Impulse oscillometry (IOS) was introduced as an alternative modality to the conventional pulmonary function test (cPFT) to test lung mechanics. The objective of this study is to assess the use of IOS as an alternative, or in conjunction with cPFT, to categorise an obstructive respiratory disorder as chronic obstructive pulmonary disease (COPD) or asthma. Patients referred to the PFT laboratory, with different diagnoses of obstructive airways disorders, completed a standardised respiratory questionnaire prior to testing. All recruited subjects completed both modalities of PFT. A total of 146 patients were included. The overall mean age was 51+/-18.4 SD. The majority were non-smokers (68.7%). A standardised diagnosis of asthma was found for 51 subjects, while COPD was diagnosed in 36 subjects and 59 subjects were categorised as normal. The sensitivity of IOS in relation to asthma was 31.3% and 19.6% for cPFT. Among cases of COPD, the cPFT had better sensitivity (47.4%) than IOS (38.95%). The specificity was comparable for IOS and cPFT in relation to asthma and COPD. IOS had better sensitivity (45.8%) in detecting normal subjects than cPFT (28.8%), while specificity was comparable (80.5% and 86.2%, respectively). IOS may replace cPFT where the latter cannot be carried out due to feasibility or lack of cooperation. It can, however, discriminate between diseased and non-diseased subjects.

Lupus patients with pulmonary involvement have a stronger pro-inflammatory cytokine bias than those without pulmonary involvement.

The first case of cavitary pulmonary disease caused by Purpureocillium lilacinum is described. The isolate showed atypical microscopic characteristics similar to Acremonium and Fusarium spp., which necessitated molecular identification by sequencing of multiple conserved loci. The patient responded to voriconazole, reinforcing its therapeutic efficacy for P. lilacinum infections. CASE REPORTA n 80-year-old asthmatic woman presented with a 3-week history of productive cough, associated with fever and pleuritic chest pain, which did not respond to a week of treatment with antibiotics and steroid therapy. She had a history of asthma, coronary artery disease, diabetes mellitus, hypertension, dyslipidemia, rheumatoid arthritis, and osteoporosis. Clinically, she presented with fever, tachypnea, tachycardia, and hypotension. Chest auscultation revealed bilateral scattered wheezes. The rest of the physical findings were unremarkable. Within 24 h of admission, her condition progressively deteriorated, requiring mechanical ventilation. As the patient was febrile, she was empirically started on ceftriaxone and clarithromycin. Her initial assessment revealed a normal white cell count, but the chest X-ray showed a consolidative lesion in the left upper lobe (LUL). The sputum culture showed heavy growth of Pseudomonas aeruginosa. Consequently, her antibiotic regimen was modified to include ciprofloxacin and meropenem for a course of 14 days, followed by a 3-week course of tazocin-ciprofloxacin. Despite an initial clinical improvement, the follow-up chest X ray showed persistence of the LUL lesion. Therefore, a computed tomography (CT) scan of the chest was performed on 7 October 2010, which revealed a cavitary lesion in the anterior segment of the LUL (Fig. 1A).Since her condition deteriorated further, as assessed by her oxygen requirements, sputum specimens were collected on 11 and 18 October 2010 and were sent to the Mycology Reference Laboratory (MRL), Faculty of Medicine, Kuwait University. Both specimens showed septate hyphal elements when examined with calcofluor-potassium hydroxide (Fig. 2) and grew a white mold after 5 days on Sabouraud dextrose agar (Difco, Becton, Dickinson and Company, Sparks, MD). On 21 October 2010, a bronchoalveolar lavage (BAL) specimen from the LUL was obtained and sent to the MRL to establish the role of this white mold in the etiology of her cavitary lung lesion. The BAL specimen also showed septate fungal elements in the calcofluor-KOH mount (Fig. 2) and yielded a morphologically identical mold culture. The mold was provisionally identified as Acremonium or Paecilomyces. Although no defined antifungal susceptibility breakpoints exist for these organisms, the isolate demonstrated high MICs to amphotericin B (Ն32 g/ml), caspofungin (4 g/ml), and itraconazole (Ն32 g/ml), suggesting resistance, but low MICs for posaconazole (0.5 g/ml) and voriconazole (0.064 g/ml), suggesting clinical efficacy. The patient was thus started on voriconazole, at 6 mg/kg of body weight at 12-h intervals for the fir...

Background: There has not been any published study on community-acquired pneumonia (CAP) in Kuwait. The aim of this study is to determine the clinical characteristics of adult patients with CAP as well as the microbial aetiology and the treatment of CAP. Methods: A retrospective study of all CAP cases admitted to the three acute care hospitals in Kuwait over a 3-year period, 1993–1995, was done. Results: There were 290 patients identified, mean age 41 ± 19 years, of which 57% were males. The patients were divided into three groups (mild, moderate and severe) according to standard published criteria: mild 27.5%, moderate 61%, and severe 11.5%. The microbial aetiology was identified for only 15% of the total cases, 11.5% of the mild group, 14% of the moderate, and 22.5% of the severe. The most common organisms identified were Streptococcus pneumoniae 32%, Mycoplasma pneumoniae 20%, Haemophilus influenzae 14%, Mycobacterium tuberculosis 11%, gram-negative organisms other than Haemophilus species 11% and others 12%. There were 243 (84%) patients who received a single antibiotic as initial therapy while the rest received a combination of antibiotics. The most common antibiotics used were macrolide 28%, ampicillin 24%, a combination of antibiotic 17%, third-generation cephalosporin 12% and others 19%. Conclusion: The rate of identification of microbial aetiology in CAP is poor in Kuwait. There are 27.5% of the patients who can be classified as mild and probably the majority of them can be treated as out-patients. Based on these results, we have started a prospective study to better evaluate the microbial aetiology of CAP in Kuwait.