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Gregorova M, Morse D, Brignoli T, Steventon J, Hamilton F, Albur M, Arnold D, Thomas M, Halliday A, Baum H, Rice C, Avison MB, Davidson AD, Santopaolo M, Oliver E, Goenka A, Finn A, Wooldridge L, Amulic B, Boyton RJ, Altmann DM, Butler DK, McMurray C, Stockton J, Nicholls S, Cooper C, Loman N, Cox MJ, Rivino L, Massey RC. Post-acute COVID-19 associated with evidence of bystander T-cell activation and a recurring antibiotic-resistant bacterial pneumonia. eLife 2020; 9:e63430. [PMID: 33331820 PMCID: PMC7775105 DOI: 10.7554/elife.63430] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/16/2020] [Indexed: 12/24/2022] Open
Abstract
Here, we describe the case of a COVID-19 patient who developed recurring ventilator-associated pneumonia caused by Pseudomonas aeruginosa that acquired increasing levels of antimicrobial resistance (AMR) in response to treatment. Metagenomic analysis revealed the AMR genotype, while immunological analysis revealed massive and escalating levels of T-cell activation. These were both SARS-CoV-2 and P. aeruginosa specific, and bystander activated, which may have contributed to this patient's persistent symptoms and radiological changes.
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Laube BL, Carson KA, Evans CM, Richardson VL, Sharpless G, Zeitlin PL, Mogayzel PJ. Changes in mucociliary clearance over time in children with cystic fibrosis. Pediatr Pulmonol 2020; 55:2307-2314. [PMID: 32427408 PMCID: PMC7674244 DOI: 10.1002/ppul.24858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 05/17/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES (a) To quantify changes in mucociliary clearance (MCC) over time in children with cystic fibrosis (CF) and the relationship between MCC and rate of infection with Pseudomonas aeruginosa (PA); (b) to determine the impact of MCC on the evolution of CF lung disease; and (c) to explore the role of mucus composition as a determinant of MCC. METHODS Children with CF, who had previously undergone an MCC measurement (visit 1), underwent the following tests 3 to 10 years later: (a) second MCC measurement (visit 2); (b) multiple breath washout to assess ventilation inhomogeneity, expressed as lung clearance index (LCI); (c) high resolution computed tomography lung scan (HRCT); and (d) induced sputum test. Number of PA + cultures/year between visits was documented and mucus dry weight was quantified in the children and adult controls. RESULTS Nineteen children completed both visits. Median time between visits was 4.6 years. Clearance declined 30% between visits. Lower MCC on visit 2 was associated with more PA+ cultures/year between visits. Lower MCC values on visit 1 were associated with higher LCI values and higher HRCT scores on visit 2. Mucus dry weight was significantly higher in children with CF compared with controls. Higher dry weights were associated with lower MCC. CONCLUSIONS Mucociliary clearance declines significantly over time in children with CF. The decline is associated with PA infection rate and is affected by mucus composition. Children with early slowing of MCC appear to be at risk for developing ventilation inhomogeneity and parenchymal lung damage when they are older.
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Tojima I, Kikuoka H, Ogawa T, Shimizu T. Severely infected pneumoceles of the frontal sinus in patients with mental retardation and brain atrophy treated by endoscopic sinus surgery. Auris Nasus Larynx 2017; 45:362-366. [PMID: 28511889 DOI: 10.1016/j.anl.2017.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/03/2017] [Accepted: 04/12/2017] [Indexed: 11/19/2022]
Abstract
We herein present three cases of abnormally expanded frontal sinuses (pneumoceles) with severe infection in patients with mental retardation and brain atrophy. Two patients previously underwent laryngotracheal separation surgery, and bacteriological examinations of purulent nasal discharge revealed infections caused by drug-resistant bacteria such as Pseudomonas aeruginosa and Acinetobacter baumannii. As conservative medical treatments were ineffective, all three patients were treated by computed tomography-guided endoscopic sinus surgery. This navigation system is useful for safer surgery in the area of anatomic deformity. The clinical findings, possible etiologies and surgical treatment of these cases are discussed.
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Morita F, Hirai Y, Suzuki K, Uehara Y, Mitsuhashi K, Takahashi M, Watanabe S, Naito T. The First Case of Pseudomonas aeruginosa Bacteremic Pneumonia in a Cancer Patient Receiving Pegfilgrastim. Intern Med 2017; 56:2039-2042. [PMID: 28768977 PMCID: PMC5577083 DOI: 10.2169/internalmedicine.56.8245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A single dose of pegfilgrastim or the daily administration of colony-stimulating factors can be used to prevent febrile neutropenia. This may delay the detection of rapidly progressive infections among cancer patients undergoing chemotherapy. We report a case of Pseudomonas aeruginosa bacteremic pneumonia that occurred in a patient receiving pegfilgrastim.
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Errichetti E, Stinco G. Dermoscopy: a useful tool for assisting the diagnosis of Pseudomonas folliculitis. An Bras Dermatol 2016; 91:835-836. [PMID: 28099614 PMCID: PMC5193203 DOI: 10.1590/abd1806-4841.20165382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 03/08/2016] [Indexed: 11/21/2022] Open
Abstract
This report describes the usefulness of dermoscopy as a supportive diagnostic tool in a pseudomonas folliculitis case.
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Setoguchi M, Iwasawa E, Hashimoto Y, Isobe M. A patient with infective endocarditis caused by community-acquired Pseudomonas aeruginosa infection. Intern Med 2013; 52:1259-62. [PMID: 23728567 DOI: 10.2169/internalmedicine.52.9059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
An 85-year-old woman complaining of nausea was admitted to our hospital after being found to have complete atrioventricular block. We diagnosed the patient with infective endocarditis after observing vegetation on transesophageal echocardiography (TEE) and detecting Pseudomonas aeruginosa in a blood culture. The patient had no history of intravenous drug use, instrumentation or valvular disease. Although sensitive antibiotics were administered intravenously, the second TEE performed on the 10th day demonstrated increased vegetation. The patient developed septic shock and died on the 14th day. To our knowledge, this is the first report of infective endocarditis caused by community-acquired Pseudomonas aeruginosa in Japan.
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Chan W, Poh E, Bartholomeusz D, Selva D. Novel use of positron emission tomography/computed tomography in the diagnosis of infected porous orbital implant. Clin Exp Ophthalmol 2012; 39:704-5. [PMID: 22452688 DOI: 10.1111/j.1442-9071.2011.02535.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chakraborty D, Bhattacharya A, Kamaleshwaran KK, Agrawal K, Gupta AK, Mittal BR. Single photon emission computed tomography/computed tomography of the skull in malignant otitis externa. Am J Otolaryngol 2012; 33:128-9. [PMID: 21764178 DOI: 10.1016/j.amjoto.2011.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 05/23/2011] [Indexed: 11/29/2022]
Abstract
Malignant otitis externa is a severe, rare infective condition of the external auditory canal and skull base. The diagnosis is generally made from a range of clinical, laboratory, and imaging findings. Technetium 99m methylene diphosphonate bone scintigraphy is known to detect osteomyelitis earlier than computed tomography. The authors present a patient with bilateral malignant otitis externa where the extent of skull base involvement was determined on 3-phase bone scintigraphy with single photon emission computed tomography/computed tomography.
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Shaulov A, Benenson S, Cahan A, Hiller N, Korem M. A 44-year-old man with cavitary pneumonia and shock. Neth J Med 2011; 69:402-406. [PMID: 21978987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Dawson NL, Brumble LM, Pritt BS, Yao JD, Echols JD, Alvarez S. Left-sided Pseudomonas aeruginosa endocarditis in patients without injection drug use. Medicine (Baltimore) 2011; 90:250-255. [PMID: 21694647 DOI: 10.1097/md.0b013e3182252133] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We aimed to determine the clinical features, predisposing factors, and outcome of left-sided Pseudomonas aeruginosa endocarditis in persons with no history of injection drug use. We performed a retrospective review of patient medical records from Mayo Clinic (Rochester, MN; Scottsdale, AZ; and Jacksonville, FL) for all cases of left-sided P. aeruginosa endocarditis. We identified 4 cases. We present these cases, as well as a review of the English-language medical literature. Data gathered included the year the case was reported; the valve involved; treatment, including valve replacement surgery; and outcome, if known. Left-sided P. aeruginosa endocarditis in persons without injection drug use is a rare but serious infection, with a history of instrumentation as a common predisposing condition. Valvular surgery is indicated, when possible, for the best chance of survival, along with extended therapy with combination antibiotics for complete recovery.
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Javad A, Vahid P, Kazem G, Alireza S, Gholamali G, Qulamreza K. Piperacillin/tazobactam in treatment of brain abscess. ACTA ACUST UNITED AC 2009; 38:224-6. [PMID: 16500789 DOI: 10.1080/00365540500348978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Central nervous system (CNS) infection is a common complication following renal transplantation. Successful management of a brain abscess usually requires a combination of antibiotics and surgical drainage for both diagnostic and therapeutic purposes. We report the successful treatment of a patient with multiple brain abscesses with piperacillin/tazobactam without surgical intervention.
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Baĭgozina EA, Sovalkin VI, Lukach VN. [Analysis of the clinical features and outcome of ventilator-associated Pseudomonas aeruginosa-related pneumonia in an intensive care unit]. ANESTEZIOLOGIIA I REANIMATOLOGIIA 2009:62-64. [PMID: 19514444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The occurrence, the course, and outcome of ventilator-associated pneumonia (VAP) related to Pseudomonas aeruginosa were prospectively followed up in 51 patients treated at an intensive care unit. The characteristic feature of P. aeruginosa-induced VAP was its severe course and poor prognosis (mortality was 38%). More than half of cases were found to have bilateral lung injury with the upper left lung being involved. Lung tissue destruction and edema were rather frequent complications. The predictors of death in VAP caused by P. aeruginosa are admission to an intensive care unit, septic shock, and infection.
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Santoshi JA, Pallapati SC, Thomas BP. Haematogenous pseudomonas osteomyelitis of the hamate--treatment by radical debridement and bone grafting. J Plast Reconstr Aesthet Surg 2008; 63:189-90. [PMID: 19041290 DOI: 10.1016/j.bjps.2008.08.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 07/31/2008] [Accepted: 08/21/2008] [Indexed: 11/19/2022]
Abstract
A case of isolated chronic osteomyelitis of the hamate bone in a 13-year-old boy, who presented with a sinus on the dorsum of the hand, is reported. Radiological examination revealed multiple marginal and intra-osseous lytic areas with sclerotic rims in the hamate and at the fourth and fifth metacarpal bases. He was treated with excision of the sinus, curettage of the hamate lesion and hamato-metacarpal fusion which provided satisfactory control of infection while salvaging the function of the affected hand.
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De Jong GM, Blankensteijn JD, Schultze Kool LJ, Van Der Vliet JA. Percutaneous treatment of aortic graft infection. THE JOURNAL OF CARDIOVASCULAR SURGERY 2008; 49:400-401. [PMID: 18446129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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El-Khuffash AF, Molloy EJ, Walsh K. Left atrial appendage mimicking an intra-cardiac vegetation in preterm neonates. Neonatology 2008; 93:113-6. [PMID: 17703106 DOI: 10.1159/000107353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Accepted: 06/13/2007] [Indexed: 11/19/2022]
Abstract
Infective endocarditis is emerging as a significant cause of morbidity in the neonatal intensive care with an incidence ranging from 0.07 to 4.3%. The rise in incidence may be explained by the increasing availability of echocardiography facilities in the neonatal unit. The diagnosis of infective endocarditis has major therapeutic implications as the neonate is treated with potentially toxic drugs and exposed to prolonged intravenous catheters. However, the consequences of a missed diagnosis of endocarditis in preterm neonates are unknown and may potentially lead to significant long-term cardiac complications. Onsite echocardiography in the neonatal unit by neonatologists may improve the speed of diagnosis in cases of endocarditis. However, lack of adequate training and experience in normal echocardiographic views may increase the false-positive rate. The posterior mitral valve leaflet is rarely affected due to the low velocity of blood passing through and because of the absence of prosthesis. We report 2 cases of the left atrial appendage rarely mimicking a posterior mitral valve leaflet vegetation, leading to an erroneous diagnosis of infective endocarditis. The features which distinguish the left atrial appendage from a posterior mitral valve leaflet vegetation are illustrated.
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Goldman M, Rosenfeld-Yehoshua N, Lazarovitch T, Aladjem M, Grisaru-Soen G. [Nitrite test in Pseudomonas aeruginosa urinary tract infections]. HAREFUAH 2007; 146:578-80, 648. [PMID: 17853549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
UNLABELLED Pseudomonas aeruginosa (PA) is considered to be bacteria with a low capability to produce nitrite. OBJECTIVE To investigate the incidence of a positive urine nitrite test in community-acquired urinary tract infections (UTI) in children, caused by PA. METHODS The medical records of 38 children (18 females) admitted for febrile PA UTI during a period of 7 years were reviewed. Urine nitrite tests were carried out using dipstrips, and results were reported as positive or negative. RESULTS Of the 38 patients, 17 had a positive nitrite test and 21 had a negative test (proportion of positive 0.45, 95% confidence interval 0.29 to 0.61). Pyuria was detected in 13/17 patients with a positive nitrate test vs. 5/21 with a negative test (p=0.003). Data regarding renal ultrasound (US) were available for 35 patients, and in 20 abnormalities were detected, 14/17 in the positive vs. 6/18 in negative nitrite group (p = 0.001). CONCLUSION The urine nitrite test may be positive in PA UTI, therefore, a positive test does not rule out Pseudomonas UTI.
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Tay E, Bainbridge J, da Cruz L. Subretinal abscess after scleral buckling surgery: a rare risk of retinal surgery. ACTA ACUST UNITED AC 2007; 42:141-2. [PMID: 17361261 DOI: 10.3129/can] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
CASE REPORT Intraocular infections after scleral buckling surgery for retinal detachment are very rare. COMMENTS We document, on ultrasound B-scan, a rare case of subretinal abscess after scleral buckling surgery.
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Ataman TS. Cholesteatoma of the tympanic part of the temporal bone. Int Tinnitus J 2007; 13:45-8. [PMID: 17691662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This article presents accounts of two patients with cholesteatoma of the tympanic part of the temporal bone, located immediately lateral to the tympanic annulus (and with an intact tympanic membrane). The lesions were located deep in the anterior and inferior walls of the canal, especially in the vaginal process of the tympanic part. These more severe cases required surgical correction (removal of the sac of cholesteatoma) with very good results. Pathogenesis and differential diagnosis are discussed.
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Izquierdo MJ, Gomez-Alamillo C, Ortiz F, Calabia ER, Ruiz JC, de Francisco ALM, Arias M. Acute renal failure associated with use of inhaled tobramycin for treatment of chronic airway colonization with Pseudomonas aeruginosa. Clin Nephrol 2006; 66:464-7. [PMID: 17176920 DOI: 10.5414/cnp66464] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aminoglycoside nephrotoxicity is a well-known clinical entity that complicates the course of infectious diseases treated under this antibiotic regime. Recently, a new administration form of tobramycin, inhaled tobramycin (TOBI), has been approved to improve the antibacterial activity and reduce nephrotoxicity. We describe the clinical case of a 73-year-old woman with chronic-obstructive pulmonary disease (COPD) who developed acute renal failure (ARF) after using TOBI. Clinical presentation and biochemical parameters were compatible with aminoglycoside-induced renal failure. Based on the clinical findings presented here, a surveillance program should be established to monitor the presence of factors predisposing to renal failure, and to measure serum levels of tobramycin.
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Chaar BT, Kudva GC, Frey S, Wolverson MK. A rod in the spine. Am J Med 2006; 119:1045-7. [PMID: 17145248 DOI: 10.1016/j.amjmed.2006.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Revised: 10/03/2006] [Accepted: 10/03/2006] [Indexed: 11/26/2022]
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Busi Rizzi E, Schininà V, Bordi E, Buontempo G, Narciso P, Bibbolino C. HIV-related bronchopulmonary infection by Pseudomonas aeruginosa in the HAART era: radiological findings. Acta Radiol 2006; 47:793-7. [PMID: 17050357 DOI: 10.1080/02841850600827569] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate whether highly active antiretroviral therapy (HAART) modifies radiographic appearances of Pseudomonas aeruginosa bronchopulmonary infection in HIV-infected patients. P. aeruginosa is increasingly reported as a respiratory pathogen in HIV+ patients with very low levels of CD4 lymphocytes. Few studies have analyzed the radiological presentation of bronchopulmonary disease that occurs in HAART-treated patients. MATERIAL AND METHODS We retrospectively reviewed the chest radiographs of 46 HIV-infected patients with bronchopulmonary diseases in which P. aeruginosa was the sole respiratory pathogen that was isolated. All cases were community-acquired infection. Twenty-four of the patients were on HAART treatment, and 22 were not. Chest radiographs were assessed for the presence and distribution of parenchymal consolidation, reticular or reticulonodular infiltrates, bronchial wall thickening, ground-glass opacities, cavitation, pleural effusion, and adenopathies. Statistical analysis was done using Epi-Info version 6 (CDC, Atlanta, GA, USA). RESULTS Normal chest radiographs were observed in 11 patients. Eight of these 11 (73%) were receiving HAART, and 3/11 (27%) were not. The most common radiographic abnormality was bronchopneumonia, present in 24 of 46 patients (52%): in 10 of 24 (42%) patients with HAART and 14 of 22 (64%) without. Cavitation was seen in 1 of 24 (4%) patients with HAART and in 5 of 22 (23%) without HAART. CONCLUSION Cavitation was more frequent in patients that were not receiving HAART, and normal chest radiographs were more frequently seen in patients on HAART.
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Debes JD, Lopez-Morra H, Dickstein G. A psoas abscess caused by Pseudomonas aeruginosa due to diverticular perforation. Am J Gastroenterol 2006; 101:2168. [PMID: 16968518 DOI: 10.1111/j.1572-0241.2006.00763_7.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Kennedy MP, Noone PG, Carson J, Molina PL, Ghio A, Zariwala MA, Minnix SL, Knowles MR. Calcium stone lithoptysis in primary ciliary dyskinesia. Respir Med 2006; 101:76-83. [PMID: 16757159 DOI: 10.1016/j.rmed.2006.04.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2006] [Revised: 04/12/2006] [Accepted: 04/16/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND An association between lithoptysis and primary ciliary dyskinesia (PCD) has not been previously reported. However, reports of lithoptysis from 2 older patients (>60 yr) prompted a study of this association. METHODS We performed a prospective study of all PCD patients presenting to our institution between August 2003 and March 2006, seeking the symptom of lithoptysis or calcium deposition on radiology. A retrospective analysis of all PCD patients presenting prior to August 2003 was also performed. Patients age > or = 40 previously reviewed were recontacted. If a history of lithoptysis or calcium deposition was present, we further reviewed radiographic, microbiologic, and biochemical data, including serum calcium and phosphate. Broncholiths were analyzed by light and electron microscopy- and electron-dispersive X-ray analysis. RESULTS In total, 142 patients (n=28 age > or = 40) were included, 41 in the prospective and 91 in the retrospective study. Lithoptysis was reported in 5 patients (all age > or = 40). Chest CT scans identified calcification (4/5), involving bronchiectatic airways in 3 patients and focal nodular calcification in 1 patient. Two other patients (age 46, 59) were identified with airway calcification without lithoptysis. Available broncholiths from 2 of these patients were composed of calcite, whereas a broncholith from 1 patient with focal nodular calcification contained calcium phosphate. Sputum was positive for Pseudomonas aeruginosa in all 7 patients, but negative for mycobacterial and fungal cultures. CONCLUSION There is an association between lithoptysis and PCD in patients age > or = 40. We hypothesize that calcite stone formation is a biomineralization response to chronic airway inflammation and retention of infected airway secretions in PCD in a subset of PCD patients.
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