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The Journal of Medical Investigation :... 2021The incidence rate of pulmonary nontuberculous mycobacterial disease (PNTMD) in Japan is the highest among major industrialized nations. Although the typical clinical... (Review)
Review
The incidence rate of pulmonary nontuberculous mycobacterial disease (PNTMD) in Japan is the highest among major industrialized nations. Although the typical clinical course and radiological manifestations of PNTMD are different from those of pulmonary tuberculosis (TB), confusion about these mycobacterial diseases leads to a diagnostic pitfall. Diagnostic challenges include the coexistence of Mycobacterium tuberculosis (MTB) and nontuberculous mycobacteria (NTM), false positives for NTM in MTB nucleic acid amplification tests, microbial substitution, and abnormal radiological manifestations caused by NTM. Features of extrapulmonary NTM diseases, such as pleurisy, vertebral osteomyelitis, and disseminated disease, are different from the corresponding tuberculous diseases. Moreover, the immunological background of the patient (status of human immunodeficiency virus infection with or without antiviral therapy, continuation or discontinuation of immunosuppressive therapy, use of immune checkpoint inhibitor, pregnancy and delivery, etc.) influences the pathophysiology of mycobacterial diseases. This review describes the varying clinical presentations of NTM disease with emphasis on the differences from TB. J. Med. Invest. 68 : 220-227, August, 2021.
Topics: Humans; Mycobacterium Infections, Nontuberculous; Mycobacterium tuberculosis; Nontuberculous Mycobacteria; Tuberculosis; Tuberculosis, Pulmonary
PubMed: 34759134
DOI: 10.2152/jmi.68.220 -
Tuberkuloz Ve Toraks Sep 2020Behcet's disease is a chronic inflammatory multi-systemic vasculitis. Recurrent oral and genital aphthous ulcers, uveitis, arthritis, arterial aneurysms, venous...
Behcet's disease is a chronic inflammatory multi-systemic vasculitis. Recurrent oral and genital aphthous ulcers, uveitis, arthritis, arterial aneurysms, venous thrombosis, gastrointestinal system lesions and skin lesions can be seen. Large, medium or small arteries and veins may be involved. While venous lesions cause occlusion, arterial lesions can cause both occlusion and aneurysm. Major forms of pulmonary involvement include pulmonary artery aneurysm, arterial and venous thrombosis, pulmonary infarction, recurrent pneumonia, and pleurisy. In Behcet's disease, pulmonary thromboembolism (PE) is often associated with endothelial damage. Neutrophils play an important role in the pathogenesis of thrombosis. Coagulation components such as fibrinogen, thrombin, factor Xa and factor VIIa activate the inflammatory cascade and induce vascular events. It is important to understand the pathogenesis of vascular events in determining the effective treatment strategy. Here we present a patient with Behcet's disease who was presented with pulmonary embolism and was investigated for the etiology of thrombosis.
Topics: Behcet Syndrome; Humans; Male; Middle Aged; Pulmonary Artery; Pulmonary Embolism; Tomography, X-Ray Computed; Ultrasonography, Doppler; Venous Thrombosis
PubMed: 33295733
DOI: 10.5578/tt.69502 -
Porcine Health Management Jun 2023Across the European Union (EU), efforts are being made to achieve modernisation and harmonisation of meat inspection (MI) code systems. Lung lesions were prioritised as...
BACKGROUND
Across the European Union (EU), efforts are being made to achieve modernisation and harmonisation of meat inspection (MI) code systems. Lung lesions were prioritised as important animal based measures at slaughter, but existing standardized protocols are difficult to implement for routine MI. This study aimed to compare the informative value and feasibility of simplified lung lesion scoring systems to inform future codes for routine post mortem MI.
RESULTS
Data on lung lesions in finisher pigs were collected at slaughter targeting 83 Irish pig farms, with 201 batches assessed, comprising 31,655 pairs of lungs. Lungs were scored for cranioventral pulmonary consolidations (CVPC) and pleurisy lesions using detailed scoring systems, which were considered the gold standard. Using the data collected, scenarios for possible simplified scoring systems to record CVPC (n = 4) and pleurisy (n = 4) lesions were defined. The measurable outcomes were the prevalence and (if possible) severity scoring at batch level for CVPC and pleurisy. An arbitrary threshold was set to the upper quartile (i.e., the top 25% of batches with high prevalence/severity of CVPC or pleurisy, n = 50). Each pair of measurable outcomes was compared by calculating Spearman rank correlations and assessing if batches above the threshold for one measurable outcome were also above it for their pairwise comparison. All scenarios showed perfect agreement (k = 1) when compared among themselves and the gold standard for the prevalence of CVPC. The agreement among severity outcomes and the gold standard showed moderate to perfect agreement (k = [0.66, 1]). The changes in ranking were negligible for all measurable outcomes of pleurisy for scenarios 1, 2 and 3 when compared with the gold standard (rs ≥ 0.98), but these changes amounted to 50% for scenario 4.
CONCLUSIONS
The best simplified CVPC scoring system is to simply count the number of lung lobes affected excluding the intermediate lobe, which provides the best trade-off between value of information and feasibility, by incorporating information on CVPC prevalence and severity. While for pleurisy evaluation, scenario 3 is recommended. This simplified scoring system provides information on the prevalence of cranial and moderate and severe dorsocaudal pleurisy. Further validation of the scoring systems at slaughter and by private veterinarians and farmers is needed.
PubMed: 37391833
DOI: 10.1186/s40813-023-00324-y -
Irish Veterinary Journal Nov 2020Respiratory disease is one of the most important factors impacting pig production worldwide. There is no available information on the prevalence of key pathogens...
BACKGROUND
Respiratory disease is one of the most important factors impacting pig production worldwide. There is no available information on the prevalence of key pathogens implicated in Irish pig production. The objective of this study was to describe the prevalence of pleurisy, pneumonia, lung abscesses, pericarditis and liver milk spots in finisher pigs of a cohort of Irish pig farms, and to describe the seroprevalence of: influenza A virus (IAV), porcine reproductive and respiratory syndrome virus (PRRSv), Mycoplasma hyopneumoniae (Mhyo) and Actinobacillus pleuropneumoniae (APP).
RESULTS
In brief, 56 farrow-to-finish farms (29% of the Irish breeding herd) were enrolled in the study in 2017. Data on lungs, heart, and liver lesions were assessed for each farm at slaughter. An average of 417 (range 129-1154) plucks per farm were assessed for pleurisy, pneumonia, lung abscesses, pericarditis, and liver milk spots. Blood samples from 32 finisher pigs were collected at slaughter for each farm. The observed prevalence of pleurisy and pneumonia was one of the lowest reported in similar studies in Europe (13 and 11% estimated average within farm, respectively). Pleurisy lesions were mostly moderate and severe. Pneumonia lesions affected a low level of lung surface (5.8%). Prevalence of pericarditis was mid-high (8%) and the prevalence of liver milk spots was high, with an average of 29% of the livers affected. For serology, 78.6% of the farms were positive for IAV, 50% were positive for PRRSv, 71.4% were positive for Mhyo, and 98.2% were positive for APP. Influenza virus was the main pathogen associated with pleurisy (P < 0.001) and Mhyo was the main pathogen associated with pneumonia (P < 0.001) and pericarditis (P = 0.024).
CONCLUSIONS
Farms affected with pleurisy had moderate to severe lesions. Farms affected with pneumonia had mild lesions, which could be the effect of the generalised use of Mhyo vaccination in piglets. The seroprevalence of IAV, PRRSv, Mhyo and APP in the present study sample is similar to or lower than in other European countries. Further research on the PRRSv and APP strains circulating in Ireland is necessary to support the design of national or regional control plans.
PubMed: 33319705
DOI: 10.1186/s13620-020-00176-w -
JACC. Case Reports Jun 2021A 53-year-old man with a background of acute myelomonocytic leukemia in remission presented with pleurisy. Repeat transthoracic echocardiography over several weeks...
A 53-year-old man with a background of acute myelomonocytic leukemia in remission presented with pleurisy. Repeat transthoracic echocardiography over several weeks revealed thickening left ventricular walls and decreasing systolic function. He died of decompensated heart failure due to cardiac myeloid sarcoma, with autopsy revealing an enlarged heart weighing >1 kg. ().
PubMed: 34317666
DOI: 10.1016/j.jaccas.2021.04.033 -
Respiratory Medicine Case Reports 2021A 37-year-old man with fever, cough, and dyspnea with no medical history developed an eosinophilic pleural effusion and blood eosinophilia. No evidence of malignancy or...
A 37-year-old man with fever, cough, and dyspnea with no medical history developed an eosinophilic pleural effusion and blood eosinophilia. No evidence of malignancy or pathogens was detected in the pleural effusion, and the pleural specimen obtained by thoracoscopy showed eosinophilic infiltration with inflammatory granulation tissue without fibrinoid necrosis or malignant cells. Since a myeloproliferative disorder was also excluded, the diagnosis was idiopathic eosinophilic pleurisy. Corticosteroid treatment was started and then slowly tapered, and the eosinophilic pleural effusion resolved. Considering the various etiologies of eosinophilic pleurisy, a practical clinical approach to the investigation and diagnosis of eosinophilic pleurisy is presented.
PubMed: 34401274
DOI: 10.1016/j.rmcr.2021.101430 -
Microbiology Spectrum Feb 2022Actinobacillus pleuropneumoniae causes porcine pleuropneumonia, an important disease in the pig industry. Accurate and sensitive diagnostics such as DNA-based...
Actinobacillus pleuropneumoniae causes porcine pleuropneumonia, an important disease in the pig industry. Accurate and sensitive diagnostics such as DNA-based diagnostics are essential for preventing or responding to an outbreak. The specificity of DNA-based diagnostics depends on species-specific markers. Previously, an insertion element was found within an A. pleuropneumoniae-specific gene commonly used for A. pleuropneumoniae detection, prompting the need for additional species-specific markers. Herein, 12 marker candidates highly conserved (99 - 100% identity) among 34 A. pleuropneumoniae genomes (covering 13 serovars) were identified to be A. pleuropneumoniae-specific , as these sequences are distinct from 30 genomes of 13 other and problematic [] species and more than 1700 genomes of other bacteria in the family. Five marker candidates are within the gene, a known A. pleuropneumoniae-specific gene, validating our marker discovery method. Seven other A. pleuropneumoniae-specific marker candidates within the , , , , and genes were validated by polymerase chain reaction (PCR) to be specific to 129 isolates of A. pleuropneumoniae (covering all 19 serovars), but not to four closely related species, four [] species, or seven other bacterial species. This is the first study to identify A. pleuropneumoniae-specific markers through genome mining. Seven novel A. pleuropneumoniae-specific DNA markers were identified by a combination of and molecular methods and can serve as additional or alternative targets for A. pleuropneumoniae diagnostics, potentially leading to better control of the disease. Species-specific markers are crucial for infectious disease diagnostics. Mutations within a marker sequence can lead to false-negative results, inappropriate treatment, and economic loss. The availability of several species-specific markers is therefore desirable. In this study, 12 DNA markers specific to A. pleuropneumoniae, a pig pathogen, were simultaneously identified. Five marker candidates are within a known A. pleuropneumoniae-specific gene. Seven novel markers can be used as additional targets in DNA-based diagnostics, which in turn can expedite disease diagnosis, assist farm management, and lead to better animal health and food security. The marker discovery strategy outlined herein requires less time, effort, and cost, and results in more markers compared with conventional methods. Identification of species-specific markers of other pathogens and corresponding infectious disease diagnostics are possible, conceivably improving health care and the economy.
Topics: Actinobacillus pleuropneumoniae; Animals; Bacterial Proteins; Genetic Markers; Genome, Bacterial; Pathology, Molecular; Pleuropneumonia; Polymerase Chain Reaction; Swine; Swine Diseases
PubMed: 34985298
DOI: 10.1128/spectrum.01311-21 -
Veterinary Medicine International 2020This review article is written to describe the results of ultrasonography of the kidneys in healthy camels as well as camels with some renal disorders. In the dromedary... (Review)
Review
This review article is written to describe the results of ultrasonography of the kidneys in healthy camels as well as camels with some renal disorders. In the dromedary camel, the physiology of the kidney is of interest in view of the specialization of the camel to hot dry deserts and to prolonged periods without water. It plays an important role in water conservation through the production of highly concentrated urine that may predispose animal to varieties of renal disorders. Examples of kidney affections in dromedary camels are renal capsular pigmentation, medullary hyperemia, subcapsular calcification, cortical and medullar discoloration, hemorrhage in renal pelvis, nephrolithiasis, and hydatidosis. Congestion, hemorrhage, hydronephrosis, acute glomerulonephritis, subacute glomerulonephritis, chronic glomerulonephritis, diffuse interstitial nephritis, focal interstitial nephritis, renal cyst, hyaline degeneration, renal amyloidosis, tubular nephrosis, pyelonephritis, hemosiderosis, and renal toxicity. When the kidney is examined by ultrasonography, the clinician can get sufficient information about the size, position, and echo patterns of the renal cortex and medulla and renal pelvis and outlines of the renal blood vessels. In recent years, ultrasonography has been used in camels for scanning of the healthy status as well as evaluation and determining the diagnosis and prognosis of diseased cases. Examples of diseases evaluated by ultrasonography are paratuberculosis, trypanosomiasis, pneumonia, pleurisy, gastrointestinal neoplasms, chronic peritonitis, splenic abscessation, and hepatic disorders. Of the renal disorders assessed by ultrasonography are nephrolithiasis, hydronephrosis, pyelonephritis, renal abscessation, and renal neoplasms. Ultrasound guidance in biopsy of renal specimens has also been reported in dromedary camels.
PubMed: 33144934
DOI: 10.1155/2020/7814927 -
Tuberculosis (Edinburgh, Scotland) May 2020Diagnosing tuberculous pleurisy (TP) remains a clinical challenge and the best method to diagnose it is controversial. Although several studies have investigated the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Diagnosing tuberculous pleurisy (TP) remains a clinical challenge and the best method to diagnose it is controversial. Although several studies have investigated the performance of pleural fluid (PF) T-SPOT for pleural tuberculosis (plTB) diagnosis, the heterogeneity of its accuracy exists. Therefore, we performed an updated meta-analysis of the existing evidence on the utility of PF T-SPOT to diagnose TP.
METHODS
PubMed and EmBase were searched for relevant English articles up to July 29, 2019. Statistical analysis was performed using Stata, Revman, and Meta-Disc. Pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were determined. Summary receiver operating characteristic (SROC) curves and the area under the curve (AUC) were used to summarize the overall diagnostic performance.
RESULTS
A total of 13 studies (997 patients with TP and 656 patients without TP) were identified and enrolled to meta-analysis, giving the following pooled values for diagnostic accuracy of PF T-SPOT: sensitivity, 0.91 (95% CI, 0.89-0.92, I = 80.9%); specificity, 0.88 (95% CI, 0.86-0.91, I = 87.3%); PLR, 6.28 (95% CI, 2.88-13.69, I = 93.3%); NLR, 0.12 (95% CI, 0.07-0.21, I = 84.9%); DOR, 59.74 (95% CI, 24.13-147.93, I = 78.3%); and the area under the SROC curve, 0.95 (95% CI, 0.93-0.97).
CONCLUSIONS
Our meta-analysis suggests that PF T-SPOT has important diagnostic value for plTB. However, the standardization of the operating procedure needs to be further promoted, which would make the results more credible.
Topics: Host-Pathogen Interactions; Humans; Interferon-gamma; Interferon-gamma Release Tests; Mycobacterium tuberculosis; Predictive Value of Tests; Reproducibility of Results; Tuberculosis, Pleural
PubMed: 32501259
DOI: 10.1016/j.tube.2020.101941 -
Journal of Thoracic Disease Sep 2017Establishing the etiology of exudative pleural effusions in the setting of an unrevealing pleural fluid analysis often requires biopsies from the parietal pleura. While... (Review)
Review
Establishing the etiology of exudative pleural effusions in the setting of an unrevealing pleural fluid analysis often requires biopsies from the parietal pleura. While closed pleural biopsy (CPB) has been a popular minimally-invasive approach, it has a poor diagnostic yield, barring a diagnosis of tuberculous pleurisy. Medical thoracoscopy (MT) is a minimally-invasive ambulatory procedure performed under local anesthesia or moderate sedation which allows for direct visualization of biopsy targets as well as simultaneous therapeutic interventions, including chemical pleurodesis and indwelling tunneled pleural catheter (ITPC) placement. The excellent yield and favorable safety profile of MT has led to it replacing CPB for many indications, particularly in the management of suspected malignant pleural effusions. As experience with MT amongst interventional pulmonologists has grown, there is an increased appreciation for its important role alongside percutaneous and surgical approaches in the diagnosis and treatment of pleural disease.
PubMed: 29214061
DOI: 10.21037/jtd.2017.06.37