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BMC Pulmonary Medicine Jun 2024Community-acquired pneumonia (CAP) patients with chronic obstructive pulmonary disease (COPD) have higher disease severity and mortality compared to those without COPD....
Exploring the microbiota difference of bronchoalveolar lavage fluid between community-acquired pneumonia with or without COPD based on metagenomic sequencing: a retrospective study.
BACKGROUND
Community-acquired pneumonia (CAP) patients with chronic obstructive pulmonary disease (COPD) have higher disease severity and mortality compared to those without COPD. However, deep investigation into microbiome distribution of lower respiratory tract of CAP with or without COPD was unknown.
METHODS
So we used metagenomic next generation sequencing (mNGS) to explore the microbiome differences between the two groups.
RESULTS
Thirty-six CAP without COPD and 11 CAP with COPD cases were retrieved. Bronchoalveolar lavage fluid (BALF) was collected and analyzed using untargeted mNGS and bioinformatic analysis. mNGS revealed that CAP with COPD group was abundant with Streptococcus, Prevotella, Bordetella at genus level and Cutibacterium acnes, Rothia mucilaginosa, Bordetella genomosp. 6 at species level. While CAP without COPD group was abundant with Ralstonia, Prevotella, Streptococcus at genus level and Ralstonia pickettii, Rothia mucilaginosa, Prevotella melaninogenica at species level. Meanwhile, both alpha and beta microbiome diversity was similar between groups. Linear discriminant analysis found that pa-raburkholderia, corynebacterium tuberculostearicum and staphylococcus hominis were more enriched in CAP without COPD group while the abundance of streptococcus intermedius, streptococcus constellatus, streptococcus milleri, fusarium was higher in CAP with COPD group.
CONCLUSIONS
These findings revealed that concomitant COPD have an mild impact on lower airway microbiome of CAP patients.
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Bronchoalveolar Lavage Fluid; Community-Acquired Infections; Male; Retrospective Studies; Aged; Female; Microbiota; Middle Aged; Metagenomics; High-Throughput Nucleotide Sequencing; Pneumonia; Aged, 80 and over
PubMed: 38867204
DOI: 10.1186/s12890-024-03087-6 -
Journal of Infection in Developing... May 2024Q fever, a zoonotic disease caused by Coxiella burnetii (C. burnetii), presents diagnostic challenges due to its clinical and radiological nonspecificity, which often...
INTRODUCTION
Q fever, a zoonotic disease caused by Coxiella burnetii (C. burnetii), presents diagnostic challenges due to its clinical and radiological nonspecificity, which often mimics community-acquired pneumonia, coupled with the limitations of traditional diagnostic methods. Metagenomic next-generation sequencing (mNGS) has become an indispensable tool in clinical diagnostics for its high-throughput pathogen identification capabilities. Herein, we detail a case of acute Q fever pneumonia diagnosed with mNGS.
CASE PRESENTATION
The patient exhibited symptoms of fever, cough, expectoration, and diarrhea for three days, with the pathogen undetected in initial laboratory assessments. Bronchoscopy and bronchoalveolar lavage (BAL) were conducted, leading to the identification of C. burnetii in the lavage fluid via mNGS. Consequently, the patient was promptly initiated on a treatment regimen of 100 mg doxycycline, administered orally every 12 hours.
RESULTS
Post-treatment, the patient's temperature normalized, and a full recovery was observed. The follow-up chest CT scan revealed complete resolution of the right lower lobe consolidation.
CONCLUSIONS
The clinical presentation of Q fever pneumonia lacks specificity, making diagnosis based solely on symptoms and imaging challenging. mNGS offers a superior alternative for identifying elusive or rarely cultured pathogens.
Topics: Humans; High-Throughput Nucleotide Sequencing; Q Fever; Coxiella burnetii; Metagenomics; Male; Pneumonia, Bacterial; Anti-Bacterial Agents; Doxycycline; Bronchoalveolar Lavage Fluid; Middle Aged; Tomography, X-Ray Computed
PubMed: 38865398
DOI: 10.3855/jidc.18314 -
Journal of Infection in Developing... May 2024Mycobacterium canariasense is a relatively rare and rapidly growing nontuberculous mycobacterium (NTM) infection.
INTRODUCTION
Mycobacterium canariasense is a relatively rare and rapidly growing nontuberculous mycobacterium (NTM) infection.
CASE REPORT
This case report describes a 36-year-old man with a Canariasense infection in the lung with solitary cavitation nodules located subpleural on CT scan, for which the final diagnosis was made by metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF-mNGS). It was successfully treated with levofloxacin and amikacin.
CONCLUSIONS
This experience is instructive because clinical diagnostic and CT imaging characteristics and treatment strategy guidelines for pulmonary infections caused by M. canariasense have not yet been established.
Topics: Humans; Male; Adult; Mycobacterium Infections, Nontuberculous; Anti-Bacterial Agents; Tomography, X-Ray Computed; Bronchoalveolar Lavage Fluid; Lung; Levofloxacin; Amikacin; Nontuberculous Mycobacteria; High-Throughput Nucleotide Sequencing; Treatment Outcome
PubMed: 38865393
DOI: 10.3855/jidc.18535 -
Wounds : a Compendium of Clinical... May 2024The use of negative pressure wound therapy with instillation and dwell time (NPWTi-d) has been shown to be effective in removing nonviable tissue, reducing bioburden,...
BACKGROUND
The use of negative pressure wound therapy with instillation and dwell time (NPWTi-d) has been shown to be effective in removing nonviable tissue, reducing bioburden, and promoting granulation tissue formation in acute and chronic infected wounds.
OBJECTIVE
To illustrate the clinical efficacy of the use of pure hypochlorous acid (pHA) antimicrobially preserved wound cleansing solution as the instillation fluid for NPWTi-d (NPWTi-d/pHA) in wound bed preparation in patients with complex wounds.
CASE REPORT
The treatment protocol for use of NPWTi-d/pHA in preparing wound beds for final closure is demonstrated in 3 illustrative cases of patients with complex wounds resulting from necrotizing infection and trauma with heavy contamination. All 3 patients developed a healthy-appearing wound bed deemed suitable for primary closure an average of approximately 1 month following initial surgical debridement.
CONCLUSION
The cases presented demonstrate the ability of a pHA antimicrobially preserved wound cleansing solution used as the instillation fluid with NPWTi-d to aid in bacterial reduction, mechanical debridement, and promotion of wound healing. Use of NPWTi-d/pHA in these cases of extensive necrotizing infection and posttraumatic injury with heavy contamination allowed for final closure an average of 1 month after initial surgical debridement.
Topics: Humans; Negative-Pressure Wound Therapy; Hypochlorous Acid; Wound Healing; Male; Middle Aged; Wound Infection; Treatment Outcome; Debridement; Female; Adult; Therapeutic Irrigation
PubMed: 38861209
DOI: 10.25270/wnds/21122 -
Immunity, Inflammation and Disease Jun 2024The hygiene hypothesis suggests that early life exposure to helminth infections can reduce hypersensitivity in the immune system.
BACKGROUND
The hygiene hypothesis suggests that early life exposure to helminth infections can reduce hypersensitivity in the immune system.
OBJECTIVE
The present study aims to evaluate the effects of Toxocara cati (T. cati) somatic products on allergic airway inflammation.
METHODS
Between 2018 and 2020, T. cati adult worms were collected from stray cats in Mashhad, Iran (31 out of 186 cats), and their somatic extract was collected. Thirty BALB/c mice were equally divided into three groups, including the OVA group (sensitized and challenged with ovalbumin), the somatic administered group (received somatic extract along with ovalbumin sensitization), and the PBS group (sensitized and challenged with phosphate buffer saline). Bronchoalveolar lavage (BAL) fluid was collected to assess the number of cells, and lung homogenates were prepared for cytokine analysis. Histopathological analysis of the lungs was performed, and inflammatory cells and mucus were detected. Cytokine levels (IL-4, IL-5, IL-10) were measured using enzyme-linked immunosorbent assay (ELISA), and ovalbumin-specific immunoglobulin E (IgE) levels were determined using a capture ELISA.
RESULTS
The somatic group significantly decreased regarding the lung pathological changes, including peribronchiolitis, perivasculitis, and eosinophil influx, compared to the group treated with ovalbumin alone. These changes were accompanied by a decrease in proinflammatory cytokines IL-4 and IL-5 and an increase in the anti-inflammatory cytokine IL-10, indicating a shift toward a more balanced immune response. The number of inflammatory cells in the BAL fluid was also significantly reduced in the somatic group, indicating a decrease in inflammation.
CONCLUSION
These preclinical findings suggest that in experimental models, T. cati somatic extract exhibits promising potential as a therapeutic agent for mitigating allergic airway inflammation. Its observed effects on immune response modulation and reduction of inflammatory cell infiltration warrant further investigation in clinical studies to assess its efficacy and safety in human patients.
Topics: Animals; Mice; Toxocara; Mice, Inbred BALB C; Cytokines; Immunoglobulin E; Ovalbumin; Lung; Bronchoalveolar Lavage Fluid; Asthma; Disease Models, Animal; Cats; Female; Toxocariasis
PubMed: 38860753
DOI: 10.1002/iid3.1307 -
Zhonghua Jie He He Hu Xi Za Zhi =... Jun 2024We reported a case of a 36-year-old woman who presented with cough, dyspnea, hypereosinophilia, multiple pulmonary nodules and mediastinal lymphadenopathy. The...
We reported a case of a 36-year-old woman who presented with cough, dyspnea, hypereosinophilia, multiple pulmonary nodules and mediastinal lymphadenopathy. The percentage of eosinophils in bronchoalveolar lavage fluid (BALF) was as high as 65%. Pathogenic tests and cytologic examination of BALF were negative. Transbronchial lung biopsy and endobronchial ultrasound-guided transbronchial needle aspiration revealed only eosinophil infiltration. As the patient responded poorly to high-dose corticosteroids, a surgical lung biopsy was performed. The pathological diagnosis was angioimmunoblastic T-cell lymphoma. The patient received chemotherapy and achieved a partial response. Her eosinophil count returned to the normal range, and the pulmonary nodules on chest CT partially resolved.
Topics: Humans; Female; Adult; Multiple Pulmonary Nodules; Bronchoalveolar Lavage Fluid; Eosinophils; Tomography, X-Ray Computed; Hypereosinophilic Syndrome; Lung; Lung Neoplasms
PubMed: 38858204
DOI: 10.3760/cma.j.cn112147-20231205-00357 -
Lancet (London, England) Jun 2024Chronic subdural haematoma is a common surgically treated intracranial emergency. Burr-hole drainage surgery, to evacuate chronic subdural haematoma, involves three... (Randomized Controlled Trial)
Randomized Controlled Trial
Burr-hole drainage with or without irrigation for chronic subdural haematoma (FINISH): a Finnish, nationwide, parallel-group, multicentre, randomised, controlled, non-inferiority trial.
BACKGROUND
Chronic subdural haematoma is a common surgically treated intracranial emergency. Burr-hole drainage surgery, to evacuate chronic subdural haematoma, involves three elements: creation of a burr hole for access, irrigation of the subdural space, and insertion of a subdural drain. Although the subdural drain has been established as beneficial, the therapeutic effect of subdural irrigation has not been addressed.
METHODS
The FINISH trial was an investigator-initiated, pragmatic, multicentre, nationwide, randomised, controlled, parallel-group, non-inferiority trial in five neurosurgical units in Finland that enrolled adults aged 18 years or older with a chronic subdural haematoma requiring burr-hole drainage. Patients were randomly assigned (1:1) by computer-generated block randomisation with block sizes of four, six, or eight, stratified by site, to burr-hole drainage either with or without subdural irrigation. All patients and staff were masked to treatment assignment apart from the neurosurgeon and operating room staff. A burr hole was drilled at the site of maximum haematoma thickness in both groups, and the subdural space was either irrigated or not irrigated before inserting a subdural drain, which remained in place for 48 h. Reoperations, functional outcome, mortality, and adverse events were recorded for 6 months after surgery. The primary outcome was the reoperation rate within 6 months. The non-inferiority margin was set at 7·5%. Key secondary outcomes that were also required to conclude non-inferiority were the proportion of participants with unfavourable functional outcomes (ie, modified Rankin Scale score of 4-6, where 0 indicates no symptoms and 6 indicates death) and mortality rate at 6 months. The primary and key secondary analyses were done in both the intention-to-treat and per-protocol populations. The trial was registered with ClinicalTrials.gov (NCT04203550) and is completed.
FINDINGS
From Jan 1, 2020, to Aug 17, 2022, we assessed 1644 patients for eligibility and 589 (36%) patients were randomly assigned to a treatment group and treated (294 assigned to drainage with irrigation and 295 assigned to drainage without irrigation; 165 [28%] women and 424 [72%] men). The 6-month follow-up period extended until Feb 14, 2023. In the intention-to-treat analysis, 54 (18·3%) of 295 participants required reoperation in the group assigned to receive no irrigation versus 37 (12·6%) of 294 in the group assigned to receive irrigation (difference of 6·0 percentage points, 95% CI 0·2-11·7; p=0·30; adjusted for study site). There were no significant between-group differences in the proportion of people with modified Rankin Scale score of 4-6 (37 [13·1%] of 283 in the no-irrigation group vs 36 [12·6%] of 285 in the irrigation group; p=0·89) or mortality rate (18 [6·1%] of 295 in the no-irrigation group vs 21 [7·1%] of 294 in the irrigation group; p=0·58). The findings of the primary intention-to-treat analysis were not materially altered in the per-protocol analysis. There were no significant between-group differences in the number of adverse events, and the most frequent severe adverse events were systemic infections (26 [8·8%] of 295 participants who did not receive irrigation vs 22 [7·5%] of 294 participants who received irrigation), intracranial haemorrhage (13 [4·4%] vs seven [2·4%]), and epileptic seizures (five [1·7%] vs nine [3·1%]).
INTERPRETATION
We could not conclude non-inferiority of burr-hole drainage without irrigation. The reoperation rate was 6·0 percentage points higher after burr-hole drainage without subdural irrigation than with subdural irrigation. Considering that there were no differences in functional outcome or mortality between the groups, the trial favours the use of subdural irrigation.
FUNDING
State Fund for University Level Health Research (Helsinki University Hospital), Finska Läkaresällskapet, Medicinska Understödsföreningen Liv och Hälsa, and Svenska Kulturfonden.
Topics: Humans; Drainage; Hematoma, Subdural, Chronic; Male; Female; Therapeutic Irrigation; Aged; Finland; Middle Aged; Treatment Outcome; Adult; Trephining; Aged, 80 and over
PubMed: 38852600
DOI: 10.1016/S0140-6736(24)00686-X -
Pediatric Surgery International Jun 2024To characterise the investigations, management and ultimate diagnosis of neonates with distal intestinal obstruction.
PURPOSE
To characterise the investigations, management and ultimate diagnosis of neonates with distal intestinal obstruction.
METHODS
Retrospective review of term (> 37 weeks) neonates with admission diagnosis of distal intestinal obstruction over 10 years (2012-2022). Patient pathways were identified and associations between presentations, response to treatments and outcome investigated.
RESULTS
A total of 124 neonates were identified and all included. Initial management was colonic irrigation in 108, contrast enema in 4, and laparotomy in 12. Of those responding to irrigations none underwent contrast enema. Ultimately, 22 neonates proceeded to laparotomy. Overall, 106 had a suction rectal biopsy and 41 had genetic testing for cystic fibrosis. Final diagnosis was Hirschsprung disease (HD) in 67, meconium ileus with cystic fibrosis (CF) in 9, meconium plug syndrome in 19 (including 3 with CF), intestinal atresia in 10 and no formal diagnosis in 17. Median length of neonatal unit stay was 11 days (7-19).
CONCLUSIONS
Initial management of neonates with distal bowel obstruction should be colonic irrigation since this is therapeutic in the majority and significantly reduces the need for contrast enema. These infants should all have suction rectal biopsy to investigate for HD unless another diagnosis is evident. If a meconium plug is passed, testing for CF is recommended. Evaluation and therapy are multimodal and time consuming, placing burden on resources and families.
Topics: Humans; Infant, Newborn; Retrospective Studies; Intestinal Obstruction; Enema; Male; Female; Contrast Media; Therapeutic Irrigation; Laparotomy; Treatment Outcome
PubMed: 38852109
DOI: 10.1007/s00383-024-05725-w -
Frontiers in Cellular and Infection... 2024Lower respiratory tract infections represent prevalent ailments. Nonetheless, current comprehension of the microbial ecosystems within the lower respiratory tract...
BACKGROUND
Lower respiratory tract infections represent prevalent ailments. Nonetheless, current comprehension of the microbial ecosystems within the lower respiratory tract remains incomplete and necessitates further comprehensive assessment. Leveraging the advancements in metagenomic next-generation sequencing (mNGS) technology alongside the emergence of machine learning, it is now viable to compare the attributes of lower respiratory tract microbial communities among patients across diverse age groups, diseases, and infection types.
METHOD
We collected bronchoalveolar lavage fluid samples from 138 patients diagnosed with lower respiratory tract infections and conducted mNGS to characterize the lung microbiota. Employing various machine learning algorithms, we investigated the correlation of key bacteria in patients with concurrent bronchiectasis and developed a predictive model for hospitalization duration based on these identified key bacteria.
RESULT
We observed variations in microbial communities across different age groups, diseases, and infection types. In the elderly group, exhibited the highest relative abundance, followed by and . and emerged as the dominant genera at the genus level in the younger group, while and were prevalent species. Within the bronchiectasis group, dominant bacteria included , , and . Significant differences in the presence of were noted between the bronchiectasis group and the control group. In the group with concomitant fungal infections, the most abundant genera were and , with and as the predominant species. Notable differences were observed in the presence of , , , , and between the group with concomitant fungal infections and the bacterial group. Machine learning algorithms were utilized to select bacteria and clinical indicators associated with hospitalization duration, confirming the excellent performance of bacteria in predicting hospitalization time.
CONCLUSION
Our study provided a comprehensive description of the microbial characteristics among patients with lower respiratory tract infections, offering insights from various perspectives. Additionally, we investigated the advanced predictive capability of microbial community features in determining the hospitalization duration of these patients.
Topics: Humans; Machine Learning; Metagenomics; Middle Aged; Respiratory Tract Infections; Aged; Male; Female; Adult; Bacteria; Bronchoalveolar Lavage Fluid; Microbiota; High-Throughput Nucleotide Sequencing; Young Adult; Bronchiectasis; Aged, 80 and over; Metagenome; Adolescent; Lung; Hospitalization
PubMed: 38846353
DOI: 10.3389/fcimb.2024.1385562 -
International Journal of Hyperthermia :... 2024The objective was to describe the technique and clinical outcome of microwave thermal ablation (MWA) and perfusion combined with synthetic bone substitutes in treating...
PURPOSE
The objective was to describe the technique and clinical outcome of microwave thermal ablation (MWA) and perfusion combined with synthetic bone substitutes in treating unicameral bone cysts (UBCs) in adolescents.
MATERIALS AND METHODS
A total of 14 consecutive patients were enrolled by percutaneous MWA and saline irrigation combined with synthetic bone substitutes. Clinical follow-up included the assessment of pain, swelling, and functional mobility. Radiological parameters included tumor volume, physis-cyst distance, cortical thickness of the thinnest cortical bone, and the Modified Neer classification system.
RESULTS
The mean follow-up was 28.9 months (26-52 months). All UBCs were primary, and all patients underwent the MWA, saline perfusion, and reconstruction combined with a synthetic bone substitute session, except for one patient (7.1%) who required a second session. All patients had good clinical results at the final follow-up. Satisfactory cyst healing was achieved in 13 cases according to radiological parameters. Tumor volume decreased from a mean of 49.7 cm before surgery treatment to 13.9 cm at the final follow-up ( < 0.01). The physis-cyst distance increased from a mean of 3.17-4.83 cm at the final follow-up ( < 0.01). Cortical thickness improved from a mean of 1.1 mm to 2.0 mm at the final follow-up ( < 0.01). According to the proposed radiological criteria, our results were considered successful (Grading I and II) in 13 patients (92.9%) at the final follow-up.
CONCLUSION
Percutaneous microwave ablation combined with a bone graft substitute is a minimally invasive, effective, safe, and cost-effective approach to treating primary bone cysts in the limbs of adolescents.
Topics: Humans; Male; Female; Adolescent; Bone Cysts; Bone Substitutes; Microwaves; Follow-Up Studies; Child; Plastic Surgery Procedures; Young Adult; Ablation Techniques
PubMed: 38843894
DOI: 10.1080/02656736.2024.2345382