Human infection with Lophomonas sp. a protozoan that parasitizes the intestinal tracts of termites and cockroaches is extremely rare; also clinical features are not fully understood. China is the country with the majority of cases reported in the literature. Here, we reported a case of Lophomonas sp. infection confirmed by tracheal aspirate on the microscopic observations. The patient was a 49-year-old male from a jungle city called "Madre de Dios" where he works as taxi driver and stonemason. He was admitted to the Intensive Care Unit on February 5, 2013, because the course with respiratory failure and hypoxemia, high fever, and generalized myalgias. The patient was successfully treated by metronidazole 500 mg t.i.d. for 17 days. This is the first case report of Lophomonas sp. in Madre de Dios city in Peru.

Community-acquired pneumonia remains a major cause of morbidity and mortality globally. Streptococcus pneumoniae is recognized the main pathogen related to pneumonia in all site of care. However, recent advances in molecular techniques have led to recognized that respiratory viruses are a common and important cause of severe CAP. Also, in the last 10 years new respiratory viruses are recognized as potential infectious agents in pneumonia. Recent studies show that in approximately 10 to 40% of pneumonia cases are involved viral pathogens being influenza virus the most common respiratory virus. A better knowledge of the role of respiratory viruses especially in cases of severe pneumonia may lead to better management of this population. This review aimed to describe the main respiratory viruses involved in severe pneumonia, specially focus in the clinical presentation, diagnosis, therapy and outcomes.

Community-acquired pneumonia (CAP) is the most frequent infectious disease, responsible for a great morbidity and mortality worldwide. It is known that poor outcome in CAP patients is not only directly related to pneumonia but also to comorbidities both during hospitalization and long term after discharge. Evidences show a high correlation between acute respiratory infections and increased risk of cardiovascular events (CVEs), such as acute myocardial infarction, arrhythmias, congestive heart failure, and stroke. The excessive systemic inflammatory response is responsible for hypoperfusion and activation of cytokines causing endothelial dysfunction, pro-coagulant effects, and atheroma instability. An established diagnostic tool to identify high-risk patients is not yet available, but cardiovascular biomarkers seem to be more effective than inflammatory molecules. Early identification of patients at higher risk for CVEs is mandatory to treat them effectively with prophylaxis medications, to establish adequate clinical surveillance and prevention with vaccinations. The present article reviews the epidemiology, pathophysiology, clinical presentation, risk factors, diagnosis, outcomes, and prevention of CVEs in patients hospitalized for CAP.

Despite the recent advances in the pharmacotherapeutics of pediatric cancer, opportunistic invasive fungal infections still cause a significant mortality and morbidity in these immunocompromised population, being attributed to the continuous marrow suppression and aggressive chemotherapy. Mucormycosis is the third leading invasive fungal infection after candidiasis and aspergillosis. The elusive presentation and the pleiotropic clinical features of this rare, yet rapidly progressive and frequently fatal infection often cause diagnostic delays, thereby resulting in poor outcomes. A physician's early suspicion and preemptive treatment remains the important key element in the early identification, irrespective of the technological advancements. We report a case of disseminated mucormycosis in a child with relapsed acute lymphoblastic leukemia, who eventually succumbed to death despite timely intervention and appropriate treatment due to aggressive nature of the invasive fungal infection.

Background and Objectives: Particulate matter 2.5 (PM2.5) has been recognized as an important factor which may cause human respiratory tract related cancer and affect the growth of embryos. In this experiment, the toxicity of PM2.5 on zebrafish's embryos was explored. Methods: Zebrafish animal models were used in the experiment. The zebrafish embryos were exposed to PM2.5 solution of different concentrations, and the aggregation rate, the hatching rate and the malformation rate as the changes in the concentration of PM2.5 were observed. Result: The results showed that when the concentration of PM2.5 was 0-.250 μg/L, it had no significant effect (P > 0.05) on the embryo aggregation rate, the hatching rate or the malformation rate. When the concentration of PM2.5 was 500-.2500 μg/L, it had a significant effect (P < 0.05) on the embryo aggregation rate, the hatching rate and the malformation rate, and PM2.5 concentration was positively correlated with the embryo aggregation rate, but negatively correlated with the embryo hatching rate. Conclusion: The experiment shows PM2.5 has clear toxic effects on zebrafish embryos, which may provide a basis for further research on PM2.5 pathogenesis.

Background and Objectives: Human immunodeficiency virus (HIV)-related stigma is present at all levels which act as critical barriers for effectively addressing it. This also influences the treatment uptake and under or nonparticipation in treatment available. In view of this, the present study was aimed to assess the stigma of otherwise healthy individuals of the community toward HIV infection/acquired immunodeficiency syndrome (AIDS). Methods: The study was conducted on 100 healthy individuals. Their responses were taken on a self-designed semi-structured questionnaire. Results: The results showed that there is more perceived stigma as compared to enacted stigma. Nearly 46% of the individuals feel that HIV-infected persons should be blamed for their illness and 41% individuals feel that they will feel ashamed if they have HIV. It was also seen that older adults. (between 46 and 55 years) had more stigma as compared to the younger adults (between 16 and 25 years). The educated individuals still have stigma to a certain extent. Most of the individuals would like to tell their partner if they were diagnosed with HIV. Participants were divided into two groups on the basis of their level of education. (<12 years of formal education and >12 years of formal education). Stigma related to HIV/AIDS was compared among these two groups, and there was no significant difference in the level of stigma in these distinctly different educational groups. Conclusion: There is still stigma present to a certain extent in the society in the educated and urban individuals. Level of stigma may not be significantly different in people with educational difference. Stigma needs to be addressed for prevention and better management of HIV/AIDS.

Background and Objectives: Carbapenems and beta-lactam-beta-lactamase inhibitors are empirical drugs of choice in the treatment of urinary tract infection. (UTI); however, de-escalation of therapy is necessary to ensure compliance. Objectives: The objective is to study the impact of antibiotic susceptibility report on the management of community-acquired UTI. Materials and Methods: Patients were classified prospectively as uncomplicated UTI (UC-UTI) and complicated UTI (C-UTI), and symptoms, microbiology, antibiotic susceptibility pattern, and treatment modification following culture report were analyzed. Extended spectrum beta-lactamase (ESBL) prevalence in patients was compared among naive and those who received empirical treatment before presentation. Patients with a history of recurrent UTI were given prophylaxis and all were followed up for 1 month. SPSS version 20 package was used for statistical analysis. Results: Nearly 75% of the study population had C-UTI. Around 70% of C-UTI and 50% of UC-UTI had ESBL-producing Gram-negative enterobacteriace. In UC-UTI, failed empirical treatment before presentation at our center was significantly associated with positive ESBL producer status. Sensitivity to amikacin and carbapenems was over. 90%; nitrofurantoin and piperacillin-tazobactam followed at around 70%. Following culture report, a significant number of C-UTI were de-escalated to oral regimens. Conclusions: Despite the high prevalence of ESBL-producing pathogens in community.acquired UTI, once systemic signs of sepsis are controlled, de-escalation is possible in the majority of patients.

Bronchiectasis, defined as permanent dilatation of the airways, usually causes chronic cough and sputum production with intermittent bacterial exacerbations. Bronchiectasis can have a severe impact on quality of life for many patients due to these symptoms. Establishing the cause of bronchiectasis may be difficult. Even with exhaustive clinical, laboratory, and pathologic testing, up to 50-80% of cases of bronchiectasis may still be idiopathic. Congenital bronchiectasis is much rarer than previously considered. A variety of respiratory and systemic diseases such as autoimmune or rheumatologic diseases may be complicated by pathological bronchial dilatation, and therefore various medical specialists will be dealing with the condition in one-way or another. Some bowel diseases are associated with a variety of systemic manifestations including large and small airway involvement: One of the most commonly associated airway diseases is bronchiectasis. On this regard, we report five patients with bronchiectasis and rare diseases admitted to our hospitals since 2012. Patients were recruited over a period of 36 months after opening a bronchiectasis outpatient clinic.

Background and Objectives: The first pandemic of the 21 ^st century was caused in 2009 by influenza A(H1N1). An increase in the number of cases caused by influenza A(H1N1) pdm09 was observed in 2013. The aim was to describe the number of influenza cases observed during 2013 in a general hospital of Argentina. Materials and Methods: A prospective, observational cohort of adult patients with influenza was confirmed by reverse transcription-polymerase chain reaction. Results: We analyzed 428 patients between epidemiological weeks 21 and 31, resulting in 134 (31%) patients who were positive for influenza A. Of these patients, 78% were infected with H1N1 (2009), 17% with H3, and 5% with a subtype that could not be determined. The mean patients' age was 53 ± 18 years. Eighty-three percent of patients had not been vaccinated, and no differences between vaccinated and nonvaccinated patients were observed. Seventy-five percent of patients had underlying conditions. Twenty-eight patients were treated as outpatients, and 86 required admission to the general ward, and 20 to the Intensive Care Unit. A significant difference in patient's age was observed between individuals infected with influenza H1N1 and those infected with other non-H1N1 subtypes. The mortality rate was 11%. In the multivariable analysis, mechanical ventilation (odds ratio: 27.66; 95% confidence interval [CI]: 6.43-119; P < 0.001) and cancer (odds ratio: 6.81; 95% CI: 1.25-37.13; P = 0.02) were predictors of mortality. Conclusions: We report a new wave of influenza A(H1N1). Most patients had underlying conditions, and a significant number of patients had not been vaccinated. Mortality was high; the only predictors of mortality were cancer and the need for mechanical ventilation.

Allergic bronchopulmonary aspergillosis (ABPA) is a complicated inflammatory condition characterized by an allergic response to the fungus Aspergillus colonizing in the bronchus. It occurs most frequently in patients with asthma or cystic fibrosis. Oral corticosteroids are the standard therapy for ABPA. Antifungal drugs can clear the fungi in the airway, reduce the body's antigen load, decrease the body's allergic reaction, and reduce corticosteroid requirement. Total serum IgE should be used as an index for efficacy assessment during treatment and follow-up.

Bronchiectasis is a common progressive respiratory disease characterized by exacerbations and recurrent chest infections with high morbidity and reduced quality of life. Cole's vicious cycle model explains the evolution of this disease, in which an initial insult in the bronchi, often on a background of impaired mucociliary clearance or bactericidal activity, results in persistence of microbes in the sinobronchial tree and microbial colonization. Microbial overgrowth then causes infection and chronic inflammation, resulting in tissue damage, and impaired mucociliary motility. Subsequent antimicrobial treatments, microbiota interactions, and hypermutation can favor the development of resistance and the appearance of multidrug-resistant (MDR) bacteria. In this paper, we summarize the current knowledge on how bacteria become MDR in noncystic fibrosis bronchiectasis, and which are the most common bacterial pathogens, excluding Mycobacteria.

Non-tuberculous mycobacteria (NTM) are ubiquitous microorganisms in our environment. Although data are not truthful, we can say that we are experiencing an increase in the incidence-prevalence of infections by these microorganisms, especially in vulnerable population such as those with certain respiratory diseases, such as bronchiectasis (BQ). In all species NTM, the most studied is Mycobacterium avium complex, although the M abscessus is considered the most serious species in cystic fibrosis (CF) and M. xenopi in non-CF BQ. They described five clinical forms, the most frequent nodular/bronchiectasis and severe disseminated. The diagnosis of NTM lung disease in BQ is complicated, and continues to rely on three variables: clinical, radiological and microbiological. Given this difficulty, many suggest an observation period before starting a treatment, not always well tolerated and with side effects. Although morbidity and mortality is not high, they have been described risk factors that make it essential early treatment to avoid further serious complications.

Bronchiectasis (BE) is a heterogeneous disease. Similarly, to other chronic airway diseases, such as asthma and chronic obstructive pulmonary disease, management of BE patients requires a specific and personalized treatment that depends on many clinical, functional, and microbiological variables. Therefore, developing phenotyping methods that can help clinical and therapeutic choices is of paramount importance. Various methodological approaches have been used to personalize patients' management. In this review, we explore the main tools identified so far to classify and phenotype BE patients, including the approaches based on BE etiologies, disease severity, cluster analysis, and endotyping. We also discuss the strengths and limitations of every approach and highlight the similarities and differences between these studies. Finally, we review the therapeutic implications and clinical management connected with each approach.