scholarly journals Pulmonary parenchymal involvement caused by Tropheryma whipplei

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 843-846
Author(s):  
Wen Mei Zhang ◽  
Ling Xu
Keyword(s):  
Chest Pain ◽  
Pulmonary Nodules ◽  
Lavage Fluid ◽  
Tropheryma Whipplei ◽  
Common Finding ◽  
Left Chest ◽  
Lung Tuberculosis ◽  
Diagnosis Rate ◽  
Pulmonary Cavity ◽  
Generation Sequencing

Abstract We report a 26-year-old man with left chest pain for 4 days. His chest CT showed a cavity in the left upper lung. Tuberculosis was suspected first, but metagenomics next generation sequencing (mNGS) in bronchoalveolar lavage fluid only detected Tropheryma whipplei. Tropheryma whipplei is the pathogen of Whipple’s disease. The most frequently involved organs are the eyes, heart, and central nervous system. Pulmonary parenchymal involvement is rare. To our knowledge, this is the first reported case of pulmonary cavity caused by Tropheryma whipplei. Nineteen cases of pulmonary parenchymal involvement were found by literature search. The most common respiratory symptom was cough, followed by dyspnea/breathlessness and chest pain. The most common finding in chest imaging was pulmonary nodules, followed by interstitial changes and patchy infiltration. Our case and literature review highlighted that Tropheryma whipplei infection should be considered in the differential diagnosis of pulmonary cavity, pulmonary nodules, interstitial changes, and patchy infiltration. mNGS is helpful to improve diagnosis rate.

scholarly journals Pulmonary coinfection of Mycobacterium tuberculosis and Tropheryma whipplei: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Binghua Zhu ◽  
Jing Tang ◽  
Rong Fang ◽  
Xuejie Fei ◽  
Qing Wang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Mycobacterium Tuberculosis ◽  
Next Generation Sequencing ◽  
Tropheryma Whipplei ◽  
Diagnostic Methods ◽  
Next Generation ◽  
Computed Tomography Scan ◽  
Chest Computed Tomography ◽  
Tomography Scan ◽  
Generation Sequencing

Abstract Background We diagnosed a clinical case of pulmonary infection involving Mycobacterium tuberculosis and Tropheryma whipplei in a patient with acute respiratory distress syndrome. The diagnosis was assisted by metagenomic next-generation sequencing of bronchoalveolar lavage fluid. Case presentation A 44-year-old Han Chinese inmate was transferred to the emergency department because of dry cough, chest tightness, and shortness of breath. The patient’s body temperature rose to 39.3 °C following empirical cephalosporin treatment for 1 week. The blood CD4+/CD8+ ratio was 0.7, suggesting immunodeficiency. Routine microbiological tests were performed, and tuberculosis interferon gamma release assays were positive. Mycobacterium tuberculosis polymerase chain reaction was also positive. Chest computed tomography scan revealed miliary nodules and ground-glass opacifications, which were in accordance with tuberculosis. To fully examine the etiology, we performed routine laboratory tests and metagenomic sequencing, the results of which indicated the presence of Mycobacterium tuberculosis and Tropheryma whipplei. We administered anti-tuberculosis regimen in combination with trimethoprim/sulfamethoxazole. The patient recovered, with chest computed tomography scan showing absorption of lesions. Conclusions Compared with traditional diagnostic methods such as culture and serology, metagenomic next-generation sequencing has the advantage of detecting a wide array of microorganisms in a single test and therefore can be used for clinical diagnosis of rare pathogens and microbial coinfections. It is particularly useful for immunocompromised patients as they are more prone to infection by opportunistic microorganisms.

scholarly journals Severe pneumonia caused by Parvimonas micra: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qing Yu ◽  
Lingling Sun ◽  
Zuqing Xu ◽  
Lumei Fan ◽  
Yunbo Du
Keyword(s):  
Bronchoalveolar Lavage Fluid ◽  
Case Reports ◽  
Severe Pneumonia ◽  
Lavage Fluid ◽  
Due Date ◽  
Case Presentation ◽  
Abdominal Abscesses ◽  
Parvimonas Micra ◽  
Next Generation Sequencing Ngs ◽  
Generation Sequencing

Abstract Background Parvimonas micra (P. micra) is a gram-positive anaerobic coccus that is detected widely on the skin, in the oral mucosa and in the gastrointestinal tract. In certain circumstances, P. micra can cause abdominal abscesses, bacteraemia and other infections. To the best of our knowledge, there have been no case reports describing the biological characteristics of P. micra-related pneumonia. These bacteria do not always multiply in an aerobic organ, such as the lung, and they could be easily overlooked because of the clinical mindset. Case presentation A 35-year-old pregnant woman was admitted to the emergency department 4 weeks prior to her due date who was exhibiting 5 points on the Glasgow coma scale. A computed tomography (CT) scan showed a massive haemorrhage in her left basal ganglia. She underwent a caesarean section and brain surgery before being admitted to the ICU. She soon developed severe pneumonia and hypoxemia. Given that multiple sputum cultures were negative, the patient’s bronchoalveolar lavage fluid was submitted for next-generation sequencing (NGS) to determine the pathogen responsible for the pneumonia; as a result, P. micra was determined to be the causative pathogen. Accordingly the antibiotic therapy was altered and the pneumonia improved. Conclusion In this case, we demonstrated severe pneumonia caused by the anaerobic organism P. micra, and the patient benefited from receiving the correct antibiotic. NGS was used as a method of quick diagnosis when sputum culture failed to distinguish the pathogen.

scholarly journals Diagnosis of pulmonary nodules by DNA methylation analysis in bronchoalveolar lavage fluids

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Lei Li ◽  
Zhujia Ye ◽  
Sai Yang ◽  
Hao Yang ◽  
Jing Jin ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Dna Methylation ◽  
Bronchoalveolar Lavage ◽  
Pulmonary Nodules ◽  
Squamous Carcinoma ◽  
Lavage Fluid ◽  
Smoking History ◽  
Lung Cancer Diagnosis ◽  
Auc Value ◽  
Validation Set

Abstract Background Lung cancer is the leading cause of cancer-related mortality. The alteration of DNA methylation plays a major role in the development of lung cancer. Methylation biomarkers become a possible method for lung cancer diagnosis. Results We identified eleven lung cancer-specific methylation markers (CDO1, GSHR, HOXA11, HOXB4-1, HOXB4-2, HOXB4-3, HOXB4-4, LHX9, MIR196A1, PTGER4-1, and PTGER4-2), which could differentiate benign and malignant pulmonary nodules. The methylation levels of these markers are significantly higher in malignant tissues. In bronchoalveolar lavage fluid (BALF) samples, the methylation signals maintain the same differential trend as in tissues. An optimal 5-marker model for pulmonary nodule diagnosis (malignant vs. benign) was developed from all possible combinations of the eleven markers. In the test set (57 tissue and 71 BALF samples), the area under curve (AUC) value achieves 0.93, and the overall sensitivity is 82% at the specificity of 91%. In an independent validation set (111 BALF samples), the AUC is 0.82 with a specificity of 82% and a sensitivity of 70%. Conclusions This model can differentiate pulmonary adenocarcinoma and squamous carcinoma from benign diseases, especially for infection, inflammation, and tuberculosis. The model’s performance is not affected by gender, age, smoking history, or the solid components of nodules.

Pulmonary Infiltrates in a Patient With Advanced Melanoma

2017 ◽  
Vol 35 (7) ◽  
pp. 705-708 ◽  
Author(s):  
Charles A. Powell
Keyword(s):  
Computed Tomography ◽  
Subcutaneous Tissue ◽  
Relevant Literature ◽  
Pulmonary Nodules ◽  
Advanced Melanoma ◽  
Resection Margins ◽  
Left Chest ◽  
Pulmonary Infiltrates ◽  
Computed Tomography Images ◽  
History Of

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 60-year-old former smoker with metastatic melanoma presented with the chief complaint of pulmonary infiltrates. Five years ago, he was diagnosed with a left chest wall melanoma. He underwent surgery but received no additional therapy for an American Joint Committee on Cancer stage T3a N0 M0 tumor that was 2.7 mm in depth with no ulceration of the epidermal surface. Resection margins were free of tumor. Four years later, he underwent excision of a raised pigmented skin lesion on his left calf that proved to be melanoma with positive margins. He underwent re-excision of melanoma but 2 months later developed a new left hip soft tissue nodule. Positron emission tomography (PET) –computed tomography showed multiple hypermetabolic lesions involving subcutaneous tissue, muscle osseous structures, and bone marrow, consistent with advanced melanoma. He began systemic therapy with ipilimumab and nivolumab. After four cycles of immunotherapy, he developed a nonproductive cough and mild dyspnea on exertion (Modified Medical Research Council dyspnea scale score of 2 [ie, he had to stop for breath when walking at his own pace on level ground]). A chest x-ray showed bilateral hilar enlargement, thickening of the right paratracheal stripe, and scattered patchy increased interstitial markings bilaterally. PET and chest computed tomography images showed enlarged mediastinal adenopathy with increased [18F]fluorodeoxyglucose uptake on PET and scattered diffuse 1- to 2-mm pulmonary nodules with ground-glass opacities ( Fig 1 ). The patient was referred for pulmonary input. The patient had smoked one pack of cigarettes per day for 35 years; he quit 6 years ago. He had no history of pneumonia, childhood asthma, or tuberculosis. His mother had asthma, but there was no other family history of asthma or other lung disease.

scholarly journals Veno-venous extracorporeal membrane oxygenation successfully treated a case of severe pulmonary hemorrhage caused by leptospirosis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
H. J. Wang ◽  
G. Z. Chen ◽  
C. J. Zhou ◽  
Y. FU ◽  
L. N. YAO
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Mainland China ◽  
Pulmonary Hemorrhage ◽  
Lavage Fluid ◽  
Case Presentation ◽  
Membrane Oxygenation ◽  
Second Generation Sequencing ◽  
Very High ◽  
Generation Sequencing ◽  
Secondary Condition

Abstract Background Pulmonary hemorrhage is an important complication of leptospirosis. Once acute respiratory distress syndrome (ARDS) occurs as a secondary condition, treatment is extremely difficult and the mortality rate is very high. Case presentation The patient was a 49-year-old. He was admitted to the hospital because he had experienced a fever and cough for 4 days. Hemorrhage, respiratory failure, ARDS and other symptoms appeared soon after admission. Due to severe pulmonary hemorrhage secondary to ARDS, mechanical ventilation was performed through tracheal intubation. During intubation, the patient suffered cardiac arrest, and the patient’s condition worsened. He was confirmed to have leptospirosis through second-generation sequencing of the alveolar lavage fluid. Finally, we successfully treated the patient with penicillin as an anti-infective medication and venous-venous extracorporeal membrane oxygenation (v-vECMO). To the best of our knowledge, this report is the first to describe the successful application of ECMO in mainland China. Conclusions Leptospirosis can induce serious but transient ARDS with a better prognosis than other causes of ARDS. Our patient was successfully treated with V-vECMO.

Responses of primate T1-T5 spinothalamic neurons to gallbladder distension

1984 ◽  
Vol 247 (6) ◽  
pp. R995-R1002 ◽  
Author(s):  
W. S. Ammons ◽  
R. W. Blair ◽  
R. D. Foreman
Keyword(s):  
Chest Pain ◽  
Dynamic Range ◽  
Discharge Rate ◽  
Gallbladder Disease ◽  
High Rate ◽  
High Threshold ◽  
Spinothalamic Tract ◽  
Left Chest ◽  
Afferent Fibers ◽  
Upper Thoracic

Extracellular unit recordings were obtained from 44 spinothalamic tract (STT) neurons in the T1-T5 segments of 15 alpha-chloralose anesthesized monkeys (Macaca fascicularis). Each cell had a somatic receptive field in the left chest region and was excited by electrical stimulation of cardiopulmonary sympathetic afferent fibers. Gallbladder distension to pressures between 20 and 100 mmHg increased activity in 16 of 44 neurons. Responses usually consisted of bursts of activity associated with increased gallbladder pressure (phasic responses) followed by maintained activity during the distension (tonic responses). Magnitude of phasic responses was linearly related to the distending pressure and was consistently greater than magnitude of tonic responses. The gallbladder-responsive and nonresponsive groups included similar proportions of wide dynamic range, high threshold, and high-threshold inhibitory cells. Nine of 10 gallbladder-responsive cells and 11 of 21 gallbladder-nonresponsive cells increased their discharge rate after injection of 2 micrograms/kg bradykinin into left atrium. Activity of cells with gallbladder input increased from 14 +/- 4 to 33 +/- 4 spikes/s. Cells without gallbladder input increased their discharge rate to a significantly less degree (10 +/- 3-23 +/- 4 spikes/s). These results indicate that upper thoracic STT neurons may increase their activity during gallbladder distension. Convergence of afferent information from the chest and gallbladder may explain chest pain occurring during gallbladder disease. Furthermore the tendency of gallbladder-responsive cells to respond to bradykinin injections with a high rate of discharge could explain how this chest pain of gallbladder origin may closely mimic pain of angina pectoris.

scholarly journals Metagenomic analysis using next-generation sequencing of pathogens in bronchoalveolar lavage fluid from pediatric patients with respiratory failure

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Suguru Takeuchi ◽  
Jun-ichi Kawada ◽  
Kazuhiro Horiba ◽  
Yusuke Okuno ◽  
Toshihiko Okumura ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Next Generation Sequencing ◽  
Bronchoalveolar Lavage ◽  
Bronchoalveolar Lavage Fluid ◽  
Pediatric Patients ◽  
Respiratory Infections ◽  
Sequence Data ◽  
Lavage Fluid ◽  
Next Generation ◽  
Generation Sequencing

Abstract Next-generation sequencing (NGS) has been applied in the field of infectious diseases. Bronchoalveolar lavage fluid (BALF) is considered a sterile type of specimen that is suitable for detecting pathogens of respiratory infections. The aim of this study was to comprehensively identify causative pathogens using NGS in BALF samples from immunocompetent pediatric patients with respiratory failure. Ten patients hospitalized with respiratory failure were included. BALF samples obtained in the acute phase were used to prepare DNA- and RNA-sequencing libraries. The libraries were sequenced on MiSeq, and the sequence data were analyzed using metagenome analysis tools. A mean of 2,041,216 total reads were sequenced for each library. Significant bacterial or viral sequencing reads were detected in eight of the 10 patients. Furthermore, candidate pathogens were detected in three patients in whom etiologic agents were not identified by conventional methods. The complete genome of enterovirus D68 was identified in two patients, and phylogenetic analysis suggested that both strains belong to subclade B3, which is an epidemic strain that has spread worldwide in recent years. Our results suggest that NGS can be applied for comprehensive molecular diagnostics as well as surveillance of pathogens in BALF from patients with respiratory infection.

scholarly journals Primary Diaphragmatic Dedifferentiated Liposarcoma in a Young Female Patient after Delivery

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Shinya Sakata ◽  
Chieko Yoshida ◽  
Sho Saeki ◽  
Susumu Hirosako ◽  
Hidenori Ichiyasu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chest Pain ◽  
Young Female ◽  
Chief Complaint ◽  
Dedifferentiated Liposarcoma ◽  
Histopathological Analysis ◽  
Tumor Mass ◽  
Left Chest ◽  
First Child ◽  
Bulky Mass

A 26-year-old woman was admitted with the chief complaint of chest pain. She had delivered her first child 9 months before admission. Computed tomography showed a bulky mass in her left chest, and histopathological analysis revealed it to be dedifferentiated liposarcoma. We initiated doxorubicin chemotherapy, and the tumor mass reduced. After that, we performed vascular embolization along with chemotherapy, but tumor size did not reduce. On the 160th day of illness, the patient died. This is the first report of a primary diaphragmatic dedifferentiated liposarcoma diagnosed after delivery. Establishment of a regimen of chemotherapy for bulky unresectable liposarcoma is necessary.

scholarly journals Actinomyces as a Cause of Unexplained Fever Diagnosed by Next-Generation Sequencing: Case Report and Review

2021 ◽  
Author(s):  
Xiu Huang ◽  
Na Du ◽  
jiaxue He ◽  
yujun Du
Keyword(s):  
Next Generation Sequencing ◽  
Laboratory Data ◽  
Lavage Fluid ◽  
Next Generation ◽  
Intermittent Fever ◽  
Thoracic Actinomycosis ◽  
Sputum Production ◽  
Unexplained Fever ◽  
Generation Sequencing

Abstract Background: Actinomycosis is a rare cause of unexplained origin fever (FUO). The NGS, particularly in cases of FUO in conventional microbiology, is a promising and advantageous technology for earlier diagnosis and more success. It gives new insights in the management of FUO, especially in infectious diseases.Case presentation: We present a case of a 71-year-old woman who had FUO that the etiology was endobronchial actinomycosis eventually diagnosed by next-generation sequencing of bronchoalveolar lavage fluid. She was admitted to the our department with intermittent fever up to 40.0℃, chills, cough with white sputum, chest distress and slightly dyspnea over one month. According to special clinical course and laboratory data of the patient, she was given intravenous sulbenicillin sodium for 11 days and oral amoxicillin at 500 mg every 8 h for another 1 month. When she returned for follow-up, she reported a notable improvement in her cough, dyspnea, sputum production and fever that was completely absent.Conclusion: In obscure causes of FUO, clinicians should consider the possibility of thoracic actinomycosis and actively use next-generation sequencing to help diagnose.

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