Objetivo: O elevado número de agentes e sintomas semelhantes dificultam o diagnóstico de agentes virais das infecções respiratórias. Avaliamos a epidemiologia de vírus e bactérias causadores das principais infecções respiratórias a partir da detecção molecular em pacientes de unidades hospitalares e ambulatoriais atendidos por uma empresa de diagnóstico e saúde de abrangência nacional. Método: Por meio de banco de dados internos, avaliamos testes no FilmArray®, por PCR multiplex, que identifica, na mesma amostra, 21 agentes respiratórios de amostras de nasofaringe e lavado brônquico. Amostras foram analisadas quanto ao gênero, à faixa etária, a regiões e à prevalência entre janeiro de 2021 e abril de 2023. Conclusão: Foram provenientes 477 pacientes de 26 cidades e 11 estados (GO, MG, MT, PA, PR, RJ, SP, TO, AM, BA, DF) de hospitais (39,8%) ou unidades ambulatoriais. Na amostragem hospitalar, 62% dos solicitantes foram da clínica médica, da cardiologia e da nefrologia, diferentemente da amostragem ambulatorial, cujos solicitantes foram essencialmente pneumologistas e infectologistas. A média etária dos que realizaram o exame foi de 36 anos, sendo o gênero masculino predominante (54%), com exceção do quadrimestre de 2023, o qual apresentou perfil feminino (60,8%). A positividade foi de 42,3%; detectaram-se 71% (15/21) de todos os agentes pesquisados. Rinovírus, enterovírus e Sars-CoV-2 representaram 55,1% desses achados e infecção mista em 29 (6%) dos pacientes: Sars-CoV-2 + rinovírus (10,3%), Sars-CoV-2 + H3N2 (6,8%), Sars-CoV-2 + VSR (6,8%), dentre outros. Os achados demonstram a importância da evolução molecular na prática clinicolaboratorial com metodologias mais rápidas, seguras e sensíveis na identificação dos germes, contribuindo na melhora e no desfecho clínico favorável.
Spontaneous chylothorax is rare in adults. We present an unusual case that was complicated by Prevotella bivia empyema. Full recovery was achieved with chest tube drainage and prompt treatment with intravenous clindamycin.
Functional diagnosis of chronic obstructive pulmonary disease is important for identifying and quantifying airflow limitation, reversibility, disease severity and exacerbations. Functional diagnosis is also important for long-term therapeutic monitoring and for establishing the need for pulmonary rehabilitation. From the functional standpoint, chronic obstructive pulmonary disease is characterised by a progressive airflow limitation which is not fully reversible. Spirometry is the gold standard for diagnosing the disease and monitoring its progression as it is non-invasive, standardised, reproducible, and objective. Spirometry should measure forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and the ratio of these two measurements. Post-bronchodilator FEV1 < 80% of the predicted value and FEV1/FVC ratio < 70% confirms the diagnosis of chronic obstructive pulmonary disease.
Endobronchial ultrasound (EBUS) is a useful diagnostic tool to localize peripheral pulmonary lesions (PPLs) and to guide transbronchial biopsy (TBB). We retrospectively evaluated the diagnostic accuracy of EBUS-guided TBB in comparison with a definitive diagnosis established by transthoracic CT-guided needle aspiration or surgical lobectomy. In the last ten months, 168 patients performed bronchoscopy for a PPL (mean diameter = 3.5±2.1 cm). PPL was visualized in 123 patients (73%) and TBB was performed in 117 patients. These patients had a PPL larger than patients with a non visualized lesion (mean diameter 3.7±2.1 vs 2.3±1.6 cm, respectively). A definitive diagnosis was obtained in 77 patients whereas 40 patients were lost to follow-up. The TBB diagnosis was cancer in 45 patients and non-malignant lesion in 32 patients. The definitive diagnosis was cancer in 67 patients and non-malignant lesion in 10 patients: all these 10 patients without cancer were correctly diagnosed with TBB. In conclusion, sensitivity of EBUS-guided TBB in the diagnosis of cancer was 67% (45/67) and the overall diagnostic accuracy was 71% (45+10/77). Our data confirm that EBUS-guided TBB is a sensitive method with a high diagnostic yield in patients with PPLs.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)
