BackgroundAcute Aspergillus fumigatus infection in immunocompetent patients is rare. This is the first known case of a patient who survived Aspergillus sepsis after being treated early with veno-venous extracorporeal membrane (ECMO) and antifungal therapy.Case presentationAn immunocompetent 54-year-old woman was exposed to plant mulch during gardening and subsequently developed pulmonary failure that progressed to sepsis with multiorgan failure. Owing to her severe clinical condition, she was treated for acute respiratory distress syndrome (ARDS) with veno-venous ECMO. Empiric antifungal therapy comprising voriconazole was also initiated owing to her history and a previous case report of aspergillosis after plant mulch exposure, though there was no microbiological proof at the time. A. fumigatus was later cultured and detected on antibody testing. The patient recovered, and ECMO was discontinued 1 week later. After 7 days of antifungal treatment, Aspergillus antibodies were undetectable.ConclusionsIn cases of sepsis that occur after gardening, clinicians should consider Aspergillus inhalation as an aetiology, and early antimycotic therapy is recommended.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0600-6) contains supplementary material, which is available to authorized users.

No abstract

The data of the registry allow a detailed characterisation of the natural course of the disease and the levels of the patient care.

ZusammenfassungDie chronisch-obstruktive Lungenerkrankung (COPD) ist charakterisiert durch eine nichtreversible und typischerweise progrediente Atemwegsobstruktion und tritt überwiegend bei älteren Personen auf. Rauchen ist wichtigster Risikofaktor. Bis zu 25% der Patienten entwickeln jedoch ungewöhnlich früh eine COPD oder haben nie geraucht; hier bestehen oft diagnostische und therapeutische Unsicherheiten.In dieser Übersicht werden Umweltfaktoren, genetische Dispositionen und Vorerkrankungen diskutiert, die in eine COPD münden können. Die Genetik der COPD ist komplex. Die einzige gesicherte genetische Prädisposition ist der α1-Antitrypsin-Mangel (AATM): Mutationen des kodierenden Gens SERPINA1 bedingen Konformationsänderungen des Proteins, die zur Akkumulation von AAT in Leberzellen und zu einem Mangel im Organismus führen, der in der Lunge in einer frühen COPD resultieren kann. Rechtzeitige Identifikation des AATM und subsequente Lebensstiländerung können helfen, den Ausbruch der COPD hinauszuzögern. SchlüsselwörterChronisch-obstruktive Lungenkrankheit (COPD) · Genetik · Umweltmedizin · α 1 -AntitrypsinMangel · Lungenemphysem α 1 -antitrypsin deficiency in the development of COPD and emphysema. Epidemiology, biology and clinical presentation of COPD in young smokers and non-smokers Abstract Chronic obstructive lung disease (COPD) is characterized by airflow limitation, which is typically progressive and irreversible. Tobacco smoking is the most important risk factor, leading primarily to development of COPD in older persons. However, there are many patients diagnosed with COPD (up to 25%) who have never smoked but nevertheless contract the disease at an unusually young age. In these cases, uncertainty often exists regarding diagnosis and therapy.This review discusses environmental factors and genetic dispositions that contribute to the development of COPD, mainly focussing on α1-antitrypsin deficiency (AATD). There are many predisposing diseases or environmental factors besides smoking that may play a role in the pathogenesis of COPD. The genetics of COPD is very complex. The only accepted genetic predisposition resulting in COPD is AATD, which is based on a mutation of the encoding gene SERPINA1. Mutations of this gene result in conformational changes of AAT leading to an accumulation of the protein in hepatocytes and a deficiency in other organs. Because of deficiency of the lung, individuals are susceptible for the development of early COPD. Early identification of AATD with subsequent lifestyle changes and therapeutic interventions can help delay the onset of COPD.