scholarly journals Early Detection of Legionella pneumophila and Aspergillus by mNGS in a Critically Ill Patient With Legionella Pneumonia After Extracorporeal Membrane Oxygenation Treatment: Case Report and Literature Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Ruiming Yue ◽  
Xiaoxiao Wu ◽  
Tianlong Li ◽  
Li Chang ◽  
Xiaobo Huang ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Antibiotic Treatment ◽  
Legionella Pneumophila ◽  
Pathogenic Bacteria ◽  
Early Stage ◽  
Clinical Manifestations ◽  
Severe Pneumonia ◽  
Detection Methods ◽  
Critically Ill Patient ◽  
Membrane Oxygenation

Legionella pneumophila can cause pneumonia, leading to severe acute respiratory distress syndrome (ARDS). Because of its harsh growth requirements, limited detection methods, and non-specific clinical manifestations, diagnosing Legionella pneumonia remains still challenging. Metagenomic next-generation sequencing (mNGS) technology has increased the rate of detection of Legionella. This study describes a patient who rapidly progressed to severe ARDS during the early stage of infection and was treated with extracorporeal membrane oxygenation (ECMO). Although his bronchoalveolar lavage fluid (BALF) was negative for infection and his serum was negative for anti-Legionella antibody, mNGS of his BALF and blood showed only the presence of Legionella pneumophila (blood mNGS reads 229, BALF reads 656). After antibiotic treatment and weaning from ECMO, however, he developed a secondary Aspergillus and Klebsiella pneumoniae infection as shown by mNGS. Mechanical ventilation and antibiotic treatment were effective. A search of PubMed showed few reports of secondary Aspergillus infections after Legionella infection. Severe pneumonia caused by any type of pathogenic bacteria may be followed by Aspergillus infection, sometimes during extremely early stages of infection. Patients with severe pneumonia caused by Legionella infection should undergo early screening for secondary infections using methods such as mNGS, enabling early and precise treatment, thereby simplifying the use of antibiotics and improving patient prognosis.

scholarly journals Critically Ill Patients With H1N1 Influenza A Undergoing Extracorporeal Membrane Oxygenation

2011 ◽  
Vol 31 (5) ◽  
pp. e8-e24 ◽  
Author(s):  
Christopher Bibro ◽  
Christine Lasich ◽  
Frank Rickman ◽  
Nichole E. Foley ◽  
Sujen K. Kunugiyama ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Critically Ill ◽  
Influenza A ◽  
H1n1 Influenza ◽  
Health Care Team ◽  
Swine Flu ◽  
Standards Of Care ◽  
Critically Ill Patient ◽  
Membrane Oxygenation

The most common cause of death due to the H1N1 subtype of influenza A virus (swine flu) in the 2009 to 2010 epidemic was severe acute respiratory failure that persisted despite advanced mechanical ventilation strategies. Extracorporeal membrane oxygenation (ECMO) was used as a salvage therapy for patients refractory to traditional treatment. At Legacy Emanuel Hospital, Portland, Oregon, the epidemic resulted in a critical care staffing crisis. Among the 15 patients with H1N1 influenza A treated with ECMO, 4 patients received the therapy simultaneously. The role of ECMO in supporting patients with severe respiratory failure due to H1N1 influenza is described, followed by discussions of the nursing care challenges for each body system. Variations from standards of care, operational considerations regarding staff workload, institutional burden, and emotional wear and tear of the therapy on patients, patients’ family members, and the entire health care team are also addressed. Areas for improvement for providing care of the critically ill patient requiring ECMO are highlighted in the conclusion.

scholarly journals Russian Experience of Transport Extracorporeal Membrane Oxygenation

2021 ◽  
Vol 9 (4) ◽  
pp. 521-528
Author(s):  
D. A. Shelukhin ◽  
A. V. Karpov ◽  
M. V. Ketskalo ◽  
K. K. Gubarev
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Clinical Experience ◽  
Russian Federation ◽  
Age Groups ◽  
Clinical Manifestations ◽  
Practical Experience ◽  
Hospital Survival ◽  
Membrane Oxygenation ◽  
Significant Difference ◽  
The Russian Federation

Relevance. The present time can be called a period of accumulation of experience of national health systems in different countries of the world in the application of transport extracorporeal membrane oxygenation (ECMO) technology at the pre- and inter-hospital stages of evacuation of patients to specialized ECMO-therapy centers. The role of such centers is to provide timely advice and, if necessary, perform inter-hospital evacuation.Material and methods. The study summarized and analyzed with the help of the national register “RosECMO” the own experience of 13 hospitals in the Russian Federation, who performed 68 inter-hospital evacuations under ECMO conditions by different modes of transport in patients of different age groups with symptoms of circulatory and respiratory failure. The following parameters were evaluated: characteristics of transport ECMO, clinical manifestations of potentially negative effects of transport, hospital survival, as well as the effect of experience (less and more than 10 cases of transport ECMO) of the presented clinics on the difference in the results obtained.Results. Connecting patients to the ECMO device reduces the likelihood of death on the SOFA and APACHE IV scales by 1.2 times (p <0.0001) and 1.4 times (p<0.0001), respectively. Despite the absence of deaths during inter-hospital transportation of patients under ECMO conditions, 14.93% of patients died within 3 days from the moment of their execution, without a significant difference in clinics with different practical experience. The overall hospital survival rate of ECMO transport scenarios in all 13 clinics of the Russian Federation was comparable to the data of the international register 48.52% versus 48.81%, at the same time it was significantly lower (1.3 times) in the group of clinics with less clinical experience 40% versus 52.08% (p<0.0001).Conclusion. The results of the first stage of the study we obtained indicate the prospects of using the method of extracorporeal membrane oxygenation at the stage of inter-hospital evacuation, due to the effective stabilization of the patient’s condition and a significant reduction in the risks of the likelihood of death. Clinics with less clinical experience showed significantly worse results of hospital survival of patients who underwent inter-hospital transportation under conditions of extracorporeal membrane oxygenation compared to clinics with more clinical experience, which can be a significant argument in adopting a model for the development of specialized regional centers for extracorporeal membrane oxygenation. The experience accumulated over the past six years and the analysis of new data from the register of transport cases of extracorporeal membrane oxygenation of the national healthcare system will make it possible to formulate the correct trajectory for the development of the method of extracorporeal membrane oxygenation and its application, including at the stage of pre- and inter-hospital evacuations of patients.

scholarly journals Exploitation of Phosphoinositides by the Intracellular Pathogen, Legionella pneumophila

2020 ◽  
Author(s):  
Colleen M. Pike ◽  
Rebecca R. Noll ◽  
M. Ramona Neunuebel
Keyword(s):  
Membrane Trafficking ◽  
Legionella Pneumophila ◽  
Pathogenic Bacteria ◽  
Severe Pneumonia ◽  
Bacterial Proteins ◽  
Specific Host ◽  
Spatiotemporal Regulation ◽  
Host Membrane ◽  
Membrane Compartments ◽  
Legionnaires Disease

Manipulation of host phosphoinositide lipids has emerged as a key survival strategy utilized by pathogenic bacteria to establish and maintain a replication-permissive compartment within eukaryotic host cells. The human pathogen, Legionella pneumophila, infects and proliferates within the lung’s innate immune cells causing severe pneumonia termed Legionnaires’ disease. This pathogen has evolved strategies to manipulate specific host components to construct its intracellular niche termed the Legionella-containing vacuole (LCV). Paramount to LCV biogenesis and maintenance is the spatiotemporal regulation of phosphoinositides, important eukaryotic lipids involved in cell signaling and membrane trafficking. Through a specialized secretion system, L. pneumophila translocates multiple proteins that target phosphoinositides in order to escape endolysosomal degradation. By specifically binding phosphoinositides, these proteins can anchor to the cytosolic surface of the LCV or onto specific host membrane compartments, to ultimately stimulate or inhibit encounters with host organelles. Here, we describe the bacterial proteins involved in binding and/or altering host phosphoinositide dynamics to support intracellular survival of L. pneumophila.

scholarly journals Silicosis-associated Severe Pneumonia Treated by Veno-veno-venous Extracorporeal Membrane Oxygenation: a Case Report

2021 ◽  
Author(s):  
Ting Xiong ◽  
Xiao Fei Su ◽  
Zuo Liang Liu ◽  
Shang Ping Zhao
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Structural Damage ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Severe Pneumonia ◽  
Life Support System ◽  
Case Presentation ◽  
Membrane Oxygenation ◽  
Death Case ◽  
Severe Lung

Abstract Background: Extracorporeal membrane oxygenation (ECMO) is an extracorporeal life support system (ECLS) for patients with severe cardiopulmonary failure, there are two basic patterns of veno-arterial (V-A) and veno-venous (V-V). Case presentation: This paper mainly introduced a death case of modified ECMO Patterns which is veno-veno-venous ECMO in the treatment of silicosis with severe pneumonia and analyzed the cause of death after treatment with VV-V ECMO. Conclusions: Although VV-V ECMO is recommended for patients with extremely poor oxygenation conditions, it still be difficult to improve the prognosis of patients with severe lung structural damage, and still has a long way to go.

scholarly journals Legionella pneumophila infection and antibiotic treatment engenders a highly disturbed pulmonary microbiome with decreased microbial diversity

2019 ◽  
Author(s):  
Ana Elena Pérez-Cobas ◽  
Christophe Ginevra ◽  
Christophe Rusniok ◽  
Sophie Jarraud ◽  
Carmen Buchrieser
Keyword(s):  
Antibiotic Treatment ◽  
Legionella Pneumophila ◽  
Severe Pneumonia ◽  
Resistant Bacteria ◽  
Rrna Gene ◽  
Microbial Composition ◽  
Bacterial Composition ◽  
Lung Microbiome ◽  
The Impact ◽  
Healthy Lung

ABSTRACTBackgroundLung microbiome analyses have shown that the healthy lung is not sterile but it is colonized like other body sites by bacteria, fungi and viruses. However, little is known about the microbial composition of the lung microbiome during infectious diseases such as pneumonia and how it evolves during antibiotic therapy. To better understand the impact of the composition of the pulmonary microbiome on severity and outcome of pneumonia we analysed the composition and evolution of the human lung microbiome during pneumonia caused by the bacterium Legionella pneumophila.ResultsWe collected 10 bronchoalveolar lavage (BAL) samples from three patients during long-term hospitalisation due to severe pneumonia and performed a longitudinal in-depth study of the composition of their lung microbiome by high-throughput Illumina sequencing of the 16S rRNA gene (bacteria and archaea), ITS region (fungi) and 18S rRNA gene (eukaryotes). We found that the composition of the bacterial lung microbiome during pneumonia is hugely disturbed containing a very high percentage of the pathogen, a very low bacterial diversity, and an increased presence of opportunistic microorganisms such as species belonging to Staphylococcaceae and Streptococcaceae. The microbiome of antibiotic treated patients cured from pneumonia represented a different perturbation state with a higher abundance of resistant bacteria (mainly Firmicutes) and a significantly different bacterial composition as that found in healthy individuals. In contrast, the mycobiome remains more stable during pneumonia and antimicrobial therapy. Interestingly we identified possible cooperation within and between both communities. Furthermore, archaea (Methanobrevibacter) and protozoa (Acanthamoeba and Trichomonas) were detected.ConclusionsBacterial pneumonia leads to a collapse of the healthy microbiome and a strongly disturbed bacterial composition of the pulmonary microbiome that is dominated by the pathogen. Antibiotic treatment allows some bacteria to regrow or recolonize the lungs but the restoration of a healthy lung microbiome composition is only regained a certain time after the antibiotic treatment. Archaea and protozoa should also be considered, as they might be important but yet overseen members of the lung microbiome. Interactions between the micro- and the mycobiome might play a role in the restoration of the microbiome and the clinical evolution of the disease.

scholarly journals Veno‐venous extracorporeal membrane oxygenation for severe pneumonia: COVID‐19 case in Japan

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Hayato Taniguchi ◽  
Fumihiro Ogawa ◽  
Hiroshi Honzawa ◽  
Keishi Yamaguchi ◽  
Shoko Niida ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Severe Pneumonia ◽  
Membrane Oxygenation

scholarly journals How bacterial effectors hijack small GTPases to divert membrane traffic

2014 ◽  
Vol 70 (a1) ◽  
pp. C802-C802
Author(s):  
Jacqueline Cherfils ◽  
Marcia Folly-Klan ◽  
Valérie Campanacci
Keyword(s):  
Legionella Pneumophila ◽  
Pathogenic Bacteria ◽  
Membrane Traffic ◽  
Severe Pneumonia ◽  
Small Gtpases ◽  
Covalent Attachment ◽  
Rab Gtpase ◽  
Postal Service ◽  
Nucleotide Exchange ◽  
Vesicular Traffic

Membrane traffic, which is the "cellular postal service" that shuttles biomolecules around the cell and organizes the structure of organelles, is among the primary targets of effectors injected by intracellular pathogenic bacteria to invade their host and avoid from being destroyed. I will present our recent structural and biochemical studies of effectors from Legionella pneumophila (the bacteria that causes the legionnaire's disease, a severe pneumonia) that divert membrane traffic to generate a membrane-bound vacuole where the pathogen hides and replicates. One of these effectors, AnkX, is a FIC domain-containing toxin that alters the functions of a Rab GTPase involved in vesicular traffic at the endoplasmic reticulum, by covalent attachment of a phosphocholine molecule. The other one, RalF, functions as an illegitimate guanine nucleotide exchange factor to activate an Arf GTPase on the vacuole. Our studies showed how AnkX binds and processes CDP-choline to transfer phosphocholine onto Rab1 [1], and uncover a novel membrane sensor in RalF that controls its localization and activity [2]

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