Authenticity of pulmonary Lophomonas blattarum infection: A case report

Pulmonary protozoal infections are rare. A 28-year-old woman was admitted to hospital with chief complains of cough, sputum, and dyspnea. The clinical laboratory tests for blood revealed an increased eosinophil percentage of 31.3%and significantly elevated total IgE. The chest computed tomography scan revealed that bilateral bronchial walls were thickening, accompanied with patchy spots scattered throughout bilateral lungs. A suspected multiflagellated protozoan was observed under a light microscope. But some different features were observed by electron microscopy, such as the orientation of flagella and nucleus. Besides, both bronchoalveolar lavage fluid and bronchoscopic brush smears underwent Gram staining and Pap staining, which revealed that numerous respiratory ciliated cells were scattered or accumulated in the sample.Finally, she was diagnosed with eosinophil pneumonia. Metronidazole,bronchodilators, and mucolytics were taken for 5 d and symptoms and pulmonary ventilation function improved. We herein report a case of chronic eosinophilic pneumonia, which was misdiagnosed as multiflagellated protozoan infection, and it is suggested that reliable diagnosis approaches are necessary,rather than clinical symptoms and morphological features.

Antimicrobial resistance profiles of ESKAPE and Escherichia coli isolated from blood at a tertiary hospital in China

Bloodstream infections(BSIs)have emerged as a worldwide concern because of their increasing incidence,mortality,and associated healthcare cost.Strains in ESKAPE including Enterococcus faecium(E.faecium),Staphylococcus aureus(S.aureus),Klebsiella pneumonia(K.pneumonia),Acinetobacter baumannii(A.baumannii),Pseudomonas aeruginosa(P.aeruginosa),and Enterobacter spp.,as well as Escherichia coli(E.coli),account for more than half of the causative pathogens of BSI.[1]Moreover,the incidences and resistance rates of ESKAPE and E.coli have changed in recent years.A study in Rome found that E.coli,followed by S.aureus,was the most frequently identified microorganism;further,the study revealed that,regardless of hospital or community-onset,the number of extended-spectrumβ-lactamases-producing E.coli was increasing,and carbapenemase-producing K.pneumoniae had become more prevalent during the study period.[1]A recent study suggested upward resistance trends of ESKAPE and E.coli organisms isolated from blood cultures from 2014 to 2018 in a hospital in Italy.[2]The frequencies and resistance rates of ESKAPE and E.coli are most likely interrelated with the spectrum of disease,geographical situation,antimicrobial management,and hand hygiene.Since 2012,some requirements have been gradually executed according to the Measures for the Administration of Clinical Application of Antibiotics(Decree No.84 of the Ministry of Health),the Guidelines for Clinical Application of Antibiotics(2015 edition),and the Notice on Continuous Management of Clinical Application of Antibiotics(General Office of the National Health Commission,2018)at our hospital.However,it is unclear whether these measures are effective to minimize the antibiotic resistance rate.This study investigated the resistance rates and antimicrobial resistance indexes(ARIs)of ESKAPE and E.coli isolated from blood samples at our hospital,and aimed to contribute to the research on ESKAPE and E.coli in China as well as the availability of methods for antibiotic administration.