No abstract available.
Acute Kidney Injury/microbiology ; Anti-Bacterial Agents/therapeutic use ; Biopsy ; Humans ; Kidney/*microbiology ; Male ; Middle Aged ; Mycoplasma pneumoniae/drug effects/*isolation & purification ; Nephritis/diagnosis/drug therapy/*microbiology ; Pneumonia, Mycoplasma/diagnosis/drug therapy/*microbiology ; Skin Diseases, Bacterial/diagnosis/drug therapy/*microbiology ; Steroids/therapeutic use ; Treatment Outcome ; Vasculitis/diagnosis/drug therapy/*microbiology

Few studies have described the key features and prognostic roles of lung microbiota in patients with severe community-acquired pneumonia (SCAP). We prospectively enrolled consecutive SCAP patients admitted to ICU. Bronchoscopy was performed at bedside within 48 h of ICU admission, and 16S rRNA gene sequencing was applied to the collected bronchoalveolar lavage fluid. The primary outcome was clinical improvements defined as a decrease of 2 categories and above on a 7-category ordinal scale within 14 days following bronchoscopy. Sixty-seven patients were included. Multivariable permutational multivariate analysis of variance found that positive bacteria lab test results had the strongest independent association with lung microbiota (R² = 0.033; P = 0.018), followed by acute kidney injury (AKI; R² = 0.032; P = 0.011) and plasma MIP-1β level (R² = 0.027; P = 0.044). Random forest identified that the families Prevotellaceae, Moraxellaceae, and Staphylococcaceae were the biomarkers related to the positive bacteria lab test results. Multivariable Cox regression showed that the increase in α-diversity and the abundance of the families Prevotellaceae and Actinomycetaceae were associated with clinical improvements. The positive bacteria lab test results, AKI, and plasma MIP-1β level were associated with patients' lung microbiota composition on ICU admission. The families Prevotellaceae and Actinomycetaceae on admission predicted clinical improvements.
Acute Kidney Injury/complications* ; Bacteria/classification* ; Chemokine CCL4/blood* ; Community-Acquired Infections/microbiology* ; Humans ; Lung ; Microbiota/genetics* ; Pneumonia, Bacterial/diagnosis* ; Prognosis ; RNA, Ribosomal, 16S/genetics*

Megalocytic interstitial nephritis is a rare form of kidney disease caused by chronic inflammation. We report a case of megalocytic interstitial nephritis occurring in a 45-yrold woman who presented with oliguric acute kidney injury and acute pyelonephritis accompanied by Escherichia coli bacteremia. Her renal function was not recovered despite adequate duration of susceptible antibiotic treatment, accompanied by negative conversion of bacteremia and bacteriuria. Kidney biopsy revealed an infiltration of numerous histiocytes without Michaelis-Gutmann bodies. The patient's renal function was markedly improved after short-term treatment with high-dose steroid.
Acute Disease ; Acute Kidney Injury/complications/*drug therapy/pathology ; Anti-Bacterial Agents/therapeutic use ; Azithromycin/therapeutic use ; Bacteremia/*drug therapy/microbiology/pathology ; Cefotaxime/therapeutic use ; Creatinine/blood ; Escherichia coli ; Escherichia coli Infections/*drug therapy/microbiology/pathology ; Female ; Humans ; Kidney/pathology ; Methylprednisolone/therapeutic use ; Middle Aged ; Nephritis, Interstitial/*drug therapy/immunology/pathology ; Pyelonephritis/complications/*drug therapy/pathology ; Renal Dialysis ; Shock, Septic/drug therapy/microbiology

Mushroom exposures are increasing worldwide. The incidence and fatality of mushroom poisoning are reported to be increasing. Several new syndromes in mushroom poisoning have been described. Rhabdomyolytic mushroom poisoning is one of new syndromes. Russula subnigricans mushroom can cause delayed-onset rhabdomyolysis with acute kidney injury in the severely poisoned patient. There are few reports on the toxicity of R. subnigricans. This report represents the first record of R. subnigricans poisoning with rhabdomyolysis in Korea, describing a 51-year-old man who suffered from rhabdomyolysis, acute kidney injury, severe hypocalcemia, respiratory failure, ventricular tachycardia, cardiogenic shock, and death. Mushroom poisoning should be considered in the evaluation of rhabdomyolysis of unknown cause. Furthermore, R. subnigricans should be considered in the mushroom poisoning with rhabdomyolysis.
Acute Kidney Injury/*etiology ; Basidiomycota/isolation & purification/*pathogenicity ; Electrocardiography ; Heart Ventricles/physiopathology ; Humans ; Male ; Middle Aged ; Mushroom Poisoning/*diagnosis/microbiology/mortality ; Rhabdomyolysis/*etiology ; Shock, Cardiogenic/*etiology ; Tachycardia, Ventricular/etiology

OBJECTIVETo explore the management of fungal pyelonephritis in infants.

METHODData from 5 cases with fungal pyelonephritis, including the clinical situation, laboratory examination, feature of imaging, and treatment were analyzed.

RESULTAll the 5 cases were preterm and low birth weight infants. In 3 cases the disease was unilateral, in 2 cases were bilateral, and acute renal failure occurred. Fungus balls presented on imaging. Urine culture was positive of Candida albicans. Treatment with percutaneous nephrostomy, irrigation and antifungal agent were associated with good prognosis. Only 1 case died. The surviving patients were followed up for 10 - 20 months and the results showed normal growth and development. B-mode ultrasound examination did not show any malformation of the urinary system.

CONCLUSIONFungal pyelonephritis was commom in preterm infants. Candida albicans was the major pathogenic microorganism. Percutaneous nephrostomy and drainage were effective in patients with urinary obstruction in relief of obstruction, early diagnosis and control of infection.

Acute Kidney Injury ; etiology ; therapy ; Amphotericin B ; administration & dosage ; Antifungal Agents ; administration & dosage ; therapeutic use ; Candida albicans ; isolation & purification ; Candidiasis ; complications ; diagnosis ; therapy ; Chymotrypsin ; administration & dosage ; Female ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Male ; Nephrostomy, Percutaneous ; Pyelonephritis ; diagnosis ; microbiology ; therapy ; Treatment Outcome ; Ultrasonography, Doppler, Color ; Ureteral Obstruction ; etiology ; therapy ; Urine ; microbiology

OBJECTIVETo carry out epidemiological study on an outbreak caused by E. coli O157:H7 infection in Jiangsu province in 1999.

METHODSEpidemiological, microbiological and moleculebiological methods were used to find out the source, route of transmission and risk factors.

RESULTS95 severe O157:H7 infected patients with acute renal failure in 9 counties and districts of 2 municipalities were reported in Jiangsu province, 1999 while 83 of the patients died with a death rate of 87.37%. Most patients were seen in mid or late June. The ratio of male to female was 1 to 1.44 and 88.42% of the patients were over 50 years old. 38 patients occurred in 2000 with 34 deaths. Major factors contributing to the outbreak would include without drinking tap water, eating leftover food, poor sanitary status in kitchen, not washing hands before meal and after bowl movement. 2 strain of O157:H7 was isolated from severe patients and 3 from diarrhea cases. Carrier rate among animals was up to 9.62% and 99.41% of the strains carried toxic gene. Strains isolated from feces of patients and animals belonged to the same colonies.

CONCLUSIONThis outbreak was severe which caused by O157:H7 and was first seen in China, which was closely related to the high carrier rate of O157:H7 in animals and to the positive rate of high toxic gene of the strains. There were various routes of transmission and the main factors of infection would include poor personal health habits and poor sanitation of the household.

Acute Kidney Injury ; epidemiology ; etiology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antibodies, Bacterial ; immunology ; Case-Control Studies ; Child ; Child, Preschool ; China ; epidemiology ; Diarrhea ; epidemiology ; microbiology ; Disease Outbreaks ; Escherichia coli Infections ; complications ; epidemiology ; Escherichia coli O157 ; isolation & purification ; Escherichia coli Proteins ; immunology ; Female ; Hemolysin Proteins ; immunology ; Humans ; Infant ; Male ; Middle Aged ; Seroepidemiologic Studies