scholarly journals Disseminated Tuberculosis Associated Hemophagocytic Lymphohistiocytosis in a Pregnant Woman With Evans syndrome: A Case Report and Literature Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Yun-Feng Shi ◽  
Xiao-Han Shi ◽  
Yuan Zhang ◽  
Jun-Xian Chen ◽  
Wen-Xing Lai ◽  
...  
Keyword(s):  
Pregnant Woman ◽  
Literature Review ◽  
Dna Sequence ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Severe Pneumonia ◽  
Corticosteroid Treatment ◽  
Lavage Fluid ◽  
Sputum Smear ◽  
Evans Syndrome ◽  
Nested Polymerase Chain Reaction

BackgroundTuberculosis (TB) is a leading cause of morbidity and mortality in underdeveloped and developing countries. Disseminated TB may induce uncommon and potentially fatal secondary hemophagocytic lymphohistiocytosis (HLH). Timely treatment with anti-tuberculosis therapy (ATT) and downmodulation of the immune response is critical. However, corticosteroid treatment for TB-associated HLH remains controversial. Herein, we report a successful case of disseminated TB-associated HLH in a pregnant woman with Evans syndrome accompanied by a literature review.Case PresentationA 26-year-old pregnant woman with Evans syndrome was transferred to the Third Affiliated Hospital of Sun Yat-Sen University because of severe pneumonia. She presented with cough, fever, and aggravated dyspnea. Nested polymerase chain reaction for Mycobacterium tuberculosis (M. tuberculosis) complex in sputum was positive. Sputum smear sample for acid-fast bacilli was also positive. Metagenome next-generation sequencing (mNGS) of the bronchoalveolar lavage fluid identified 926 DNA sequence reads and 195 RNA sequence reads corresponding to M. tuberculosis complex, respectively. mNGS of blood identified 48 DNA sequence reads corresponding to M. tuberculosis. There was no sequence read corresponding to other potential pathogens. She was initially administered standard ATT together with a low dose of methylprednisolone (40 mg/day). However, her condition deteriorated rapidly with high fever, acute respiratory distress syndrome, pancytopenia, and hyperferritinemia. Bone marrow smears showed hemophagocytosis. And caseating tuberculous granulomas were found in the placenta. A diagnosis of disseminated TB-associated HLH was made. Along with the continuation of four drug ATT regimen, therapy with a higher dose of methylprednisolone (160 mg/day) combined with immunoglobulin and plasma exchange was managed. The patient’s condition improved, and she was discharged on day 19. Her condition was good at follow-up with the continuation of the ATT.ConclusionsClinicians encountering patients with suspected TB accompanied by unexplainable inflammation not responding to ATT should consider complications with HLH. Timely administration of ATT combined with corticosteroids may result in a favorable outcome.

New Detection and Treatment for Chlamydia Psittaci: A Case Report

2020 ◽  
Author(s):  
Xiaojing Wu ◽  
Yang Li ◽  
Yingying Feng ◽  
Min Li ◽  
Ye Tian ◽  
...  
Keyword(s):  
Pregnant Woman ◽  
Left Lung ◽  
Severe Pneumonia ◽  
Lavage Fluid ◽  
Chlamydia Psittaci ◽  
Premature Delivery ◽  
Correct Treatment ◽  
Case Presentation ◽  
Paired Serum ◽  
Next Generation Sequencing Ngs

Abstract Background: The presentation of psittacosis can vary from subclinical infection to fatal pneumonia with a high mortality rate. Chlamydia psittaci infection during pregnancy is rare and might result in placental involvement, premature delivery or miscarriage. Herein, we report a case of severe pneumonia in a pregnant woman caused by C. psittaci.Case presentation: A 27-year-old female with a pregnancy at 22 weeks was admitted with hyperpyrexia, dry cough and dyspnea. Laboratory tests showed increased white blood cell count and slightly-elevated procalcitonin. Chest computed tomography scan revealed consolidation in the lingual and inferior lobe of the left lung. She suffered rapidly progressing respiratory failure and required mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Her sample of bronchoalveolar lavage fluid (BALF) was collected, from which C. psittaci was detected using next-generation sequencing (NGS). The pathogen was further confirmed by polymerase chain reaction (PCR) with the primers specific for the microorganism. Moreover, paired serum tests showed elevated C. psittaci group titer in both IgG and IgM. She was treated with azithromycin and tigecycline. After 24-day hospitalization, the patient was clinically well and discharged home.Conclusion: We report a case of severe pneumonia in a pregnant woman caused by C. psittaci, which diagnosed by NGS, and was cured without adverse effects on infant with tigecycline. The introduction of NGS and other effective assays might increase the detection rate. C. psittaci infection in pregnant women is very rare, but critical. Early diagnosis and correct treatment may save the mother and fetus. New tetracycline agent, tigecycline, may also be an effective alternative and should be further evaluated in psittacosis.

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 Correlation between α-SMA and ß-catenin levels in bronchoalveolar lavage fluid and severity of pneumonia

2022 ◽  
Vol 38 (3) ◽  
Author(s):  
Xiaoying Li ◽  
Zinan Jiang
Keyword(s):  
Bronchoalveolar Lavage ◽  
Bronchoalveolar Lavage Fluid ◽  
Pearson Correlation ◽  
Severe Pneumonia ◽  
Lavage Fluid ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Creative Commons ◽  
Mechanical Ventilation Time ◽  
Deterioration Group

Objectives: To assess the association of bronchoalveolar lavage fluid (BALF) α-SMA and ß-catenin levels and the severity of pneumonia. Methods: The records of patients with severe pneumonia treated in our hospital from June 2019 to June 2020 were selected. The clinical outcome was observed within 10 days. For the purpose of analysis, patients were divided into two groups according to the outcome, 47 cases in the improvement group and 39 cases in the deterioration group. The intubation time, mechanical ventilation time and APACHE II score 10 days after admission were compared between the two groups; We assessed pulmonary infections using the clinical pulmonary infection score(CPIS). The levels of α-SMA and ß-catenin in bronchoalveolar lavage fluid at different time points were compared and analyzed, to analyze the association between the levels and the CPIS. Results: The APACHE II score in the improvement group were lower than those in the deterioration group (P<0.05). The expressions of α-SMA and ß-catenin in the BALF of patients in the improvement group were significantly lower than those of patients in the deterioration group on day 1, 3, and 7 (P<0.05); and the expressions of α-SMA and ß-catenin in the BALF of patients in the improvement group decreased with time, while those of patients in the deterioration group increased gradually with time(P<0.05). The expressions of α-SMA and ß-catenin in patients with CPIS>6 was significantly higher than those in patients with CPI≤6(P<0.05). Pearson correlation analysis showed that the levels of α-SMA and ß-catenin in BALF were positively correlated with the CPIS. Conclusion: The levels of α-SMA and ß-catenin in BALF are closely associated with the clinical condition of patients with severe pneumonia; the levels are positively associated with the severity of the disease and they increase with symptomatic worsening. doi: https://doi.org/10.12669/pjms.38.3.5329 How to cite this:Li X, Jiang Z. Correlation between α-SMA and ß-catenin levels in bronchoalveolar lavage fluid and severity of pneumonia. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5329 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Endobronchial tuberculosis: histopathological subsets and microbiological results

2012 ◽  
Vol 7 ◽  
Author(s):  
Sevket Ozkaya ◽  
Salih Bilgin ◽  
Serhat Findik ◽  
Hayriye Çete Kök ◽  
Canan Yuksel ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Lavage Fluid ◽  
Tracheobronchial Tree ◽  
Sputum Smear ◽  
Tuberculous Infection ◽  
Bronchial Lavage ◽  
Culture Positivity ◽  
Endobronchial Tuberculosis ◽  
Smear Negative ◽  
Histopathological Evidence

Background: Endobronchial tuberculosis (EBTB) is defined as a tuberculous infection of the tracheobronchial tree with microbial and histopathological evidence, with or without parenchymal involvement. Bronchoscopic appearances of EBTB have been divided into seven subtypes: actively caseating, edematous-hyperemic, fibrostenotic, tumorous, granular, ulcerative, and nonspecific bronchitic. However, information for establishing a definite microbiological diagnosis in each of these categories is lacking. We aimed to present bronchoscopic appearances and percentages for the EBTB subtypes and to compare bronchoscopic appearances with microbiological positivity in bronchial lavage fluid. Methods: From 2003 to 2009, 23 biopsy-proven EBTB patients were enrolled in the study. Diagnosis of EBTB was histopathologically confirmed in all patients. Results: The commonest subtype was the edematous-hyperemic type (34.7%); other subtypes in order of occurrence were: tumorous (21.7%), granular (17.3%), actively caseating (17.3%), fibrostenotic (4.3%), and nonspecific bronchitic (4.3%). Although all patients were sputum-smear-negative for acid-fast bacilli (AFB), 26% of patients were smear-positive for AFB in the bronchial lavage fluid. The bronchial lavage fluid grew Mycobacterium tuberculosis in 39.1% of all patients. The bronchial lavage smear positivity for AFB in the bronchial lavage fluid was 75%, 25%, 20%, 12.5%, 0%, and 0% for the granular, actively caseating, tumorous, edematous-hyperemic, fibrostenotic, and nonspecific bronchitic subtypes of EBTB, respectively. Culture positivity for Mycobacterium tuberculosis in bronchial lavage fluid was 75%, 50%, 40%, 25%, 0%, and 0%, respectively. Conclusion: The commonest subtype of EBTB was the edematous-hyperemic subtype. The granular type had the highest smear positivity and culture positivity for Mycobacterium tuberculosis in bronchial lavage fluid. Bronchoscopy should be performed in all patients suspected to have EBTB.

scholarly journals Endometriosis of Rectus Muscle Excised During Cesarean Section: A Case Report and Literature Review

2016 ◽  
Author(s):  
Recep Erin ◽  
Kübra Baki Erin ◽  
Derya Burkankulu Ağırbaş ◽  
Burcu Kemal Okatan
Keyword(s):  
Case Report ◽  
Pregnant Woman ◽  
Literature Review ◽  
Cesarean Section ◽  
Abdominal Wall ◽  
Rectus Muscle ◽  
Surgical Excision ◽  
Treatment Method ◽  
Abdominal Wall Endometriosis ◽  
Subcutaneous Mass

<p>We aimed to present a case with abdominal wall endometriosis following cesarean section in this case report. <br />A 32 year old 39 weeks pregnant woman with G2P1 was admitted to gynaecology clinic with abdominal lump and pain in the midline. Her physical examination included a hard and painful palpable subcutaneous mass of 4x5 cm size in the midline of the abdomen which was semisolid and irreducible. <br />Under general anesthesia, the mass on the rectus muscle was excised with the healthy tissue around with the diagnosis of endometriosis during cesarean section and the pathological diagnosis was reported as endometriosis.<br />Surgical excision is the best treatment method in abdominal wall endometriosis. <br /><br /></p>

scholarly journals EXPERIENCES OF PREGNANT WOMEN AT THE PROCESS OF LABOR: SCOPING REVIEW

2021 ◽  
Vol 2 (3) ◽  
pp. 87-98
Author(s):  
Ria Harnita Sari ◽  
Farida Kartini ◽  
Menik Sridaryanti
Keyword(s):  
Pregnant Woman ◽  
Literature Review ◽  
Pregnant Women ◽  
Health Worker ◽  
Scoping Review ◽  
Labor Process ◽  
Normal Delivery ◽  
Research Questions

Background: Each pregnant woman desires normal labor and the trust from health staffs and the support from other people. This literature review is to determine the experiences of pregnant women at labor process. Aim: Knowing  the psychological and support of pregnant women. Methods: Five stages were used to conduct a scoping review. The stages include identifying research questions, identifying relevant studies, selecting studies, charting data and compiling, summarizing and reporting the results.  Result: the experience of giving birth in pregnant women includes experiences related to the knowledge and information received by them, adjustment, fears, hopes, readiness for childbirth, support from family and husbands. The information given can become the answer on the question and assist women in managing their mind, better understanding, and the support from other people. Conclucion: Interestingly, it was found that the women wanted a normal delivery and the trust of a health worker (midwife) where they also needed empowerment and support from others.

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