RESUMO
ObjectiveTo summarize the clinical features and prognosis of pulmonary mucormycosis （PM） in southern China， and to explore the diagnostic value of metagenomic next generation sequencing （mNGS） in PM. MethodsThe clinical manifestations， diagnosis， treatment and prognosis of patients diagnosed with PM in The First Affiliated Hospital of Sun Yat-sen University from January 1， 2019 to January 31， 2022 who had undergone mNGS detection in lung tissue or alveolar lavage fluid were collected retrospectively. A total of 14 patients with PM were included， including 4 patients with confirmed diagnosis and 10 patients with clinical diagnosis. ResultsAll patients had underlying medical conditions， with hematological malignancies and diabetes being the most common. The most common symptoms were fever （n = 10）， cough （n = 9） and shortness of breath （n = 9）. Consolidation was the most common sign of chest CT， followed by mass， mostly with cavity. On laboratory tests， decreased CD4+T lymphocytes， elevated CD8+T lymphocytes， and decreased CD4+/CD8+ ratio， and presentation with pleural effusion indicate poor prognosis. The positive rate of mNGS diagnosis was 78.5%， which was significantly higher than that of histopathology （50%）， fungus rapid fluorescence staining （61.5%） and fungal culture （23.1%） of bronchoalveolar lavage fluid. ConclusionsPulmonary mucormycosis is more likely to occur in patients with underlying diseases or who are immunocompromised. The clinical manifestations lack specificity. The low CD4/CD8 ratio and presentation of pleural effusion on CT imaging indicate poor prognosis of patients. mNGS is a rapid， convenient and sensitive method for the diagnosis of PM， which has advantages in the diagnosis of pulmonary mucormycosis.
RESUMO
OBJECTIVE: Fractional exhaled nitric oxide (FeNO) is a non-invasive method used to reveal the eosinophilic inflammation of airway and to diagnose and manage asthma. The use of FeNO measurement or its combination with the small airway function in differentiating CVA patients from chronic cough patients is unexplored. METHODS: From December 2012 to June 2016, patients with chronic non-productive cough for more than 8 weeks based on physician's opinion were subjected to FeNO, pulmonary function, and bronchial hyperresponsiveness (BHR) tests. Receiver operating characteristic (ROC) curves were obtained to evaluate the clinical value of FeNO and small airways indices in CVA diagnosis. The optimal cutoff point for the level of FeNO was also determined. RESULTS: The FeNO value in the CVA group was significantly higher than that in the non-cough-variant asthma (NCVA) group [42(41) parts per billion (ppb) vs. (16(11) ppb), P < 0.05]. The area under the ROC curve was estimated to be 0.874 for FeNO. An optimal cutoff point of 25 ppb had respective sensitivity and specificity values of 81.3% and 84.0% in differentiating CVA patients from NCVA patients. The CVA group showed small airway dysfunction, and the small airway resistance was significantly higher than in the NCVA group. The area under the ROC curve of FeNO combined with maximal midexpiratory flow (MEF) (% predicted) was 0.883, and that combined with MEF50 (% predicted) was 0.886. CONCLUSIONS: The measurement of FeNO is a non-invasive, reproducible, and sensitive method of differentiating CVA patients from NCVA patients. A combination of the level of FeNO (25 ppb) and the abnormal small airway function suggested higher CVA possibility, thereby resulting in a rapid diagnosis. Unnecessary treatments are avoided. This finding provides a new perspective for the management of patients with CVA.
