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Research Square May 2024one of the pathogens strongly implicated in hospital infections. Data on the resistance and molecular characteristics of this bacterium are rare in Mali.
BACKGROUND
one of the pathogens strongly implicated in hospital infections. Data on the resistance and molecular characteristics of this bacterium are rare in Mali.
OBJECTIVE
This study aimed to evaluate the antibiotic resistance patterns, virulence factors of isolates from pleural fluid infections in hospitalized patients.
METHODS
Pleural effusion samples were obtained by thoracentesis for bacteriological examination from October 2021 to December 2022 at the "Hôpital du Mali" teaching hospital. Comorbidities such as HIV/AIDS and diabetes were assessed. Standard microbiological procedures were used for bacterial identification. The disk diffusion method was used to identify methicillin-resistant . The PCR amplification method was used to detect the following genes: , , , , and .
RESULTS
This study analyzed 6096 samples from inpatients and found a pooled frequency of bacterial pleuritis of 526 (8.6%) in thoracic surgery and pediatric wards. was isolated in 52 (9.88%) cases, of which 39 (75%) isolates were MRSA. There was no significant difference between the sexes (). The median age of the patients was 30 years. All isolates showed resistance to penicillin-G. The leucocidin toxin was detected in 7.7% of thoracic surgery patients, but , , , and toxins were not found.
CONCLUSION
In this study, we found a high frequency of (and MRSA) in pleurisy patients at the "Hôpital du Mali". Only the leukocidin was found. The empirical treatment protocol for pleurisy may need revision. Clindamycin, linezolid, teicoplanin, daptomycin, fosfomycin, vancomycin, moxifloxacin and fusidic acid were the most active antibiotics on our isolates in this study. Infection prevention measures, active surveillance, and effective therapeutic options are recommended.
PubMed: 38826428
DOI: 10.21203/rs.3.rs-3579825/v1 -
Cureus Apr 2024Pleural effusion is a medical condition where an excessive amount of fluid accumulates in the pleural space. This can be caused by inflammation or malignant growth in...
INTRODUCTION
Pleural effusion is a medical condition where an excessive amount of fluid accumulates in the pleural space. This can be caused by inflammation or malignant growth in the body. Doctors use medical thoracoscopy for both diagnostic and therapeutic purposes. This technique allows them to view the internal pleural surfaces and take biopsies of any abnormal lesions within the pleural cavity.
OBJECTIVE
This work aimed to evaluate the diagnostic value of pleuroscopy in patients with undiagnosed exudative pleural effusion.
PATIENTS AND METHODS
A study was conducted on 61 patients who had undiagnosed exudative pleural effusion and were admitted to the chest department at the cardiothoracic unit of the Minia University Hospital. All patients provided written consent and underwent a complete history and clinical examination. Standard laboratory tests, including routine liver and kidney function tests, a complete blood count, and a coagulation profile, were conducted on all patients, along with chest X-rays. If necessary, a chest CT scan was also performed. Diagnostic thoracentesis was done, and the pleural fluid was analyzed for sugar, protein, and lactate dehydrogenase and sent for bacteriological analysis (Gram stain, culture, and acid-fast bacilli smear) and cytopathological examination. Medical thoracoscopy was performed in cases where an etiological diagnosis was not established.
RESULTS
A total of 61 patients with undiagnosed exudative pleural effusions were included. A definitive etiological diagnosis was reached in 58 (95%) patients. In 47 (77%) of the studied group, malignant etiology was confirmed; nine (14.8%) had tuberculous pleurisy, one (1.6%) had empyema, and one (1.6%) had inflammatory/autoimmune pleurisy. A definite diagnosis was not reached in three (5%) patients. The malignant pathology was caused by bronchogenic carcinoma in 20 (42.5%) cases, malignant mesothelioma in 10 (21.3%) cases, metastatic malignant deposits from other organs in six (12.7%) cases, and lymphoma in three (6.5%) cases. No serious adverse events related to the procedure were recorded. The most common minor complications were transient chest pain in 34 (55.7%) patients, followed by surgical emphysema in 10 (16.4%) patients.
CONCLUSION
Pleuroscopy is an effective diagnostic tool for identifying the cause of pleural effusion when it is unclear. It is a minimally invasive and straightforward procedure associated with high diagnostic accuracy and low complication rates.
PubMed: 38813283
DOI: 10.7759/cureus.59300 -
Clinical Microbiology and Infection :... May 2024Tuberculous pleurisy is one of the most common types of extra-pulmonary tuberculosis, but the sensitivity of conventional mycobacterial culture (Culture) or Xpert...
Evaluation of droplet digital polymerase chain reaction by detecting cell-free deoxyribonucleic acid in pleural effusion for the diagnosis of tuberculous pleurisy: a multicentre cohort study.
OBJECTIVES
Tuberculous pleurisy is one of the most common types of extra-pulmonary tuberculosis, but the sensitivity of conventional mycobacterial culture (Culture) or Xpert MTB/RIF assay (Xpert) is not satisfying. This multicentre cohort study evaluated the accuracy of a new cell-free DNA droplet digital PCR assay (cf-ddPCR) for diagnosing tuberculous pleurisy.
METHODS
Patients with suspected tuberculosis (≥5 years of age) with pleural effusion were consecutively recruited from nine research sites across six provinces in China between September 2020 to May 2022. Culture, Xpert, Xpert MTB/RIF Ultra assay (Ultra), real-time PCR, and cf-ddPCR were performed simultaneously for all specimens.
RESULTS
A total of 321 participants were enrolled, and data from 281 (87.5%) participants were available, including 105 definite tuberculous pleurisy, 113 possible tuberculous pleurisy and 63 non-tuberculous pleurisy according to the composite reference standard. The sensitivity of cf-ddPCR was 90.5% (95/105, 95% CI, 82.8-95.1%) in the definite tuberculous pleurisy group, which was significantly higher than those of Culture (57.1%, 60/105, 95% CI, 47.1-66.6%, p < 0.001), Xpert (46.7%, 49/105, 95% CI, 37.0-56.6%, p < 0.001), Ultra (69.5%, 73/105, 95% CI, 59.7-77.9%, p < 0.001) and real-time PCR (75.2%, 79/105, 95% CI, 65.7-82.9%, p < 0.001). In possible tuberculous pleurisy, whose results of Culture and Xpert were both negative, the sensitivity of cf-ddPCR was 61.1% (69/113, 95% CI, 51.4-70.0%), which was still significantly higher than that of Ultra (27.4%, 31/113, 95% CI, 19.7-36.8%, p < 0.001) and real-time PCR (38.9%, 44/113, 95% CI, 30.0-48.6%, p < 0.001).
DISCUSSION
The performance of cf-ddPCR is superior to Culture, Xpert, Ultra, and real-time PCR, indicating that improved diagnostic accuracy can be anticipated by incorporating this new assay.
PubMed: 38810928
DOI: 10.1016/j.cmi.2024.05.012 -
Frontiers in Immunology 2024The possible protective effect of interleukin-32 (IL-32) in () infection has been indicated. However, few studies have been focused on IL-32 in tuberculosis patients....
The possible protective effect of interleukin-32 (IL-32) in () infection has been indicated. However, few studies have been focused on IL-32 in tuberculosis patients. Additionally, the regulation of IL-32 production has rarely been reported. In the present study, the production, regulation, and role of IL-32 in tuberculous pleurisy (TBP) were investigated. We found that the content of IL-32 in tuberculous pleural effusion (TPE) was higher than the level in the malignant pleural effusion and transudative pleural effusion. The level of IL-32 mRNA in pleural fluid mononuclear cells (PFMCs) was higher than that in peripheral blood mononuclear cells (PBMCs) of patients with TBP, and this difference was mainly reflected in the splice variants of IL-32α, IL-32β, and IL-32γ. Compared with the PBMCs, PFMCs featured higher IL-32β/IL-32γ and IL-32α/IL-32γ ratios. In addition, lipopolysaccharide (LPS), Bacillus Calmette-Guérin (BCG), and H37Ra stimulation could induce IL-32 production in the PFMCs. IL-32 production was positively correlated with the TNF-α, IFN-γ, and IL-1Ra levels in TPE, whereas IFN-γ, but not TNF-α or IL-1Ra, could induce the production of IL-32 in PFMCs. Furthermore, IL-32γ could induce the TNF-α production in PFMCs. Monocytes and macrophages were the main sources of IL-32 in PFMCs. Nevertheless, direct cell-cell contact between lymphocytes and monocytes/macrophages plays an important role in enhancing IL-32 production by monocyte/macrophage cells. Finally, compared with the non-tuberculous pleural effusion, the purified CD4 and CD8 T cells in TPE expressed higher levels of intracellular IL-32. Our results suggested that, as a potential biomarker, IL-32 may play an essential role in the protection against infection in patients with TBP. However, further studies need to be carried out to clarify the functions and mechanisms of the IFN-γ/IL-32/TNF-α axis in patients with TBP.
Topics: Humans; Interleukins; Tuberculosis, Pleural; Male; Female; Middle Aged; Adult; Pleural Effusion; Leukocytes, Mononuclear; Mycobacterium tuberculosis; Aged; Interferon-gamma
PubMed: 38803498
DOI: 10.3389/fimmu.2024.1342641 -
International Journal of Rheumatic... May 2024
Chest trauma-induced pleuritis with elevated pleural rheumatoid factor and adenosine deaminase levels in a patient subsequently diagnosed with rheumatoid arthritis: A case report.
Topics: Humans; Arthritis, Rheumatoid; Adenosine Deaminase; Pleurisy; Rheumatoid Factor; Biomarkers; Thoracic Injuries; Male; Treatment Outcome; Predictive Value of Tests; Up-Regulation; Tomography, X-Ray Computed; Middle Aged
PubMed: 38794838
DOI: 10.1111/1756-185X.15191 -
Cureus Apr 2024Immunoglobulin A vasculitis (IgAV), also known as Henoch-Schönlein purpura (HSP), is a disease that causes inflammation and bleeding in small blood vessels in the skin,...
Immunoglobulin A vasculitis (IgAV), also known as Henoch-Schönlein purpura (HSP), is a disease that causes inflammation and bleeding in small blood vessels in the skin, joints, intestines, and kidneys. Although various infections and chemicals are known to be triggers, the underlying cause of IgAV remains unknown. Here, we describe a case of an 86-year-old male patient with IgAV that developed after anti-tuberculosis treatment for tuberculous pleurisy. There have been several case reports implicating and other acid-fast bacterium in the development of IgAV, but only a few case reports implicating anti-tuberculous drugs. This case highlights the importance of recognizing that IgAV can be caused by anti-tuberculous drugs.
PubMed: 38779276
DOI: 10.7759/cureus.58707 -
Respiratory Research May 2024The association between tuberculous fibrosis and lung cancer development has been reported by some epidemiological and experimental studies; however, its underlying...
BACKGROUND
The association between tuberculous fibrosis and lung cancer development has been reported by some epidemiological and experimental studies; however, its underlying mechanisms remain unclear, and the role of macrophage (MФ) polarization in cancer progression is unknown. The aim of the present study was to investigate the role of M2 Arg-1 MФ in tuberculous pleurisy-assisted tumorigenicity in vitro and in vivo.
METHODS
The interactions between tuberculous pleural effusion (TPE)-induced M2 Arg-1 MФ and A549 lung cancer cells were evaluated. A murine model injected with cancer cells 2 weeks after Mycobacterium bovis bacillus Calmette-Guérin pleural infection was used to validate the involvement of tuberculous fibrosis to tumor invasion.
RESULTS
Increased CXCL9 and CXCL10 levels of TPE induced M2 Arg-1 MФ polarization of murine bone marrow-derived MФ. TPE-induced M2 Arg-1 MФ polarization facilitated lung cancer proliferation via autophagy signaling and E-cadherin signaling in vitro. An inhibitor of arginase-1 targeting M2 Arg-1 MФ both in vitro and in vivo significantly reduced tuberculous fibrosis-induced metastatic potential of lung cancer and decreased autophagy signaling and E-cadherin expression.
CONCLUSION
Tuberculous pleural fibrosis induces M2 Arg-1 polarization, and M2 Arg-1 MФ contribute to lung cancer metastasis via autophagy and E-cadherin signaling. Therefore, M2 Arg-1 tumor associated MФ may be a novel therapeutic target for tuberculous fibrosis-induced lung cancer progression.
Topics: Animals; Lung Neoplasms; Humans; Mice; Autophagy; Arginase; Disease Progression; Signal Transduction; Macrophages; Tuberculosis, Pleural; A549 Cells; Mice, Inbred C57BL; Pleural Effusion; Cell Polarity
PubMed: 38720340
DOI: 10.1186/s12931-024-02829-8 -
BMC Research Notes May 2024Thoracoscopy under local anaesthesia is widely performed to diagnose malignancies and infectious diseases. However, few reports have described the use of this procedure... (Observational Study)
Observational Study
OBJECTIVES
Thoracoscopy under local anaesthesia is widely performed to diagnose malignancies and infectious diseases. However, few reports have described the use of this procedure for diagnosing and treating intrathoracic infections. This study aimed to evaluate the safety and efficacy of thoracoscopy under local anaesthesia for the management of intrathoracic infections.
RESULTS
Data from patients who underwent thoracoscopy procedures performed by chest physicians under local anaesthesia at our hospital between January 2018 and December 2023 were retrospectively reviewed. We analysed their demographic factors, reasons for the examinations, diseases targeted, examination lengths, anaesthetic methods used, diagnostic and treatment success rates, as well as any adverse events. Thirty patients were included. Of these, 12 (40%) had thoracoscopies to diagnose infections, and 18 (60%) had them to treat pyothorax. In terms of diagnosing pleurisy, the causative microorganism of origin was identified via thoracoscopy in only three of 12 (25.0%) patients. For diagnosing pyothorax, the causative microorganism was identified in 7 of 18 (38.9%) patients. Methicillin-resistant Staphylococcus aureus was the most common causative microorganism identified. The treatment success rates were very high, ranging between 94.4 and 100%, whereas the identification rate of the causative microorganisms behind infections was low, ranging between 25.0 and 38.9%. The most frequent adverse events included perioperative hypoxaemia and pain. There were two (6.7%) serious adverse events of grade ≥ 3, but none resulted in death.
CONCLUSIONS
The efficacy of managing intrathoracic infections through thoracoscopy under local anaesthesia is commendable. Nonetheless, the diagnostic accuracy of the procedure, regarding the precise identification of the causative microorganisms responsible for intrathoracic infections, persists at a notably low level, presenting a substantial clinical hurdle.
Topics: Humans; Thoracoscopy; Male; Anesthesia, Local; Female; Middle Aged; Aged; Retrospective Studies; Adult; Treatment Outcome; Aged, 80 and over; Pleurisy; Empyema, Pleural
PubMed: 38705975
DOI: 10.1186/s13104-024-06794-9 -
Cureus Mar 2024Group B Streptococcus (GBS or ) is a common component of the human flora. However, infections in adults are infrequent, and occurrences of infectious pleurisy or septic...
Group B Streptococcus (GBS or ) is a common component of the human flora. However, infections in adults are infrequent, and occurrences of infectious pleurisy or septic arthritis are exceedingly uncommon. To our knowledge, the concurrent manifestation of both conditions has not been previously documented. We present the case of a 61-year-old man who exhibited an unusual association of infectious pleurisy and septic arthritis in the knee, both attributed to GBS. The patient was admitted to the hospital due to thoracic pain and discomfort in the left knee. Clinical examination revealed a pleural effusion in the left lung and arthritis in the left knee. Synovial and pleural fluid samples were sent to the bacteriology laboratory for cytobacteriological examination, confirming the presence of GBS in both fluids. The patient is diabetic and has a history of undergoing total cystoprostatectomy for a urothelial tumor, with the placement of a mono J catheter. The prevailing hypothesis suggests that the colonization of the mono J catheter, followed by hematogenous dissemination, is the probable source of the infection. This unusual clinical case underscores GBS's ability to induce severe invasive infections in adults, particularly in those with underlying medical conditions.
PubMed: 38681291
DOI: 10.7759/cureus.57160 -
Physiotherapy Theory and Practice Apr 2024Patients presenting to direct access physiotherapists may present with a serious pathology that mimics a musculoskeletal condition. Recognition of atypical clinical...
INTRODUCTION
Patients presenting to direct access physiotherapists may present with a serious pathology that mimics a musculoskeletal condition. Recognition of atypical clinical patterns allows for referral to an appropriate provider when a serious pathology is present. This case report details a patient with a pulmonary pathology who presented to a physiotherapist with a complaint of neck and chest pain following medical consultations.
CASE PRESENTATION
A 29-year-old amateur volleyball player arrived at the physiotherapist's clinic five days after experiencing the onset of neck pain. She complained of pain on the right side, which extended to the trapezius, as well as occasional discomfort in the lower lateral and anterior chest. The patient noted that the pain worsened when lying supine or on her left side, and during coughing. After developing symptoms resembling a cold, she sought care at two different emergency clinics where physicians diagnosed seasonal flu and an unrelated muscle strain. Despite treatment, the pain persisted, accompanied by fever and general weakness, disrupting her sleep. Following a review of a medical history and a physical examination, musculoskeletal causes of pain appeared unlikely, prompting consideration of a pulmonary pathology. Referral to a specialist was deemed necessary.
CONCLUSION
This case report highlights the importance of screening for serious pathology in direct access physiotherapy, irrespective of a prior physician consultation.
PubMed: 38661029
DOI: 10.1080/09593985.2024.2336103