OBJECTIVE: To determine the patho-mechanism of pleural effusion or hydropneumothorax in Mycobacterium avium complex (MAC) lung disease through the computed tomographic (CT) findings. MATERIALS AND METHODS: We retrospectively collected data from 5 patients who had pleural fluid samples that were culture-positive for MAC between January 2001 and December 2013. The clinical findings were investigated and the radiological findings on chest CT were reviewed by 2 radiologists. RESULTS: The 5 patients were all male with a median age of 77 and all had underlying comorbid conditions. Pleural fluid analysis revealed a wide range of white blood cell counts (410-100690/microL). The causative microorganisms were determined as Mycobacterium avium and Mycobacterium intracellulare in 1 and 4 patients, respectively. Radiologically, the peripheral portion of the involved lung demonstrated fibro-bullous changes or cavitary lesions causing lung destruction, reflecting the chronic, insidious nature of MAC lung disease. All patients had broncho-pleural fistulas (BPFs) and pneumothorax was accompanied with pleural effusion. CONCLUSION: In patients with underlying MAC lung disease who present with pleural effusion, the presence of BPFs and pleural air on CT imaging are indicative that spread of MAC infection is the cause of the effusion.
Aged ; Aged, 80 and over ; Female ; Fistula/complications ; Humans ; Hydropneumothorax/complications/microbiology/*radiography ; Lung/radiography ; Male ; Middle Aged ; Mycobacterium avium/*isolation & purification ; Mycobacterium avium Complex/isolation & purification ; Mycobacterium avium-intracellulare Infection/*diagnosis/microbiology ; Pleural Diseases/complications/microbiology/*radiography ; Pleural Effusion/complications ; Retrospective Studies ; *Tomography, X-Ray Computed

OBJECTIVETo explore the value of pleural biopsy in the diagnosis of tuberculous pleurisy in children.

METHODFifty-one cases with tuberculous pleurisy, whose diagnosis was established according to the clinical diagnostic criteria of the child pulmonary tuberculosis formulated by the Chinese Medical Association (CMA) in 2006, after pleural biopsy hospitalized in Children's Hospital of Chongqing Medical University from Jan. 1, 2007 to Jan. 1, 2013 were enrolled into this study. Clinical symptoms, history traits, laboratory examination, imaging tests, pleural fluid characteristics and the results of pleural biopsy were retrospectively analyzed. Medical records of the cases who were diagnosed with tuberculous pleurisy by histological examination were reviewed to assess tuberculosis detection rate of pleural biopsy and to get the percentage of cases with a preoperative diagnosis inconsistent with the final diagnosis.

RESULTThere were 35 boys and 16 girls, and the mean age was (9.7 ± 3.5) years. The common symptoms included fever (82%), cough (71%) , chest pain (23%), weakness (10%) and shortness of breath (10%); 27% (14/51) children had shown tuberculosis toxic symptoms; 76% (39/51) patients had BCG vaccination history; 12% (6/51) cases had a history of contact with tuberculosis patients. The positive rates of the tuberculin skin test, serum tuberculosis antibody detection, detection of Mycobacterium tuberculosis DNA by polymerase chain reaction, acid-fast bacillus test of sputum (or gastric juice) smear, acid-fast bacilli (AFB) smear and culture of pleural effusion were respectively 61% (20/33), 6% (3/46), 0 (0/12), 4% (1/27), 22% (7/32). Pleural effusion was found by using imaging tests in 50 cases, among whom 28 cases (55%) with encapsulated effusion, and the multilocular cysts separated by fibrous tissue in 12 patients (23%) . Other features included pleural thickening (53%) , hilar and mediastinal lymph-nodes enlargement (14%) and white nodules of calcification (10%) . Thoracocentesis was performed in 31 cases, and pleural effusion obtained from which were exudative. The cell count, mainly mononuclear cells, increased in 28 patients (90%) . Among the 51 children investigated, 47 (92%) were histologically diagnosed to be tuberculous pleurisy. The typical pathologic changes of tuberculosis (caseous necrosis, granulomas, Langhans' giant cells and inflammatory cell infiltration) were observed in 40 cases, granulomatous inflammation without caseous necrosis were the main manifestations in 7 other patients. The pathological changes of the remaining 4 cases were not consistent with the pathological characteristics of tuberculosis. All 47 cases were given a preoperative diagnosis of tuberculous pleurisy (32%), purulent pleurisy (51%) and pleural effusion of unknown origin (17%) respectively before pleural biopsy. Therefore, the tuberculosis detection rate of pleural biopsy was 92%, and the preoperative misdiagnosis rate was 68%.

CONCLUSIONPleural biopsy was of great diagnostic value for children with tuberculous pleurisy.

Biopsy, Needle ; methods ; Child ; DNA, Bacterial ; isolation & purification ; Diagnostic Errors ; Female ; Humans ; Lung ; microbiology ; pathology ; Male ; Mycobacterium tuberculosis ; isolation & purification ; Pleura ; microbiology ; pathology ; Pleural Effusion ; microbiology ; pathology ; Polymerase Chain Reaction ; Retrospective Studies ; Sputum ; microbiology ; Tuberculin Test ; Tuberculosis, Pleural ; diagnosis ; microbiology ; pathology

OBJECTIVETo analyze the clinical characteristics of Mycoplasma pneumoniae-associated hemophagocytic syndrome (MP-HLH).

METHODA retrospective investigation of the clinical manifestation, laboratory test, imagelogy, clinical course and outcome of 3 cases with MP-HLH seen between June 2013 and July 2013 in Shenzhen Children's Hospital, and review of relevant literature were conducted.

RESULTOf the 3 cases of MP-HLH, 2 were males, one was female, the ages were 1 year, 3 years and 6 years, respectively. They had no underlying disease previously. All the 3 cases had onset of fever, cough as main symptoms. Diagnosis of refractory Mycoplasma pneumoniae pneumonia was made, which was accompanied by decreased neutrophils [(0.08-0.68)×10(9)/L], hemoglobin [(79-103) g/L], platelet [(64-157)×10(9)/L], plasma fibrinogen [(1.3-1.5) g/L], lactate dehydrogenase [(1,170-1,285) U/L] and increased serum ferritin [(936.7-39 789.0) µg/L] in the third week of course. In two cases the T lymphocytes decreased, and the NK cell activity decreased significantly in one. Bone marrow cytology showed prompted bone marrow hyperplasia, and the phenomenon of phagocytosed blood cells. CT scan was performed for all the cases and consolidation with pleural effusion were shown. Two cases were admitted to PICU, and required endotracheal intubation and mechanical ventilation. Flexible bronchoscopy and bronchial lavage were performed and bronchial cast was found in two cases. All of them were treated with macrolide combined with other antibiotics, glucocorticoids and gamma globulin combination therapy, including one case given dexamethasone [10 mg/(m2·d)], cyclosporine[6 mg/(kg·d)], etoposide [150 mg/(m2·d)] chemotherapy. Two cases were cured, and 1 case died. The authors summarized the 18 cases reported in domestic and foreign literature. Foreign children were diagnosed and treated with steroids in 1-2 weeks, and 10 cases were cured, and 2 cases died. They died of massive hemorrhage and meningoencephalitis, and domestic children were diagnosed and treated within two to 4 weeks after onset, 5 cases were cured, one case died of severe pneumonia.

CONCLUSIONMP-HLH is a rare disease in children, and had acute onset, rapid progression and high mortality. Early treatment with steroids was associated with a good prognosis, the key to successful treatment is early diagnosis and treatment, avoiding the immune cascade. Too late a diagnosis or development of serious complications may lead to death.

Anti-Bacterial Agents ; therapeutic use ; Bronchoalveolar Lavage Fluid ; Bronchoscopy ; Child ; Child, Preschool ; Fatal Outcome ; Female ; Fever ; Glucocorticoids ; therapeutic use ; Humans ; Infant ; Lymphohistiocytosis, Hemophagocytic ; diagnosis ; drug therapy ; microbiology ; Macrolides ; therapeutic use ; Male ; Mycoplasma pneumoniae ; isolation & purification ; Pleural Effusion ; Pneumonia, Mycoplasma ; complications ; diagnosis ; drug therapy ; Respiration, Artificial ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome

No abstract available.
Anti-Bacterial Agents/therapeutic use ; Cardiac Tamponade/etiology ; Drainage ; Empyema, Pleural/diagnosis/*etiology/microbiology/therapy ; Heart Diseases/diagnosis/*etiology/microbiology/therapy ; Humans ; Kidney Failure, Chronic/*therapy ; Male ; Methicillin-Resistant Staphylococcus aureus/isolation & purification ; Middle Aged ; Pericardial Effusion/etiology ; Pericardial Window Techniques ; Pericardiocentesis ; Peritoneal Dialysis, Continuous Ambulatory/*adverse effects ; Peritonitis/diagnosis/drug therapy/*etiology/microbiology ; Pleural Effusion/etiology ; Staphylococcal Infections/diagnosis/drug therapy/*etiology/microbiology ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVETo study the clinical characteristics of Streptococcus pneumonia-associated hemolytic uremic syndrome (SP-HUS) in children.

METHODClinical and laboratory data of a pediatric case of SP-HUS were retrospectively analyzed and the key points of diagnosis and therapy were reviewed.

RESULTAn 18-month old girl was admitted with chief complaint of fever and cough for 5 days combined with mild labored breath. Breath sound was found weakened in right lung with lower lobe dullness on percussion. Laboratory tests revealed: WBC 3.7×10(9)/L, Hb 83 g/L, PLT 11×10(9)/L, C-reactive protein (CRP) > 180 mg/L. Morphological study of the RBCs showed marked anisocytosis and schistocytosis. Urinalysis showed 42.66 RBCs per high-power field, occult blood (+++), proteinura (++++). Streptococcus pneumoniae was isolated from blood, pleural fluid and sputum. Serotyping with simplified chessboard system was 3. The direct Coombs test was positive. Serum complement levels (C3 and C4) were depressed at 0.699 g/L, 0.064 g/L, respectively. Chest X-ray showed pleural effusion and infection of the right hemothorax. The computerized tomographic scan of the chest revealed pneumatoceles in the right lower lobe. The diagnosis on admission we considered was SP-HUS. Intravenous antibiotic therapy (vancomycin + cefoperazone/sulbactam) was administered. The renal replacement theraphy was administered to maintain electrolyte and fluid balances and adequate nutrition. Transfusions of washed red blood cells were administered to correct the anemia. One month after admission the patient was good with recovery. Liver and renal function recovered and the pneumonia was resolving, anemia and platelets were corrected. The direct Coombs test turned to be negative. Serum complement levels (C3 and C4) were normal. After 3-month follow-up, no clinical anomalies were detected.

CONCLUSIONSP-HUS should be suspected when the following occurs in the context of pneumococcal infections: microangiopathic hemolytic anemia, thrombocytopenia, acute renal failure and a positive Coombs test result. Serotype 3 of SP was associated with HUS.

Anti-Bacterial Agents ; therapeutic use ; Biomarkers ; analysis ; Coombs Test ; Female ; Hemolytic-Uremic Syndrome ; diagnosis ; etiology ; microbiology ; therapy ; Humans ; Infant ; Lung ; diagnostic imaging ; pathology ; Pleural Effusion ; etiology ; Pneumococcal Infections ; complications ; Radiography ; Retrospective Studies ; Serotyping ; Streptococcus pneumoniae ; classification ; isolation & purification

BACKGROUNDThe Toll-like receptors (TLRs) represent a group of single-pass transmembrane receptors expressed on sentinel cells that are central to innate immune responses.The aim of this study was to investigate the presence of soluble TLRs in pleural effusions, and the diagnostic values of TLRs for pleural effusion with various etiologies.

METHODSPleural effusion and serum samples were collected from 102 patients (36 with malignant pleural effusion, 36 with tuberculous pleural effusion, 18 with bacterial pleural effusion, and 12 with transudative pleural effusion). The concentrations of TLR1 to TLR10 were determined in effusion and serum samples by enzyme linked immunosorbent assay. Four classical parameters (protein, lactate dehydrogenase, glucose and C-reactive protein (CRP)) in the pleural fluid were also assessed. Receiver-operating characteristic curves were used to assess the sensitivity and specificity of pleural fluid TLRs and biochemical parameters for differentiating bacterial pleural effusion.

RESULTSThe concentrations of TLR1, TLR3, TLR4, TLR7 and TLR9 in bacterial pleural effusion were significantly higher than those in malignant, tuberculous, and transudative groups, respectively. Analysis of receiver operating characteristic curves revealed that the area under the curves of TLR1, TLR3, TLR4, TLR7 and TLR9 were 0.831, 0.843, 0.842, 0.883 and 0.786, respectively, suggesting that these TLRs play a role in the diagnosis of bacterial pleural effusion. Also, the diagnostic value of TLRs for bacterial pleural effusions was much better than that of biochemical parameters (protein, lactate dehydrogenase, glucose and CRP).

CONCLUSIONSThe concentrations of TLR1, TLR3, TLR4, TLR7 and TLR9 appeared to be increased in bacterial pleural effusion compared to non-bacterial pleural effusions. Determination of these pleural TLRs may improve the ability of clinicians to differentiate pleural effusion patients of bacterial origin from those with other etiologies.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bacterial Infections ; metabolism ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Male ; Middle Aged ; Pleural Effusion ; metabolism ; microbiology ; Prospective Studies ; Toll-Like Receptor 1 ; metabolism ; Toll-Like Receptor 3 ; metabolism ; Toll-Like Receptor 4 ; metabolism ; Toll-Like Receptor 7 ; metabolism ; Toll-Like Receptor 9 ; metabolism ; Toll-Like Receptors ; metabolism ; Young Adult

OBJECTIVETo study the incidence, etiology, outcome, and risk factors of early (is less than or equal to 30 days) pulmonary infection following adult-to-adult living donor liver transplantation (AALDLT).

METHODSMedical records of 108 AALDLT without pre-operative respiratory disease from 2005 to 2008 were retrospective to evaluate the incidence, etiology, outcome, and risk factors of pulmonary infection following AALDLT. Univariate analysis was used to determine relative risk factors leading to postoperative pneumonia, and significant factors (P less than 0.05) were then used for multivariate logistic regression analysis.

RESULTSThe incidence of pneumonia was 22.2 % (n = 24 ); etiology including bacteria (n = 23, 21.3%), gram negative bacteria account for 78.3%, fungi (n = 4, 3.7%) and virus (n = 1, 0.9%), 4 patients were coinfection by bacteria and fungi; 6 among 24 patients (25%) and 4 out of the other 84 patients (4.76%) died early following the AALDLT, respectively (x2 = 6.850, P = 0.009). In univariate analysis, intraoperative volume of whole blood/packed red blood cells transfusion (P less than 0.01), intraoperative volume of fresh frozen plasma transfusion (P = 0.001), total volume of intraoperative transfusion (P = 0.015), mechanical ventilation (P less than 0.01), intensive unit care (ICU) stay (P = 0.012) and acute rejection (P = 0.001) are of statistical significance. Multivariate logistic regression showed only mechanical ventilation (P = 0.023) and acute rejection (P = 0.026) are independent factors predicting pneumonia.

CONCLUSIONGram negative bacteria is the main etiology for pneumonia following AALDLT which has high morbidity and mortality; mechanical ventilation and acute rejection are independent risk factors.

Adult ; Female ; Graft Rejection ; epidemiology ; Gram-Negative Bacterial Infections ; epidemiology ; mortality ; Humans ; Immunosuppressive Agents ; adverse effects ; therapeutic use ; Incidence ; Liver Transplantation ; adverse effects ; methods ; mortality ; Living Donors ; Lung Diseases ; epidemiology ; microbiology ; mortality ; Male ; Middle Aged ; Pleural Effusion ; epidemiology ; Pneumonia ; epidemiology ; microbiology ; mortality ; Postoperative Complications ; epidemiology ; Regression Analysis ; Retrospective Studies ; Risk Factors ; Transfusion Reaction ; Young Adult

This study investigated the serum vascular endothelial growth factor (VEGF) levels in children with community-acquired pneumonia. Serum VEGF levels were measured in patients with pneumonia (n=29) and in control subjects (n=27) by a sandwich enzyme-linked immunosorbent assay. The pneumonia group was classified into bronchopneumonia with pleural effusion (n=1), bronchopneumonia without pleural effusion (n=15), lobar pneumonia with pleural effusion (n=4), and lobar pneumonia without pleural effusion (n=9) groups based on the findings of chest radiographs. We also measured serum IL-6 levels and the other acute inflammatory parameters. Serum levels of VEGF in children with pneumonia were significantly higher than those in control subjects (p<0.01). Children with lobar pneumonia with or without effusion showed significantly higher levels of serum VEGF than children with bronchopneumonia. For lobar pneumonia, children with pleural effusion showed higher levels of VEGF than those without pleural effusion. Children with a positive urinary S. pneumonia antigen test also showed higher levels of VEGF than those with a negative result. Serum IL-6 levels did not show significant differences between children with pneumonia and control subjects. Serum levels of VEGF showed a positive correlation with the erythrocyte sedimentation rate in the children with pneumonia. In conclusion, VEGF may be one of the key mediators that lead to lobar pneumonia and parapneumonic effusion.
Vascular Endothelial Growth Factor A/*blood ; Streptococcus pneumoniae/growth & development/immunology ; Pneumonia, Bacterial/*blood/complications/microbiology ; Pleural Effusion/*blood/complications/microbiology ; Mycoplasma pneumoniae/growth & development/immunology ; Male ; Interleukin-6/blood ; Infant ; Humans ; Female ; Enzyme-Linked Immunosorbent Assay ; Community-Acquired Infections/blood/microbiology ; Child, Preschool ; Child ; Antigens, Bacterial/immunology ; Antibodies, Bacterial/immunology ; Adolescent

We isolated non-O1, non-O139 Vibrio cholerae from pleural effusion in a patient with recurred advanced gastric caner after total gastrectomy. We also recovered the organism from the patient's stool culture. The patient did not experience gastrointestinal symptoms such as diarrhea except heartburn and epigastric discomfort from stomach cancer before admission. The suspected route of infection is directly from the gastrointestinal tract through the previous surgical wounds. After antibiotic treatment, no more V. cholerae was isolated and the patient was well discharged from the hospital. This is the first report of V. cholerae infection associated with pleural effusion in a long-term latent carrier of the organism.
Vibrio cholerae non-O1/*isolation & purification ; Stomach Neoplasms/microbiology/surgery ; Pleural Effusion/*microbiology ; Middle Aged ; Male ; Humans ; *Gastrectomy ; Carrier State

Interstitial pneumonia (IP) frequently occurs in patients with scrub typhus, but its clinical significance is not well known. This study was designed to evaluate interstitial pneumonia as a marker of severity of the disease for patients with scrub typhus. We investigated clinical parameters representing the severity of the disease, and the chest radiographic findings for 101 patients with scrub typhus. We then compared these clinical factors between patients with and without IP. We also studied the relationship between IP and other chest radiographic findings. The chest radiography showed IP (51.4%), pleural effusion (42.6%), cardiomegaly (14.9%), pulmonary alveolar edema (20.8%), hilar lymphadenopathy (13.8%) and focal atelectasis (11.8%), respectively. The patients with IP (n=52) had higher incidences in episode of hypoxia (p=0.030), hypotension (p=0.024), severe thrombocytopenia (p=0.036) and hypoalbuminemia (p=0.013) than the patients without IP (n=49). The patients with IP also had higher incidences of pleural effusion (p<0.001), focal atelectasis (p=0.019), cardiomegaly (p<0.001), pulmonary alveolar edema (p=0.011) and hilar lymphadenopathy (p<0.001) than the patients without IP. Our data suggest that IP frequently occurs for patients with scrub typhus and its presence is closely associated with the disease severity of scrub typhus.
Adult ; Aged ; Aged, 80 and over ; Female ; Fluorescent Antibody Technique, Indirect ; Humans ; Incidence ; Lung/microbiology/radiography ; Lung Diseases, Interstitial/epidemiology/*microbiology/*radiography ; Male ; Middle Aged ; Pleural Effusion/epidemiology/microbiology/radiography ; Predictive Value of Tests ; Prognosis ; Scrub Typhus/*complications/epidemiology/*radiography ; *Severity of Illness Index