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Cureus Nov 2023Tuberculosis is a highly infectious respiratory disease due to (MTb). The most common manifestation of MTb is pulmonary tuberculosis, but some patients can present with...
Tuberculosis is a highly infectious respiratory disease due to (MTb). The most common manifestation of MTb is pulmonary tuberculosis, but some patients can present with extrapulmonary manifestations as their initial presentation. Tuberculous pleurisy and pleural effusion are among the most common extrapulmonary manifestations of MTb. The treatment of pleural MTb is the same as the treatment for pulmonary disease, with a four-drug regimen with rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) under directly observed therapy (DOT). Drainage of the pleural effusion is usually not recommended in tuberculosis pleural effusion. We present a case of a complex, loculated pleural effusion due to MTb in an otherwise healthy middle-aged male who responded rapidly and completely to an early, short course of intrapleural tissue plasminogen activator and dornase alfa (TPA/DNase) therapy.
PubMed: 38125208
DOI: 10.7759/cureus.49125 -
Frontiers in Immunology 2023Emerging infectious diseases pose a significant threat to both human and animal populations. Rapid identification of protective antigens from a clinical isolate and...
BACKGROUND
Emerging infectious diseases pose a significant threat to both human and animal populations. Rapid identification of protective antigens from a clinical isolate and development of an antigen-matched vaccine is a golden strategy to prevent the spread of emerging novel pathogens.
METHODS
Here, we focused on , which poses a serious threat to the pig industry, and developed a general workflow by integrating proteosurfaceomics, secretomics, and BacScan technologies for the rapid identification of bacterial protective proteins from a clinical isolate.
RESULTS
As a proof of concept, we identified 3 novel protective proteins of . Using the protective protein HBS1_14 and toxin proteins, we have developed a promising multivalent subunit vaccine against .
DISCUSSION
We believe that our strategy can be applied to any bacterial pathogen and has the potential to significantly accelerate the development of antigen-matched vaccines to prevent the spread of an emerging novel bacterial pathogen.
Topics: Animals; Humans; Swine; Antigens, Bacterial; Bacterial Vaccines; Bacterial Proteins; Pleuropneumonia; Actinobacillus pleuropneumoniae
PubMed: 38098490
DOI: 10.3389/fimmu.2023.1274027 -
Frontiers in Medicine 2023Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibro-inflammatory disease with the potential to involve virtually all organs, including the pancreas, kidneys,...
Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibro-inflammatory disease with the potential to involve virtually all organs, including the pancreas, kidneys, lungs, and pleura, amongst others. IgG4-RD pleural involvement may cause diverse complications such as pleural effusion, pleural thickening, pleural nodules, and additional lesions, which can be presented in many clinical diseases. However, isolated cases of pleurisy are still rare in IgG4-RD. We report a 72-year-old patient who was admitted to our hospital with cough, expectoration, and fatigue. He had a right-sided pleural effusion, and the tissue evaluation of the pleural biopsy by medical thoracoscopy met the diagnostic criteria of IgG4-RD. His serum IgG4 levels were elevated and he was finally diagnosed with IgG4-RD pleural involvement. He was subsequently started on prednisone 40 mg daily and his pleural effusion was almost disappeared 2 weeks later. This paper reported a case of IgG4-RD who had exclusive involvement of the pleura and highlighted the significance of considering IgG4-RD as a potential diagnosis in patients with unexplained pleural effusion.
PubMed: 38089862
DOI: 10.3389/fmed.2023.1247884 -
Frontiers in Cellular and Infection... 2023There is a clinical challenge in diagnosing tuberculous pleurisy accurately and promptly, highlighting the urgent need for a rapid and sensitive diagnostic method. This...
INTRODUCTION
There is a clinical challenge in diagnosing tuberculous pleurisy accurately and promptly, highlighting the urgent need for a rapid and sensitive diagnostic method. This study aimed to evaluate the diagnostic accuracy of metagenomic next-generation sequencing (mNGS) and GeneXpert (MTB) for identifying tuberculous pleurisy and analyzing the microbial profiles of both tuberculous and non-tuberculous pleural effusions.
METHODS
The study enrolled 31 patients with suspected tuberculous pleurisy, of which 15 were confirmed to have tuberculous pleurisy and subsequently allocated to the tuberculous pleurisy group (TP group), while the remaining 16 individuals were assigned to the non-tuberculous pleurisy group (NTP group). mNGS and GeneXpert MTB were performed on pleural effusion samples, and the diagnostic accuracy of both tests was compared. We employed established formulas to compute crucial indicators, including sensitivity, specificity, missed diagnosis rate, misdiagnosed rate, positive predictive value (PPV), and negative predictive value (NPV).
RESULTS
The results showed that both tests had high specificity (100%) and positive predictive value (100%) for detecting tuberculous pleurisy, along with comparable sensitivity (46.67% for mNGS and 40.0% for GeneXpert MTB). Further analysis of the combined efficacy of mNGS and GeneXpert MTB showed that the combined test had a sensitivity of 66.67% and a specificity of 100%. mNGS analysis revealed that MTB was detected in 7 out of 15 patients with tuberculous pleural effusions, while non-tuberculous pleural effusions were associated with a diverse range of microbial genera and species. The most frequently detected genera at the microbial genus level in the NTP group were spp. (6/16), spp. (5/16), and spp. (5/16).
DISCUSSION
These findings suggest that mNGS and GeneXpert MTB are useful diagnostic tools for identifying patients with tuberculous pleurisy, and mNGS can provide valuable insights into the microbial profiles of both tuberculous and non-tuberculous pleural effusions.
Topics: Humans; Mycobacterium tuberculosis; Tuberculosis, Pleural; High-Throughput Nucleotide Sequencing; Sensitivity and Specificity; Pleural Effusion
PubMed: 38089819
DOI: 10.3389/fcimb.2023.1243441 -
Journal of Medical Biochemistry Oct 2023Tuberculous pleuritis (TP) is one of the most common extra-pulmonary tuberculosis form. Because of tuberculous pleurisy is hard to diagnose due to slow course of disease...
Tuberculous pleuritis (TP) is one of the most common extra-pulmonary tuberculosis form. Because of tuberculous pleurisy is hard to diagnose due to slow course of disease and lack of specificity in symptoms and diagnostic methods. In that reason, we need multidisciplinary approach and efficient biomarkers. Acid-fast bacilli (AFB) staining, cultures and pathophysiological biopsy finding from the majority of patients are positive only in less than 10%. Löwenstein culture results need time about 6-8 weeks what delays diagnosis. Adenosine deaminase (ADA) is biomarker with high sensitivity and specificity (more than 90%) and considered as gold standard of biomarkers in the diagnosis of TP. It is very hard to distinguish malignant from TP with lymphocyte predomination, but in patient with malignant pleural effusion the level of ADA is decreased, opposite from TP. ADA in pleural punctate is a fast, simple, efficient and economical way for clarification the etiology of the pleural effusion as tuberculous pleurisy. Also, many studies have proved the role of ADA in the response to treatment for tuberculosis at follow up period.
PubMed: 38084235
DOI: 10.5937/jomb0-44018 -
Journal of Veterinary Science Sep 2023Leopard cat () is a small wild cat assessed as an endangered wildlife in Korea. There have been very few reports of their diseases. Herein, we describe fibrinous...
Leopard cat () is a small wild cat assessed as an endangered wildlife in Korea. There have been very few reports of their diseases. Herein, we describe fibrinous pleuritis caused by infection with excessive pleural effusion, hydropericardium, mild ascites, and liver fibrosis in a leopard cat. is a commensal microflora in domestic cats and often affects the upper respiratory tract inducing chronic and severe respiratory diseases. However, there is no literature regarding the in leopard cats. Therefore, we first report fibrinous pleuritis associated with an infection in a leopard cat.
Topics: Cats; Animals; Streptococcus; Animals, Wild; Pleurisy; Cat Diseases
PubMed: 38031647
DOI: 10.4142/jvs.23080 -
Interventional Radiology... Nov 2023Image-guided percutaneous drainage for abscesses is known as a safe and effective treatment. The computed tomography-guided percutaneous drainage kit (SB Kawasumi Co.,...
PURPOSE
Image-guided percutaneous drainage for abscesses is known as a safe and effective treatment. The computed tomography-guided percutaneous drainage kit (SB Kawasumi Co., Ltd.), developed on the basis of a modified trocar method, has made it possible to complete the procedure only under computed tomography guidance without radiographic fluoroscopy. This study investigated the feasibility and safety of for abscess drainage.
MATERIAL AND METHODS
In this retrospective observational study, 28 procedures in 27 patients (18 men and 9 women; age 67.0 ± 12.3 years) who underwent computed tomography-guided drainage using between March and December 2021 at seven affiliated hospitals were analyzed. Patients with symptomatic, puncturable on computed tomography and refractory abscesses were included. Technical success (successful drainage with computed tomography alone), primary clinical success (successful drainage with alone), secondary clinical success (avoidance of surgery), and complications were evaluated.
RESULTS
The sites of the abscesses were the intraperitoneal, retroperitoneal, and thoracic cavities in 19, 5, and 2 patients, respectively, and subcutaneous tissue in 1 patient. The mean size of the abscesses was 7.1 ± 3.4 cm. The technical success rate was 96.4%; the ligament of the puncture route could not be penetrated in one case. The primary clinical success rate was 77.8%, whereas the secondary clinical success rate of catheter upsizing or replacement was 96.3%. Complications included one case of biliary pleurisy that required drainage.
CONCLUSIONS
is a useful device that allows abscess drainage using only computed tomography guidance without radiographic fluoroscopy.
PubMed: 38020458
DOI: 10.22575/interventionalradiology.2022-0027 -
Cureus Oct 2023Castleman's disease (CD) is an uncommon lymphoproliferative disorder with various presentations in different age groups. Although CD predominantly affects younger...
Castleman's disease (CD) is an uncommon lymphoproliferative disorder with various presentations in different age groups. Although CD predominantly affects younger individuals, cases in older people are rare. The presentation of CD can range from asymptomatic to severe. We present the case of a 91-year-old male who reported dyspnea and was subsequently diagnosed with right-sided pleural effusion. The patient's condition deteriorated despite an initial provisional diagnosis of tuberculous pleurisy and multiple interventions. A cervical lymph node biopsy later revealed a diagnosis consistent with the plasma cell type of CD. Considering the patient's age and atypical presentation, this case adds a unique perspective to the limited literature on CD in elderly patients. Its presentation can be highly variable, and pleural effusion is rare. Our case highlights the heterogeneity of CD presentation, particularly in older age groups. The diagnosis of CD requires high suspicion, particularly in non-traditional populations. Clinicians should be aware of the varied presentations of CD, including in older patients. Unexplained pleural effusion, even in older patients, should prompt a broad differential diagnosis, including rare conditions such as CD.
PubMed: 37965415
DOI: 10.7759/cureus.47035 -
BMC Infectious Diseases Nov 2023Pleural effusion (PE) is a common clinical feature that presents a diagnostic challenge for clinicians. In this retrospective study, we aimed to assess the biomarkers,...
BACKGROUND
Pleural effusion (PE) is a common clinical feature that presents a diagnostic challenge for clinicians. In this retrospective study, we aimed to assess the biomarkers, ratios, and multiple indicators in serum and Pleural effusion for the differential diagnosis of tuberculous pleural effusion (TPE) from non-tuberculosis effusion (non-TPE).
METHODS
The participants, who were divided into two groups: TPE and non-TPE (MPE and PPE), from Ningbo First Hospital, were incorporated in this study. The clinical and laboratory features were collected and analyzed using logistic regression analysis. Twelve biomarkers and their ratios in serum and PE were investigated for TPE versus non-TPE. Additionally, the value of multiple indicators for joint diagnosis was estimated.
RESULTS
Biomarkers and ratios showed good diagnostic performance. The five variables including Serum ADA, IGRA, Effusion ADA, Effusion ADA/Serum ADA and Effusion LDH/Effusion ADA were identified as valuable parameters for differential diagnosis of TPE from non-TPE. The combined diagnosis of the five indexes yielded the highest diagnostic accuracy for TPE with an AUC (0.919), sensitivity (90.30%), and specificity (94.50%).
CONCLUSIONS
The biomarkers and ratios demonstrated strong diagnostic performance, and the utilization of multiple indicators for joint diagnosis can improve the diagnostic efficacy of tuberculous pleurisy.
Topics: Humans; Retrospective Studies; Adenosine Deaminase; Pleural Effusion; Biomarkers; Tuberculosis, Pleural; Diagnosis, Differential
PubMed: 37940883
DOI: 10.1186/s12879-023-08781-0 -
Respiratory Medicine Dec 2023The pulmonary manifestations of Systemic Lupus Erythematosus (SLE) in pediatric patients are poorly understood and the pulmonary manifestations reported from the adult...
The pulmonary manifestations of Systemic Lupus Erythematosus (SLE) in pediatric patients are poorly understood and the pulmonary manifestations reported from the adult population are generally extrapolated to the pediatric population. In the present work, the review of 228 files was carried out, in which the pulmonary manifestations, symptoms and antibody levels of the patients treated at the Hospital Regional de Alta Especialidad de Ixtapaluca (HRAEI), State of Mexico, Mexico, were identified. Statistical significance between groups was estimated using the Chi-square and Mann-Whitney U test. The main pulmonary manifestations identified were pleurisy (14 %), pulmonary hemorrhage (3.9 %), pulmonary thromboembolism (0.9 %), acute lupus pneumonitis (0.4 %), pulmonary arterial hypertension (0.4 %), and small lung syndrome (0.4 %). While the initial symptomatology was dyspnea with an incidence of 9.6 %, the mean oxygen saturation in the population was 96.87 %. Pleural effusion was identified as the most frequent pulmonary manifestation in radiographic changes. No statistically significant difference was found in antibody levels when comparing the groups. The most common pulmonary manifestation associated with SLE is pleurisy, however, the range of pulmonary manifestations in this type of patient can be very varied, as well as the presentation of each of them.
Topics: Adult; Humans; Child; Lupus Erythematosus, Systemic; Lung Diseases; Lung; Pleurisy; Pleural Effusion
PubMed: 37926179
DOI: 10.1016/j.rmed.2023.107456