Lung abscesses are cavitating lesions containing necrotic debris caused by microbial infection. Patients with chronic lung disease, bronchial obstruction secondary to cancer, a history of aspiration or risk of aspiration caused by alcoholism, altered mental status, structural or physiologic alterations of the pharynx and esophagus, neuromuscular disorders, anesthesia, are among others at higher risk of developing lung abcess. The main bacteriological characteristics, the diagnosis, therapy and prognosis are considered. The problem of antimicrobial resistance is also referred.

A case of tricuspid valve infective endocarditis is presented. Since this was not the first episode, the patient had not undergone invasive procedures and there was no history of intravenous drug abuse, the possibility of congenital heart disease was considered, a hypothesis that was confirmed.

Vitamin D receptor [VDR] expression promotes LL37 expression, possibly contributing to host defense. The hypothesis was that an increase in 25 hydroxyvitamin D [25vitD] could lead to enhanced VDR expression and increased LL-37 production, thereby contributing to improved prognosis in critically ill patients. Methods: A nonblinded, randomized controlled trial was conducted. A total of 207 patients admitted to ICU with severe SARS-CoV-2 pneumonia were included and received different doses of cholecalciferol (500 MU, 3 MU/day, no cholecalciferol) during their ICU and hospital stay. 25vitD levels as well as LL37 and monocytes’ VDR gene expression were evaluated on admission and after. Clinical evolution, ICU mortality, hospital mortality, and 60-day mortality were evaluated. Results: The median age was 57.7 years and the majority of patients were Caucasian [87.4%] and male [70.5%]. There was a significant difference in 25vitD levels between groups on the third [p = 0.002] and seventh [p < 0.001] days. Patients supplemented with 500 MU of cholecalciferol had a very significant increase in monocytes’ VDR gene expression and showed a better clinical evolution in the ICU, with a significant correlation to evolution factors. Higher LL37 on admission had a significant negative association with hospital and ICU mortality, lost after adjustment for comorbidities to a nearly significant association with ICU, hospital, and 60-day mortality. Conclusion: Supplementation with higher doses of cholecalciferol may contribute to a significant increase in 25vitD levels but not in LL37 levels. Higher LL37 levels on admission may be related to a decrease in ICU, hospital, and 60-day mortality. VDR gene expression in monocytes is much higher in patients supplemented with higher doses of cholecalciferol.

Background: Research suggests that patients with low vitD levels are more susceptible to severe SARS-CoV-2 infections with need for hospitalization and admission to an intensive care unit (ICU). Our objectives were to evaluate the impact of cholecalciferol supplementation in critical care patients with severe SARS-CoV-2 pneumonia in regards to prognosis, evolution of organ failure and need for organ support.Methods: A nonblinded controlled trial was conducted in patients with severe SARS-CoV-2 pneumonia admitted to the ICU. Patients were randomized by block of two, into three groups (no cholecalciferol, 500MU cholecalciferol arm, 2MU/day cholecalciferol during ICU stay and remaining hospitalization). Serum 25-hydroxyvitamin D levels were measured and correlated with organ failure indicators (based on SOFA), ICU length of stay, need for organ support, days on mechanical ventilation and ICU, intra-hospital and 60 day mortality.Results: 207 patients were included. The number of organ failures showed a significant negative correlation with 25vitD levels on admission (r= -0.208, p=0.005), on the third day (r= -0.312, p<0,001), and on the seventh day(r= -0.224, p=0.01). In the group of patients supplemented with 500MU of cholecalciferol there was a significant negative correlation between the number of organ failures and 25vitD levels on third day (r= -0.454, p<0.001).Conclusions: Lower vitD levels on admission were related to more organ failures and high doses cholecalciferol supplementation was related to lower organ failures. More studies are needed to evaluate the impact of baseline vitD levels on clinical outcome and prognosis, to identify potential subpopulations that can benefit from supplementation and to understand the impact of critical illness on cholecalciferol action and protective effect.

Resumo: Os abcessos pulmonares são cavidades que surgem no parênquima pulmonar, apresentando maior ou menor quantidade de tecido necrosado no seu interior. Surgem em indivíduos predispostos, como sejam os doentes com doença pulmonar crónica ou obstrução secundária a neoplasia e os doentes com maior risco de aspiração, estando incluidos os doentes com alteração do estado neurológico, os utilizadores de drogas endovenosas, os doentes com alcoolismo, patologia da faringe e esofágica, doença neuromuscular, entre outras. à feita a revisão dos principais agentes causais, da metodologia diagnóstica, da abordagem terapêutica na actualidade e do prognóstico destas situações.Os abcessos pulmonares, para além de relativamente pouco frequentes, são difíceis de caracterizar, sendo a resistência aos antibióticos um problema a ter presente, na sua abordagem terapêutica. Lung abscesses are cavitating lesions containing necrotic debris caused by microbial infection. Patients with chronic lung disease, bronchial obstruction secondary to cancer, a history of aspiration or risk of aspiration caused by alcoholism, altered mental status, structural or physiologic alterations of the pharynx and esophagus, neuromuscular disorders, anesthesia, are among others at higher risk of developing lung abcess.The main bacteriological characteristics, the diagnosis, therapy and prognosis are considered. The problem of antimicrobial resistance is also referred. Palavras-chave: Abcesso pulmonar, pneumonia de aspiração, resistência antimicrobiana, anaeróbios, Key-words: Lung abscesses, aspiration pneumonia, antimicrobial resistance, anaerobe