HCPS). HCPS patients can progress quickly to a severe condition with respiratory failure and cardiogenic shock that can be fatal in 30% of the cases. The role of the host’s immune responses in this progression towards HCPS remains elusive. In this study, 12 patients hospitalized with severe HCPS were analyzed using a transcriptome approach combined with clinical laboratory data to gain a better insight into factors associated with a severe clinical course. Patients were further classified in two levels of severity, a first group that required mechanical ventilation and vasoactive drugs (VM+VD) and a second group that also needed ECMO or died (ECMO/Fatal). Their transcriptional profile was compared during acute (early and late) and convalescent phases. Our results showed that overexpression of the interferon response is correlated with a worse (ECMO/Fatal) outcome and an increased viral load and proinflammatory cytokines in the early-acute-phase. This report provides insights into the differences in innate immune activation between severe patients that associates with different clinical outcomes, using a non-biased approximation. Author Summary Hantavirus are rodent-borne zoonotic pathogens that when transmitted to humans cause two diseases: hantavirus renal syndrome in Europe and Asia, and hantavirus cardiopulmonary syndrome (HCPS) in the Americas. The latter, the goal of this work, is a highly lethal disease with a case fatality rate of 30%. Moreover no specific treatment or vaccine is available for this disease. In this study, we analyzed hospitalized HCPS patients with severe disease, to understand how they respond to hantavirus infection. We used a method that can measure every mRNA that is being transcribed in one moment (transcriptome analysis) and thus provide an accurate idea of how cells (specifically peripheral blood mononuclear cells) are responding to infection. The knowledge gained in this study helps us further understand the pathogenesis of this disease and might help us to design specific therapies to treat it.

Case fatality rate

Hantavirus pulmonary syndrome

Hantavirus Infection

Cytokine Storm

10.1101/2021.07.28.21260540

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Citations (0)

Prognostic Value of Frequent Exacerbations in Bronchiectasis: The Relationship With Disease Severity

Archivos de Bronconeumología (2019)

Miguel Ángel Martínez‐García Rodrigo Abensur Athanazio Giorgina Gramblicka Mónica Corso Fernando Cavalcanti Lundgren

10.1016/j.arbr.2018.07.015

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Citations (11)

Importance of Legionella pneumophila in the Etiology of Severe Community-Acquired Pneumonia in Santiago, Chile

CHEST Journal (2013)

Francisco Arancibia Claudia P. Cortés Marcelo Valdés Javier Cerda Antonio M. Hernández

Bacteremia

Pneumonia severity index

Etiology

10.1378/chest.13-0162

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Citations (38)

Antimicrobial Treatment Failures in Patients with Community-acquired Pneumonia

American Journal of Respiratory and Critical Care Medicine (2000)

Francisco Arancibia Santiago Ewig JOSE ANTONIO MARTINEZ Mauricio Ruiz Torsten Bauer

The aim of the study was to determine the causes and prognostic implications of antimicrobial treatment failures in patients with nonresponding and progressive life-threatening, community-acquired pneumonia. Forty-nine patients hospitalized with a presumptive diagnosis of community-acquired pneumonia during a 16-mo period, failure to respond to antimicrobial treatment, and documented repeated microbial investigation ⩾ 72 h after initiation of in-hospital antimicrobial treatment were recorded. A definite etiology of treatment failure could be established in 32 of 49 (65%) patients, and nine additional patients (18%) had a probable etiology. Treatment failures were mainly infectious in origin and included primary, persistent, and nosocomial infections (n = 10 [19%], 13 [24%], and 11 [20%] of causes, respectively). Definite but not probable persistent infections were mostly due to microbial resistance to the administered initial empiric antimicrobial treatment. Nosocomial infections were particularly frequent in patients with progressive pneumonia. Definite persistent infections and nosocomial infections had the highest associated mortality rates (75 and 88%, respectively). Nosocomial pneumonia was the only cause of treatment failure independently associated with death in multivariate analysis (RR, 16.7; 95% CI, 1.4 to 194.9; p = 0.03). We conclude that the detection of microbial resistance and the diagnosis of nosocomial pneumonia are the two major challenges in hospitalized patients with community-acquired pneumonia who do not respond to initial antimicrobial treatment. In order to establish these potentially life-threatening etiologies, a regular microbial reinvestigation seems mandatory for all patients presenting with antimicrobial treatment failures.

Etiology

10.1164/ajrccm.162.1.9907023

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Citations (217)

Etiology of Community-Acquired Pneumonia:

American Journal of Respiratory and Critical Care Medicine (1999)

Mauricio Ruiz Santiago Ewig María Άngeles Marcos JOSE ANTONIO MARTINEZ Francisco Arancibia

The aim of this study was to determine the etiology of community-acquired pneumonia (CAP) and the impact of age, comorbidity, and severity on microbial etiologies of such pneumonia. Overall, 395 consecutive patients with CAP were studied prospectively during a 15-mo period. Regular microbial investigation included examination of sputum, blood culture, and serology. Sampling of pleural fluid, transthoracic puncture, tracheobronchial aspiration, and protected specimen brush (PSB) sampling were performed in selected patients. The microbial etiology was determined in 182 of 395 (46%) cases, and 227 pathogens were detected. The five most frequent pathogens were Streptococcus pneumoniae (65 patients [29%]), Haemophilus influenzae (25 patients [11%]), Influenza virus A and B (23 patients [10%]), Legionella sp. (17 patients [8%]), and Chlamydia pneumoniae (15 patients [7%]). Gram-negative enteric bacilli (GNEB) accounted for 13 cases (6%) and Pseudomonas aeruginosa for 12 cases of pneumonia (5%). Patients aged < 60 yr were at risk for an “atypical” bacterial etiology (odds ratio [OR]: 2.3; 95% confidence interval [CI]: 1.2 to 4.5), especially Mycoplasma pneumoniae (OR: 5.3; 95% CI: 1.7 to 16.8). Comorbid pulmonary, hepatic, and central nervous illnesses, as well as current cigarette smoking and alcohol abuse, were all associated with distinct etiologic patterns. Pneumonia requiring admission to the intensive care unit was independently associated with the pathogens S. pneumoniae (OR: 2.5; 95% CI: 1.3 to 4.7), gram-negative enteric bacilli, and P. aeruginosa (OR: 2.5; 95% CI: 0.99 to 6.5). Clinical and radiographic features of “typical” pneumonia were neither sensitive nor specific for the differentiation of pneumococcal and nonpneumococcal etiologies. These results support a management approach based on the associations between etiology and age, comorbidity, and severity, instead of the traditional syndromic approach to CAP.

Etiology

10.1164/ajrccm.160.2.9808045

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Citations (644)

Severe Community-acquired Pneumonia

American Journal of Respiratory and Critical Care Medicine (1999)

Mauricio Ruiz Santiago Ewig Antoni Torres Francisco Arancibia Francesc Marco

The aim of the study was to determine risk factors for severe community-acquired pneumonia (CAP) as well as to compare microbial patterns of severe CAP to a previous study from our respiratory intensive care unit (ICU) originating from 1984 to 1987. Patients admitted to the ICU according to clinical judgment were defined as having severe CAP. For the study of risk factors, a hospital-based case-control design was used, matching each patient with severe CAP to a patient hospitalized with CAP but not requiring ICU admission. Microbial investigation included noninvasive and invasive techniques. Overall, 89 patients with severe CAP were successfully matched to a control patient. The presence of an alcohol ingestion of ⩾ 80 g/d (odds ratio [OR] 3.9, 95% confidence interval [CI] 1.4 to 10.6, p = 0.008) was found to be an independent risk factor for severe CAP and prior ambulatory antimicrobial treatment (OR 0.37, 95% CI 0.17 to 0.79, p = 0.009) to be protective. Streptococcus pneumoniae (24%) continued to be the most frequent pathogen; however, 48% of strains were drug-resistant. “Atypical” bacterial pathogens were significantly more common (17% versus 6%, p = 0.006) and Legionella spp. less common (2% versus 14%, p = 0.004) than in our previous study, whereas gram-negative enteric bacilli (GNEB) and Pseudomonas aeruginosa continued to represent important pathogens (6% and 5%, respectively). Our findings provide additional evidence for the importance of the initiation of early empiric antimicrobial treatment for a favorable outcome of CAP. Variations of microbial patterns are only in part due to different epidemiological settings. Therefore, initial empiric antimicrobial treatment will also have to take into account local trends of changing microbial patterns.

Legionella

Pneumonia severity index

10.1164/ajrccm.160.3.9901107

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Citations (530)

Severe Community-acquired Pneumonia

American Journal of Respiratory and Critical Care Medicine (1998)

Santiago Ewig Mauricio Ruiz Josep Mensa María Ángeles Marcos JOSE ANTONIO MARTINEZ

The purpose of the study was to validate the criteria used in the guidelines of the American Thoracic Society (ATS) for severe community-acquired pneumonia (CAP). Severe pneumonia was defined as admission to the intensive care unit (ICU). Overall 331 nonsevere (84%) and 64 severe cases (16%) of CAP were prospectively studied. Mortality was 19 of 395 (5%) and 19 of 64 (30%), respectively. Single severity criteria as well as the ATS definition of severe pneumonia were assessed calculating the operative indices. A modified prediction rule including minor (baseline) and major (baseline or evolutionary) criteria was derived. Single minor criteria at admission had a low sensitivity and positive predictive value. Defining severe pneumonia according to the ATS guidelines had a high sensitivity (98%). However, specificity and positive predictive value were low (32% and 24%, respectively). A modified prediction rule (presence of two or three minor criteria [systolic blood pressure < 90 mm Hg, multilobar involvement, PaO2/FIO2 < 250] or one of two major criteria [requirement of mechanical ventilation, presence of septic shock]) had a sensitivity of 78%, a specificity of 94%, a positive predictive value of 75%, and a negative predictive value of 95%. The ATS definition of severe pneumonia was highly sensitive but insufficiently specific and had a low positive predictive value. Our suggested modified rule had a more balanced performance and, if validated in an independent population, may represent a more accurate definition of severe CAP.

10.1164/ajrccm.158.4.9803114

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Citations (357)

Actualización del Plan Estratégico de la Asociación Latinoamericana de Tórax (ALAT). «Los diez mandamientos para el quinquenio 2021-2026»

Archivos de Bronconeumología (2021)

Mark E. Cohen Alejandro Casas Gustavo Zabert Carlos A. Torres‐Duque Francisco Arancibia

10.1016/j.arbres.2021.05.028

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Citations (2)