Resolution Of Radiographic Findings Research Articles

ACTINOMYCOSIS

SESSION TITLE: Chest Infections 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Actinomycosis is a rarely encountered infection and technically difficult to culture, hence may pose a challenge for the clinician. Awareness regarding this uncommon infection, when dealing with susceptible patients, can lead to early diagnosis and optimal treatment. CASE PRESENTATION: 37 M with history of chronic alcohol abuse, presented complaining of hemoptysis, SOB, subjective fever and generalized myalgias for 2 weeks. PE revealed tachypnea, fever and left lung crackles. Labs showed acute hypoxic respiratory failure and lactate elevation. CT revealed 9 x 6 cm inflammatory-appearing cavitary lung mass in the left lower lobe most likely representing a lung abscess, along with large left sided loculated pleural effusion. Patient was intubated and empiric antibiotic therapy was started.2 left CT were placed for loculated pleural effusion. Sputum and pleural fluid AFB were negative. Pleural fluid was exudative and revealed Gram positive cocci and Gram positive rods, with identification of sulfur granules which was highly suggestive of Actinomyces. Intrapleural fibrinolytic agents were given with optimal drainage of empyema. Patient was extubated and improved clinically DISCUSSION: Diagnosis of Pulmonary Actinomycosis, solely based on clinical presentation is not possible. Imaging studies commonly show air-space consolidation and/or cavitary or mass-like lesions. Parenchymal disease can also extend to pleural cavity and chest wall. BAL for culture is inappropriate since it may only represent colonization. Acceptable specimen include lung biopsy or pleural fluid. Gold-standard for diagnosing Actinomycosis is growth of the bacteria in culture, but is technically difficult and occurs only in a minority of cases. If the suspicion is high, the clinician should indicate this to the microbiologist to ensure appropriate processing specimen measures. Identification of sulfur granules from pleural fluid is strongly supportive of Actinomycosis and may be enough to lead the clinician into the diagnosis and appropriate management. Carbapenems or combination of a beta-lactam with beta-lactamase inhibitor in the setting of lung abscess, is a proper empiric approach.Therapy should be targeted once Actinomycosis has been diagnosed. Intravenous therapy should be given for 2 to 6 weeks, followed by oral route.Length of the oral antibiotic depends on clinical and radiological response. Resolution of radiographic findings may take several months, with 6 months to 1 yr. of oral antibiotics being recommended. CONCLUSIONS: Actinomycosis should be suspected in patients with history of aspiration or at risk for it and individuals with chronic alcohol abuse. A high clinical index of suspicion could lead to the proper usage of diagnostic tools and facilitate the rare growth of the causative pathogen in culture. Proper diagnosis should guide to targeted treatment and follow up, along with optimal duration of antibiotics. Reference #1: Choi J, Koh WJ, Kim TS, et al. Optimal duration of IV and oral antibiotics in the treatment of thoracic actinomycosis. Chest. 2005 Oct. 128(4):2211-7. Reference #2: De Montpreville VT, Nashashibi N, Dulmet EM. Actinomycosis and other bronchopulmonary infections with bacterial granules. Ann Diagn Pathol. 1999 Apr. 3(2):67-74. Reference #3: Kim TS, Han J, Koh WJ, et al. Thoracic Actinomycosis: CT Features with Histopathologic Correlation. AJR Am J Roentgenol. 2006 Jan. 186(1):225-31. DISCLOSURES: No relevant relationships by Jonathan Arnedo, source=Web Response No relevant relationships by Yesika Garcia, source=Web Response No relevant relationships by Seyedmohammad Pourshahid, source=Web Response No relevant relationships by Theo Trandafirescu, source=Web Response

Unusual Presentation of Sand Aspiration in a 14-mo-Old Child

Accidental sand aspiration is an unusual but potentially life-threatening condition in children. Sand aspiration often occurs in cases of near drowning and accidental burial in sand. The authors report a case of accidental sand aspiration in a 14-mo-old girl while she was playing with sand. Though child was symptomatic and chest radiograph was showing obstructive emphysema initially, there was spontaneous resolution of radiographic findings and clinical condition within 48 h. Child was treated conservatively and was discharged. Follow up examination after 2 mo revealed persistent wheeze but no respiratory distress. Computed tomography (CT) of thorax was done which revealed a small sand particle measuring 0.2 × 0.4 × 0.3 cm in left main bronchus and was removed via rigid bronchoscopy. This report underscores the importance of performing bronchoscopy in all cases of suspected foreign body aspirations.

Combined treatment for child refractory Mycoplasma pneumoniae pneumonia with ciprofloxacin and glucocorticoid

To evaluate the efficacy of combined treatment of ciprofloxacin and glucocorticoid for child refractory Mycoplasma pneumoniae (M. pneumoniae) pneumonia. Clinical and laboratory characteristics of six pediatric refractory M. pneumoniae pneumonia cases treated with ciprofloxacin and glucocorticoids were reported. Five cases complicated with pleural effusion. The average febrile period prior to admission was 8.5 ± 2.0 days, the average total febrile period was 14.6 ± 7.6 days, and the average febrile period after treatment was 3.3 ± 3.0 days. The average time in hospital for patients was 23.6 ± 4.8 days. The initial mean WBC count was 10,100 ± 2,400/mm(3) . The erythrocyte sedimentation rate (ESR), lactate dehydrogenase (LDH), and C-reactive protein (CRP) in all cases were elevated during the course of illness. After combined therapy, all children clinically improved, with resolution of radiographic findings and normal laboratory items. We analyzed the 23S rRNA gene in four nasopharyngeal secretions, and found mutations in A2063G of domain V in three cases, and mutation in A2064G in the other case. Combined treatment of ciprofloxacin and glucocorticoids can significantly ameliorate child refractory M. pneumoniae pneumonia further comparative study is needed to well evaluate the treatment efficacy.

Near-Drowning: Clinical Course of Lung Injury in Adults

Although anoxic encephalopathy is the most dreaded consequence of submersion accidents, respiratory involvement is also very common in these patients. Nevertheless, few data are available about the clinical course and resolution of lung injury in adult victims of near-drowning. Our goal was to study the clinical manifestations of near-drowning and the course of respiratory involvement in a retrospective cohort of adult, mostly elderly patients. Our study included adult patients who were hospitalized after near-drowning in seawater over an 8-year period. Forty-three patients (26 female, 17 male), with an age range of 18-88 years old, were studied. Most (79%) of the patients were elderly (>60 years). In the Emergency Department two patients were comatose and required intubation. Another patient was intubated within the first 24 h because of ARDS. At presentation, all patients but two had a PaO(2)/FiO(2) < 300, while ARDS was present in 17 and acute lung injury in 15 cases. The nine remaining hypoxemic patients had either focal infiltrates or a negative chest X-ray. Superimposed pneumonia was observed in four patients and resulted in a protracted hospital stay. Improvement of lung injury was rapid in most cases: by day 4 resolution of hypoxemia was observed in 33/43 (76.7%) of the cases and resolution of radiographic findings in 66.6%. Duration of hospitalization varied from 2 to 14 days (mean = 5.2 +/- 0.5 days). One patient with coma died due to ventilator-associated pneumonia (mortality = 2.3%). Respiratory manifestations of near-drowning in adult immersion victims are often severe. Nevertheless, in noncomatose patients at least, intubation can often be avoided and quick improvement is the rule while a good outcome is usually expected even in elderly patients.

Radiographic resolution of lymphocytic interstitial pneumonitis (LIP) in children with human immunodeficiency virus (HIV): not a sign of clinical deterioration.

The literature and anecdotal evidence associate the resolution of radiographic findings of lymphocytic interstitial pneumonitis (LIP) with a decline in immune and clinical status of human immunodeficiency virus (HIV) infected children. As our clinical impression was the opposite, we sought to elucidate this contradiction. Of 52 pediatric patients infected with the HIV currently being followed at our institution, 20 (38.5%) carried the diagnosis of LIP and 13 (65%) of these have had complete resolution of radiographic findings of LIP. We retrospectively reviewed the chest radiographs, CD4 counts, and clinical history of these 13 patients. Of the 13 patients who had resolution of radiographic findings, 11 (84.6%) had no significant change in CD4 count at the time of resolution and remained clinically stable during a mean follow-up period of 32 months. Two patients (15.3%) developed severe CD4 lymphocytopenia at the time of resolution of LIP, but clinically remained stable. None of these 13 patients had a recurrence of LIP, even with subsequent increases in CD4 count. We suggest that in contradiction to previously published data, resolution of LIP on chest radiographs is not an indicator for poor prognosis for the HIV-infected pediatric patient.