RESUMO
BACKGROUND: Invasive pulmonary aspergillosis (IPA) is a deep fungal infection caused by invasion of Aspergillus mycelium into the lung parenchyma resulting in tissue destruction and necrosis, which occurs more often in im-munosuppressed populations. The severity of the disease and the rapid progression of the lung lesions puts pa¬tients at high risk of death and poor prognosis if the correct therapeutic intervention is not given as early as possible. METHODS: Here we report a case of IPA, which was initially diagnosed as community-acquired pneumonia in a local hospital. The symptoms did not improve after receiving anti-infective treatment. The patient was diagnosed with IPA after completing a chest CT examination and an electronic bronchoscopy, as well as pathogenetic examination of the bronchoalveolar lavage fluid and pathological examination of the left bronchial mass in the respiratory department of our hospital, which was finally diagnosed as IPA. After one week of administration of voriconazole for anti-fungal infection treatment, the patient's symptoms improved significantly, and a repeat chest CT suggested that the lung lesions were better than before. In order to raise clinicians' awareness of this disease, we also conducted a literature analysis. RESULTS: The final diagnosis of IPA was made by analyzing the patient's history, symptoms, signs, and relevant findings. CONCLUSIONS: When the patient's clinical symptoms and imaging manifestations are consistent with IPA, electronic bronchoscopy and pathogenetic and pathological examinations may be appropriately performed to clarify the na-ture of the lesion. More consideration should be given to the possibility of disease diagnosis to avoid misdiagnosis and underdiagnosis. Appropriate treatment should be given at an early stage.
Assuntos
Antifúngicos , Aspergilose Pulmonar Invasiva , Tomografia Computadorizada por Raios X , Voriconazol , Humanos , Aspergilose Pulmonar Invasiva/diagnóstico , Aspergilose Pulmonar Invasiva/tratamento farmacológico , Aspergilose Pulmonar Invasiva/microbiologia , Antifúngicos/uso terapêutico , Voriconazol/uso terapêutico , Broncoscopia , Masculino , Líquido da Lavagem Broncoalveolar/microbiologia , Pessoa de Meia-Idade , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Pulmão/patologiaRESUMO
BACKGROUND: IgG4-related disease (IgG4-RD) is an immune-mediated systemic inflammatory fibrotic disease, which is a relatively rare and novel disease that can involve multiple organs or tissues, with variable clinical manifestations, and for which pulmonary involvement has been reported relatively infrequently. METHODS: Here we report a case of pulmonary infection that was initially suspected and received anti-inflammatory treatment, but the symptoms did not improve. CT examination indicated progression of the pulmonary lesion, and the nature of the lesion could not be determined by tracheoscopy and bronchoalveolar lavage. The diagnosis of IgG4 related lung disease (IgG4-RLD) was confirmed by percutaneous lung biopsy. A joint literature analysis was conducted to improve clinicians' understanding of this disease. RESULTS: The patient's history, symptoms, signs and relevant examination results were analyzed. The final diagnosis was IgG4-RLD. CONCLUSIONS: When the clinical symptoms and imaging manifestations of the patients are consistent with IgG4-RLD, pathological examination can be appropriately performed to clarify the nature of the lesions. More consideration should be given to the possibility of disease diagnosis to avoid misdiagnosis and underdiagnosis, and proper treatment should be given at an early stage.
Assuntos
Doença Relacionada a Imunoglobulina G4 , Imunoglobulina G , Pneumopatias , Tomografia Computadorizada por Raios X , Humanos , Doença Relacionada a Imunoglobulina G4/diagnóstico , Doença Relacionada a Imunoglobulina G4/imunologia , Pneumopatias/diagnóstico , Pneumopatias/imunologia , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Masculino , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/imunologia , Pessoa de Meia-Idade , BiópsiaRESUMO
BACKGROUND: Post-transplant lymphoproliferative disorders are characterized by atypical clinical manifestations, high mortality, and missed diagnosis rates. METHODS: We report a case of renal transplantation in a patient with unexplained soft-tissue nodular shadows, and the type of the post-transplant abnormal soft-tissue shadows was clarified by puncture biopsy. RESULTS: The pathologic returns were consistent with the post-transplant lymphoproliferative disease, and the immunohistochemical returns supported a diffuse large B-cell lymphoma (non-growth center origin). CONCLUSIONS: In organ transplant patients, when unexplained soft tissue nodular shadows are present, the possibility of post-transplant lymphoproliferative disorders should be considered, and an aggressive puncture biopsy should be performed to clarify the diagnosis.
Assuntos
Transplante de Rim , Linfoma Difuso de Grandes Células B , Humanos , Transplante de Rim/efeitos adversos , Linfoma Difuso de Grandes Células B/diagnóstico , Masculino , Pessoa de Meia-Idade , BiópsiaRESUMO
BACKGROUND: Coronavirus disease 2019 (COVID-19) is an acute respiratory infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). With the normalization of COVID-19 globally, it is crucial to construct a prediction model that enables clinicians to identify patients at risk for ProLOS based on demographics and serum inflammatory biomarkers. METHODS: The study included hospitalized patients with a confirmed diagnosis of COVID-19. These patients were randomly grouped into a training (80%) and a test (20%) cohort. The LASSO regression and ten-fold cross-validation method were applied to filter variables. The training cohort utilized multifactorial logistic regression analyses to identify the independent factors of ProLOS in COVID-19 patients. A 4-variable nomogram was created for clinical use. ROC curves were plotted, and the area under the curve (AUC) was calculated to evaluate the model's discrimination; calibration analysis was planned to assess the validity of the nomogram, and decision curve analysis (DCA) was used to evaluate the clinical usefulness of the model. RESULTS: The results showed that among 310 patients with COVID-19, 80 had extended hospitalization (80/310). Four independent risk factors for COVID-19 patients were identified: age, coexisting chronic respiratory diseases, white blood cell count (WBC), and serum albumin (ALB). A nomogram based on these variables was created. The AUC in the training cohort was 0.808 (95% CI: 0.75 - 0.8671), and the AUC in the test cohort was 0.815 (95% CI: 0.7031 - 0.9282). The model demonstrates good calibration and can be used with threshold probabilities ranging from 0% to 100% to obtain clinical net benefits. CONCLUSIONS: A predictive model has been created to accurately predict whether the hospitalization duration of COVID-19 patients will be prolonged. This model incorporates serum WBC, ALB levels, age, and the presence of chronic respiratory system diseases.
Assuntos
COVID-19 , Tempo de Internação , Nomogramas , Humanos , COVID-19/diagnóstico , COVID-19/sangue , COVID-19/epidemiologia , COVID-19/complicações , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Tempo de Internação/estatística & dados numéricos , Fatores de Risco , SARS-CoV-2 , Adulto , Curva ROC , Hospitalização , Estudos RetrospectivosRESUMO
BACKGROUND: Organizing pneumonia (OP) is a pathologic diagnosis with clinical and imaging manifestations that often resemble other diseases, such as infections and cancers, which can lead to delays in diagnosis and inappropriate management of the underlying disease. In this article, we present a case of organized pneumonia that resembles lung cancer. METHODS: We report a case of initial suspicion of pulmonary malignancy, treated with anti-inflammatory medication and then reviewed with CT suggesting no improvement, and finally confirmed to be OP by pathological biopsy taken via transbronchoscopy. A joint literature analysis was performed to raise clinicians' awareness of the diagnosis and treatment of OP. RESULTS: Initially, because of the atypical auxiliary findings, we thought that the disease turned out to be a lung tumor, which was eventually confirmed as OP by pathological diagnosis. CONCLUSIONS: The diagnosis and treatment of OP requires a combination of clinical information and radiological expertise, as well as biopsy to obtain histopathological evidence. That is, clinical-imaging-pathological tripartite cooperation and comprehensive analysis.
Assuntos
Neoplasias Pulmonares , Tomografia Computadorizada por Raios X , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Diagnóstico Diferencial , Pneumonia em Organização Criptogênica/diagnóstico , Pneumonia em Organização Criptogênica/patologia , Pneumonia em Organização Criptogênica/diagnóstico por imagem , Biópsia , Masculino , Idoso , Pessoa de Meia-Idade , Pulmão/patologia , Pulmão/diagnóstico por imagem , Broncoscopia , Pneumonia em OrganizaçãoRESUMO
BACKGROUND: Reactivation of cytomegalovirus is more common in lymphoma patients undergoing hematopoietic stem cell transplantation, but reactivation of cytomegalovirus due to chemotherapy for lymphoma has rarely been reported. We report a case of a lymphoma patient with secondary pulmonary fungal infection and cytomegalovirus infection after chemotherapy, which ultimately led to organizing pneumonia. METHODS: Percutaneous lung biopsy, Next Generation Sequencing (NGS). RESULTS: NGS examination suggestive of cytomegalovirus infection, percutaneous lung biopsy suggests the presence of organizing pneumonia. The patient was discharged after a combination of antifungal and antiviral treatment with posaconazole, ganciclovir, and anti-inflammatory treatment with methylprednisolone. CONCLUSIONS: In patients with lymphoma, one should be alert for fungal and viral infections of the lungs when lung related clinical manifestations occur. Patients with persistent unrelieved symptoms after treatment should undergo lung biopsy or bronchoscopy to obtain pathologic tissue for definitive diagnosis.
Assuntos
Infecções por Citomegalovirus , Linfoma , Humanos , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/virologia , Linfoma/complicações , Masculino , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/microbiologia , Pneumopatias Fúngicas/complicações , Antivirais/uso terapêutico , Antifúngicos/uso terapêutico , Pessoa de Meia-Idade , Citomegalovirus/isolamento & purificação , Citomegalovirus/genética , Pulmão/patologia , Pulmão/diagnóstico por imagem , Biópsia , Sequenciamento de Nucleotídeos em Larga Escala , Pneumonia em OrganizaçãoRESUMO
BACKGROUND: Herpesvirus IgG antibody positivity can be a lifelong burden of disease replication and reinfection or recent viruses can be reactivated and play an important role in the diagnosis and monitoring of herpesvirus [1]. However, sometimes serum IgG antibody positivity is of limited help in determining the onset of disease. We reported a case of herpesvirus IgG antibody positive in a patient with lung cancer who was initially misdiagnosed as herpes simplex and later confirmed drug-induced pemphigus (DIP) by histological and immunofluorescence studies. METHODS: Appropriate laboratory tests, enzyme-linked immunosorbent assay (ELISA), immunofluorescence and histological tests were performed for diagnosis. RESULTS: In lung cancer patients who were positive for herpesvirus IgG antibodies, were initially misdiagnosed as herpes simplex and eventually confirmed by histological and immunofluorescence examinations as DIP. CONCLUSIONS: Positive herpesvirus IgG antibody is not a specific manifestation of herpesvirus infection. For patients with unexplained skin blisters, we should improve histological examinations as soon as possible to clarify the type of lesion.
Assuntos
Herpes Simples , Neoplasias Pulmonares , Pênfigo , Humanos , Imunoglobulina G , Neoplasias Pulmonares/tratamento farmacológico , Imunofluorescência , Anticorpos Antivirais , Ensaio de Imunoadsorção EnzimáticaRESUMO
BACKGROUND: Coronavirus Disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus type 2, which is characterized by high infectiousness and diverse clinical manifestations. They are more likely to become critical in people who have underlying diseases or are immunocompromised. In the daunting task of treating patients with COVID-19, those with comorbid fungal infections are susceptible to underdiagnosis or misdiagnosis, which can ultimately lead to increased morbidity and mortality in this group of patients. We report a case of intrapulmonary cavitary lesions after COVID-19, which was eventually diagnosed as pulmonary aspergillosis (PA) by metagenomic Next Generation Sequencing (mNGS) to improve our understanding of the disease. METHODS: Appropriate laboratory tests, chest computed tomography (CT), mNGS, and serologic tests were performed for diagnosis. RESULTS: Laboratory tests showed Glactomannan (GM) of 1.41, multiple cavitary lesions in both lungs on chest CT and the presence of aspergillus infection was confirmed by sputum sent for mNGS. CONCLUSIONS: In the case of cavitary lesions after COVID-19, we should be alert to the possibility of combined fungi and should promptly perform mNGS to clarify whether there is a combination of specific pathogenic fungal infections.
Assuntos
COVID-19 , Aspergilose Pulmonar , Tomografia Computadorizada por Raios X , Humanos , COVID-19/complicações , COVID-19/diagnóstico , Aspergilose Pulmonar/diagnóstico , Aspergilose Pulmonar/complicações , Masculino , SARS-CoV-2/isolamento & purificação , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Pessoa de Meia-Idade , Sequenciamento de Nucleotídeos em Larga Escala , Metagenômica/métodos , FemininoRESUMO
BACKGROUND: Non-tuberculous mycobacterial pulmonary infections (NTM-PD) are becoming increasingly common in clinical practice, and early detection and accurate determination of the infecting pathogen is crucial for subsequent treatment. We report a case of NTM-PD in a healthy middle-aged female with Mycobacterium tuberculosis complex group (MAC) infection confirmed by mNGS examination. METHODS: Appropriate laboratory tests, chest CT scan, bronchoscopic alveolar lavage fluid (BALF) examination, and macrogenomic next-generation sequencing (mNGS) were performed to establish the diagnosis. RESULTS: Chest CT showed multiple inflammatory lesions in the right middle lobe, and BALF sent for mNGS finally confirmed the diagnosis of MAC infection. After symptomatic treatment with azithromycin combined with ethambutol and rifampicin, the patient improved and was discharged from the hospital. CONCLUSIONS: In patients with pulmonary infections, pathogens should be clarified early to determine the diagnosis. mNGS of BALF samples have high specificity in detecting pathogens of infectious diseases, especially complex mixed infectious disease pathogens.
Assuntos
Líquido da Lavagem Broncoalveolar , Complexo Mycobacterium avium , Infecção por Mycobacterium avium-intracellulare , Humanos , Feminino , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Infecção por Mycobacterium avium-intracellulare/microbiologia , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , Infecção por Mycobacterium avium-intracellulare/complicações , Complexo Mycobacterium avium/isolamento & purificação , Complexo Mycobacterium avium/genética , Líquido da Lavagem Broncoalveolar/microbiologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Sequenciamento de Nucleotídeos em Larga Escala , Pneumonia/microbiologia , Pneumonia/diagnóstico , Pneumonia/tratamento farmacológico , Azitromicina/uso terapêutico , Rifampina/uso terapêuticoRESUMO
BACKGROUND: Pulmonary tuberculosis (PTB) is an important infectious disease that threatens the health and life of human beings. In the diagnosis of PTB, imaging plays a dominant role, but due to the increasing drug resistance of Mycobacterium tuberculosis, atypical clinical manifestations, "different images with the same disease" or "different diseases with the same image" in chest imaging, and the low positivity rate of routine sputum bacteriology, which leads to a high rate of misdiagnosis of PTB. We report a case of pulmonary tuberculosis that was misdiagnosed on imaging. We report a case of pulmonary tuberculosis that resembled sarcoidosis on imaging and was negative for antacid staining on sputum smear and alveolar lavage fluid, and was later diagnosed by microbial next-generation sequencing (NGS). The case was initially misdiagnosed as sarcoidosis. METHODS: Alveolar lavage fluid NGS, chest CT, bronchoscopy. RESULTS: Chest CT showed multiple inflammatory lesions in both lungs, multiple nodular foci in both lungs, and multiple enlarged lymph nodes in the mediastinum and hilar region on both sides. Fiberoptic bronchoscopy was performed in the basal segment of the left lower lobe of the lungs to carry out bronchoalveolar lavage, and the lavage fluid was sent to the NGS test and returned the following results: Mycobacterium tuberculosis complex group detected in the number of sequences of 293. Based on the results of the NGS test, the diagnosis of pulmonary tuberculosis could be confirmed. CONCLUSIONS: The diagnosis of pulmonary tuberculosis cannot be easily excluded in patients with "different images with the same disease" or "different diseases with the same image" on chest imaging without the support of sputum positivity. The goal was to improve the alertness of medical personnel to the misdiagnosis of tuberculosis and the application of NGS technology.
Assuntos
Mycobacterium tuberculosis , Sarcoidose , Tuberculose Pulmonar , Humanos , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/microbiologia , Mycobacterium tuberculosis/genética , Líquido da Lavagem Broncoalveolar/microbiologia , Sarcoidose/diagnóstico , Escarro/microbiologia , Erros de Diagnóstico , Sequenciamento de Nucleotídeos em Larga Escala , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Community-acquired pneumonia (CAP) is a common cause of hospitalization, characterized by high mortality, morbidity, and cost and has serious human health implications. Various scoring criteria have been used to predict the severity of pneumonia, including the CURB-65 score, Pneumonia Severity Index (PSI) score, and Severe Community-Acquired Pneumonia (SCAP) score. However, these scoring criteria have shortcomings such as low sensitivity, cumbersome clinical application, and limited application. This study aimed to construct a nomogram model to predict the severity of CAP patients by blood indicators. METHODS: This is a retrospective study. Patients with CAP were enrolled and then tested by routine blood, coagulation series, biochemical and inflammatory indicators, and general information such as imaging findings and disease history of the patients were recorded. The main observation was the progression of the patients' disease. Univariate analysis and binary logistic regression analysis were used to explore the independent risk factors for the severity of CAP patients, followed by plotting a nomogram to obtain the prediction model and constructing calibration curves to assess the authenticity and accuracy of the prediction model. Finally, the sensitivity, specificity, and other evaluation indexes were calculated by the receiver operating characteristic curve (ROC) to evaluate the clinical application value of the nomogram prediction model. RESULTS: Univariate analysis and binary logistic regression analysis of 277 hospitalized patients yielded platelet to lymphocyte ratio (PLR) and serum amyloid A (SAA) as independent risk factors for the severity of CAP patients. The AUC of the nomogram model for PLR and SAA was 0.889 (95% CI 0.845 - 0.932). The sensitivity was 77.3%, and the specificity was 85.3%, which had an excellent predictive value. CONCLUSIONS: The nomogram model based on PLR and SAA to predict the severity of CAP patients has a high specificity and sensitivity.
Assuntos
Infecções Comunitárias Adquiridas , Pneumonia , Humanos , Nomogramas , Prognóstico , Estudos Retrospectivos , Linfócitos , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Current studies have reported that it is rare for the coronavirus disease 2019 (COVID-19) to be combined with two fungal infections and that COVID-19 can be combined with multiple cardiovascular complications, both of which can complicate the condition and increase the risk of death. METHODS: We report a case of COVID-19 in which Aspergillus fumigatus and Cryptococcus neoformans were detected by sputum targeted next-generation sequencing (tNGS) and cardiac monitoring during treatment revealed cardiovascular complications. RESULTS: We consider that this patient's fungal infection was associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the application of corticosteroids. In addition, cardiovascular complications were associated with an inflammatory response and increased sympathetic stimulation due to SARS-CoV-2 infection. CONCLUSIONS: The presence of COVID-19-associated fungal infections cannot be excluded when multiple risk factors for fungal infections are present in patients with COVID-19 and the condition is rapidly deteriorating. Effective long-term monitoring of cardiac function during the patient's hospitalization is necessary to reduce morbidity and mortality.
Assuntos
COVID-19 , Criptococose , Insuficiência Cardíaca , Humanos , COVID-19/complicações , Aspergillus fumigatus , SARS-CoV-2 , Insuficiência Cardíaca/diagnósticoRESUMO
BACKGROUND: Detection of serum neuron specific enolase (NSE) has high sensitivity and specificity in the diagnosis of lung cancer, especially small cell lung cancer, but sometimes serum NSE provides limited help. We report a case of high-density shadow of the left lung and elevated serum NSE which mimicked lung cancer. It was ultimately confirmed to be pulmonary aspergillosis (PA) by bronchoscopic alveolar lavage fluid (BALF) and next-generation sequencing (NGS). METHODS: Appropriate laboratory tests, chest computed tomography (CT) scan, bronchoscopic alveolar lavage fluid, and next-generation sequencing were used to explore latent causes. RESULTS: NSE level was elevated, chest CT scan showed high-density shadow of the left lung, bronchoscopy showed flesh-colored new organisms in the lower lobe of the left lung, BALF and NGS revealed the presence of Aspergillus. CONCLUSIONS: Elevated NSE is not a typical manifestation of lung cancer, and we should perform BALF and NGS early to determine whether there is infection with special pathogenic bacteria.
Assuntos
Pneumopatias , Neoplasias Pulmonares , Aspergilose Pulmonar , Humanos , Pulmão/patologia , Neoplasias Pulmonares/patologia , Aspergilose Pulmonar/diagnóstico , Aspergilose Pulmonar/patologia , Fosfopiruvato HidrataseRESUMO
BACKGROUND: Carcinoembryonic antigen (CEA) is a polysaccharide complex present in the human respiratory system, which can reflect the presence of tumors in the human body and has important value in the monitoring of lung cancer [1], but sometimes serum CEA provides limited help. We reported a case of multiple consolidation of the lungs with elevated serum CEA, initially misdiagnosed as lung cancer and eventually confirmed by bronchoscopic lung biopsy as pulmonary cryptococcosis (PC). METHODS: Appropriate laboratory examination, chest computed tomography (CT) scan, and bronchoscopy lung biopsy were used to explore the latent etiology. RESULTS: CEA level was elevated, chest CT scan showed multiple consolidation of the lungs, serum cryptococcal antigen was positive, and pathological findings on bronchoscopic lung biopsy confirmed pulmonary cryptococcosis. CONCLUSIONS: Elevated CEA is not typical of lung cancer. We should also consider the possibility of specific pathogenic infection. Bronchoscopic lung biopsy is the gold standard should be performed as soon as possible to identify the lesion.
Assuntos
Criptococose , Pneumopatias , Neoplasias Pulmonares , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Antígeno Carcinoembrionário , Pulmão/diagnóstico por imagem , Pulmão/patologia , Criptococose/diagnóstico , Erros de DiagnósticoRESUMO
BACKGROUND: Pulmonary tuberculosis presenting as solitary pulmonary nodules in imaging is sometimes difficult to differentiate from lung cancer and is more likely to be misdiagnosed when accompanied by elevated CEA and positive PET-CT findings. METHODS: By reporting a case of misdiagnosed lung cancer, which was confirmed to be pulmonary tuberculosis by lung biopsy, a joint literature analysis was performed to raise clinicians' awareness of isolated nodules in the lung. RESULTS: With a series of ancillary tests, we initially considered the nodule to be malignant, and the lung biopsy pathology eventually confirmed pulmonary tuberculosis. CONCLUSIONS: When chest imaging suggests the presence of malignant features in solitary pulmonary nodules, invasive procedures can be performed appropriately to clarify the nature of the lesion. The diagnosis cannot be made blindly to ensure that no incorrect diagnosis is made nor wrong treatment given.
Assuntos
Neoplasias Pulmonares , Nódulo Pulmonar Solitário , Tuberculose Pulmonar , Humanos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Nódulo Pulmonar Solitário/diagnóstico , Nódulo Pulmonar Solitário/patologia , Fluordesoxiglucose F18 , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Tuberculose Pulmonar/diagnóstico por imagemRESUMO
BACKGROUND: Infectious pulmonary diseases caused by nontuberculous mycobacteria (NTM) are becoming more common in clinical work, and early detection of the bacterium and its early identification are prerequisites for accurate treatment. METHODS: By reporting a case of confirmed NTM infection in a patient with connective tissue disease-associated interstitial lung fibrosis, a joint literature analysis was performed to improve clinicians' understanding of NTM and the clinical application of targeted next-generation sequencing (tNGS). RESULTS: Chest CT suggested a partially enlarged cavitary lesion in the upper lobe of the right lung, combined with positive sputum antacid staining, and sputum tNGS was sent to confirm the final diagnosis of Mycobacterium paraintracellulare infection. CONCLUSIONS: The successful application of tNGS helps in the rapid diagnosis of NTM infection. It also reminds medical practitioners to consider the presence of NTM infection in advance in the presence of many NTM infection factors, combined with imaging manifestations.
Assuntos
Doenças do Tecido Conjuntivo , Infecções por Mycobacterium não Tuberculosas , Mycobacterium , Humanos , Infecções por Mycobacterium não Tuberculosas/complicações , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Micobactérias não Tuberculosas , FibroseRESUMO
BACKGROUND: Tuberculosis is an airborne infectious disease with multiple morphologic changes on chest imaging. Tuberculosis-specific enzyme-linked immunospot assay (T-SPOT.TB) is widely used in the diagnosis of tuberculosis. Clinically, pulmonary tuberculosis with T-SPOT.TB negative and interstitial changes is very rare. METHODS: T-SPOT.TB, pathogenetic testing, chest CT scan, next-generation sequencing (NGS). RESULTS: Laboratory tests showed negative T-SPOT.TB and sputum antacid staining, chest CT showed interstitial fibrosis and multiple high-density shadows in both lungs, and sputum NGS showed Mycobacterium tuberculosis infection. CONCLUSIONS: Negative T-SPOT.TB and interstitial lung changes do not exclude Mycobacterium tuberculosis infection. NGS has a high specificity in the detection of pathogens in infectious diseases, especially in complex, mixed infectious diseases.
Assuntos
Mycobacterium tuberculosis , Tuberculose Pulmonar , Tuberculose , Humanos , Tuberculose Pulmonar/diagnóstico , Tuberculose/diagnóstico , ELISPOT , Sequenciamento de Nucleotídeos em Larga Escala , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Tuberculosis (TB) is a common infectious disease in developing countries. Tuberculosis and sarcoidosis are difficult to differentiate. We report a case of a patient who was initially misdiagnosed as tuberculosis due to positive tuberculin test (PPD test) and tuberculosis antibody (TB-Ab), which was eventually proven as sarcoidosis by thoracoscopy. METHODS: Appropriate laboratory tests are carried out and a chest CT scan, bronchoscopy, thoracoscopic pathological biopsy were done. RESULTS: Serum sedimentation was increased and tuberculosis antibody was positive. The chest CT scan showed multiple pulmonary nodules in both lungs. The bronchoscopy demonstrated no abnormality. Thoracoscopic pathology showed noncaseating granulomas and acid-fast staining was negative. CONCLUSIONS: When a patient has multiple pulmonary nodules and lymphadenopathy without obvious tuberculosis poisoning symptoms, physicians should pay attention to tuberculosis, sarcoidosis, and lung cancer. Pathology is crucial for the ultimate diagnosis.
Assuntos
Nódulos Pulmonares Múltiplos , Sarcoidose , Tuberculose , Humanos , Tuberculina , Anticorpos , Toracoscopia , Erros de DiagnósticoRESUMO
BACKGROUND: A young patient characterized by rapid enlargement of mediastinal lymph nodes was diagnosed as non-tuberculous mycobacterial pulmonary disease (NTM-PD) by bronchoalveolar lavage fluid Next Generation Sequencing (NGS). METHODS: Laboratory examination, Chest CT scan, electronic bronchoscopy, and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) were performed to diagnose non-tuberculous mycobacterium pulmonary disease. RESULTS: Detection of bird-intracellular mycobacterium complex in bronchoalveolar lavage fluid by NGS. Chest CT scan showed multiple enlarged lymph nodes in mediastinum. 4R region TBNA: chronic granulomatous inflammation, positive bacilli were found by acid-fast staining. After the anti-NTM treatment, the symptoms of the patients were relieved. CONCLUSIONS: When the patient shows mediastinal lymph node enlargement of unknown cause, NTM-PD can be considered and NGS can be used to assist in the diagnosis.
Assuntos
Pneumopatias , Neoplasias Pulmonares , Linfadenopatia , Humanos , Mediastino/diagnóstico por imagem , Mediastino/patologia , Micobactérias não Tuberculosas/genética , Sequenciamento de Nucleotídeos em Larga Escala , Linfonodos/patologia , Linfadenopatia/diagnóstico , Neoplasias Pulmonares/diagnóstico , Estudos RetrospectivosRESUMO
BACKGROUND: The CURB-65 scoring system is a simple tool for assessment and prognosis prediction for community-acquired pneumonia (CAP) patients. However, the variations in the performance of CURB-65 in young and elderly patients, underestimation, or overestimation of the severity have often been reported. It is worth noting that the application of biomarkers is helpful for improving the accuracy of the scoring system. In recent years, more and more reports and studies paid attention to procalcitonin (PCT) in respiratory infectious diseases, and its clinical value has attracted increasing attention. The study aimed at investigating the effectiveness of the CURB-65 score combined with PCT in predicting admission of CAP patients to intensive care units (ICU). METHODS: We conducted a retrospective study. We analyzed data from 520 non-immune individuals over the age of 18 in this study. All patients received blood indicators measurement and CURB-65 score calculation on admission. The primary outcome used to assess the probability of a CAP patient was who would get a bed in general ward or ICU. Receiver operating characteristic curves (ROC) were used to evaluate the sensitivity and specificity of the CURB-65 model and PCT combined CURB-65 augmented model in predicting the main outcomes. RESULTS: After analyzing the data from 520 patients, we found that the probability of entering the ICU was 22.1% (115/520). The AUC of Combination 1 (PCT&CURB-65 scores), Combination 2 (WBC&CURB-65 scores), Combination 3 (hs-CRP&CURB-65 scores) and Combination 4 (D-dimer&CURB-65 scores) for predicting CAP patients entering the ICU was 0.92 (95% CI 0.88 - 0.95), 0.91 (95% CI 0.87 - 0.94), 0.89 (95% CI 0.85 - 0.92), and 0.90 (95% CI 0.87 - 0.94), respectively, with statistically significant differences (p = 0.00); the sensitivities were 0.83, 0.82, 0.77 and 0.77, respectively, and the specificities were 0.92, 0.84, 0.90 and 0.91, respectively. PCT was superior to other indexes to improve the sensitivity and specificity of the CURB-65 score. CONCLUSIONS: Procalcitonin improves the accuracy and sensitivity of the CURB-65 score in predicting the probability of CAP patients entering the ICU, and PCT was superior to other indexes to improve the sensitivity and specificity of the CURB-65 score.