Genetic Homology between Bacteria Isolated from Pulmonary Abscesses or Pyothorax and Bacteria from the Oral Cavity.

Pulmonary abscesses and pyothorax are bacterial infections believed to be caused primarily by oral microbes. However, past reports addressing such infections have not provided genetic evidence and lack accuracy, as they used samples that had passed through the oral cavity. The aim of this study was to determine whether genetically identical bacterial strains exist in both the oral microbiota and pus specimens that were obtained percutaneously from pulmonary abscesses and pyothorax, without oral contamination. First, bacteria isolated from pus were identified by 16S rRNA gene sequencing. It was then determined by quantitative PCR using bacterial-species-specific primers that DNA extracted from paired patient oral swab sample suspensions contained the same species. This demonstrated sufficient levels of bacterial DNA of the targeted species to use for further analysis in 8 of 31 strains. Therefore, the whole-genome sequences of these eight strains were subsequently determined and compared against an open database of the same species. Five strain-specific primers were synthesized for each of the eight strains. DNA extracted from the paired oral swab sample suspensions of the corresponding patients was PCR amplified using five strain-specific primers. The results provided strong evidence that certain pus-derived bacterial strains were of oral origin. Furthermore, this two-step identification process provides a novel method that will contribute to the study of certain pathogens of the microbiota. IMPORTANCE We present direct genetic evidence that some of the bacteria in pulmonary abscesses and pyothorax are derived from the oral flora. This is the first report describing the presence of genetically homologous strains both in pus from pulmonary abscesses and pyothorax and in swab samples from the mouth. We developed a new method incorporating quantitative PCR and next-generation sequencing and successfully prevented contamination of pus specimens with oral bacteria by percutaneous sample collection. The new genetic method would be useful for enabling investigations on other miscellaneous flora; for example, detection of pathogens from the intestinal flora at the strain level.

Toward Easy and Rapid Bronchial Occlusion With an Endobronchial Watanabe Spigot: A New Technique Using a Guide Sheath and Curette.

BACKGROUND: Bronchial occlusion using an endobronchial Watanabe spigot (EWS) is reportedly effective for intractable bronchopleural fistula. Here, we describe a rapid and easy method for bronchial occlusion using a guide sheath (GS) and curette. METHODS: Thirty consecutive patients who underwent bronchial occlusion under mild sedation between October 2014 and February 2018 were enrolled. The devices used were a flexible bronchoscope (BF-1T260 or BF-1TQ290), GS (SG-201C; with 30 mm of the proximal end cutaway), and a CC-4CR-1 curette (all supplied by Olympus Ltd). The curette was inserted into the GS with the tip of the curette exposed outside the GS. The curette and GS were inserted into the bronchoscope. The EWS attached to the curette tip was inserted into the target bronchus and left in position by pulling the curette back through the GS while pushing the EWS with the GS under the bronchoscopic view. The success rate and procedure time were recorded. RESULTS: Bronchial occlusion with an EWS was performed on 143 target bronchi (2 to 9 bronchi/patient). The bronchial occlusion success rate was 98.6%. The median procedure time for bronchial occlusion per EWS on video recordings of the 10 most recent procedures was 110 (range, 40 to 521) seconds. The target bronchial occlusion success rate was 100%. This method enabled easy insertion of the EWS, even in the sharply branching upper lobe bronchus. No complications were observed. CONCLUSION: Bronchial occlusion using a GS and curette is a rapid and easy technique even in a sharply branching target bronchus.

[A case of primary lung cancer with swollen mediastinal lymph nodes due to pre-existing sarcoidosis].

A 69-year-old man, who had been followed up for sarcoidosis at another hospital from 10 years previously, was referred to our hospital because of a new lesion in the left upper lobe. A chest CT scan revealed a nodular lesion at the orifice of the left B3b and mediastinal lymphadenopathy. Bronchoscopic biopsy established a diagnosis of squamous cell carcinoma. Because there had been no distant metastasis and no change in size of the mediastinal lymph nodes over the previous 5 years, left upper lobectomy with lymph node dissection was performed. The histology of the resected tumor indicated a moderately-differentiated squamous cell carcinoma, and the dissected lymph nodes contained non-caseous epithelioid cell granuloma without metastasis. Thus, we made a final diagnosis of squamous cell carcinoma (pT1N0M0, stage IA) that complicated the sarcoidosis. Surgical resection can be the first option for lung cancer complicating sarcoidosis with mediastinal lymphadenopathy, because making a preoperative assessment of N status is difficult.

[A case of ruptured bronchial artery aneurysm with hemothorax and mediastinal hematoma].

We encountered a case of ruptured bronchial artery aneurysm, which presented with hemothorax and mediastinal hematoma. The patient was a 65-year-old man. He was admitted because of a sudden onset of right chest pain. The chest X-ray film revealed a right pleural effusion and a pleural tap was reported to be bloody. Chest contrast CT revealed a subcarinal mass and several nodes, about 10 mm in diameter, in the thyroid. Because fine needle aspiration of the thyroid was positive, we suspected that the mediastinal lesion was a metastatic lymph node, and that the ruptured metastasis and carcinomatous pleurisy might have caused the hemothorax. However, mediastinoscopy confirmed no tumor but only mediastinal hematoma. This made us strongly suspect ruptured bronchial artery aneurysm. We next performed selective angiography of the bronchial artery, revealing an aneurysm, 10 mm in diameter. On this basis, a definitive diagnosis of ruptured bronchial artery aneurysm was made. Since the feeding vessel was too narrow to cannulate for embolization, we performed video-assisted thoracic surgery to dissect the hematoma. Although it was too organized to identify the aneurysm, it was assumed to be have been removed, and no recurrence was observed after the operation. Since a rupture of the bronchial artery could be life-threatening, a ruptured bronchial artery aneurysm should be considered as one of the differential diagnoses of hemothorax.

[A case of severe radiation pneumonitis--a trial of plasma exchange].

A 77-year-old man underwent radiotherapy for the squamous cell carcinoma of the right lung. Two months after the 60Gy/30fr irradiation was completed, he complained of dyspnea and his chest X-ray showed ground glass opacities and reticular shadows in both lung fields. Severe radiation pneumonitis was diagnosed. Two grams of methylprednisolone did not improve his symptoms and on the next day his hypoxemia worsened. We then tried plasma exchange because of his critical status. His respiratory status improved rapidly after plasma exchange and his chest X-ray showed remarkable improvement 10 days later. We think this case suggests the effectiveness of plasma exchange for severe radiation pneumonitis.