Successful management of Mycobacterium abscessus pneumonia in a 53-day-old immunocompetent infant.

Pulmonary infection due to Mycobacterium abscessus complex (MABC) usually occurs in children with underlying risk factors including cystic fibrosis (CF), chronic lung disease, and immunocompromised status, but rarely in immunocompetent children without underlying lung disease, especially in infants. We present a case of MABC pulmonary disease (MABC-PD) in an otherwise healthy 53-day-old male infant with one week of cough and respiratory distress. Computed tomography showed multiple masses across both lungs. Isolated mycobacteria from his bronchoalveolar lavage fluid were identified as MABC. We describe our complete evaluation, including immunodeficiency evaluation incorporating whole exome sequencing and our therapeutic process given complicated susceptibility pattern of the M. abscessus isolate, and review literature for MABC-PD in immunocompetent children. The infant was successfully treated through prolonged treatment with parenteral Amikacin, Cefoxitin, Linezolid, and Clarithromycin, combined with inhaled Amikacin.

Efficacy of fiberoptic bronchoscopy and bronchoalveolar lavage in childhood-onset, complicated plastic bronchitis.

BACKGROUND: Plastic bronchitis (PB) is a rare, variable, and potentially fatal disease. This study aimed to assess the efficacy of fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) in treating children with PB. METHODS: In total, 15 children with PB, between 2012 and 2020, were enrolled in our study. Within 12 hours of admission, FOB and BAL were performed and reviewed under local anesthesia and sedation. Before and after FOB, clinical findings and chest imaging were evaluated. RESULTS: Regarding the onset of symptoms before FOB, all cases had prominent cough for 7.00 ± 4.55 days, and 14 had persistent high fever. In total, 13 cases had complete obstruction from bronchial casts, consistent with consolidated lesions; 2 had partial airway obstruction. Within 3 days, complete resolution was revealed in nine cases. Overall, six cases underwent repeated FOB (range, 2-3 times) for persistent atelectasis and airway obstruction. Except for two cases with type 2 PB, cast histology confirmed type 1 PB for all cases. Only eight children had minor intra- and post-procedure complications. Reverse transcription-polymerase chain reaction for Mycoplasma pneumoniae in sputum and BAL samples were positive in 13 cases. Next-generation sequencing of the BAL samples was positive for adenovirus and Human parainfluenza virus in one case, respectively. During 1 month to 7 years of follow-up, no patient developed PB recurrence, asthmatic attacks, or chronic cough. CONCLUSIONS: Early FOB and BAL were effective in alleviating clinical findings, atelectasis, and airway obstruction. Serial FOB could be performed in patients with recurrent symptoms.

Fatal congenital tuberculosis owing to late diagnosis of maternal tuberculosis: case report and review of congenital tuberculosis in China.

Congenital tuberculosis (TB) is rare and the prognosis is poor if not detected early. The diagnosis is often delayed owing to non-specific clinical presentation, misdiagnosis and undiagnosed maternal TB during pregnancy. A 12-day-old girl presented with a 5-day history of fever, cough, poor feeding and respiratory distress. Her mother had a cough and fever at 30 weeks gestation which was managed empirically as community-acquired pneumonia without a TB workup. Immediately postpartum, her mother developed a high fever and shortness of breath and required admission to the intensive care unit. The infant was separated from her mother after delivery. The infant's chest radiograph showed bilateral miliary nodules. Thoracic and abdominal computed tomography (CT) showed multiple enlarged lymph nodes and congenital TB was suspected. Early morning gastric aspirate and sputum (obtained through a suction tube) were positive for acid-fast bacilli on smear microscopy and subsequently Mycobacterium tuberculosis was cultured from both specimens. Lumbar puncture was performed and cerebrospinal fluid (CSF) was compatible with TB meningitis. TB-polymerase chain reaction (TB-PCR) was positive. Her mother was diagnosed with miliary TB on postpartum day 17. Both were given anti-TB chemotherapy. Unfortunately, despite the treatment, the infant died from multiple organ dysfunction syndrome (MODS) caused by congenital TB at the age of 14 days. This case highlights the importance of screening pregnant women for TB in regions where it is highly prevalent. A high index of suspicion of maternal and congenital TB is critical to early diagnosis, especially in such regions.

[Comparison of two tracing method of transplanted mouse embryonic stem cell].

OBJECTIVE: To trace the embryonic stem (ES) cells transplanted into rat brain by labeling the cells with green fluorescent protein (GFP) and by mouse neuronal specific antibody Thy-1 and compare their features. METHODS: For GFP labeling,transfect pEGFP-N1 plasmid containing GFP and anti-neomycin sequences into embryonic stem cell and add neomycin for more than 10 passages. To test the GFP expression in vivo, the GFP-ES was transplanted into healthy rat brain, and the frozen sectioned slides were observed under fluorescence microscope and laser con-focal microscope 21 days later. For the antibody labeling,embryonic stem cells were directly transplanted into the rat brain. The specific mouse thy-1 antibody was used in immunostaining of transplanted cells. For both of the two labeling method, the slides were also examined by double labeling with the antibodies,neuronal nuclei (NeuN) or glial fibrillary acidic protein (GFAP) to identify the differentiation of transplanted cells. RESULTS: Both single ES cell and cell pellets expressed bright green fluorescence the day after plasmid transfection, and more than 30% ES cells were labeled. The GFP-labeled cells could still be found gathered around the infusion channel at least 21 days later, but the GFP fluorescent could not be overlapped with NeuN or GFAP staining. On the contrary, Thy-1 antibody overlapped well with NeuN or GFAP staining. CONCLUSIONS: Liposome-helped plasmid GPF transfection is effective in labeling mouse embryonic stem cell in vivo,but is not effective in showing the differentiated cells. On the contrary, Thy-1 antibody can not only show the transplanted cells, but also trace the transplanted cells after their differentiation.