Relapsing bronchopneumonia due to community-associated methicillin-resistant Staphylococcus aureus: a case report.

BACKGROUND: The emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has increased the incidence of community-onset MRSA infection. Respiratory tract infections caused by MRSA has been noted for their severity; however, repeated relapses that require extended antibiotic therapy are rare. CASE PRESENTATION: We report a case of relapsing bronchopneumonia caused by CA-MRSA in a 56-year-old man. The patient responded to antibiotics, but repeatedly relapsed after stopping treatment. MRSA was consistently isolated from airway specimens during each relapse. Extended oral antibiotic treatment with trimethoprim/sulfamethoxazole (TMP/SMX) for 6 months achieved infection control. Whole-genome sequencing of the isolated strain revealed that the causative agent was sequence type (ST)1/staphylococcal cassette chromosome mec (SCCmec) type IVa, a clone that is rapidly increasing in Japan. DISCUSSION AND CONCLUSIONS: This patient had an unusual course of MRSA bronchopneumonia with repeated relapses. Although the choice of antibiotics for long-term use in MRSA respiratory tract infections has not been well established, TMP/SMX was effective and well tolerated for long-term therapy in this case. The clinical course of infections related to the rapid emerging clone, ST1/SCCmec type IVa warrants further attention.

Cefalea e hipertensión como forma de presentación de un feocromocitoma y simulando un síndrome post-COVID-19 / Headache and hypertension as a form of presentation of pheochromocytoma and simulating a post-COVID-19 syndrome

El síndrome post-COVID-19 es un conjunto de síntomas y signos que persisten durante más de 12 semanas después de una infección por COVID-19 y actualmente carece de una definición clínica estandarizada. Únicamente se ha informado un caso en el que un feocromocitoma se confundió con un síndrome post-COVID-19. La sintomatología de este síndrome es variable y abarca desde la cefalea y la fatiga hasta la disnea persistente y las alteraciones neurocognitivas. Además, el SARS-CoV-2 puede afectar al sistema nervioso autónomo, contribuyendo a síntomas que se asemejan a los del feocromocitoma. Se recalca la importancia y la necesidad de discernir entre síntomas relacionados con la COVID-19 y otras afecciones, ya que la especificidad de las manifestaciones clínicas del síndrome post-COVID-19 es muy baja y puede ser confundido con otras enfermedades vitales. Se presenta un caso en el que un feocromocitoma fue confundido con un síndrome post-COVID-19 en una paciente sin antecedentes médicos.(AU)

Post-COVID-19 syndrome is a set of symptoms and signs that persist for more than 12 weeks after COVID-19 infection and currently lacks a standardised clinical definition. Only one case has been reported in which a pheochromocytoma was mistaken for post-COVID-19 syndrome. The symptomatology of this syndrome is variable and ranges from headache and fatigue to persistent dyspnoea and neurocognitive disturbances. In addition, SARS-CoV-2 can affect the autonomic nervous system, contributing to symptoms resembling those of pheochromocytoma. The importance and need to discern between COVID-19-related symptoms and other conditions is emphasised, as the specificity of the clinical manifestations of post-COVID-19 syndrome is very low and can be confused with other vital pathologies. A case is presented in which a pheochromocytoma was mistaken for post-COVID-19 syndrome in a patient with no medical history.(AU)

Remimazolam attenuates inflammation in bronchopneumonia through the inhibition of NLRP3 activity by PDPK1 ubiquitination.

Bronchopneumonia is the most common pneumonia in childhood. Therefore, we tested the effects of Remimazolam presented Bronchopneumonia and its possible mechanisms. Phillygenin increased survival rate, reduced W/D ratio, and lung injury score, and inhibited IL-1ß, IL-6, TNF-α, and INF-γ levels in mice model of bronchopneumonia. Remimazolam induced PDPK1 and p-AKT protein expressions, and suppressed NLRP3 protein expression in lung tissue of mice model. In vitro model, Remimazolam also induced PDPK1 and p-AKT protein expressions, and suppressed NLRP3 protein expression. Remimazolam also inhibited inflammation levels in vitro model. PDPK1 inhibitor, PHT-427 (100 mg/kg) reduced survival rate, increased W/D ratio and lung injury score, and promoted inflammation levels in mice model of bronchopneumonia by treated with Remimazolam. PHT-427 suppressed PDPK1 and p-AKT protein expressions and induced NLRP3 protein expression in mice model of bronchopneumonia by treated with Remimazolam. Remimazolam interlinked PDPK1 protein. Remimazolam increased the expressions of PDPK1 and p-AKT in vitro model. Remimazolam reduced PDPK1 ubiquitination in vitro model.

Chest imaging classification in Mycoplasma pneumoniae pneumonia is associated with its clinical features and outcomes.

BACKGROUND: The imaging findings of Mycoplasma pneumoniae pneumonia (MPP) vary; however, few studies have focused on the relationship of imaging classification with clinical manifestations and outcomes. OBJECTIVE: To prospectively investigate whether chest imaging classification in Mycoplasma pneumoniae pneumonia (MPP) is associated with its clinical features and outcomes. METHODS: A total of 1,401 hospitalized children with MPP were enrolled from January 2019 to December 2021. Imaging findings were categorized as bronchopneumonia and consolidation/atelectasis according to X-ray, and bronchopneumonia, consolidation/atelectasis, bronchiolitis, and mosaic pattern according to computed tomography (CT). Clinical characteristics and outcomes of patients with different imaging classifications were prospectively analyzed based on electronic medical records. RESULTS: Bronchopneumonia was the most common finding (59.6%), while consolidation/atelectasis was the most severe group. Clinical manifestations and laboratory indicators for the consolidation/atelectasis group included serious abnormalities. Further, outcomes of the patients were worse, including having longer total durations of fever and hospitalization, greater hospitalization expenses, and a higher likelihood of developing refractory MPP, necrotizing pneumonia, and bronchiolitis obliterans (BO) in this group. The incidence of bronchiolitis, a disease characterized by a high prevalence of fever, moist rales, and an atopic constitution, tended to increase after the coronavirus disease pandemic and predisposed patients to BO. A mosaic pattern occurred in allergic and young individuals, with wheezing as the main manifestation, with patients having relatively mild symptoms and good outcomes. CONCLUSION: Different imaging classifications have different clinical features and clinical outcomes; thus, formulating an imaging-based classification system is of great clinical value.

Severe bronchiectasis resulting from chronic bacterial bronchitis and bronchopneumonia in a jungle cat.

Bronchiectasis is irreversible bronchial dilation that can be congenital or acquired secondary to chronic airway obstruction. Feline bronchiectasis is rare and, to our knowledge, has not been reported previously in a non-domestic felid. An ~10-y-old female jungle cat (Felis chaus) was presented for evaluation of an abdominal mass and suspected pulmonary metastasis. The animal died during exploratory laparotomy and was submitted for postmortem examination. Gross examination revealed consolidation of the left caudal lung lobe and hila of the cranial lung lobes. Elsewhere in the lungs were several pale-yellow pleural foci of endogenous lipid pneumonia. On cut section, there was severe distension of bronchi with abundant white mucoid fluid. The remaining lung lobes were multifocally expanded by marginal emphysema. Histologically, ectatic bronchi, bronchioles, and fewer alveoli contained degenerate neutrophils, fibrin, and mucin (suppurative bronchopneumonia) with rare gram-negative bacteria. Aerobic culture yielded low growth of Proteus mirabilis and Escherichia coli. There was chronic bronchitis, marked by moderate bronchial gland hyperplasia, lymphoplasmacytic inflammation, and lymphoid hyperplasia. The palpated abdominal mass was a uterine endometrial polyp, which was considered an incidental, but novel, finding. Chronic bronchitis and bronchopneumonia should be considered as a cause of bronchiectasis and a differential diagnosis for respiratory disease in non-domestic felids.

Clinical characteristics, early blood biochemical indicators, and prognostic status of children with bronchopneumonia.

To investigate the clinical characteristics, early blood biochemical indicators, and prognostic status of children with bronchopneumonia. We conducted a retrospective analysis of data from 500 children diagnosed with bronchopneumonia at our hospital from June 2019 to December 2022. Based on the severity of the disease, patients were assigned to the severe group (n = 180) or mild group (n = 320), and an additional 150 healthy children were chosen as the control group. Blood indicators [aspartate aminotransferase (AST), plasma carbon dioxide combining power (CO2CP), serum potassium (K+), serum sodium (Na+)], inflammatory markers [interleukin-17 (IL-17), interleukin-10 (IL-10), C-reactive protein (CRP), procalcitonin (PCT)], and cardiac enzyme profiles [lactate dehydrogenase (LDH), creatine kinase (CK), alpha-hydroxybutyrate dehydrogenase (α-HBDH), creatine kinase isoenzyme (CK-MB)] were compared among the 3 groups. The severe group showed more signs such as diarrhea, pleural effusion, and respiratory distress than the mild group. AST levels in the severe group were significantly higher than those in the mild group and control group, while CO2CP, K+, and Na+ were lower than those in the mild group and control group. AST levels in the mild group were significantly higher than those in the control group, while CO2CP and Na + were significantly higher than those in the control group (P < .05). IL-10, IL-17, PCT, and CRP levels in the severe group were higher than those in the mild group and control group, while those in the mild group were higher than those in the control group (P < .05). CK, CK-MB, LDH, and α-HBDH levels in the severe group were significantly higher than those in the mild group and control group. CK, CK-MB, LDH, and α-HBDH levels in the mild group were higher than those in the control group (P < .05). The severe group had a longer duration of fever, disappearance of symptoms, and cough relief time than the mild group (P < .05). Children with bronchopneumonia exhibit increased cardiac enzyme (CK, CK-MB, LDH, and α-HBDH) activity, and PCT and CRP expression levels increase with disease severity. Timely detection of relevant blood biochemical indicators and early implementation of prevention and treatment measures can improve the cure rate and reduce mortality in children with bronchopneumonia.

Identification of Astrovirus in the virome of the upper and lower respiratory tracts of calves with acute signs of bronchopneumonia.

IMPORTANCE: Astroviruses (AstV) are known suspects of enteric disease in humans and livestock. Recently, AstV have been linked to encephalitis in immunocompromised patients and other animals, such as cattle, minks, and swine. In our study, we also identified AstV in the respiratory samples of calves with signs of bronchopneumonia, suggesting that their tropism could be even broader. We obtained one bovine AstV (BAstV) complete genome sequence by next-generation sequencing and showed that respiratory and enteric AstV from different species formed a divergent genetic cluster with AstV isolated from encephalitis cases, indicating that tropism might be strain-specific. These data provide further insight into understanding the biology of these understudied pathogens and suggest BAstV as a potential new candidate for bovine respiratory disease.

Bronchogenic cyst with concurrent chronic suppurative bronchopneumonia in a 10-year-old German shepherd dog.

A 10-year-old spayed female German shepherd dog was transferred for acute respiratory distress and a bulla-like pulmonary lesion identified on referral radiographs. Computed tomography (CT) imaging identified a bronchiole from a dilated left cranial lobar bronchus terminating into a partially fluid-filled, cyst-like pulmonary lesion and surrounding multilobar pulmonary hyperattenuation. After failure of medical management, a left cranial lung lobectomy was done. Histopathology was consistent with a bronchogenic cyst and chronic, suppurative bronchopneumonia of the remaining parenchyma. Bronchogenic cysts with concurrent bronchopneumonia should be considered in older German shepherd dogs with acute respiratory distress that fail medical management. Key clinical message: Canine bronchogenic cyst is an uncommon condition that previously has only been reported in younger German shepherd dogs. This case highlights the importance of considering this condition in a senior German shepherd dog with no prior respiratory history, as well as the difficulty of medical management with concurrent bronchopneumonia.

Kyste bronchogénique avec bronchopneumonie suppurée chronique concomitante chez un chien berger allemand de 10 ans. Une chienne berger allemand stérilisée âgée de 10 ans a été transférée pour une détresse respiratoire aiguë et une lésion pulmonaire de type bulle identifiée sur les radiographies de référence. L'imagerie par tomodensitométrie (TDM) a identifié une bronchiole d'une bronche lobaire crânienne gauche dilatée se terminant par une lésion pulmonaire ressemblant à un kyste partiellement rempli de liquide et une hyperatténuation pulmonaire multipolaire. Après échec de la prise en charge médicale, une lobectomie pulmonaire crânienne gauche a été effectuée. L'histopathologie était compatible avec un kyste bronchogénique et une bronchopneumonie suppurée chronique du parenchyme restant. Les kystes bronchogéniques avec bronchopneumonie concomitante doivent être envisagés chez les chiens berger allemand âgés souffrant de détresse respiratoire aiguë qui échouent à la prise en charge médicale.Message clinique clé :Le kyste bronchogénique canin est une affection rare qui n'a été signalée auparavant que chez les jeunes bergers allemands. Ce cas met en évidence l'importance de considérer cette condition chez un chien berger allemand âgé sans antécédents respiratoires, ainsi que la difficulté de la prise en charge médicale avec une bronchopneumonie concomitante.(Traduit par Dr Serge Messier).

Risk factors of peripheral venous catheter-related complication and infection in children with bronchopneumonia.

OBJECTIVE: To investigate the risk factors associated with the peripheral venous catheter-related complication and infection in children with bronchopneumonia. METHODS: A total of 185 patients were divided into case group (n = 114) and control group (n = 71) according to the presence of catheter-related infection and complications related to indwelling needle. We performed a multivariate logistic regression analysis to explore the risk factors associated with the infection. RESULTS: Age was divided into 4 categories (0 < age ≤ 1, 1 < age ≤ 3, 3 < age ≤ 6, age > 6). The case group had a higher percentage of patients with 0 < age ≤ 1 than the control group (21% vs. 9.7%) and the age distribution was significant different between the two groups (P = 0.045). The case group had a longer retention time than the control group (≥ 3 days: 56% vs. 35%, P < 0.001). The results of binary logistics regression analysis revealed that the indwelling time and indwelling site were the factors that influenced the complications or bacterial infection. Among the three indwelling sites, the hand is more prone to infection and indwelling needle-related complications than the head (OR: 2.541, 95% CI 1.032 to 6.254, P = 0.042). The longer the indwelling time, the more likely the infection and indwelling needle related complications (OR: 2.646, 95% CI 1.759 to 3.979, P< 0.001). CONCLUSION: Indwelling time and indwelling site are the influencing factors of complications or bacterial infection, which should be paid more attention to prevent the catheter-related infection in children with bronchophenumonia.

Assessing the utilization of antimicrobial agents in pediatric pneumonia during the era of the 13-valent pneumococcal conjugate vaccine: A retrospective, single-center study.

BACKGROUND AND PURPOSE: Pneumonia and bronchopneumonia are the most common infectious diseases in children. This study aimed to analyze changes in causative pathogens and antibiotic use for bronchopneumonia or pneumonia after the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in children. METHODS: This retrospective study was conducted from 2009 to 2019. Hospitalized children aged 6 months-3 years with a discharge diagnosis of bronchopneumonia or pneumonia were included to analyze changes in the potential mismatch between the diagnosed pathogen and antibiotic use. RESULTS: The cohort comprised 1100 patients, including 648 (59%) and 452 (41%) with a discharge diagnosis of bronchopneumonia and pneumonia, respectively. The trend of viral pneumonia increased every year (rs = 0.101, p < 0.05) Antibiotics were administered in 97% patients, with an increasing annual trend in macrolide use (rs = 0.031, p = 0.009). Regarding antibiotic utilization, no significant variations were observed in the days of therapy (DOT) (rs = 0.076, p = 0.208) or length of therapy (LOT) (rs = -0.027, p = 0.534) per patient-year throughout the study duration. Interestingly, the LOT for combined therapy with macrolides and first-line beta-lactams was high (rs = 0.333, p = 0.028). In viral pneumonia treatment, neither the DOT nor LOT exhibited significant variations (rs = -0.006, p = 0.787 and rs = -0.156, p = 0.398). CONCLUSION: After the introduction of PCV13 in Taiwan, no decrease in antibiotic use has been observed among children aged 6 months-3 years with a discharge diagnosis of bronchopneumonia and pneumonia.

Postmortem diagnoses and factors influencing diagnoses in captive white-tailed deer in Wisconsin, 2009-2021.

There have been significant changes to Wisconsin agriculture since ~2010, one of which is the growth of commercial farming of white-tailed deer (WTD; Odocoileus virginianus). These high-density populations may lead to the emergence of previously unrecognized or under-recognized disease trends. I evaluated archived pathology records at the Wisconsin Veterinary Diagnostic Laboratory (WVDL) from 2009-2021 for captive WTD postmortem cases and included records from 277 WTD cases. Diagnoses were found in 81.9% of cases, with an average of 1.3 diagnoses per animal. Submissions with a clinical history of respiratory disease were 7.0 times more likely to have a diagnosis than the average case. Fawns were 1.9 times more likely to have a diagnosis. The most common diagnoses were bronchopneumonia and enteritis and/or enterocolitis (both 16.2% of total diagnoses). The most common isolates from bronchopneumonia cases were Pasteurella multocida, Bibersteinia trehalosi, and Trueperella pyogenes. The pathogens identified most often in enteritis and/or enterocolitis cases were rotavirus, Clostridium perfringens, and Escherichia coli. The most common non-infectious diagnoses were poor nutritional status or inanition, hepatic lipidosis, and selenium and/or vitamin E deficiency. Focusing on testing for pathogens in fawns and in cervid respiratory disease complex submissions may be recommended for laboratories expanding their WTD testing.

Bronchiolitis versus bronchopneumonia: navigating antibiotic use within the LRTI spectrum.

Bronchiolitis, a common reason for infant hospitalisation in South Africa (SA), is caused by viral pathogens. Bronchiolitis is typically an illness of mild to moderate severity that occurs in well-nourished children. Hospitalised SA infants frequently have severe disease and/or coexisting medical conditions, and these cases of bronchiolitis may have bacterial co-infection that requires antibiotic therapy. However, the existence of widespread antimicrobial resistance in SA warrants the judicious use of antibiotics. This commentary describes: (i) common clinical pitfalls leading to an incorrect diagnosis of bronchopneumonia; and (ii) considerations for antibiotic therapy in hospitalised infants with bronchiolitis. If antibiotics are prescribed, the indication for their use should be clearly stated, and antibiotic therapy must be stopped promptly if investigations indicate that bacterial co-infection is unlikely. Until more robust data emerge, we recommend a pragmatic management strategy to inform antibiotic use in hospitalised SA infants with bronchiolitis in whom bacterial co-infection is suspected.

Bayesian evaluation of the accuracy of a thoracic auscultation scoring system in dairy calves with bronchopneumonia using a standard lung sound nomenclature.

BACKGROUND: Although thoracic auscultation (AUSC) in calves is quick and easy to perform, the definition of lung sounds is highly variable and leads to poor to moderate accuracy in diagnosing bronchopneumonia (BP). HYPOTHESIS/OBJECTIVES: Evaluate the diagnostic accuracy of an AUSC scoring system based on a standard lung sound nomenclature at different cut-off values, accounting for the absence of a gold standard test for BP diagnosis. ANIMALS: Three hundred thirty-one calves. METHODS: We considered the following pathological lung sounds: increased breath sounds (score 1), wheezes and crackles (score 2), increased bronchial sounds (score 3), and pleural friction rubs (score 4). Thoracic auscultation was categorized as AUSC1 (positive calves for scores ≥1), AUSC2 (positive calves for scores ≥2), and AUSC3 (positive calves for scores ≥3). The accuracy of AUSC categorizations was determined using 3 imperfect diagnostic tests with a Bayesian latent class model and sensitivity analysis (informative vs weakly informative vs noninformative priors and with vs without covariance between ultrasound and clinical scoring). RESULTS: Based on the priors used, the sensitivity (95% Bayesian confidence interval [BCI]) of AUSC1 ranged from 0.89 (0.80-0.97) to 0.95 (0.86-0.99), with a specificity (95% BCI) of 0.54 (0.45-0.71) to 0.60 (0.47-0.94). Removing increased breath sounds from the categorizations resulted in increased specificity (ranging between 0.97 [0.93-0.99] and 0.98 [0.94-0.99] for AUSC3) at the cost of decreased sensitivity (0.66 [0.54-0.78] to 0.81 [0.65-0.97]). CONCLUSIONS AND CLINICAL IMPORTANCE: A standardized definition of lung sounds improved AUSC accuracy for BP diagnosis in calves.

Morbimortalidade por pneumonia no estado da Bahia no período pré e durante a pandemia de COVID-19 ­ base de dados do DATASUS / Pneumonia morbidity and mortality in the state of Bahia in the period before and during the COVID-19 pandemic ­ DATASUS database

Introdução: a pneumonia é uma infecção nos pulmões, provocada pela penetração de microrganismos. Outras infeções respiratórias, incluindo a SARS-COV-2, podem agravar a clínica do paciente. Por sua vez, esta é uma doença sistêmica, com foco pulmonar que pode gerar complicações respiratórias, dentre elas a pneumonia. Neste seguimento, estudos evidenciam que 15% dos pacientes com COVID-19 podem apresentar pneumonia leve e 5% evoluir para pneumonia grave. Objetivo: comparar a ocorrência de morbimortalidade por pneumonia no Estado da Bahia, no período pré e durante a pandemia de COVID-19. Metodologia: trata-se de um estudo ecológico, quantitativo, com dados públicos, disponíveis no Sistema Informações em Saúde da plataforma DataSUS/ TABNet, referentes ao Estado da Bahia, no período de jan./2018 a dez./2021. Foram selecionados os dados: internamentos, média de internamento, óbitos e taxa de mortalidade. Os dados foram analisados através da estatística descritiva, frequência relativa, e estatística analítica com o teste de frequências relativas U de Mann-Whitney. Resultados: o Estado da Bahia, registrou um total de 48 mil internações por pneumonia, com média de taxa de permanência de internamento de 6,4 dias e um total de 8 mil óbitos, com média de taxa de mortalidade de 16,91% ao ano. Observa-se que ocorreu redução nas internações e óbitos, e aumento na taxa de mortalidade por pneumonia, no período estudado (P<0,001). Conclusão: contudo, verificou-se que no Estado da Bahia durante o período da pandemia de COVID-19, ocorreram redução no número de internados e óbitos, e aumento na taxa de mortalidade por pneumonia, comparando-se ao mesmo período pré pandemia.

Introduction: pneumonia is an infection in the lungs, caused by exposure to microorganisms. Other respiratory infections, including SARS-COV-2, may aggravate the patient's health condition. In turn, this is a systemic disease, with a pulmonary focus that can lead to respiratory complications, including pneumonia. In this area, studies show that 15% of patients with COVID-19 may have mild pneumonia and 5% progress to severe pneumonia. Objective: to compare the occurrence of morbidity and mortality from pneumonia in the State of Bahia, in the period before and during the COVID-19 pandemic. Methodology: this is an ecological, quantitative study, with public data, available in the Health Information System of the DataSUS/TABNet platform, referring to the State of Bahia, from Jan./2018 to Dec./2021. Selected data: hospitalizations, average hospitalization, deaths and mortality rate. Data were analysed using descriptive statistics, relative frequency, and analytical statistics with the Mann-Whitney U relative frequency test. Results: the State of Bahia recorded a total of 48,000 hospitalizations for pneumonia, with an average hospitalization stay rate of 6.4 days and a total of 8,000 deaths, with an average mortality rate of 16.91% per year. It is observed that there was a reduction in hospitalizations and deaths, and an increase in the mortality rate due to pneumonia, in the studied period (P<0.001). Conclusion: however, it was found that in the State of Bahia during the period of the COVID-19 pandemic, there was a reduction in the number of hospitalizations and deaths, and an increase in the mortality rate due to pneumonia, compared to the same pre-pandemic period.

The application of probiotic after antibiotics treatment promotes the recovery of pediatric bronchopneumonia infection.

OBJECTIVE: We aim to investigate the treatment efficacy of combinational applications of oral probiotic with intravenous infusion of antibiotics in pediatric bronchopneumonia infection. PATIENTS AND METHODS: A total of 76 pediatric patients with bronchopneumonia infection were included in the study. We divided the patients into observation group (n=38) and control group (n=38). The patients in control group received intravenous infusion of antibiotics and symptomatic treatments. In the observation group, in addition to the treatments of the control group, the patients also received oral probiotic. We compared the effective times of treatment, including the durations of wet rale in lung auscultation, cough, fever, and the total time of hospitalization. Additionally, we also recorded the occurrence of adverse reaction, including rash and gastrointestinal reaction. Meanwhile, laboratory tests for systemic inflammation were recorded at different time points. RESULTS: The durations of rale in lung auscultation (p=0.006), cough (p=0.019), fever (p=0.012), and the total time of hospitalization (p=0.046) in observation group were significantly shorter than those in the control group. The incidence rate of diarrhea was 10.5% (4/38) in the observation group, and 34.2% (13/38) in the control group, with a significantly statistical difference (p=0.013). In the laboratory tests, we found that blood lymphocyte (p=0.034) and high-sensitive C reactive protein (p=0.004) were significantly higher in the control group than that in the observation group at 7th day after the treatments. CONCLUSIONS: The combinational applications of probiotic and antibiotics in pediatric bronchopneumonia infection were safe and effective and can lower the diarrhea rate.

Complete tracheal duplication with a communicating oesophageal foregut malformation in a dog.

A complete tracheal duplication with a communicating foregut malformation has not been previously reported. We now describe the clinical presentation, computed tomography imaging features and pathological findings associated with this condition in a 12-week-old dog. The dog presented with recurrent episodes of bronchopneumonia and a soft tissue swelling in the ventral cervical region. The main findings were a congenital tracheoesophageal fistula connecting the tracheal and oesophageal anomalies, with secondary moderately neutrophilic bronchopneumonia. In addition, there was a suspected concurrent congenital hypertrophic cardiomyopathy and atrioventricular endocardiosis. This report highlights a novel foregut duplication and may assist in understanding the currently debated aetiopathogenesis of this condition in both humans and animals.

Targeted delivery of inhalable drug particles in the tracheobronchial tree model of a pediatric patient with bronchopneumonia: A numerical study.

Pneumonia is a common cause of hospitalization and death in children worldwide. Inhalation therapy is one of the methods treating pneumonia However, there are limited studies that distinguish between the physiology of children and adults, especially with respect to targeted drug delivery. A tracheobronchial (TB) tree model of an 11-year-old child with bronchopneumonia is selected as a testbed for in silico trials of targeted drug delivery. The airflow and particle transport are solved by the computational fluid dynamics method at an airflow rate of 15 LPM. The results indicate that the distribution of deposited particles shows aggregation on the particle release map. Point-source aerosol release (PSAR) method can significantly reduce the deposition efficiency (DE) of particles in the TB tree model. Specifically, the PSAR method can reduce the DE of large particles (i.e., 7.5 µm and 10 µm) by 7.57% and 9.61%, respectively. This enables rapid design of patient-specific treatment for different population age groups and different airway diseases.

Endogenous lipid pneumonia associated with atherosclerosis in a blue-fronted Amazon parrot (Amazona aestiva).

Endogenous lipid pneumonia is a rare inflammatory, non-infectious lung disease characterized by the accumulation of endogenous lipids in alveolar macrophages. It has been associated with bronchial obstruction, chronic lung inflammation, alveolar proteinosis and lipid storage disorders. A 14-year-old female blue-fronted Amazon parrot (Amazona aestiva) presented with intermittent dyspnoea, neurological signs and persistent lipaemia of unknown aetiology. At necropsy, the most relevant gross findings were increased rigidity of the great vessels, lungs with diffuse grey to whitish discolouration of the parenchyma and multifocal small yellowish nodules. Microscopic examination revealed typical lesions of atherosclerosis and severe multifocal accumulation of foamy macrophages filling the parabronchi, which led to a diagnosis of endogenous lipid pneumonia. Although the relationship between dyslipidaemia, atherosclerosis and endogenous lipid pneumonia in birds is not well established, the chronic dyslipidaemia of unknown origin could be involved in the pathogenesis of both the atherosclerosis and the endogenous lipid pneumonia. The present case highlights the need to better understand the relationships between various disorders of lipid metabolism in psittacine birds.