ObjectiveTo evaluate the diagnostic value of cryptococcal antigen lateral flow immunochromatographic assay (CrAg-LFA) in bronchoalveolar lavage fluid (BALF) among pulmonary cryptococcosis (PC) patients.MethodsPatients from the Zhongshan Hospital, Xiamen University, Zhangzhou Municipal Hospital of Fujian Medical University, Second Affiliated Hospital of Fujian Medical University, and Quanzhou First Hospital of Fujian Medical University were enrolled prospectively from March 2015 to October 2018. They were confirmed without human immunodeficiency virus infection and were divided into non-PC group (236 cases) and PC group (72 cases). The PC was definitely diagnosed by histopathological evidence from lung biopsy. The CrAg-LFA and culture were performed in both the serum and BALF among the enrolled patients.ResultsAmong 72 PC patients, 54 had a positive serum CrAg-LFA, 1 had positive serum culture; 67 patients had a positive BALF CrAg-LFA, 9 had positive BALF culture. Among the non-PC group, only 1 patient had a weak positive serum CrAg-LFA, none had positive serum culture of PC; 236 cases non-PC patients underwent BALF CrAg-LFA detection, none had a positive BALF CrAg-LFA; none of the 121 cases who had BALF culture yielded a positive result in PC. The sensitivity, specificity, positive predicted value, and negative predicted value in serum were 75.0%, 99.6%, 98.2%, and 92.9%, respectively. Those above mentioned values in the BALF yielded 93.6%, 100.0%, 100.0%, and 97.9%, respectively. Among the PC group, the sensitivity was higher in BALF than that in serum (χ2=8.745, P<0.05).ConclusionsThe CrAg-LFA is a simple and rapid diagnostic method for PC. The diagnostic value of CrAg-LFA in the BALF is superior to that in serum and fungal culture among the PC patients. The positive BALF CrAg-LFA result is consistent with mycological positive results.
Objective To assess the value of procalcitonin ( PCT) in serum and percentage of infected cells ( PIC) in bronchoalveolar lavage fluid ( BALF) for the diagnosis of early ventilator-associatedpneumonia ( VAP) .Methods A prospective observational study was conducted in a teaching hospital. The patients consecutively admitted to the intensive care unit from January 2011 to June 2012, who received mechanical ventilation for more than 48h and clinically suspected for VAP, were recruited in the study.Patients with infection outside the lungs and previous diagnosed infection were excluded. PCT was detected and bronchoalveolar lavage was performed in the day when VAP was diagnosed. BALF cells were stained by May-Grunwald Giemsa ( MGG) for counting 100 phagocytic cells and calculating infected cells ( ICs )percentage.Results 76 of all 421 patients were enrolled in this study, 64 of which were diagnosed, 12 were under-diagnosed. The PCT [ ( 3. 48 ±1. 46) ng/mL vs. ( 1. 53 ±0. 60) ng/mL] and PIC [ ( 3. 11 ±1. 47) % vs. ( 1. 08 ±0. 29) % ] were significant higher in the patients with VAP. The threshold of 2 ng/mL of PCT and 2% of PIC corresponded to sensitivity of 78. 12% and 78. 12% , and specificity of 75. 00% and 91. 67% , respectively. The area under the receiver operating characteristic ( ROC) curve was 0. 87 ( 95% CI 78. 9%-95. 9% ) and 0. 874 ( 95% CI 79. 2% -94. 9% ) , respectively. The area under ROC curve was 0. 979, and the sensitivity was 97. 36% , specificity was 97. 36% when the two cutoff values were both achieved. Conclusion PCT and PIC are useful markers to diagnose early VAP quickly and conveniently and allow early antibiotic treatment of patients with suspected VAP.
ObjectiveTo explore the changes of the B lymphocyte-derived microparticles (BLMPs) in the bronchoalveolar lavage fluid in patients with chronic obstructive pulmonary disease (COPD),and analyze the correlation between BLMPs changes and the stages of the disease. Methods33 COPD patients in acute exacerbation and 12 COPD patients in stable phase in Southwest Hospital,Xinqiao Hospital,and First Affiliated Hospital of Chongqing Medical University between March 2012 and March 2013 were enrolled in the study. 31 subjects who underwent physical examination and bronchoscopy were recruited as control. The lavage fluid specimens were collected through fiberoptic bronchoscopy,then marked with the corresponding antibodies after centrifugation. The numbers of microparticles were analyzed by flow cytometry. ResultsThe number of the BLMPs was significant different among three groups (P<0.05). Compared with the control group and the stable COPD group,the number of BLMPs in the AECOPD group was significantly reduced (P<0.05). Compared with the control group,the number of the BLMPs in the stable COPD group was reduced but with no significant difference (P>0.05). The numbers of BLMPs had no correlation with the smoking history,gender,age and body surface area. ConclusionThe number of BLMPs is reduced in COPD,especially in the acute exacerbation stage,so the reductions of the BLMPs may be associated with the stages of the disease. Smoking,gender,age,body surface area have no effect on the number of BLMPs.
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.
ObjectiveTo improve the understanding of psittacosis, the clinical data of 8 cases are reviewed. The application of pathogen metagenomics next-generation sequencing (mNGS) in the diagnosis of nocardiosis is also investigated.MethodsThe clinical data of eight patients with psittacosis diagnosed by mNGS in Nanjing Drum Tower Hospital from January 2018 to May 2020 were reviewed. The clinical characteristics, laboratory examination characteristics and imaging changes were analyzed, and the treatment outcome was followed-up.ResultsAmong the eight cases, there were six males and two females, aged 43～83 years old, with an average age of 64±12 years old. Six of them had a clear history of poultry exposure. The major clinical manifestations were fever, cough, dyspnea, etc. Chest high-resolution computed tomography (HRCT) may have solid shadow, ground glass like shadow. Chlamydia psittaci was detected by mNGS in eight patients’ bronchoalveolar lavage fluid. Minocycline or moxifloxacin were administrated, six patients were discharged after their condition improved, and two patients died.ConclusionsThe incidence of psittacosis is low, and its clinical manifestations lack specificity. In the course of the disease, there may be different degrees of fever, cough, sputum, dyspnea and other symptoms. The lungs can be heard with wet rales, chest HRCT can be seen ground glass shadow, consolidation shadow, accompanied by air bronchogram. Chlamydia psittaci can be detected in alveolar lavage fluid by mNGS. The patients need to be treated for a long time, lasting at least 10 to 14 days. Tetracycline drugs should be the first choice, and can be combined with other antibiotics with activity against gram-positive and gram-negative bacteria in critical patients.
Objective To compare the diagnostic value of sterile sputumsuction tube with protected specimen brush in mechanically ventilated patients with serious lung infection, and explore the safety and efficacy of bronchofibroscope combining mechanical ventilation in the treatment of severe lung infection.Methods Seventy-four severe lung infection patients with invasive mechanical ventilation support were recruited in the study. Based on the routine treatment, the subjects were randomly divided into a control group received only mechanical ventilation, and a treatment group received sputum aspiration and bronchial lavage by bronchofibroscope combiningmechanical ventilation. Lower respiratory tract secretion was collected to analyze the bacterial etiology with sterile sputum suction tube in the control group, and with protectedspecimen brush in the treatment group. Results The positive rate of sputum suction tube and protected specimen brush was 70. 27% and 75. 68% , respectively, with no statistical difference between the two groups ( P gt; 0. 05) . The PaO2 of the treatment group increased and PaCO2 decreased obviously after sputum aspiration and bronchial lavage by bronchofibroscope ( P lt; 0. 01) . The total effective rate was also highly increased, and the heart rate and respiration were stable in the treatment group. The time of mechanical ventilation and the length of ICU stay were all shortened in the treatment group compared with the control group. Conclusions Sterile sputum suction tube can not only acquire accurate pathogen, but also is a simple and economical method for patients with severe lung infection with mechanical ventilation. Sputum aspiration and bronchial lavage with bronchofibroscope combining mechanical ventilation are effective and safe treatment for patients with severe lung infection.
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 detect the levels of Krebs von den lungen 6 (KL-6) in bronchoalveolar lavage fluid (BALF) and serum of patients with idiopathic pulmonary fibrosis (IPF),and explore its clinical significance. MethodsThirty-four patients with IPF and 10 patients with sarcoidosis in Ⅰ period were recruited in the study. ELISA was used to detect the level of KL-6 in BALF and serum. ResultsIn the IPF group,the forced vital capacity as percentage of predicted value (FVC% pred) and diffusion capacity for carbon monoxide as percentage of predicted value (DLCO %pred) were both significantly lower than those of the sarcoidosis group[(69.51±13.65)% vs. (82.06±5.84)%,(48.58±12.73)% vs. (81.47±6.39)%,P<0.01]. In the BALF of IPF group,the percentage of neutrophils was higher[(8.91±6.79)% vs. (5.50±3.60)%,P<0.05],and the percentages of lymphocytes and CD4/CD8 ratio were lower than those of the sarcoidosis group[(11.71±6.64)% vs. (23.30±12.68)%,(1.46±0.83) vs. (4.01±5.10),P<0.05]. In the IPF group,the level of KL-6 in the BALF and serum was higher than that of the arcoidosis group[(437.43±251.70) U/mL vs. (221.59±127.41) U/mL,(857.81±515.53) U/mL vs. (338.67±168.13) U/mL,P<0.001]. There was obvious correlation between the level of serum KL-6 with FVC%pred and DLCO%pred in the IPF group (r=-0.46,r=-0.58,P<0.05). ConclusionsThe level of KL-6 in BALF and serum is elevated in patients with IPF. There is obvious correlation between the level of serum KL-6 with FVC%pred and DLCO%pred in IPF patients. KL-6 may be an indicator of IPF in clinical diagnose.
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.
ObjectiveTo explore the expression of periostin in bronchoalveolar lavage fluid (BALF) of patients with dermatomyositis-related interstitial lung disease (DM-ILD) and rheumatoid arthritis-related interstitial lung disease (RA-ILD).MethodsA total of 44 patients with DM-ILD and 28 patients with RA-ILD were underwent bronchoalveolar lavage. Cells in BALF were collected and analyzed by absolute different cell counts. The level of periostin and Krebs von den Lungen-6 (KL-6) were tested by enzyme linked immunosorbent assay. Results of high resolution CT of patients were scored. Thirty patients without interstitial lung disease (ILD) served as a control group.ResultsLevels of periostin and KL-6 were significantly increased in BALF of patients with DM-ILD and RA-ILD compared with control group (all P<0.05). Levels of periostin were positively correlated with lymphocyte counts and levels of KL-6 in BALF (allP<0.05). Furthermore, levels of periostin were significantly correlated with high resolution CT scores (P<0.05).ConclusionsLevels of periostin are increased in patients with DM-ILD and RA-ILD. Periostin might be served as an indicator of CTD-ILD.