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Acute fibrinous and organising pneumonia following lung transplantation is associated with severe allograft dysfunction and poor outcome: a case series 肺移植后急性纤维性和组织性肺炎与严重的同种异体移植物功能障碍和不良预后相关:一个病例系列
IF 6.8 Q1 RESPIRATORY SYSTEM Pub Date : 2015-09-01 DOI: 10.15172/pneu.2015.6/648
K. Meyer, J. Bierach, J. Kanne, J. Torrealba, N. D. de Oliveira
Acute fibrinous and organising pneumonia (AFOP) is a histopathologic variant of acute lung injury that has been associated with infection and inflammatory disorders and has been reported as a complication of lung transplantation. A retrospective chart review was performed for all patients transplanted at the University of Wisconsin Hospital and Clinics from January 1995 to December 2013 (n = 561). We identified 6 recipients whose clinical course was complicated by AFOP. All recipients were found to have AFOP on lung biopsy or at post-mortem examination, and 5 of the 6 patients suffered progressive allograft dysfunction that led to fatal outcome. Only 1 of the 6 patients stabilised with augmented immunosuppression and had subsequent improvement and stabilisation of allograft function. We could not clearly identify any specific cause of AFOP, such as drug toxicity or infection. Lung transplantation can be complicated by lung injury with an AFOP pattern on histopathologic examination of lung biopsy specimens. The presence of an AFOP pattern was associated with irreversible decline in lung function that was refractory to therapeutic interventions in 5 of our 6 cases and was associated with severe allograft dysfunction and death in these 5 individuals. AFOP should be considered as a potential diagnosis when lung transplant recipients develop progressive decline in lung function that is consistent with a clinical diagnosis of chronic lung allograft dysfunction.
急性纤维性和组织性肺炎(AFOP)是急性肺损伤的一种组织病理学变异,与感染和炎症性疾病有关,已被报道为肺移植的并发症。对1995年1月至2013年12月在威斯康星大学医院和诊所进行移植的所有患者进行回顾性图表回顾(n = 561)。我们确定了6例临床过程因AFOP而复杂的患者。所有受者均在肺活检或尸检中发现AFOP, 6例患者中有5例出现进行性同种异体移植物功能障碍,导致死亡。6例患者中只有1例稳定增强免疫抑制,随后同种异体移植物功能得到改善和稳定。我们不能清楚地确定AFOP的任何具体原因,如药物毒性或感染。肺移植可并发肺损伤,肺活检标本病理检查呈AFOP型。AFOP模式的存在与肺功能不可逆转的下降有关,在我们的6例病例中,有5例治疗干预无效,并与这5例患者的严重同种异体移植物功能障碍和死亡有关。当肺移植受者肺功能进行性下降,与慢性同种异体肺移植功能障碍的临床诊断一致时,应将AFOP视为一种潜在的诊断。
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引用次数: 7
Standardisation and evaluation of a quantitative multiplex real-time PCR assay for the rapid identification of Streptococcus pneumoniae 快速鉴定肺炎链球菌的多重实时荧光定量PCR方法的标准化和评价
IF 6.8 Q1 RESPIRATORY SYSTEM Pub Date : 2015-08-25 DOI: 10.15172/pneu.2015.6/559
Feroze A. Ganaie, V. Govindan, Ravi Kumar
Rapid diagnosis of Streptococcus pneumoniae can play a significant role in decreasing morbidity and mortality of infection. The accurate diagnosis of pneumococcal disease is hampered by the difficulties in growing the isolates from clinical specimens and also by misidentification. Molecular methods have gained popularity as they offer improvement in the detection of causative pathogens with speed and ease. The present study aims at validating and standardising the use of 4 oligonucleotide primer-probe sets (pneumolysin [ply], autolysin [lytA], pneumococcal surface adhesion A [psaA] and Spn9802 [DNA fragment]) in a single-reaction mixture for the detection and discrimination of S. pneumoniae. Here, we validate a quantitative multiplex real-time PCR (qmPCR) assay with a panel consisting of 43 S. pneumoniae and 29 non-pneumococcal isolates, 20 culture positive, 26 culture negative and 30 spiked serum samples. A standard curve was obtained using S. pneumoniae ATCC 49619 strain and glyceraldehyde 3-phosphate dehydrogenase (GAPDH) gene was used as an endogenous internal control. The experiment showed high sensitivity with lower limit of detection equivalent to 4 genome copies/µl. The efficiency of the reaction was 100% for ply, lytA, Spn9802 and 97% for psaA. The test showed sensitivity and specificity of 100% with culture isolates and serum specimens. This study demonstrates that qmPCR analysis of sera using 4 oligonucleotide primers appears to be an appropriate method for the genotypic identification of S. pneumoniae infection.
肺炎链球菌的快速诊断对降低感染的发病率和死亡率具有重要作用。肺炎球菌疾病的准确诊断受到临床标本中分离株生长困难和误诊的阻碍。分子方法已经获得了普及,因为它们提供了快速和容易的致病病原体的检测改进。本研究旨在验证和标准化在单反应混合物中使用4个寡核苷酸引物探针组(肺炎溶素[ply]、自溶素[lytA]、肺炎球菌表面粘附A [psaA]和Spn9802 [DNA片段])检测和鉴别肺炎链球菌。在这里,我们验证了一种定量多重实时PCR (qmPCR)检测方法,该方法由43个肺炎链球菌和29个非肺炎球菌分离物、20个培养阳性、26个培养阴性和30个加标血清样本组成。以肺炎链球菌ATCC 49619菌株为标准菌株,以甘油醛3-磷酸脱氢酶(GAPDH)基因为内源性内对照,获得标准曲线。实验结果显示灵敏度高,检测下限相当于4个基因组拷贝/µl。该反应对ply、lytA、Spn9802的反应效率为100%,对psaA的反应效率为97%。该方法对培养分离物和血清标本的敏感性和特异性均为100%。本研究表明,使用4个寡核苷酸引物对血清进行qmPCR分析是一种适合肺炎链球菌感染基因型鉴定的方法。
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引用次数: 7
Upper airway viruses and bacteria detection in clinical pneumonia in a population with high nasal colonisation do not relate to clinical signs 在高鼻定植人群中,临床肺炎的上呼吸道病毒和细菌检测与临床体征无关
IF 6.8 Q1 RESPIRATORY SYSTEM Pub Date : 2015-08-21 DOI: 10.15172/pneu.2015.6/636
A. Chang, H. Smith-Vaughan, T. Sloots, P. Valery, D. Whiley, J. Beissbarth, P. Torzillo
Indigenous Australian children have high (up to 90%) rates of nasopharyngeal microbial colonisation and of hospitalisation for pneumonia. In Indigenous children hospitalised with pneumonia in Central Australia, we describe the nasopharyngeal detection of viruses and bacteria and assessed whether their presence related to signs of pneumonia (tachypnoea and/or chest in-drawing) on hospital admission and during subsequent days. Nasopharyngeal swabs (NPS) and data were prospectively collected from 145 children (median age = 23.5 months, interquartile range [IQR] 8.7–50) hospitalised with pneumonia at Alice Springs Hospital, Australia, between April 2001 and July 2002. The cohort was enrolled in a randomised controlled study using zinc and/or vitamin A supplementation. NPS were taken within 24 hours of hospitalisation and kept frozen at-80°C until analysed in 2014. Polymerase chain reaction (PCR) was used to detect Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, Chlamydophila pneumoniae, Mycoplasma pneumoniae, and 16 respiratory viruses. Uni- and multi-variate analyses were used to examine the relationships. One or more organisms were present in 137 (94.5%) NPS; 133 (91.7%) detected ≥ 1 bacterium, 34 (37.2%) for ≥ 1 virus and 50 (34.5%) were positive for both viruses and bacteria. C. pneumoniae (n = 3) and M. pneumoniae (n = 2) were rare. In multi-variate analyses, age < 12 months (odds ratio [OR] 6.6 [95% confidence interval {CI} 1.7–25.4]) and fever (OR 4.1 [95% CI 1.7–10.4]) were associated with tachypnoea and chest in-drawing. However the presence of bacteria and/or virus type was not associated with tachypnoea and/or chest in-drawing on admission or during recovery. In children with high nasopharyngeal microbial colonisation rates, the utility of NPS in determining the diagnosis of clinical pneumonia or duration of tachypnoea or in-drawing is likely limited. Larger cohort and case-control studies are required to confirm our findings.
澳大利亚土著儿童的鼻咽微生物定植率和肺炎住院率很高(高达90%)。在澳大利亚中部因肺炎住院的土著儿童中,我们描述了对病毒和细菌的鼻咽检测,并评估了它们的存在是否与入院时和随后几天的肺炎症状(呼吸急促和/或胸部收缩)有关。本研究前瞻性地收集了2001年4月至2002年7月期间在澳大利亚Alice Springs医院因肺炎住院的145名儿童(中位年龄= 23.5个月,四分位数间距[IQR] 8.7-50)的鼻咽拭子(NPS)和数据。该队列纳入了一项随机对照研究,使用锌和/或维生素a补充剂。NPS在住院24小时内服用,并在80°C下冷冻,直到2014年进行分析。采用聚合酶链反应(PCR)检测卡他莫拉菌、流感嗜血杆菌、肺炎链球菌、金黄色葡萄球菌、肺炎衣原体、肺炎支原体及16种呼吸道病毒。采用单变量和多变量分析来检验两者之间的关系。137个(94.5%)NPS中存在一种或多种生物;检出≥1种细菌133例(91.7%),检出≥1种病毒34例(37.2%),病毒和细菌双阳性50例(34.5%)。肺炎支原体(3例)和肺炎支原体(2例)少见。在多因素分析中,年龄< 12个月(比值比[OR] 6.6[95%可信区间{CI} 1.7-25.4])和发烧(比值比[OR] 4.1 [95% CI 1.7-10.4])与呼吸急促和胸腔内吸有关。然而,在入院或康复期间,细菌和/或病毒类型的存在与呼吸急促和/或胸腔吸积无关。在鼻咽微生物定植率高的儿童中,NPS在确定临床肺炎诊断或呼吸急促或吸入持续时间方面的作用可能有限。需要更大规模的队列研究和病例对照研究来证实我们的发现。
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引用次数: 11
Corticosteroids for all adult patients with community-acquired pneumonia? 所有社区获得性肺炎的成年患者使用糖皮质激素?
IF 6.8 Q1 RESPIRATORY SYSTEM Pub Date : 2015-08-18 DOI: 10.15172/pneu.2015.6/690
Simone M C Spoorenberg, Stefan M T Vestjens, W. Albrich, G. Rijkers
Corticosteroid therapy as adjunctive treatment in community-acquired pneumonia (CAP) is a promising but controversial subject. The potentially beneficial effect of corticosteroids is based on the ability of steroids to dampen an excessive inflammatory response that often occurs in patients with CAP. This excessive inflammatory response can cause damage to the lungs and other organs, and is associated with poor outcome.
皮质类固醇治疗作为社区获得性肺炎(CAP)的辅助治疗是一个有前途但有争议的课题。皮质类固醇的潜在有益作用是基于类固醇抑制CAP患者经常发生的过度炎症反应的能力。这种过度的炎症反应可能导致肺部和其他器官的损害,并与不良预后相关。
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引用次数: 0
A review of the role of Haemophilus influenzae in community-acquired pneumonia 流感嗜血杆菌在社区获得性肺炎中的作用综述
IF 6.8 Q1 RESPIRATORY SYSTEM Pub Date : 2015-06-29 DOI: 10.15172/pneu.2015.6/520
M. Slack
In an era when Haemophilus influenzae type b (Hib) conjugate vaccine is widely used, the incidence of Hib as a cause of community-acquired pneumonia (CAP) has dramatcally declined. Non-typeable H. influenzae (NTHi) strains and, occasionally, other encapsulated serotypes of H. influenzae are now the cause of the majority of invasive H. influenzae infectons, including bacteraemic CAP. NTHi have long been recognised as an important cause of lower respiratory tract infecton, including pneumonia, in adults, especially those with underlying diseases. The role of NTHi as a cause of non-bacteraemic CAP in children is less clear. In this review the evidence for the role of NTHi and capsulated strains of H. influenzae will be examined.
在广泛使用b型流感嗜血杆菌(Hib)结合疫苗的时代,Hib作为社区获得性肺炎(CAP)原因的发病率急剧下降。不可分型的流感嗜血杆菌(NTHi)菌株和偶尔出现的其他被封装的流感嗜血杆菌血清型现在是大多数侵袭性流感嗜血杆菌感染的原因,包括细菌性CAP。长期以来,NTHi一直被认为是成年人下呼吸道感染(包括肺炎)的重要原因,特别是那些有基础疾病的人。NTHi作为儿童非细菌性CAP病因的作用尚不清楚。在这篇综述的证据NTHi和流感嗜血杆菌的荚膜菌株的作用将进行审查。
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引用次数: 42
Decreased serum level of thioredoxin 1 in female patients with pneumonia and its combinational use with haptoglobin for the specific diagnoses of pneumonia and lung cancer 女性肺炎患者血清硫氧还蛋白1水平下降及其与触珠蛋白联合诊断肺炎和肺癌的意义
IF 6.8 Q1 RESPIRATORY SYSTEM Pub Date : 2015-06-29 DOI: 10.15172/pneu.2015.6/542
M. Cha, Il-Han Kim
Thioredoxin 1 (Trx1) and haptoglobin (Hp) are known to be involved in pathophysiology. This study was conducted to evaluate their diagnostic significance. We employed an enzyme-linked immunosorbent assay (ELISA) to determine the concentrations of both Trx1 and Hp in sera from female patients with community-acquired pneumonia (CAP) and those with lung cancer. The Trx1 levels remarkably decreased in cases of female patients with CAP, while the Hp levels increased in both female patients with lung cancer and CAP. In addition, the serum levels of Trx1 were not significantly changed in patients with lung cancer, rheumatoid arthritis, and cardiovascular diseases compared to healthy controls. At the cut-off point of 0.396 at A450 nm on the receiver operating characteristic (ROC) curve, Trx1 could discriminate between patients with CAP from normal female controls with a sensitivity of 72.5%, a specificity of 89.8%, and area under the ROC curve (AUC) of 0.877 ± 0.040. The serum levels of Trx1 in female CAP patients were inversely correlated with the levels of Hp (p < 0.05). The characteristic reduction in serum Trx1 levels, especially in female CAP patients, indicates that Trx1 could be used as a diagnostic marker for CAP. The advantage of serum Trx1 over Hp in discriminating female CAP patients among female patients who have a positive serum level of Hp suggests the use of Trx1 as an excellent combination marker with Hp for the specific diagnosis of CAP and lung carcinoma, because serum Hp levels increase in female patients with lung cancer and those with CAP without selectivity.
已知硫氧还蛋白1 (Trx1)和触珠蛋白(Hp)参与了病理生理。本研究旨在评价其诊断意义。我们采用酶联免疫吸附试验(ELISA)测定了女性社区获得性肺炎(CAP)患者和肺癌患者血清中Trx1和Hp的浓度。女性CAP患者的Trx1水平显著降低,而女性肺癌和CAP患者的Hp水平均升高。此外,与健康对照相比,肺癌、类风湿关节炎和心血管疾病患者的血清Trx1水平无显著变化。在A450 nm处受试者工作特征(ROC)曲线截点0.396处,Trx1能够区分CAP患者与正常女性对照,灵敏度为72.5%,特异性为89.8%,ROC曲线下面积(AUC)为0.877±0.040。女性CAP患者血清Trx1水平与Hp水平呈负相关(p < 0.05)。血清Trx1水平的特征性降低,特别是在女性CAP患者中,表明Trx1可以作为CAP的诊断标志物。血清Trx1在区分女性CAP患者与血清Hp阳性的女性患者方面的优势,提示Trx1与Hp联合使用是CAP和肺癌特异性诊断的一个很好的联合标志物。因为女性肺癌患者和无选择性CAP患者血清Hp水平升高。
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引用次数: 0
Plenary abstract 全体抽象
IF 6.8 Q1 RESPIRATORY SYSTEM Pub Date : 2015-01-01 DOI: 10.1007/BF03371467
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引用次数: 0
Childhood Pneumonia Screener: a concept 儿童肺炎筛查:一个概念
IF 6.8 Q1 RESPIRATORY SYSTEM Pub Date : 2014-12-01 DOI: 10.15172/pneu.2014.5/515
J. Räsänen, N. Gavriely
Childhood pneumonia continues to be the number one cause of death in children under five years of age in developing countries. In addition to mortality, pneumonia constitutes an enormous economic and social burden because late diagnosis is associated with high cost of treatment and often leads to chronic health problems. There are several bottlenecks in developing countries in the case flow of a child with lung infection: 1) recognising the symptoms as a reason to seek care, 2) getting the patient to a first-tier health facility, 3) scarcity of trained healthcare personnel who can diagnose the condition and its severity, 4) access to a second-tier facility in severe cases. These factors are commonly present in rural areas but even in more urban settings, access to a physician is often delayed. The Childhood Pneumonia Screener project aims at bridging the diagnostic gap using emerging technology. Mobile “smart” phone communication with several inexpensive dedicated sensors is proposed as a rapid data-collection and transmission unit that is connected to a central location where trained personnel assisted by sophisticated signal processing algorithms, evaluate the data and determine if the child is likely to have pneumonia and what the level and urgency of care should be.
儿童肺炎仍然是发展中国家五岁以下儿童死亡的头号原因。除了死亡率外,肺炎还构成巨大的经济和社会负担,因为诊断晚与治疗费用高有关,并常常导致慢性健康问题。在发展中国家,肺部感染儿童的病例流存在几个瓶颈:1)认识到症状是寻求治疗的理由;2)将患者送到一线卫生机构;3)缺乏能够诊断病情及其严重程度的训练有素的卫生保健人员;4)在严重病例中无法到二线医疗机构就诊。这些因素在农村地区普遍存在,但即使在更多的城市环境中,就诊也常常被推迟。儿童肺炎筛查项目旨在利用新兴技术弥合诊断差距。建议将带有几个廉价专用传感器的移动“智能”电话通信作为一种快速数据收集和传输单元,连接到一个中心位置,在那里训练有素的人员在复杂的信号处理算法的协助下评估数据并确定儿童是否可能患有肺炎以及护理的级别和紧迫性。
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引用次数: 0
Pneumococcal colonization and carriage 肺炎球菌的定植和携带
IF 6.8 Q1 RESPIRATORY SYSTEM Pub Date : 2014-12-01 DOI: 10.1007/BF03399438
C. Chewapreecha, S. Harris, N. Croucher, C. Turner, L. Cheng, A. Pessia, D. Aanensen, -. S.J.Salt, er, A. Mather, A. Page, D. Harris, F. Nosten, J. Corander, J. Parkhill, P. Turner, S. Bentley, D. Bogaert
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引用次数: 0
The Promiscuous Pneumococcus---Evolution and Biology 混杂性肺炎球菌——进化与生物学
IF 6.8 Q1 RESPIRATORY SYSTEM Pub Date : 2014-12-01 DOI: 10.1007/BF03399442
S. Dawid, T. Kochan, W. Wholey, N. LaCross, R. Mostowy, N. Croucher, C. Chewapreecha, S. Salter, P. Turner, C. Turner, L. Po, X. Didelot
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引用次数: 0
期刊
Pneumonia
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