An Accuracy-Based Approach to the Microbiologic Diagnosis of Pulmonary Infection: Part III

Fungal infections

Objective To investigate the effect of spiral CT combined with chest X-ray on diagnosis of early pulmonary infection. Methods Ninety-eight patients suspected with pulmonary infection from May 2016 to August 2018 in the Central Hospital of Jiamusi were selected, and all underwent spiral CT and chest X-ray. Compared with sputum culture results, the diagnostic results and value of chest X-ray examination and spiral CT combined with chest X-ray examination were compared, and the imaging signs of spiral CT in diagnosis of patients with different types of infection were analyzed. Results Among the 98 suspected cases, 52 cases were positive for pulmonary infection and 46 cases were negative. The accuracy of spiral CT combined with chest X-ray examination for pulmonary infection was significantly higher than that of chest X-ray examination (P<0.05). The diagnostic value of spiral CT combined with chest X-ray examination (positive predictive value, sensitivity, negative predictive value, specificity) in the diagnosis of pulmonary infection was higher than that of pure chest X-ray examination (P<0.05). According to sputum culture, among 52 patients with pulmonary infection, 17 cases had mixed infection, 19 cases had non-specific bacterial infection, 4 cases had viral infection and 12 cases had fungal infection. Among CT imaging signs, ground glass was the main type of virus infection; consolidation, nodule and ground glass were visible in fungal infections, consolidation was the main type of non-specific bacterial infections; and consolidation and ground glass were the main types of mixed infections. Conclusions Spiral CT combined with chest X-ray examination is of high diagnostic value in the diagnosis of early pulmonary infection, which can further identify the types of infection and provide a basis for the development of treatment programs. Key words: Early pulmonary infection; Spiral CT; Chest X-ray; Diagnostic value; CT imaging features

Value of platelet count in the early diagnosis of nosocomial invasive fungal infections in premature infants

Treatment of respiratory infections in the patient at risk

Analysis of factors of pulmonary fungal infection in mice in respiratory medicine department based on logistic regression analysis model and Progranulin.

Schmallenberg virus infection suspected in a calf born to an imported heifer.

Objective To explore the outcome of invasive fungal infection in kidney transplantation and the influencing factors.Methods The clinical data of 83 cases of invasive fungal infection after kidney transplantation in our center since Jan.1994 to May 2008 were retrospectively analyzed.The fatal rate of invasive fungal infection and the death reasons were observed.The effects of different fungal types,infection position,accompanied virus and bacteria infections,the number of risk factors,different anti-fungal drugs and initial time of therapy on the fatal rate were investigated.Results The total fatal rate was 39.8%.The primary reasons for deaths were severe pulmonary infection and pulmonary dysfunction.Non-candida fungal infection,pulmonary infection,accompanied virus and bacterial infection,the number of risk factors no less than 3,and initial anti-fungal therapy 3 days after suspected diagnosis of invasive fungal infection could significantly increase the fatal rate(P<0.05).Compared with fluconazole,the administration of intraconazole,voriconazole,and echinocandin could significantly reduce the ratal rate(P<0.05).Echinocandin had the best outcome.Conclusion Early diagnosis of invasive fungal infection,and administration of anti-fungal drugs promptly may improve the outcome of invasive fungal infection after kidney transplantation. Key words: Kidney transplantation; Invasive; Fungal infection; Outcome

Antifungal therapy in 'bone marrow failure'.

To evaluate the diagnostic and prognostic value of the serum procalcitonin (PCT) level in the non-acquired immune deficiency syndrome (AIDS) immunocompromised critically ill patients suspected to have infection. A retrospective study was conducted in the non-AIDS immunocompromised patients who were admitted to Department of Critical Care Medicine of Xiangya Hospital, Central South University during January 2011 to December 2014. Demographic characteristics, underlying disease, acute physiology and chronic health evaluation II (APACHEII) score at admission, and clinical records including baseline and peak levels of temperature, white blood count (WBC), PCT, and survival rate within 28 days, infection focus, infectious agents (bacterial, fungi or mixed infection), and the severity of infection (sepsis, severe sepsis, or septic shock) were recorded. Receiver operating characteristic (ROC) curve was plotted, and the diagnostic and protective value of above parameters was evaluated. A total of 98 patients (43 male and 55 female) were enrolled in the study with a median age of 44 (28, 52) years old and a median APACHEII score of 17 (11, 20); 47 with malignant hematological tumor, 45 with autoimmune diseases, and 6 post solid organ transplantation. Among them 53 patients (54.1%) died within 28 days. Twenty-seven patients were diagnosed as systemic inflammatory response syndrome (SIRS) without infection. Among 71 patients with infection, 45 were diagnosed as bacterial infection, 10 with fungal infection, and 16 with mixed infection. Sepsis was diagnosed in 7 patients, severe sepsis in 32 patients, and septic shock in 32 patients. (1) There was no statistical significance in the baseline and peak levels of PCT and WBC, or baseline level of temperature between the groups of SIRS patients without infection and infected patients. The peak level of temperature was significantly higher in the patients with infection as compared with that of the SIRS without infection patients [centigrade: 39.4 (38.9, 40.0) vs. 38.8 (37.8, 39.2), Z=-3.268, P=0.001]. It was showed by subgroup analysis that in patients with hematological malignant disease or autoimmune diseases, higher level of body temperature was found in infection group compared with non-infection SIRS group [centigrade: 39.5 (39.0, 40.0) vs. 39.0 (38.4, 39.4), Z=-2.349, P=0.019; 39.0 (38.4, 39.5) vs. 38.2 (37.0, 38.9), Z=-2.221, P=0.026]. (2) The baseline level of PCT (μg/L) were 0.54 (0.20, 4.19), 2.78 (0.50, 9.54), 1.00 (0.45, 6.89), and 0.22 (0.07, 1.86) in non-infection SIRS patients or the patients with bacterial, fungal, and mixed infection, respectively. The peak level of PCT (μg/L) were 4.19 (1.95, 13.42), 12.37 (3.82, 45.89), 1.82 (0.49, 17.86), and 5.14 (2.66, 12.62), respectively, in each subgroup. When the comparison was conducted among the patients with different infectious agent, the baseline level of PCT in patients with bacterial infection was significantly higher than that in SIRS patients without infection (P=0.026) and mixed infection patients (P=0.001), and the peak level of PCT was significantly higher than that in the SIRS patients without infection (P=0.009) and the patients with fungal infection (P=0.016). ROC curve showed that the higher value was found in the baseline and peak levels of PCT for diagnosis of septic shock in all patients [ area under ROC curve (AUC) of baseline level=0.681±0.054, P=0.001; AUC of peak level=0.690±0.054, P=0.002], and the same value was also found in the baseline and peak levels of PCT for diagnosis of bacterial infection in the patients with malignant hematological tumor (AUC of baseline level=0.687±0.080, P=0.008; AUC of peak level=0.697±0.079, P=0.021). (3) The peak level of PCT (μg/L) were 4.05 (0.53, 31.22), 5.78 (2.14, 16.68), and 11.64 (2.94, 58.14) in subgroup of patients with sepsis, severe sepsis and septic shock, respectively, and they showed no statistical significance among subgroups (P>0.05). A high serum level of peak PCT strongly indicated the presence of septic shock (AUC=0.646±0.060, P=0.019), especially in the subgroup of patients with systemic autoimmune disease (AUC=0.689±0.081, P=0.035). (4) The peak level of PCT (μg/L) in the APACHEII>18 group (38 cases) was significantly higher than that of APACHEII≤18 group [ 60 cases, PCT (μg/L): 11.64 (3.36, 39.39) vs. 4.42 (1.32, 14.70), P=0.016]; there was a certain correlation between the peak level of PCT and the severity of the disease. (5) The peak level of PCT in death group was significantly higher than that of the survival group [μg/L: 9.07 (3.05, 33.09) vs. 4.19 (1.26, 14.61), P=0.043]. ROC curve showed that the peak level of PCT might be valuable in predicting the prognosis in immunocompromised patients (AUC=0.619±0.057, P=0.043). The serum level of PCT is found to be a reliable marker for the diagnosis of bacterial infection in immunocompromised critical patients, especially in those with hematologic malignancy. Additionally, PCT provides a useful tool for evaluating the severity of infection and the prognosis of critically ill patients.

Infections Are a Major Cause of Prolongation of Hospital Stay in Hematopoietic Stem Cell Transplants in Tropical, Developing Countries: Profile of a Transplant Center in North India

Procalcitonin: a new marker for diagnosis of acute rejection and bacterial infection in patients after heart and lung transplantation

ABSTRACTMetagenomic next-generation sequencing (mNGS) has been gradually applied to clinical practice due to its unbiased characteristics of pathogen detection. However, its diagnostic performance and clinical value in suspected pulmonary infection need to be evaluated. We systematically reviewed the clinical data of 246 patients with suspected pulmonary infection from 4 medical institutions between January 2019 and September 2021. The diagnostic performances of mNGS and conventional testing (CT) were systematically analyzed based on bronchoalveolar lavage fluid (BALF). The impacts of mNGS and CT on diagnosis modification and treatment adjustment were also assessed. The positive rates of mNGS and CT were 47.97% and 23.17%, respectively. The sensitivity of mNGS was significantly higher than that of CT (53.49% versus 23.26%, P < 0.01), especially for infections of Mycobacterium tuberculosis (67.86% versus 17.86%, P < 0.01), atypical pathogens (100.00% versus 7.14%, P < 0.01), viruses (92.31% versus 7.69%, P < 0.01), and fungi (78.57% versus 39.29%, P < 0.01). The specificity of mNGS was superior to that of CT, with no statistical difference (90.32% versus 77.42%, P = 0.167). The positive predictive value (PPV) and negative predictive value (NPV) of mNGS were 97.46% and 21.88%, respectively. Diagnosis modification and treatment adjustment were conducted in 32 (32/246, 13.01%) and 23 (23/246, 9.35%) cases, respectively, according to mNGS results only. mNGS significantly improved the diagnosis of suspected pulmonary infection, especially infections of M.tuberculosis, atypical pathogens, viruses, and fungi, and it demonstrated the pathogen distribution of pulmonary infections. It is expected to be a promising microbiological detection and diagnostic method in clinical practice.IMPORTANCE Pulmonary infection is a heterogeneous and complex infectious disease with high morbidity and mortality worldwide. In clinical practice, a considerable proportion of the etiology of pulmonary infection is unclear, microbiological diagnosis being challenging. Metagenomic next-generation sequencing detects all nucleic acids in a sample in an unbiased manner, revealing the microbial community environment and organisms and improving the microbiological detection and diagnosis of infectious diseases in clinical settings. This study is the first multicenter, large-scale retrospective study based entirely on BALF for pathogen detection by mNGS, and it demonstrated the superior performance of mNGS for microbiological detection and diagnosis of suspected pulmonary infection, especially in infections of Mycobacterium tuberculosis, atypical pathogens, viruses, and fungi. It also demonstrated the pathogen distribution of pulmonary infections in the real world, guiding targeted treatment and improving clinical management and prognoses.

Emerging & Rare Fungal Infections in Solid Organ Transplant Recipients

Bedside diagnostics in dermatology: Viral, bacterial, and fungal infections

Leveraging single-cell Raman spectroscopy and single-cell sorting for the detection and identification of yeast infections