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Objective: To determine the prevalence rates of infections among intensive care unit patients, the predominant infecting organisms, and their resistance patterns. To identify the related factors for intensive care unit-acquired infection and mortality rates., Design: A 1-day point-prevalence study., Setting: A total of 19 intensive care units at the Hospital das Clínicas-University of São Paulo, School of Medicine (HC-FMUSP), a teaching and tertiary hospital, were eligible to participate in the study., Patients: All patients over 16 years old occupying an intensive care unit bed over a 24-hour period. The 19 intensive care unit s provided 126 patient case reports., Main Outcome Measures: Rates of infection, antimicrobial use, microbiological isolates resistance patterns, potential related factors for intensive care unit-acquired infection, and death rates., Results: A total of 126 patients were studied. Eighty-seven patients (69%) received antimicrobials on the day of study, 72 (57%) for treatment, and 15 (12%) for prophylaxis. Community-acquired infection occurred in 15 patients (20.8%), non-intensive care unit nosocomial infection in 24 (33.3%), and intensive care unit-acquired infection in 22 patients (30.6%). Eleven patients (15.3%) had no defined type. The most frequently reported infections were respiratory (58.5%). The most frequently isolated bacteria were Enterobacteriaceae (33.8%), Pseudomonas aeruginosa (26.4%), and Staphylococcus aureus (16.9%; [100% resistant to methicillin]). Multivariate regression analysis revealed 3 risk factors for intensive care unit-acquired infection: age > or = 60 years (p = 0.007), use of a nasogastric tube (p = 0.017), and postoperative status (p = 0.017). At the end of 4 weeks, overall mortality was 28.8%. Patients with infection had a mortality rate of 34.7%. There was no difference between mortality rates for infected and noninfected patients (p = 0.088)., Conclusion: The rate of nosocomial infection is high in intensive care unit patients, especially for respiratory infections. The predominant bacteria were Enterobacteriaceae, Pseudomonas aeruginosa, and Staphylococcus aureus (resistant organisms). Factors such as nasogastric intubation, postoperative status, and age 60 years were significantly associated with infection. This study documents the clinical impression that prevalence rates of intensive care unit-acquired infections are high and suggests that preventive measures are important for reducing the occurrence of infection in critically ill patients.

Background: Diffuse panbronchiolitis is a clinical pathologic condition characterized by chronic inflammation of respiratory bronchioles, with clinical features that position it as a differential diagnosis among the sinopulmonary syndromes., Methods and Results: We present 4 cases (1 Black, 2 Japanese descendants, and 1 Japanese), living in Brazil, in which the diagnosis was made by the clinical and radiological features and confirmed by transbronchial biopsy. The clinical findings included chronic sinusitis, productive cough, rhonchi, and wheezes. The pulmonary function tests showed an obstructive pattern. High resolution computerized tomography showed a diffuse nodular pattern, airway ectasia, and airway wall thickening. The biopsy showed interstitial accumulation of foam cells and lymphoid cells in the walls of respiratory bronchioles: 2 of our cases had bronchus-associated lymphoid tissue hyperplasia. We searched for the HLA Bw54 in all of our patients, but only 1 was positive. A low dose macrolide treatment was introduced, resulting in with clinical and functional improvement. A score that rated the extent of nodules, airway ectasia, mucus plugging, and airway wall thickening was applied on pre- and post-treatment High resolution computerized tomography results, revealing an improvement in tomographic pattern related to that observed in the pulmonary function tests., Conclusion: We conclude that diffuse panbronchiolitis is a systemic disease that is not exclusive to the Asian population, whose clinical and radiological features should be better known by occidental pulmonary physicians.

In spite of the efforts to control the spread of tuberculosis worldwide this disease remains one of the biggest problems in public health. Multiresistance has a dramatic effect in this scenario. Non compliance with treatment is directly related to disease spread and the appearance of multiresistance bacilli. Aiming to verify if it is possible to identify patients prone to non compliance from data obtained in the first visit we have studied a population enrolled in a prospective study. Among 257 consecutive patients evaluated between january 1991 and january 1994, we compared 87 patients that abandoned treatment before six months (group A) with 97 that completed six months of treatment (group C). The abandon rate in this group as 33.85% which is larger than 12.9% rate reported by the Health Ministry. Comparing A to C, only the prevalence of alcoholism (A 33.3% x C 22.5%, p = 0.015) and risk behavior for HIV infection (A 27.6% x C 10.2%, p = 0.046), as well as the frequency of non pulmonary disease (A 38.0% x C 24.5%, p = 0.034) were significantly different between both groups. Regarding the moment of abandon (0, 1st or 3rd month) there was no difference in the A group. We conclude that patients at high risk of abandoning tuberculosis treatment can be identified with data obtained at the first visit, allowing to establish a different policy such as supervised treatment for this population.

Sulfadiazine is one of the drugs of choice in the treatment of paracoccidioidomycosis. Side effects are uncommon. Cutaneous and gastrointestinal reactions and rarely leucopenia and jaundice may occur. A patient on sulfadiazine 6 g daily exhibiting a good response is reported. On the 12th day, he presented an intense abdominal pain and reduced urinary output. An ultrasonography revealed diffuse calculosis in urinary tract. Peritoneal dialysis, urinary alkalinization and rehydration were instituted with complete restoration of renal function. This case illustrates the importance of an adequate hydratation of patients receiving sulfadiazine, a simple measure in the prevention of this uncommon complication which carries a high morbidity.

In the conducting airway, the epithelial electrolyte transport processes play an important role in determining the composition of the respiratory tract fluid. Apical membrane Cl- and Na+ channels control the secretion and absorption of epithelial cells. Defective regulation of these channels is a prominent characteristic of cystic fibrosis.

A case of septic pulmonary embolism is presented in which the primary site of infection was the middle ear. The implicated bacteria were aerobics both Gram positive and Gram negative and anaerobics. There were 8 different agents isolated from blood cultures. The cultures of urine and sputum were also positive. The patient received a broad spectrum antibiotic therapy and a surgical exploration of the initial site of infection was performed. A favorable response was observed after 40 days of treatment with antibiotics.

A spirometric study was performed in order to evaluate the response to the administration of 200 mg of salbutamol, just before and after the daily administration of 8 mg of triamcinolone, for an average period of 2 weeks, in 21 patients with chronic obstructive pulmonary disease or asthma. Eleven patients responded with a significant increase of FVC or FEV1 or FEF25-75%, after administration of corticoid. Ten patients did not respond. In average there was a significant increase of the FVC and VEF1 (p < 0.01) and of FEF25-75% (p < 0.05) after the administration of corticoid. There was no significant difference between the responders and not responders when the age, initial FVC, FEV1 and FEF25-75% were taken in consideration. A significantly greater number of responders to corticoid responded also to the bronchodilator with an increase of FEF25-75%. There was a significant negative correlation between the intensity of the response to corticoid versus bronchodilator measured with delta FEF25-75%. The administration of corticoid did not change the response to bronchodilator.

Four cases of bronchial stenosis as an unusual complication of tuberculosis are described. In the first case, a 18-year-old woman, the bronchial stenosis resulted from cicatrization of a primary focus. The X-ray examination showed no pulmonary lesion and she did not receive any specific treatment for tuberculosis. In other three patients the bronchial stenosis was due to active disease, and there were acid-fast bacilli in the sputum. They received treatment for tuberculosis which resulted in resolution of stenosis in one of them while in the other two the fibrotic bronchial stenosis persisted.

Pulmonary alveolar proteinosis is a rare disease characterized by the filling of the alveolar spaces of the lung by a PAS-positive lipoproteinaceous material. Despite the clear characterization of this material, the etiopathogenesis of the disease remains obscure. We present four patients who were admitted in our Department over the last seven years. The diagnosis was confirmed by lung biopsy in all cases. Three patients improved after bronchoalveolar lavage. Spontaneous remission was observed in one case.

A pulmonary nodule in a patient with a previous or concomitant diagnosis of extrathoracic malignancy is not always a synonym of metastasis. When dealing with breast cancer this is very important since the pulmonary lesion is usually not related to the primary tumor. We present a white, 69 years old patient, submitted to mastectomy four years earlier, in which a solitary pulmonary nodule was found, and after resection, the histopathologic examination disclosed a intravascular bronchoalveolar tumor. This is a rare lesion, here represented in an unusual way.

Tuberculous lymphadenitis is a form of extrapulmonary tuberculosis that was observed in 8.4% of all cases with tuberculosis in our series. In all instances the organism isolated was M. tuberculosis. There was a high rate of PPD positiveness. The chemotherapy yielded good results. The evolution was satisfactory in 75% of the patients treated for six months.