Bronchoscopic diagnostic procedures and microbiological examinations in proving endobronchial tuberculosis / Procedimentos diagnósticos broncoscópicos e exames microbiológicos para a confirmação de tuberculose endobrônquica

ABSTRACT Objective: To determine the proportional distribution of endobronchial tuberculosis (EBTB) subtypes and to evaluate the types of bronchoscopic diagnostic procedures that can prove granulomatous inflammation. Methods: This was a retrospective study of 18 HIV-negative patients with biopsy-proven EBTB treated between 2010 and 2014. Results: The most common EBTB subtypes, as classified by the bronchoscopic features, were tumorous and granular (in 22.2% for both). Sputum smear microscopy was performed in 11 patients and was positive for AFB in 4 (36.3%). Sputum culture was also performed in 11 patients and was positive for Mycobacterium tuberculosis in 10 (90.9%). Smear microscopy of BAL fluid (BALF) was performed in 16 patients and was positive for AFB in 10 (62.5%). Culture of BALF was also performed in 16 patients and was positive for M. tuberculosis in 15 (93.7%). Culture of BALF was positive for M. tuberculosis in 93.7% of the 16 patients tested. Among the 18 patients with EBTB, granulomatous inflammation was proven by the following bronchoscopic diagnostic procedures: bronchial mucosal biopsy, in 8 (44.4%); bronchial brushing, in 7 (38.8%); fine-needle aspiration biopsy, in 2 (11.1%); and BAL, in 2 (11.1%). Bronchial anthracofibrosis was observed in 5 (27.7%) of the 18 cases evaluated. Conclusions: In our sample of EBTB patients, the most common subtypes were the tumorous and granular subtypes. We recommend that sputum samples and BALF samples be evaluated by smear microscopy for AFB and by culture for M. tuberculosis, which could increase the rates of early diagnosis of EBTB. We also recommend that bronchial brushing be employed together with other bronchoscopic diagnostic procedures in patients suspected of having EBTB.

RESUMO: Objetivo: Determinar a distribuição proporcional dos subtipos de tuberculose endobrônquica (TBEB) e avaliar os tipos de procedimentos diagnósticos broncoscópicos que podem revelar inflamação granulomatosa. Métodos: Este foi um estudo retrospectivo com 18 pacientes HIV negativos com TBEB comprovada por biópsia tratados entre 2010 e 2014. Resultados: Os subtipos mais comuns de TBEB, classificados pelas características na broncoscopia, foram tumoral e granular (em 22,2% para ambas) A baciloscopia de escarro foi realizada em 11 pacientes e foi positiva para BAAR em 4 (36,3%). A cultura de escarro também foi realizada em 11 pacientes e foi positiva para Mycobacterium tuberculosis em 10 (90,9%). A baciloscopia do LBA foi realizada em 16 pacientes e foi positiva para BAAR em 10 (62,5%). A cultura do LBA foi também realizada em 16 pacientes e foi positiva para o M. tuberculosis em 15 (93,7%). A cultura do LBA foi positiva para M. tuberculosis em 93,7% dos 16 pacientes testados. Nos 18 pacientes com TBEB, a presença de inflamação granulomatosa foi comprovada pelos seguintes procedimentos diagnósticos broncoscópicos: biópsia da mucosa brônquica, em 8 (44,4%); escovação brônquica, em 7 (38,8%); punção aspirativa por agulha fina, em 2 (11,1%); e LBA, em 2 (11,1%). Antracose/fibrose brônquica foi observada em 5 (27,7%) dos 18 casos avaliados. Conclusões: Em nossa amostra de pacientes com TBEB, os subtipos mais comuns foram o tumoral e o granular. Recomendamos que amostras de escarro e do LBA sejam avaliadas por baciloscopia para BAAR e cultura de M. tuberculosis, o que poderia aumentar as taxas de diagnóstico precoce de TBEB. Também recomendamos que a escovação brônquica seja empregada em conjunto com outros procedimentos diagnósticos broncoscópicos em pacientes com suspeita de TBEB.

An Appropriate Lower Respiratory Tract Specimen Is Essential for Diagnosis of Middle East Respiratory Syndrome (MERS)

No abstract available.

Haemoptysis after four years of lobectomy for aspergilloma.

We present a case of a 26-year-old male who underwent lobectomy for life-threatening haemoptysis due to aspergilloma in an old tuberculosis left upper lobe cavity who presented with recurrence of haemoptysis four years after the surgery. Fibreoptic bronchoscopy revealed Aspergillus colonisation in the ectatic residual bronchus which is an uncommon complication of lobectomy. The patient was successfully managed with antifungal agents.

The response of bronchial associated lymphoid tissue to intratracheal administration of peste des petit ruminants virus and its Co-Infection with mannheimia hemolytica in goats / Respuesta del tejido linfoide asociado con bronquios a la administración intratraqueal del virus peste de pequeños rumiantes y su coinfección con Mannheimia hemolytica en cabras

The morphometry of bronchial associated lymphoid tissue (BALT) and its possible exploration as to the control of common viral and bacterial pneumonia and their co-infection in Sub-Saharan goats is scanty in literatures. This investigation utilizes archival tissues from study that involved 35 apparently healthy West Africa Dwarf goats which were divided into groups PPRV and PPRV+MH with 15 goats each while 5 goats served as control. PPRV goats were infected intratracheally with 1ml of pure cultured 106.5 TCID50 PPR Pestes des petit Ruminant virus (PPRV) grown in baby hamster kidney cell lines and PPRV+MH with 1 ml of PPRV and a week later 1ml of MH (Mannheimia hemolytica) A2. The BALT number, type and cellularity were determined using standard methods with the use of an image analyzer. Student t-test was used to test for significant differences. The results showed that the average number of BALT was significantly more in PPRV+MH infection than that of PPRV infection i.e. 6.20+/-3.63 for PPRV+MH and 4.11+/-2.92 for PPRV with more nodular types of BALT (8.01+/-1.83) than the aggregates type (4.3+/-1.50) while the average number of lymphocytes in the nodular, aggregate BALT significantly increased with 82.25+/-15.95, 56.00+/-7.28 in PPRV to 103.33+/-44.10, 66.00+/-7.93 in PPRV+MH respectively. There was an irregular pattern in the surface Area (SA) and Perimeter (P) of BALT following infections. The increase in average number of BALT and lymphocytes in PPRV+MH infection than that of PPRV infection showed that the development of BALT and the number of lymphocytes in BALT could be used to assess the mucosal immunity following intratracheal administration of PPRV and MH in goats. This is however the first study that described the morphometry of bronchial associated lymphoid tissue in experimental PPRV and PPRV+MH infection in Sub-Saharan goats.

Es escaso en la literatuta el conocimiento de la morfometría del tejido linfoide asociado a bronquios (BALT) y su posible exploración para el control de la neumonía viral común, pneumonia bacteriana y su co-infección en el ganado caprino subsahariano. Esta investigación utilizó tejidos archivados pertenecientes a 35 cabras enanas del oeste africano aparentemente sanas, que fueron divididas en grupos PPRV y PPRV+MH con 15 cabras cada uno, mientras que 5 cabras sirvieron como control. Las cabras PPRV fueron infectadas por vía intratraqueal con 1 ml de cultivo puro 106,5 TCID50 PPR virus Peste de Pequeños Rumiantes (PPRV) cultivados en líneas celulares renales de hámsters recien nacidos y PPRV+MH con 1 ml de PPRV y una semana después de 1 ml de MH (Mannheimia haemolytica) A2. El número de BALT, tipo y la celularidad se determinaron utilizando métodos estándar con el uso de un analizador de imágenes. Se utilizó la prueba t de Student para probar las diferencias significativas. Los resultados mostraron que el número promedio de BALT fue significativamente mayor en la infección PPRV+MH que la infección PPRV, es decir, 6,20+/-3,63 para PPRV+MH y 4,11+/-2,92 para PPRV con un BALT principalmente de tipo nodular (8,01+/-1,83) que de tipo agregado (4,3+/-1,50), mientras que el número promedio de linfocitos en el BALT nodular y agregado aumentó significativamente con 82,25+/-15,95 y 56,00+/-7,28 en PPRV y, 103,33+/-44,10 y 66,00+/-7,93 en PPRV+MH respectivamente. No hubo un patrón irregular en el área de superficie y perímetro del BALT después de las infecciones. El aumento en el número promedio de BALT y linfocitos en la infección PPRV+MH comparado con la de infección PPRV mostró que el desarrollo de BALT y el número de linfocitos en BALT podría ser utilizado para evaluar la inmunidad de la mucosa después de la administración intratraqueal de PPRV+MH en cabras. Este es el primer estudio que describe la morfometría del tejido linfoide asociado a bronquios en la...

The role of quantitative cultures of non-bronchoscopic samples in ventilator associated pneumonia.

PURPOSE: The objective of this study is to determine the role of quantitative cultures of non-bronchoscopic samples such as blinded bronchial sampling (BBS) and endotracheal aspirates (ETA) in the management of ventilator associated pneumonia (VAP). The study also evaluates the clinical diagnosis of VAP based on the inclusion of Gram stain results of BBS/ETA samples into modified clinical pulmonary infection score (CPIS). METHODS: Fifteen out of the 120 patients admitted to respiratory intensive care unit under mechanical ventilation for more than 48 hours with a clinical suspicion of VAP, were included in this study. Quantitative cultures of BBS and ETA were performed from all the 15 patients. RESULTS: VAP was confirmed in 11 out of 15 cases by quantitative cultures of either the BBS or ETA samples. The condition of 8/11 VAP confirmed patients improved significantly with the change in antibiotic therapy. The overall mortality rate was found to be 18%. The agreement between BBS and ETA results was found to be 83.3%. Modified-clinical pulmonary infection score (CPIS) increased significantly when Gram stain results of BBS/ETA samples were included, thereby strengthening the clinical diagnosis of VAP. CONCLUSIONS: Quantitative culture of lower respiratory tract samples obtained by non-bronchoscopic methods may be a useful alternative to bronchoscopy, in the diagnosis of VAP. Inclusion of Gram stain results of BBS/ETA into modified-CPIS may augment the diagnostic evaluation of VAP.

Foreign body-induced Actinomycosis Mimicking Bronchogenic Carcinoma

Actinomycosis is a slowly progressive infectious disease caused by an anaerobic and microaerophilic bacteria that colonizes the face, neck, lung, pleura and the ileocecal region. There have been a few cases of this disease which have involved in the lung but one very rare case has been reported. We report a case of foreign body-induced endobronchial actinomycosis mimicking bronchogenic carcinoma in a 69-year-old man. On admission, the patient presented with weight loss, cough and hemoptysis. The fiberoptic bronchoscopy revealed a soft tissue mass, with a partial occlusion of the left upper bronchus, which resembled bronchogenic carcinoma. Contrary to the first impression, the biopsy of the bronchus revealed the mass lesion to be an actinomycotic infection involving the bronchus. After the confirmation of the lesion, treatment with penicillin was initiated. The follow-up bronchoscopy revealed an aspirated fish bone at the site of infection. The foreign body was safely removed.

Microbial flora variations in the respiratory tract of mice

A stable microbial system in the respiratory tract acts as an important defense mechanism against pathogenic microorganisms. Perturbations in this system may allow pathogens to establish. In an ecological environment such as the respiratory tract, there are many diverse factors that play a role in the establishment of the indigenous flora. In the present work we studied the normal microbial flora of different areas of the respiratory tract of mice and their evolution from the time the mice were born. Our interest was to know which were the dominant groups of microorganisms in each area, which were the first capable of colonizing and which dominated over time to be used as probiotic microorganisms. Our results show that Gram negative facultatively anaerobic bacilli and strict anaerobic microorganisms were the last ones to appear in the bronchia, while aerobic and Gram positive cocci were present in all the areas of the respiratory tract. The number of facultative aerobes and strict anaerobes were similar in the nasal passage, pharynx instilled and trachea, but lower in bronchia. The dominant species were Streptococcus viridans and Staphylococcus saprophyticcus, followed by S. epidermidis, Lactobacilli and S. cohnii I which were present on every studied days but at different proportions. This paper is the first part of a research topic investigating the protective effect of the indigenous flora against pathogens using the mice as an experimental model.

Diagnóstico de pneumonia por Pneumocystis carnii através de broncoaspiraçäo: relato de 3 casos / Diagnosis of pneumnonia by Pneumocystis carinii using bronchoaspiration: report of 3 cases

Os autores apresentam três casos de pneumonia por Pneumocystis carinii, diagnosticados por broncoaspiraçäo, entre 20 casos de insuficiência respiratória aguda que necessitaram de ventilaçäo mecânica, num período de 6 meses. Apesar do número de casos näo ser estatisticamente significativo, a incidência de 15% de pneumonia por Pneumocystis carinii sugere que esta patologia seja mais freqüente do que o esperado. Finalmente, os autores discutem o método de aspiraçäo via cânula traqueal, inócuo e simples, e sugerem sua inclusäo como exame de rotina em pacientes submetidos a ventilaçäo mecânica