Lung abscess: 14 years of experience in a tertiary paediatric hospital

Diagnosis and treatment of refractory infectious diseases using nanopore sequencing technology: Three case reports

BACKGROUND

Infectious diseases are still one of the greatest threats to human health, and the etiology of 20% of cases of clinical fever is unknown; therefore, rapid identification of pathogens is highly important. Traditional culture methods are only able to detect a limited number of pathogens and are time-consuming; serologic detection has window periods, false-positive and false-negative problems; and nucleic acid molecular detection methods can detect several known pathogens only once. Three-generation nanopore sequencing technology provides new options for identifying pathogens.

CASE SUMMARY

Case 1: The patient was admitted to the hospital with abdominal pain for three days and cessation of defecation for five days, accompanied by cough and sputum. Nanopore sequencing of the drainage fluid revealed the presence of oral-like bacteria, leading to a clinical diagnosis of bronchopleural fistula. Cefoperazone sodium sulbactam treatment was effective. Case 2: The patient was admitted to the hospital with fever and headache, and CT revealed lung inflammation. Antibiotic treatment for Streptococcus pneumoniae, identified through nanopore sequencing of cerebrospinal fluid, was effective. Case 3: The patient was admitted to our hospital with intermittent fever and an enlarged neck mass that had persisted for more than six months. Despite antibacterial treatment, her symptoms worsened. The nanopore sequencing results indicate that voriconazole treatment is effective for Aspergillus brookii. The patient was diagnosed with mixed cell type classical Hodgkin's lymphoma with infection.

CONCLUSION

Three-generation nanopore sequencing technology allows for rapid and accurate detection of pathogens in human infectious diseases.

The Enigma of Recurrent Lung Abscess: Management and Outcomes in a School-Aged Child With a Review of Literature

Pediatric lung abscess is a rare and poorly studied disease entity. In the past, prolonged courses of intravenous (IV) antibiotics have been successfully used; however, with the advent of interventional radiology, the main therapeutic approach is through percutaneous placement of pigtail catheters with ultrasound and computed tomography (CT) direction, where available. The pathogen yield identified from fluid samples of the abscess has dramatically increased owing to the greater invasive measures, such as aspiration and drainage, as well as enhanced microbiological diagnostic methods, which also include polymerase chain reaction testing. In our case report, in 2012 when the patient was two years old, she was diagnosed with pulmonary Koch's and underwent anti-Koch's therapy, category 2. High-resolution CT of the chest revealed a large lobulated cavitary lesion with an air-fluid level suggestive of a right lung abscess. After initial therapy with IV antibiotics for three weeks and a negative tuberculosis work-up, she underwent right limited lateral thoracotomy and drainage with decortication of the right lung abscess (LA) in 2019 via a left endobronchial tube with a bronchial blocker (general endobronchial anesthesia). All samples sent for histopathologic examination after surgery yielded negative results, and she was discharged after a course of injectable antibiotics for 21 days. She remained almost symptom-free for the next four years. Thereafter, she presented with a right LA recurrence due to a thick-walled cavitary lesion, with a severely damaged right lower lung lobe resulting in right lower lobectomy under single-lung ventilation (double-lumen endotracheal tube No. 26 Fr.). Culture results should guide management, particularly for immunocompromised patients, as the LA may be attributed to complications arising from underlying conditions. Primary lung abscesses (PLA) in children are typically caused by Staphylococcus aureus, Streptococcal species, and Klebsiella pneumoniae. Compared to adults, children with PLA and secondary lung abscesses have a meaningfully greater rate of recovery.

Point-of-care ultrasound in early diagnosis and monitoring of deep abscess in newborns: a case report of two cases

Objective

This study sought to analyze the value of point of care ultrasound (POCUS) in early diagnosis and monitoring of deep abscess in newborns.

Methods

Retrospective analysis of the clinical data of two newborns admitted to the Neonatal Intensive Care Unit (NICU) of our hospital and diagnosed with deep abscess of the newborn. Combined with literature analysis, the value of POCUS in early diagnosis and monitoring of deep abscess of the newborn was evaluated.

Results

The two newborns reported in this article were all admitted to NICU due to" "fever". POCUS was used to assist in early diagnosis of "liver abscess" and "lung abscess". Subsequently, POCUS was used to monitor lesion changes and adjust treatment plans. All patients were cured and discharged with a good prognosis.

Conclusions

Deep abscesses in newborns are very rare and often life-threatening, but apart from fever, they often have no specific clinical manifestations and are easily misdiagnosed or missed. POCUS, as a bedside auxiliary examination tool, has high accuracy, radiation free, non-invasive, and convenient, and has high diagnostic and monitoring value in early diagnosis and monitoring of deep abscess in newborns.

Lung abscess by Fusobacterium nucleatum and Streptococcus spp. co-infection by mNGS: A case series

A lung abscess is a necrotizing infection caused by microbiomes that lead to the loss of healthy lung tissue. The routine culture is a waste of time and yields false-negative results, and clinicians could only choose empiric therapy or use broad-spectrum antibiotics, which could significantly contribute to the problem of resistance or aggravate the condition. We report three patients with a routine-culture-negative lung abscess. The presenting symptoms included fever, cough, dyspnea, and chest pain, and a computed tomography scan revealed a lesion in the lungs. The bronchoalveolar lavage fluid and pleural fluid were tested for pathogens using metagenome next-generation sequencing (mNGS), and the results revealed Fusobacterium nucleatum and Streptococcus spp. (S. constellatus, S. intermedius) as the most represented microbial pathogens. Our data demonstrated that mNGS could be a promising alternative diagnostic tool for pathogen detection, and the pathogen lists indicate that it will be important to focus on the Streptococcus genus rather than the dominant Streptococcus spp. in terms of co-infection of pathogen determined by shotgun mNGS.

Lung Abscess Case Series and Review of the Literature

(1) Background: Lung abscess is a lung infection that leads to the destruction of the lung parenchyma, resulting in a cavity formation and central necrosis filled with purulent fluids. It is an uncommon pediatric problem, and there is a paucity of literature reviews on this subject, especially for the pediatric age group. Lung abscess is commonly divided into those considered primary in previously well children or secondary in those with predisposing co-morbidities. The predominant pathogens isolated from primary lung abscesses are the aerobic organisms, including streptococcal species, Staphylococcus aureus, and Klebsiella pneumoniae, while anaerobic bacteria such as Bacteroides species are predominant in secondary groups. Children usually present with fever, cough, shortness of breath, chest pain, and sputum. While physical examination may reveal diffuse crackles on auscultation, the diagnosis is usually confirmed by chest X-ray. (2) Methods: We report four different cases with lung abscesses from both primary and secondary group with similar presentations and radiological findings, but the approach was different in each according to the underlining cause. (3) Conclusions: Conservative therapies with a prolonged course of antibiotics remain the cornerstone of therapy for both primary and secondary lung abscesses. The underlying cause should be considered when there is a suboptimal response. However, invasive intervention is becoming more popular with better yield, shorter duration of antibiotics and admission, and excellent prognosis.