ABSTRACT
Objective To investigate the clinical manifestations, imaging features, diagnosis and management of pulmonary mycosis.Methods Fifty-four patients were identified with pulmonary mycosis by pathological examination in our hospital from January 2002 to June 2008. Data of clinical manifestations, imaging features, diagnosis and management were retrospectively reviewed.Results Of the 54 cases, 30 (55.6%) were pulmonary aspergillosis, 15 (27.8%) were pulmonary cryptococcosis. Underlying disease was reported in 42 of 54 (77.8%) cases. The diagnosis of all the patients was confirmed by pathological exami-nation. Lung or bronchi tissue was obtained by operation in 30 (55.6%) cases, by bronchofibroscope in 12 (22.2%) cases, by CT-guided percutaneous needle biopsy in 9 (16.7%) cases, and by lymphoid node biopsy in 4 cases. Main symptoms included cough (41, 75.9%), expectoration (30, 55.6%), hemoptysis (20, 37.0%), fever (16, 29.6%), and asymptomatic (6, 11.1%). The X-ray and chest CT showed masses or nodule lesions (41, 75.9%), patchy lesions (8, 14.8%), cavity (12, 22.2%), diffuse milliary nodules (1 case). Bilateral lungs were involved in 7 cases (13.0%);right lung alone in 26 cases (48.1%);left lung alone in 21 cases (38.9%). Among the 54 cases, 41 (75.9%) were misdiagnosed before pathological examination. Thirty (55.6%) cases underwent surgical resection of pulmonary lesions. One patient suffered from cryptococcal meningitis after operation. Twenty (37.0%) patients received systemic anti-fugal therapy. Cure or significant improvement was found in 16 cases. Conclusions The most frequently isolated fungi were Aspergillus, followed by Cryptococcus. Final diagnosis is mainly dependent on pathological examination. Clinical manifestations, imaging features, diagnostic procedures and management are different due to the difference of pathogenic fungi. Satisfactory Results can be obtained by anti-fungal therapy combined with surgical management.
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Objective To determine the characterization of mucA gene mutation in clinically isolated Pseudomonas aeruginosa (P.aeruginosa), and the relation between mucA mutation and the mucoid phenotype.Methods A total of 58 strains of P.aeruginosa were collected. Of them,8 were nonmucoid phenotype and 50 were mucoid phenotype.We detected mucA mutations with PCR-SSCP and sequencing analysis. Alginate was examined by colorimetry. Results All strrains had mucA mutations (100%), 16 of the 50 (32%) isolates contained mucA mutations that could alter the encoding sequence of amino acids, and the rate in nonmucoid isolates was 0. Fourteen mutation sites were found, 5 of which could alter the encoding sequence of amino acids, and the others were silent mutations. The alginate concentration of mucoid P.aeruginosa was higher than the nonmucoid P.aeruginos(P＜0.01). The alginate concentration of the isolates which contained mucA mutations that could alter the encoding sequence of amino acid was higher than the strains only with silent mutations (P＜0.01).Conclusion mucA mutation correlates with the alginate production and phenotype of bacterial colonies.
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OBJECTIVE To investigate the pathogenic bacteria distribution and susceptibility of lower respiratory tract infection in patients in our respiratory ward.METHODS All the clinical isolates from sputum or secretion of lower respiratory tract from 2003 to 2007 were analyzed retrospectively.RESULTS A total of 1529 clinical isolates were collected,including 1326 strains of Gram-negative bacilli(86.7%) and 203 strains of Gram-positive cocci(13.3%).The proportion of Gram-negative bacilli was higher in lung underlying diseases group when compared with non-lung underlying diseases.Haemophilus parainfluenzae and H.influenzae were susceptible to spectinonycin,doxycycline and third-generation cephalosporins.Pseudomonas aeruginosa and Acinetobacter baumanni were susceptible to meropenem,cefoperazone/sulbactam and cefepime.Klebsiella pneumoniae and Escherichia coli were susceptible to meropenem,cefoperazone/sulbactam and amikacin.The major Gram-positive isolates were highly resistant to azithromycin,erythromycin,penicillin.All Staphylococcus aureus isolates were susceptible to vancomycin.Streptococcus pneumoniae isolates were highly susceptible to meropenem,levofloxacin,cefazolin and vancomycin.CONCLUSIONS Infection caused by Gram-negative bacilli are predominant in lower respiratory tract infection patients,especially in the patients with lung underlying diseases.Antibiotics resistance of some pathogens become increasingly severe.Therefore,the rational use of antibiotics is important for the containment of bacterial resistance.