RESUMEN
OBJECTIVE: To build and merge a diagnostic model called multi-input DenseNet fused with clinical features (MI-DenseCFNet) for discriminating between Staphylococcus aureus pneumonia (SAP) and Aspergillus pneumonia (ASP) and to evaluate the significant correlation of each clinical feature in determining these two types of pneumonia using a random forest dichotomous diagnosis model. This will enhance diagnostic accuracy and efficiency in distinguishing between SAP and ASP. METHODS: In this study, 60 patients with clinically confirmed SAP and ASP, who were admitted to four large tertiary hospitals in Kunming, China, were included. Thoracic high-resolution CT lung windows of all patients were extracted from the picture archiving and communication system, and the corresponding clinical data of each patient were collected. RESULTS: The MI-DenseCFNet diagnosis model demonstrates an internal validation set with an area under the curve (AUC) of 0.92. Its external validation set demonstrates an AUC of 0.83. The model requires only 10.24s to generate a categorical diagnosis and produce results from 20 cases of data. Compared with high-, mid-, and low-ranking radiologists, the model achieves accuracies of 78% vs. 75% vs. 60% vs. 40%. Eleven significant clinical features were screened by the random forest dichotomous diagnosis model. CONCLUSION: The MI-DenseCFNet multimodal diagnosis model can effectively diagnose SAP and ASP, and its diagnostic performance significantly exceeds that of junior radiologists. The 11 important clinical features were screened in the constructed random forest dichotomous diagnostic model, providing a reference for clinicians. CLINICAL RELEVANCE STATEMENT: MI-DenseCFNet could provide diagnostic assistance for primary hospitals that do not have advanced radiologists, enabling patients with suspected infections like Staphylococcus aureus pneumonia or Aspergillus pneumonia to receive a quicker diagnosis and cut down on the abuse of antibiotics. KEY POINTS: ⢠MI-DenseCFNet combines deep learning neural networks with crucial clinical features to discern between Staphylococcus aureus pneumonia and Aspergillus pneumonia. ⢠The comprehensive group had an area under the curve of 0.92, surpassing the proficiency of junior radiologists. ⢠This model can enhance a primary radiologist's diagnostic capacity.
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Aprendizaje Profundo , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Persona de Mediana Edad , Diagnóstico Diferencial , Tomografía Computarizada por Rayos X/métodos , Neumonía Estafilocócica/diagnóstico por imagen , Neumonía Estafilocócica/microbiología , Anciano , Aspergilosis Pulmonar/diagnóstico por imagen , Staphylococcus aureus/aislamiento & purificación , Adulto , Interpretación de Imagen Radiográfica Asistida por Computador/métodosAsunto(s)
COVID-19 , Neumonía Estafilocócica , Neumonía , Infecciones Estafilocócicas , Humanos , Neumonía Estafilocócica/diagnóstico por imagen , Neumonía Estafilocócica/tratamiento farmacológico , SARS-CoV-2 , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureusRESUMEN
A 66-year-old man was transferred to our hospital for pneumonia that was resistant to sulbactam/ampicillin and levofloxacin therapy. Chest computed tomography showed the rapidly progressive formation of multiple cavities. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated, and the patient was diagnosed with necrotizing pneumonia caused by community-acquired MRSA (CA-MRSA). The MRSA strain had type IV staphylococcus cassette chromosome mec and genes encoding Panton-Valentine leucocidin (PVL). CA-MRSA necrotizing pneumonia with the PVL gene is rare; only three cases have been previously reported in Japan. We administered anti-MRSA antibiotics and the patient achieved complete clinical and radiological improvement.
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Toxinas Bacterianas/genética , Exotoxinas/genética , Leucocidinas/genética , Staphylococcus aureus Resistente a Meticilina/genética , Neumonía Necrotizante/diagnóstico por imagen , Neumonía Estafilocócica/diagnóstico por imagen , Anciano , Antibacterianos/uso terapéutico , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/microbiología , Humanos , Masculino , Resistencia a la Meticilina , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Neumonía Necrotizante/tratamiento farmacológico , Neumonía Necrotizante/microbiología , Neumonía Estafilocócica/tratamiento farmacológico , Neumonía Estafilocócica/microbiología , Radiografía , Tomografía Computarizada por Rayos XAsunto(s)
Neumonía Necrotizante/fisiopatología , Neumonía Necrotizante/cirugía , Neumonía Estafilocócica/fisiopatología , Neumonía Estafilocócica/cirugía , Stents , Tráquea/cirugía , Femenino , Humanos , Lactante , Masculino , Neumonía Necrotizante/diagnóstico por imagen , Neumonía Estafilocócica/diagnóstico por imagen , Resultado del TratamientoRESUMEN
No disponible
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Humanos , Femenino , Persona de Mediana Edad , Staphylococcus aureus Resistente a Meticilina , Neumonía Estafilocócica/diagnóstico por imagen , Neumonía Estafilocócica/microbiología , AireRESUMEN
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen in cystic fibrosis (CF), with increasing incidence in recent years. We examined the association between bacterial colonization in the sputum (MRSA with or without pseudomonas (PA)) and computed tomography (CT) scores in CF patients. METHODS: MRSA patients were divided according to PA status based on at least three consecutive sputum cultures; controls were patients without MRSA (with or without PA), matched for gender and age at CT. Clinical data and CT scores were compared between groups. RESULTS: Of 33 patients with MRSA, 14 had no PA (MRSA + PA-) and 19 had also PA (MRSA + PA+). MRSA + PA- and MRSA + PA+ patients had CT scores similar to their controls PA+ (38.25 ± 20.18 vs. 32.22 ± 18.74, P = .4, and 41.88 ± 18.18 vs. 45.33 ± 11.5, P = .4, respectively). Although MRSA + PA- had worse CT scores than their matched PA- controls, their mean FEV1 values were similar. CONCLUSIONS: Colonization with MRSA in CF is associated with structural CT changes at least similar to those in PA. A cause and effect relationship cannot be established. The current findings call for a larger study assessing longitudinally the impact of MRSA acquisition and eradication protocols.
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Antibacterianos/administración & dosificación , Fibrosis Quística/diagnóstico por imagen , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Neumonía Estafilocócica/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Factores de Edad , Niño , Estudios Transversales , Fibrosis Quística/complicaciones , Fibrosis Quística/microbiología , Femenino , Humanos , Masculino , Staphylococcus aureus Resistente a Meticilina/patogenicidad , Pruebas de Sensibilidad Microbiana , Neumonía Estafilocócica/tratamiento farmacológico , Neumonía Estafilocócica/etiología , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Factores Sexuales , Resultado del Tratamiento , Adulto JovenAsunto(s)
Artritis Infecciosa/tratamiento farmacológico , Neumonía Estafilocócica/tratamiento farmacológico , Articulación Esternoclavicular , Artritis Infecciosa/diagnóstico por imagen , Artritis Infecciosa/microbiología , Infecciones Comunitarias Adquiridas/complicaciones , Farmacorresistencia Bacteriana , Femenino , Humanos , Persona de Mediana Edad , Derrame Pleural/diagnóstico por imagen , Neumonía Estafilocócica/diagnóstico por imagen , Neumonía Estafilocócica/microbiología , Dolor de Hombro/microbiología , Infecciones Estafilocócicas/diagnóstico por imagen , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/aislamiento & purificación , Articulación Esternoclavicular/diagnóstico por imagen , Articulación Esternoclavicular/microbiología , Tomografía Computarizada por Rayos XRESUMEN
Almost all traumatic pulmonary pseudocysts (TPP), such as cavitary pulmonary lesions after blunt chest trauma, resolve spontaneously. On the contrary, secondary infection of a TPP should be considered in the presence of purulent sputum or hemosputum and a persistent cavity. We report a case of an infected TPP that was successfully treated by early surgical treatment. A 25-year-old man was transferred to our hospital with a TPP, shown by computed tomography (CT) as having a thick-walled large cavity, after the acute phase of blunt chest trauma. Purulent hemosputum suggested infection of the cavity. Serial CT scans of the chest revealed a persistent cavity. The thick-walled large cavity was diagnosed as a secondary infection of the TPP, that is, a potential lung abscess. We resected the cavity before a systemic inflammatory reaction occurred.
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Quistes/diagnóstico , Diagnóstico Diferencial , Enfermedades Pulmonares/diagnóstico , Lesión Pulmonar/complicaciones , Neumonía Estafilocócica/cirugía , Adulto , Humanos , Masculino , Neumonía Estafilocócica/diagnóstico por imagen , Neumonía Estafilocócica/microbiologíaRESUMEN
Necrotising pneumonia (NP) is a rare but life-threatening complication of pulmonary infection. It is characterised by progressive necrosis of lung parenchyma with cavitating foci evident upon radiological investigation. This article reports the case of a 52-year-old woman, immunocompetent healthcare professional presenting to Accident and Emergency with NP and Staphylococcus aureus septicaemia. The cavitating lesion was not identified on initial chest X-ray leading to a delay in antimicrobial optimisation. However, the patient went on to achieve a full symptomatic recovery in 1 month and complete radiological recovery at 2-year follow-up. Long-term prognosis for adult cases of NP currently remains undocumented. This case serves as the first piece of published evidence documenting full physiological and radiological recovery following appropriate treatment of NP in an immunocompetent adult patient.
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Neumonía Necrotizante/diagnóstico , Neumonía Estafilocócica/diagnóstico , Staphylococcus aureus/aislamiento & purificación , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Dolor en el Pecho/etiología , Diagnóstico Diferencial , Femenino , Humanos , Inmunocompetencia , Persona de Mediana Edad , Neumonía Necrotizante/diagnóstico por imagen , Neumonía Necrotizante/tratamiento farmacológico , Neumonía Estafilocócica/diagnóstico por imagen , Neumonía Estafilocócica/tratamiento farmacológico , Radiografía Torácica , Tomografía Computarizada por Rayos XAsunto(s)
Quistes/diagnóstico por imagen , Quistes/microbiología , Neumonía Estafilocócica/complicaciones , Neumonía Estafilocócica/diagnóstico por imagen , Humanos , Masculino , Staphylococcus aureus Resistente a Meticilina , Persona de Mediana Edad , Radiografía Torácica , Tomografía Computarizada por Rayos XRESUMEN
Our objective was to illustrate the potential of metabolomics to identify novel biomarkers of illness severity in a child with fatal necrotizing pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA). We present a case report with two control groups and a metabolomics analysis: an infant with fatal MRSA pneumonia, four children with influenza pneumonia (pneumonia control group), and seven healthy children with no known infections (healthy control group). Urine samples were collected from all children. Metabolites were identified and quantified using 1 H-nuclear magnetic resonance spectrometry. Normalized metabolite concentration data from children with influenza pneumonia and healthy controls were compared by using an unpaired Student t test. To identify differentiating metabolites of MRSA pneumonia, the fold change of each metabolite was calculated by dividing each urine metabolite concentration of the patient with fatal MRSA pneumonia by the median urine concentration values of the same metabolite of the patients with influenza pneumonia and healthy controls, respectively. MetScape (http://metscape.ncibi.org/), a bioinformatics tool, was used for data visualization and interpretation. Urine metabolite concentrations previously identified as associated with sepsis in children (e.g., 3-hydroxybutyrate, carnitine, and creatinine) were higher in the patient with fatal MRSA pneumonia compared with those of patients with influenza pneumonia and healthy controls. The concentrations of additional metabolites-acetone, acetoacetate, choline, fumarate, glucose, and 3-aminoisobutyrate-were more than 25-fold higher in the patient with MRSA pneumonia than those of patients with influenza pneumonia and healthy controls. These metabolic changes in the urine preceded the clinical severe sepsis phenotype, suggesting that detection of the extent of metabolic disruption can aid in the early identification of a sepsis phenotype in advance of the clinical diagnosis. These data also support the utility of metabolomics for the development of clinical assays to identify patients with pediatric pneumonia at high risk for deterioration.
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Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Neumonía Necrotizante/orina , Neumonía Estafilocócica/orina , Sepsis/orina , Índice de Severidad de la Enfermedad , Biomarcadores/orina , Niño , Resultado Fatal , Femenino , Humanos , Lactante , Espectroscopía de Resonancia Magnética/métodos , Masculino , Metabolómica/métodos , Neumonía Necrotizante/complicaciones , Neumonía Necrotizante/diagnóstico por imagen , Neumonía Estafilocócica/complicaciones , Neumonía Estafilocócica/diagnóstico por imagen , Sepsis/complicaciones , Sepsis/diagnóstico por imagenRESUMEN
OBJECTIVE: To describe two cases of Panton-Valentine leukocidin-producing Staphylococcus aureus (PVL-SA) necrotizing pneumonia treated with ECMO, and complete pulmonary evaluation at six months. METHODS: Retrospective analysis of two patients presenting with severe PVL-SA pneumonia who both underwent complete respiratory function testing and chest CT scan six months after hospital discharge. RESULTS: Indications for ECMO were refractory hypoxia and left ventricular dysfunction associated with right ventricular dilatation. Patients were weaned off ECMO after 52 and 5 days. No ECMO-related hemorrhagic complication was observed. Pulmonary function tests performed at six months were normal and the CT scan showed complete regression of pulmonary injuries. CONCLUSION: PVL-SA pneumonia is characterized by extensive parenchymal injuries, including necrotic and hemorrhagic complications. ECMO may be used as a salvage treatment without any associated hemorrhagic complication, provided anticoagulant therapy is carefully monitored, and may lead to complete pulmonary recovery at six months.
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Toxinas Bacterianas/análisis , Exotoxinas/análisis , Oxigenación por Membrana Extracorpórea , Leucocidinas/análisis , Neumonía Necrotizante/terapia , Neumonía Estafilocócica/terapia , Staphylococcus aureus/química , Adolescente , Adulto , Anticoagulantes/administración & dosificación , Anticoagulantes/uso terapéutico , Femenino , Estudios de Seguimiento , Hemorragia/inducido químicamente , Hemorragia/etiología , Hemorragia/prevención & control , Humanos , Pulmón/diagnóstico por imagen , Enfermedades Pulmonares/inducido químicamente , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/prevención & control , Staphylococcus aureus Resistente a Meticilina/química , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Neumonía Necrotizante/complicaciones , Neumonía Necrotizante/diagnóstico por imagen , Neumonía Necrotizante/microbiología , Neumonía Estafilocócica/complicaciones , Neumonía Estafilocócica/diagnóstico por imagen , Neumonía Estafilocócica/microbiología , Inducción de Remisión , Pruebas de Función Respiratoria , Estudios Retrospectivos , Terapia Recuperativa , Staphylococcus aureus/aislamiento & purificación , Tomografía Computarizada por Rayos X , Vasoconstrictores/uso terapéuticoAsunto(s)
Neumonía en Organización Criptogénica/diagnóstico por imagen , Quistes/diagnóstico por imagen , Neumonía Estafilocócica/diagnóstico por imagen , Anciano , Broncoscopía , Neumonía en Organización Criptogénica/complicaciones , Quistes/complicaciones , Humanos , Masculino , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Neumonía Estafilocócica/complicaciones , Radiografía TorácicaAsunto(s)
Taponamiento Cardíaco/microbiología , Neumonía Estafilocócica/complicaciones , Neumopericardio/microbiología , Taponamiento Cardíaco/diagnóstico por imagen , Resultado Fatal , Femenino , Humanos , Lactante , Neumonía Estafilocócica/diagnóstico por imagen , Neumopericardio/diagnóstico por imagen , RadiografíaAsunto(s)
Diagnóstico Diferencial , Prótesis de Cadera/efectos adversos , Neumonía Estafilocócica/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Estafilocócicas/diagnóstico por imagen , Tuberculosis Miliar/diagnóstico por imagen , Anciano , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Artroplastia de Reemplazo de Cadera , Terapia Combinada , Remoción de Dispositivos , Quimioterapia Combinada , Disnea/etiología , Fracturas del Cuello Femoral/cirugía , Humanos , Masculino , Ofloxacino/administración & dosificación , Ofloxacino/uso terapéutico , Neumonía Estafilocócica/diagnóstico , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/cirugía , Rifampin/administración & dosificación , Rifampin/uso terapéutico , Tomografía Computarizada por Rayos XRESUMEN
A previously healthy 60-year-old male presented with fever, general pain and a C-reactive protein (CRP) of 160 mg/L. He was prescribed doxycycline. In the emergency room three days later, he was intubated and had a saturation of 70% on 100% oxygen. The chest X-ray showed bilateral lobar pneumonia. Streptococcus pneumonia was later verified. As a Jehovah's Witness, he had refused blood transfusions, but accepted albumin. Two days after admission, veno-venous extracorporeal membrane oxygenation (V-V ECMO) was started and the patient was then transported on ECMO to Stockholm. After two days, echocardiography showed right cardiac failure and the patient had to be converted to veno-arterial ECMO (VV-A ECMO) by cannulation of the left femoral artery. The haemoglobin decreased from 10.0 to 6.0 g/dL. Iron, folic acid, and erythropoietin were administered to stimulate erythropoesis. Romiplostim, to stimulate the production of platelets, was also started immediately. Blood samples were reduced to a minimum. The ECMO circuit was changed twice, using saline for priming, and the blood in the old circuit was then given back to the patient. The haemoglobin concentration varied between 4.5 and 6.0 g/dL during the ECMO treatment and the platelets between 80 and 140 x10(9)/L. After 44 days on ECMO, the patient was weaned off ECMO with 50% oxygen and nitric oxide (NO) at 20ppm in the ventilator. Four days after decannulation, he was transferred to a nearby intensive care unit. Long-term ECMO treatment without transfusion of blood products is possible. Being a Jehovah's Witness should not automatically be a contraindication for ECMO.
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Oxigenación por Membrana Extracorpórea/métodos , Insuficiencia Cardíaca/terapia , Testigos de Jehová , Neumonía Estafilocócica/terapia , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/etiología , Humanos , Masculino , Persona de Mediana Edad , Neumonía Estafilocócica/complicaciones , Neumonía Estafilocócica/diagnóstico por imagen , Radiografía , Factores de TiempoRESUMEN
OBJECTIVES: The purpose of this study was to compare the clinical and thin-section CT findings in patients with meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-susceptible S. aureus (MSSA). METHODS: We retrospectively identified 201 patients with acute MRSA pneumonia and 164 patients with acute MSSA pneumonia who had undergone chest thin-section CT examinations between January 2004 and March 2009. Patients with concurrent infectious disease were excluded from our study. Consequently, our study group comprised 68 patients with MRSA pneumonia (37 male, 31 female) and 83 patients with MSSA pneumonia (32 male, 51 female). Clinical findings in the patients were assessed. Parenchymal abnormalities, lymph node enlargement and pleural effusion were assessed. RESULTS: Underlying diseases such as cardiovascular were significantly more frequent in the patients with MRSA pneumonia than in those with MSSA pneumonia. CT findings of centrilobular nodules, centrilobular nodules with a tree-in-bud pattern, and bronchial wall thickening were significantly more frequent in the patients with MSSA pneumonia than those with MRSA pneumonia (p = 0.038, p = 0.007 and p = 0.039, respectively). In the group with MRSA, parenchymal abnormalities were observed to be mainly peripherally distributed and the frequency was significantly higher than in the MSSA group (p = 0.028). Pleural effusion was significantly more frequent in the patients with MRSA pneumonia than those with MSSA pneumonia (p = 0.002). CONCLUSIONS: Findings from the evaluation of thin-section CT manifestations of pneumonia may be useful to distinguish between patients with acute MRSA pneumonia and those with MSSA pneumonia.