Clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment

PURPOSEWe aimed to investigate clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment.MATERIALS AND METHODSWe retrospectively reviewed the medical records, initial and follow-up chest computed tomography scans and/or radiographs for initial clinical and radiologic manifestations and outcomes following antifungal treatment of 12 immunocompetent patients diagnosed with pulmonary cryptococcosis between 1990 and 2012.RESULTSTwelve patients (age range, 21–62 years; males, eight patients [66.7%]) were included. Nine (75%) patients were symptomatic, eight of whom had disseminated infection with central nervous system involvement. Initial pulmonary abnormalities consisted of single nodules/masses (n=5), single segmental or lobar mass-like consolidation (n=3), multiple cavitary and noncavitary nodules (n=1), and multifocal consolidation plus nodules (n=3). These lesions ranged from less than 1 cm to 15 cm in greatest diameter. Distinct subpleural and lower lung predominance was observed. Seven patients (58.3%) had one or more atypical/aggressive findings, namely endobronchial obstruction (n=4), calcified (n=1) or enlarged (n=4) mediastinal/hilar lymph nodes, vascular compression (n=1), pericardial involvement (n=1), and pleural involvement (n=2). Following antifungal therapy, radiologic resolution was variable within the first six months of eight nonsurgical cases. Substantial (>75%) improvement with some residual abnormalities, bronchiectasis, cavitation, and/or fibrotic changes were frequently observed after 12–24 months of treatment (n=6).CONCLUSIONPulmonary cryptococcosis in immunocompetent patients frequently causes disseminated infection with atypical/aggressive radiologic findings that are gradually and/or incompletely resolved after treatment. The presence of nonenhanced low-attenuation areas within subpleural consolidation or mass and the absence of tree-in-bud appearance should raise concern for pulmonary cryptococcosis, particularly in patients presenting with meningitis

Dietary Germinated Paddy Rice and Stocking Density Affect Egg Performance, Serum Biochemical Properties, and Proteomic and Transcriptomic Response of Laying Hens Exposed to Chronic Heat Stress

Germinated paddy rice (GPR) could be a good alternative feed source for poultry with stocking density and heat stress problems. A total of 72 Hy-line Brown laying hens raised under low (LSD, 0.12 m2/bird) and high stocking densities (HSD, 0.06 m2/bird) were investigated. Three dietary GPR levels (0, 74 and 148 g/kg) were used. It was found that average daily feed intake, hen-day egg production, and egg mass significantly decreased in the HSD group. The levels of serum glucose (GLU), phosphorous (P), corticosterone (CORT), total Ig, lysozyme (LZY), and superoxide dismutase activities (SOD) in the HSD group were higher than those in the LSD group. Dietary GPR significantly affected GLU, P, alternative complement haemolytic 50 (ACH50), total Ig, and LZY. Moreover, CORT level significantly decreased in 74 and 148 g/kg dietary GPR groups, whereas SOD significantly increased only in the 148 g/kg dietary GPR group. Serum samples were analyzed using liquid chromatography-tandem mass spectrometry, and 8607 proteins were identified. Proteome analysis revealed 19 proteins which were enriched in different stocking densities and dietary GPR levels. Quantitative real-time reverse transcription-PCR technique was successfully used to verify the differentiated abundant protein profile changes. The proteins identified in this study could serve as appropriate biomarkers

Effects of aqua agar as water replacement for posthatch chicks during transportation on residual yolk-sac and growth performance of young broiler chickens

Water is one of the most essential nutrients for the maintenance of chicks' function, and delayed access to feed and water post hatch has been reported to dehydrate chicks. Aqua agar (AA) was formulated to contain more than 95% water and an experiment was conducted to evaluate the effects of AA as water replacement for posthatch chicks during transportation. During the simulated transport, chicks were held for 24 h with (AA group) or without (NO-AA group) aqua agar in chick boxes. During the holding period, chicks in the AA group lost less body weight, compared with the NO-AA group. However, the weight of residual yolk tended to be lower in the AA-treated birds. There were no significant differences in the weight of gizzard, proventriculus, and liver, nor in the weights and lengths of the duodenum, jejunum and ileum. A higher body weight was also observed in the AA group at 7 days of age. At 21 days of age, weight gain and feed intake were higher (P < 0.05) in the AA group, when compared to that of the NO-AA group. No significant differences were observed in the feed conversion rate (FCR) between the two groups. In conclusion, the data suggests that the use of AA as a water replacement could reduce the negative impact of water deficiency in posthatch period during transportation, resulting in greatly improved growth performance of young broilers at 21 days of age

Clinical and Pathological Correlation in Pediatric Invasive Pulmonary Aspergillosis

IntroductionInvasive’ pulmonary aspergillosis (IPA) has been one of the major causes of mortality in immunocompromised patients. The gold standard method for a diagnosis of IPA is histopathological examination of the lung tissue; however, post-procedural bleeding limits the feasibility of lung biopsy. The European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and The National Institute of Allergy and Infectious Disease Mycoses Study Group (EORTC/MSG) defined IPA. The objective of this study was to validate the EORTC/MSG 2008 definition of IPA, compared with histopathology in the pediatric population.MethodsHistopathological examinations of lung tissues of children aged 1 month–18 years with respiratory tract infection at the time of obtaining biopsy were retrieved. Retrospective chart reviews for clinical characteristics were performed. IPA diagnosis was classified according to the EORTC/MSG 2008 definition.ResultsDuring the 10-year period, there were 256 lung tissues, of which 58 specimens were suspected to have pulmonary infection. Fourteen patients (24%) were noted to have IPA. Seven patients (50%) with proven IPA were classified as probable, while the remaining 50% were classified as possible, and none were classified as no IPA, by using EORTC/MSG 2008 definition. Other 44 specimens demonstrated 14 (32%), 14 (32%), and 16 (36%) were classified as probable, possible, and no IPA, respectively. When comparing probable or possible IPA with no IPA, we found that the EORTC/MSG 2008 definition had 100% sensitivity, 36% specificity, 33% positive predictive value, and 100% negative predictive value in diagnosis of IPA.ConclusionOur study illustrated that the EORTC/MSG 2008 definition provided an excellent sensitivity but low specificity for diagnosing IPA

Rapidly progressive interstitial pneumonia associated with anti-NXP2 antibody secondary to malignancy

The diagnosis of a diffuse lung disease is challenging for physicians and it requires a multidisciplinary team approach to solve this problem. Herein, we present a case of common bile duct obstruction from pancreatic ductal adenocarcinoma after biliary stent placement, which developed a rapidly progressive bilateral lung infiltration after oesophagogastroduodenoscopy. After a diagnostic evaluation based on clinical, radiographic, and pathological findings, a diagnosis of rapidly progressive interstitial pneumonia associated with anti-nuclear matrix protein (NXP) 2 antibody secondary to malignancy was made. In patients with interstitial lung disease with unclear aetiologies, autoantibodies, including antinuclear antibody and myositis-specific antibodies should be evaluated, even if there are no clinical signs of autoimmune disease. Although this is the first case report of an acute interstitial pneumonitis-associated anti-NXP2 antibody, physicians should recognise this condition as it can rapidly cause acute fulminant respiratory failure

Histology of intestinal villi and epithelial cells in chickens fed low protein or low fat diets

To establish the intestinal histological alterations in chickens fed low crude protein (CP) or low crude fat (EE) in long-term isocaloric diets, 60 birds were allotted to three treatments, each with five replicates of four chickens. They were fed the control, low-CP, or low-EE diet from the age of 9 to 16 weeks. The chickens receiving the low-CP diet showed a clear reduction in performance and carcass characteristics like breast and wings. However, these adverse effects did not occur in the chickens fed the low-EE diet. The villus height in the duodenum and ileum were lower (P<0.05) in the low-CP group. The duodenal villus area decreased (P<0.05) in both the low-CP and low-EE groups, whereas the ileum showed a lower value (P<0.05) in only the low-CP group. The cell area of the duodenum and jejunum displayed decreasing values (P<0.05) in the low-CP and low-EE groups. As regards the mitotic numbers, the jejunum and ileum showed a decrease (P<0.05) in the low-CP group. On the villus tip surface in the duodenum of the control and low-EE groups, clear protuberant cells and cell clusters with a great number of epithelial cells were found. These cell clusters degraded to faintly dome-shaped cells in the low-CP group, resulting in a lower level of morphological changes than in the other two groups. The epithelial cells on the jejunal and ileal tip surfaces did not show a specific change in the treatment groups

Feeding Thai Native Sheep Molasses Either Alone or in Combination with Urea-Fermented Sugarcane Bagasse: The Effects on Nutrient Digestibility, Rumen Fermentation, and Hematological Parameters

The purpose of this study was to find out how adding molasses to fermented sugarcane bagasse (FSB) alone or in combination with urea affected sheep&rsquo;s rumen fermentation, hematological parameters, and ability to digest nutrients. Four Thai native sheep with an initial body weight (BW) of 20.87 &plusmn; 1.95 kg and 11 &plusmn; 1.0 months old were assigned to a 4 &times; 4 Latin square design with 4 periods of 14-d adaptation and 7 d of sample collection. Each treatment received a different combination of experimental roughage as follows: FSB without additives (T1), FSB + 10% molasses (T2), FSB + 20% molasses (T3), and FSB + 10% molasses + 3% urea (T4). The concentrate diet was fed twice daily at 2% BW, while roughage sources were provided ad libitum for each treatment. The crude protein (CP) digestibility in the T2 and T3 groups was higher (p &lt; 0.05) than in the FSB group without additions, with the T4 group having the highest (p &lt; 0.05). Although there were no significant differences in blood glucose, packed cell volume, ruminal pH, ammonia&ndash;nitrogen (NH3-N), propionic acid, or acetic acid, the plasma urea nitrogen (PUN) at 0 h was highest in the T4 group (p &lt; 0.05) compared with the other groups. However, the proportion of butyric acid tended to be higher in all FSB groups with additives. Thus, the current experiment concluded that the addition of molasses alone or in combination with urea had positive effects on pH and LAB population, and including both together in FSB improved the CP digestibility of sheep. In conclusion, FSB with 10% molasses and 3% urea might be used as an alternate roughage source for ruminants without affecting the animal&rsquo;s ruminal fermentation or hematological parameters