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Barp N, Marcacci M, Biagioni E, Serio L, Busani S, Ventura P, Franceschini E, Orlando G, Venturelli C, Menozzi I, Tambassi M, Scaltriti E, Pongolini S, Sarti M, Pietrangelo A, Girardis M, Mussini C, Meschiari M. A Fatal Case of Pseudomonas aeruginosa Community-Acquired Pneumonia in an Immunocompetent Patient: Clinical and Molecular Characterization and Literature Review. Microorganisms 2023; 11:1112. [PMID: 37317086 DOI: 10.3390/microorganisms11051112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 06/16/2023] Open
Abstract
Rare cases of Pseudomonas aeruginosa community-acquired pneumonia (PA-CAP) were reported in non-immunocompromised patients. We describe a case of Pseudomonas aeruginosa (PA) necrotizing cavitary CAP with a fatal outcome in a 53-year-old man previously infected with SARS-CoV-2, who was admitted for dyspnea, fever, cough, hemoptysis, acute respiratory failure and a right upper lobe opacification. Six hours after admission, despite effective antibiotic therapy, he experienced multi-organ failure and died. Autopsy confirmed necrotizing pneumonia with alveolar hemorrhage. Blood and bronchoalveolar lavage cultures were positive for PA serotype O:9 belonging to ST1184. The strain shares the same virulence factor profile with reference genome PA01. With the aim to better investigate the clinical and molecular characteristics of PA-CAP, we considered the literature of the last 13 years concerning this topic. The prevalence of hospitalized PA-CAP is about 4% and has a mortality rate of 33-66%. Smoking, alcohol abuse and contaminated fluid exposure were the recognized risk factors; most cases presented the same symptoms described above and needed intensive care. Co-infection of PA-influenza A is described, which is possibly caused by influenza-inducing respiratory epithelial cell dysfunction: the same pathophysiological mechanism could be assumed with SARS-CoV-2 infection. Considering the high rate of fatal outcomes, additional studies are needed to identify sources of infections and new risk factors, along with genetic and immunological features. Current CAP guidelines should be revised in light of these results.
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Affiliation(s)
- Nicole Barp
- Infectious Diseases, Azienda Ospedaliera-Universitaria of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Matteo Marcacci
- Internal Medicine, Azienda Ospedaliera-Universitaria of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Emanuela Biagioni
- Intensive Care Unit, Azienda Ospedaliera-Universitaria of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Lucia Serio
- Intensive Care Unit, Azienda Ospedaliera-Universitaria of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Stefano Busani
- Intensive Care Unit, Azienda Ospedaliera-Universitaria of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Paolo Ventura
- Internal Medicine, Azienda Ospedaliera-Universitaria of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Erica Franceschini
- Infectious Diseases, Azienda Ospedaliera-Universitaria of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Gabriella Orlando
- Infectious Diseases, Azienda Ospedaliera-Universitaria of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Claudia Venturelli
- Microbiology, Azienda Ospedaliera-Universitaria of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Ilaria Menozzi
- Risk Analysis and Genomic Epidemiology Unit, Experimental Zooprophylactic Institute of Lombardy and Emilia-Romagna, 43126 Parma, Italy
| | - Martina Tambassi
- Risk Analysis and Genomic Epidemiology Unit, Experimental Zooprophylactic Institute of Lombardy and Emilia-Romagna, 43126 Parma, Italy
| | - Erika Scaltriti
- Risk Analysis and Genomic Epidemiology Unit, Experimental Zooprophylactic Institute of Lombardy and Emilia-Romagna, 43126 Parma, Italy
| | - Stefano Pongolini
- Risk Analysis and Genomic Epidemiology Unit, Experimental Zooprophylactic Institute of Lombardy and Emilia-Romagna, 43126 Parma, Italy
| | - Mario Sarti
- Microbiology, Azienda Ospedaliera-Universitaria of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Antonello Pietrangelo
- Internal Medicine, Azienda Ospedaliera-Universitaria of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Massimo Girardis
- Intensive Care Unit, Azienda Ospedaliera-Universitaria of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Cristina Mussini
- Infectious Diseases, Azienda Ospedaliera-Universitaria of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Marianna Meschiari
- Infectious Diseases, Azienda Ospedaliera-Universitaria of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
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Franquet T, Domingo P. Pulmonary Infections in People Living with HIV. Radiol Clin North Am 2022; 60:507-520. [DOI: 10.1016/j.rcl.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cook AE, Garrana SH, Martínez-Jiménez S, Rosado-de-Christenson ML. Imaging Patterns of Pneumonia. Semin Roentgenol 2021; 57:18-29. [DOI: 10.1053/j.ro.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/14/2021] [Accepted: 10/17/2021] [Indexed: 11/11/2022]
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Al-Jaghbeer MJ, Justo JA, Owens W, Kohn J, Bookstaver PB, Hucks J, Al-Hasan MN. Risk factors for pneumonia due to beta-lactam-susceptible and beta-lactam-resistant Pseudomonas aeruginosa: a case–case–control study. Infection 2018; 46:487-494. [DOI: 10.1007/s15010-018-1147-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/05/2018] [Indexed: 12/18/2022]
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Sakamoto N, Tsuchiya K, Hikone M. Community-acquired necrotizing pneumonia with bacteremia caused by Pseudomonas aeruginosa in a patient with emphysema: An autopsy case report. Respir Investig 2018; 56:189-194. [PMID: 29548659 DOI: 10.1016/j.resinv.2017.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/02/2017] [Accepted: 12/20/2017] [Indexed: 11/16/2022]
Abstract
We report the case of a 47-year-old man with chronic obstructive pulmonary disease who was referred to our hospital for acute dyspnea. The radiologic findings revealed consolidation with a cavity in the left upper lobe of the lung. Blood/sputum cultures detected Pseudomonas aeruginosa. Despite intensive care, the patient died from respiratory failure. Autopsy revealed multiple small necrotizing cavities that had coalesced. Although P. aeruginosa is a known causative pathogen of community-acquired pneumonia in patients with structural lung disease, the radiologic findings were non-specific. Irrespective of imaging findings, P. aeruginosa should be considered a cause of community-acquired pneumonia.
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Affiliation(s)
- Naoya Sakamoto
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan.
| | - Kyohei Tsuchiya
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan
| | - Mayu Hikone
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan
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Garg M, Prabhakar N, Kiruthika P, Agarwal R, Aggarwal A, Gulati A, Khandelwal N. Imaging of Pneumonia: An Overview. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0209-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Comparison of high-resolution computed tomography findings between Pseudomonas aeruginosa pneumonia and Cytomegalovirus pneumonia. Eur Radiol 2014; 24:3251-9. [DOI: 10.1007/s00330-014-3326-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 06/25/2014] [Accepted: 07/08/2014] [Indexed: 01/15/2023]
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Okada F, Ono A, Ando Y, Nakayama T, Ishii R, Sato H, Kira A, Tokimatsu I, Kadota J, Mori H. Thin-section CT findings in Pseudomonas aeruginosa pulmonary infection. Br J Radiol 2012; 85:1533-8. [PMID: 22844034 DOI: 10.1259/bjr/54468236] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess clinical and pulmonary thin-section CT findings in patients with acute Pseudomonas aeruginosa (PA) pulmonary infection. METHODS We retrospectively identified 44 patients with acute PA pneumonia who had undergone chest thin-section CT examinations between January 2004 and December 2010. We excluded nine patients with concurrent infections. The final study group comprised 35 patients (21 males, 14 females; age range 30-89 years, mean age 66.9 years) with PA pneumonia. The patients' clinical findings were assessed. Parenchymal abnormalities, enlarged lymph nodes and pleural effusion were evaluated on thin-section CT. RESULTS Underlying diseases included malignancy (n=13), a smoking habit (n=11) and cardiac disease (n=8). CT scans of all patients revealed abnormal findings, including ground-glass opacity (n=34), bronchial wall thickening (n=31), consolidation (n=23) and cavities (n=5). Pleural effusion was found in 15 patients. CONCLUSION PA pulmonary infection was observed in patients with underlying diseases such as malignancy or a smoking habit. The CT findings in patients with PA consisted mainly of ground-glass attenuation and bronchial wall thickening. ADVANCES IN KNOWLEDGE The CT findings consisted mainly of ground-glass attenuation, bronchial wall thickening and cavities. These findings in patients with an underlying disease such as malignancy or a smoking habit may be suggestive of pneumonia caused by PA infection.
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Affiliation(s)
- F Okada
- Department of Radiology, Oita University Faculty of Medicine, Japan.
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Gharabaghi MA, Abdollahi SMM, Safavi E, Abtahi SH. Community acquired Pseudomonas pneumonia in an immune competent host. BMJ Case Rep 2012; 2012:bcr.01.2012.5673. [PMID: 22669213 DOI: 10.1136/bcr.01.2012.5673] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pseudomonas aeruginosa is an uncommon cause of community-acquired pneumonia in immune-competent hosts. It is commonly seen in patients with structural lung abnormality such as cystic fibrosis or in immune compromised hosts. Here, the authors report a case of community-acquired Pseudomonas pneumonia in a 26-year old healthy man who presented with 8-week history of malaise and cough.
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Affiliation(s)
- Mehrnaz Asadi Gharabaghi
- Department of Pulmonary Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
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10
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Fujitani S, Sun HY, Yu VL, Weingarten JA. Pneumonia Due to Pseudomonas aeruginosa. Chest 2011; 139:909-919. [DOI: 10.1378/chest.10-0166] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Fujita T, Gu Y, Kishida N, Okinaka K, Ohmagari N. [Two cases of bacteremic pneumonia caused by Pseudomonas aeruginosa in solid-organ cancer patients]. ACTA ACUST UNITED AC 2010; 84:588-91. [PMID: 20960938 DOI: 10.11150/kansenshogakuzasshi.84.588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Pseudomonas aeruginosa, the leading nosocomial pneumonia pathogen in immunocompromised patients, has Recently become typically presented as slowly progressive ventilator-associated pneumonia. We report two cases of bacteremic pneumonia due to Pseudomonas aeruginosa in non-neutropenic solid-organ cancer. Both subjects had sudden sepsis or septic shock but few respiratory symptoms. Chest radiography showed a diffuse unilateral decrease in permeability, becoming necrotizing pneumonia and lung abscess in 7-10 days. Conventional literature describe fulminant pseudomonas bacteremic pneumonia in non-neutropenic immunocompromised hosts as the initial presentation with septic shock and interstitial lung opacity, leading lung abscess.
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Affiliation(s)
- Takahiro Fujita
- Division of Infectious Diseases, Shizuoka Cancer Center Hospital
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Okada F, Ando Y, Honda K, Nakayama T, Ono A, Tanoue S, Maeda T, Mori H. Acute Klebsiella pneumoniae pneumonia alone and with concurrent infection: comparison of clinical and thin-section CT findings. Br J Radiol 2010; 83:854-60. [PMID: 20647513 DOI: 10.1259/bjr/28999734] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The purpose of this study was to identify the clinical and thin-section CT findings in patients with acute Klebsiella pneumoniae pneumonia (KPP) alone and with concurrent infection. We retrospectively identified 160 patients with acute KPP who underwent chest thin-section CT examinations between August 1998 and August 2008 at our institution. The study group comprised 80 patients (54 male, 26 female; age range 18-97 years, mean age 61.5) with acute KPP alone, 55 (43 male, 12 female; age range 46-92 years, mean age 76.0) with KPP combined with methicillin-resistant Staphylococcus aureus (MRSA) and 25 (23 male, 2 female; age range 56-91 years, mean age 72.7) with KPP combined with Pseudomonas aeruginosa (PA). Underlying diseases in patients with each type of pneumonia were assessed. Parenchymal abnormalities were evaluated along with enlarged lymph nodes and pleural effusion. In patients with concurrent pneumonia, underlying conditions such as cardiac diseases, diabetes mellitus and malignancy were significantly more frequent than in patients with KPP alone. The mortality rate in patients with KPP combined with MRSA or PA was significantly higher than in those with KPP alone. In concurrent KPP, CT findings of centrilobular nodules, bronchial wall thickening, cavity, bronchiectasis, nodules and pleural effusion were significantly more frequent with concurrent pneumonia than in those with KPP alone.
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Affiliation(s)
- F Okada
- Department of Radiology, Oita University Faculty of Medicine, Oita, Japan.
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Abstract
PURPOSE OF REVIEW Pneumonia is one of the major infectious diseases responsible for significant morbidity and mortality throughout the world. Radiological imaging plays a prominent role in the evaluation and treatment of patients with pneumonia. This paper reviews recent innovations in the radiologic diagnosis and management of suspected pulmonary infections. RECENT FINDINGS Chest radiography is the most commonly used imaging tool in pneumonias because of availability and an excellent cost-benefit ratio. Computed tomography is mandatory in unresolved cases or when complications of pneumonia are suspected. A specific radiologic pattern can suggest a diagnosis in many cases. Bacterial pneumonias are classified into four main groups: community-acquired, aspiration, healthcare-associated and hospital-acquired pneumonia. The radiographic patterns of community-acquired pneumonia may be variable and are often related to the causative agent. Aspiration pneumonia involves the lower lobes with bilateral multicentric opacities. The radiographic patterns of healthcare-associated and hospital-acquired pneumonia are variable, most commonly showing diffuse multifocal involvement and pleural effusion. SUMMARY Combination of pattern recognition with knowledge of the clinical setting is the best approach to the radiologic interpretation of pneumonia. Radiological imaging will narrow the differential diagnosis of direct additional diagnostic measures and serve as an ideal tool for follow-up examinations.
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Affiliation(s)
- Sat Sharma
- Sections of Pulmonary and Critical Care Medicine, University of Manitoba, St. Boniface General Hospital, Canada.
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Abstract
Pneumonia is one of the leading causes of morbidity, hospitalization, and mortality in both industrialized and developing countries. In particular, pulmonary infections acquired in the community, and pneumonias arising in the hospital setting, represent a major medical and economic problem and thus a continuous challenge to health care. For the radiologist, it is important to understand that community-acquired pneumonia (CAP) and nosocomial pneumonia (NP) share a number of characteristics, but should, in many respects be regarded as separate entities. CAP and NP arise in different populations, host different spectra of causative pathogens, and pose different challenges to both the clinician and the radiologist. CAP is generally seen in outpatients, is most frequently caused by Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, and Chlamydia, and its radiologic diagnosis is relatively straightforward. NP, in contrast, develops in the hospital setting, is commonly caused by gram-negative bacteria, and may generate substantial problems for the radiologist. Overall, both for CAP and NP, imaging is an integral component of the diagnosis, important for classification and differential diagnosis, and helpful for follow-up.
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Affiliation(s)
- Christian J Herold
- Department of Radiology, University of Vienna, Vienna General Hospital, Austria.
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Tuengerthal S. Pneumonien. Thorax 2003. [DOI: 10.1007/978-3-642-55830-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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