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1.
Chinese Journal of Contemporary Pediatrics ; (12): 31-36, 2024.
Article in Chinese | WPRIM | ID: wpr-1009889

ABSTRACT

OBJECTIVES@#To study the efficacy of bronchoalveolar lavage (BAL) combined with prone positioning in children with Mycoplasma pneumoniae pneumonia (MPP) and atelectasis and its effect on pulmonary function.@*METHODS@#A prospective study was conducted on 94 children with MPP and atelectasis who were hospitalized in Ordos Central Hospital of Inner Mongolia from November 2020 to May 2023. The children were randomly divided into a treatment group and a control group, with 47 children in each group. The children in the treatment group were given conventional treatment, BAL, and prone positioning, and those in the control group were given conventional treatment and BAL. The two groups were compared in terms of fever, pulmonary signs, length of hospital stay, lung recruitment, and improvement in pulmonary function.@*RESULTS@#Compared with the control group, the treatment group had significantly shorter time to improvement in pulmonary signs and length of hospital stay and a significantly higher rate of lung recruitment on day 7 of hospitalization, on the day of discharge, and at 1 week after discharge (P<0.05). Compared with the control group, the treatment group had significantly higher levels of forced vital capacity (FVC) as a percentage of the predicted value, forced expiratory volume (FEV) in 1 second as a percentage of the predicted value, ratio of FEV in 1 second to FVC, forced expiratory flow at 50% of FVC as a percentage of the predicted value, forced expiratory flow at 75% of FVC as a percentage of the predicted value, and maximal mid-expiratory flow as a percentage of the predicted value on the day of discharge and at 1 week after discharge (P<0.05). There was no significant difference in the time for body temperature to return to normal between the two groups (P>0.05).@*CONCLUSIONS@#In the treatment of children with MPP and atelectasis, BAL combined with prone positioning can help to shorten the time to improvement in pulmonary signs and the length of hospital stay and promote lung recruitment and improvement in pulmonary function.


Subject(s)
Child , Humans , Prospective Studies , Mycoplasma pneumoniae , Prone Position , Pulmonary Atelectasis/therapy , Pneumonia, Mycoplasma/therapy , Bronchoalveolar Lavage , Dimercaprol
2.
Chinese Journal of Contemporary Pediatrics ; (12): 1-13, 2024.
Article in Chinese | WPRIM | ID: wpr-1009885

ABSTRACT

Bronchoalveolar lavage (BAL) has become an important technique in the diagnosis and treatment of respiratory diseases in children. In order to standardize the clinical application of BAL in children, the Branch of Pediatric Critical Care Physicians of Chinese Medical Association, in collaboration with other institutions, has developed the "Clinical practice guidelines for bronchoalveolar lavage in Chinese children (2024)" based on the principles of the World Health Organization guidelines and the formulation/revision principles of the Chinese clinical practice guidelines (2022 edition). This guideline provides 30 recommendations to guide the operational procedures of BAL in children.


Subject(s)
Child , Humans , Bronchoalveolar Lavage/standards , Critical Care , East Asian People
3.
Rev. chil. infectol ; 40(5)oct. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1521875

ABSTRACT

Introducción: Las opacidades pulmonares en receptores de trasplante de precursores hematopoyéticos (TPH) representan un desafío diagnóstico y son una causa de morbimortalidad. Existen grandes discrepancias con respecto a la sensibilidad diagnóstica del lavado broncoalveolar (LBA), sus complicaciones, y los factores asociados a la identificación microbiológica. Objetivo: Conocer la utilidad del estudio microbiológico del LBA en el diagnóstico, modificación de la conducta médica y estimar las complicaciones y mortalidad asociada al procedimiento, en receptores de TPH con opacidades pulmonares. Pacientes y Métodos: Estudio de cohorte, retrospectivo, en adultos receptores de TPH a los que se les realizó una broncoscopía con LBA por presentar opacidades pulmonares, en el Hospital Italiano de Buenos Aires entre el 01/01/2011 y el 31/12/2020. Resultados: De los 189 procedimientos analizados, en 79 se logró un hallazgo microbiológico (41,8%) y 122 permitieron modificar la conducta médica (64,6%). En 11 casos se observaron complicaciones graves dentro de las 12 horas (5,8%) de efectuado el LBA. La mortalidad intrahospitalaria fue de 16,8% (N = 21/125). El valor de neutrófilos en sangre previo al LBA (p = 0,037) y la presencia de nódulos pulmonares como lesión tomográfica predominante (p = 0,029) se asociaron independientemente al hallazgo microbiològico global. Conclusiones: Nuestra investigación apoya la realización del LBA como herramienta diagnóstica en pacientes que reciben un TPH y presentan opacidades pulmonares.


Background: Lung opacities are a cause of morbimortality in bone marrow transplant patients, and represent a diagnostic challenge. There are large discrepancies regarding the diagnostic sensitivity of bronchoalveolar lavage (BAL), its complications, and the factors associated with microbiological detection. Aim: To know the usefulness of the microbiological study of BAL in the diagnosis, in the modification in medical behavior and to estimate the complications and associated mortality of this diagnostic procedure in patients transplanted with hematopoietic progenitor cells with pulmonary opacities. Methods: Retrospective cohort study in bone marrow transplant adult patients who underwent bronchoscopy with BAL due to lung opacities at Hospital Italiano de Buenos Aires between 01/01/2011 and 12/31/2020. Results: Of the 189 BAL analyzed, 79 presented a microbiological detection (41.8%) and 122 allowed to modify the medical behavior (64.6%). Severe complications were observed within 12 hours after the procedure in11 cases (5.8%). In-hospital mortality was 16,8% (N = 21/125). The value of blood neutrophils prior to bronchoalveolar lavage (p = 0.037) and the presence of pulmonary nodules as the predominant tomographic lesion (p = 0.029) were independently associated with global microbiological detection. Conclusion: Our research supports the performance of BAL as a diagnostic tool in bone marrow transplant patients with lung opacities.

4.
Article | IMSEAR | ID: sea-223577

ABSTRACT

Background & objectives: Tuberculosis, most commonly caused by Mycobacterium tuberculosis (MTB), is an infectious bacterial disease, with a major impact on global health. In this study, immunohistochemistry (IHC), acid-fast bacilli (AFB) culture and Ziehl-Neelsen (ZN) staining, techniques were compared on bronchoalveolar lavage (BAL) and bronchial washings (BW) with respect to sensitivity and specificity for detecting mycobacteria, taking culture as the gold standard. Methods: Consecutive BAL and BW specimens were included in the study, over a period of one year for which AFB cultures were available. Samples with diagnosis other than inflammatory pathology such as malignancies or inadequate samples were excluded. A total of 203 BAL and BW specimens from patients with age ranging from 14 to 86 yr were analyzed for the presence of mycobacteria. The utility and efficacy of ZN stain and IHC in detecting mycobacteria was tested using AFB culture as a gold standard. Results: Out of 203 cases, 10.3 per cent (n=21) were positive on AFB culture. Of these, 5.9 per cent (n=12) smears were positive for ZN stain, whereas IHC positivity was seen in 8.4 per cent (n=17) of the cases. ZN staining had a sensitivity of 57.1 per cent and a specificity of 100 per cent whereas, IHC had a sensitivity of 81 per cent and a specificity of 81.9 per cent. Interpretation & conclusions: Comparison with AFB culture (gold standard), IHC was found to be superior to ZN stain in terms of sensitivity, whereas ZN stain was found to be superior to IHC in terms of specificity. These findings therefore suggest that IHC may be a useful adjunct to ZN stain in the detection of mycobacteria in specimens from the respiratory tract.

5.
Article | IMSEAR | ID: sea-223569

ABSTRACT

Background & objectives: As CD4+ and CD8+ T lymphocyte numbers decline, the conventional, localized forms of tuberculosis shift to the atypical, disseminated forms. Variations in lymphocyte and immune cell expression levels affect how tuberculosis manifests in disseminated forms. Understanding the relationship between lymphocyte counts (CD4+ and CD8+) and pro-inflammatory cytokines such as tumour necrosis factor-alpha, interleukin-12 and interferon, we may therefore be able to shed light on how infections spread and suggest potential biomarkers for these immune factors. Methods: In this study, 15 guinea pigs were infected with Mycobacterium tuberculosis (M.tb) H37Rv strain and grouped into three groups of five each for further investigation. Serum samples and bronchoalveolar lavage (BAL) fluid were examined for the expression of pro-inflammatory cytokines and T-cell subsets in guinea pigs infected with pulmonary tuberculosis and disseminated tuberculosis. Results: We found that M.tb escapes macrophages due to pro-inflammatory cytokine dysregulation. Despite the protective immunity created by T-cells and cytokines, M.tb bacilli may spread to other organs due to inflammation induced by these immune components. A high number of T-cells and stimulated cytokine production are involved in triggering inflammation after necrotic tissue develops and tuberculosis spreads. Interpretation & conclusions: Our findings imply that increased bacilli in the spleen at the 8th wk of infection may be caused by the overexpression of CD4+ T-cell lymphocyte subsets and cytokines that generated inflammation during the 4th wk of infection. This is a pilot study with a small sample size and less assertive inference. Larger studies would be helpful to validate the results of the present investigation.

6.
Journal of International Oncology ; (12): 419-424, 2023.
Article in Chinese | WPRIM | ID: wpr-989579

ABSTRACT

Objective:To evaluate the diagnostic value and safety of transbronchial lung biopsy and bronchoalveolar lavage (BAL) in pulmonary complications in patients with hematological tumors.Methods:A retrospective analysis was performed on 68 patients with hematological tumors combined with lung lesions from The University of Hong Kong-Shenzhen Hospital and The Third People's Hospital of Shenzhen from May 2016 to May 2022, including 37 males, 31 females, with a median age of 56 years (age range 21-90 years), among which 20 patients were >65 years old. Diagnostic fiberoptic bronchoscopy was performed with signs including fever, cough, hypoxemia, hemoptysis, unexplained dyspnea, and imaging changes. Patients with pulmonary masses were evaluated for transbronchial lung biopsy, including inner and outer leaf mass and high-density shadow of lung leaves, pathological and special staining of biopsy tissue (Grocott staining), BAL acquisition of bronchoalveolar lavage fluid (BALF) for microbiological smear/culture, cytomegalovirus, Pneumocystis jirovecii and Mycobacterium tuberculosis (TB) smear, TB DNA, TB and fungal culture. Etiological analysis of pulmonary complications and observation of the complications associated with fiberoptic bronchoscopy in patients with hematological tumors were conducted. Results:BALF test was performed in all patients after bronchoscopy, bronchoscopic lung tissue biopsy was performed in 46 cases. The total number of confirmed pathogenic infections was 40, including 12 cases of fungal infections, 9 cases of bacterial infections (2 cases each of E. faecalis and Pseudomonas aeruginosa, 1 case of Staphylococcus aureus, 1 case of Klebsiella pneumoniae, 1 case of E. coli, 1 case of coagulase-negative Staphylococcus, and 1 case of Streptococcus mitis), 9 cases of viral infection (5 cases of cytomegalovirus, 3 cases of parainfluenza virus type Ⅲ, and 1 case of respiratory syncytial virus), 4 confirmed cases of Pneumocystis jirovecii pneumonia, 3 cases of suspected mixed infection of Pneumocystis jirovecii and fungi, 1 case of Cryptococcus, 2 cases of suspected TB infection. No pathogenic organisms were found in 28 cases, including 6 cases of mechanized pneumonia, 6 cases associated with a history of hematological tumors, and 16 cases of other unidentified pathogens. All patients did not experience death or other serious complications caused by bronchoscopy complications. Conclusion:Pulmonary complications are common in patients with hematological tumors, and the application of transbronchial lung biopsy has good safety. Early examination of fiberoptic bronchoscopy can provide pathogenic diagnostic evidence of bacterial, fungal, Pneumocystis jirovecii and viral infections, thus improving the diagnostic rate.

7.
China Tropical Medicine ; (12): 857-2023.
Article in Chinese | WPRIM | ID: wpr-1005154

ABSTRACT

@#Abstract:Objective To investigate the morphological features of the Pneumocystis jirovecii, in order to facilitate early detection and rapid diagnosis of this rare pathogen from a morphology point of view by laboratory technicians. By analyzing the laboratory features and application value of different pathogen detection methods in the diagnosis of Pneumocystis jirovecii pneumonia, we aim to provide the most reliable diagnostic basis for rapid diagnosis of Pneumocystis jirovecii pneumonia.Methods A retrospective analysis was conducted on the test results of bronchoalveolar lavage fluid samples from a comprehensive hospital in Zhangqiu District, Jinan City, Shandong Province, and a hospital in Changde City from April 2022 to October 2022. Five confirmed cases of Pneumocystis jirovecii pneumonia were detected. Its clinical manifestations, laboratory results, and morphological characteristics of pathogens under different stains were analyzed to discuss the advantages and disadvantages of different detection methods. Results Cytological examination of bronchoalveolar lavage fluid found the trophozoites and cysts of Pneumocystis jirovecii by Wright's-Giemsa staining in 4 cases (80%), and the cysts of Pneumocystis jirovecii by Silver hexamine staining in 4 cases (80%), while the metagenomic next-generation sequencing confirmed all the 5 positive results. All 5 patients had different degrees of reduction in the absolute count of peripheral blood lymphocytes, and the serum lactic dehydrogenase and (1-3)-β-D-Glucan were increased. Among the 5 patients in this study, 4 were treated with sulfamethoxazole combined with caspofungin, and 1 was treated with sulfamethoxazole. Three patients were cured and discharged from hospital after treatment, but two died. Conclusions The method of Wright's-Giemsa staining for the cytological examination of bronchoalveolar lavage fluid to find Pneumocystis jirovecii has the unique and irreplaceable advantages as silver staining. Metagenomic next-generation sequencing can further increase the positive detection rate of Pneumocystis jirovecii. The combination of cytological examination of bronchoalveolar lavage fluid with metagenomic nextgeneration sequencing is a powerful diagnostic method for rapid diagnosis of Pneumocystis jirovecii pneumonia, which can diagnose accurately and reduce missed diagnosis.

8.
China Tropical Medicine ; (12): 1099-2023.
Article in Chinese | WPRIM | ID: wpr-1016704

ABSTRACT

@#Abstract: Objective To analyze the clinical characteristics of children with lobar pneumonia and the distribution of pathogens in bronchoalveolar lavage fluid (BALF) collected from these patients, hence providing a scientific basis for their precise diagnosis and treatment. Methods A total of 115 children diagnosed with lobar pneumonia from August 2019 to August 2022 at Suining Central Hospital were screened as the research subjects. The clinical manifestations and occurrence of complications in the patients were investigated. All the children underwent bronchoalveolar lavage after admission, and BALF samples were collected. Fluorescence quantitative PCR was adopted to detect and analyze the distribution and clinical characteristics of Streptococcus pneumoniae (SP) and other related pathogenic microorganisms in BALF specimens. Results Among the 115 pediatric patients with lobar pneumonia, the occurrence of manifestations or complications including involvement of ≥2 lung lobes, myocardial damage, pleural effusion, abnormal liver function, digestive system involvement, nervous system involvement, rash, renal function impairment, and lung atelectasis were observed in 46, 46, 39, 33, 18, 17, 11, 5, and 4 cases, respectively. The pathogen positivity rate in the BALF samples of the 115 patients was 87.0% (100/115), with 81 cases of single infection and 19 cases of mixed infection. A total of 121 strains of pathogens were isolated, including 83 strains of Mycoplasmal pneumonia (MP) (accounting for 68.6%) and SP(13.2%). The differences in the detection rates of HI, MP, RSV strains among different age groups were statistically significant (χ2=8.834, 19.454, 10.284, P<0.05), while the differences in the infection rates of SP, KP, CP, and ADV were not statistically significant (χ2=3.393, 2.67, 0.565, 0.097, P>0.05). The MP pneumonia group showed significantly higher incidence of complications such as pleural effusion, nervous system involvement, and abnormal liver function than the non-MP pneumonia group (χ2=3.925, 4.195, and 4.513, P<0.05). The highest pathogen detection rate was in winter, accounting for 33.91%. Conclusions MP is the most common pathogen in BALF of children with lobar pneumonia. There is variation in the pathogen detection rate among different age groups and seasons. Those with combined infections were more prone to complications, which is worthy of attention by clinicians.

9.
China Tropical Medicine ; (12): 647-2023.
Article in Chinese | WPRIM | ID: wpr-979781

ABSTRACT

@#Abstract: Objective To investigate the diagnostic value of joint detection of Mycobacterium tuberculosis rifampicin resistance gene (Xpert MTB/RIF), Mycobacterium tuberculosis ribonucleic acid (TB-RNA) and Mycobacterium tuberculosis deoxyribonucleic acid (TB-DNA) in bronchoalveolar lavage fluid for smear-negative pulmonary tuberculosis. Methods A total of 806 patients with suspected smear-negative pulmonary tuberculosis admitted to our hospital from May 2020 to July 2022 were selected, 506 patients diagnosed as bacterial negative pulmonary tuberculosis by clinical, X-ray and sputum samples were classified as bacterial negative pulmonary tuberculosis group, and the other 300 patients with non-tuberculous pulmonary disease were classified as non-tuberculous pulmonary disease group. XpertMTB/RIF, TB-RNA and TB-DNA in bronchoalveolar lavage fluid of all patients were detected. With clinical, X-ray and sputum specimen examination of mycobacterium tuberculosis as the gold standard, the diagnostic efficacy of alveolar lavage solution Xpert MTB/RIF, TB-RNA and TB-DNA alone and in combination was analyzed. Results The positive detection rates of Xpert MTB/RIF, TB-RNA and TB-DNA in bronchoalveolar lavage fluid of the smear-negative pulmonary tuberculosis group and the non-tuberculosis pulmonary disease group were 69.96% (354/506) and 2.67% (8/300), 61.46% (311/506) and 5.00% (15/300), and 63.64% (322/506) and 8.00% (24/300), respectively. The rates in the smear-negative pulmonary tuberculosis group were higher than those in the non-tuberculosis lung disease group, and the differences were statistically significant (χ2=342.005, 246.930, 235.687, P<0.01). Compared with the gold standard, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of Xpert MTB/RIF in the diagnosis of smear-negative pulmonary tuberculosis were 69.96%, 97.33%, 80.15%, 97.79% and 65.77%, respectively; those values of TB-RNA were 61.46%, 95.00%, 73.95%, 95.40% and 59.38%, respectively; those values of TB-DNA were 63.64%, 92.00%, 74.19%, 93.06% and 60.00%, respectively; those values of combined diagnosis with Xpert MTB/RIF, TB-RNA and TB-DNA were 61.26%, 100.00%, 75.68%, 100.00% and 60.48%, respectively; the specificity and positive predictive value of combined detection were higher than those of single detection (P<0.05). Conclusions The joint detection of Xpert MTB/RIF, TB-RNA and TB-DNA in bronchoalveolar lavage fluid can improve the diagnostic efficacy of smear-negative pulmonary tuberculosis and is worthy of clinical promotion and application.

10.
Frontiers of Medicine ; (4): 1-14, 2023.
Article in English | WPRIM | ID: wpr-971637

ABSTRACT

The Omicron family of SARS-CoV-2 variants are currently driving the COVID-19 pandemic. Here we analyzed the clinical laboratory test results of 9911 Omicron BA.2.2 sublineages-infected symptomatic patients without earlier infection histories during a SARS-CoV-2 outbreak in Shanghai in spring 2022. Compared to an earlier patient cohort infected by SARS-CoV-2 prototype strains in 2020, BA.2.2 infection led to distinct fluctuations of pathophysiological markers in the peripheral blood. In particular, severe/critical cases of COVID-19 post BA.2.2 infection were associated with less pro-inflammatory macrophage activation and stronger interferon alpha response in the bronchoalveolar microenvironment. Importantly, the abnormal biomarkers were significantly subdued in individuals who had been immunized by 2 or 3 doses of SARS-CoV-2 prototype-inactivated vaccines, supporting the estimation of an overall 96.02% of protection rate against severe/critical disease in the 4854 cases in our BA.2.2 patient cohort with traceable vaccination records. Furthermore, even though age was a critical risk factor of the severity of COVID-19 post BA.2.2 infection, vaccination-elicited protection against severe/critical COVID-19 reached 90.15% in patients aged ≽ 60 years old. Together, our study delineates the pathophysiological features of Omicron BA.2.2 sublineages and demonstrates significant protection conferred by prior prototype-based inactivated vaccines.

11.
Frontiers of Medicine ; (4): 562-575, 2023.
Article in English | WPRIM | ID: wpr-982577

ABSTRACT

The Omicron family of SARS-CoV-2 variants are currently driving the COVID-19 pandemic. Here we analyzed the clinical laboratory test results of 9911 Omicron BA.2.2 sublineages-infected symptomatic patients without earlier infection histories during a SARS-CoV-2 outbreak in Shanghai in spring 2022. Compared to an earlier patient cohort infected by SARS-CoV-2 prototype strains in 2020, BA.2.2 infection led to distinct fluctuations of pathophysiological markers in the peripheral blood. In particular, severe/critical cases of COVID-19 post BA.2.2 infection were associated with less pro-inflammatory macrophage activation and stronger interferon alpha response in the bronchoalveolar microenvironment. Importantly, the abnormal biomarkers were significantly subdued in individuals who had been immunized by 2 or 3 doses of SARS-CoV-2 prototype-inactivated vaccines, supporting the estimation of an overall 96.02% of protection rate against severe/critical disease in the 4854 cases in our BA.2.2 patient cohort with traceable vaccination records. Furthermore, even though age was a critical risk factor of the severity of COVID-19 post BA.2.2 infection, vaccination-elicited protection against severe/critical COVID-19 reached 90.15% in patients aged ≽ 60 years old. Together, our study delineates the pathophysiological features of Omicron BA.2.2 sublineages and demonstrates significant protection conferred by prior prototype-based inactivated vaccines.


Subject(s)
Humans , Aged , Middle Aged , COVID-19/prevention & control , SARS-CoV-2 , Pandemics/prevention & control , China/epidemiology , Disease Outbreaks/prevention & control , Vaccination
12.
Chinese Journal of Industrial Hygiene and Occupational Diseases ; (12): 247-254, 2023.
Article in Chinese | WPRIM | ID: wpr-986023

ABSTRACT

Objective: To explore the composition of bacteria in lower respiratory tract of patients with pneumoconiosis and dust exposure, and to compare and analyze the difference and correlation between them. Methods: From May 2020 to January 2021, a prospective multicenter cross-sectional study was conducted to select patients with pneumoconiosis who underwent bronchoalveolar lavage treatment at the Respiratory and Critical Care Medical Department of the 920th Hospital of the Joint Support Force and the Respiratory Department of Tongren Hospital in Kunming, as well as the population of dust recipients. A total of 24 patients with pneumoconiosis (pneumoconiosis group) were included, and 16 dust exposed individuals (dust exposed group) were used as controls. Two groups of patients' alveolar lavage fluid were collected. The 16SrRNA gene V3-V4 sequencing technology and bioinformatics analysis platform were used to measure and analyze the differences in microbial structure composition and associations between bacterial communities. Results: Compared with the dust exposed group, the top 5 bacterial phyla in the alveolar lavage fluid level of patients with pneumoconiosis were the same, followed by Proteobacteria, Firmicutes, Bacteroidetes, Fusobacteria, and Actinobacteria. Compared with the dust exposure group, the pneumoconiosis group patients belong to the top 5 genera of horizontal flora abundance, which are different. The dust exposure group is respectively: Pseudomonas, Proctor, Streptococcus, Achromobacter, and Neisseria. The pneumoconiosis group is respectively: Pseudomonas, Achromobacter, Streptococcus, Ralstonia, and Proctor. The Alpha diversity analysis results showed that compared with the dust exposed group, the level of bacterial diversity in the pneumoconiosis group was difference (P<0.05), and there was no statistically significant difference in bacterial evenness (P>0.05) ; Beta diversity showed differences in microbial community structure between the two groups (P<0.05 ). Single factor microbial association network analysis showed that there was a high correlation between Firmicutes and Bacteroidetes in the pneumoconiosis and dust exposed groups and other species, showing a positive correlation; The correlation between Proteobacteria and other species is high, showing a negative correlation. Conclusion: The structure and relative abundance of bacteria in lower respiratory tract were different between patients with pneumoconiosis and dust exposure, and the diversity of bacteria in lower respiratory tract increased in patients with pneumoconiosis, which may be related to disease status.


Subject(s)
Humans , Cross-Sectional Studies , Prospective Studies , Pneumoconiosis , Bacteria/genetics , Dust , Respiratory System
13.
Chinese Journal of Contemporary Pediatrics ; (12): 1253-1258, 2023.
Article in Chinese | WPRIM | ID: wpr-1009877

ABSTRACT

OBJECTIVES@#To investigate the clinical application of metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) in the etiological diagnosis and treatment of refractory pneumonia (RTP) in children.@*METHODS@#A retrospective analysis was performed on 160 children with RTP who were admitted to the Department of Pediatric Internal Medicine, Maternal and Child Health Hospital of Inner Mongolia Autonomous Region, from January 2020 to March 2023. According to whether mNGS was performed, they were divided into two groups: mNGS (n=80) and traditional testing (n=80). All children received the tests of inflammatory markers and pathogen tests after admission. Traditional pathogenicity tests included microbial culture (sputum specimen collected by suction tube), nucleic acid detection of respiratory pathogens, and serological test (mycoplasma, tuberculosis, and fungi). For the mNGS group, BALF specimens were collected after bronchoscopy and were sent to the laboratory for mNGS and microbial culture. The two groups were analyzed and compared in terms of the detection of pathogens and treatment.@*RESULTS@#Compared with the traditional testing group, the mNGS group had a significantly higher detection rate of pathogens (92% vs 58%, P<0.05), with more types of pathogens and a higher diagnostic rate of mixed infections. Compared with the traditional testing group, the mNGS group had a significantly higher treatment response rate and a significantly lower incidence rate of complications during hospitalization (P<0.05). Treatment was adjusted for 68 children in the mNGS group according to the results of mNGS, with a treatment response rate of 96% (65/68) after adjustment.@*CONCLUSIONS@#Compared with traditional pathogen tests, BALF mNGS can significantly improve the detection rate of pathogens and find some rare pathogens. In clinical practice, when encountering bottlenecks during the diagnosis and treatment of children with RTP, it is advisable to promptly perform the mNGS to identify the pathogens.


Subject(s)
Humans , Child , Bronchoalveolar Lavage Fluid , Retrospective Studies , Pneumonia/therapy , High-Throughput Nucleotide Sequencing , Bronchoscopy , Sensitivity and Specificity
14.
Chinese Journal of Contemporary Pediatrics ; (12): 1052-1058, 2023.
Article in Chinese | WPRIM | ID: wpr-1009846

ABSTRACT

OBJECTIVES@#To investigate the risk factors for performing bronchoalveolar lavage (BAL) in children with Mycoplasma pneumoniae pneumonia (MPP) and pulmonary consolidation, and to construct a predictive model for performing BAL in these children.@*METHODS@#A retrospective analysis was performed for the clinical data of 202 children with MPP who were hospitalized in the Department of Pediatrics, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, from August 2019 to September 2022. According to whether BAL was performed, they were divided into BAL group with 100 children and non-BAL group with 102 children. A multivariate logistic regression analysis was used to identify the risk factors for performing BAL in MPP children with pulmonary consolidation. Rstudio software (R4.2.3) was used to establish a predictive model for performing BAL, and the receiver operator characteristic (ROC) curve, C-index, and calibration curve were used to assess the predictive performance of the model.@*RESULTS@#The multivariate logistic regression analysis demonstrated that the fever duration, C-reactive protein levels, D-dimer levels, and presence of pleural effusion were risk factors for performing BAL in MPP children with pulmonary consolidation (P<0.05). A nomogram predictive model was established based on the results of the multivariate logistic regression analysis. In the training set, this model had an area under the ROC curve of 0.915 (95%CI: 0.827-0.938), with a sensitivity of 0.826 and a specificity of 0.875, while in the validation set, it had an area under the ROC curve of 0.983 (95%CI: 0.912-0.996), with a sensitivity of 0.879 and a specificity of 1.000. The Bootstrap-corrected C-index was 0.952 (95%CI: 0.901-0.986), and the calibration curve demonstrated good consistency between the predicted probability of the model and the actual probability of occurrence.@*CONCLUSIONS@#The predictive model established in this study can be used to assess the likelihood of performing BAL in MPP children with pulmonary consolidation, based on factors such as fever duration, C-reactive protein levels, D-dimer levels, and the presence of pleural effusion. Additionally, the model demonstrates good predictive performance.


Subject(s)
Child , Humans , Mycoplasma pneumoniae , Retrospective Studies , C-Reactive Protein/analysis , Pneumonia, Mycoplasma/diagnosis , Bronchoalveolar Lavage , Pleural Effusion
15.
Acta bioquím. clín. latinoam ; 56(4): 407-413, dic. 2022. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1439095

ABSTRACT

Resumen La hemorragia alveolar difusa (HAD) es un síndrome clínico con una alta mortalidad que compromete la función respiratoria. Su diagnóstico se basa en pruebas clínicas, radiológicas y citológicas. El objetivo del trabajo fue ratificar el valor de referencia de hemosiderófagos en lavados broncoalveolares (BAL) (hemosiderófagos ≥20%), correlacionar con la etiología y definir las condiciones preanalíticas para que la reacción de Perls alcance valores elevados de sensibilidad. De 109 muestras de pacientes con sospecha de HAD, se analizaron 90 por cumplir los criterios de inclusión; 36 resultaron positivas para HAD, 3 falsamente negativas y 51 resultaron negativas. La sensibilidad fue de 92% y la especificidad de 100%. La mediana de hemosiderófagos para muestras con diagnóstico de HAD fue de 70%. Se agruparon según la etiología: procesos infecciosos puros (PI), enfermedades autoinmunes puras (EA), enfermedades neoplásicas puras (EN), enfermedades autoinmunes más procesos infecciosos (EA+PI), enfermedades neoplásicas más procesos infecciosos (EN+PI), misceláneas (MI). La mediana de hemosiderófagos para cada grupo fue: PI (n=7) 50%, EA (n=15) 58%, EN (n=6) 73%, EA+PI (n=5) 80%, EN+PI (n=4) 80%, MI (n=2) 45% (p=0,57). El porcentaje de pacientes fallecidos fue de 49% (n=19), con una mediana de hemosiderófagos de 70%, en comparación con la de pacientes no fallecidos de 64% (p=0,25). Se ratificó el valor de referencia para establecer el diagnóstico de HAD en muestras de BAL obtenidas luego de las 36 h de comenzados los síntomas utilizando la reacción de Perls, la cual demuestra una alta sensibilidad y especificidad para dicho diagnóstico.


Abstract Difusse alveolar hemorrhage (DAH) is a clinical syndrome with high mortality. Its diagnosis is based on clinical, radiological and cytological tests. The objective of this study was to ratify the reference value of hemosiderophages in bronchoalveolar lavages (BAL) (hemosiderophagues ≥20%), to correlate with the etiology and define the pre-analytical conditions for the Perls reaction to reach high sensitivity values. Out of the 109 samples from patients with suspected ADH, 90 were analysed for meeting the inclusion criteria; 36 were positive for HAD, 3 were false negatives, and 51 were negative (sensitivity 92%; specificity 100%). The median number of hemosiderophagues for samples with a diagnosis of ADH was 70%; they were grouped according to etiology: pure infectious processes (PI), pure autoimmune diseases (AD), pure neoplastic diseases (ND), autoimmune diseases plus infectious processes (AD + PI), and miscellaneous (MI). The median number of hemosiderophagues for each group was: PI (n=7) 50%, AD (n=15) 58%, ND (n=6) 73%, AD + PI (n=5) 80%, ND + PI (n=4) 80%, MI (n=2) 45% (p=0.57). The percentage of deceased patients was 49% (n=19), with a median hemosiderophague of 70%, compared with 64% of non-deceased patients (p=0.25). The reference value to establish the diagnosis of ADH in BAL simples obtained 36 hours after the beginning of symptoms using the Perls reaction was ratified, which shows a high sensitivity and specificity to make the diagnosis of ADH.


Resumo A hemorragia alveolar difusa (HAD) é uma síndrome clínica com alta mortalidade que compromete a função respiratória. Seu diagnóstico se baseia em testes clínicos, radiológicos e citológicos. O objetivo do trabalho foi ratificar o valor de referência de hemossiderófagos em lavagens broncoalveolares (LBA) (hemossiderófagos ≥20%), relacioná-los com a etiologia e definir as condições pré-analíticas para que a reação de Perls alcance valores elevados de sensibilidade. De 109 amostras de pacientes com suspeita de HAD, 90 foram analisadas para cumprir com os critérios de inclusão; 36 resultaram positivas para HAD, 3 foram falsos negativos e 51 resultaram negativas. A sensibilidade foi de 92% e a especificidade de 100%. A média de hemossiderófagos para amostras com diagnóstico de HAD foi de 70%, eles foram agrupados de acordo com a etiologia: processos infecciosos puros (PI), doenças autoimunes puras (DA), doenças neoplásicas puras (DN), doenças autoimunes mais processos infecciosos (DA+PI), doenças neoplásicas mais processos infecciosos (DN+PI), miscelâneas (MI). A média de hemossiderófagos para cada grupo foi: PI (n=7) 50%, DA (n=15) 58%, DN (n=6) 73%, DA+PI (n=5) 80%, DN+PI (n=4) 80%, MI (n = 2) 45% (p= 0,57). A porcentagem de pacientes falecidos foi de 49% (n=19), com uma média de hemossiderófagos de 70%, em comparação com 64% de pacientes não falecidos (p=0,25). Foi ratificado o valor de referência para estabelecer o diagnóstico de HAD em amostras LBA obtidas 36 horas após o início dos sintomas através da reação de Perls, que apresenta alta sensibilidade e especificidade para esse diagnóstico.

16.
Biomédica (Bogotá) ; 42(3): 460-469, jul.-set. 2022. tab, graf
Article in Spanish | LILACS | ID: biblio-1403598

ABSTRACT

Introducción. La coloración de Ziehl-Neelsen, con más de 100 años de uso, continúa vigente mundialmente. Objetivo. Comparar el rendimiento de las pruebas diagnósticas utilizadas para la determinación de micobacterias en el laboratorio clínico de patología en muestras de lavado broncoalveolar. Materiales y métodos. Se revisaron retrospectivamente 737 muestras de lavado broncoalveolar procesadas en el 2019 y el 2020 en el Hospital San Vicente Fundación (Medellín, Colombia) y se compararon las características de tres pruebas diagnósticas realizadas en paralelo: la reacción en cadena de la polimerasa (PCR) para micobacterias con detección de resistencia, el cultivo, y la coloración de Ziehl-Neelsen. Resultados. Se catalogaron como enfermos a 93 de los 737 pacientes a partir de los resultados positivos en alguna de las tres pruebas. El cultivo tuvo una sensibilidad de 0,80, la PCR una de 0,76 y la coloración de Ziehl-Neelsen una de 0,51. Sin embargo, solo 5 de 75 (6,5 %) cultivos fueron positivos a las cuatro semanas y el resto lo fue a las ocho semanas. La PCR combinada con la coloración de Ziehl-Neelsen mejoró la sensibilidad de la PCR por sí sola, de 0,76 a 0,88, diferencia que fue estadísticamente signifcativa (p=0,022). Conclusión. En las muestras de lavado broncoalveolar, el cultivo sigue siendo la prueba con mejor sensibilidad. El uso conjunto de la prueba de PCR y la coloración de ZiehlNeelsen mejora signifcativamente la sensibilidad de la primera, lo que compensa la demora relativa en la entrega de los resultados debida al tiempo requerido para la tinción de Ziehl-Neelsen.


Introduction: With more than 100 years of use, the Ziehl-Neelsen stain is still currently used worldwide. Objective: To compare the performance of diagnostic tests used to determine mycobacteria in the clinic and pathology laboratory in bronchoalveolar lavage samples. Materials and methods: We retrospectively reviewed 737 bronchoalveolar lavage samples from 2019 to 2020 in the San Vicente Fundación hospital (Medellín, Colombia) comparing the performance of three tests done in parallel: mycobacteria and resistance PCR, culture, and Ziehl-Neelsen stain. Results: In total, 93/737 patients were classifed as sick due to a positive result in any of the three tests. The culture, PCR, and Ziehl-Neelsen stain had a sensibility of 0.80, 0.76 y 0.51, respectively. However, only 5/75 (6.5%) of the positive cultures had results within the frst four weeks and the rest in eight weeks. The PCR test combined with the Ziehl-Neelsen stain improved the sensibility of the PCR test alone from 0.76 a 0.88, a change that was statistically signifcant (p = 0.022). Conclusion: At least in bronchoalveolar lavage samples, culture is still the test with better sensibility. The use in parallel of the PCR test and the Ziehl-Neelsen stain improved in a statistically signifcant manner the performance of the PCR test alone, regardless of the higher turnaround time of the Ziehl-Neelsen stain.


Subject(s)
Tuberculosis/diagnosis , Sensitivity and Specificity , Colombia , Bronchoalveolar Lavage
17.
Article | IMSEAR | ID: sea-221831

ABSTRACT

Understanding the etiology and the tempo of progression with inexorable and self-perpetuating fibrosis [identification of progressive-fibrotic (PF) phenotype of interstitial lung disease (ILD) (PF-ILD)] can help to decide the treatment of diffuse parenchymal lung disease (DPLD) in the real-world practice. An evidence-supported pragmatic approach has been forwarded for such circumstances.

18.
Rev. cuba. med. trop ; 74(2): e493, May.-Aug. 2022. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1408912

ABSTRACT

Introducción: Cryptosporidium spp. son parásitos que causan infecciones respiratorias principalmente en pacientes inmunocomprometidos. Objetivo: Detectar Cryptosporidium spp. en el lavado broncoalveolar (BAL) de pacientes VIH positivos y con síndrome respiratorio. Métodos: Se seleccionaron 60 muestras de BAL y se analizaron mediante microscopía óptica con tinción de Ziehl-Neelsen y PCR de punto final; esta última es una técnica eficiente para el diagnóstico de patógenos oportunistas. Se recolectaron datos clínicos y epidemiológicos de cada paciente. Resultados: La prevalencia hallada en este estudio mediante PCR de punto final fue del 5 %. Los signos y síntomas que se presentaron con mayor frecuencia, sobre todo en el grupo etario de 31 a 40 años, fueron fiebre, tos y disnea; sin embargo, no se obtuvieron asociaciones estadísticamente significativas a ninguna de las variables y no se pudo visualizar parásitos mediante la tinción de Ziehl-Neelsen. Conclusión: Cryptosporidium spp. puede causar infecciones pulmonares de difícil reconocimiento clínico, pues se confunde con otras infecciones oportunistas. En el presente estudio no puede establecerse si la detección del ADN parasitario correspondió a una verdadera infección o solamente a colonización, lo que es importante para implementar técnicas con mayor sensibilidad para el diagnóstico. Se debe considerar relevante la prevalencia encontrada en Ecuador, al ser inusualmente alta en comparación con países cercanos como Brasil(AU)


Introduction: Cryptosporidium spp. are parasites that cause respiratory infections mainly in immunocompromised patients. Objective: To detect Cryptosporidium spp. in bronchoalveolar lavage (BAL) of HIV-positive patients with respiratory syndrome. Methods: Sixty samples of BAL were selected and analyzed by optical microscopy with Ziehl-Neelsen staining and end-point PCR. The latter is an efficient technique for the diagnosis of opportunistic pathogens. Clinical and epidemiological data were collected from every patient. Results: In this study, the prevalence by end-point PCR was 5%. The most frequent signs and symptoms, mainly in the age group 31-40 years old, were fever, cough, and dyspnea. However, no significant statistical associations to any variable were obtained, and no parasites were observed with the Ziehl-Neelsen staining technique. Conclusions: Cryptosporidium spp. can cause pulmonary infections that are difficult to identify clinically, since they are confused with other opportunistic diseases. The current study could not establish whether the detection of parasitic DNA corresponded to a real infection or only to colonization, which is important to implement diagnostic techniques with greater sensitivity. The prevalence found in Ecuador should be considered relevant, as it is unusually high in comparison with nearby countries such as Brazil(AU)


Subject(s)
Humans
19.
Article | IMSEAR | ID: sea-220986

ABSTRACT

Abstract:Introduction:Tuberculosis (TB) has been one of the health problems in the world.Diagnosis of pulmonary tuberculosis based on finding of AFB in thesputum has several limitations and mycobacterial culture is timeconsuming. So we decided to evaluate biomarker like AdenosineDeaminase (ADA) activity in Bronchoalvolar Lavage(BAL) fluid .Objectives: To study level of BAL ADA in sputum negative suspectedcases of pulmonary tuberculosis and correlate it with BAL GenXpert(Cartridge Based Nucleic Acid Amplification) result.Method: We have enrolled suspected sputum negative pulmonary TBand suspected lung malignancy patients (as control). Total 33 patients -17 suspected sputum negative pulmonary TB, 16 suspected lungmalignancy were enrolled in study and subjected to bronchoscopy andBAL fluid was submitted for ADA level and GenXpert for TB.Result: Increased BAL ADA level was found in suspected sputumnegative pulmonary TB as compare to suspected malignancy. IncreasedBAL level was well correlared with GenXpert positivity in suspected TBgroup.Conclusion: BAL fluid ADA can be useful tool for early diagnosis ofsuspected sputum negative pulmonary TB.

20.
Organ Transplantation ; (6): 19-2022.
Article in Chinese | WPRIM | ID: wpr-907028

ABSTRACT

In recent years, the quantity of lung transplantation has been gradually increased in China along with the accumulation of surgical techniques and postoperative management experience of lung transplantation. Multiple lung allograft complications may occur after lung transplantation, mainly including primary graft dysfunction (PGD) caused by ischemia-reperfusion injury (IRI) of the lung allograft, acute and chronic rejection, opportunistic infection or lymphoproliferative disorder of lymphoid tissues induced by the decrease of host immunity due to postoperative use of immunosuppressants, etc. The diagnosis of complications after lung transplantation mainly relies on biopsy of the lung allograft. In this article, the brief history of lung allograft pathology, main approaches and pathological processing techniques of lung allograft biopsy, major complications after lung transplantation and pathological diagnostic criteria were elucidated, aiming to provide reference for targeted management of these complications in clinical practice.

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