Objective To summarize the characteristics of disseminated Penicillium marneffei infection.Methods The clinical, imageological and bacteriological characteristics were summarized by reviewing one case of disseminated Penicillium marneffei infection in an immunocompetent patient diagnosed in our hospital and the related literatures. Results The patient was a 32-year-old Guangdong male, whose main clinical features were fever, cough, and the abscess of pulmonary, tracheomucosa and subcutaneous. Routine blood examination showed leukocytosis. Other laboratory examination revealed multiple lesions of heart, liver, and kidney. Multiple masses histopathology revealed inflammation, but the culture from the purulent exudates were negative and standard antibiotic therapy was useless. Bronchoscope revealed gray nodus on airway mucosa. Under the direction of bacteriologist, final diagnosis of Penicillium marneffei infection was obtained by the fungal culture from the purulent exudates and the deep sputum. Conclusions Penicillium marneffei can infect immunocompetent patients. Disseminated Penicillium marneffei infection should be considered when patients presented with multiple organ lesions and multiple subcutaneous pyogenic masses which can not explained by connective tissue disease or common pyogenic infection, and with epidemiology of southeast life history.
Objective Chronic cough is often present as increasing cough reaction to various physical and chemical stimulating factors. This study is aimed to investigate the difference of cough sensitivity and its mechanisms which are not clear among different causes of chronic cough. Methods Patients with chronic cough were recruited from cough clinic of Guangzhou Institute of Respiratory Diseases between 2005 to 2010. Using a modified diagnostic algorithm of chronic cough, common causes were identified. Capsaicin cough provocation test was also performed in these patients to assess the cough threshold. The relations between cough reflex sensitivity and duration of cough, cough severity, pulmonary function, induced sputum cell counts were then investigated. Results Through the diagnostic algorithm of chronic cough, the current study evaluated 133 adult patients, including 24 cases with upper airway cough syndrome (UACS) , 26 patients with cough variant asthma (CVA) , 31 cases with eosinophilic bronchitis (EB) , 30 patients with atopic cough (AC) , 22 cases with gastroesophageal reflux induced cough (GERC) . There were 30 healthy volunteers recruited as normal control. The cough threshold of LgC5 in AC, CVA, EB, GERC and UACS was 1.70 ±0.70, 2.12 ±0.67, 2.13 ±0.69, 1.69 ±0.73, 2.16 ±0.66, respectively. The LgC5 of the normal group ( 2.63 ±0.39) was higher than those in chronic cough groups( All P lt; 0.05) . The LgC5 of AC and GERC were lower than CVA, EB and UACS ( all Plt;0.05) . Duration and daytime score of cough showed positive correlations with LgC5( r =-0. 280, -0. 168, all P lt;0.05) . Pulmonary function and differential cell count of induced sputumwere not associated with LgC5 ( all Pgt;0.05) . Conclusions Different cause of chronic cough exhbit high cough reflex sensitivity to different extent. The difference of cough sensitivity may reflect the different pathogenesis among different causes, and may be related to the type of nerve fiber dominating the cough reflex.
【Abstract】 Objective To study the role of house dust mite ( HDM) induced airway epithelium TLR4 expression and T lymphocyte activation in asthmatic inflammation. Methods Thirty BALB/ c mice were randomly divided into an ovalbumin ( OVA) group, a HDMgroup, and a control group. The mice in the OVA group were sensitized with OVA and Al( OH) 3 , and repeatedly exposed to aerosolized OVA. The mice in the HDMgroup and the control group were sensitized and challenged with HDMand saline, respectively.Histopathology changes of pulmonary tissue and airway were observed under light microscope. Levels of IL-4, IL-5, IL-13, IL-17, and IFN-γin BALF were measured by ELISA. Total and differential cell counts in bronchoalveolar lavage fluid ( BALF) were also measured. The mRNA and protein expressions of TLR4 weredetected by quantitative real-time PCR and Western blot, respectively. Th1, Th2, and cells in the peripheral blood were detected by flow cytometry. Results Light microscope revealed eosinophil specific inflammatory cells infiltration around the peribronchovascular region,mucus gland hyperplasia, and airway mucous plug inthe OVA group. The HDM group showed more severe alveolar and intersititial congestion and neutrophils infiltration. The control group showed intact alveolus with few mucous plug and inflammatory cells.Compared with the OVA group, significant increases in the number of total cells and neutrophils, as well as significantly higher expression of IL-4, IL-5, IL-13, and IL-17 were detected in the HDMgroup ( P lt;0. 05) ,while IFN-γexpression had no significant change ( P gt;0. 05) . The expression of TLR4 mRNA and protein significantly increased in the HDMgroup( P lt; 0. 05) , and did not change significantly in the other two groups ( P gt;0. 05) . The percentages of Th2 and Th17 cells in peripheral blood in the HDMgroup were significantly higher than the OVA group ( P lt;0. 05) . Conclusion HDM may induce inflammatory cells infiltration andactivation of Th2 and Th17 lymphocyte cells via up-regulation of TLR4 expression in airway epithelium,which might play an important role in asthmatic inflammation.