ABSTRACT
Most episodes of peritoneal dialysis (PD)-related peritonitis could be attributed to a single organism, but in almost 10% of peritonitis episodes multiple organisms are identified. Polymicrobial peritonitis is often related to intra-abdominal pathology, and the prognosis may be poor. Aeromonas spp. have rarely been identified as the causative pathogen in PD-related peritonitis, and a very small number of cases has been reported in the literature. These rod-shaped, gram-negative microorganisms have been isolated from wastewater drainage systems, food, vegetables, and soil. Herein we report a case of polymicrobial peritonitis in a continuous ambulatory peritoneal dialysis (CAPD) patient with systemic lupus erythematosus (SLE), due to a combination of Streptococcus viridans and Aeromonas hydrophila infection. The patient was involved in gardening and was not compliant with her technique protocol. She did not wear a mask and omitted thorough hand washing. The patient was treated with i.p. vancomycin and ceftazidime and peritonitis was resolved. The patient's technique was reassessed, and she was retrained by our PD nurses.
Subject(s)
Aeromonas hydrophila/isolation & purification , Gram-Negative Bacterial Infections/microbiology , Kidney Failure, Chronic/therapy , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Peritonitis/microbiology , Anti-Bacterial Agents/therapeutic use , Female , Gram-Negative Bacterial Infections/drug therapy , Health Behavior , Health Knowledge, Attitudes, Practice , Humans , Middle Aged , Patient Education as Topic , Peritonitis/drug therapy , Streptococcal Infections/drug therapy , Streptococcal Infections/microbiology , Treatment Outcome , Viridans Streptococci/isolation & purificationABSTRACT
BACKGROUND: Accumulating evidence confirms the presence of pan-airway inflammation in allergic rhinitis patients. Smoking is known to affect the asthmatic airway inflammation. However, no study has evaluated the impact of smoking on airway inflammation of allergic rhinitis patients. OBJECTIVE: The aim of the present study was to evaluate the impact of smoking on inflammatory and oxidative stress biomarkers in patients with seasonal allergic rhinitis, using non-invasive methods for sample collection. METHODS: Forty patients with seasonal allergic rhinitis (20 smokers and 20 non-smokers) and 30 healthy subjects (15 smokers and 15 non-smokers) were recruited for the study during pollen season. All subjects were submitted to measurement of the fraction of exhaled NO (FeNO), exhaled breath condensate (EBC) collection, nasal lavage collection, pre- and post- bronchodilation spirometry and metacholine bronchial challenge testing. pH, leukotriene B(4) (LTB(4)) and 8-isoprostane were determined in EBC and nasal lavage samples. RESULTS: Patients with allergic rhinitis presented higher LTB(4) and 8-isoprostane levels in nasal lavage (P<0.0001 for both comparisons), with no significant differences between smokers and non-smokers. Patients with allergic rhinitis also presented higher LTB(4) levels and lower pH in EBC (P<0.001 and P=0.004, respectively), with prominent differences between smokers and non-smokers (P<0.0001 and P=0.003, for LTB(4) and pH, respectively). A significant correlation between nasal lavage and EBC LTB(4) values was observed (r(s)=0.313, P=0.048). CONCLUSIONS: Patients with allergic rhinitis present increased LTB(4) and 8-isoprostane in their nasal cavity, however, with no significant differences between smokers and non-smokers. In contrast, smokers with allergic rhinitis present higher LTB(4) levels and lower pH in EBC, suggesting that these patients may be more susceptible to the deleterious effects of smoking, compared with non-smokers.
Subject(s)
Inflammation/metabolism , Oxidative Stress , Rhinitis, Allergic, Seasonal/metabolism , Smoking/adverse effects , Smoking/metabolism , Adult , Biomarkers/analysis , Biomarkers/metabolism , Breath Tests , Dinoprost/analogs & derivatives , Dinoprost/analysis , Dinoprost/metabolism , Eosinophils/cytology , Female , Humans , Hydrogen-Ion Concentration , Immunoglobulin E/blood , Leukotriene B4/analysis , Leukotriene B4/metabolism , Male , Nasal Lavage Fluid/chemistry , Nasal Lavage Fluid/cytology , Nitric Oxide/analysis , Nitric Oxide/metabolism , Rhinitis, Allergic, Seasonal/bloodSubject(s)
Aquaporin 1/physiology , Peritoneal Dialysis/methods , Sodium/blood , Animals , Aquaporin 1/drug effects , Aquaporin 1/genetics , Biological Transport , Mercuric Chloride/pharmacology , Mice , Mice, Knockout , Permeability , Sheep , Sodium Channels/drug effects , Sodium Channels/physiologyABSTRACT
The effect of adrenaline on the transmesothelial resistance (RTM) of sheep's visceral and parietal pleura was studied using the Ussing chamber technique. Basal transmesothelial resistance of visceral pleura was found to be 20.71 +/- 0.31 Omega cm2, whereas that of parietal pleura was found to be 19.53 +/- 0.34 Omega cm2. Immediately after the addition of adrenaline (10(-7) M) both apically and basolaterally on the visceral and parietal pleura, these values were significantly increased (P < 0.05). Addition of the nonselective beta-receptor blocker, propranolol (10(-5) M), suppressed this effect in both visceral and parietal pleura, while addition of the nonselective alpha-receptor blocker, phentolamine (10(-5) M), partly suppressed the above-mentioned increase in the parietal pleura. In conclusion, our results show that adrenaline has a rapid effect on both pleurae. This rapid effect is mediated by the stimulation of beta-adrenergic receptors in the case of visceral pleura, while in the case of parietal pleura this effect seems to be due to a stimulation of alpha- and beta-adrenergic receptors. On the visceral pleura the effect of adrenaline vanishes after some minutes and on the parietal this effect is more permanent than the visceral's one, suggesting differences in the distribution of the adrenergic receptors between the visceral and parietal pleura.
