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Despite international efforts to identify biomarkers of depression, none has been transferred to clinical practice, neither for diagnosis, evolution, nor therapeutic response. This led us to build a French national cohort (through the clinical and research network named SoPsy within the French biological psychiatry society (AFPBN) and sleep society (SFRMS)), to better identify markers of sleep and biological rhythms and validate more homogeneous subgroups of patients, but also to specify the manifestations and pathogeneses of depressive disorders. Before inclusions, we sought to provide a predefined, standardized, and robust set of data to be collected in all centers.A Delphi process was performed to achieve consensus through the independent rating of invited experts, the SoPsy-depression co-investigators (n=34). The initial set open for vote included 94 questionnaires targeting adult and child psychiatry, sleep and addiction.Two questionnaire rounds were completed with 94% participation in the first round and 100% participation in the second round. The results of the Delphi survey incorporated the consensus opinion of the 32 members who completed both rounds. Nineteen of the 94 questionnaires achieved consensus at the first round and seventy of 75 at the second round. The five remaining questionnaires were submitted to three experts involved in the steering committee during a dedicated meeting. At the end, 24 questionnaires were retained in the mandatory and 26 in the optional questionnaire set.A validated data collection set of questionnaires is now available to assess psychiatry, addiction, sleep and chronobiology dimensions of depressive disorders.

Pulmonary arterial hypertension (PAH) is a severe complication of connective tissue disease (CTD). Data on use of prostanoids in this particular subset of patients are lacking. We aimed to describe the characteristics of patients with PAH-CTD treated with prostanoids and the outcomes under treatment.In this multicenter retrospective study, all patients treated with prostanoids since 2006 were included. Data on PAH and CTD were collected at the time of prostanoid introduction and under treatment.Twenty-one patients were included, of whom 20 (95%) had limited cutaneous systemic sclerosis. Nineteen patients were treated with oral monotherapy or combination before addition of prostanoid. Treprostinil was the most used molecule (57% of patients). At the time of prostanoid introduction, 90% of patients were considered at high risk for death. Among patients who had right heart catheterization during follow-up, there was no significant difference in haemodynamics. No extrarespiratory worsening of the CTD was reported. The 1-year survival under prostanoid was 62%. In univariate analysis, NYHA functional class was associated with survival under treatment.This study provides original data on use of prostanoids in a cohort consisting mainly of systemic sclerosis. It underlines the difficulty to achieve a standardized assessment in this subset of patients. Safety profile was comparable with data reported in idiopathic PAH.

Most of the continuous positive airway pressure (CPAP) devices currently in use allow telemonitoring of observance, leaks and the apnoea-hypopnoea index (AHI). La Société française de recherche et de médecine du sommeil (SFRMS) and La Société de pneumologie de langue française (SPLF) workgroup offer to CPAP prescribers and to home care providers a scientific document which has the following purposes: to underline the relevance of the telemonitoring of leaks and the AHI, to define alert thresholds, to describe the principal mechanisms generating excessive leaks and high AHI, and to propose a diagnostic algorithm.

Introduction Les PID constituent un groupe heterogene de maladies peu frequentes, dont la frequence variable selon les etudes, est generalement appreciee a partir d’etudes conduites essentiellement en CHU. Neanmoins, les pneumologues liberaux et des hopitaux generaux sont le plus souvent les initiateurs de la demarche diagnostique qui devrait aboutir idealement a une DMD pour securiser le diagnostic. L’usage d’une consultation digitale commune aux divers lieux d’exercice permet de faciliter le cheminement diagnostique multi intervenant et notamment d’observer les differences des etiologies retenues par les DMD selon le lieu d’exercice du pneumologue referent. Methodes Sur les 3007 consultations initiales colligees dans Colibri-PID, nous avons retenu pour l’analyse uniquement les dossiers pour lesquels la DMD a retenu un diagnostic soit formel, soit provisoire de travail. Selon le lieu d’exercice du pneumologue referent, nous avons compare les principales etiologies (FPI, Autre PI idiopathiques, PI de cause ou maladie connue, Sarcoidose & Granulomatoses, PI particulieres, PI inclassables), les caracteristiques cliniques, et les modalites diagnostiques. Resultats Globalement les dossiers presentes en DMD par l’intermediaire de la consultation digitale colibri-PID proviennent majoritairement de CHU (45%) Fig. 1 ). 42% des etiologies retenues concernait les PID idiopathiques dont 30% considerees comme FPI. Parmi les dossiers presentes: le % de FPI etait identique quel que soit le lieu d’exercice (environ 30%) alors que le diagnostic de PID Idiopathiques non FPI etait plus frequemment retenu pour les dossiers de CH ou liberal. Par contre, les PID retenues comme inclassables representaient un % plus eleve des dossiers presentes par un pneumologue liberal qu’hospitalier (CH et CHU). Bien que moins frequemment retenus (14,3% du total des etiologies) les diagnostiques de Sarcoidose/granulomatose et PID particulieres etaient proportionnellement semblables quel que soit le lieu d’exercice. Conclusion L’utilisation croissante de la consultation digitale Colibri-PID (environ 80 nouveaux dossiers/mois) permet d’observer les caracteristiques cliniques et l’evolution des etiologies retenues par diverses DMD hospitalieres ou non, rendant compte de certaines differences liees a l’origine du pneumologue referent. La generalisation de cette application pour la constitution des dossiers de PID et la gestion des DMD permettrait de valoriser la prise en charge individuelle et collective des PID.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a prevalent disease characterized by recurrent episodes of partial or complete obstruction of upper airway during sleep. Untreated moderate to severe OSAHS is recognized as a cardiovascular (CV) risk factor. Data from the Pays de la Loire sleep cohort and other clinic- or population-based cohorts demonstrate a strong association between OSAHS and the different components of the metabolic syndrome including systemic hypertension, diabetes and impaired lipid metabolism. Beside sleep-disordered breathing severity, these factors contribute to increase the risk of CV events in OSAHS patients. Continuous positive airway pressure (CPAP) therapy of OSAHS is associated with a modest but clinically significant blood pressure reduction. Conversely, there is no clear evidence in support of a metabolic impact of CPAP in OSAHS patients. Considering the multifactorial pathophysiology of CV risk in OSAHS patients and the beneficial impact of various lifestyle and pharmacologic interventions on blood pressure and metabolic dysfunction, combined modality therapy is a promising strategy to improve CV outcomes in individuals with OSAHS.

Neuromuscular diseases include a wide range of conditions that may involve potentially life-threatening respiratory complications (infection, respiratory failure).For patients with neuromuscular diseases, clinical assessment of respiratory function and regular pulmonary function tests are needed to screen for nocturnal respiratory disorders, weakness of the diaphragm and potential restrictive disorders and/or chronic hypercapnic respiratory insufficiency, possibly with couch deficiency. MANAGEMENT OF NOCTURNAL RESPIRATORY DISORDERS AND CHRONIC RESPIRATORY FAILURE: Nocturnal respiratory assistance is an important phase of care for nocturnal respiratory disorders and chronic respiratory failure. This may involve continuous positive airway pressure, adaptative servo-ventilation or non-invasive ventilation with a facial or nasal mask. As needed, diurnal assistance may be proposed by mouthpiece ventilation. Should non-invasive ventilation prove insufficient, or if significant swallowing disorders or recurrent bronchial obstruction develop, or in case of prolonged intubation, tracheotomy may be required.In case of lower airway infection with ineffective cough, physical therapy, associated with air stacking, intermittent positive pressure breathing or mechanical in-exsufflation may be proposed.Care for swallowing disorders, nutritional counseling (cachexia, obesity), vaccinations and therapeutic education are integral elements of patient-centered management aiming to prevent the negative impact of infection and to manage respiratory failure of chronic neuromuscular disease.

Obstructive sleep apnea (OSA) is associated with increased cardiovascular diseases, including myocardial infarction and stroke and promotes cardiovascular risk factors including diabetes and hypertension. OSA has also been proposed to have a direct proatherogenic effects. Recent studies have investigated the role of microparticles (MPs) in the atherogenic process. MPs are small plasma membrane vesicles that can be released by a variety of vascular or blood cells and that contain membrane and cytosolic elements. Case-control studies have suggested that OSA is associated with an increase in circulating platelet-, endothelial- and leukocyte-derived MPs. MPs from OSA patients injected to mice have also been shown to induce vascular inflammation and endothelial dysfunction. In this article, we provide an overview of the main characteristics of MPs expressed in OSA and their potential role in the atherogenic process.

Resume Le diabete est une pathologie tres frequente avec 400 millions de cas dans le monde. Cette pathologie est grave du fait des complications micro et macro-vasculaires qu’elle engendre. Le syndrome d’apnees du sommeil est un facteur de risque de diabete via l’hypoxie intermittente chronique et la fragmentation du sommeil. Le syndrome d’apnees du sommeil rend plus difficile le controle glycemique chez les diabetiques. Le traitement par pression positive continue n’a pas montre son efficacite en termes de controle glycemique et de diminution significative du risque cardio-vasculaire. Des etudes complementaires, avec des durees d’utilisation optimale sont necessaires. La pathologie diabetique est frequente chez les apneiques et reciproquement. Cette relation entre le diabete et le syndrome d’apnees du sommeil necessite des depistages bilateraux. La prise en charge du syndrome d’apnees du sommeil est bien entendu multidisciplinaire.

La nefrocalcinosis, cuyo diagnostico en la actualidad resulta sencillo gracias a la ecografia, no es excepcional en el nino ni en el lactante. Las etiologias son multiples, pero implican casi todas un trastorno metabolico, a menudo de origen genetico, a veces iatrogenico, que aumenta la excrecion urinaria de calcio o de oxalato. Las causas mas frecuentes varian en funcion de la edad. En el recien nacido y en el lactante se habla principalmente de «hipercalciuria del prematuro», cuyo origen, multifactorial, es en gran medida iatrogenico, tubulopatias de aparicion precoz (acidosis tubular distal, sindrome de Bartter) y, afortunadamente muy rara, la hiperoxaluria primaria en su forma de aparicion infantil. En el nino, las principales causas que hay que buscar son: la acidosis tubular distal, la hiperoxaluria primaria y las hipercalciurias de origen genetico conocido (enfermedad de Dent, hipomagnesemia-hipercalciuria familiar) o tambien las causas «idiopaticas». Su evolucion depende de la extension de los depositos calcicos y sobre todo de la causa, es decir, de la posibilidad o no de parar el proceso de calcificacion.

Resume La nephrocalcinose, dont le diagnostic est maintenant facilite par l'echographie, n'est pas exceptionnelle chez l'enfant et meme le nourrisson. Les etiologies en sont multiples, mais impliquent presque toutes un trouble metabolique, souvent d'origine genetique, parfois iatrogene, augmentant l'excretion urinaire du calcium ou de l'oxalate. Les causes les plus frequentes varient suivant l'âge. Chez le nouveau-ne et le nourrisson, on evoque principalement : l'« hypercalciurie du premature », dont l'origine, multifactorielle, est en grande partie iatrogene, les tubulopathies a revelation precoce (acidose tubulaire distale, syndrome de Bartter), et, heureusement tres rare, l'hyperoxalurie primitive dans sa forme a revelation infantile. Chez l'enfant, les principales causes a rechercher sont : l'acidose tubulaire distale, l'hyperoxalurie primitive, et les hypercalciuries, d'origine genetique connue (maladie de Dent, hypomagnesemie-hypercalciurie familiale), ou encore « idiopathiques ». L'evolution depend de l'extension des depots calciques et surtout de la cause, c'est-a-dire de la possibilite ou non d'arreter le processus de calcification.

Resume Objectif Determiner dans une large population francaise d’âge moyen, la prevalence des principaux symptomes du syndrome d’apnees du sommeil (SAS) et evaluer la proportion de sujets presentant l’association de plusieurs symptomes justifiant une exploration pendant le sommeil. Methodes Etude transversale chez 2 195 hommes et 2 247 femmes de 33 a 69 ans (cohorte DESIR) ayant rempli un autoquestionnaire « sommeil » et un autoquestionnaire general (sante, mode de vie). Resultats La prevalence des symptomes etait, chez les hommes et les femmes : ronflements (69 %, 46 %), somnolence diurne frequente (14 %, 18 %), apnees frequentes (5 %, 2 %). La forte suspicion de SAS (association de ronflements habituels avec somnolence diurne et/ou apnees) trouvee chez 8,5 % des hommes et 6,3 % des femmes, etait liee a l’âge, a l’index de masse corporelle, a une sante ressentie comme mediocre et a l’usage de tranquillisants ou de benzodiazepines. Chez les hommes, cette suspicion etait aussi liee a l’existence d’une hypertension et a la consommation d’alcool et de tabac. Conclusion Ronflements, somnolence diurne et apnees sont des symptomes frequents en population generale. L’association de ces symptomes, tres evocatrice de SAS et justifiant une exploration pendant le sommeil, est retrouvee chez 7,5 % de la population.

Whereas numerous case reports have described statin-induced lung injuries, statin-induced pleural effusions are uncommon.An 84-year-old man presented with bilateral pleural effusions two years after starting treatment with atorvastatin. No other cause of pleural effusion was found and all symptoms and radiological signs resolved rapidly after discontinuation of the drug. Furthermore, an accidental reintroduction of the treatment resulted in recurrence of the same clinical picture, reinforcing the hypothesis that atorvastatin was responsible for this pleural effusion.Pleuropulmonary manifestations in a patient treated with atorvastatin should rapidly evoke an iatrogenic origin and the discontinuation of the drug should be discussed.

Resume La lithiase des voies urinaires n'est pas exceptionnelle chez l'enfant et il faut la rechercher par echographie devant toute pyurie, hematurie ou douleur abdominale. Grâce a l'analyse precise du calcul ou, a defaut, des urines, une cause peut etre retrouvee dans 80 % des lithiases de l'enfant. Chez le petit enfant, les deux etiologies principales sont l'infection a germes ureasiques, favorisee ou non par une malformation des voies urinaires, et les perturbations metaboliques induites par la prematurite et le traitement de ses complications (furosemide, corticoides). Chez l'enfant d'âge scolaire, les anomalies metaboliques, en particulier celles dues aux maladies hereditaires, expliquent la majorite des lithiases : hypercalciuries secondaires, iatrogenes, ou idiopathiques, hyperoxaluries primaires genetiques, secondaires ou « moderees » idiopathiques, cystinurie, hyperuricosuries genetiques ou secondaires et autres anomalies de l'excretion des purines. La prevention des recidives, essentielle en cas d'etiologie metabolique, passe toujours par une hydratation abondante (1,5 a 2 l/m 2 /24 h) et par le traitement de la cause si possible. Si un geste chirurgical est necessaire, la lithotritie extracorporelle est le traitement de choix comme chez l'adulte.

Resumen La proteinuria es un signo que puede revelar casi todas las enfermedades nefrologicas infantiles, desde las mas benignas, por ejemplo la proteinuria ortostatica, a las mas graves, como la glomerulonefritis rapidamente progresiva. Por tanto, su deteccion nunca debe omitirse, obligando a practicar un minimo de pruebas complementarias y a establecer un control posterior. En la mayoria de los casos, las proteinurias que no remiten casi por completo en menos de 1 mes justifican la consulta con un especialista para evitar la evolucion de una patologia potencialmente curable. La hematuria pediatrica puede tener multiples causas, pero al contrario que en el adulto, las etiologias «urologicas», y en especial los tumores, no son las mas habituales, de forma que no se justifica iniciar el estudio con una cistoscopia. En realidad, lo mas frecuente es que el contexto clinico y los resultados de algunas pruebas complementarias, siguiendo un arbol de decisiones simple, permitan rapidamente sospechar la causa. Solo dos trastornos, la hematuria microscopica prolongada, sola o asociada con una pequena proteinuria, asi como la hematuria macroscopica recidivante aislada, plantean problemas diagnosticos significativos, y en ambos casos la biopsia renal permite en general encontrar la solucion. No obstante, hay un pequeno porcentaje de hema-turias transitorias cuya etiologia nunca Ilega a demostrarse.

S.AGES is a prospective cohort of70-years-old patients with obstructive sleep apnea syndrome having been diagnosed in a pulmonary or a geriatric medical unit.The main objective of S.AGES is to get a description of older patients with OSAS in France. The secondary objectives will be to prospectively describe the management and the treatment of these patients, to describe their 5-years outcome as compared to younger patients in the literature. It will also contribute to better characterize the compliance and tolerance of the treatment and the incidence of comorbidities like respiratory diseases and cardiovascular disorders.All consecutive ≥70-years-old patients having received a diagnosis of OSAS (after polygraphy or polysomnography) will be included in the study. All patients will be followed in a pulmonary or a geriatric department.S.AGES should better characterize the OSAS in the elderly patients, the specific management of this disease and its related risk factors. It may also identify the 5-years mortality and morbidity rates in this population.

International audience; IntroductionThe principal secondary effects of anti-TNF alpha therapy are now well understood, particularly the risk of opportunistic infections. Other paradoxical effects have been described much more occasionally such as the developement of sarcoid-like granulomatous reactions.Case reportWe report here the case of a woman of 39 years treated for severe rheumatoid arthritis for five years with etanercept. She was admitted to hospital as an emergency with vomiting and diffuse abdominal pain. Investigations revealed severe hypercalcaemia and acute renal failure. After correction of the metabolic disturbances with rehydration and biphosphonates, CT scanning of the abdomen, pelvis and thorax showed bilateral interstitial infiltration and splenomegaly. The diagnosis of sarcoidosis was confirmed by endoscopic bronchial biopsies. Progress was satisfactory following withdrawal of the etanercept and corticosteroid therapy in reducing dosage.ConclusionThe risk of induced sarcoidosis should be understood in patients receiving anti-TNF therapy and should be considered in cases of hypercalcaemia and/or splenomegaly.; IntroductionLes principaux effets secondaires des biothérapies anti-TNF alpha sont maintenant bien connus, notamment le risque d’infections opportunistes. Certains effets paradoxaux sont plus exceptionnellement décrits, tels que le développement de réactions granulomateuses de type sarcoïdose.ObservationNous rapportons ici l’observation d’une femme de 39ans suivie pour une polyarthrite rhumatoïde sévère traitée par étanercept depuis cinq ans, hospitalisée en urgence pour vomissements et douleurs abdominales diffuses révélant une hypercalcémie majeure avec insuffisance rénale aiguë. Après correction des troubles métaboliques sous hydratation et biphosphonates, le scanner thoracoabdominopelvien a montré la présence d’un syndrome interstitiel bilatéral et d’une volumineuse splénomégalie hétérogène. Le diagnostic de sarcoïdose a été confirmé par les biopsies bronchiques perendoscopiques. L’évolution a été favorable après l’arrêt de l’étanercept et une corticothérapie à doses décroissantes.ConclusionLe risque de sarcoïdose induite doit être connu chez les patients sous anti-TNF et doit être évoqué en cas d’hypercalcémie majeure et/ou de splénomégalie.

Epidemiological cohorts based on population samples, established in the 1990s, have helped to clarify the prevalence of obstructive sleep apnoea syndrome (OSAS) and to identify key risk factors and co-morbidities.OSAS is a common disease whose prevalence increases with age. Its main risk factor is obesity, but familial and genetic predisposition may also promote the condition. The association of OSAS with increased cardiovascular mortality has been known for several years and has been confirmed by recent data from epidemiological cohorts showing increased mortality including an increased incidence of coronary events and stroke in particular in men aged below 70 years. Recent studies also show an independent association between OSAS and cancer mortality.OSAS is a common disease whose prevalence continues to increase with the increase of obesity in the population. Large epidemiological studies have shown an independent relationship between OSAS and cardiovascular diseases, metabolic disorders and more recently cancer.

The principal secondary effects of anti-TNF alpha therapy are now well understood, particularly the risk of opportunistic infections. Other paradoxical effects have been described much more occasionally such as the developement of sarcoid-like granulomatous reactions.We report here the case of a woman of 39 years treated for severe rheumatoid arthritis for five years with etanercept. She was admitted to hospital as an emergency with vomiting and diffuse abdominal pain. Investigations revealed severe hypercalcaemia and acute renal failure. After correction of the metabolic disturbances with rehydration and biphosphonates, CT scanning of the abdomen, pelvis and thorax showed bilateral interstitial infiltration and splenomegaly. The diagnosis of sarcoidosis was confirmed by endoscopic bronchial biopsies. Progress was satisfactory following withdrawal of the etanercept and corticosteroid therapy in reducing dosage.The risk of induced sarcoidosis should be understood in patients receiving anti-TNF therapy and should be considered in cases of hypercalcaemia and/or splenomegaly.

Type 1 neurofibromatosis (NF1) is a hereditary disease inherited as an autosomal dominant. Respiratory involvement is rare. We report the case of a woman suffering from NF1 with mutation of the corresponding gene and with respiratory involvement combining diffuse parenchymatous lesions, severe precapillary pulmonary hypertension and an enlarging, spiculated pulmonary nodule, very suspicious of malignancy, though histological examination was not possible on account of the patient's poor respiratory function. There was progressive deterioration of the patient's respiratory condition, leading to death, despite the introduction of oral therapy combining a phosphodiesterase 5 inhibitor and an endothelin receptor antagonist. Our case illustrates the development of multiple severe respiratory pathologies in the setting of NF1. The specific contribution of the NF1 gene mutation in the pathophysiology of these different pulmonary manifestations needs to be examined in detail.

Aim: Visceral distribution of adipose tissue (AT) is one of the key components of Metabolic Syndrome (MetS). Plasma concentrations of leptin and adiponectin are closely linked to AT distribution. Pulse wave velocity (PWV), a marker of arterial stiffness, is linked to metabolic syndrome and cardiovascular risk. The purpose of this study is to describe the extent of the usefulness of the Leptin/Adiponectin (L/A) ratio as a marker of MetS. Methods: Leptin and adiponectin concentrations, magnetic resonance image-based of visceral and subcutaneous fat measurements, and carotid PWV were analyzed in the subjects of a French prospective cohort composed of 97 subjects not presenting metabolic syndrome (MetS-), 122 patients with metabolic syndrome (MetS+) without diabetes, and 94 type 2 diabetics (T2D) with MetS. Results: After adjustment for gender and age, leptinemia was found to be higher in MetS+ patients than in T2D patients. Adiponectinemia alone was not discriminated. There was a statistically significant difference in the L/A ratio between MetS- patients and the other groups. For the whole population, there is a positive correlation between the L/A and waist circumference, waist-to-hip ratio, visceral fat (r=0.53), triglyceride concentrations, fasting glucose concentrations, insulinemia, systolic and diastolic blood pressure, and number of MetS criteria (r=0.39). The L/A ratio is also significantly correlated with carotid artery stiffness. Conclusion: This study demonstrates the potential usefulness of the L/A ratio as a marker, independent of age and gender, of a subject’s metabolic risk. The L/A Ratio is also a reliable marker for arterial stiffness.

International audience; INTRODUCTION: Atypical mycobacteria and Aspergillus are opportunistic organisms responsible for severe pulmonary diseases whose development is encouraged by the presence of chronic obstructive pulmonary disease (COPD) and related immunosuppression.CASE REPORTS: We report the cases of two patients, both alcoholics with emphysematous COPD, who developed chronic pulmonary aspergillosis following atypical mycobacterial infection. Patient 1 developed chronic necrotising aspergillosis several months after the diagnosis of infection with Mycobacterium avium. Patient 2 developed an aspergilloma several weeks after the diagnosis of infection with Mycobacterium xenopi. The association of these two pathologies presents diagnostic and therapeutic problems that are discussed.CONCLUSION: The development of Aspergillus pulmonary disease may complicate atypical mycobacterial infections and explain a poor response to treatment. Our two case reports suggest that a systematic search should be made for pulmonary aspergillosis during the follow-up of patients with atypical mycobacterial infection.; IntroductionLes mycobactéries atypiques et l’Aspergillus sont des agents opportunistes responsables de pathologies pulmonaires sévères dont la survenue est favorisée par l’existence d’une bronchopneumopathie pulmonaire chronique obstructive (BPCO) et de facteurs d’immunodépression relative.ObservationNous rapportons les observations de deux patients éthyliques chroniques porteurs d’une BPCO post-tabagique emphysémateuse, ayant développé une aspergillose pulmonaire chronique dans les suites d’une infection pulmonaire à mycobactérie atypique. Le patient 1a développé une aspergillose pulmonaire chronique nécrosante (APCN) plusieurs mois après le diagnostic d’une infection à Mycobacterium avium. Le patient 2a développé un aspergillome quelques semaines après le diagnostic d’une infection à Mycobacterium xenopi. L’association de ces deux pathologies pose des problèmes diagnostiques et thérapeutiques qui sont discutés.ConclusionLa survenue d’une pathologie pulmonaire à Aspergillus peut compliquer les infections à mycobactéries atypiques et expliquer une évolution défavorable sous traitement. Nos deux observations suggèrent l’intérêt d’une recherche systématique d’aspergillose pulmonaire au cours du suivi évolutif des infections à mycobactéries atypiques.