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We report an experience of successful treatment for a case of intractable chronic empyema complicated by bronchopleural fistula (BPF). A 75-year-old woman who had severe diabetes mellitus complained of general fatigue and anorexia. A lung abscess in the right upper lobe was diagnosed and treated with antibiotics. Regrettably, it ruptured into a pyopneumothorax. The BPF was closed primarily and covered with intercostal muscle, but the procedure was not effective. The pyopneumothorax led to the development of chronic empyema with BPF. The patient was admitted to our hospital for treatment and the BPF was managed with a Dumon stent and endobronchial Watanabe spigot (EWS) but failed to heal. Therefore, open drainage was chosen as a 1st stage treatment. After healing the infected space, closure of the BPF and a bronchial embolization by EWS was performed with a closeire of space by pediculed omentum and muscle flap and with a thoracoplasty as a 2nd stage treatment. The postoperative course was uneventful, and the patient was discharged on post-operative day 51.
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PMID:[Experience of successful treatment for a case of intractable chronic empyema with a bronchopleural fistula]. 2021 53

We report the case of a 27-year-old man with a history of diabetes mellitus who presented with conscious disturbance, fever, and stiff neck after upper respiratory tract infection. Following diagnosis of meningoencephalitis, antibiotic therapy and deamethasone was initiated. He received endotracheal tube intervention under mechanical ventilation in the intensive care unit, and underwent successful weaning on day 4. One week later, he was diagnosed with pneumonia and a rapidly progressing lung empyema with abscess formation was noted. Microbiological culture of the pleural fluid revealed the presence of Pseudomonas aeruginosa. Nosocomial pneumonia is often caused by Staphylococcus aureus and P. aeruginosa; however, the latter often causes bronchopneumonia rather than fulminant empyema or lung abscess formation. The underlying diabetes mellitus and the history of steroid therapy may explain the present condition of this patient. The possibility of P. aeruginosa being the causative agent should be considered during differential diagnosis in patients presenting with fulminant lung empyema, especially in immunocompromised patients.
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PMID:[Fulminant lobulated lung empyema caused by Pseudomonas aeruginosa]. 2255 23

A 58-year-old man with a history of diabetes mellitus and end-stage renal disease acquired pneumonia with acute respiratory failure during his stay in an intensive care unit (ICU). Empirical antimicrobial therapy with ceftazidime and vancomycin was initiated, and imipenem replaced ceftazidime 2 days later due to the patients pulmonary condition failed to improve. However, within 5 days, pulmonary consolidation rapidly progressed to necrotizing pneumonia complicated by lung abscess, empyema, pyopneumothorax, and tension pneumothorax, leading to the patient's death. After the patient had died, all bacterial isolates from cultures of pleural effusion, blood, and tracheal aspirate were identified as Enterobacter cloacae (E. cloacae), which was susceptible to imipenem but resistant to ceftazidime. E. cloacae should be considered in the differential diagnosis of complicated necrotizing pneumonia with lung abscess, empyema, pyopneumothorax, and tension pneumothorax. Carbapenem therapy should be immediately initiated until the pathogen in such rapidly progressive ICU-acquired pneumonia is confirmed. Increased awareness among physicians regarding E. cloacae-induced complicated necrotizing pneumonia acquired in ICUs could enable earlier detection and appropriate antimicrobial therapy for this invasive disease.
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PMID:Intensive care unit-acquired complicated necrotizing pneumonia caused by Enterobacter cloacae: A case report. 3056 23

Objective In Japan, the aging demographic structure is becoming pronounced, and the full-blown graying of society appears not far off, which indicates an increasing population that will require healthcare contact. Klebsiella spp. are major pathogens in healthcare-associated infections, and their importance is increasing. The aim of this study was to clarify the characteristics of Klebsiella spp. chest infections by evaluating the differences in the characteristics of chest infections caused by Klebsiella spp. and pneumoniae. Methods We conducted a retrospective study of consecutive patients hospitalized with pneumonia, lung abscess/necrotizing pneumonia, and empyema due to Klebsiella spp. and S. pneumoniae for 15 years at our institution in Saitama, Japan. Patients Patients with chest infections due to Klebsiella spp. (K group, n=76) and S. pneumoniae (S group, n=446) were included. Results The K group more frequently was male, older, coinfected by Pseudomonas aeruginosa, and had diabetes mellitus, a history of upper digestive system surgery, alcohol drinking habit, a smoking habit, and an impaired premorbid performance status than the S group. The percentages of lung abscesses or necrotizing pneumonia (31.6% vs. 0.9%) and empyema without pulmonary parenchymal shadow (3.9% vs. 0.7%) were higher in the K group than those in the S group. Severity on admission and mortality did not differ between the groups; however, patients in the K group required a longer duration of antibiotics administration and hospital stay than those in the S group. Conclusion Klebsiella spp. chest infections have some marked characteristics when compared with pneumococcal infections, and our results serve to differentiate Klebsiella spp. infection from pneumococcal infection.
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PMID:Comparison between Patients with Chest Infection due to Klebsiella spp. and Streptococcus pneumoniae. 3176 85

Hypervirulent Klebsiella pneumoniae (HV-KP) is typically associated with community-acquired liver abscess and bacteremia with metastatic infection; however, primary lung abscess (PLA) caused by HV-KP is rare, with only one such case report to date. A 69-year-old man with a history of diabetes mellitus (DM) was admitted to hospital complaining of slight bloody sputum. Chest imaging showed multiple consolidations with cavities in both lung fields. A culture of bronchoalveolar lavage fluid confirmed the presence of K. pneumoniae. Genetic analyses identified the isolate as serotype K2 and sequence type 375 (K2-ST375), and that it harbored the rmpA gene. The patient was an Asian middle-aged male with DM, all of which are risk factors for HV-KP infection. Although complicating DM and the presence of the rmpA gene are more likely to induce disseminated infection, metastatic infections were not found in this patient. The clinical and microbiological characteristics of our patient were different from those of a previous reported case, although in both cases the patient was from Asia and had DM. Therefore, DM appears to be one of the predisposing factors for HV-KP lung abscesses and physicians should pay attention to emerging HV-KP lung abscess infection, particularly in Asian countries. Previous studies have also revealed that K2-ST375 is one of the major clones causing HV-KP infection, and that it is mainly isolated from patients with liver abscess. Interestingly, including the present case, most of the infectious cases caused by K2-ST375 have been reported from Okinawa Prefecture in Japan. Therefore, the trend of the K2-ST375 strain should be carefully monitored, particularly in Okinawa, Japan. The serotype of HV-KP that causes PLA is still unknown and further study is needed to elucidate the etiology of PLA due to HV-KP and the relationship between the strain K2-ST375 and PLA.
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PMID:Case Report of Primary Lung Abscesses Due to Hypervirulent Klebsiella pneumoniae (Serotype K2, Sequence Type 375): an Emerging Isolate in Okinawa, Japan. 3260 19

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) (polyglandular endocrinopathy type 1) is a rare autosomal recessive disorder caused by mutations in the autoimmune regulator gene (AIRE). The major clinical features of APECED are hypoparathyroidism, adrenal insufficiency (Addison disease), and chronic mucocutaneous candidiasis. This disease is also associated with multiple other and uncommon autoimmune (autoimmune hepatitis, autoimmune enteropathy, atrophic gastritis with or without pernicious anemia, gonadal failure, diabetes mellitus, hypothyroidism, functional hyposplenism), ectodermal (alopecia and vitiligo), and inflammatory (intestinal lung disease, nephritis) features. Here, we report a case of a 13-year-old Turkish boy who presented wih enteropathy and lung abscess. Molecular genetic analysis demonstrated a homozygous frameshift mutation (p.Asp70fs, c.208_209insCAGG) in exon 2, in AIRE gene. APECED may present with severe, life-threatening infections due to functional hyposplenism. Multidisciplinary approach, careful follow-up, and molecular genetic studies are needed.
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PMID:A Patient With AIRE Mutation Who Presented With Severe Diarrhea and Lung Abscess. 3328 51


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