Fluticasone propionate/prednisone
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Human metapneumovirus, Moraxella catarrhalis and Staphylococcus aureus infections: 2 case reports In a case series of three patients, two men were described. A 38-year-old man developed human metapneumovirus (hMPV) infection during treatment with fluticasone-propionate for chronic obstructive pulmonary disease (COPD), and a 73-year-old man developed fatal hMPV, Moraxella catarrhalis and Staphylococcus aureus infections during treatment with fluticasone-propionate and prednisone for COPD [dosages and durations of treatments to reactions onsets not stated]. Case 1: The 38-year-old man was hospitalised with progressive dyspnoea, fever and a productive cough lasting several days. He had COPD, diabetes mellitus and schizophrenia, and he had been receiving fluticasone propionate [fluticasone] inhalation for COPD along with salbutamol, metformin and clozapine. Physical examination showed slightly dyspnea, anxiety, heart rate 152 beats/minute and body temperature of 40°C. Laboratory examination showed elevated CRP, ESR, leucocytes and γ-glutamyl transferase. A chest X-ray revealed a consolidation in the left lung. Viral cultures of the throat revealed a positive PCR for hMPV. Then, he was treated with ceftriaxone, unspecified steroids and bronchodilators. However, he experienced progressive dyspnoea, and antibacterial therapy was switched to penicillin and erythromycin on the following day. However, he developed respiratory failure. He was admitted to the ICU for mechanical ventilation, and penicillin was switched to cefotaxime based on the ICU protocol. The mechanical ventilation was discontinued five days later. Four days later, he was discharged with a good clinical condition. He had developed severe hMPV infection due to the immunocompromised state secondary to fluticasone propionate. Case 2: The 73-year-old man presented to the emergency room with progressive dyspnoea and a productive cough lasting 1 day, along with nausea and anorexia. He had a history of COPD Gold stage IV, and he had been receiving fluticasone propionate [fluticasone] inhalation and oral prednisone 5mg once daily (corticosteroid maintenance therapy). Concomitantly, he received tiotropium bromide [tiotropium], salmeterol and salbutamol. Physical examination showed acute illness, dyspnoea, tachypnea and cachexia. Also, he could not speak full sentences. Bilateral wheezing was observed on auscultation of the lungs, and a chest X-ray revealed severe emphysema. He was treated with amoxicillin/ clavulanic acid, gentamicin, dexamethasone with bronchodilators. He was moved to the ICU for non-invasive positive pressure ventilation. Sputum culture detected Moraxella catarrhalis and Staphylococcus aureus. PCR of the nose and throat swabs were found to be positive for hMPV. He had been receiving the treatment; however, he experienced further deterioration. Due to the end-stage COPD and his advance directive, the treatment was stopped. Subsequently, he died due to hMPV, Moraxella catarrhalis and Staphylococcus aureus infections, which he developed due to
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