Diagnosis of bronchobiliary fistula by bilirubin crystallization in the alveolar lavage fluid: case reports and literature review.

Bronchobiliary fistula (BBF) refers to the abnormal traffic between the biliary tract and the bronchus. The condition is very rare and usually develops secondary to liver echinococcosis or amebiasis, liver abscess, trauma, biliary obstruction, or tumors. BBF has a high mortality rate and currently, there are no accurate and effective diagnostic methods. This study reports the diagnosis and treatment of two patients with BBF which were confirmed by detecting bilirubin crystallization in the sputum. The first patient was a 45-year-old woman admitted to the hospital with "recurrent cough and lung infection". She had a history of multiple biliary tract surgeries and bilirubin crystallization was detected in bronchoalveolar lavage fluid (BALF) upon examination. Computed tomography (CT) imaging and magnetic resonance cholangiopancreatography (MRCP), together with clinical features, confirmed a diagnosis of BBF. The second patient was a 53-year-old woman admitted to the hospital with coughing and bile-like sputum. She had a history of cholangiocarcinoma surgery and bilirubin crystallization was detected in the cytomorphological BALF examination. Endoscopic retrograde cholangiopancreatography (ERCP) combined with clinical features confirmed a diagnosis of BBF. Both patients recovered after treatment and were discharged from the hospital. The clinical diagnosis of BBF largely relies upon imaging combined with clinical standards, and BALF examinations are rarely performed. This current investigation retrospectively analyzed the diagnosis and treatment of two cases of BBF, and demonstrated that bilirubin crystallization in the BALF may be an important diagnostic indicator for BBF.

Extent of agreement between the body fluid model of Sysmex XN-20 and the manual microscopy method.

BACKGROUND: Although the correlations concerning cellular component analysis between the Sysmex XN-20 body fluid (BF) model and manual microscopy have been investigated by several studies, the extent of agreement between these two methods has not been investigated. METHODS: A total of 90 BF samples were prospectively collected and analyzed using the Sysmex XN-20 BF model and microscopy. The extent of agreement between these two methods was evaluated using the Bland-Altman approach. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the diagnostic accuracy of high-fluorescence (HF) BF cells for malignant diseases. RESULTS: The agreements of white blood cell (WBC), red blood cell (RBC), and percentages of neutrophils, lymphocytes, and monocytes between the Sysmex XN-20 BF model and manual microscopy were imperfect. The areas under the ROC curves for absolute and relative HF cells were 0.67 (95% confidence interval [CI]: 0.56-0.78) and 0.60 (95% CI: 0.48-0.72), respectively. CONCLUSION: Due to the Sysmex XN-20 BF model's imperfect agreement with manual microscopy and its weak diagnostic accuracy for malignant diseases, the current evidence does not support replacing manual microscopy with this model in clinical practice.

Red Cell Distribution Width (RDW) as a Prognostic Tool in Burn Patients.

BACKGROUND: Red cell distribution width (RDW) is associated with mortality in patients with certain diseases. However, the relationship between RDW and burn patients remains unknown. The objective of this study was to evaluate the diagnostic and prognostic performance of RDW. METHODS: Data of 149 patients admitted to the Burn ICU of the Changhai Hospital were retrospectively included in this study. Clinical and laboratory information of all subjects was extracted from medical records. RESULTS: This study demonstrated that: 1) burn patients with higher RDW had increased mortality, third-degree burn, total burn surface area (TBSA), length of hospital stay, infection rate, WBC, temperature, and CRP; 2) TBSA and length of hospital stay were positively correlated with RDW. 3) RDW levels were higher in burn patients with infection than non-infected burn patients. 4) There were differences in time trend of RDW between survivors and non-survivors from burns. CONCLUSIONS: RDW can provide useful information about burn severity and outcome. It may be used as a monitoring index for the illness of burn.

[Pathogen Identification for An Imported Case with African Trypanosomiasis].

Objective: To perform laboratory diagnosis for an imported case of human African trypanosomiasis and identify the pathogen. Methods: Clinical and epidemiological information was collected. Blood and cerebrospinal fluid samples were collected, stained with Wright-Giemsa, and microscopically examined. Genomic DNA from the blood samples was amplified with primers specific for Trypanosoma sp. expression site-associated gene (ESAG), Trypanosoma brucei gambiense specific glycoprotein (TgsGP) and 18S rRNA（M18S-Ⅱ-Tb） gene, and Trypanosoma brucei rhodesiense specific serum resistance associated （SRA） gene. Complete blood count, blood chemistry, and CSF examination were also conducted. Results: The patient had a 4-month history of lower extremity weakness and swelling of surface lymph nodes. Physical examination showed somnolence, and occasional emotional abnormalities, accompanied by anemia (hemoglobin 85 g/L), electrolyte disturbance (sodium 124 mmol/L; chlorine 87 mmol/L) and significantly increased nonspecific immune globulin protein （globulin 63 g/L）. Epidemiological survey showed that the patient suffered insect bites and stings for several times during his work in the Republic of Gabon in Africa. Microscopic examination revealed flagella of trypanosome in peripheral blood. PCR amplification produced bands of 286, 308, and 150 bp with primers specific for ESAG, TgsGP and M18S-Ⅱ-Tb, respectively. Conclusion: The patient was diagnosed with Trypanosoma brucei gambiense infection from the clinical information, epidemiological history, etiology and PCR results.

Coinfection of Strongyloides stercoralis and Aspergillus found in bronchoalveolar lavage fluid from a patient with stubborn pulmonary symptoms.

We report a case involving coinfection with Strongyloides stercoralis (S. stercoralis) and Aspergillus found in the bronchoalveolar lavage fluid (BALF) of an elderly male patient who had a medical history of autoimmune pancreatitis (AIP) and who was treated with prednisone therapy 6 months previously. The patient presented with stubborn pulmonary symptoms and signs because of Aspergillus invasion and mechanical destruction caused by larval migration. We found S. stercoralis and Aspergillus in his BALF that provided diagnostic proof.

[Amiodarone pneumonitis with Hypermastigote lung infection: a case report and review of the literatures].

OBJECTIVE: To describe the clinical features of amiodarone pneumonitis with Hypermastigote lung infection. METHODS: Case report and review of the related literatures. The clinical symptoms, laboratory tests, radiographic patterns, diagnosis, and therapeutic management of amiodarone pneumonitis with Hypermastigote lung infection were described. RESULTS: A 58 year old male patient presented dyspnea after exertion. Pulmonary function showed decrease of the diffusing capacity, and CT showed interstitial changes and alveolar exudation. Foamy cells and Hypermastigotes were found in the bronchoalveolar lavage fluid. After cessation of amiodarone and the start of anti-parasite therapy, the symptoms relieved. CONCLUSIONS: Amiodarone pneumonitis with Hypermastigote lung infection is very rare. The infection may be due to decrease of local immunity caused by amiodarone pneumonitis.