Nannizziopsis Immune Reconstitution Inflammatory Syndrome in a Patient with HIV: First Reported Case

We describe the case of a 35-year-old HIV-positive male of African origin diagnosed with neurotoxoplasmosis and a Nannizziopsis spp. cavitating pulmonary lesion unmasking immune reconstitution inflammatory syndrome (IRIS). The patient presented with headache, left hemiparesis and confusion. MRI of the brain showed two space-occupying lesions in the right basal ganglia and left parietal lobe typical for neurotoxoplasmosis. The patient tested positive for HIV and had advanced CD4 lymphopenia. After commencement of antiretroviral treatment, a CT scan of the chest showed a cavitating lesion in the right upper lobe. The diagnosis of Nannizziopsis spp. fungal infection was confirmed by DNA sequencing on a bronchial wash sample. The patient achieved complete recovery with antiretroviral therapy, standard neurotoxoplasmosis treatment and antifungal treatment with voriconazole for 12 weeks.

Radiographic Changes vis-à-vis Tracheo-bronchial Aspirate Cytology Profile in Pneumonic Cattle

Background: The study was conducted to establish the utility of radiography in the diagnosis of lung diseases in cattle and its correlation with different pneumonia diagnosed on the basis of TBA cytology. Methods: Lateral chest radiography and tracheo-bronchial wash was performed in control (n=21) and diseased group (n=55). Diseased group included cattle presented with respiratory signs and diagnosed with pulmonary diseases on the basis of history, physical and clinical examination and tracheo-bronchial wash cytology. Cytologic diagnosis was established as chronic pneumonia (n=24), acute pneumonia (n=18), tuberculosis (n=5) and aspiration pneumonia (n=8). Survivability was also correlated with lung patterns in diseased cattle. Result: Nodular interstitial pattern (27.3%), unstructured interstitial pattern (25.4%), bronchial pattern (20.0%), pleural effusions (12.7%), mixed lung patterns (10.9%) and miliary interstitial pattern (4.54%) was observed in diseased group. Unstructured interstitial pattern and pleural effusions were most evident in acute pneumonia. The radiographic findings in aspiration pneumonia did not correlate well with cytologic findings. Highest survivability was recorded in cows with bronchial pattern (81.8%) and lowest in miliary interstitial pattern (zero per cent).

THE MIMICKER OF MALADIES: A SUCCESS STORY

Melioidosis is being diagnosed more frequently from Indian subcontinent in the recent days. It is a serious multisystem infection caused by Burkholderi pseudomallei. 1-2 We discuss the case of a 55 year old Diabetic patient, who presented with complaints of fever, cough, breathlessness and loss of weight of one month duration. Due to poor response to conventional treatment, he was further investigated – Bronchoscopy and CT Thorax was done. Bronchial wash and sputum culture confirmed Pulmonary Melioidosis. The patient received treatment with Inj. Ceftazidime and was continued on oral Cotrimoxazole. Treatment was successful with good clinic radiological resolution. The patient is under follow up and is asymptomatic. Keywords: burkholderia, diabetics, melioidosis, pneumonia

Efficacy of Bronchial Wash Cytology and its Correlation with Histopathology in Diagnosis of Lung Carcinoma in a Tertiary Care Hospital

Introduction: Cytological evaluation is an important, usually initial diagnostic modality in patients with suspected malignant lung masses. Bronchoscopic washing, bronchoalveolar lavage, bronchial brushing and fine needle aspirations may complement tissue biopsies in the diagnosis of lung cancer. This study was undertaken to compare the efficacy of bronchial wash cytology and to correlate it with histopathology in diagnosis of suspected cases of lung cancer at a tertiary care hospital. Material and methods: Bronchial washings and bronchial biopsy were collected from total 60 clinically suspected cases of carcinoma lung. Bronchial washing smears were stained with MGG and H&E stain and were categorized as unequivocally positive / unequivocally negative for malignancy and atypical (equivocal for diagnosis). Biopsy sections were examined for histopathological diagnosis. Results: Cytomorphologically, 30 cases were reported as positive for malignancy, 28 cases were negative for malignancy and 02 cases were atypical. On histopathology, lung carcinoma was diagnosed in 48 patients out of them 35 cases were of squamous cell carcinoma, 7 cases were of small cell carcinoma and 6 were of large cell carcinoma. Conclusion: Maximum diagnostic yield can be obtained by combining biopsy with cytological procedures of washing rather alone.

Analysis of virulence phenotypes and antibiotic resistance in clinical strains of Acinetobacter baumannii isolated in Nashville, Tennessee

Background Acinetobacter baumannii is a gram-negative bacterium which causes opportunistic infections in immunocompromised hosts. Genome plasticity has given rise to a wide range of strain variation with respect to antimicrobial resistance profiles and expression of virulence factors which lead to altered phenotypes associated with pathogenesis. The purpose of this study was to analyze clinical strains of A. baumannii for phenotypic variation that might correlate with virulence phenotypes, antimicrobial resistance patterns, or strain isolation source. We hypothesized that individual strain virulence phenotypes might be associated with anatomical site of isolation or alterations in susceptibility to antimicrobial interventions. Methodology A cohort of 17 clinical isolates of A. baumannii isolated from diverse anatomical sites were evaluated to ascertain phenotypic patterns including biofilm formation, hemolysis, motility, and antimicrobial resistance. Antibiotic susceptibility/resistance to ampicillin-sulbactam, amikacin, ceftriaxone, ceftazidime, cefotaxime, ciprofloxacin, cefepime, gentamicin, levofloxacin, meropenem, piperacillin, trimethoprim-sulfamethoxazole, ticarcillin- K clavulanate, tetracyclin, and tobramycin was determined. Results Antibiotic resistance was prevalent in many strains including resistance to ampicillin-sulbactam, amikacin, ceftriaxone, ceftazidime, cefotaxime, ciprofloxacin, cefepime, gentamicin, levofloxacin, meropenem, piperacillin, trimethoprim-sulfamethoxazole, ticarcillin- K clavulanate, tetracyclin, and tobramycin. All strains tested induced hemolysis on agar plate detection assays. Wound-isolated strains of A. baumannii exhibited higher motility than strains isolated from blood, urine or Foley catheter, or sputum/bronchial wash. A. baumannii strains isolated from patient blood samples formed significantly more biofilm than isolates from wounds, sputum or bronchial wash samples. An inverse relationship between motility and biofilm formation was observed in the cohort of 17 clinical isolates of A. baumannii tested in this study. Motility was also inversely correlated with induction of hemolysis. An inverse correlation was observed between hemolysis and resistance to ticarcillin-k clavulanate, meropenem, and piperacillin. An inverse correlation was also observed between motility and resistance to ampicillin-sulbactam, ceftriaxone, ceftoxamine, ceftazidime, ciprofloxacin, or levofloxacin. Conclusions Strain dependent variations in biofilm and motility are associated with anatomical site of isolation. Biofilm and hemolysis production both have an inverse association with motility in the cohort of strains utilized in this study, and motility and hemolysis were inversely correlated with resistance to numerous antibiotics.

Bacterial Profile and Antimicrobial Susceptibility of Isolates Recovered from Lower Respiratory Tract Infection for Patients in Rizgary Hospital, Erbil

Recognition of etiologies of lower respiratory tract infection (LRTI) may help in delivering effective treatment options and circumvent emergence of antibiotic resistance. This study was carried out to uncover bacterial profile and antibiotic sensitivity patterns among 310 LRTI patients attended Rizagary Hospital between January 2014 to December 2016. Standard laboratory techniques were applied in collecting, processing, and culturing sputum and bronchial wash specimens. VITEK® 2 compact systems were used to identify bacteria and their antibiotic sensitivity patterns. Results showed that Streptococcus parasanguinis and Acinetobacter baumannii were the most abundant gram-positive and gram-negative bacteria (GPB & GNB), respectively, isolated from sputum specimens. From bronchial wash specimens, only GNB were detected and Serratia marcescens was the most abundant one. Antibiotic sensitivity tests revealed that Streptococcus parasanguinis was the most resistant GPB and Acinetobacter baumannii was the most resistant GNB. Sputum recovered GPB were highly resistant to Ampicillin, Erythromycin, Levofloxacin, Trimethoprim/Sulfamethoxazole, and Tetracycline. Bronchial wash recovered GNB were highly resistant to Ampicillin, Minocycline, Pefloxacin, Piperacillin, and Ticarcillin. In conclusion, LRTIs are mainly associated with GNB rather than GPB. The recovered Streptococcus parasanguinis and Acinetobacter baumannii were found to be multidrug-resistant pathogens. Ampicillin was ineffective against any of recovered pathogenic bacteria.

Bronchoscope-Related Outbreaks and Pseudo-Outbreaks: CDC Consultations—United States, 2014–2019

Background: Exposure to medical devices can be a risk factor for the development of healthcare-associated infections; bronchoscopes are a leading cause of device-associated outbreaks. We describe bronchoscope-related outbreaks and pseudo-outbreaks reported to the Centers for Disease Control and Prevention’s Division of Healthcare Quality Promotion (DHQP), and we summarize investigation steps and control measures. Methods: We identified bronchoscope-related consultations with state and local health departments between July 1, 2014, and September 30, 2019, in the DHQP database. We abstracted data on patient symptoms, clinical culture results, investigation findings, and subsequent infection prevention and control interventions. Results: We identified 15 consultations involving 150 patients (range, 3–31 patients per consultation). Each consultation involved at least 1 cluster of the same organism. Organisms associated with bronchoscope-associated clusters were nontuberculous mycobacteria (n = 7), Candida spp (n = 3), Exophiala spp (n = 2), Pseudomonas aeruginosa (n = 2), Enterobacter spp (n = 2), and Raoultella planticola, Stenotrophomonas maltophilia, Achromobacter spp, Mycobacterium tuberculosis, and Aspergillus spp (1 each; 2 consultations involved multiple pathogens). Procedures from which these patient specimens were collected included bronchoalveolar lavage, bronchial wash, bronchial brushing, sputum swab, and lymph node biopsy. For the 7 outbreaks in which clinical data were available, 5 did not have patients with clinical infections related to the pathogen recovered. Two consultations involved pseudo-outbreaks: one involved contamination of specimen collection tubes and the other involved contamination of cultures within the laboratory. Potential underlying pathogen sources included contaminated bronchoscopes (inadequate reprocessing or device damage) (n = 10, 67%), use of nonsterile ice, water, or saline during the procedure (n = 4, 27%), contaminated specimen collection tubes (n = 1, 7%), contaminated bronchoscope suite (n = 1, 7%), and clinical laboratory contamination (n = 1, 7%). The most common interventions included improvement of reprocessing procedures (n = 5), removal of possibly damaged bronchoscopes (n = 4), and eliminating nonsterile ice and water exposures in bronchoscopy (n = 3). Conclusions: Water-related organisms were the most commonly identified pathogens in bronchoscope-related consultations, highlighting the important role that exposure to contaminated water during bronchoscopy and bronchoscope reprocessing might play in bronchoscopy-associated outbreaks and pseudo-outbreaks. During bronchoscope-related outbreaks identifying a common pathogen could indicate problems in bronchoscope handling or reprocessing, device damage, or exposure to nonsterile water.Funding: NoneDisclosures: None