Objective To assess the value of procalcitonin ( PCT) in serum and percentage of infected cells ( PIC) in bronchoalveolar lavage fluid ( BALF) for the diagnosis of early ventilator-associatedpneumonia ( VAP) .Methods A prospective observational study was conducted in a teaching hospital. The patients consecutively admitted to the intensive care unit from January 2011 to June 2012, who received mechanical ventilation for more than 48h and clinically suspected for VAP, were recruited in the study.Patients with infection outside the lungs and previous diagnosed infection were excluded. PCT was detected and bronchoalveolar lavage was performed in the day when VAP was diagnosed. BALF cells were stained by May-Grunwald Giemsa ( MGG) for counting 100 phagocytic cells and calculating infected cells ( ICs )percentage.Results 76 of all 421 patients were enrolled in this study, 64 of which were diagnosed, 12 were under-diagnosed. The PCT [ ( 3. 48 ±1. 46) ng/mL vs. ( 1. 53 ±0. 60) ng/mL] and PIC [ ( 3. 11 ±1. 47) % vs. ( 1. 08 ±0. 29) % ] were significant higher in the patients with VAP. The threshold of 2 ng/mL of PCT and 2% of PIC corresponded to sensitivity of 78. 12% and 78. 12% , and specificity of 75. 00% and 91. 67% , respectively. The area under the receiver operating characteristic ( ROC) curve was 0. 87 ( 95% CI 78. 9%-95. 9% ) and 0. 874 ( 95% CI 79. 2% -94. 9% ) , respectively. The area under ROC curve was 0. 979, and the sensitivity was 97. 36% , specificity was 97. 36% when the two cutoff values were both achieved. Conclusion PCT and PIC are useful markers to diagnose early VAP quickly and conveniently and allow early antibiotic treatment of patients with suspected VAP.
ObjectiveTo investigate the clinical features, diagnosis and treatment of scedosporiosis in lung transplant patients.MethodsA retrospective analysis was carried out on a lung transplant patient with scedosporiosis admitted to the First Affiliated Hospital of Guangzhou Medical University. A literature review was performed with “scedosporium”/“scedosporiosis”+“lung transplant” or “scedosporium”/“scedosporiosis”+“lung transplantation” as the key words in Pubmed, Wanfang Database and China Knowledge Resource Integrated Database. The date of retrieval was up to May 2018. Related articles of scedosporiosis in lung transplant patients were retrieved. Clinical characters, diagnosis, treatment and outcome were analyzed.ResultsThe patient was a 65 years old male who received the right lung transplantation 7 months before. He presented with seizure, dyspnea and multiple organ failure. The CT scan illustrated right lower pulmonary nodular lesions. The culture and DNA sequencing of the bronchoalveolar lavage fluid established the diagnosis of scedosporium prolificans. The patient died finally despite the combined anti-fungal treatment. Literature review found 20 relative articles, and all of which were case report with a total of 35 patients. Scedosporium was always disseminated and with a high mortality, with no specificity in chest CT and bronchoscopy. The diagnosis always established by the culture and DNA sequencing, and the combination of anti-fugal agents was needed.ConclusionsScedosporium in lung transplant patient is a disseminated disease with high mortality. The high risk patients should be focused on and early diagnosis and treatment was demanded.
Objective To investigate the diagnostic value and complications of fibrobronchoscopy and bronchoalveolar lavage in immunocompromised patients with pulmonary infiltrates. Methods Fiberoptic bronchoscopy was performed in 31 immunocompromised patients. The clinical data and results of bronchoalveolar lavage were collected. In addition to conventional microbiological methods, molecular detection for cytomegalovirus( CMV) and respiratory viruses were performed. Results In all cases BAL was performed. The overall diagnostic yield of fibrobronchoscopy was 65% . The diagnosis was more likely to be established by fibrobronchoscopy when the lung infiltrate was due to an infectious agent( 86%) than to a noninfectious process( 25% ) . By molecular detection, CMV was identified in 4 cases, and other respiratory viruses were identified in 3 cases. Fever ( 23% ) was the most common complication. Conclusions Fibrobronchoscopy and BAL are effective and safe for the diagnosis of pulmonary infiltrates in immunocompromised patients. The molecular technique may help to enhance the diagnostic yield of BAL.
ObjectiveTo analyze the microbiological characteristics of airway bacteria in adult patients with bronchiectasis and to analyze their correlation with the clinical features. MethodsPatients diagnosed with bronchiectasis in the Department of Respiratory and Critical Care Medicine of West China Hospital of Sichuan University from October 2017 to April 2018 were classified into the bronchiectasis group, while the control group was those who were found to have pulmonary nodules (diameter less than 10 mm) requiring bronchoscopy by physical examination. All subjects in both groups had not used antibiotics or hormones within 4 weeks and had no other respiratory diseases. Bronchoalveolar lavage fluid (BALF) from the lesion site of the branchial expansion group was collected, and BALF from the basal segment of the contralateral inferior bronchial lobe of the pulmonary nodule was collected in the control group. Bacterial culture and 16S rRNA gene sequencing were performed in both groups. ResultsSeventeen cases and six controls were enrolled in this study and the BALF specimens were collected. Eight cases were in stable period and nine cases were in acute period. The case group was divided into the bacteria-positive group and negative group based on bacterial culture of BALF. Shannon index in the bacteria-positive group was significantly lower than the bacteria-negative group and the control group. And Shannon index showed a negative correlation with positive bacterial culture in BALF. When Shannon index ≤4.5 was used to predict positive bacterial culture, the sensitivity and specificity were 83.3% and 90.9% respectively. The average relative abundance of bacteria was higher and the average sample distribution uniformity was lower in patients with acute period, compared with those in patients with stable period. Shannon index was negatively correlated with the acute exacerbation in patients. When Shannon index <5.0 was used to predict acute exacerbation, the sensitivity and specificity were 77.8% and 100.0%, respectively. ConclusionsShannon index in 16S rRNA gene sequencing results has certain predictive value for acute exacerbation stage. 16S rRNA gene sequencing combined with bacterial culture results can help guide clinicians to provide more precise treatment plans.
ObjectiveTo evaluate the diagnostic value of sTREM-1 level in bronchoalveolar lavage fluid (BALF) for diagnosing early lung infection of patients with post-traumatic acute respiratory distress syndrome. Methods64 patients with post-traumatic ARDS,who were admitted in ICU from emergency department or other trauma surgery department from January 2010 to December 2012,were divided into a pulmonary infection group (n=34) and a non-pulmonary infection group(n=30).30 healthy volunteers aged over 18 years were taken as healthy control group.The ROC curve was used to analyze the diagnostic value of C-reactive protein (CRP),procalcitonin (PCT) and sTREM-1 in early pulmonary infection of patients with post-traumatic ARDS. ResultsGender and age composition showed no significant difference among the healthy control group,the pulmonary infection group,and the non-pulmonary infection group(P>0.05). Injury severity scale(ISS),APACHEⅡ and the mortality in 28 days showed significant difference between the groups of pulmonary infection and non-pulmonary infection(P<0.05).Oxygenation index (PaO2/FiO2),tracheal intubation time,mechanical ventilation time and length of ICU stay also showed significant difference between the groups of pulmonary infection and non-pulmonary infection(P<0.01).Compared with the healthy control group,levels of serum CRP,PCT and sTREM-1 increased significantly in the groups of pulmonary infection and non-pulmonary infection(P<0.001).Compared with the non-pulmonary infection group,the levels of CRP,PCT and sTREM-1 in serum,and sTREM-1 in BALF increased significantly in the pulmonary infection group (P<0.05).The area under the ROC curve (AUC) of serum CRP was 0.67 with the sensitivity of 0.68 and the specificity of 0.70.AUC of serum PCT was 0.67 with the sensitivity of 0.70 and the specificity of 0.64.AUC of serum sTREM-1 was 0.73 with the sensitivity of 0.73 and the specificity of 0.68.AUC of sTREM-1 in BALF was 0.90 with the sensitivity of 0.90 and the specificity of 0.82. ConclusionsTREM-1 in BALF can be used as a diagnostic indicator for early pulmonary infection in patients with post-traumatic ARDS.Its sensitivity and specificity are higher than serum CRP,PCT and sTREM-1.
Objective To analyse the clinical and pathological characteristics of Chlamydia psittaci pneumonia, and increase the comprehensive understanding of the Chlamydia psittaci pneumonia. Methods Five patients diagnosed with Chlamydia psittaci pneumonia were selected in this hospital from November 2021 to November 2022, and their clinical and pathological characteristics were analysed. Results Out of these five patients, 2 patients were male and 3 were female, with a mean age (65±9) years and length of hospital stay (11 - 13) d. The first symptom of all five patients was fever; 3 patients were complicated with hypoxemia; there were several accompanying symptoms, including chilly, shiver, fatigue, headache, cough, muscle soreness, hearing loss and so on. In the laboratory indicators, white blood cell count was not significantly abnormal, the C-reactive protein and procalcitonin were high. In the chest CT, the diseased regions were mostly located in unilateral lesions, 3 cases were on the right side; the forms included pulmonary consolidation, lung glass opacity, pleural effusion, pleural thickening, etc.; the mNGS results of bronchoalveolar lavage fluid showed the Chlamydia psittaci; the pathology of lung biopsy showed significant proliferation of fibers in the interstitial lung and partly fibrosis, with histiocytic reaction and minimal lymphocyte infiltration. Conclusion Clearly diagnosing patients with pneumonia which are suspected being infected Chlamydia psittaci as soon as earlier can prompt anti-infection treatment, and avoid further damage to the lung interstitium, eventually decrease the deterioration of lung function and progression to severe pneumonia.
ObjectiveTo explore the expression of periostin in bronchoalveolar lavage fluid (BALF) of patients with dermatomyositis-related interstitial lung disease (DM-ILD) and rheumatoid arthritis-related interstitial lung disease (RA-ILD).MethodsA total of 44 patients with DM-ILD and 28 patients with RA-ILD were underwent bronchoalveolar lavage. Cells in BALF were collected and analyzed by absolute different cell counts. The level of periostin and Krebs von den Lungen-6 (KL-6) were tested by enzyme linked immunosorbent assay. Results of high resolution CT of patients were scored. Thirty patients without interstitial lung disease (ILD) served as a control group.ResultsLevels of periostin and KL-6 were significantly increased in BALF of patients with DM-ILD and RA-ILD compared with control group (all P<0.05). Levels of periostin were positively correlated with lymphocyte counts and levels of KL-6 in BALF (allP<0.05). Furthermore, levels of periostin were significantly correlated with high resolution CT scores (P<0.05).ConclusionsLevels of periostin are increased in patients with DM-ILD and RA-ILD. Periostin might be served as an indicator of CTD-ILD.
ObjectiveTo evaluate the diagnostic value of cryptococcal antigen lateral flow immunochromatographic assay (CrAg-LFA) in bronchoalveolar lavage fluid (BALF) among pulmonary cryptococcosis (PC) patients.MethodsPatients from the Zhongshan Hospital, Xiamen University, Zhangzhou Municipal Hospital of Fujian Medical University, Second Affiliated Hospital of Fujian Medical University, and Quanzhou First Hospital of Fujian Medical University were enrolled prospectively from March 2015 to October 2018. They were confirmed without human immunodeficiency virus infection and were divided into non-PC group (236 cases) and PC group (72 cases). The PC was definitely diagnosed by histopathological evidence from lung biopsy. The CrAg-LFA and culture were performed in both the serum and BALF among the enrolled patients.ResultsAmong 72 PC patients, 54 had a positive serum CrAg-LFA, 1 had positive serum culture; 67 patients had a positive BALF CrAg-LFA, 9 had positive BALF culture. Among the non-PC group, only 1 patient had a weak positive serum CrAg-LFA, none had positive serum culture of PC; 236 cases non-PC patients underwent BALF CrAg-LFA detection, none had a positive BALF CrAg-LFA; none of the 121 cases who had BALF culture yielded a positive result in PC. The sensitivity, specificity, positive predicted value, and negative predicted value in serum were 75.0%, 99.6%, 98.2%, and 92.9%, respectively. Those above mentioned values in the BALF yielded 93.6%, 100.0%, 100.0%, and 97.9%, respectively. Among the PC group, the sensitivity was higher in BALF than that in serum (χ2=8.745, P<0.05).ConclusionsThe CrAg-LFA is a simple and rapid diagnostic method for PC. The diagnostic value of CrAg-LFA in the BALF is superior to that in serum and fungal culture among the PC patients. The positive BALF CrAg-LFA result is consistent with mycological positive results.