ObjectiveTo investigate the clinical features of patients who went through Nocardia co-infection with Aspergillus in lung.MethodsClinical data of 3 pulmonary nocardiosis patients complicated with aspergillosis from China-Japan Hospital during June 2015 and May 2016 were retrospectively analyzed. Nine related literatures found at PubMed were reviewed and they all were case report. No Chinese literature was found at Wanfang data and Chinese Journal Fulltext Database.ResultsAll of the 3 patients were diagnosed as pulmonary nocardiosis by etiological detection, at the same time meeting the diagnostic criteria of invasive pulmonary aspergillosis. Two cases were infected with Aspergillus fumigatus. Aspergillus was not detected in the third case, but the galactomannan of serum and bronchoalveolar lavage fluid significantly increased.ConclusionPulmonary nocardiosis complicated with aspergillosis trends to occur in immunocompromised patients, and pathogen detection is important for diagnosis.
ObjectiveTo investigate the clinical features, diagnosis and treatment of scedosporiosis in lung transplant patients.MethodsA retrospective analysis was carried out on a lung transplant patient with scedosporiosis admitted to the First Affiliated Hospital of Guangzhou Medical University. A literature review was performed with “scedosporium”/“scedosporiosis”+“lung transplant” or “scedosporium”/“scedosporiosis”+“lung transplantation” as the key words in Pubmed, Wanfang Database and China Knowledge Resource Integrated Database. The date of retrieval was up to May 2018. Related articles of scedosporiosis in lung transplant patients were retrieved. Clinical characters, diagnosis, treatment and outcome were analyzed.ResultsThe patient was a 65 years old male who received the right lung transplantation 7 months before. He presented with seizure, dyspnea and multiple organ failure. The CT scan illustrated right lower pulmonary nodular lesions. The culture and DNA sequencing of the bronchoalveolar lavage fluid established the diagnosis of scedosporium prolificans. The patient died finally despite the combined anti-fungal treatment. Literature review found 20 relative articles, and all of which were case report with a total of 35 patients. Scedosporium was always disseminated and with a high mortality, with no specificity in chest CT and bronchoscopy. The diagnosis always established by the culture and DNA sequencing, and the combination of anti-fugal agents was needed.ConclusionsScedosporium in lung transplant patient is a disseminated disease with high mortality. The high risk patients should be focused on and early diagnosis and treatment was demanded.
Objective To analyze the clinical data of patients with Tropheryma whipplei pneumonia, and summarize the clinical characteristics, diagnosis, and treatment methods of Tropheryma whipplei pneumonia. Methods The data of Tropheryma whipplei pneumonia patients from three hospitals in Hunan Province between January 1, 2021 and October 1, 2022 were retrospectively collected. The clinical symptoms, laboratory examination, metagenomics next-generation sequencing (mNGS), CT imaging features, diagnosis and treatments of the included patients were analyzed. Results A total of 4 patients were included. Among them, there were 2 males and 2 females. The main manifestations were cough, expectoration, fever, and shortness of breath. There were 2 cases of diffuse ground glass opacity in both lungs, 1 case of pulmonary nodule, 1 case of pulmonary cavity, 1 case of pleural disease, 2 cases of pulmonary exudative lesions, and 1 case of mediastinal lymphadenectasis. The mNGS results showed that Tropheryma whipplei was detected in all 4 patients, and the median number of serial number (lower quartile, upper quartile) was 1 528 (1 480, 1 576). After anti infection treatment, 3 cases were treated effectively, and 1 case had poor treatment effect. Conclusions mNGS is an effective method to diagnose Tropheryma whipplei pneumonia. The measurement of serum lactate dehydrogenase level is helpful to evaluate the disease and determine the prognosis. Piperacillin tazobactam, meropenem and doxycycline are effective for this disease, while moxifloxacin and trimethoprim / sulfamethoxazole are not recommended because they may be naturally resistant. Without active etiological treatment, the disease may persist in migration and lead to extrapulmonary involvement.
Objective To analyse the clinical and pathological characteristics of Chlamydia psittaci pneumonia, and increase the comprehensive understanding of the Chlamydia psittaci pneumonia. Methods Five patients diagnosed with Chlamydia psittaci pneumonia were selected in this hospital from November 2021 to November 2022, and their clinical and pathological characteristics were analysed. Results Out of these five patients, 2 patients were male and 3 were female, with a mean age (65±9) years and length of hospital stay (11 - 13) d. The first symptom of all five patients was fever; 3 patients were complicated with hypoxemia; there were several accompanying symptoms, including chilly, shiver, fatigue, headache, cough, muscle soreness, hearing loss and so on. In the laboratory indicators, white blood cell count was not significantly abnormal, the C-reactive protein and procalcitonin were high. In the chest CT, the diseased regions were mostly located in unilateral lesions, 3 cases were on the right side; the forms included pulmonary consolidation, lung glass opacity, pleural effusion, pleural thickening, etc.; the mNGS results of bronchoalveolar lavage fluid showed the Chlamydia psittaci; the pathology of lung biopsy showed significant proliferation of fibers in the interstitial lung and partly fibrosis, with histiocytic reaction and minimal lymphocyte infiltration. Conclusion Clearly diagnosing patients with pneumonia which are suspected being infected Chlamydia psittaci as soon as earlier can prompt anti-infection treatment, and avoid further damage to the lung interstitium, eventually decrease the deterioration of lung function and progression to severe pneumonia.
ObjectiveTo explore the clinical characteristics of idiopathic hypereosinophilic syndrome (IHES), and improve the early diagnosis and treatment of such diseases.MethodsThe clinical diagnosis and treatment data were retrospectively analyzed from the patients with confirmed IHES hospitalized in China-Japan Friendship Hospital between September 2010 to May 2018.ResultsFifteen patients were included. There were 3 women and 12 men in the study, with an average age of 53.7±21.3 years. Eleven patients had respiratory problems, with an average course of 7 months. Most lesions occurred in both lungs. Patchy distribution, ground glass opacity, pleural effusion and mediastinal lymph node enlargement were common in the chest computed tomography. Serum total IgE was significantly increased. Four patients had other systems involved rather than respiratory system. One of them had digestive problems and another 3 had skin diseases. There was a significant increase in eosinophils in peripheral blood, bone marrow and histopathology, the same as eosinophils in sputum, pleural effusion, and bronchoalveolar lavage fluid. Hypoxemia was common in patients with respiratory problems. The blood eosinophil and total IgE were reduced after glucocorticoid treatment, and the hypoxemia was significantly improved.ConclusionsThe clinical symptoms, signs and image of chest computed tomography are not specific in IHES, so the rate of misdiagnosis and wrong diagnosis is high. This disease involves many organs or systems, so the pathological examination should be completed as soon as possible to make a clear diagnosis to prevent further damage. Glucocorticoid treatment is effective in this disease.
ObjectiveTo evaluate the diagnostic value of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) level in bronchoalveolar lavage fluid (BALF) for discrimination of Acinetobacter baumannii (A. baumannii) colonization from infection.MethodsSixty patients with tracheal intubation or tracheotomy who were admitted in intensive care unit from July 2016 to July 2018, were divided into an infection group (n=20), a colonization group (n=20) and a control group (n=20). The serum and BALF samples were collected from the patients on the day when lower respiratory tract sample culture was positive so as to detect sTREM-1, serum procalcitonin (PCT) and interleukin-6 (IL-6). The value of serum PCT, IL-6, sTREM-1 and BALF sTREM-1 in differentiation of infection or colonization for A. baumannii was analyzed by mean of receiver operating characteristic (ROC) curve.ResultsThere were no significant differences in gender composition, age or Glasgow coma score among the three groups (P>0.05). The clinical pulmonary infection score (CPIS) of the infection group was higher than that in the control group (P<0.05). Compared with the control group, while the sTREM-1 concentration of BALF with A. baumannii colonization increased significantly but levels of PCT, IL-6 and sTREM-1 remained unchanged in serum. The levels of PCT, IL-6 and sTREM-1 in serum, and sTREM-1 in BALF increased significantly in the infection group (P<0.001). Compared with the colonization group, the levels of PCT, IL-6 and sTREM-1 in serum, and sTREM-1 in BALF increased significantly in the infection group (P<0.05). The area under the ROC curve (AUC) of serum PCT was 0.67 with the sensitivity of 0.55 and the specificity of 0.90 (95%CI 0.52 - 0.82). AUC of serum IL-6 was 0.72 with the sensitivity of 0.60 and the specificity of 0.95 (95%CI 0.58 - 0.85). AUC of serum sTREM-1 was 0.72 with the sensitivity of 0.75 and the specificity of 0.60 (95%CI 0.55 - 0.85). AUC of sTREM-1 in BALF was 0.92 with the sensitivity of 0.95 and the specificity of 0.70 (95%CI 0.79 - 0.98). The diagnostic accuracy of sTREM-1 in BALF was higher than that of PCT, IL-6 and sTREM-1 in serum (P<0.05).ConclusionssTREM-1 in BALF has good diagnostic performance in differentiating patients with infection of colonization for A. baumannii. Its sensitivity and specificity are higher than serum PCT, IL-6 and sTREM-1.
ObjectiveTo evaluate the diagnostic value of sTREM-1 level in bronchoalveolar lavage fluid (BALF) for diagnosing early lung infection of patients with post-traumatic acute respiratory distress syndrome. Methods64 patients with post-traumatic ARDS,who were admitted in ICU from emergency department or other trauma surgery department from January 2010 to December 2012,were divided into a pulmonary infection group (n=34) and a non-pulmonary infection group(n=30).30 healthy volunteers aged over 18 years were taken as healthy control group.The ROC curve was used to analyze the diagnostic value of C-reactive protein (CRP),procalcitonin (PCT) and sTREM-1 in early pulmonary infection of patients with post-traumatic ARDS. ResultsGender and age composition showed no significant difference among the healthy control group,the pulmonary infection group,and the non-pulmonary infection group(P>0.05). Injury severity scale(ISS),APACHEⅡ and the mortality in 28 days showed significant difference between the groups of pulmonary infection and non-pulmonary infection(P<0.05).Oxygenation index (PaO2/FiO2),tracheal intubation time,mechanical ventilation time and length of ICU stay also showed significant difference between the groups of pulmonary infection and non-pulmonary infection(P<0.01).Compared with the healthy control group,levels of serum CRP,PCT and sTREM-1 increased significantly in the groups of pulmonary infection and non-pulmonary infection(P<0.001).Compared with the non-pulmonary infection group,the levels of CRP,PCT and sTREM-1 in serum,and sTREM-1 in BALF increased significantly in the pulmonary infection group (P<0.05).The area under the ROC curve (AUC) of serum CRP was 0.67 with the sensitivity of 0.68 and the specificity of 0.70.AUC of serum PCT was 0.67 with the sensitivity of 0.70 and the specificity of 0.64.AUC of serum sTREM-1 was 0.73 with the sensitivity of 0.73 and the specificity of 0.68.AUC of sTREM-1 in BALF was 0.90 with the sensitivity of 0.90 and the specificity of 0.82. ConclusionsTREM-1 in BALF can be used as a diagnostic indicator for early pulmonary infection in patients with post-traumatic ARDS.Its sensitivity and specificity are higher than serum CRP,PCT and sTREM-1.
ObjectiveTo investigate the changes of inflammatory cytokines in bronchoalveolar lavage fluid (BALF) in rats exposed to paraquat (PQ). MethodsAdult healthy SD rats were randomly divided into a control group (n=8) and three experimental groups (PQ in low dosage of 15 mg/kg,medium dosage of 30 mg/kg,and high dosage of 60 mg/kg,n=24 in each group). The rats in three experimental groups were intragastrically administered with PQ,and the rats in the control group were treated with saline by gavage. Two rats in the control group and six rats in three experimental groups were sacrificed on 1st,7th,14th,and 21st day after exposure respectively. BALF was collected for measurement of interleukin-1(IL-1),IL-6,macrophage inflammatory protein-2(MIP-2),monocyte chemoattractant protein-1(MCP-1),and biopterin by ELISA. ResultsThe levels of cytokines in all experimental groups were higher than those in the control group at any time point. In the exposure day 1 to day 14, IL-1 and biopterin levels in BALF increased significantly with the increase in PQ dose. On 14th and 21st day,IL-6 level in BALF increased significantly with the increase in PQ dosage. The levels of IL-1,IL-6,and biopterin in the experimental groups reached the peak on 14th day. On 14th day,the MIP-2 level in BALF of high-dosage group was significantly higher than that of low-dosage and medium-dosage groups (all P<0.05). The level of MCP-1 in the low-dosage group was lower than that in the medium-dosage and high-dosage groups at any time point (P<0.05). ConclusionIL-1,IL-6,MIP-2,MCP-1,and biopterin may play important roles in the development and progression of PQ-induce lung inflammation.
Objective To enhance the understanding of nonfibrotic hypersensitivity pneumonitis (nfHP) by summarizing the clinical characteristics of 32 cases of nfHP. Methods The data of 32 cases with nfHP was collected and analyzed. They were diagnosed in Beijing Friendship Hospital, Capital Medical University from Jan 1st, 2017 to Oct 31, 2021. Results The median age of the nfHP patients was 54 years, among whom 75.0% were females. The cases developed in a majority of avian exposure (22 cases, 68.8%). The main symptoms were dyspnea/shortness of breath (28 cases, 87.5%), cough (25 cases, 78.1%）and sputum production (21 cases, 65.6%). High-resolution CT (HRCT) showed diffuse ground glass opacification (25 cases, 78.1%), centrilobular ground glass nodules (20 cases, 62.5%) and air trapping (9 cases, 28.1%). Bronchoalveolar lavage fluid (BALF) featured an increase of proportion of lymphocytes (>20%, 90.6% and >40%, 50%), and a decrease of CD4+/CD8+ T cell ratio (<1.2, 65.6% and <0.8, 40.6%). Most of the cases had reduced diffusion capacity for carbon monoxide (16 cases out of 26 cases, 61.5%) and decreased total lung capacity (13 cases out of 26 cases, 50%). Few cases showed obstructive ventilatory function (6 cases out of 26 cases, 23.1%). Most cases (22 cases, 68.8%) of nfHP showed an excellent survival with short-term corticosteroid treatment. Few cases (5 cases, 15.6%) experienced spontaneous remission after antigen avoidance. Conclusions The diagnosis of nfHP includes identifying antigenic exposures, featured chest HRCT and lymocytosis in BALF. nfHP patients showed an excellent survival with short-term corticosteroid treatment as well as antigen avoidance.