Pyopneumothorax Caused by Trichomonas tenax and Porphyromonas endodontalis Coinfection in a Patient with Previous Cerebral Infarction: A Case Report and Literature Review

Background

Even with the advent of NGS and PCR diagnostic tools, cases of chest infections caused by Trichomonas are still very rare. Such pathogens are less likely to be considered by clinicians. These cases frequently involve the pleura and lead to pneumothorax, hydropneumothorax, or pyopneumothorax, making the disease severe.

Case Presentation

A 69-year-old man diagnosed with cerebral infarction a year ago sought medical attention for right-sided pyopneumothorax and respiratory failure. The pathogen found in the pleural fluid was highly suspected to be Trichomonas tenax (T. tenax). Pleural fluid mNGS confirmed T. tenax and Porphyromonas endodontalis coinfection. Metronidazole combined with piperacillin tazobactam was administered to counteract infection. Simultaneously, closed chest drainage and thoracoscopic release of pleural adhesions were performed. The patient was cured, discharged from the hospital, and was in good condition after six months of follow-up.

Conclusion

When chest infections occur in patients with poor oral hygiene and underlying diseases that may lead to aspiration, the identification of Trichomonas infection should be noted. Early confirmation of the diagnosis often requires mNGS and PCR. Metronidazole is essentially effective against Trichomonas, and medical thoracoscopy can be used to manage pleural conditions if necessary.

Successful treatment of Talaromyces marneffei pneumonia in a HIV-negative renal transplantation recipient: A case report

RATIONALE

Talaromyces marneffei causes life-threatening opportunistic fungal infections in immunocompromised patients. It often has a poorer prognosis in non-human immunodeficiency virus (HIV)-infected than in HIV-infected individuals because of delayed diagnosis and improper treatment.

PATIENT CONCERNS

A 51-year-old man presented with complaints of pyrexia, cough, and expectoration that had lasted for 15 day. This patient has been taking anti-rejection medication since kidney transplant in 2011.

DIAGNOSIS

T marneffei pneumonia; post renal transplantation; renal insufficiency; hypertension.

INTERVENTIONS

Intravenous moxifloxacin was administered on admission. After the etiology was established, moxifloxacin was discontinued and replaced with voriconazole. The tacrolimus dose was adjusted based on the blood concentration of tacrolimus and voriconazole.

OUTCOMES

The patient was successfully treated and followed-up without recurrence for 1 year.

LESSONS

A high degree of caution should be maintained for the possibility of T marneffei infection in immunodeficient non-HIV patients who live in or have traveled to T marneffei endemic areas. Early diagnosis and appropriate treatment can prevent progression of T marneffei infection and achieve a cure. Metagenomic next-generation sequencing (mNGS) can aid the physician in reaching an early pathogenic diagnosis. Close monitoring of tacrolimus and voriconazole blood levels during treatment remains a practical approach at this time.

Strongyloides stercoralis hyperinfection syndrome mimicking pseudomembranous enteritis, complicated by Escherichia coli bacteremia and Pneumocystis jirovecii pneumonia in a patient after immunosuppressive therapy: a case report

Background

Strongyloidiasis, caused by Strongyloides stercoralis (S. stercoralis), is endemic worldwide, especially in countries with warm and humid climates. Strongyloides stercoralis hyperinfection syndrome (SHS) is an extremely serious manifestation of strongyloidiasis, which results from an acute exacerbation of auto-infection and is often fatal.

Case presentation

We present a case of SHS mimicking pseudomembranous enteritis with a final definitive diagnosis of a triple infection including S. stercoralis, Escherchia coli (E. coli) and Pneumocytis jirovecii (P. jirovecii) that occurred in a microscopic polyangiitis (MPA) patient after immunosuppressive therapy. SHS, together with E. coli bacteremia and Pneumocytis jirovecii pneumonia (PJP) in the same patient, is rare in clinical practice, which is first reported worldwide, to our knowledge. After the diagnosis was confirmed, the treatment protocol was quickly adjusted; however, the patient’s life could not be saved.

Conclusion

This case reminds us of the necessity to consider strongyloidiasis as a differential diagnosis in immunocompromised populations who live in or have visited to S. stercoralis endemic areas, especially patients with suspected pseudomembranous enteritis, even if stool examination, serological tests, and eosinophilia are negative. For this group, it is advisable to complete the relevant endoscopy and/or PCR as soon as possible. The fundamental solution to prevent this catastrophic outcome is to implement effective preventive measures at multiple levels, including physicians, patients, and relevant authorities.

Portulaca Oleracea-associated oxalate nephropathy complicated with an ANCA-positive acute renal injury: A case report

Oxalate nephropathy is a rare disease that can lead to acute kidney injury (AKI). In clinical practice, as renal biopsy is required for diagnosis, physicians often do not have sufficient understanding of this disease. When AKI is associated with positive blood anti-neutrophil cytoplasmic antibodies (ANCA), a diagnosis of renal injury due to ANCA-associated vasculitis is likely to be made, leading to treatment with immunosuppressive therapy. A case of AKI after eating a large quantity of Portulaca oleracea is reported. While blood P-ANCA was positive, both urine proteinuria and urine occult blood were negative. Renal biopsy was performed and identified an acute tubulointerstitial injury: disc-shaped crystals were seen in the lumen of renal tubules that demonstrated birefringence under polarized light, and an oxalate nephropathy was therefore diagnosed. Typical histological changes of an ANCA-associated vasculitis with renal injury such as cellulose-like necrosis and crescent formation were not present. After the patient stopped eating P. oleracea, and following rehydration and hemodialysis, renal function returned to normal. In patients with AKI, the secondary causes of hyperoxalemia should be sought and attention paid to excluding an oxalate nephropathy. In patients with AKI who are ANCA-positive, it is prudent to complete the renal pathological diagnostic process before assuming that the renal injury is caused by an ANCA-associated vasculitis, and before starting hormone and immunosuppressive therapy.

A case of triple infection including strongyloides stercoralis in a microscopic polyangiitis patient

We present the case of a microscopic polyangiitis (MPA) patient who developed strongyloidiasis, nocardia and citrobacter freundii (CF) infection after corticosteroides and immunosuppressant therapy. When digestive, respiratory or other system symptoms consecutively occur in a immunocompromised host who lives in tropical or temperate zone and have close contact with soil, we should take strongyloidiasis into consideration despite absence of eosinophilia. Mixed infection with nocardia cannot be easily excluded. It is essential to search for the etiology proof with multiple approaches positively and repeatedly.

[Effects of p-Phenylene diamine on liver and kidney functions of occupational exposed workers]

Objective: To study the effect of p-phenylenediamine (PPD) on liver and kidney function in occupational exposed workers. Methods: Workers in a hair dye production enterprise which used p-phenylenediamine as a raw material for production were selected as the main research population. Then we conducted a questionnaire survey on the basic conditions of workers and conducted occupational health checkups on general health status, liver and kidney function. Occupational health examination assessment results were tested in Taizhou Cancer Hospital. All data was built using EpiData 3.1 software, and statistical analysis was performed using software SPSS 20.0. Results: The liver function indicators including direct bilirubin, prealbumin, total protein, and white protein, globulin, aspartate aminotransferase, glutamyl transpeptidase, and total bilirubin in the workers exposed to high concentration of PPD were at high normal values, and these indicators were significantly different from low PPD concentration group (P<0.05) . The serum creatinine and serum uric acid in the renal function index were significantly higher in workers exposed to PPD than in workers exposed to low concentrations and in the control group (P<0.05) . Conclusion: Occupational exposed to PPD may have a hazard to the workers' liver and kidney function. Long-term occupational exposure to PPD may lead to increased cumulative exposure of workers, which may cause potential chronic liver and kidney damage in occupationally exposed populations.

Endostatin Gene Therapy for Endometriosis in Rats

Objective:

Endostatin gene therapy for endometriosis was studied in an experimental autotransplantation model in rats.

Methods:

Endometriotic lesions were transfected by intralesional injection of the plasmid lipofectamine-endostatinpBud (group 1), lipofectamine-pBud (empty vector; group 2) or phosphatebuffered saline (group 3). Endostatin mRNA and protein levels in lesions were evaluated by quantitative real-time reverse transcription-polymerase chain reaction and Western blot analysis. Endostatin and vascular endothelial growth factor (VEGF) protein levels in serum, and microvessel density (MVD) and matrix metalloproteinase (MMP)-2 protein levels in endometriotic lesions, were also determined.

Results:

Lipofectamine- endostatin-pBud injection increased endostatin mRNA and protein levels in lesions. Lesions were significantly smaller, and serum VEGF levels significantly lower, in group 1 versus controls. Serum VEGF was significantly and negatively correlated with serum endostatin. In group 1, MMP-2 levels and MVD were significantly lower versus controls. MMP-2 level was negatively correlated with endostatin.

Conclusions:

Gene therapy with endostatin appears to be an effective treatment for endometriosis. Restoration of endostatin gene expression by gene transfer in vivo might be a potential gene therapy approach for human endometriosis.

In vitro and in vivo antimicrobial activity of Xenorhabdus bovienii YL002 against Phytophthora capsici and Botrytis cinerea

AIMS

Developing new bio-agents to control plant disease is desirable. Entomopathogenic bacteria Xenorhabdus spp. have potential antimicrobial activity in agriculture. This work was conducted to evaluate the antimicrobial activity of Xenorhabdus bovienii YL002 on plant pathogenic fungi and oomycete in vitro and the efficiency of this strain to reduce the in vivo incidence of grey mould rot on tomato plants caused by Botrytis cinerea and leaf scorch on pepper plants caused by Phytophthora capsici.

METHODS AND RESULTS

The antimicrobial activity of X. bovienii YL002 was firstly determined on in vitro plant pathogenic fungi and oomycete and then on tomato fruits and plants infected with B. cinerea and pepper plants infected with P. capsici. The cell-free filtrate of X. bovienii YL002 exhibited highest inhibition effects (>98%) on mycelia growth of P. capsici and B. cinerea. The 50% inhibition concentration (EC₅₀) of the methanol-extracted bioactive compounds (methanol extract) of the cell-free filtrate against P. capsici and B. cinerea were 164·83 and 42·16 μg ml⁻¹. The methanol extract also had a strong effect on the spore germination of P. capsici and B. cinerea, with a EC₅₀ of 70·38 and 69·33 μg ml⁻¹, respectively. At 1000 μg ml⁻¹, the methanol extract showed a therapeutic effect of 70·82% and a protective effect of 77·4% against B. cinerea on tomato plants compared with the control. The methanol extract also showed potent effect against P. capsici, with a therapeutic effect of 68·14% and a protective effect of 65·46% on pepper plants compared with the control.

CONCLUSIONS

Xenorhabdus bovienii YL002 produces antimicrobial compounds with strong activity on plant pathogenic fungi and oomycete and has the potential for controlling grey mould rot of tomato plants and leaf scorch of pepper and could be useful in integrated control against diverse plant pathogenic fungi and oomycete.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study showed the potential that X. bovienii YL002 can be used to control the grey mould rot caused by B. cinerea on tomato plants and leaf scorch caused by P. capsici on pepper plants with the objective to reduce treatments with chemical fungicides.

Sex differentials in perinatal mortality in China and Finland

This study describes patterns of sex differentials in perinatal mortality in China and Finland. The analysis is based on three population-based one-year birth cohorts, one from Qingdao, China, in 1992 and two from Northern Finland in 1966 and 1985-86, comprised of 9,219, 11,422 and 9,207 singletons with at least 28 gestational weeks and 1000 g in birthweight, respectively. Both Finnish cohorts had an excess of male over female perinatal deaths, but in the Chinese cohort girls were more likely to die than boys. The adjusted odds ratio (OR) of perinatal mortality for boys was 1.31 (95 per cent confidence interval [CI] 0.98, 1.78) and 1.57 (95 per cent CI 0.89, 2.78) in the Finnish 1966 and 1985-86 cohorts, respectively, and 0.82 (95 per cent CI 0.55, 1.20) in the Chinese cohort. The corresponding figure for stillbirths in the Chinese was 0.57 (95 per cent CI 0.33, 0.98), which could explain the total excess of female deaths during the perinatal period. Our results suggest that the role of different social and cultural environments on the existing sex differentials in perinatal mortality between the countries needs further evaluation.

[Toxicity of drugs on nasal mucocilia and the method of its evaluation]

Effect of solutions or suspensions of eight drugs including analgin, paracetamol, propafenone hydrochloride, propranolol hydrochloride, ephedrine hydrochloride, gentamycin sulfate, sodium deoxycholate and hydrocortisone on ciliary movement were evaluated with in vitro or in situ toad palate model and scanning electron microscope. In vitro toad palate model: 0.2 ml of test drug solution or suspension was applied to a piece of freshly dissected upper palate of toad. The mucocilia were examined with an optical microscope and the lasting time of ciliary movement was recorded after drug application. The upper palate was rinsed with physiological saline when the ciliary movement stopped. The lasting time of ciliary movement after rinsing was then recorded again. In situ palate model: 0.5 ml of test drug solution or suspension was applied to the upper palate of toad for 30 min, and rinsed with physiological saline. The palate was dissected out and the operation was carried out in a similar manner. The results showed that the in situ toad palate model is a satisfactory method for studying the ciliotoxicity of drugs. The in vitro toad palate model is unsuitable for suspension and gel. The results of the eight drugs revealed that ciliary movement is frequently affected by many drugs and, therefore, care must be taken in developing any nasal dosage form to ensure its least ciliotoxicity.

[Comparison of concentration of piroxicam in blood and local site after two routes of administration]

The systematic and local concentrations of piroxicam after oral and transdermal administration were determined and compared. Mice were randomly grouped, and oral suspensions (0.72 mg.ml-1) or transdermal gels 1 mg.ml-1 were given. Systematic concentration (Cs) and local concentration (C1) of the drug in each mouse were determined by HPLC method. After transdermal administration of 0.25 mg of piroxicam gels Cmax(s) = 8.06 micrograms.ml-1 and AUC(s)0-24(s) = 58.36 micrograms.h.ml-1 were obtained, whereas after oral administration of 0.026 mg.10 g-1 body weight of piroxicam suspensions Cmax(s) was 36.82 micrograms.ml-1 and AUC(s)0-24 was 155.59 micrograms.h.ml-1. The C1/Cs ratio (0.01) through oral route was far lower than the C1/Cs ratio (0.13) through transdermal route. The area under local concentration-time curve (15.85 micrograms.h.ml-1) calculated from transdermal administration was much higher than that from oral administration (1.93 micrograms.h.ml-1). So, it seems to be unreasonable that only serum concentration is taken as a criterion for bioavailability test of piroxicam for local dosage forms, the local drug concentration should also be investigated and evaluated.