Raoultella ornithinolytica in MALT-type non-Hodgkin Lymphoma.

Raoultella ornithinolytica is a bacterium that belongs to the Enterobacteriaceae family. The most frequently reported infections are gastrointestinal and hepatobiliary. Urinary tract infections are very rarely reported and bloodstream infections are usually reported without an identified source. This bacterium is responsible for an increasing number of infections, especially in immunocompromised patients. The authors describe the first case ever reported of an immunocompromised patient due to non-Hodgkin lymphoma MALT type and corticotherapy, who developed urinary tract infection and subsequently bacteriemia due to this pathogen. LEARNING POINTS: Raoultella ornithinolytica is a virulent pathogen causing community-acquired and hospital-acquired infection, especially in immunocompromised populations.Although most cases of R. ornithinolytica infection are susceptible to standard antibiotic regimens, multi-drug resistant strains have been reported, which may pose a severe risk to the immunocompromised patient.Physicians should be aware that some treatments may increase immunosuppression, thus enabling infection by opportunistic agents such as R. ornithinolytica.

Conventional versus pigtail chest tube-are they similar for treatment of malignant pleural effusions?

INTRODUCTION: The optimal chest tube type and size for drainage and chemical pleurodesis of malignant pleural effusions remains controversial. This retrospective study was conducted to compare the efficacy of conventional versus pigtail chest tube in the treatment of malignant pleural effusions. METHODS: Patients submitted to chest tube drainage and slurry talc pleurodesis due to malignant pleural effusion in our pulmonology ward from 2012 to 2016 were eligible. According to the type of chest tube, they were divided into two groups: group I-conventional chest tube and group II-pigtail chest tube. Number of deaths, recurrence of malignant pleural effusion, and timelines associated with the procedures were reviewed and compared between groups. RESULTS: Out of the 61 included patients, 46 (75.4%) were included in group I and 15 (24.6%) in group II. Only one patient had pigtail chest tube obstruction, with posterior insertion of conventional chest tube. Death during hospital stay and up to 3 months, recurrence at 4 weeks, total duration of hospital stay, time from chest tube insertion to pleurodesis, and time from chest tube insertion to removal were not significantly different between the two groups (all p > 0.05). DISCUSSION: These findings suggest that pigtail chest tube can be an alternative on palliation, with no compromise in pleurodesis performance.

Cork workers' occupational asthma: lack of association with allergic sensitisation to fungi of the work environment.

OBJECTIVES: To evaluate allergic sensitisation to Chrysonilia sitophila, Penicillium glabrum, and Trichoderma longibrachiatum in cork workers with asthma. METHODS: Skin prick tests with a battery of common allergens and with the three fungi were performed on ten cork workers with asthma and eight non-exposed asthmatics. Based on serial peak expiratory flow measurements, five were classified as having occupational asthma (AO) and five as having non-occupational asthma (NOA). In exposed patients, specific antibodies for the three fungi were also studied by immunoblotting RESULTS: Two out of ten patients with occupational exposure and four out of eight of the control group showed positive results for skin prick tests for common allergens. Moreover, two out of five patients with OA and three out of eight controls exhibited sensitisation to storage mites. All exposed patients (with OA or NOA) had negative skin prick test results for the fungal extracts. In patients with asthma and occupational exposure, immunoblotting results confirmed the absence of specific IgE. However, specific IgG4 was present in some cases. CONCLUSIONS: Atopy does not seem to characterise occupational asthma in cork workers. Despite their long exposure to moulds, we could not find evidence of IgE sensitisation to the three most prevalent cork fungi in patients with OA, which points to the search for other causative agents, such as cork chemical compounds or contaminants.