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Pulmonary Alveolar Proteinosis

Francesco Bonella, Ilaria Campo
Ruhrlandklinik University Essen, Germany
The term pulmonary alveolar proteinosis (PAP) comprises a heterogeneous group of rare disorders characterized by abundant deposition of surfactant- and lipoproteins in the alveoli. The autoimmune form accounts for 90 % of cases and is characterized by the presence of GM-CSF autoantibodies. Secondary PAP is associated with several underlying conditions, mainly hematologic malignancies, infections and inhalation exposure, and is GM-CSF antibody negative. Several conditions can mimic PAP, in particular the radiological findings: the crazy paving pattern on high resolution computed tomography (HRCT) is common also to infections, neoplasms, and other interstitial lung diseases. Bronchoalveolar lavage (BAL) typical findings and the detection of serum GM-CSF antibodies are usually sufficient for the diagnosis of PAP.
Whole lung lavage (WLL) is still the gold standard for treatment of PAP and is followed by complete remission in about 50 % of cases. Inhalative treatment with GM- CSF alone or in combination with WLL could represent the future approach for patients with autoimmune PAP refractory to WLL alone. The anti CD-20 antibody rituximab represents a further promising approach for autoimmune PAP. The treatment of secondary PAP should be focused on the underlying disease.
Keywords: alveolar proteinosis, granulocyte- macrophage colony stimulating factor autoantibody, whole lung lavage

Cryptococcosis a common fungal infection in immunosuppressed patient

Victor Botnaru1, Doina Rusu1,2, Ion Haidarlî2, Oxana Munteanu1, Alexandru Corlateanu1
Cryptococcosis a common fungal infection in immunosuppressed patient
Cryptococcus is a leading mycological cause of morbidity among HIV-infected patients. In many patients, cryptococcosis is the first indication of AIDS. The lung is invariably the portal of entry and initial site of infection for C.neoformans. In immunosuppressed patients all areas of the body can be infected, and central nervous sistem involvement is the most severe complication. Cryptococcosis is an important fungal infection that should be considered in the differential diagnosis of the pulmonary infiltrates in the immunosuppressed patient. The purpose of this paper is to review the current knowledge of the management and treatment strategies of cryptococcosis. 

Keywords: pulmonary cryptococcosis,meningoencephalitis, immunosuppression