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Revista Peruana de Medicina... 2020We present the case of an immunocompetent patient whose illness began at age 49 with a cough, followed by purulent and hemoptoic sputum; bronchiectasis was diagnosed....
We present the case of an immunocompetent patient whose illness began at age 49 with a cough, followed by purulent and hemoptoic sputum; bronchiectasis was diagnosed. Three years later, after hemoptysis, she underwent medial segmentectomy of the middle lobe and was asymptomatic for months. When tuberculosis was found in the pathology report, she was treated with 4HREZ2R2H2. Five years later her BK was 2+, thus receiving a new scheme of 4HREZ2R2H2, which did not succeed in obtaining negative results and the treatment was declared as a failure. After genotyping her Mycobacterium intracellulare culture, the patient received azithromycin, moxifloxacin and ethambutol. There was improvement, but she abandoned the treatment at 8 months; she restarted it 18 months later, along with treatment for depression and gastroesophageal reflux. After one month the patient was asymptomatic, but she had a dermal reaction to moxifloxacin which was replaced with amikacin. One year later, she was cured and discharged, at the age of 64.
Topics: Female; Humans; Immunocompromised Host; Lung Diseases; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Peru
PubMed: 32876230
DOI: 10.17843/rpmesp.2020.372.4632 -
Journal of Medical Ultrasonics (2001) Jul 2023In inflammatory bowel disease, including Crohn's disease and ulcerative colitis, an excessive immune response due primarily to T-cell lymphocytes causes inflammation in... (Review)
Review
In inflammatory bowel disease, including Crohn's disease and ulcerative colitis, an excessive immune response due primarily to T-cell lymphocytes causes inflammation in the gastrointestinal tract. Lesions in Crohn's disease can occur anywhere in the gastrointestinal tract, i.e., from the oral cavity to the anus. Endoscopically, aphthoid lesions/ulcers believed to be initial lesions progress to discrete ulcers, which coalesce to form a longitudinal array and progress to longitudinal ulcers with a cobblestone appearance, which is a typical endoscopic finding. Before long, complications such as strictures, fistulas, and abscesses form. Lesions in ulcerative colitis generally extend continuously from the rectum and diffusely from a portion of the colon to the entire colon. Endoscopically, lack of vascular pattern, fine granular mucosa, erythema, aphthae, and small yellowish spots are seen in mild cases; coarse mucosa, erosions, small ulcers, bleeding (contact bleeding), and adhesion of mucous, bloody, and purulent discharge in moderate cases; and widespread ulcers and marked spontaneous bleeding in severe cases.
Topics: Humans; Colitis, Ulcerative; Crohn Disease; Ulcer; Inflammatory Bowel Diseases
PubMed: 36036332
DOI: 10.1007/s10396-022-01250-2 -
JAMA Ophthalmology Dec 2023Acute infectious conjunctivitis is a common ocular condition with major public health consequences.
IMPORTANCE
Acute infectious conjunctivitis is a common ocular condition with major public health consequences.
OBJECTIVE
To assess regional variations and microbial etiologies of acute infectious conjunctivitis to guide treatment.
DESIGN, SETTING, AND PARTICIPANTS
In this cross-sectional study, patients with presumed acute infectious conjunctivitis were enrolled in the study at 5 sites (Honolulu, Hawaii; Los Angeles, San Francisco, and San Diego, California; and Petah-Tikva, Israel) from March 2021 to March 2023. Patients with allergic or toxic conjunctivitis were excluded.
MAIN OUTCOMES AND MEASURES
Pathogens were identified by unbiased RNA deep sequencing.
RESULTS
In all, 52 patients (mean [range] age, 48 [7-80] years; 31 females [60%]) were enrolled at 5 sites (6 patients from Honolulu, 9 from San Diego, 11 from Los Angeles, 13 from San Francisco, and 13 from Petah-Tikva). RNA deep sequencing detected human adenovirus species D in one-quarter of patients (13 of 52). A wide range of pathogens, including human coronavirus 229E, SARS-CoV-2, and herpes simplex virus type 1, was also identified, as well as several bacteria and fungi. Moreover, 62% (32 of 52) of patients presented with purulent discharge, while only 8% (4 of 52) of patients had confirmed bacterial pathogens.
CONCLUSION AND RELEVANCE
In this cross-sectional study, pathogens associated with acute infectious conjunctivitis varied between all 5 sites in the US and Israel. Purulent discharge was a common presenting sign in this study, with a low specificity for bacteria-associated conjunctivitis, suggesting that further diagnostic workup may be necessary to inform antibiotic stewardship. Additional research on cost-effectiveness of using RNA deep sequencing is needed to ascertain whether it is better to monitor patients clinically until resolution of disease.
Topics: Female; Humans; Middle Aged; Bacteria; Conjunctivitis; Cross-Sectional Studies; Acute Disease; Public Health Surveillance
PubMed: 37917077
DOI: 10.1001/jamaophthalmol.2023.4785 -
Pediatric Annals May 2022An 11-day-old girl, who was diagnosed with Neisseria gonorrhoeae ophthalmia neonatorum, presents with a purulent ocular discharge. Although rare in regions with high... (Review)
Review
An 11-day-old girl, who was diagnosed with Neisseria gonorrhoeae ophthalmia neonatorum, presents with a purulent ocular discharge. Although rare in regions with high implementation rates of ocular prophylaxis, ophthalmia neonatorum remains an important diagnostic consideration, especially in developing countries and areas of low socioeconomic status. In this article, we review the evolving epidemiology, diagnostic considerations, prevention, and treatment of ophthalmia neonatorum. .
Topics: Female; Gonorrhea; Humans; Infant, Newborn; Neisseria gonorrhoeae; Ophthalmia Neonatorum; Patient Discharge
PubMed: 35575542
DOI: 10.3928/19382359-20220314-04 -
Scientific Reports Jun 2022Purulent vulvar discharges, primarily caused by genito-urinary tract infections, are an important source of economic loss for swine producers due to sow culling and...
Purulent vulvar discharges, primarily caused by genito-urinary tract infections, are an important source of economic loss for swine producers due to sow culling and mortality. However, the agents that compose the vaginal microbiota of sows and their changes during infections are not well understood. The first goal of this study was to characterize and compare the vaginal bacterial content of healthy (HE, n = 40) and purulent vulvar discharge sows (VD, n = 270) by a culture-dependent method and MALDI-TOF MS identification. Secondly, we performed 16S rRNA targeted metagenomic approach (n = 72) to compare the vaginal microbiota between these groups. We found a wide variety of bacteria, with Proteobacteria, Firmicutes, and Bacteroidota being the most abundant phyla in both groups, as well as Escherichia-Shigella, Streptococcus, and Bacteroides at the genus level. Most agents identified in the sequencing method also grew in the culture-dependent method, showing the viability of these bacteria. Alpha diversity did not differ between HE and VD sows, regarding sample richness and diversity, but a beta-diversity index showed a different microbiota composition between these groups in two tested herds. ANCOM analysis revealed that Bacteroides pyogenes were more abundant in VD females and can be a marker for this group. Other agents also require attention, such as the Streptococcus dysgalactiae and Staphylococcus hyicus found in remarkably greater relative abundance in VD sows. Network analysis revealed important positive correlations between some potentially pathogenic genera, such as between Escherichia-Shigella, Trueperella, Streptococcus, Corynebacterium, and Prevotella, which did not occur in healthy sows. We conclude that the alteration of the vaginal microbiota between healthy and purulent vulvar discharge sows, although not extreme, could be due to the increase in the relative abundance of specific agents and to associations between potentially pathogenic bacteria.
Topics: Animals; Bacteria; Female; Humans; Microbiota; RNA, Ribosomal, 16S; Swine; Vagina; Vulva
PubMed: 35650232
DOI: 10.1038/s41598-022-13090-8 -
Animal : An International Journal of... May 2023This paper reviews recent data and concepts on metritis, purulent vaginal discharge (PVD), and endometritis in dairy cows and the ways in which these diseases affect... (Review)
Review
This paper reviews recent data and concepts on metritis, purulent vaginal discharge (PVD), and endometritis in dairy cows and the ways in which these diseases affect reproductive performance. Metritis is characterized by fetid discharge from the uterus, with or without fever. Purulent vaginal discharge describes exudate that is >50% pus that may be attributable to uterine infection or cervicitis. Endometritis is inflammation of the uterus diagnosed by endometrial cytology with a proportion of neutrophils (typically ≥5%) that is associated with impaired fertility. Metritis and PVD are associated with uterine bacterial dysbiosis: changes in the microbiota to lesser diversity and greater abundance of pathogens, especially Gram-negative anaerobic bacteria, and Trueperella pyogenes in the case of PVD. Metritis is justifiably treated with approved antibiotics but criteria for more selective treatment without loss of performance are emerging. Purulent vaginal discharge is not synonymous with clinical endometritis, and greater precision in terminology is warranted. PVD is likely under-diagnosed and represents an opportunity for improved management in many herds. Endometritis seems in many cases to reflect persistent, dysregulated inflammation, for which the inciting cause is unclear. Postpartum uterine infection and inflammation have harmful effects on oocytes, embryo development, and the endometrium for at least three months, even if the disease is apparently resolved. Emerging concepts of the resolution and regulation of inflammation are promising for the improvement of prevention and therapy of endometritis.
Topics: Female; Cattle; Animals; Endometritis; Vaginal Discharge; Postpartum Period; Fertility; Puerperal Disorders; Inflammation; Cattle Diseases
PubMed: 37567665
DOI: 10.1016/j.animal.2023.100781 -
BMC Pulmonary Medicine Aug 2023Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a clinical syndrome with various causes. It is not uncommon that COPD patients presenting with... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a clinical syndrome with various causes. It is not uncommon that COPD patients presenting with dyspnea have multiple causes for their symptoms including AECOPD, pneumonia, or congestive heart failure occurring concurrently.
METHODS
To identify clinical, radiographic, and laboratory characteristics that might help distinguish AECOPD from another dominant disease in patients with a history of COPD, we conducted a retrospective cohort study of hospitalized patients with admitting diagnosis of AECOPD who were screened for a prospective randomized controlled trial from Sep 2016 to Mar 2018. Clinical characteristics, course in hospital, and final diagnosis at discharge were reviewed and adjudicated by two authors. The final diagnosis of each patient was determined based on the synthesis of all presenting signs and symptoms, imaging, and laboratory results. We adhered to AECOPD diagnosis definitions based on the GOLD guidelines. Univariate and multivariate analyses were performed to identify any associated features of AECOPD with and without other acute processes contributing to dyspnea.
RESULTS
Three hundred fifteen hospitalized patients with admitting diagnosis of AECOPD were included. Mean age was 72.5 (SD 10.6) years. Two thirds (65.4%) had spirometry defined COPD. The most common presenting symptom was dyspnea (96.5%), followed by cough (67.9%), and increased sputum (57.5%). One hundred and eighty (57.1%) had a final diagnosis of AECOPD alone whereas 87 (27.6%) had AECOPD with other conditions and 48 (15.2%) did not have AECOPD after adjudication. Increased sputum purulence (OR 3.35, 95%CI 1.68-6.69) and elevated venous pCO2 (OR 1.04, 95%CI 1.01 - 1.07) were associated with a diagnosis of AECOPD but these were not associated with AECOPD alone without concomitant conditions. Radiographic evidence of pleural effusion (OR 0.26, 95%CI 0.12 - 0.58) was negatively associated with AECOPD with or without other conditions while radiographic evidence of pulmonary edema (OR 0.31; 95%CI 0.11 - 0.91) and lobar pneumonia (OR 0.13, 95%CI 0.07 - 0.25) suggested against the diagnosis of AECOPD alone.
CONCLUSION
The study highlighted the complexity and difficulty of AECOPD diagnosis. A more specific clinical tool to diagnose AECOPD is needed.
Topics: Humans; Aged; Prospective Studies; Retrospective Studies; Pulmonary Disease, Chronic Obstructive; Dyspnea; Cough; Disease Progression; Acute Disease
PubMed: 37580731
DOI: 10.1186/s12890-023-02587-1 -
Reproduction (Cambridge, England) Aug 2023Clinical and subclinical endometritis are different manifestations of reproductive tract inflammatory disease in dairy cows. This review addresses the genesis of... (Review)
Review
IN BRIEF
Clinical and subclinical endometritis are different manifestations of reproductive tract inflammatory disease in dairy cows. This review addresses the genesis of clinical and subclinical endometritis considering metabolic stress, innate immune dysfunction, and shifts in the composition of the uterine microbiota in the postpartum period.
ABSTRACT
Up to half of dairy cows may develop one or more types of reproductive tract inflammatory disease within 5 weeks after calving. Clinical endometritis (CE) results from uterine bacterial dysbiosis with increased relative abundance of pathogenic bacteria associated with luminal epithelial damage. These bacteria cause endometrial stromal cell lysis, followed by massive polymorphonuclear neutrophil (PMN) migration, and pyogenesis. CE is defined as endometrial inflammation accompanied by purulent discharge. Purulent discharge is not always accompanied by uterine inflammation (being (rarely) vaginitis or (commonly) cervicitis), hence referred to as purulent vaginal discharge (PVD). Subclinical endometritis (SCE) is an asymptomatic uterine disease defined by a threshold of PMN on cytology that is associated with worse reproductive performance; it has not been linked with bacterial dysbiosis. Current evidence suggests that SCE is a result of metabolic and inflammatory dysfunction that impairs innate immune function and the ability of endometrial PMN to undergo apoptosis, necrosis, and ultimately achieve resolution of inflammation. CE and SCE are diagnosed between 3 and 5 weeks postpartum and commonly overlap, but they are considered distinct manifestations of reproductive tract inflammatory disease. This review addresses the genesis of CE and SCE in postpartum dairy cows considering metabolic stress, innate immune dysfunction, and shifts in the composition of the uterine microbiota.
Topics: Animals; Female; Humans; Cattle; Endometritis; Dysbiosis; Uterus; Reproduction; Postpartum Period; Inflammation; Cattle Diseases
PubMed: 37294111
DOI: 10.1530/REP-22-0452