Elena Dantes

By Elena Dantes, Emanuela Tudorache and Milena Adina Man

Idiopathic pulmonary fibrosis (IPF) is known as one of the most severe lung conditions and the worst form of interstitial lung disease (ILD). There is a continuing concern about clinical research to identify new therapies that influence the quality of life in patients diagnosed with this chronic progressive pulmonary disease, with an average survival of 3–5 years. Although in recent years great progress has been made to slow down the functional decline of the disease with new antifibrotic therapies, it has failed to alter the prognosis and survival of IPF patients. Clinical trials and recent ATS/ERS guidelines have brought at least moderate and low levels of evidence for increased effort tolerance, decreased symptoms, and improved quality of life following participation in lung rehabilitation programs for ILD patients and in particular those with IPF. Pulmonary rehabilitation has been shown to be a standard of care for COPD patients, but their personalized application to patients with IPF has had positive short-term results, becoming a safe alternative to non-pharmacological treatment. The chapter includes the general objectives of rehabilitation programs, their type and structure, ways of complex assessment of patients before and after a training exercise, types of exercises, and short- and long-term results.

Part of the book: Interstitial Lung Diseases

By Elena Dantes and Elena Dumea

Part of the book: Histoplasmosis

By Elena Dumea and Elena Dantes

The diagnosis of histoplasmosis is based on clinical, imaging, and laboratory evidence of the disease. The gold standards of laboratory diagnosis are the presence of the fungus in the pathological examination of tissues and its isolation (direct microscopy, histopathology, cytopathology) in mycological culture (4–6 weeks required) by clinical specimens. The antibody test, sometimes negative in immunocompromised patients, must be performed at least four weeks after acute infection to be positive. The antibody test is most useful in subacute and chronic forms of histoplasmosis. The antigen test is the most common method for establishing the diagnosis of acute pulmonary histoplasmosis or progressive disseminated histoplasmosis. The antigen test in urine or serum has good sensitivity, better in bronchoalveolar lavage fluid. There are skin sensitivity tests with low sensitivity that are used only for epidemiologic studies and are not recommended for diagnosis. Molecular diagnosis has improved the sensitivity of clinical specimens. Laboratory PCR assays with different molecular targets have been developed. Currently, the main procedure for molecular diagnosis of histoplasmosis is the application of a rapid DNA probe on a fungus isolated from a culture. This chapter summarizes the currently available tools for the laboratory diagnosis of histoplasmosis, focusing on the complexity of the assays and their performance in different clinical contexts.

Part of the book: Histoplasmosis