Browsing by Author "Dudvarski-Ilic, Aleksandra (7004055911)"

Introduction: Acute eosinophilic pneumonia (AEP) is idiopathic disease characterized by acute febrile illness, progressive respiratory failure, diffuse pulmonary infiltrates, and pulmonary eosinophilia. The aetiology of AEP is unknown, although several studies have proposed that cigarette smoke is potentially related to the onset of AEP. Herein is a report of a rare case showing the causal association between short-term period of excessive smoking and AEP Case report: A 25-year-old patient was admitted to the ICU (during on-duty hours) as an emergency case due to acute disease occurred a day prior to hospitalisation. His symptoms were febricity, dry cough, excessive fatigue and general weakness. The patient was a non-smoker who had smoked 30 cigarettes a day prior to the onset of the symptoms. At the time of admission, he was voluntary, but somnolent, orientated, febrile, dyspneic, cyanotic, adynamic, and without peripheral lymphadenopathy. Due to both poor oxygenation and the life-threatening condition, the corticosteroid therapy, in addition to the antibiotic therapy were immediately administered to the patient. The eosinophilia was diagnosed based on control tests, such as Le 22.0x10 9, with dominating eosinophilic leucocytes of 12.59 (0-7% reference value) and neutrophils of 86.26 (44-72% reference range), Se 58mm/h, CRP 115, fibrinogen 6.5, while other parametres ranged within the reference scales. Afterwards, eosinophil chamber count of 2300 was found (<350mm 3 reference value). The specific protein value amounted to IgE 255.0 IU/ml (0-100 reference value). The MSCT of the thorax revealed: pneumonic infiltrates of sub-segment type, including associated pleural thickening, observed in the subhilar and bibasal parts, both sides. Moreover, pleural effusion was observed in a minor incisure on the right and in the upper part of a major incisure on the left. Conclusion: The majority of reported cigarette smoking-induced AEP cases are young adults who were first-time smokers. In light of such reports and considering the increase of early cigarette smoking in young adults, it is important that physicians are aware of the possibility of this potentially life-threatening, but fully reversible disease.

Introduction: Alpha-1-antitrypsin deficiency (AATD), genetic risk factor for premature chronic obstructive pulmonary disease (COPD), often remains undetected. The aim of our study was to analyse the effectiveness of an integrative laboratory algorithm for AATD detection in patients diagnosed with COPD by the age of 45 years, in comparison with the screening approach based on AAT concentration measurement alone. Subjects and methods: 50 unrelated patients (28 males / 22 females, age 52 (24-75 years) diagnosed with COPD before the age of 45 years were enrolled. Immunonephelometric assay for alpha-1-antitrypsin (AAT) and PCR-reverse hybridization for Z and S allele were first-line, and isoelectric focusing and DNA sequencing (ABI Prism BigDye) were reflex tests. Results: AATD associated genotypes were detected in 7 patients (5 ZZ, 1 ZMmalton, 1 ZQ0amersfoort), 10 were heterozygous carriers (8 MZ and 2 MS genotypes) and 33 were without AATD (MM genotype). Carriers and patients without AATD had comparable AAT concentrations (P = 0.125). In majority of participants (48) first line tests were sufficient to analyze AATD presence. In two remaining cases reflex tests identified rare alleles, Mmalton and Q0amersfoort, the later one being reported for the first time in Serbian population. Detection rate did not differ between algorithm and screening both for AATD (P = 0.500) and carriers (P = 0.063). Conclusion: There is a high prevalence of AATD affected subjects and carriers in a group of patients with premature COPD. The use of integrative laboratory algorithm does not improve the effectiveness of AATD detection in comparison with the screening based on AAT concentration alone. © Croatian Society of Medical Biochemistry and Laboratory Medicine.

Introduction: Alpha-1-antitrypsin deficiency (AATD), genetic risk factor for premature chronic obstructive pulmonary disease (COPD), often remains undetected. The aim of our study was to analyse the effectiveness of an integrative laboratory algorithm for AATD detection in patients diagnosed with COPD by the age of 45 years, in comparison with the screening approach based on AAT concentration measurement alone. Subjects and methods: 50 unrelated patients (28 males / 22 females, age 52 (24-75 years) diagnosed with COPD before the age of 45 years were enrolled. Immunonephelometric assay for alpha-1-antitrypsin (AAT) and PCR-reverse hybridization for Z and S allele were first-line, and isoelectric focusing and DNA sequencing (ABI Prism BigDye) were reflex tests. Results: AATD associated genotypes were detected in 7 patients (5 ZZ, 1 ZMmalton, 1 ZQ0amersfoort), 10 were heterozygous carriers (8 MZ and 2 MS genotypes) and 33 were without AATD (MM genotype). Carriers and patients without AATD had comparable AAT concentrations (P = 0.125). In majority of participants (48) first line tests were sufficient to analyze AATD presence. In two remaining cases reflex tests identified rare alleles, Mmalton and Q0amersfoort, the later one being reported for the first time in Serbian population. Detection rate did not differ between algorithm and screening both for AATD (P = 0.500) and carriers (P = 0.063). Conclusion: There is a high prevalence of AATD affected subjects and carriers in a group of patients with premature COPD. The use of integrative laboratory algorithm does not improve the effectiveness of AATD detection in comparison with the screening based on AAT concentration alone. © Croatian Society of Medical Biochemistry and Laboratory Medicine.

Subacute invasive pulmonary aspergillosis (IPA) represents a form of chronic pulmonary aspergillosis which affects immunocompetent individuals or mildly immunocompromised persons with underlying pulmonary disease. Pneumothorax can be a rare complication of subacute IPA due to a leakage of air from an air-filled lung cavitation into the pleural space. Herein, we report rare and unusual case of pneumothorax in a patient with pulmonary cavity infection. A 40-year-old woman was admitted to thoracic surgery due to complete pneumothorax of the left lung. She was active smoker with untreated chronic obstructive pulmonary disease (COPD). After thoracic drainage multiple cavity forms in the both lungs were noticed. Galactomannan antigen was positive in bronchoalveolar lavage as well as culture of Aspergillus fumigatus. Antifungal treatment by voriconazole was started and continued during 6 months with a favorable outcome. This case highlights that subacute IPA is a diagnose that should be considered in patients with end-stage COPD, low body mass index, or patient who developed pneumothorax. The results of our case show that voriconazole is a safe and effective treatment as primary or salvage therapy in subacute forms of IPA, irrespective of the immunological status of the patients. © 2017, Springer-Verlag Berlin Heidelberg.