Diagnosis Of Infectious Pneumonia Research Articles

Application of metagenomic next-generation sequencing technology for difficult lung lesions in patients with haematological diseases.

BackgroundThe purpose of this study was to evaluate the diagnostic value of combined virtual bronchoscopic navigation (Direct Path), radial endobronchial ultrasound with guide-sheath (EBUS), ultrathin bronchoscopy, rapid on-site evaluation of cytology (ROSE), and metagenomic next-generation sequencing (mNGS) for difficult lung lesions in patients with haematological diseases.MethodsIn this study, lung specimens were obtained from patients with haematological diseases by transbronchial lung biopsy (TBLB) and bronchoalveolar lavage (BAL). The specimens were subjected to mNGS for sequencing of pathogenic microorganisms and sent to the laboratory for examination and pathological analysis. Additionally, the clinical data and pathogenic characteristics of the patients were analysed. The sensitivity and specificity of mNGS for sequencing pathogenic microorganisms were compared between TBLB and BAL specimens.ResultsIn this study, the diagnosis of infectious pneumonia mainly included cytomegalovirus pneumonia, Pneumocystis jirovecii pneumonia (PCP), pulmonary aspergillosis, and tuberculosis. Some patients had non-infectious pulmonary complications, and the clinical and therapeutic outcomes were diagnosed as graft-versus-host disease (GVHD), idiopathic pneumonia syndrome (IPS), and delayed pulmonary toxicity syndrome (DPTS). The sensitivity of mNGS for pathogenic microbes in lung tissue is better than that of alveolar lavage fluid, whereas compared with alveolar lavage fluid, its specificity is reduced.ConclusionsThe results of this study indicate that combined virtual bronchoscopic navigation (Direct Path), radial EBUS, ultrathin bronchoscopy, and ROSE of target control specimens reduce the risk of bleeding, and their combination with mNGS has high diagnostic value for difficult lung lesions in patients with haematological diseases, especially in the field of infection diagnosis. TBLB and BAL specimens have respective advantages in specificity and sensitivity for mNGS analysis.

Value of bedside lung ultrasound in the diagnosis of infectious pneumonia in premature infant

Objective To investigate the clinical value of lung ultrasound ( LUS) in the diagnosis of infectious pneumonia in premature infant. Methods 20 premature infants with infective pneumonia were selected and examined by high-frequency ultrasound. The results were compared with chest X-ray data. Pulmonary ultrasound was monitored on the 3rd to 5th, 8th to 10th days of treatment and before discharge. The total number and maximum depth of pulmonary consolidation were calculated and the changes of the above parameters with the progression of pulmonary diseases were compared. Results The LUS imaging of 20 cases showed: A-line disappearance and pulmonary interstitial syndrome (100%), lung consolidation (95%), abnormal pleural lines (55%), interstitial syndrome (100%) and pleural effusion (15%). The X-ray of 20 cases showed: increased lung texture(100%), patchy blurred glass shadow (40%), lung consolidation(40%). The maximum depth of lung consolidation and the total number of lung consolidation involving rib clearance are decreased after therapy. Conclusions LUS is of great value in diagnosis and monitor the progresses of infectious pneumonia in premature infant, and can be used as the preferred diagnostic method in imaging. Key words: Ultrasonography; Infant, premature; Pneumonia

Diagnostic Value of the Thoracic Ultrasonography Compared to Conventional Chest X-Rays in Pneumonia for Children between 0 to 15 Years: Case Study in Two Hospitals in Yaoundé

Introduction: The diagnosis of pneumonia is usually made based on clinical manifestations and chest X-ray. The use of ultrasound in detecting pulmonary diseases in general, and especially consolidation syndrome has been demonstrated. The objective of this study was to determine the accuracy of thoracic ultrasound compared to chest X-ray in the diagnosis of infectious pneumonia in children. Methods: Children between 0 to 15 years were included in our study. The lung ultrasound results obtained were compared with those of the chest X-ray used as the reference. Our data were introduced into the EpiInfo 3.5.4 software and analyzed with the EpiInfo 3.5.4 and IBMSPSS Statistics version 20.0 softwares. Microsoft Office Excel 2016 was used to produce Charts. Continuous quantitative variables were presented. Cohen’s Kappa concordance test was applied with confidence interval of 95%. Results: 52 children were enrolled in the study. In imaging, the dominant sign was consolidation syndrome (75.0%) of cases by chest radiography, and in 78.8% of cases by lung ultrasound (p < 0.05). The chest radiograph was identified pleural effusion in 5 cases whereas lung ultrasound was identified in 6 cases. 3 patients with apparently normal chest X-rays had pulmonary ultrasounds suggestive of pneumonia. The degree of agreement between chest X-ray and lung ultrasound in detecting lesions compatible with pneumonia was satisfactory (kappa: 0.784) and excellent in the detection of pleural effusion (0.898). Conclusion: Our study demonstrated that lung echography is a non-ionizing and reliable tool in the diagnosis of childhood’s pneumonia.

Pathogen screening and prognostic factors in children with severe ARDS of pulmonary origin.

BackgroundAcute respiratory distress syndrome (ARDS) is one of the most lethal diseases encountered in the pediatric intensive care unit (PICU). The etiological pathogens and prognostic factors of severe ARDS of pulmonary origin in children with respiratory virus infections were prospectively investigated.MethodsEnrolled children fulfilled the following criteria: (1) PICU admission; (2) age of 1 month to 16 years; (3) diagnosis of infectious pneumonia and respiratory virus infection; and (4) development of severe ARDS within 72 h after PICU admission. Pathogens were detected in the blood and tracheal lavage fluid using molecular techniques and a conventional culture system. The serum levels of inflammatory mediators on the day of PICU admission were examined.ResultsFifty‐seven patients (32 boys; median age, 9 months) were enrolled. Multiple virus infections, co‐infection with bacteria/fungus, and bacteremia/fungemia were observed in 60%, 49%, and 32% of children, respectively. Adenovirus‐B, measles virus, and cytomegalovirus were detected predominantly in tracheal lavage fluid. There were no statistically significant differences between non‐survivors and survivors regarding the types of pathogen, incidence of multiple virus infection, gender, age, clinical features, and treatment. The serum levels of interferon (IFN)‐γ and the IFN‐γ/interleukin (IL)‐10 ratio were higher in non‐survivors.ConclusionsIFN‐γ upregulation as detected on the day of PICU admission was found to be one of the possible prognostic factors affecting a fatal outcome. These results suggest that modulation of inflammatory responses is critical for the clinical management of children with ARDS.

Pneumonia in Severe Burn Patients

Pneumonia is an important cause of morbidity and mortality in severe burn patients. Risk factors associated with pneumonia are the severity of the thermal injury and the presence of inhalation injury. Most pneumonias are endogenous, that is, infection of the respiratory tract is preceded by colonization of the digestive tract, oropharynx, and/or gut. Strategies to prevent pneumonia are based on strict proper airway management. Selective digestive decontamination may play an important role in the prophylaxis of pneumonia. Severely ill burn patients have a higher incidence of pneumonia than other generally critically ill patients. Because burn trauma and inhalation injury induce a marked systemic inflammatory response syndrome, the diagnosis of infectious pneumonia in these patients is especially difficult. Nevertheless, the same criteria used in other subsets of critically ill patients should be used in burn patients for the diagnosis of pneumonia. Clinicians should be aware of pharmacokinetic alterations when prescribing systemic antibiotics.