Diagnostic value of lymphocyte subset classification for active pulmonary tuberculosis in renal transplant recipients / 器官移植

Objective To evaluate the clinical value of lymphocyte subset classification in the diagnosis of active pulmonary tuberculosis in renal transplant recipients. Methods Clinical data of 52 recipients undergoing renal transplantation were retrospectively analyzed. According to the results of imaging and etiological examination, 52 recipients were divided into the stable group(n=19), tuberculosis group (n=9), bacteria group (n=12) and fungi group (n=12), respectively. The renal function of recipients was compared, and the proportion and absolute value of lymphocyte subset were analyzed and compared among four groups. The diagnostic value of lymphocyte subset classification for active pulmonary tuberculosis after renal transplantation was evaluated. Results Compared with the stable group, the levels of blood urea nitrogen and serum creatinine in the tuberculosis group, bacteria group and fungi group were significantly increased (all P < 0.05). The proportion of CD3+, CD8+, CD4+, natural killer (NK) cells and CD19+ lymphocyte subsets were not significantly different (all P>0.05). And the absolute values of CD3+, CD8+, CD4+, NK cells and CD19+ lymphocyte subsets were significantly decreased (all P < 0.05). The proportion of CD8+ lymphocyte subset in the tuberculosis group and fungi group was significantly higher than that in the bacteria group (both P < 0.05). The optimal cut-off value of CD8+ lymphocyte subset ratio in the differential diagnosis of active pulmonary tuberculosis and bacterial pneumonia was 33.27%, and the sensitivity and specificity were 0.889 and 0.833, respectively. The area under the curve (AUC) was 0.880. Conclusions The classification of lymphocyte subset can provide auxiliary diagnostic basis for differential diagnosis and individualized treatment of active pulmonary tuberculosis and bacterial pneumonia in renal transplant recipients.

Systemic air embolism in a fungal pneumonia patient with lung cavities formation and review of literature / 中华创伤杂志(英文版)

Systemic air embolism is a rare but potentially fatal complication related to many factors. The purpose of this article is to alert clinicians once patients occurs an abnormal neurological and cardiovascular status, following minor traumatic treatment, air embolism should be considered. A 20-year-old man who presented with fungal pneumonia with lung cavities formation was admitted to an intensive care unit (ICU) and received positive airway pressure ventilation. Four days later, the fungal pneumonia was improved, but the patient's blood pressure and arterial oxygen saturation deteriorated, so computed tomography (CT) scans were preformed to reevaluate him. The scans detected air embolism in the left atrium and ventricle, ascending aorta, aortic arch and its branches (right brachiocephalic, bilateral common carotid and right subclavian arteries), descending aorta and right coronary artery. A CT scan of the abdomen revealed air in the spleen, cauda pancreatic, superior mesenteric artery and right external iliac artery. The patient died two days later from multiple organ dysfunction. We suggest that vascular air embolism should be considered under mechanical ventilation when patients' neurologic and cardiovascular status deteriorates, and hyperbaric oxygen therapy should be conducted immediately.

Fungal pneumonia in dogs and cats with pulmonary clinical signs in southern Brazil / Pneumonia fúngica em cães e gatos do sul do Brasil com sinais clínicos pulmonares

Fungal pneumonia has been a differential diagnosis in dogs and cats with pulmonary clinical signs, posting also a public health risk to respective owners. Since a common-source environmental exposure may result in infection, dogs and cats may also act as sentinels for both animal and human disease. Accordingly, the present study has aimed to evaluate the occurrence of fungal pneumonia in dogs and cats with pulmonary clinical signs from May 2013 to February 2015 in southern Brazil. Thoracic radiographs, blood work and non-bronchoscopic Bronchoalveolar Lavage (BAL), followed by cytology and microbiologic analysis were performed in all animals. One dog was positive in the BAL fluid culture for a pathogenic fungus (Cryptococcus neoformans) and another dog to an opportunistic fungus (Candida parapsilosis). Both dogs have presented cough as the prior clinical sign and showed thoracic radiographic changes. In conclusion, the occurrence of fungal pneumonia in southern Brazil in dogs and cats through of this study was relatively low. The BAL fluid culture may allow diagnosis of fungal pneumonia caused by opportunistic or pathogenic fungi and this diagnosis should be a concern in dogs and cats with pulmonary clinical signs.(AU)

Pneumonia fúngica tem sido um diagnóstico diferencial em cães e gatos com sinais clínicos pulmonares, sendo também um risco de saúde pública para seus respectivos proprietários. Uma vez que uma fonte comum de exposição ambiental pode resultar em infecção, cães e gatos podem agir como sentinelas da doença para ambos, pessoas e animais. Assim, o presente estudo teve como objetivo avaliar a ocorrência de pneumonia fúngica em cães e gatos com sinais clínicos pulmonares, de maio de 2013 a fevereiro 2015 no sul do Brasil. Radiografias torácicas, exame de sangue e lavado broncoalveolar (LBA) não broncoscópico seguido de análise citológica e microbiológica foram realizados em todos os animais. Um cão foi positivo na cultura do fluido do LBA para um fungo patogênico (Cryptococcus neoformans) e outro cão para um fungo oportunista (Candida parapsilosis). Ambos os cães apresentaram tosse como sinal clínico principal e alterações radiológicas torácicas. Em conclusão, a ocorrência de pneumonia fúngica no sul do Brasil em cães e gatos por meio deste estudo foi relativamente baixa. A cultura do LBA pode possibilitar o diagnóstico de pneumonia fúngica causada por fungos oportunistas ou patogênicos e este diagnóstico diferencial deve ser uma preocupação em cães e gatos com sinais clínicos pulmonares.(AU)

The clinical predictive factors of ventilator-associated fungal pneumonia in emergency intensive care unit / 中华急诊医学杂志

Objective To explore the clinical risk factors of ventilator-associated fungal pneumonia (VAFP) in emergency intensive care unit.Methods One hundred and ninety-seven consecutive patients with 121 males and 76 females,aged from 17 to 98 years met the criteria of ventilator-associated pneumonia in emergency intensive care unit admitted from July 2009 to June 2014,were retrospectively evaluated.Those with mechanical ventilation less than 48 hours or treatment discontinued were excluded.Patients were divided into VAFP group and ventilator-associated non-fungal pneumonia group according to the results of fungal culture and microscopy.Univariate analysis was used to find out preliminary risk factors for VAFP,and then the ultimate independent risk factors were determined with multivariate stepwise logistic regression analysis.Results The occurrence of VAFP was 32.0 ％ (63 cases) out of 197 patients with ventilatorassociated pneumonia.In those 63 patients,there were 71 species found from fungus culture.Candida albicans counted for 33 (46.5％),Candida glabrata for 11 (15.5％),other Candida Albicans for 26 (36.6％).The preliminary univariate analysis showed that 19 factors were statistically significant,while multivariate stepwise logistic regression analysis revealed that acute physiology and chronic health evaluation Ⅱ score≥ 22,radiotherapy or chemotherapy,mechanical ventilation ≥14.11 days,use of antibiotics ≥14 days,use of glucocorticoid and other immuno-suppressants were independent predictors of VAFP,and the adjusted odds ratios with 95％ confidential intervals were 4.133 (2.831-6.033),2.977 (1.942-4.564),2.305 (1.439-3.736),1.988 (1.441-2.741),1.528 (1.337-1.746),respectively.Conclusion Higher APACHE Ⅱ score,radiotherapy or chemotherapy,prolonged use of mechanical ventilation,prolonged use of antibiotics,use of glucocorticoid and immunosuppressants are independent risk factors of VAFP.The incidence rate of VAFP may be reduced by improving patients' overall clinical setting,shortening the duration of mechanical ventilation and employment of antibiotics,and more strict guidelines to the application of glucocorticoid and immunosuppressants.

Aspergilose pulmonar em paciente imunocompetente e previamente sadio / Pulmonary aspergillosis in an immunocompetent and previously healthy patient

A aspergilose pulmonar compreende uma das formas de infecção por fungo do gênero Aspergillus, tendo diversos modos de apresentação clínica a depender da imunidade e comorbidades. O objetivo deste trabalho é relatar um caso de paciente, imunocompetente e previamente hígido, que desenvolveu uma forma de aspergilose pulmonar crônica e fazer uma breve revisão sobre o assunto.

Pulmonary aspergillosis includes one of the forms of fungal infection due to the genus Aspergillus, and has several modes of clinical presentation that depend on the immunity and comorbidities. The aim of this study was to report on the case of an immunocompetent and previously healthy patient who developed a form of chronic pulmonary aspergillosis, and to make a brief review on the subject.