A case report of aspergillosis accompanied by saccular bronchodilation after bronchial thermoplasty in a 19-year-old woman

Background Fungal infections are rarely reported as a complication of bronchial thermoplasty (BT) in patients without immunosuppressive comorbidity. Case presentation A 19-year-old woman college student was admitted to our hospital owing to uncontrolled severe asthma despite using the maximum dose of steroid inhalation. She experienced asthmatic attacks more frequently while cheerleading, which is an extracurricular activity. She received BT because she wanted to continue cheerleading. After the second BT session, she developed more sputum and cough. During the third session, white secretion and saccular bronchodilation appeared in the left lower bronchus. Aspergillus fumigatus was detected in the culture of the bronchial lavage sample, and saccular bronchodilation in the affected bronchus was observed on computed tomography (CT). Five months after the start of oral itraconazole, her subjective symptoms as well as her CT findings improved. Her asthma condition improved enough for the patient to continue cheerleading without exacerbation. Conclusions It is necessary to consider the possibility of respiratory tract infections including fungal infections after BT. Detailed observations of the entire bronchus and sample collection for microbial culture are highly recommended.

Detection of Methanobrevobacter smithii and Methanobrevibacter oralis in Lower Respiratory Tract Microbiota

Methanogens, the sole microbes producing methane, are archaea commonly found in human anaerobic microbiota. Methanogens are emerging as opportunistic pathogens associated with dysbiosis and are also detected and cultured in anaerobic abscesses. Their presence in the respiratory tract is yet unknown. As a preliminary answer, prospective investigation of 908 respiratory tract samples using polyphasic approach combining PCR-sequencing, real-time PCR, fluorescent in situ hybridization (FISH), and methanogens culture was carried out. Methanobrevibacter smithii and Methanobrevibacter oralis DNA sequences, were detected in 21/527 (3.9%) sputum samples, 2/188 (1.06%) bronchoalveolar lavages, and none of 193 tracheo-bronchial aspirations. Further, fluorescence in situ hybridization detected methanogens in three sputum investigated specimens with stick morphology suggesting M. oralis and in another one bronchoalveolar lavage sample investigated, diplococal morphology suggesting M. smithii. These observations extend the known territory of methanogens to the respiratory tract and lay the foundations for further interpretation of their detection as pathogens in any future cases of isolation from bronchoalveolar lavages and the lungs.

Aelurostrongilosis en un gato (Felis silvestris catus) de la Ciudad de México

Clínica Veterinaria: abordaje diagnóstico y terapéutico ISSN: 2395-8766Una forma de citar este artículo:Tovar-Dorantes M de J, Díaz-Hernández T, Larios-Barajas MK, Lima-Melo A, Núñez-Ochoa L. Aelurostrongilosis en un gato (Felis silvestris catus) de la Ciudad de México. Clínica veterinaria: abordaje diagnóstico y terapéutico. 2020;6.e57202064. doi: 10.22201/fmvz.23958766e.2020.6.57Descripción del caso. Gato doméstico macho de cinco meses de edad con taquipnea, dificultad respiratoria y patrón restrictivo con un patrón intersticial no estructurado generalizado observado en el estudio radiográfico de campos pulmonares.Hallazgos clínicos. El diagnóstico se obtuvo mediante la observación de larvas de Aelurostrongylus abstrusus en el lavado traqueobronquial y se corroboró en heces por la técnica de Baermann seriada.Tratamiento y evolución. Se eligió un esquema de tratamiento con doxiciclina a 5 mg/kg vía oral cada 12 h por quince días; fenbendazol 50 mg/kg con pamoato de pirantel 20 mg/kg y prazicuantel 5 mg/kg vía oral cada 24 h por tres días consecutivos; prednisolona a 1 mg/kg vía oral cada 12 h dosis reducción por quince días; omeprazol a 1.25 mg/kg vía oral cada 12 h por diez días y pipeta tópica de imidacloprid 10 % y moxidectina 1 % al cuarto día de iniciado el tratamiento. El paciente mostró mejoría clínica.Pruebas de laboratorio. Los estudios radiográficos de los días 37 y 143 de evolución y el resultado negativo del estudio coproparasitoscópico por la técnica de Baermann seriada los días 53 y 143 de evolución corroboraron la mejora clínica; así el tratamiento fue efectivo.Relevancia clínica. Este es el segundo caso informado en México de Aelurostrongylus abstrusus en gatos domésticos y en una ciudad diferente a la del primer caso. Abstract Case description. A 5-month-old, male, indoor-outdoor domestic shorthair cat from Mexico City with cough, tachypnea and respiratory distress. Thoracic radiographs revealed a generalized unstructured interstitial pattern. Diagnostic and interpretation. Diagnosis of Aelurostrongylus abstrusus was obtained by observing larvae in a tracheobronchial lavage sample and corroborated through Baermann funnel technique.Treatment and clinical response. The chosen treatment scheme was doxycycline at 5 mg/kg orally every 12 h for 15 days; fenbendazole 50 mg/kg with pyrantel pamoate 20 mg/kg and praziquantel 5 mg/kg orally every 24 h for 3 consecutive days; prednisolone at 1 mg/kg oral every 12 h reduction dose over 15 days; omeprazole at 1.25 mg/kg orally every 12 h for 10 days and topical imidacloprid 10% and moxidectin 1% pippete at fourth day of treatment. The patient had clinical improvement.Laboratory tests. The patient improvement was corroborated by the radiographic studies on days 37 and 143 of evolution and in the coproparasitoscopic study, by serial Baermann technique, negative on day 53 and 143 of evolution.Clinical relevance. This is the second case report of Aelurostrongylus abstrusus in domestic cats in Mexico, happening in a different city from the first case.

Acute Pulmonary Aspergillosis as a Severe Complication of Influenza, Pneumococcal Pneumonia, and Staphylococcus aureus Bacteremia in ICU

Background. Acute aspergillosis is a disease with dramatic progression and high mortality if not treated rapidly. However, diagnosing and treating is challenging, as the risk factors are not fully understood. Case Presentation. A fifty-three-year-old woman without any comorbidities was admitted to hospital due to high fever. Infections with influenza and pneumonia and Staphylococcus aureus bacteremia were diagnosed. The patient improved at first due to antimicrobial therapy; nine days after admission, her clinical condition deteriorated again, and she was transferred to ICU due to septic shock accompanied by respiratory failure, necessitating mechanical ventilation and high-dose catecholamine support. A CT scan showed a resolving inflammatory infiltrate bilateral caverns with markedly thickened walls. A culture from a bronchoalveolar lavage grew Aspergillus fumigatus. Galactomannan testing was positive in a bronchoalveolar lavage sample, and beta-D-glucan was positive in serum. Antifungal therapy with voriconazole and intermittent isavuconazole due to renal failure was performed, followed by a surgical resection of the caverns. Patient’s recovery was complicated by several severe bleeding episodes in the lungs. However, the patient showed full recovery and was discharged after 109 days in hospital. Conclusions. This case report highlights multiple complications of influenza and the difficulties of diagnosing and treating acute pulmonary aspergillosis. Furthermore, it stresses the importance for further studies to deepen the understanding about the association between influenza and aspergillosis and to shed further light on adequate therapy.

Complete Genome Sequence of Streptacidiphilus sp. Strain 15-057A, Obtained from Bronchial Lavage Fluid

Streptacidiphilus sp. strain 15-057A was isolated from a bronchial lavage sample and represents the only member of the genus not isolated from acidic soils.

Pulmonary Alveolar Microlithiasis: A commonly misdiagnosed rare entity

Pulmonary alveolar microlithiasis (PAM) is an uncommon entity which can pose a diagnostic challenge. We report a 45-year-old female who was referred to the All India Institute of Medical Sciences, Bhopal, India, in 2017 with a two-year history of progressively worsening dyspnoea and dry coughing. She had been previously diagnosed with pulmonary tuberculosis elsewhere and prescribed antitubercular therapy; however, there was little improvement in her symptoms. Following referral, the patient was diagnosed with PAM based on high-resolution computed tomography findings and the abundance of lamellar microliths in a bronchoalveolar lavage sample. She was subsequently managed symptomatically and enrolled in a rehabilitation programme.Keywords: Calcinosis; Pulmonary Alveolar Microlithiasis; Pulmonary Tuberculosis; Misdiagnosis; Case Report; India.

FilmArray Respiratory Panel Assay: Comparison of Nasopharyngeal Swabs and Bronchoalveolar Lavage Samples

The FilmArray respiratory panel (FARP) reliably and rapidly identifies 17 viruses and 3 bacterial pathogens. A nasopharyngeal swab FARP (NP FARP) is performed for many patients with respiratory symptoms. For patients who are acutely ill or immunocompromised or fail to improve, a bronchoalveolar lavage sample FARP (BAL FARP) is performed in addition to the NP FARP. To date, no studies have compared the yield of a BAL FARP with that of an NP FARP. We retrospectively studied all patients who had a BAL FARP within 7 days after an NP FARP between June 2013 and May 2014. Demographic information, comorbidities, FARP results, and all microbiologic data from BAL fluid were collected. Eighty-six patients had a BAL FARP performed within 7 days (mean, 1.6; median, 1) after an NP FARP. Of these, 66 (77%) had concordant BAL and NP FARP results: 15 (23%) had the same pathogen identified from the NP and BAL FARPs, and 51 (77%) had concordant negative FARP results. In 18 of the 86 patients (21%), a pathogen was detected from the NP FARP; of these, 15 (83%) had a concordant match on a subsequent BAL FARP, and the remaining 3 had negative BAL FARPs. In 17 of the 86 patients (20%), pathogens were identified from the BAL FARPs that were not detected by the NP FARPs; of these, 16 (94%) had initial negative NP FARPs. The data suggest that once a pathogen is identified by an NP FARP, a subsequent BAL FARP is unlikely to add new microbiologic information. However, a BAL FARP may provide new, useful microbiologic information when performed within 7 days after a negative NP FARP.

PER-7, an Extended-Spectrum β-Lactamase with Increased Activity toward Broad-Spectrum Cephalosporins in Acinetobacter baumannii

ABSTRACTAcinetobacter baumanniiisolate AP2 was recovered from a bronchial lavage sample of a patient hospitalized in Paris, France.A. baumanniiAP2 was resistant to all β-lactams, including carbapenems, and expressed the extended-spectrum β-lactamase (ESBL) PER-7, which differs from PER-1 by 4 amino acid substitutions. Compared to PER-1, PER-7 possessed higher-level hydrolytic activities against cephalosporins and aztreonam. TheblaPER-7gene was chromosomally located and associated with a mosaic class 1 integron structure. Additionally, isolate AP2 expressed the carbapenem-hydrolyzing oxacillinase OXA-23 and the 16S RNA methylase ArmA, conferring high-level resistance to aminoglycosides.