Damage To Respiratory Tract Research Articles

Features of severe forms of new coronavirus infection (COVID-19) in children

BACKGROUND: The problem of the complicated course of COVID-19 and deaths in children with severe comorbid pathology is relevant. Severe forms of the disease are often the cause of critical conditions and deaths, including decompensated respiratory failure, acute respiratory distress syndrome, septic shock, cardiac, hepatic, renal insufficiency, coagulation disorders, damage to the central nervous system.
 AIM: The aim is to analyze the features of the course of COVID-19 in children who require mandatory hospitalization in specialized hospitals for background pathology, to identify predictors of the development of severe forms of COVID-19 in order to choose the optimal ways of treating this pathology.
 MATERIALS AND METHODS: Under the supervision of the St. Petersburg State Pediatric Medical University in the department for children with new coronavirus infection COVID-19 with intensive care and intensive care wards in the period 2020–2022 with a confirmed diagnosis of “new coronavirus infection” there were 791 patients aged 0 to 17 years. The diagnosis was made on the basis of clinical and epidemiological data, the results of a comprehensive laboratory and instrumental study. The severity of the disease was determined in accordance with the methodological recommendations of the Ministry of Health of the Russian Federation.
 RESULTS: The severe form of COVID-19 was diagnosed in 34 patients out of 791 (4.3%). Adverse outcomes were 1.4%. In 27 out of 34 children (79.4%), new coronavirus infection occurred against the background of severe comorbid pathology. Pneumonia was diagnosed in 91.2% of cases. 88.2% of patients needed oxygen therapy.
 CONCLUSIONS: Severe forms of COVID-19 in children are characterized by high fever with severe intoxication, respiratory tract damage with a significant volume of lung damage (CT-3 and CT-4) with the development of multiple organ failure. Predictors that require mandatory hospitalization in specialized hospitals for background pathology in severe forms of COVID-19 are: primary immunodeficiency conditions, oncohematological pathology with postcytostatic aplasia of hematopoiesis, severe organic lesions of the central nervous system, epilepsy, protein-energy deficiency of 3–4 degrees, bronchopulmonary dysplasia, atypical emolytic uremic syndrome with acute kidney damage. Comprehensive treatment of such patients should be carried out by a multidisciplinary team in a specialized department with extensive diagnostic and therapeutic capabilities.

Bronquiolitis obliterante posinfecciosa secundaria a adenovirus

Bronchiolitis obliterans is a rare chronic obstructive respiratory disease secondary to damage of the lower respiratory tract causing inflammation and partial or total obliteration of it. There are different causes, being infectious the most frequent in pediatrics, mainly due to adenovirus. We present the case of an 18-month-old male infant with a history of admission to the Pediatric Intensive Care Unit at 8 months of age due to bronchitis secondary to respiratory syncytial virus and adenovirus. After this episode, he presented persistent respiratory distress and pathological pulmonary auscultation. High resolution pulmonary computed tomography showed a mosaic pattern with areas of air trapping and decreased vascular caliber in the affected areas, findings suggestive of bronchiolitis obliterans.

Эндотелиальная дисфункция сосудов как возможный предиктор тяжелого течения COVID-19

Objective. To study the role of the main marker of endothelial dysfunction VEGF-A as a possible predictor of severe COVID-19 formation. Patients and methods. On the basis of the clinic of the Republican Specialized Scientific and Practical Medical Center of Epidemiology, Microbiology, Infectious and Parasitic Diseases (RSSPMCEMIPD) and Samarkand Regional Specialized Medical Center, 210 patients with coronavirus infection were examined during 2020–2022. Patients were divided into 2 groups comparable by main characteristics: I consisted of 98 (47%) patients with a moderate form of COVID-19, II – 112 (53%) with a severe form of the disease. All patients were fully examined at admission to the hospital and at discharge from it. The level of medium molecular peptides (MMP) in blood plasma was determined by the method of N.I.Gabrielyan on spectrophotometer SF-46 in ultraviolet spectrum; the levels of vascular endothelial growth factor (VEGF-A) – in 163 patients – and interleukins 1 and 6 (IL-1, IL-6) in blood serum – by enzyme immunoassay (test systems of Cytokin LLC and Vector-Best JSC). The level of C-reactive protein (CRP) was determined using the immunoenzyme analyzer "MINDRAY MR-96A"; procalcitonin and D-dimer values were determined using an automatic ELISA analyzer mini-VIDAS. The obtained results were processed by methods of descriptive and variation statistics. Differences were considered reliable at (p < 0.05). Results. The clinical picture of COVID-19 complicated by pneumonia was characterized by pronounced symptoms of intoxication, respiratory tract damage, respiratory failure. In group II patients, such comorbidities as ischemic heart disease (23.5 vs. 41.1%), arterial hypertension (9.2 vs. 25.4%), and diabetes mellitus (2.0 vs. 12.5%) were recorded significantly more often. In 119 (56.7%) cases (mostly in the group with severe coronavirus infection), there was a combination of several comorbidities. In 36 (17.1%) patients with elevated blood sugar level before hospitalization for COVID-19 neither clinical nor laboratory signs of diabetes ellitus were present; in group II stable elevated blood sugar level against the background of therapy of the main disease was recorded 2 times more often (23.2 vs. 10.2%, respectively). In the same group, the level of CPR was 1.5 times higher. A significant correlation (p < 0.05) of elevated levels of CRP and D-dimer with the severity of COVID-19 course was established. In 163 patients the mean values of VEGF-A on admission were elevated; in patients from group II this index was significantly (p < 0.01) higher: 303.02 ± 21.47 vs. 390.52 ± 29.05 pg/mL. At discharge, this index increased to 466.56 ± 37.59 pg/mL in group II patients and decreased to 237.60 ± 17.03 pg/mL in group I patients (differences were significant; p < 0.01). In group I, this index returned to normal after 1 month, and in group II, it decreased to 205.05 ± 15.90 pg/mL only 2 months after discharge. A reliable correlation (p < 0.05) of elevated levels of D-dimer, CRP, MMP with high VEGF-A levels, as well as with the severity of the disease and increasing respiratory failure was established. Positive results of bacteriologic study of upper respiratory tract secretions were found in 63 (64.3%) patients of group I and in 78 (69.6%) patients of group II; Staphylococcus aureus predominated in patients from group II (11.1 vs. 38.5%) and Candida spp (85.7 vs. 28.2%) from group I. Conclusion. The relationship between blood levels of VEGF-A and standard inflammatory markers allows us to propose this factor of endothelial dysfunction as a predictor of inflammation and disease progression, as well as to use it to assess the efficacy of therapy. Key words: bacterial pneumonia, novel coronavirus infection, procalcitonin, C-reactive protein, vascular endothelial growth factor, endothelial dysfunction

Энтеровирусные неполиомиелитные инфекции у госпитализированных взрослых Краснодарского края

Objective. Characteristics of non-polio enteroviruses in outpatients in the Krasnodar. Materials and methods. The analysis of the incidence of non-polio enteroviruses in 2006–2022 was carried out in Krasnodar. The clinical course of verified non-polio enteroviruses is characterized based on the materials of a retrospective analysis of the medical stories of 157 outpatients. Results. Non-polio enteroviruses in the Krasnodar are constantly recorded in the form of sporadic morbidity with fluctuations from 0.12 to 11.26 per 100,000 population, mainly in toddlers, more often in the summer and autumn. Enterovirus meningitis prevailed in the clinical forms in the first ten years of follow-up, and in the last seven years – small forms of non-polio enteroviruses. Among adult outpatients with a moderate course of the disease predominate (98.2%), more often in the form of serous meningitis (50.9%) and exanthema of the oral mucosa and extremities (40.1%), less often acute respiratory disease (8,9%). Pathognomonic symptoms are not typical for non-polio enteroviruses. The main clinical signs of non-polio enteroviruses infection in all clinical forms are short-term febrile fever, malaise and weakness, symptoms of upper respiratory tract damage, absolute monocytosis, eosinopenia, lymphopenia, increased levels of C RP, as well as clinical and laboratory signs of serous meningitis in meningeal form and typical exanthem in "exanthem of the oral mucosa and extremities". Laboratory diagnostics should include tests to verify non-polio enteroviruses, as well as differential diagnostic studies to exclude clinically similar diseases that may involve etiotropic treatment with drugs of direct action on pathogens. The lack of approved antiviral drugs and the complexity of diagnosis lead to the inclusion of antimicrobial, broad-spectrum antiviral drugs, pathogenetic and symptomatic therapy in the treatment complex. Key words: non-polio enteroviruses, clinical characteristics, diagnosis, treatment

Raynaud’s Phenomenon as a Manifestation of Vasculitis C – ANCA: Case Report and Literature Review

Raynaud's phenomenon is a vasospastic condition affecting capillaries in the distal region of the extremities. It is divided into primary and secondary and 80-90% of patients are associated with primary or idiopathic disease, while 10-20% are secondary, with multiple etiologies including connective tissue, vascular, hematologic, and endocrinopathic diseases. Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) correspond to a group of necrotizing vasculitides of medium (0.2 to 2.0 mm in diameter) and small blood vessels (arterioles, capillaries, postcapillary venules). Clinically, it is characterized by multisystem involvement, with upper and lower respiratory tract and renal damage standing out for their frequency. The least frequent manifestations are cutaneous, with digital ischemia and gangrene occurring in less than 1% of cases. The diagnosis is based on a detailed clinical history and physical examination in addition to complementary studies including a complete metabolic panel, muscle enzymes, viral panel, thyroid profile and a rheumatologic panel to assess secondary causes of Raynaud's phenomenon. Calcium antagonists are considered the first-line treatment in both etiologies, and phosphodiesterase-5 inhibitors are another alternative. This article presents a case of a patient with Raynaud's phenomenon as an initial clinical manifestation and later presentation of C-ANCA vasculitis.

A clinical case of metastatic ophthalmia against the background of a severe course of new coronavirus infection

The article presents a clinical case of severe bilateral metastatic ophthalmia caused by a bacterial infection against the background of a new coronavirus infection. In a female patient with a new coronavirus infection and viral pneumonia against the background of a septic condition signs of a liver abscess were revealed and a clinic of bilateral endogenous endophthalmitis developed. Despite intensive antibacterial therapy, the clinic of panophthalmitis of the left eye developed, the left eye was eviscerated. The same pathogen Klebsiellae pneumonia was isolated in vitreous body culture of the removed eye, conjunctiva smear and pus exudate from liver abscess. Bilateral metastatic ophthalmia was caused by the presence of an infectious focus in the body (liver abscess) on the background of weakened immunity due to severe septic condition of the patient. In turn, coronary viral infection led to severe respiratory tract damage and development of secondary immunodeficiency. The low effectiveness of intensive antibiotic therapy is associated with this. The rare case of bilateral metastatic ophthalmia described by us is of interest for ophthalmologists in terms of the possibility of such a serious complication caused by the bacterium Klebsiellae pneumonia, combined with liver abscess. At as-association of this pathology with severe coronavirus infection complicates the course, therapy and prognosis of this disease.

Bilateral Staged Ureteral Stenosis Secondary to Wegener s Disease A Case report

Wegener's disease is a rare vasculitis characterized by inflammation of the endometrium of blood vessels. Ureteral stenosis is a rare manifestation of granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis). We report the case of a 38-year-old woman with acute renal failure in which bilateral hydronephrosis due to staged ureteral stenosis was the second manifestation of the disease after necrotico-inflammatory skin lesions. Our patient had high titers of anti-proteinase 3 c-ANCA, but no upper or lower respiratory tract damage was demonstrated. Hydronephrosis and renal function improved rapidly under immunosuppressive therapy with high dose of corticosteroids. We reviewed the literature and found only ten other reported cases of Wegener's granulomatosis and intrinsic ureteral stenosis: in two cases the presenting clinical manifestation was unilateral hydronephrosis and in only three others bilateral hydronephrosis. All of these complications have developed on disease relapse except in one case where the first manifestation of vasculitis is bilateral ureteral stenosis. This case highlights the importance of including ANCA-related vasculitis in the differential diagnosis of unusual cases of unilateral or bilateral ureteral stenosis.

Cutaneous and Respiratory Lesions in Bushfire-Affected Koalas.

In the wake of increasingly frequent bushfires emerging as a threat to wildlife worldwide, koalas have notably been the most rescued species in Australia. However, our understanding of burns and their severity in koalas is limited; hence, this study investigated the histopathological features and depth of burns in koala skin, as well as the presence of smoke-induced respiratory tract damage. In four bushfire-affected koalas that had been euthanised on welfare grounds, skin burns in various body regions were scored based on clinical appearance as superficial, partial thickness, or full thickness. Histological sections of affected regions of skin were assessed as Grades I-IV and showed that furred regions on the ear margins and dorsum were histologically more severe, at Grade III, compared with the clinical score. There was a similar finding for footpad burns, which were the most common body region affected. In the respiratory tract, pulmonary oedema and congestion were evident in all koalas. Overall, the results highlight that cutaneous burn lesions on furred and palmar/plantar surfaces can have higher severity based on the burn depth than is clinically apparent. Therefore, there is a need to consider this when developing treatment plans and establishing prognosis for burnt koalas at triage, as well as that a high likelihood of pulmonary oedema exists.

A difficult to diagnose case of respiratory tract injury in granulomatosis with polyangiitis

Granulomatosis with polyangiitis (GPA, Wegener's granulomatosis) is a rare autoimmune disease, characterized by vasculitis of small and medium-sized vessels, as well as the formation of granulomas and the most frequent involvement of the upper respiratory tract, lungs, kidneys and eyes in the pathological process. In the absence of treatment, the disease progresses rapidly and is fatal. The onset of the disease is possible at any age. Pharmacotherapy is aimed at suppressing the immunopathological reactions underlying the disease in order to achieve complete remission associated with anti-neutrophil cytoplasmic antibodies of systemic vasculitis (ANCA-SV). The article deals with a difficult case for diagnosis of respiratory tract damage in GPA in a 60-year-old woman.

Oxylipin concentration shift in exhaled breath condensate (EBC) of SARS-CoV-2 infected patients

Infection of airway epithelial cells with severe acute respiratory coronavirus 2 (SARS-CoV-2) can lead to severe respiratory tract damage and lung injury with hypoxia. It is challenging to sample the lower airways non-invasively and the capability to identify a highly representative specimen that can be collected in a non-invasive way would provide opportunities to investigate metabolomic consequences of COVID-19 disease. In the present study, we performed a targeted metabolomic approach using liquid chromatography coupled with high resolution chromatography (LC-MS) on exhaled breath condensate (EBC) collected from hospitalized COVID-19 patients (COVID+) and negative controls, both non-hospitalized and hospitalized for other reasons (COVID−). We were able to noninvasively identify and quantify inflammatory oxylipin shifts and dysregulation that may ultimately be used to monitor COVID-19 disease progression or severity and response to therapy. We also expected EBC-based biochemical oxylipin changes associated with COVID-19 host response to infection. The results indicated ten targeted oxylipins showing significative differences between SAR-CoV-2 infected EBC samples and negative control subjects. These compounds were prostaglandins A2 and D2, LXA4, 5-HETE, 12-HETE, 15-HETE, 5-HEPE, 9-HODE, 13-oxoODE and 19(20)-EpDPA, which are associated with specific pathways (i.e. P450, COX, 15-LOX) related to inflammatory and oxidative stress processes. Moreover, all these compounds were up-regulated by COVID+, meaning their concentrations were higher in subjects with SAR-CoV-2 infection. Given that many COVID-19 symptoms are inflammatory in nature, this is interesting insight into the pathophysiology of the disease. Breath monitoring of these and other EBC metabolites presents an interesting opportunity to monitor key indicators of disease progression and severity.

Management of acquired bronchobiliary fistula: A case report

Bronchobiliary fistula (BBF) is an abnormal connection between the bronchial system and biliary tree. It is a rare condition that often manifests as bilioptysis. BBF has several causes; however infectious disease of the liver and lungs, mostly hydatid cysts, is the leading cause of BBF. For a conclusive diagnosis, imaging studies are useful and able to show the fistula tract, as we did by CT scan. The treatment of BBF is still a challenge for surgeons. In children, in the acute fulminating phase, an aggressive and rapid approach is essential to prevent respiratory tract damage. We present a case of a 17-year-old girl, who complained of bilioptysis, chest pain and loss of appetite for about nine months. Her past history revealed that she developed bilioptysis after laparotomy for excision of liver hydatid cyst 10 months ago. For which she underwent conservative and surgical treatment of bilioptysis, which all failed. After investigations, a bronchobiliary fistula was identified. A right thoracotomy was performed. After the release of adhesions and debridement of damaged tissues, the fistula tract was excised. The connection was sealed by a diaphragmatic muscle flap, which was successful in the outcome after 12 months of follow-up. BBF is a condition that requires strong presumptive evidence for diagnosis and a well-planned approach for management. Hence, each surgeon must carefully consider the optimal method for open surgery or conservative therapy after thoroughly evaluating the patient's profile and imaging. In children, a thoracic approach with a diaphragmatic flap is safe, easily available, and can easily divide the lung from the liver since that is its normal function.

Improvement of the scheme of preventive and treatment measures for associated respiratory infections in cats

The aim of the research was to study the etiological structure of associated infectious rhinotracheitis in cats. It has been established that infectious rhinotracheitis is registered among cats in association with infectious diseases of bacterial aetiology.
 Materials and methods. The research was conducted based on a private veterinary clinic in the city of Kharkiv in 2021–2023. A total of 48 cats with signs of respiratory tract damage were examined in the clinic. Samples for laboratory diagnosis were obtained by oropharyngeal swab and transnasal lavage. To confirm the laboratory diagnosis of infectious rhinotracheitis in cats, we used the PCR method (using the Rynovir test system), as well as rapid IXA tests (FHV Ag) manufactured by ASAN PHARM (China) or ZRbio (China). To detect specific antibodies, the method of serological (retrospective) ELISA diagnostics was used using the immunoComb Feline VacciCheck device-free ELISA test system manufactured by Biogal, Israel. Bacteriological studies were carried out according to well-known methods using special nutrient media for the selection and identification of associated bacterial microflora. The sensitivity of selected dominant cultures of bacteria to antibiotics was determined by diffusion in agar using discs containing antibiotics.
 Results. It was investigated that Bordetella bronchiseptica was determined as the dominant pathogen in the bacterial association – 52.0 %. Isolated cultures of Bordetella bronchiseptica were sensitive to cefamycin. The proposed science-based scheme for the treatment of infectious rhinotracheitis in association with feline bordetelliosis ensures high therapeutic efficiency.
 Conclusions. For the treatment of infectious respiratory diseases in cats, it is necessary to carry out individual complex etiotropic, pathogenetic and symptomatic therapy. Homoeopathic therapy relieves the symptoms of the disease, promotes faster recovery, and is an addition to the main methods of treatment. The main specific measure of disease prevention is timely vaccination (inoculation), the effectiveness of which, according to our research, ranges from 71 % to 100 %.

ДИАГНОСТИКА БАКТЕРИАЛЬНЫХ РЕСПИРАТОРНЫХ ИНФЕКЦИЙ У СВИНЕЙ С ПОМОЩЬЮ ПОЛИМЕРАЗНОЙ ЦЕПНОЙ РЕАКЦИЕЙ С ГИБРИДИЗАЦИОННО-ФЛУОРЕСЦЕНТНОЙ ДЕТЕКЦИЕЙ В РЕЖИМЕ РЕАЛЬНОГО ВРЕМЕНИ

Indications for laboratory testing for the purpose of etiological diagnosis of bacterial respiratory infections were the presence in pigs of an acute disease with local symptoms of respiratory tract damage. The aim of the study was to use PCR with hybridization-fluorescence detection in real time to detect bacterial pathogens of respiratory infections of pigs Mycoplasma hyopneumoniae, Streptococcus pneumoniae, Pasterella multocida, Staphylococcus aureus. We used PCR kits "Vet-factor" (Russia) and LLC NPF "Litech" (Russia). The materials for laboratory studies were: blood, flushes from the nasal mucosa, pieces of parenchymal organs, lymph nodes, trachea and tonsils from sows and corpses of piglets aged from one to four months. The following equipment was used to set up the reactions: The Real-time CFX Connect amplifier (Bio-Rad Laboratories, USA). The results of the PCR analysis were taken into account by the presence or absence of the intersection of the fluorescence curve with the threshold line set at the appropriate level (which corresponds to the presence or absence of the threshold cycle value "Ct" for the sample under study). The results obtained during laboratory diagnostic studies of the material from pigs received by the Kropotkin regional Laboratory over the past 4 years (from 2019 to 2022) indicate a high frequency of detection of bacterial pathogens of respiratory infections in pigs (from 10 to 72%). PCR diagnostics with real-time hybridization-fluorescence detection is optimal for rapid detection of Mycoplasma hyopneumoniae, Streptococcus pneumoniae, Pasterella multocida, Staphylococcus aureus in pigs.

Vaccination as an immune system status optimization tool for the high-performance sports: review

Objective: consideration of the importance of vaccination as a preventive measure of support the athlets immunne system in conditions of extreme physical exertion and increased epidemic risks.Materials and methods: analysis of local and foreign dates of immunocorrection and vaccination problems.Results: the presented review provides an integral assessment of the transitory immunosuppression, developing by the intensive training and competitive activities — exercise-induced immunosuppression. These dates described as an “open window” syndrome and characterized by an increased risk of viral and/or bacterial infection with predominant damage of the upper respiratory tract and gastrointestinal tract. Widespread immunoprophylaxis provides an effective and relatively safe method of infectious control at risk groups including athletes.Conclusion: Vaccines of National Immunization Schedule and Epidemiological Immunization Schedule provide complex impact to the athletes immune status in wide variety of physical and psychological stresses. Vaccination increases the ability of specific and nonspecific resistance to infections that provide significant prevention of the “open window” syndrome.

Acute lung and lower respiratory tract damage after inhalation exposure to hydrogen fluoride

Relevance. Hydrogen fluoride is a highly active chemical substance widely used in industry for production of inorganic fluorides, organofluorine compounds, in the processing of aluminum, stainless steel and alloys. The chemical properties of hydrogen fluoride determine its ability to have a destructive effect on the tissues of the human body and high toxicity with local and systemic exposure. Hydrogen fluoride poisoning is severe and difficult to treat. Clarification of the clinical picture and the search for new methods of treating lesions with hydrogen fluoride are of great importance for protecting the health of workers in chemical industries and eliminating the consequences of technogenic accidents.Intention. To consider the features of the observed clinical case of severe damage to the lungs and lower respiratory tract after inhalation exposure to hydrogen fluoride and treatment methods that made it possible to achieve favorable clinical results. Methodology. The article discusses clinically important chemical properties of hydrogen fluoride, the mechanisms and manifestations of characteristic lesions developing in the human body with various routes of exposure. Modern approaches to the treatment of patients exposed to hydrogen fluoride are outlined.Results and Discussion. Inhalation of gas mixtures, even with low concentrations of hydrogen fluoride, can lead to severe inflammatory-necrotic lung damage with interstitial pneumonia (chemical pneumonitis), adult respiratory distress syndrome, and severe respiratory failure. Improvement of clinical condition of the affected person in the observed case was achieved via complex treatment with glucocorticosteroids, antimicrobial agents, calcium gluconate inhalations. A key role in the patient’s treatment was played by long-term replacement of the impaired function of the lungs using extracorporeal membrane oxygenation.Conclusion. In severe forms of acute damage to the lungs and lower respiratory tract as a result of inhaled exposure to hydrogen fluoride, clinical recovery and improvement in the quality of life of the injured can be achieved through complex therapy using glucocorticosteroids, antibacterial agents, specific antidotes (calcium gluconate) and prolonged replacement of the respiratory function via artificial ventilation and extracorporeal membrane oxygenation.

Malignant course of invasive pulmonary aspergillosis in the new coronavirus infection COVID-19

Respiratory infections caused by fungal pathogens are the main cause of death in immunocompromised patients. During the COVID-19 pandemic, the registration of respiratory fungal pathology, especially pulmonary aspergillosis, has increased significantly.
 We present a histopathologically confirmed case of fatal invasive pulmonary aspergillosis complicating COVID-19. A 65-year-old patient with long-term diabetes backgrounded with a severe course of COVID-19 (the virus was identified ICD-10 code U07.1) described. During the illness bilateral polysegmental pneumonia of fungal-bacterial (Klebsiella pneumoniae) etiology with necrosis and sequestration of the affected tissue the lower lobe of the right lung with the formation of a fungal ball and the development of a right-sided pneumothorax was developed. In other parts of both lungs, focal destruction of the interalveolar septa was determined with the formation of small cavities filled with detritus and accumulations of segmented neutrophils, with the proliferation of fungal mycelium, positively stained in the PAS reaction. Fungal hyphae and conidial heads were also found in the lumens of individual bronchi and vessels with invasion of their walls. Long-term (more than one month) course of the disease, clinical and radiological dynamics, and detection of a forming connective tissue capsule along the periphery of the necrosis zone during microscopy testifies in favor of the subacute nature of the infection.
 The presented clinical case, as well as a review of current publications and meta-analyses on invasive pulmonary aspergillosis, point to diagnostic problems and poor outcomes of invasive pulmonary aspergillosis in patients with COVID-19.
 Pulmonary aspergillosis associated with COVID-19 is a serious and potentially life ― threatening complication in patients with severe COVID-19 receiving immunosuppressive treatment. Early diagnosis of fungal infections is crucial to ensure the survival of such patients. Targeted biopsy examination with microscopy and/or seeding of a lung biopsy allows not only to establish the diagnosis of aspergillosis, but also to determine the presence of tissue invasion.
 Further research should include approaches aimed at developing an effective diagnosis of fungal tissue invasion and respiratory tract damage, determining the patients immune status in order to conduct personalized immunotherapy.

Club cell protein (CC)16 as potential lung injury marker in a porcine 72 h polytrauma model

BackgroundPolytrauma and respiratory tract damage after thoracic trauma cause about 25% of mortality among severely injured patients. Thoracic trauma can lead to the development of severe lung complications such as acute respiratory distress syndrome, and is, therefore, of great interest for monitoring in intensive care units (ICU). In recent years, club cell protein (CC)16 with its antioxidant properties has proven to be a potential outcome-related marker. In this study, we evaluated whether CC16 constitutes as a marker of lung damage in a porcine polytrauma model. MethodsIn a 72 h ICU polytrauma pig model (thoracic trauma, tibial fracture, hemorrhagic shock, liver laceration), blood plasma samples (0, 3, 9, 24, 48, 72 h), BAL samples (72 h) and lung tissue (72 h) were collected. The trauma group (PT) was compared to a sham group. CC16 as a possible biomarker for lung injury in this model, and IL-8 concentrations as known indicator for ongoing inflammation during trauma were determined by ELISA. Histological analysis of ZO-1 and determination of total protein content were used to show barrier disruption and edema formation in lung tissue from the trauma group.ResultsSystemic CC16 levels were significantly increased early after polytrauma compared vs. sham. After 72 h, CC16 concentration was significantly increased in lung tissue as well as in BAL in PT vs. sham. Similarly, IL-8 and total protein content in BAL were significantly increased in PT vs. sham. Evaluation of ZO-1 staining showed significantly lower signal intensity for polytrauma.ConclusionThe data confirm for the first time in a larger animal polytrauma model that lung damage was indicated by systemic and/or local CC16 response. Thus, early plasma and late BAL CC16 levels might be suitable to be used as markers of lung injury in this polytrauma model.

Case Study: Efficacy of Engineering Controls in Mitigating Diacetyl and 2,3-Pentanedione Emissions During Coffee Grinding.

Exposure to elevated levels of diacetyl in flavoring and microwave popcorn production has been associated with respiratory impairment among workers including from a severe lung disease known as obliterative bronchiolitis. Laboratory studies demonstrate damage to the respiratory tract in rodents exposed to either diacetyl or the related alpha-diketone 2,3-pentanedione. Respiratory tract damage includes the development of obliterative bronchiolitis-like changes in the lungs of rats repeatedly inhaling either diacetyl or 2,3-pentanedione. In one flavored coffee processing facility, current workers who spent time in higher diacetyl and 2,3-pentanedione areas had lower lung function values, while five former flavoring room workers were diagnosed with obliterative bronchiolitis. In that and other coffee roasting and packaging facilities, grinding roasted coffee beans has been identified as contributing to elevated levels of diacetyl and 2,3-pentanedione. To reduce worker exposures, employers can take various actions to control exposures according to the hierarchy of controls. Because elimination or substitution is not applicable to coffee production facilities not using flavorings, use of engineering controls to control exposures at their source is especially important. This work demonstrates the use of temporary ventilated enclosures around grinding equipment in a single coffee roasting and packaging facility to mitigate diacetyl and 2,3-pentanedione emissions from grinding equipment to the main production space. Concentrations of diacetyl and 2,3-pentanedione were measured in various locations throughout the main production space as well as inside and outside of ventilated enclosures to evaluate the effect of the enclosures on exposures. Diacetyl and 2,3-pentanedione concentrations outside one grinder enclosure decreased by 95 and 92%, respectively, despite ground coffee production increasing by 12%, after the enclosure was installed. Outside a second enclosure, diacetyl and 2,3-pentanedione concentrations both decreased 84%, greater than the 33% decrease in ground coffee production after installation. Temporary ventilated enclosures used as engineering control measures in this study effectively reduced emissions of diacetyl and 2,3-pentanedione at the source in this facility. These findings motivated management to explore options with a grinding equipment manufacturer to permanently ventilate their grinders to reduce emissions of diacetyl and 2,3-pentanedione.

Respiratory tract involvement in primary Sjögren’s syndrome, focus on interstitial lung disease

The article provides a literature review on the current understanding of respiratory tract damage in primary Sjögren’s syndrome (pSS) with an emphasis on interstitial lung disease (ILD), as well as approaches to the differential diagnosis, treatment, and screening of pSS-ILD.

Comparative characteristics of the nasal mucosa microflora at different level of allergic inflammation in the respiratory tract

In the modern world, allergic respiratory diseases hold a huge place among all chronic diseases. The annual increase in the prevalence of allergic rhinitis and bronchial asthma among the global population makes relevant studies underlying their pathogenesis. Changes in the nasal mucosa alter its most important function protection from aggressive environmental factors allergens and pollutants. Inflammatory processes in the nasal cavity interfere with the normal mucosa functioning as a non-specific barrier, and facilitate their further penetration into the macroorganism. Objective of the study is to provide a comparative microbiological characteristic of the nasal mucosa of patients with respiratory allergies of various origin and level of respiratory tract damage. Patients with respiratory allergies aged 23 to 51 years old as well as sex- and age-matched apparently healthy subjects (n = 120) were examined. The study groups were as follows: atopic rhinosinusitis (AR, n = 28), atopic bronchial asthma (ABA, n = 28), polyposis rhinosinusitis (PRS, n = 68), and asthmatic triad (AT, n = 28). Diagnostics were carried out by an allergist-immunologist as well as an otorhinolaryngologist. Isolation of microorganisms was carried out by placing them on nutrient differential diagnostic media. Seeding was carried out by using the sector method. The culture media were incubated in a thermostat at 37C for 48 hours. Statistical processing was performed using the Statistica 7.0 software package. The study sample is described by calculating median as well as 25 and 75 percentiles. The normality distribution was checked by using the KolmogorovSmirnov method. The significance of differences between parameters of independent samples was assessed by using the nonparametric MannWhitney test. Dominance of opportunistic microorganisms in respiratory atopy (AR, ABA) relative to respiratory pseudoatopia (PRS, AT) was noted. The increased number of bacteria from the family Enterobacteriaceae and Enterococcus on the nasal mucosa characterizes dysbacteriosis, emphasizing the greatest importance of these families in the initiation of allergic pathology in the upper and lower respiratory tract during atopy. A distinctive intergroup feature is a high concentration of the Enterobacteriaceae family members in AR vs. PRS as well as microorganisms of the genus Enterococcus in ABA vs. AT. Thus, regardless of the cause of inflammation, allergic rhinosinusitis and bronchial asthma were featured with a pronounced dysbacteriosis due to rise in the opportunistic microflora on the nasal mucosa compared to the control group.