This study examined a case of ventilator-associated pneumonia caused by Ralstonia mannitolilytica in a neonatal department in order to determine the source of infection and mode of transmission.Symptoms of infection b...This study examined a case of ventilator-associated pneumonia caused by Ralstonia mannitolilytica in a neonatal department in order to determine the source of infection and mode of transmission.Symptoms of infection began to appear on day 16 of admission,and both sputum and catheter tip cultures revealed R.mannitolilytica.The infection control department of the hospital later sampled and identified R.mannitolilytica in the ventilator tube that was used by the patient with the exact gene sequence as the infecting strain.These findings indicate that ventilator tubing is a significant contamination source of this pathogen,and hospitals need to enhance their disinfection methods of ventilator-related devices.展开更多
Background:Hua-Yi-Jie-Du formula(HYJD)is a traditional Chinese medicine that has proven effective against viral pneumonia and was extensively used during the COVID-19 pandemic.This study investigates how HYJD influenc...Background:Hua-Yi-Jie-Du formula(HYJD)is a traditional Chinese medicine that has proven effective against viral pneumonia and was extensively used during the COVID-19 pandemic.This study investigates how HYJD influences group 2 innate lymphoid cell(ILC2)and nucleotide oligomerization domain(NOD)-like receptor protein 3(NLRP3)inflammasome activation in a mouse model of viral pneumonia.Methods:A mouse model of viral pneumonia was established through the administration of polyinosinic-polycytidylic acid(poly(I:C))via nasal drops.Histopathological analysis of lung tissue was conducted,alongside enzyme-linked immunosorbent assay to quantify cytokine levels in serum and bronchoalveolar lavage fluid(BALF).Flow cytometry was employed to detect ILC2 cells in lung tissue and spleen,while immunofluorescence techniques were utilized to visualize ILC2 cells in lung tissue.Transcriptomic sequencing was performed,and the results were validated using qRT-PCR and western blot analysis.Results:HYJD significantly ameliorated inflammatory infiltration in lung tissue,decreased mucus protein secretion,and reduced the serum levels of inflammatory cytokines interleukin(IL)-1β,IL-6,and tumor necrosis factor-alpha(TNF-α).Additionally,it lowered the expression of cytokines IL-4,IL-5,IL-13,IL-25,thymic stromal lymphopoietin(TSLP),and IL-33 in BALF,and reduced the differentiation of ILC2 cells in both lung tissue and spleen.Transcriptomic analysis and experimental validation revealed that HYJD downregulated the expression of NLRP3 related genes and proteins within the NOD-like receptor signaling pathway.Conclusion:The mechanism by which HYJD intervenes in acute lung injury associated with viral pneumonia may involve the reduction of ILC2 cells differentiation and the inhibition of NLRP3 activation.展开更多
Psittacosis pneumonia is a zoonotic disease caused by Chlamydia psittaci infection,with the lungs being the most affected organ.[1]Rhabdomyolysis is a clinical syndrome characterized by the massive release of intracel...Psittacosis pneumonia is a zoonotic disease caused by Chlamydia psittaci infection,with the lungs being the most affected organ.[1]Rhabdomyolysis is a clinical syndrome characterized by the massive release of intracellular components—such as myoglobin and creatine kinase—into the bloodstream due to skeletal muscle injury or necrosis.Common causes include trauma,medications,metabolic disorders,and infections.When psittacosis pneumonia is complicated by rhabdomyolysis,patients often develop multiple organ dysfunction and have a poor prognosis,necessitating early clinical intervention.展开更多
Community-acquired pneumonia(CAP)is a common respiratory tract infection in children that is caused by various pathogens,including bacteria,Mycoplasma pneumoniae(MP),respiratory syncytial virus(RSV),and SARS-CoV-2,whi...Community-acquired pneumonia(CAP)is a common respiratory tract infection in children that is caused by various pathogens,including bacteria,Mycoplasma pneumoniae(MP),respiratory syncytial virus(RSV),and SARS-CoV-2,whichwas themostwidespread causative pathogen in recent years.We compared pathogen-specific CAP to identify shared and distinct host responses.This single-center,retrospective cohort study enrolled 200 children hospitalized for CAP caused by SARS-CoV-2,MP,RSV and bacterial infections from January 2019 to February 2023.We included only patients with mild symptoms and performed propensity scorematching to adjust for age and sex.Patients with CAP due to COVID-19 were more prone to fever and poor appetite(P<0.01)but had a lower incidence of cough and moist and wheezing rales(P<0.01)and a shorter disease course(P<0.01).The frequencies of antibiotic,anti-inflammatory drug and oxygen therapy use were lower in the CAP-COVID-19 group than in the non-COVID-19 CAP groups(P<0.01).Additionally,white blood cell,lymphocyte and eosinophil counts were lower in the CAP-COVID-19 group than in the non-COVID-19 CAP groups(P<0.01).However,the procalcitonin levels in the CAP-COVID-19 group were higher than those in the CAP-bacteria(P<0.05)and CAP-MP groups(P<0.01).Moreover,we observed significant differences in nutritional status(total protein and albumin),renal function(serum creatinine and urea)and myocardial function(creatine kinase and creatine kinase-MB)between the CAP-COVID-19 and CAP-MP groups.Our results revealed shared and distinct pathophysiological features across pathogen-specific CAP,enabling precise diagnosis and treatment.展开更多
Mycoplasma pneumoniae(M.pneumoniae)is a common pathogen that causes community-acquired pneumonia in children.The clinical presentation of this pathogen can range from mild self-limiting illness to severe and refractor...Mycoplasma pneumoniae(M.pneumoniae)is a common pathogen that causes community-acquired pneumonia in children.The clinical presentation of this pathogen can range from mild self-limiting illness to severe and refractory cases.Complications may occur,such as necrotizing pneumonia and respiratory failure.Extrapulmonary complications,including encephalitis,myocarditis,nephritis,hepatitis,or even multiple organ failure,can also arise.In this editorial,we dis-cuss the clinical implications of the significant findings from the article"Serum inflammatory markers in children with M.pneumoniae pneumonia and their predictive value for mycoplasma severity"published by Wang et al.They reported that measuring lactic dehydrogenase,interleukin-6 levels,and D-dimer effectively predicts refractory M.pneumoniae pneumonia cases.展开更多
Background: Mycoplasma pneumoniae (MP) is the primary causative agent of community-acquired pneumonia, which has increasingly become resistant to macrolides, complicating treatment regimens, especially with the co-inf...Background: Mycoplasma pneumoniae (MP) is the primary causative agent of community-acquired pneumonia, which has increasingly become resistant to macrolides, complicating treatment regimens, especially with the co-infection factor. Its worldwide prevalence has fluctuated due to the influence of the COVID-19 pandemic. The study investigated co-infection patterns in children diagnosed with Mycoplasma pneumoniae pneumonia (MPP). Methods: From June 2022 to December 2023, we retrospectively analyzed the clinical data for hospitalized children with Mycoplasma pneumoniae pneumonia in Wuhan, China. We collected data on age, sex, clinical information, and pathogenic results. We also collected sputum or bronchoalveolar lavage fluid (BALF) samples to test respiratory pathogens and macrolide resistance using targeted microbial next-generation sequencing (tNGS). We analyzed the data using SPSS. Results: The study involved 417 patients diagnosed with MPP, of whom 86.33% had co-infections. Co-infections were notably linked to lobar pneumonia, prominent imaging shadows and higher macrolide resistance rate. Key bacterial pathogens were Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, rhinoviruses, and human adenoviruses (HADV). In MPP cases, Candida albicans was the fungal pathogen related to co-infections. The co-infection with HADV and human bocavirus 1 (HBoV1) correlated with prolonged fever, whereas Bordetella pertussis was linked to prolonged cough. In contrast, Candida albicans exhibited a weaker association with diffuse large-area infiltration on chest imaging, and its co-infection was less likely to result in severe disease. Conclusion: These results offer valuable insight into Mycoplasma pneumoniae pneumonia in children, highlighting the impact of co-infections on the disease’s clinical outcomes.展开更多
BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits f...BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits for nonischemic chest pain in Western Europe and North America.The most common symptoms of clinical presentation are chest pain and shortness of breath with associated unique electrocardiographic changes.Acute pericarditis is generally self-limited.However,some cases may be complicated by either tamponade or a large pericardial effusion,which carries a significant risk of recurrence.Risk factors for acute pericarditis include viral infections,cardiac surgery,and autoimmune disorders.A rarer cause of pericardial inflammation includes pneumonia,which can induce purulent pericarditis that has been increasingly rare since the advent of antibiotics.Purulent pericarditis carries a high fatality rate,especially in the setting of tamponade,and is invariably deadly without the administration of antibiotics.Bedside transthoracic echocardiogram is a quick and helpful method that can aid in the diagnosis and management.CASE SUMMARY We present the case of a 62-year-old woman who sought medical attention at the emergency department(ED)due to a 5-day history of chest pain,shortness of breath,and subjective fevers.Laboratory findings in the ED were significant for leukocytosis and elevated erythrocyte sedimentation rate and C-reactive protein.A chest X-ray revealed a new focal density within the left lower lung base,and a bedside point-of-care ultrasound showed a pericardial fluid collection.The patient was subsequently admitted,where she underwent pericardiocentesis.Fluid cultures from drainage grew streptococcus pneumoniae.She was started on broadspectrum antibiotics immediately after the procedure.The patient was ultimately discharged in stable condition with cardiology and infectious disease follow-up.CONCLUSION This case report emphasizes a unique complication of community-acquired pneumonia.Purulent pericarditis due to streptococcus pneumonia occurs via intrathoracic spread of the organism to the pericardium.This condition is virtually fatal without the administration of antibiotics.Therefore,in the context of suspected pneumonia and a new pericardial fluid collection on imaging,clinicians should suspect purulent pericarditis until proven otherwise,which requires emergent intervention.展开更多
Background:Bacterial pneumonia remains a leading cause of morbidity and mortality worldwide despite the widespread availability of antibiotics.Novel pneumonia therapies and biomarkers are urgently needed to improve ou...Background:Bacterial pneumonia remains a leading cause of morbidity and mortality worldwide despite the widespread availability of antibiotics.Novel pneumonia therapies and biomarkers are urgently needed to improve outcomes and advance personalized therapy.Using an established baboon model of S.pneumoniae pneumonia,we sought to characterize the temporal dynamics of pneumonia host responses to identify novel potential diagnostic and therapeutic molecular targets.Methods:We performed whole blood transcriptomics,unbiased proteomics,and peripheral cytokine measurements serially in baboons inoculated with S.pneumoniae(n=23)or saline(n=10)and modeled the peripheral blood host response using principal components analysis and complex sparse logistic regression.Differentially expressed genes were analyzed for pathway analysis.Results:Inoculated animals developed characteristic signs and symptoms of pneumonia.A 39-gene signature was derived that classified S.pneumoniae infection with high accuracy(auROC 0.9 and 0.99 at 24 and 48 h post-inoculation,respectively).Similar performance was observed for 48-h biomarker signatures derived from peripheral blood plasma proteomic and cytokine measurements(both auROC>0.9).The gene signature retained strong diagnostic performance(auROC=0.88)when transformed to human orthologs and applied to patients with acute respiratory illness(n=34)or healthy controls(n=20).Pathway analysis at 48 h identified downregulation of mitophagy and glucocorticoid signaling in peripheral blood.Conclusions:We report novel peripheral blood gene and protein expression signatures of S.pneumoniae pneumonia that could improve pneumonia diagnosis and found distinct pathways that may be amenable to modulation.Our findings illustrate how non-human primate models of bacterial pneumonia can successfully translate biomarker discoveries to patients.展开更多
BACKGROUND Mycoplasma pneumoniae(MP)is a prevalent pathogen that causes respiratory infections in children and adolescents.AIM To assess the differences in the clinical features of MP-associated communityacquired pneu...BACKGROUND Mycoplasma pneumoniae(MP)is a prevalent pathogen that causes respiratory infections in children and adolescents.AIM To assess the differences in the clinical features of MP-associated communityacquired pneumonia(CAP)in children who presented with mild or severe mycoplasma pneumoniae pneumonia(MPP);to identify the incidence of myocardial damage between the two groups.METHODS This work is a retrospective study.We identified children between 2 mo and 16 years of age with clinical and radiological findings consistent with CAP.We admitted patients to the inpatient department of the Second Hospital of Jilin University,Changchun,China,from January 2019 to December 2019.RESULTS A total of 409 hospitalized patients were diagnosed with MPP.Among them were 214(52.3%)males and 195(47.7%)females.The duration of fever and cough was the longest in severe MPP cases.Similarly,plasma levels of highly sensitive Creactive protein(t=-2.834,P<0.05),alanine transaminase(t=-2.511,P<0.05),aspartate aminotransferase(t=-2.939,P<0.05),and lactate dehydrogenase(LDH)(t=-2.939,P<0.05)were all elevated in severe MPP cases compared with mild MPP cases,and these elevations were statistically significant(P<0.05).Conversely,the neutrophil percentage was significantly lower in severe MPP cases than in mild MPP cases.The incidence of myocardial damage was significantly higher in severe MPP cases than in mild MPP cases(χ^(2)=157.078,P<0.05).CONCLUSION Mycoplasma pneumoniae is the main cause of CAP.The incidence of myocardial damage was higher and statistically significant in severe MPP cases than in mild MPP cases.展开更多
BACKGROUND Liver transplant(LT)recipients are susceptible to carbapenem-resistant Klebsiella pneumoniae(CRKP)infections.Comprehensive research addressing the incidence,timing,infection sites,resistance patterns,treatm...BACKGROUND Liver transplant(LT)recipients are susceptible to carbapenem-resistant Klebsiella pneumoniae(CRKP)infections.Comprehensive research addressing the incidence,timing,infection sites,resistance patterns,treatment options,and associated risk factors among LT recipients with CRKP is now lacking.AIM To assess the incidence,resistance,therapy,and risk factors of CRKP infections post-LT,and to evaluate the impact of them on prognosis.METHODS A retrospective study was conducted,including 430 consecutive patients who underwent LT between January 2015 and June 2023.This study aimed to investigate the risk factors for CRKP infections and their influence on outcomes using logistic regression analysis.RESULTS Among the 430 patients who underwent LT,20(4.7%)experienced at least one documented CRKP infection within 3 months post-transplantation.The median time from LT to the onset of CRKP infections was 6.5 days.The lungs and bloodstream were the most common sites of CRKP infections.CRKP isolates were relatively susceptible to ceftazidime/avibactam(93.7%),polymyxin B(90.6%),and tigecycline(75.0%)treatment.However,all isolates were resistant to piperacillin/tazobactam,ceftazidime,cefepime,aztreonam,meropenem,and levofloxacin treatment.Recipients with CRKP infections had a mortality rate of 35%,the rate was 12.5%for those receiving ceftazidime/avibactam therapy.Multivariate analysis identified female sex[odds ratio(OR)=3.306;95%confidence interval(CI):1.239-8.822;P=0.017],intraoperative bleeding≥3000 mL(OR=3.269;95%CI:1.018-10.490;P=0.047),alanine aminotransferase on day 1 post-LT≥1500 U/L(OR=4.370;95%CI:1.686-11.326;P=0.002),and post-LT mechanical ventilation(OR=2.772;95%CI:1.077-7.135;P=0.035)as significant variables associated with CRKP.CRKP infections were related to an intensive care unit length(ICU)of stay≥7 days and 6-month all-cause mortality post-LT.CONCLUSION CRKP infections were frequent complications following LT,with poor associated outcomes.Risk factors for post-LT CRKP infections included female sex,significant intraoperative bleeding,elevated alanine aminotransferase levels,and the need for mechanical ventilation.CRKP infections negatively impacted survival and led to prolonged ICU stays.展开更多
AIM:To report the demographic and systemic characteristics of patients,clinical progression of endophthalmitis,and the efficacy of various treatment strategies,with a focus on identifying key factors for preserving vi...AIM:To report the demographic and systemic characteristics of patients,clinical progression of endophthalmitis,and the efficacy of various treatment strategies,with a focus on identifying key factors for preserving vision in eyes with endogenous endophthalmitis due to Klebsiella pneumoniae(K.pneumoniae)liver abscess.METHODS:In this single-center,retrospective case series of 18 patients with endogenous endophthalmitis due to K.pneumoniae liver abscess were analyzed.Ophthalmologic features of endophthalmitis at early,intermediate and advanced stages were obtained from eyes with endophthalmitis of different severities.Prompt vitrectomy was considered primarily for all eyes except for very early endophthalmitis.Intravitreal injections of antibiotics were performed in eyes with endophthalmitis in the very early stages and in eyes where vitrectomy was not available,and additional control of infection was needed after vitrectomy.Evisceration was performed in eyes with corneoscleral perforation,advanced endophthalmitis,perforation with preseptal or orbital cellulitis,uncontrolled infection,or severe pain with no vision.RESULTS:Mean(±standard deviation)age of the 18 patients with endophthalmitis was 64.5±12.2(range:32-84)y,and 14 patients(77.8%)were males.Endophthalmitis tended to involve the retinal parenchyma first and then progressed into the vitreous cavity and anterior segments.However,it presented a tendency to cause massive subretinal abscesses even after vitrectomy with silicone oil tamponade.Very high intraocular pressure with new vessels on the iris(41.7%)were also commonly observed.Although all but three patients had systemic disease such as diabetes or hypertension,visual prognosis after treatment did not appear to depend significantly on underlying comorbidities.A final best-corrected visual acuity better than 20/60 was achieved only when lesions were detected very early,with relatively good initial visual acuity,likely reflecting lower bacterial inoculation in the eye.CONCLUSION:Detection of early endophthalmitis lesions appears to be the only way to preserve good vision in patients with K.pneumoniae liver abscesses.Therefore,proper guidelines for ophthalmologic screening remain to be established for subjects at a high risk of endophthalmitis.展开更多
There exists a notion that there is an obesity paradox in the prognosis of community-acquired pneumonia.In other words,obese individuals with communityacquired pneumonia have a better prognosis.The study by Wang et al...There exists a notion that there is an obesity paradox in the prognosis of community-acquired pneumonia.In other words,obese individuals with communityacquired pneumonia have a better prognosis.The study by Wang et al supports this claim,but we believe that the obesity paradox should not be proposed hastily as it is influenced by numerous subjective and objective confounding factors.展开更多
Introduction: The misuse of antibiotics has driven the emergence of antimicrobial resistance, with certain bacterial species, including Klebsiella pneumoniae, initially susceptible to most antibiotics, now exhibiting ...Introduction: The misuse of antibiotics has driven the emergence of antimicrobial resistance, with certain bacterial species, including Klebsiella pneumoniae, initially susceptible to most antibiotics, now exhibiting resistance to multiple antimicrobial agents. The objective of this study was to investigate the distribution and antimicrobial resistance profiles of Klebsiella pneumoniae strains isolated at the Yaoundé Central Hospital. Methodology: The study was conducted over a period of 4 months (March 1st, 2023-July 1st, 2023) and involved 32 strains isolated from bacterial cultures performed on patients, regardless of sex. The different Klebsiella pneumoniae strains were isolated using conventional methods. Identification, antibiogram, and detection of resistance enzyme production were generated using the VITEK 2 system. The Carbapenem-resistant K.N.I.V.O. kit was used to detect carbapenemases. Data analysis was performed using EXCEL 2019 software. Results: Out of 196 samples collected from various biological products, 32 Klebsiella pneumoniae strains were isolated, representing 16.32% (196/32). Urine samples were most frequently affected, accounting for 53.125%. The emergency department was the most represented (40.63%) by these isolates. The mean age was 50 years, with a minimum of 20 years and a maximum of 80 years. The sex ratio was equal to 1. The identified strains were resistant to cefotaxime (78.13%), cefoxitin (62.50%), tobramycin (71.88%), gentamicin (56.25%), ofloxacin (81.25%), and cotrimoxazole (78.13%). 78.25% were ESBL producers. Three strains were resistant to carbapenems, accounting for 9.37%;one of which exhibited the NDM type. Conclusion: This study highlights the evolving bacterial resistance to antibiotics, which requires adequate measures through the strengthening of the Antimicrobial Resistance (AMR) program in Cameroon.展开更多
Sickle cell anemia (SCA) is a prevalent genetic disorder primarily affecting individuals of African descent and populations in malaria-endemic regions, with significant global public health implications. Sickle cell c...Sickle cell anemia (SCA) is a prevalent genetic disorder primarily affecting individuals of African descent and populations in malaria-endemic regions, with significant global public health implications. Sickle cell crises are their most common acute complication, characterized by episodes of intense pain and systemic manifestations that impair quality of life and impose a high healthcare burden. We present the case of a 19-year-old male diagnosed with SCA since the age of two, who developed a sickle cell crisis precipitated by right basal pneumonia. The patient exhibited sudden-onset, cyclic lumbar pain with progressive dyspnea. Initial management included multimodal pain control, volume optimization, and targeted antimicrobial therapy to achieve clinical stabilization. This case underscores the importance of a comprehensive approach to managing sickle cell crises, addressing both symptomatic relief and the prevention and treatment of complications. It also highlights the need for public health strategies promoting early diagnosis, access to disease-modifying therapies such as hydroxyurea, and interdisciplinary follow-up to mitigate the socioeconomic and clinical impact of SCA.展开更多
Background: Puffy hand syndrome (PHS) is a rare complication primarily associated with intravenous drug use (IVDU), characterized by chronic swelling and fibrosis of the hands due to lymphatic damage. Concurrent pulmo...Background: Puffy hand syndrome (PHS) is a rare complication primarily associated with intravenous drug use (IVDU), characterized by chronic swelling and fibrosis of the hands due to lymphatic damage. Concurrent pulmonary complications, such as pneumonia and pneumothorax, significantly contribute to increased morbidity in this population. Case Presentation: We report the case of a 28-year-old female who injects drugs, and presents with fever, bilateral hand edema, and respiratory symptoms. Clinical evaluation revealed erythema and edema of both hands, elevated inflammatory markers, and a left lower lobe infiltration that progressed to pneumothorax. A diagnosis of PHS and left lower lobe pneumonia complicated by pneumothorax was established. Management and Outcomes: The patient was treated with broad-spectrum antibiotics, including ceftriaxone, levofloxacin, dexamethasone, and oxygen supplementation, as well as antipyretics. She demonstrated partial clinical improvement and was referred to another hospital’s thoracic surgery department for specialized care. Conclusions: This case underscores the importance of early recognition and multidisciplinary management of rare but serious complications in IVDU patients. Further research is necessary to elucidate the interplay between lymphatic dysfunction and pulmonary pathophysiology in this demographic.展开更多
Background:Bacterial pneumonia continues to be a significant global health concern,particularly among high-risk groups,necessitating the development of precise and early diagnostic biomarkers.While the efficacy of pro...Background:Bacterial pneumonia continues to be a significant global health concern,particularly among high-risk groups,necessitating the development of precise and early diagnostic biomarkers.While the efficacy of procalcitonin(PCT)and C-reactive protein(CRP)as inflammatory markers is widely recognized,their relative diagnostic performance across different age groups remains debate.This meta-analysis was designed to assess the diagnostic accuracy of PCT and CRP in bacterial pneumonia.Methods:In this meta-analysis adhering to PRISMA guidelines,we searched PubMed,Web of Science,and the Cochrane Library for relevant diagnostic accuracy studies.From 19 included studies(n=2,603),data were extracted to construct tables.Study quality was assessed with the QUADAS-2 tool.The bivariate random-effects model was employed to derive pooled sensitivity,specificity,positive and negative likelihood ratios,and summary AUCs.To explore the substantial heterogeneity(I^(2)>80%),we performed pre-specified subgroup analyses based on age demographics.Results:Our findings indicate superior diagnostic performance for PCT,evidenced by a pooled sensitivity of 0.8841 and specificity of 0.8499,relative to CRP’s sensitivity of 0.8371 and specificity of 0.7185.The area under the ROC curve(AUC)for PCT was 0.992,a value significantly higher than that of CRP(0.987).Intriguingly,subgroup analyses revealed age-dependent variations:CRP demonstrated enhanced diagnostic utility in minors,while PCT proved substantially more effective in non-elderly adults.Conclusion:These results reinforce the clinical relevance of PCT as a more dependable biomarker for bacterial pneumonia,particularly in informing antibiotic treatment and mitigating misuse.This study uniquely includes age-stratified analyses based on predefined groups(minors and non-elderly adults),providing refined insights for individualized diagnostic approaches.We propose further multicenter research endeavors to confirm threshold optimization and explore combined biomarker strategies.展开更多
BACKGROUND Pediatric complicated community-acquired pneumonia(CCAP)is on the rise.The three subtypes include para-pneumonic effusion(PPE),necrotizing pneumonia(NP),and empyema.AIM To study different sub-types of pedia...BACKGROUND Pediatric complicated community-acquired pneumonia(CCAP)is on the rise.The three subtypes include para-pneumonic effusion(PPE),necrotizing pneumonia(NP),and empyema.AIM To study different sub-types of pediatric CCAP,and compare their etiology,clinical profile,and outcome in the post-pneumococcal vaccination era.METHODS This prospective observational study was conducted over a 2-year period.All details(demographics,clinical,management,and outcomes)were recorded.Continuous data were presented either as mean and SD,or as median and interquartile range.Categorical data were presented as frequencies and percentages(%).Data were analyzed by using the IBM SPSS Statistics for Windows,version 21(IBM Corp.,Armonk,NY,United States).RESULTS Of the 80 cases included(71%aged 4-8 years),the distribution was as follows:PPE(42%),empyema(39%),and NP(19%).Bacterial etiology was identified in 28%(empyema 63%,P=0.012).Staphylococcus aureus(45%)was most common followed by Escherichia coli(E.coli)(22.7%),and Streptococcus pneumoniae(13.6%).Patients with empyema,compared to PPE and NP,were less likely to receive prior antibiotics(32%vs 56%and 58%,respectively,P=0.03).Duration(days,mean±SD)of hospitalization was longer in children with NP compared to empyema and PPE(17.7±9.8,16.1±7.5,and 13.6±4.2,respectively).All children recovered with the medical management except 2 children requiring decortication.CONCLUSION Staphylococcus aureus and E.coli are the most common bacterial etiology in the post-pneumococcal vaccination era.Empyema might be related to a delay in antibiotics administration.NP is the most severe pediatric CCAP with prolonged hospitalization.展开更多
Multidrug-resistant Klebsiella pneumoniae(MDR-KP)is characterized by high mortality and risk of nosocomial transmission,and biofilm constitutes the primary challenge in the treatment of its implant-associated and refr...Multidrug-resistant Klebsiella pneumoniae(MDR-KP)is characterized by high mortality and risk of nosocomial transmission,and biofilm constitutes the primary challenge in the treatment of its implant-associated and refractory pulmonary infections.Notably,the hypoxic microenvironment and the physical barrier of biofilm leading to the increased tolerance of the bacteria to antibiotics.Herein,a hypoxia-responsive hybrid nanoparticle(CHLip@FLD/COL)loaded separately with anti-biofilm candidate fingolimod(FLD)and antibiotic colistin(COL)is achieved targeting antibacterial efficacy against MDR-KP in vitro and in vivo.CHLip@FLD/COL is composed of hybridizing hypoxia-responsive lipids(HLipid)and lipid A targeting materials DSPE-mPEG-COL.HLipid is synthesized by hexadecanedioic acid esterified with nitroimidazole,while DSPE-mPEG is coupling with vector COL via amide reaction.The relative level of extracellular polymeric substances and the NIR-IIb sO2 images of the infection site are used as indicators to establish mature biofilm models.CHLip@FLD/COL readily releases FLD and COL in hypoxic conditions,and its MIC against MDR-KP is only one-sixteenth of that when COL is used alone in vitro.The nanoparticle exhibits bacterial targeting ability and antibacterial effect in the pulmonary infection and biofilm infection mice models.Bacterial loads eliminated by 4 Log10 CFU and 2 Log10 CFU,respectively.The strategy provides a valuable reference for the treatment of refractory infections caused by MDR-KP.展开更多
Exogenous lipoid pneumonia is a rare and under recognized pulmonary disorder caused by the inhalation or aspiration of fat-like substances.Nasal decongestants containing mineral oils or paraffin are emerging as overlo...Exogenous lipoid pneumonia is a rare and under recognized pulmonary disorder caused by the inhalation or aspiration of fat-like substances.Nasal decongestants containing mineral oils or paraffin are emerging as overlooked etiological agents.This review consolidates existing literature to delineate the clinical,radiological,and pathological features of exogenous lipoid pneumonia induced by nasal decongestants,highlight diagnostic challenges,and underscore the importance of thorough patient history in early diagnosis and management.This condition,while preventable,can result in serious pulmonary complications if not recog-nized early.It necessitates a multidisciplinary approach that incorporates careful history taking,high-resolution imaging,cytological assessment,and public health vigilance.展开更多
BACKGROUND:Community-acquired pneumonia(CAP)represents a significant public health concern due to its widespread prevalence and substantial healthcare costs.This study was to utilize an integrated proteomic and metabo...BACKGROUND:Community-acquired pneumonia(CAP)represents a significant public health concern due to its widespread prevalence and substantial healthcare costs.This study was to utilize an integrated proteomic and metabolomic approach to explore the mechanisms involved in severe CAP.METHODS:We integrated proteomics and metabolomics data to identify potential biomarkers for early diagnosis of severe CAP.Plasma samples were collected from 46 CAP patients(including27 with severe CAP and 19 with non-severe CAP)and 19 healthy controls upon admission.A comprehensive analysis of the combined proteomics and metabolomics data was then performed to elucidate the key pathological features associated with CAP severity.RESULTS:The proteomic and metabolic signature was markedly dif ferent between CAPs and healthy controls.Pathway analysis of changes revealed complement and coagulation cascades,ribosome,tumor necrosis factor(TNF)signaling pathway and lipid metabolic process as contributors to CAP.Furthermore,alterations in lipid metabolism,including sphingolipids and phosphatidylcholines(PCs),and dysregulation of cadherin binding were observed,potentially contributing to the development of severe CAP.Specifi cally,within the severe CAP group,sphingosine-1-phosphate(S1P)and apolipoproteins(APOC1 and APOA2)levels were downregulated,while S100P level was signifi cantly upregulated.CONCLUSION:The combined proteomic and metabolomic analysis may elucidate the complexity of CAP severity and inform the development of improved diagnostic tools.展开更多
文摘This study examined a case of ventilator-associated pneumonia caused by Ralstonia mannitolilytica in a neonatal department in order to determine the source of infection and mode of transmission.Symptoms of infection began to appear on day 16 of admission,and both sputum and catheter tip cultures revealed R.mannitolilytica.The infection control department of the hospital later sampled and identified R.mannitolilytica in the ventilator tube that was used by the patient with the exact gene sequence as the infecting strain.These findings indicate that ventilator tubing is a significant contamination source of this pathogen,and hospitals need to enhance their disinfection methods of ventilator-related devices.
基金supported by Yunnan Provincial Major Science and Technology Special Program(No.202402AA310035)Yunnan Key Laboratory of Dai and Yi Medicines(Yunnan University of Chinese Medicine)(No.2024JS2404)Research Foundation of Chuxiong Medical College(No.2024YYXM38).
文摘Background:Hua-Yi-Jie-Du formula(HYJD)is a traditional Chinese medicine that has proven effective against viral pneumonia and was extensively used during the COVID-19 pandemic.This study investigates how HYJD influences group 2 innate lymphoid cell(ILC2)and nucleotide oligomerization domain(NOD)-like receptor protein 3(NLRP3)inflammasome activation in a mouse model of viral pneumonia.Methods:A mouse model of viral pneumonia was established through the administration of polyinosinic-polycytidylic acid(poly(I:C))via nasal drops.Histopathological analysis of lung tissue was conducted,alongside enzyme-linked immunosorbent assay to quantify cytokine levels in serum and bronchoalveolar lavage fluid(BALF).Flow cytometry was employed to detect ILC2 cells in lung tissue and spleen,while immunofluorescence techniques were utilized to visualize ILC2 cells in lung tissue.Transcriptomic sequencing was performed,and the results were validated using qRT-PCR and western blot analysis.Results:HYJD significantly ameliorated inflammatory infiltration in lung tissue,decreased mucus protein secretion,and reduced the serum levels of inflammatory cytokines interleukin(IL)-1β,IL-6,and tumor necrosis factor-alpha(TNF-α).Additionally,it lowered the expression of cytokines IL-4,IL-5,IL-13,IL-25,thymic stromal lymphopoietin(TSLP),and IL-33 in BALF,and reduced the differentiation of ILC2 cells in both lung tissue and spleen.Transcriptomic analysis and experimental validation revealed that HYJD downregulated the expression of NLRP3 related genes and proteins within the NOD-like receptor signaling pathway.Conclusion:The mechanism by which HYJD intervenes in acute lung injury associated with viral pneumonia may involve the reduction of ILC2 cells differentiation and the inhibition of NLRP3 activation.
文摘Psittacosis pneumonia is a zoonotic disease caused by Chlamydia psittaci infection,with the lungs being the most affected organ.[1]Rhabdomyolysis is a clinical syndrome characterized by the massive release of intracellular components—such as myoglobin and creatine kinase—into the bloodstream due to skeletal muscle injury or necrosis.Common causes include trauma,medications,metabolic disorders,and infections.When psittacosis pneumonia is complicated by rhabdomyolysis,patients often develop multiple organ dysfunction and have a poor prognosis,necessitating early clinical intervention.
基金supported by the Science and Technology Project for Disease Control and Prevention of Zhejiang Province(2025JK133)the Scientific Research Foundation of Taizhou Enze Medical Center(Group)-Major Project(20EZZDB1).
文摘Community-acquired pneumonia(CAP)is a common respiratory tract infection in children that is caused by various pathogens,including bacteria,Mycoplasma pneumoniae(MP),respiratory syncytial virus(RSV),and SARS-CoV-2,whichwas themostwidespread causative pathogen in recent years.We compared pathogen-specific CAP to identify shared and distinct host responses.This single-center,retrospective cohort study enrolled 200 children hospitalized for CAP caused by SARS-CoV-2,MP,RSV and bacterial infections from January 2019 to February 2023.We included only patients with mild symptoms and performed propensity scorematching to adjust for age and sex.Patients with CAP due to COVID-19 were more prone to fever and poor appetite(P<0.01)but had a lower incidence of cough and moist and wheezing rales(P<0.01)and a shorter disease course(P<0.01).The frequencies of antibiotic,anti-inflammatory drug and oxygen therapy use were lower in the CAP-COVID-19 group than in the non-COVID-19 CAP groups(P<0.01).Additionally,white blood cell,lymphocyte and eosinophil counts were lower in the CAP-COVID-19 group than in the non-COVID-19 CAP groups(P<0.01).However,the procalcitonin levels in the CAP-COVID-19 group were higher than those in the CAP-bacteria(P<0.05)and CAP-MP groups(P<0.01).Moreover,we observed significant differences in nutritional status(total protein and albumin),renal function(serum creatinine and urea)and myocardial function(creatine kinase and creatine kinase-MB)between the CAP-COVID-19 and CAP-MP groups.Our results revealed shared and distinct pathophysiological features across pathogen-specific CAP,enabling precise diagnosis and treatment.
文摘Mycoplasma pneumoniae(M.pneumoniae)is a common pathogen that causes community-acquired pneumonia in children.The clinical presentation of this pathogen can range from mild self-limiting illness to severe and refractory cases.Complications may occur,such as necrotizing pneumonia and respiratory failure.Extrapulmonary complications,including encephalitis,myocarditis,nephritis,hepatitis,or even multiple organ failure,can also arise.In this editorial,we dis-cuss the clinical implications of the significant findings from the article"Serum inflammatory markers in children with M.pneumoniae pneumonia and their predictive value for mycoplasma severity"published by Wang et al.They reported that measuring lactic dehydrogenase,interleukin-6 levels,and D-dimer effectively predicts refractory M.pneumoniae pneumonia cases.
文摘Background: Mycoplasma pneumoniae (MP) is the primary causative agent of community-acquired pneumonia, which has increasingly become resistant to macrolides, complicating treatment regimens, especially with the co-infection factor. Its worldwide prevalence has fluctuated due to the influence of the COVID-19 pandemic. The study investigated co-infection patterns in children diagnosed with Mycoplasma pneumoniae pneumonia (MPP). Methods: From June 2022 to December 2023, we retrospectively analyzed the clinical data for hospitalized children with Mycoplasma pneumoniae pneumonia in Wuhan, China. We collected data on age, sex, clinical information, and pathogenic results. We also collected sputum or bronchoalveolar lavage fluid (BALF) samples to test respiratory pathogens and macrolide resistance using targeted microbial next-generation sequencing (tNGS). We analyzed the data using SPSS. Results: The study involved 417 patients diagnosed with MPP, of whom 86.33% had co-infections. Co-infections were notably linked to lobar pneumonia, prominent imaging shadows and higher macrolide resistance rate. Key bacterial pathogens were Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, rhinoviruses, and human adenoviruses (HADV). In MPP cases, Candida albicans was the fungal pathogen related to co-infections. The co-infection with HADV and human bocavirus 1 (HBoV1) correlated with prolonged fever, whereas Bordetella pertussis was linked to prolonged cough. In contrast, Candida albicans exhibited a weaker association with diffuse large-area infiltration on chest imaging, and its co-infection was less likely to result in severe disease. Conclusion: These results offer valuable insight into Mycoplasma pneumoniae pneumonia in children, highlighting the impact of co-infections on the disease’s clinical outcomes.
文摘BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits for nonischemic chest pain in Western Europe and North America.The most common symptoms of clinical presentation are chest pain and shortness of breath with associated unique electrocardiographic changes.Acute pericarditis is generally self-limited.However,some cases may be complicated by either tamponade or a large pericardial effusion,which carries a significant risk of recurrence.Risk factors for acute pericarditis include viral infections,cardiac surgery,and autoimmune disorders.A rarer cause of pericardial inflammation includes pneumonia,which can induce purulent pericarditis that has been increasingly rare since the advent of antibiotics.Purulent pericarditis carries a high fatality rate,especially in the setting of tamponade,and is invariably deadly without the administration of antibiotics.Bedside transthoracic echocardiogram is a quick and helpful method that can aid in the diagnosis and management.CASE SUMMARY We present the case of a 62-year-old woman who sought medical attention at the emergency department(ED)due to a 5-day history of chest pain,shortness of breath,and subjective fevers.Laboratory findings in the ED were significant for leukocytosis and elevated erythrocyte sedimentation rate and C-reactive protein.A chest X-ray revealed a new focal density within the left lower lung base,and a bedside point-of-care ultrasound showed a pericardial fluid collection.The patient was subsequently admitted,where she underwent pericardiocentesis.Fluid cultures from drainage grew streptococcus pneumoniae.She was started on broadspectrum antibiotics immediately after the procedure.The patient was ultimately discharged in stable condition with cardiology and infectious disease follow-up.CONCLUSION This case report emphasizes a unique complication of community-acquired pneumonia.Purulent pericarditis due to streptococcus pneumonia occurs via intrathoracic spread of the organism to the pericardium.This condition is virtually fatal without the administration of antibiotics.Therefore,in the context of suspected pneumonia and a new pericardial fluid collection on imaging,clinicians should suspect purulent pericarditis until proven otherwise,which requires emergent intervention.
基金Bill and Melinda Gates Foundation,Grant/Award Number:OPP1017554。
文摘Background:Bacterial pneumonia remains a leading cause of morbidity and mortality worldwide despite the widespread availability of antibiotics.Novel pneumonia therapies and biomarkers are urgently needed to improve outcomes and advance personalized therapy.Using an established baboon model of S.pneumoniae pneumonia,we sought to characterize the temporal dynamics of pneumonia host responses to identify novel potential diagnostic and therapeutic molecular targets.Methods:We performed whole blood transcriptomics,unbiased proteomics,and peripheral cytokine measurements serially in baboons inoculated with S.pneumoniae(n=23)or saline(n=10)and modeled the peripheral blood host response using principal components analysis and complex sparse logistic regression.Differentially expressed genes were analyzed for pathway analysis.Results:Inoculated animals developed characteristic signs and symptoms of pneumonia.A 39-gene signature was derived that classified S.pneumoniae infection with high accuracy(auROC 0.9 and 0.99 at 24 and 48 h post-inoculation,respectively).Similar performance was observed for 48-h biomarker signatures derived from peripheral blood plasma proteomic and cytokine measurements(both auROC>0.9).The gene signature retained strong diagnostic performance(auROC=0.88)when transformed to human orthologs and applied to patients with acute respiratory illness(n=34)or healthy controls(n=20).Pathway analysis at 48 h identified downregulation of mitophagy and glucocorticoid signaling in peripheral blood.Conclusions:We report novel peripheral blood gene and protein expression signatures of S.pneumoniae pneumonia that could improve pneumonia diagnosis and found distinct pathways that may be amenable to modulation.Our findings illustrate how non-human primate models of bacterial pneumonia can successfully translate biomarker discoveries to patients.
文摘BACKGROUND Mycoplasma pneumoniae(MP)is a prevalent pathogen that causes respiratory infections in children and adolescents.AIM To assess the differences in the clinical features of MP-associated communityacquired pneumonia(CAP)in children who presented with mild or severe mycoplasma pneumoniae pneumonia(MPP);to identify the incidence of myocardial damage between the two groups.METHODS This work is a retrospective study.We identified children between 2 mo and 16 years of age with clinical and radiological findings consistent with CAP.We admitted patients to the inpatient department of the Second Hospital of Jilin University,Changchun,China,from January 2019 to December 2019.RESULTS A total of 409 hospitalized patients were diagnosed with MPP.Among them were 214(52.3%)males and 195(47.7%)females.The duration of fever and cough was the longest in severe MPP cases.Similarly,plasma levels of highly sensitive Creactive protein(t=-2.834,P<0.05),alanine transaminase(t=-2.511,P<0.05),aspartate aminotransferase(t=-2.939,P<0.05),and lactate dehydrogenase(LDH)(t=-2.939,P<0.05)were all elevated in severe MPP cases compared with mild MPP cases,and these elevations were statistically significant(P<0.05).Conversely,the neutrophil percentage was significantly lower in severe MPP cases than in mild MPP cases.The incidence of myocardial damage was significantly higher in severe MPP cases than in mild MPP cases(χ^(2)=157.078,P<0.05).CONCLUSION Mycoplasma pneumoniae is the main cause of CAP.The incidence of myocardial damage was higher and statistically significant in severe MPP cases than in mild MPP cases.
文摘BACKGROUND Liver transplant(LT)recipients are susceptible to carbapenem-resistant Klebsiella pneumoniae(CRKP)infections.Comprehensive research addressing the incidence,timing,infection sites,resistance patterns,treatment options,and associated risk factors among LT recipients with CRKP is now lacking.AIM To assess the incidence,resistance,therapy,and risk factors of CRKP infections post-LT,and to evaluate the impact of them on prognosis.METHODS A retrospective study was conducted,including 430 consecutive patients who underwent LT between January 2015 and June 2023.This study aimed to investigate the risk factors for CRKP infections and their influence on outcomes using logistic regression analysis.RESULTS Among the 430 patients who underwent LT,20(4.7%)experienced at least one documented CRKP infection within 3 months post-transplantation.The median time from LT to the onset of CRKP infections was 6.5 days.The lungs and bloodstream were the most common sites of CRKP infections.CRKP isolates were relatively susceptible to ceftazidime/avibactam(93.7%),polymyxin B(90.6%),and tigecycline(75.0%)treatment.However,all isolates were resistant to piperacillin/tazobactam,ceftazidime,cefepime,aztreonam,meropenem,and levofloxacin treatment.Recipients with CRKP infections had a mortality rate of 35%,the rate was 12.5%for those receiving ceftazidime/avibactam therapy.Multivariate analysis identified female sex[odds ratio(OR)=3.306;95%confidence interval(CI):1.239-8.822;P=0.017],intraoperative bleeding≥3000 mL(OR=3.269;95%CI:1.018-10.490;P=0.047),alanine aminotransferase on day 1 post-LT≥1500 U/L(OR=4.370;95%CI:1.686-11.326;P=0.002),and post-LT mechanical ventilation(OR=2.772;95%CI:1.077-7.135;P=0.035)as significant variables associated with CRKP.CRKP infections were related to an intensive care unit length(ICU)of stay≥7 days and 6-month all-cause mortality post-LT.CONCLUSION CRKP infections were frequent complications following LT,with poor associated outcomes.Risk factors for post-LT CRKP infections included female sex,significant intraoperative bleeding,elevated alanine aminotransferase levels,and the need for mechanical ventilation.CRKP infections negatively impacted survival and led to prolonged ICU stays.
文摘AIM:To report the demographic and systemic characteristics of patients,clinical progression of endophthalmitis,and the efficacy of various treatment strategies,with a focus on identifying key factors for preserving vision in eyes with endogenous endophthalmitis due to Klebsiella pneumoniae(K.pneumoniae)liver abscess.METHODS:In this single-center,retrospective case series of 18 patients with endogenous endophthalmitis due to K.pneumoniae liver abscess were analyzed.Ophthalmologic features of endophthalmitis at early,intermediate and advanced stages were obtained from eyes with endophthalmitis of different severities.Prompt vitrectomy was considered primarily for all eyes except for very early endophthalmitis.Intravitreal injections of antibiotics were performed in eyes with endophthalmitis in the very early stages and in eyes where vitrectomy was not available,and additional control of infection was needed after vitrectomy.Evisceration was performed in eyes with corneoscleral perforation,advanced endophthalmitis,perforation with preseptal or orbital cellulitis,uncontrolled infection,or severe pain with no vision.RESULTS:Mean(±standard deviation)age of the 18 patients with endophthalmitis was 64.5±12.2(range:32-84)y,and 14 patients(77.8%)were males.Endophthalmitis tended to involve the retinal parenchyma first and then progressed into the vitreous cavity and anterior segments.However,it presented a tendency to cause massive subretinal abscesses even after vitrectomy with silicone oil tamponade.Very high intraocular pressure with new vessels on the iris(41.7%)were also commonly observed.Although all but three patients had systemic disease such as diabetes or hypertension,visual prognosis after treatment did not appear to depend significantly on underlying comorbidities.A final best-corrected visual acuity better than 20/60 was achieved only when lesions were detected very early,with relatively good initial visual acuity,likely reflecting lower bacterial inoculation in the eye.CONCLUSION:Detection of early endophthalmitis lesions appears to be the only way to preserve good vision in patients with K.pneumoniae liver abscesses.Therefore,proper guidelines for ophthalmologic screening remain to be established for subjects at a high risk of endophthalmitis.
文摘There exists a notion that there is an obesity paradox in the prognosis of community-acquired pneumonia.In other words,obese individuals with communityacquired pneumonia have a better prognosis.The study by Wang et al supports this claim,but we believe that the obesity paradox should not be proposed hastily as it is influenced by numerous subjective and objective confounding factors.
文摘Introduction: The misuse of antibiotics has driven the emergence of antimicrobial resistance, with certain bacterial species, including Klebsiella pneumoniae, initially susceptible to most antibiotics, now exhibiting resistance to multiple antimicrobial agents. The objective of this study was to investigate the distribution and antimicrobial resistance profiles of Klebsiella pneumoniae strains isolated at the Yaoundé Central Hospital. Methodology: The study was conducted over a period of 4 months (March 1st, 2023-July 1st, 2023) and involved 32 strains isolated from bacterial cultures performed on patients, regardless of sex. The different Klebsiella pneumoniae strains were isolated using conventional methods. Identification, antibiogram, and detection of resistance enzyme production were generated using the VITEK 2 system. The Carbapenem-resistant K.N.I.V.O. kit was used to detect carbapenemases. Data analysis was performed using EXCEL 2019 software. Results: Out of 196 samples collected from various biological products, 32 Klebsiella pneumoniae strains were isolated, representing 16.32% (196/32). Urine samples were most frequently affected, accounting for 53.125%. The emergency department was the most represented (40.63%) by these isolates. The mean age was 50 years, with a minimum of 20 years and a maximum of 80 years. The sex ratio was equal to 1. The identified strains were resistant to cefotaxime (78.13%), cefoxitin (62.50%), tobramycin (71.88%), gentamicin (56.25%), ofloxacin (81.25%), and cotrimoxazole (78.13%). 78.25% were ESBL producers. Three strains were resistant to carbapenems, accounting for 9.37%;one of which exhibited the NDM type. Conclusion: This study highlights the evolving bacterial resistance to antibiotics, which requires adequate measures through the strengthening of the Antimicrobial Resistance (AMR) program in Cameroon.
文摘Sickle cell anemia (SCA) is a prevalent genetic disorder primarily affecting individuals of African descent and populations in malaria-endemic regions, with significant global public health implications. Sickle cell crises are their most common acute complication, characterized by episodes of intense pain and systemic manifestations that impair quality of life and impose a high healthcare burden. We present the case of a 19-year-old male diagnosed with SCA since the age of two, who developed a sickle cell crisis precipitated by right basal pneumonia. The patient exhibited sudden-onset, cyclic lumbar pain with progressive dyspnea. Initial management included multimodal pain control, volume optimization, and targeted antimicrobial therapy to achieve clinical stabilization. This case underscores the importance of a comprehensive approach to managing sickle cell crises, addressing both symptomatic relief and the prevention and treatment of complications. It also highlights the need for public health strategies promoting early diagnosis, access to disease-modifying therapies such as hydroxyurea, and interdisciplinary follow-up to mitigate the socioeconomic and clinical impact of SCA.
文摘Background: Puffy hand syndrome (PHS) is a rare complication primarily associated with intravenous drug use (IVDU), characterized by chronic swelling and fibrosis of the hands due to lymphatic damage. Concurrent pulmonary complications, such as pneumonia and pneumothorax, significantly contribute to increased morbidity in this population. Case Presentation: We report the case of a 28-year-old female who injects drugs, and presents with fever, bilateral hand edema, and respiratory symptoms. Clinical evaluation revealed erythema and edema of both hands, elevated inflammatory markers, and a left lower lobe infiltration that progressed to pneumothorax. A diagnosis of PHS and left lower lobe pneumonia complicated by pneumothorax was established. Management and Outcomes: The patient was treated with broad-spectrum antibiotics, including ceftriaxone, levofloxacin, dexamethasone, and oxygen supplementation, as well as antipyretics. She demonstrated partial clinical improvement and was referred to another hospital’s thoracic surgery department for specialized care. Conclusions: This case underscores the importance of early recognition and multidisciplinary management of rare but serious complications in IVDU patients. Further research is necessary to elucidate the interplay between lymphatic dysfunction and pulmonary pathophysiology in this demographic.
基金supported by the National Natural Science Foundation of China(82360801,82460822)Natural Science Foundation of Inner Mongolia Autonomous Region(2022LHQN08001,2023QN08050,2025LHMS08061)+4 种基金the Scientific Research Project of Higher Education Institutions in Inner Mongolia Autonomous Region(NJZY23135)the Laboratory Open Fund of Inner Mongolia Medical University(2024ZN23)and the General Project of Inner Mongolia Medical University(YKD2025MS047Inner Mongolia Medical University Undergraduate Science and Technology Innovation"Talent Cultivation"Project(YCPY2025028,YCPY2025024)Inner Mongolia Medical University Undergraduate Innovation and Entrepreneurship Training Program Project(101322025034).
文摘Background:Bacterial pneumonia continues to be a significant global health concern,particularly among high-risk groups,necessitating the development of precise and early diagnostic biomarkers.While the efficacy of procalcitonin(PCT)and C-reactive protein(CRP)as inflammatory markers is widely recognized,their relative diagnostic performance across different age groups remains debate.This meta-analysis was designed to assess the diagnostic accuracy of PCT and CRP in bacterial pneumonia.Methods:In this meta-analysis adhering to PRISMA guidelines,we searched PubMed,Web of Science,and the Cochrane Library for relevant diagnostic accuracy studies.From 19 included studies(n=2,603),data were extracted to construct tables.Study quality was assessed with the QUADAS-2 tool.The bivariate random-effects model was employed to derive pooled sensitivity,specificity,positive and negative likelihood ratios,and summary AUCs.To explore the substantial heterogeneity(I^(2)>80%),we performed pre-specified subgroup analyses based on age demographics.Results:Our findings indicate superior diagnostic performance for PCT,evidenced by a pooled sensitivity of 0.8841 and specificity of 0.8499,relative to CRP’s sensitivity of 0.8371 and specificity of 0.7185.The area under the ROC curve(AUC)for PCT was 0.992,a value significantly higher than that of CRP(0.987).Intriguingly,subgroup analyses revealed age-dependent variations:CRP demonstrated enhanced diagnostic utility in minors,while PCT proved substantially more effective in non-elderly adults.Conclusion:These results reinforce the clinical relevance of PCT as a more dependable biomarker for bacterial pneumonia,particularly in informing antibiotic treatment and mitigating misuse.This study uniquely includes age-stratified analyses based on predefined groups(minors and non-elderly adults),providing refined insights for individualized diagnostic approaches.We propose further multicenter research endeavors to confirm threshold optimization and explore combined biomarker strategies.
文摘BACKGROUND Pediatric complicated community-acquired pneumonia(CCAP)is on the rise.The three subtypes include para-pneumonic effusion(PPE),necrotizing pneumonia(NP),and empyema.AIM To study different sub-types of pediatric CCAP,and compare their etiology,clinical profile,and outcome in the post-pneumococcal vaccination era.METHODS This prospective observational study was conducted over a 2-year period.All details(demographics,clinical,management,and outcomes)were recorded.Continuous data were presented either as mean and SD,or as median and interquartile range.Categorical data were presented as frequencies and percentages(%).Data were analyzed by using the IBM SPSS Statistics for Windows,version 21(IBM Corp.,Armonk,NY,United States).RESULTS Of the 80 cases included(71%aged 4-8 years),the distribution was as follows:PPE(42%),empyema(39%),and NP(19%).Bacterial etiology was identified in 28%(empyema 63%,P=0.012).Staphylococcus aureus(45%)was most common followed by Escherichia coli(E.coli)(22.7%),and Streptococcus pneumoniae(13.6%).Patients with empyema,compared to PPE and NP,were less likely to receive prior antibiotics(32%vs 56%and 58%,respectively,P=0.03).Duration(days,mean±SD)of hospitalization was longer in children with NP compared to empyema and PPE(17.7±9.8,16.1±7.5,and 13.6±4.2,respectively).All children recovered with the medical management except 2 children requiring decortication.CONCLUSION Staphylococcus aureus and E.coli are the most common bacterial etiology in the post-pneumococcal vaccination era.Empyema might be related to a delay in antibiotics administration.NP is the most severe pediatric CCAP with prolonged hospitalization.
基金granted by National Key Research and Development Program of China(2021YFD1800900)Science and Technology Innovation Key R&D Program of Chongqing(CSTB2024TIAD-STX0038)+3 种基金National Natural Science Foundation of China(82574334,32501226)Chongqing Science and Technology Commission(CSTB2023NSCQ-JQX0002)Special Fund for Youth Team of Southwest University(SWU-XJLJ202306)Chongqing Natural Science Foundation(CSTB2024NSCQ-MSX0547).
文摘Multidrug-resistant Klebsiella pneumoniae(MDR-KP)is characterized by high mortality and risk of nosocomial transmission,and biofilm constitutes the primary challenge in the treatment of its implant-associated and refractory pulmonary infections.Notably,the hypoxic microenvironment and the physical barrier of biofilm leading to the increased tolerance of the bacteria to antibiotics.Herein,a hypoxia-responsive hybrid nanoparticle(CHLip@FLD/COL)loaded separately with anti-biofilm candidate fingolimod(FLD)and antibiotic colistin(COL)is achieved targeting antibacterial efficacy against MDR-KP in vitro and in vivo.CHLip@FLD/COL is composed of hybridizing hypoxia-responsive lipids(HLipid)and lipid A targeting materials DSPE-mPEG-COL.HLipid is synthesized by hexadecanedioic acid esterified with nitroimidazole,while DSPE-mPEG is coupling with vector COL via amide reaction.The relative level of extracellular polymeric substances and the NIR-IIb sO2 images of the infection site are used as indicators to establish mature biofilm models.CHLip@FLD/COL readily releases FLD and COL in hypoxic conditions,and its MIC against MDR-KP is only one-sixteenth of that when COL is used alone in vitro.The nanoparticle exhibits bacterial targeting ability and antibacterial effect in the pulmonary infection and biofilm infection mice models.Bacterial loads eliminated by 4 Log10 CFU and 2 Log10 CFU,respectively.The strategy provides a valuable reference for the treatment of refractory infections caused by MDR-KP.
文摘Exogenous lipoid pneumonia is a rare and under recognized pulmonary disorder caused by the inhalation or aspiration of fat-like substances.Nasal decongestants containing mineral oils or paraffin are emerging as overlooked etiological agents.This review consolidates existing literature to delineate the clinical,radiological,and pathological features of exogenous lipoid pneumonia induced by nasal decongestants,highlight diagnostic challenges,and underscore the importance of thorough patient history in early diagnosis and management.This condition,while preventable,can result in serious pulmonary complications if not recog-nized early.It necessitates a multidisciplinary approach that incorporates careful history taking,high-resolution imaging,cytological assessment,and public health vigilance.
基金supported by the National Key Research and Development Program of China(2021YFC2501800,2023YFC0872500 and 2024YFC3044600)the National Natural Science Foundation of China(82072214,82272198,82202373)+1 种基金the Science and Technology of Shanghai Committee(21MC1930400,22Y11900100 and 23Y31900100)the Shanghai Municipal Health Commission(2023ZDFC0101)。
文摘BACKGROUND:Community-acquired pneumonia(CAP)represents a significant public health concern due to its widespread prevalence and substantial healthcare costs.This study was to utilize an integrated proteomic and metabolomic approach to explore the mechanisms involved in severe CAP.METHODS:We integrated proteomics and metabolomics data to identify potential biomarkers for early diagnosis of severe CAP.Plasma samples were collected from 46 CAP patients(including27 with severe CAP and 19 with non-severe CAP)and 19 healthy controls upon admission.A comprehensive analysis of the combined proteomics and metabolomics data was then performed to elucidate the key pathological features associated with CAP severity.RESULTS:The proteomic and metabolic signature was markedly dif ferent between CAPs and healthy controls.Pathway analysis of changes revealed complement and coagulation cascades,ribosome,tumor necrosis factor(TNF)signaling pathway and lipid metabolic process as contributors to CAP.Furthermore,alterations in lipid metabolism,including sphingolipids and phosphatidylcholines(PCs),and dysregulation of cadherin binding were observed,potentially contributing to the development of severe CAP.Specifi cally,within the severe CAP group,sphingosine-1-phosphate(S1P)and apolipoproteins(APOC1 and APOA2)levels were downregulated,while S100P level was signifi cantly upregulated.CONCLUSION:The combined proteomic and metabolomic analysis may elucidate the complexity of CAP severity and inform the development of improved diagnostic tools.
