Case Of Fatal Pneumonia Research Articles

A Retrospective Case Series Study of Alcaligenes faecalis Pneumonia

Background: The potentially developing human pathogen Alcaligenes faecalis is a gram-negative, nonfermenting bacterium. Treatment of A. faecalis infections is frequently difficult due to increased resistance to many antibiotics, such as β-lactam antibiotics, aminoglycosides, and quinolones. In the literature, A. faecalis pneumonia has never been documented in a case series study. Here, we provide a case series study of patients with A. faecalis pneumonia. Objectives: The aim of this study was to elucidate the clinical characteristics, management strategies, and outcomes of A. faecalis pneumonia patients. Methods: Patients with A. faecalis pneumonia between January 2014 and December 2019 were included in a retrospective investigation. We examined the clinical outcomes of patients with A. faecalis pneumonia, together with the risk factors for pneumonia, prior intravenous antibiotic use within 90 days, respiratory secretion culture results, antibiotic sensitivity test results, and other variables. Results: Observations revealed eight patients with A. faecalis pneumonia, including six males and two females. The mean age of patients was 70 years. These eight patients shared risk factors for pneumonia. Six patients were discharged, and two patients died as a result of A. faecalis pneumonia. Two patients with pneumonia caused by extensively drug-resistant A. faecalis were identified. Conclusions: Rare cases of A. faecalis pneumonia have been documented in the literature. Recently, A. faecalis has developed extensive drug resistance. To treat pneumonia caused by A. faecalis with substantial antibiotic resistance, either polymyxin B or tigecycline is needed. The clinical outcome is typically satisfactory when A. faecalis pneumonia patients receive appropriate antibiotic therapy, but cases of fatal pneumonia have been documented in the literature.

Динамическое наблюдение за возбудителями пневмонии с летальным исходом болезни при СOVID-19 в период пандемии и в постпандемийный период

Objective. To determine the trend of circulating pneumonia pathogens and their levels of antimicrobial resistance (AMR) during the pandemic of new coronavirus infection (NCI) and in the early postpandemic period with terminal episodes. Materials and Methods. The peculiarity of this study is the study material – autopsy specimens (lung tissue) obtained from fatal pneumonia cases. Surveillance was conducted from April 2021 to June 2022 in different phases of the epidemic process of the pandemic with the inclusion of periods of decline and wave rises in incidence (I, II, III periods, a total of 435 samples were studied). Postpandemic IV period was considered from August 2022 to July 2023 – 111 samples were examined. A total of 608 bacterial isolates were isolated during postmortem examination of samples from 546 pneumonia patients. Bacteriological examination was performed by the classical method, identification of pathogens and determination of their sensitivity to germicide was performed using a Vitek 2 Compact 30 bacterial analyzer. Results. During four periods of observation there was a change in the rank position of the leading and other pathogens of pneumonia by the frequency of detection from patients: Klebsiella pneumoniae (42.7; 61.1; 62.9; 40.5%), Acinetobacter baumannii (34.0; 20.4; 12.9; 18.9%), Staphylococcus aureus (9.7; 4.3; 12.9; 20.7%), Escherichia coli (14.6; 1.8; 7.6; 11.7%), Proteus mirabilis (2.9; 0.62; 3.5; 8.1%), Pseudomonas aeruginosa (6.8; 11.1; 6.5; 7.2%), and Stenotrophomonas maltophilia (0.8; 0.6; 1.6; 2.7%). The group Enterobacter aerogenes, Serratia marcescens was isolated in 3.9; 1.9; 4.1; 3.6% of cases. Achromobacter xylosoxidans was detected in periods 2 and 4 (1.2; 0.9%). The proportion of carbapenem-resistant strains (carbR) decreased in the postpandemic period for K. pneumoniae (70.5; 81.8; 76.6; 51.1%) and remained high in all periods of observation for A. baumannii (100; 97.0; 100; 95.2%) and P. aeruginosa (57.1;77.8;72.7;100%). S. aureus was represented mainly by germicide-sensitive variants during all periods of observation. Circulation of E. coli in the postpandemic period was due to BLRS producers (63.8% of cases). All 100% of P. mirabilis strains were resistant to cefepime (IV generation cephalosporin). Thus, during the first year of follow-up in the postpandemic period, there was a decrease in the share of K. pneumoniae in the etiology of fatal pneumonias with simultaneous decrease in the level of carb R-variants against the background of decreased pressure of intensive germicide use. The frequency of isolation of fungi of the genus Candida from autopsy specimens was 8.2%. The species structure was represented by 6 species of fungi: C. albicans – 33.3%, C. glabrata – 28.6%, C. krusei – 14.3%, C. tropicalis – 14.3%, C. lusitaniae – 4.8%, C. kefyr – 4.8%. Antimycotic-resistant strains were detected among the fungi C. glabrata and C. krusei, which is probably the reason for the increased proportion of these species in autopsy specimens. Conclusion. Bacteriological study of autopsy material in fatal pneumonias is a significant direction of microbiological monitoring, which allows obtaining important information about the bacterial flora that accompanies the patient's death, about the change of priority pathogens, the extent of their resistance, and the duration of circulation of resistant forms. Key words: pneumonia, fatal outcome, COVID-19 pandemic, postpandemic period, autopsy specimens, bacterial pathogens, circulation trends

Diagnosis, treatment protocols, and outcomes of liver transplant recipients infected with COVID-19.

Several cases of fatal pneumonia during November 2019 were linked initially to severe acute respiratory syndrome coronavirus 2, which the World Health Organization later designated as coronavirus disease 2019 (COVID-19). The World Health Organization declared COVID-19 as a pandemic on March 11, 2020. In the general population, COVID-19 severity can range from asymptomatic/mild symptoms to seriously ill. Its mortality rate could be as high as 49%. The Centers for Disease Control and Prevention have acknowledged that people with specific underlying medical conditions, among those who need immunosuppression after solid organ transplantation (SOT), are at an increased risk of developing severe illness from COVID-19. Liver transplantation is the second most prevalent SOT globally. Due to their immunosuppressed state, liver transplant (LT) recipients are more susceptible to serious infections. Therefore, comorbidities and prolonged immunosuppression among SOT recipients enhance the likelihood of severe COVID-19. It is crucial to comprehend the clinical picture, immunosuppressive management, prognosis, and prophylaxis of COVID-19 infection because it may pose a danger to transplant recipients. This review described the clinical and laboratory findings of COVID-19 in LT recipients and the risk factors for severe disease in this population group. In the following sections, we discussed current COVID-19 therapy choices, reviewed standard practice in modifying immunosuppressant regimens, and outlined the safety and efficacy of currently licensed drugs for inpatient and outpatient management. Additionally, we explored the clinical outcomes of COVID-19 in LT recipients and mentioned the efficacy and safety of vaccination use.

Lenalidomide-Rituximab or Lenalidomide-Rituximab-Bendamustine in Patients with Relapsed/Refractory Follicular Lymphoma: Priimary Analysis of the Randomized Phase II HOVON110/Rebel Trial

Introduction The R2 regimen (lenalidomide-rituximab) is effective in treatment-naive and relapsed/refractory follicular lymphoma (R/R FL). Combining R2 with bendamustine (R2B) is feasible (Stevens WBC et al., Hemasphere 2020) and hypothesized to deepen remission and prolong event-free survival (EFS) compared to historic controls. We performed a randomized phase II trial of R2 and R2B, aiming at identifying the most promising arm to take forward to a randomized phase III trial. Methods In the multicenter, prospective, randomized, non-comparative phase II part of the HOVON110/ReBeL study (Dutch Clinical Trial Register NTR3028), patients (pts) with FL relapsed after ≤5 prior therapies were randomized 1:1 to R2 (Arm A) or R2B (Arm B). Stratification factors used were FLIPI score (0-2 vs 3-5), number of prior treatments (1 vs 2-5), prior bendamustine use and relapse during rituximab maintenance (RM). Arm A pts received 6 cycles of R2 q28 days (lenalidomide 20 mg day 1-21, rituximab 375 mg/m2 day 1); Arm B pts received 6 cycles of R2B q28 days (lenalidomide 20 mg day 3-21, rituximab 375 mg/m2 day 1, bendamustine 90 mg/m2 day 1,2). In both arms, pts with partial or complete remission (PR/CR) received 2 years of RM treatment, once every three months. Subcutaneous rituximab was allowed. Thrombosis prophylaxis was advised during induction; antimicrobial prophylaxis with valaciclovir and cotrimoxazole was mandatory in arm B. Arms A and B were separately evaluated for efficacy and toxicity. Co-primary endpoints were CT-based CR rate according to Cheson 2007 criteria at end of induction (EOI) and incidence of severe toxicities (ST), defined as grade ≥ 3 non-hematological toxicity, specified grade 4 hematologic toxicity (neutropenia lasting ≥ 7 days despite GCSF, febrile neutropenia, thrombocytopenia) or non-lymphoma related death. An event for event-free survival was defined as induction failure, progression, relapse or death from any cause. PET-CT was performed before and after induction. Central pathology and blinded central PET-CT review (Lugano classification) were performed. Results Between 2014 and 2019, 92 of 150 planned pts were randomized. The trial was stopped early because of slow accrual. Two pts (1 in each arm) were ineligible. Baseline characteristics were comparable between Arms A/B in terms of gender and median age (64/62 years). Most pts had stage III/IV disease (85%/80%), an intermediate/high risk FLIPI score (78%/89%) and had undergone 1 prior treatment (75%/76%; range 1-5). For pts in arms A/B, 80%/76% completed all 6 induction cycles and 41%/43% completed 8 cycles of RM. Main reasons for discontinuation during induction were progressive disease (PD) (n=4 per arm) and toxicity or other reasons in 5/7 patients. Severe toxicity (ST) occurred in 3 pts in arm A (6.8%; 2 fatal pneumonia cases) and in 6 pts in arm B (13.0%; no fatalities), while 43%/66% of pts experienced any grade 3-4 AE (2%/7% grade 4). These comprised mainly skin toxicity, infections and gastrointestinal toxicity. In the R2B arm, 1 pt had Pneumocystis carinii pneumonia during RM. Based on intention to treat (ITT) and local CT assessment (efficacy co-primary endpoint), 16% of R2 and 22% of R2B treated pts achieved a CR at EOI; the overall response rate (ORR) was 70% and 72%, respectively. The complete metabolic remission rate (CMR) by central PET-CT review at EOI was 48% and 54%. At a median follow-up of 48 months (mo), EFS was 39% and 61%; median EFS was 24.6 mo and not reached (NR). Importantly, median time to next treatment (TTnT) was 9.2 mo and NR. There were 7 second primary malignancies (SPM) in 5 pts in Arm A) and 5 SPM in 4 pts in Arm B). Overall survival was excellent in both arms with 72% and 91% of pts alive at 48 months. Causes of death during the study were progression of FL (n=8) and toxicity (n=3) in Arm A; FL (n=3), toxicity (n=1) and suicide (n=1) in Arm B. Conclusions This randomized non-comparative phase II trial of R2 and R2B in R/R FL patients showed high CT-based OR rates and PET-CT CMR rates, but low CT-based CR rates for both treatments. At a median FU of 48 months, 39% of R2 treated patients and 61% of R2B treated patients were still alive and in remission; this compares favorably with historic real world controls (Batlevi et al, Blood Cancer J 2020). Both regimens were associated with less severe toxicity than expected (pre-set acceptability threshold of 20% ST), supporting further investigation of R2 combinations in randomized phase III trials. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

New onset refractory status epilepticus after BNT162b2 nCoV-19

Coronavirus is a pathogen that caused fatal pneumonia cases in Wuhan province of China in December 2019 [1]. It was declared as a pandemic in March 2020 by the World Health Organization [2]. The disease is a severe acute respiratory syndrome with multi-organ involvement, including the cardiovascular system, musculoskeletal system, gastrointestinal and neurological system. Neurological manifestations may be common in COVID-19 patients [3]. Among these, several autoimmunity-affecting syndromes that may result in encephalitis and new-onset refractory status epilepticus (NORSE) have been described. New-onset refractory status epilepticus (NORSE) is an uncommon clinical entity with a mortality rate of 16-27% in adults and significant long-term neurological sequelae. Approximately 50% of patients with NORSE have an unknown aetiology. There is a lack of consensus regarding the best treatment options available for managing patients with NORSE. However, immediate cessation of seizure activity, early institution of continuous infusion of anaesthetic agents, and immunotherapies can play an important role in reducing morbidity and mortality in NORSE.

Concurrent pigeon paramyxovirus-1 and Acinetobacter baumannii infection in a fatal case of pneumonia

ABSTRACT Pigeon paramyxovirus type 1 (PPMV-1), an antigenic variant of avian paramyxovirus type 1 (APMV-1), mainly infects pigeons. PPMV-1 genotype VI is the dominant genotype infecting pigeons in China. Human infection of avian paramyxovirus was rarely reported, and usually developed mild symptoms, such as conjunctivitis. We detected PPMV-1 in the lower respiratory sample from a fatal case with severe pneumonia; this patient aged 64 years presented cough, fever, and haemoptysis for 8 days and was admitted to hospital on Dec 26, 2020. He developed acute respiratory distress syndrome and sepsis in the following days and died of multiple organ failure on Jan 7, 2021. Sputum and blood culture reported multidrug-resistant Acinetobacter baumannii (ABA) for samples collected on days 22 and 19 post-illness, respectively. However, clinical metagenomic sequencing further reported PPMV-1 besides ABA in the bronchoalveolar lavage fluid. The PPMV-1 genome showed 99.21% identity with a Chinese strain and belonged to VI genotype by BLAST analysis. Multiple basic amino acids were observed at the cleavage site of F protein (113RKKRF117), which indicated high virulence of this PPMV-1 strain to poultry. The patient had close contact with pigeons before his illness, and PPMV-1 nucleic acid was detected from the pigeon feather. PPMV antibody was also detected in the patient serum 20 days after illness. In conclusion, concurrent PPMV-1 genotype VI.2.1.1.2.2 and ABA infection were identified in a fatal pneumonia case, and cross-species transmission of PPMV-1 may occur between infected pigeons and the human being.

Fatal pneumonia caused by extraintestinal pathogenic Escherichia coli in a young dog

This paper describes a fatal case of pneumonia in a 14-day-old dog caused by extraintestinal pathogenic Escherichia coli (ExPEC). The necropsy showed that almost all of left lobes of the lungs had dark-red consolidation. A histopathology examination revealed moderate acute fibrino-hemorrhagic necrotizing pneumonia with intralesional bacterial colonies. Non-suppurative epicarditis, congestion in the liver, and necrosis in the white pulp of the spleen also were found. E. coli with cytotoxic necrotizing factor 1 and α-hemolysin was isolated from the lung. This case was confirmed to have fatal pneumonia caused by ExPEC that led to a systemic infection.

Fatal Calf Pneumonia Outbreaks in Italian Dairy Herds Involving Mycoplasma bovis and Other Agents of BRD Complex.

Mycoplasma bovis is increasingly recognized worldwide as an important cause of disease with major welfare and production impairments on cattle rearing. Although it was detected in veal calves and beef cattle, little is known on the infection impact and on its temporal morbidity pattern in Italian dairy herds. Thus, this study aimed to investigate the involvement of M. bovis on fatal calf pneumonia outbreaks that occurred during 2009–2019 in 64 Italian dairy farms. Furthermore, a deeper diagnostic workup of concurrent infection with other viral and bacterial respiratory pathogens was assessed. Out of the investigated fatal pneumonia cases, M. bovis was frequently detected (animal prevalence, 16.16%; 95%CI, 11.82–21.33; herd prevalence, 26.56; 95%CI, 16.29–39.08) either as the single agent of the disease in more than half of the positive samples (20/37) or in concurrent infections with Histophilus somni (9/37, 24.3%), Mannheimia haemolytica (6/37, 16.621%), Trueperella pyogenes (1/37, 2.70%), Pasteurella multocida (1/37, 2.70%), bovine respiratory syncytial virus (5/37, 13.51%), and bovine viral diarrhea virus (2/37, 5.55%). Based on time-series analysis, M. bovis was recorded in the area since 2009 with outbreaks displaying a clear morbidity seasonal pattern with peaks in April (43.21%) and in September (13.51%). This might be due to the stressing conditions during spring and late summer periods. Results of this study highlight that M. bovis infection warrants consideration, and control measures are needed given its involvement in lethal pneumonia outbreaks in dairy herds from an extended area.

SARS-CoV-2 and Coronavirus Disease 2019: What We Know So Far.

In December 2019, a cluster of fatal pneumonia cases presented in Wuhan, China. They were caused by a previously unknown coronavirus. All patients had been associated with the Wuhan Wholefood market, where seafood and live animals are sold. The virus spread rapidly and public health authorities in China initiated a containment effort. However, by that time, travelers had carried the virus to many countries, sparking memories of the previous coronavirus epidemics, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), and causing widespread media attention and panic. Based on clinical criteria and available serological and molecular information, the new disease was called coronavirus disease of 2019 (COVID-19), and the novel coronavirus was called SARS Coronavirus-2 (SARS-CoV-2), emphasizing its close relationship to the 2002 SARS virus (SARS-CoV). The scientific community raced to uncover the origin of the virus, understand the pathogenesis of the disease, develop treatment options, define the risk factors, and work on vaccine development. Here we present a summary of current knowledge regarding the novel coronavirus and the disease it causes.

An African pygmy hedgehog adenovirus 1 (AhAdV-1) outbreak in an African pygmy hedgehog (Atelerix albiventris) colony in Japan

An African pygmy hedgehog adenovirus 1 (AhAdV-1) outbreak in a colony of 24 African pygmy hedgehogs (APHs) with a case of fatal pneumonia occurred in Japan. Thirteen out of a colony of 15 APHs with respiratory symptoms were diagnosed with AhAdV-1 infection based on the detection of AhAdV-1 genome in throat/nasal swabs and further one APH was diagnosed on isolation of the virus. Five infected APHs died during the outbreak and AhAdV-1 caused severe pneumonia and death in one case. After the outbreak, persistent AhAdV-1 infection was suggested in one surviving APH. AhAdV-1 is a novel adenovirus and is suspected to be an emerging pathogen.

Microbiology of Aspiration Pneumonia

The number of patients with pneumonia has been increasing as the population ages, and most fatal pneumonia cases are the elderly with aspiration pneumonia. Although aspiration pneumonia leads to poor short- and long-term prognosis, there have been no practical ways to diagnose it precisely. Persistent subclinical aspiration without any subjective symptoms is problematic in clinical practice in patients with aspiration pneumonia, and physicians can only use aspiration risks such as brain infarction to diagnose aspiration pneumonia. Anaerobes have been believed to be major causative pathogens in aspiration pneumonia, based on data from the 1970's. In relation to these data, Marik insisted that there is a possible overestimation of anaerobes because 1) the sampling of microbiologic specimens was in the late phase in the course of the illness, especially frequently after developing complications such as abscesses, necrotizing pneumonia, or empyema thoracis; 2) the organisms recovered by percutaneous transtracheal aspiration (PTA) sampling could have been contaminated by the aspiration of oropharyngeal flora during the PTA procedure or colonized in the trachea; and 3) many of the patients had chronic alcoholism or were under general anesthesia. In addition, 4) oral care was not common in the 1970s, and 5) the patients in these reports were relatively young. Molecular biological approaches using the 16S ribosomal RNA (rRNA) gene have recently been used, and have enabled us to detect more exact pathogens compared to conventional bacterial culture. Using the method with the detection of the 16S rRNA gene, we evaluated the bacterial phylotypes in bronchoalveolar lavage fluid in patients with aspiration pneumonia and found that oral streptococci were the most detected phylotypes (31.0%), while anaerobes were only 6.0%. Our results suggest that oral streptococci are important, and anaerobes may have been overestimated as causative pathogens in patients with aspiration pneumonia.

Investigation of an outbreak caused by antibiotic-susceptible Klebsiella oxytoca in a neonatal intensive care unit in Norway.

Klebsiella spp. have been stated to be the most frequent cause of neonatal intensive care unit (NICU) outbreaks. We report an outbreak of Klebsiella oxytoca in a NICU at a tertiary care hospital in Norway between April 2016 and April 2017. This study describes the outbreak, infection control measures undertaken and the molecular methods developed. The outbreak prompted detailed epidemiological and microbial investigations, where whole-genome sequencing (WGS) was particularly useful for both genotyping and development of two new K.oxytoca-specific real-time PCR assays. Routine screening of patients, as well as sampling from numerous environmental sites, was performed during the outbreak. A bundle of infection control measures was instigated to control the outbreak, among them strict cohort isolation. Five neonates had symptomatic infection, and 17 were found to be asymptomatically colonised. Infections varied in severity from conjunctivitis to a fatal case of pneumonia. A source of the outbreak could not be determined. This report describes K.oxytoca as a significant pathogen in a NICU outbreak setting and highlights the importance of developing appropriate microbiological screening methods and implementing strict infection control measures to control the outbreak in a setting where the source could not be identified.

Invasive pneumococcal disease caused by mucoid serotype 3 Streptococcus pneumoniae: a case report and literature review

BackgroundAmong the different serotypes of Streptococcus pneumoniae, serotype 3 has received global attention. We report the fatal case of a 76-year-old Japanese man who had an invasive pneumococcal disease associated with pneumonia caused by serotype 3 S. pneumoniae.Case presentationThe patient had a history of hypertension, laryngeal cancer, chronic obstructive pulmonary disease, and type 2 diabetes mellitus. Following a cerebral arteriovenous malformation hemorrhage, he underwent surgery to remove the hematoma and began rehabilitation. On day 66 of hospitalization, he suddenly developed a fever, and coarse crackles and wheezes were heard in his right lung. A diagnosis of hospital-acquired aspiration pneumonia was made, and initial treatment with piperacillin/tazobactam was started. Teicoplanin was added after S. pneumoniae was isolated from the blood culture, however, the patient died 5 days later. The S. pneumoniae detected in the sputum smear was serotype 3, showed mucoid colonies and susceptibility to penicillins, cephalosporins, carbapenems, and levofloxacin, but resistance to erythromycin.ConclusionWe experienced a fatal case of pneumonia caused by mucoid serotype 3 S. pneumoniae with a thick capsule. Serotype 3-associated pneumonia may develop a wider pulmonary infiltrative shadow, a prolonged therapeutic or hospitalization course, and a poor outcome. Careful observation and intervention are required, and the use of additional antibiotics or intravenous immunoglobulins should be considered in such cases. Pneumococcal immunization is also an important public health measure to minimize the development of severe infections caused by serotype 3 strains.

Fatal pneumonia cases caused by human adenovirus 55 in immunocompetent adults

Background: Adenovirus is a frequent cause of mild self-limiting upper respiratory tract infection, gastroenteritis, and conjunctivitis. Severe or fatal infection mostly occurs in newborn, elderly or immunocompromised persons. Methods: Fatal adenovirus pneumonia in three immunocompetent adults was identified. The clinical data and virological findings were reported from patients. Additional review of recently recorded fatal patients with adenovirus infection was carried out. Results: The patients presented with sudden onset respiratory distress that progressed rapidly to respiratory failure and death. Human adenovirus (HAdV)-55 was detected in both nasopharyngeal aspirates and serum samples in all three cases, and moreover detected in lung, liver, and kidney in one case. In another case, remarkably elevated aspartate aminotransferase, alanine transaminase, and lactate dehydrogenase were identified. Three HAdV-55 strains were isolated and genome sequencing revealed a high similarity with other strains from mild infection. Conclusions: Fatal infection with HAdv-55 might occur in otherwise healthy adults. Diagnosis of adenovirus infection should be considered in patients with severe pneumonia yielding negative bacterial culture and presenting no response to antibiotic therapy.

Finished Genome Sequence of Bacillus cereus Strain 03BB87, a Clinical Isolate with B.anthracis Virulence Genes.

Bacillus cereus strain 03BB87, a blood culture isolate, originated in a 56-year-old male muller operator with a fatal case of pneumonia in 2003. Here we present the finished genome sequence of that pathogen, including a 5.46-Mb chromosome and two plasmids (209 and 52 Kb, respectively).

Molecular Characterization of Staphylococcus aureus and Influenza Virus Coinfections in Patients with Fatal Pneumonia

Molecular techniques were used to characterize genetic features of Staphylococcus aureus in 66 fatal cases of pneumonia caused by S. aureus and influenza A or B viruses. Nucleic acids were extracted from formalin-fixed, paraffin-embedded tissues. The majority of cases revealed genetic markers for Panton-Valentine leukocidin, mecA, and spa type t008.

Fatal pneumonia caused by Penicillium digitatum: a case report

BackgroundPenicillium species are among the most common fungi present in the environment and are usually considered non-pathogenic to humans. However, in immunocompromised hosts they can be virulent pathogens and can cause death. Penicillium digitatum is a plant pathogen that commonly causes a postharvest fungal disease of citrus called green mould; it very rarely causes systemic mycosis in humans. Here, we report a case of fatal pneumonia due to P. digitatum infection, as confirmed by repeated examination of cultured sputum.Case presentationA cavity was found in the left upper lung on routine chest X-ray in a 78-year-old undernourished male who had been diagnosed at age 66 with bronchial asthma and pulmonary emphysema. No increased sputum production was present. The presence of antigen-specific precipitating antibodies to Aspergillus flavus and P. digitatum was confirmed in the patient’s serum and also later pleural fluid by using Ouchterlony double immunodiffusion testing with A. flavus and P. digitatum antigens. The patient was treated over a period of months with itraconazole, micafungin, voriconazole, amphotericin B, and antibacterials. However, the cavity enlarged, the pleural effusion increased, and the patient began producing purulent sputum. He died from progressive renal failure. From sputum culture only one fungus was isolated repeatedly on potato-dextrose agar in large quantities. This fungus was confirmed to be P. digitatum by molecular identification. Partial sequences of the beta-tubulin gene were determined by using the primers Bt2a and Bt2b for PCR amplification and sequencing and underwent a BLAST search at the National Centre for Biotechnology Information, these results confirmed that the isolated fungus was P. digitatum.ConclusionTo our knowledge, this is the first report of pulmonary infection with P. digitatum. Our patient had pulmonary emphysema and was elderly, and undernourished. These factors might have facilitated the infection. In his case, antimycotics were ineffective in treating the lung involvement. Although human infection with P. digitatum is considered rare, it appears that this organism can be very virulent and resistant to antimycotics.

The New Age of Virus Discovery: Genomic Analysis of a Novel Human Betacoronavirus Isolated from a Fatal Case of Pneumonia

ABSTRACTA new human betacoronavirus in lineage c, tentatively called HCoV-EMC, was isolated from a patient from the Kingdom of Saudi Arabia who died from acute severe pneumonia and renal failure. The viral RNA has been detected in eight additional cases. Sequencing and bioinformatic analysis of the viral genomic RNA showed that it is a novel virus not previously detected in any other species and that its closest relatives are two Asian bat coronaviruses. HCoV-EMC may represent a sporadic spillover to humans from an unknown animal reservoir. In a recent article, van Boheemen et al. demonstrated how state-of-the-art sequencing technology and bioinformatic analysis can quickly provide critical insight into the viral genome sequence, phylogeny, replication strategy, and potential drug and vaccine targets and generate tools to evaluate the possible epidemic risk associated with this novel human virus.

The first case of fatal pneumonia caused by Panton–Valentine leukocidin-producing Staphylococcus aureus in an infant in the Czech Republic

Panton-Valentine leukocidin-producing strains of Staphylococcus aureus can cause severe skin and soft tissue infections and necrotizing pneumonia with a high mortality rate. This is a report on the first case of fatal pneumonia with mediastinitis in an infant in the Czech Republic. The causative agent was a methicillin-susceptible S. aureus strain with pronounced production of the PVL toxin and hyperproduction of enterotoxin A.

Pneumopathie fulminante au cours de la varicelle chez une fillette de 16 mois immunocompétente

Varicella is a cosmopolitan communicable disease caused by varicella-zoster virus (VZV) characterized by papulovesicular rash and fever. Management of fever and pruritus and prevention of bacterial infection are the main aspects of treatment. Severe complications and death may occur in pregnancy, in newborns, in adults, and in immunocompromised children. Contrary to immunocompetent adults in whom pneumonia occurs in 50% of cases during varicella, this complication in children is rare. We report a fatal case of pneumonia with severe hypoxemia during varicella in an immunocompetent 16-month-old child. Based on a literature review, we discuss the main aspects of diagnosis, treatment, and prognosis of varicella. Active immunization of children after 12 months of age is the primary prevention of varicella.