Accidental fish bone ingestion is a common manifestation at emergency departments. In most cases, ingested foreign bodies usually pass uneventfully through the gastrointestinal tract and complications only present in less than 5% of all patients. In this report, we present the first documented case of pulmonary artery injury due to a fish bone in a 63-year-old male patient hospitalized with hemoptysis after accidentally swallowing a fish bone 30 days ago. This patient subsequently had surgery and endoscopy to safely remove the foreign body and then recovered well on a follow-up examination. For cases of fish bone ingestion, contrast-enhanced chest computed tomography is one of the most essential tools to assess vascular problems and associated mediastinal infections-risk factors for life-threatening and long-term recurrent inflammation. Reconstructing planes along the foreign body axis and changing windows when analyzing CT scans is necessary to avoid missing lesions and dilemmas.

Streptomyces, the largest genus in the Streptomycetaceae family and a prolific producer of antibacterial drugs, is a saprophytic soil organism that rarely causes invasive infections. Here we report a case of necrotic pneumonia caused by Streptomyces albireticuli in a 75-year-old man who presented with progressive chest tightness and dyspnea. Streptomyces albireticuli was isolated from his bronchoalveolar lavage fluid and identified through whole-genome sequencing (WGS) and phylogenetic analysis. The patient responded satisfactorily to clarithromycin therapy. The findings of this study may enhance our vigilance in identifying visceral infections caused by Streptomyces.

UNASSIGNED: Pneumonia is quite common in people with chronic bedridden, severe malnutrition and underlying diseases of cerebral palsy. Although poor oral hygiene and inadequate airway protection are risk factors, case reports of childhood pneumonia caused by oral obligate anaerobes are rare.
UNASSIGNED: We reported 4 cases of oral anaerobic pneumonia and empyema diagnosed by the pediatric intensive care unit (PICU) of our hospital.
UNASSIGNED: No bacteria were detected in sputum bacterial culture, pleural water bacterial culture and blood culture of the four children. Considering that multiple sputum cultures were negative, the pleural effusion and bronchoalveolar lavage fluid were subjected to next-generation sequencing (NGS) to identify the pathogen causing pneumonia. The results found oral obligate anaerobes represented by Parvimonas micra and Porphyromonas gingivalis. After identifying the pathogenic bacteria, we changed to piperacillin tazobactam combined with metronidazole for anti-infection treatment, and the pneumonia in the above patients was improved. In addition, all four patients had different basic medical histories, and long-term bed rest, severe malnutrition, poor oral hygiene and insufficient airway protection were all high risk factors for oral anaerobic pneumonia in these children.
UNASSIGNED: Oral obligate anaerobes are one of the pathogens to consider for pneumonia in the elderly, but they may be easily overlooked in pediatric groups. Therefore, when receiving children with high-risk factors, we should be alert to the possibility of oral obligate anaerobic bacteria infection. Educating family members to pay attention to children\'s oral hygiene plays an important role in preventing oral obligatory anaerobic bacteria pneumonia. NGS can be used as a rapid diagnostic method when sputum culture cannot distinguish between pathogens.

BACKGROUND: Kartagener syndrome (KS) is recognized as an inherited, autosomal recessive disorder characterized by a combination of chronic sinusitis, bronchiectasis, and situs inversus. It affects one in 12,500-50,000 live births worldwide.
OBJECTIVE: This paper aims to discuss the dental management of patients diagnosed with KS.
METHODS: A 31-year-old male with KS manifests by impaired cilia motility which increases the risk of a frequent lung infection. The dental examination revealed that the patient required comprehensive oral hygiene care which included patient education and nonsurgical periodontal therapy under local anesthesia.
CONCLUSIONS: Dental care providers should ask affected patients with KS about their signs and symptoms of cardiac and pulmonary disease and seek consultation with their attending physician regarding these health concerns before the initiation of general anesthesia and perhaps conscious sedation administration. Patients with KS with emerging cardiac and/or respiratory impairment should be referred promptly for medical assessment.

BACKGROUND: Blastoschizomyces capitatus infection is a rare fungal infection; mainly occurring in immunodeficient patients, which can cause multiple organ involvement. At present, there is no clear designated treatment regimen. This case was a rare example of Blastoschizomyces capitatus lung infection in patient with normal immune function, which was effectively controlled by combined antifungal therapy.
METHODS: We report a 67-year-old male smoker, who, after cleaning a small bungalow for a long period, without any protective measures, developed cough with expectoration, fever and dyspnea. Pre-admission anti-infective medication (amoxicillin and roxithromycin) had little effect, and the patient\'s condition worsened. He had a past history of pulmonary tuberculosis with pleurisy 6 years before. Chest computed tomography (CT) showed evidence of old tuberculosis in the right upper lobe and inflammation in both lower lobes. White blood cell count was 14.51×109/L, neutrophils was 13.39×109/L and C-reactive protein (CRP) was 170 mg/L. Broad-spectrum antibiotics piperacillin sodium 4.0 g and tazobactam sodium 0.5 g q8h were administered empirically for 5 days. Blastoschizomyces capitatus infection was confirmed by next generation of macro genome sequencing (NGS) of bronchoalveolar lavage fluid and mass spectrum analysis of sputum. He was then switched to voriconazole antifungal therapy combined with aerosol inhalation of amphotericin B. His temperature normalized, expectoration and dyspnea were relieved. Total white cell count fell to 8.10×109/L, neutrophils to 5.81×109/L, and CRP to 76.8 mg/L.
CONCLUSIONS: This case demonstrates that Blastoschizomyces capitatus infection can occur in patients with normal immune function. Mass spectrometry and metagenomic NGS methods may have an advantage over traditional methods in identifying this fungal infection. In addition, the combination of voriconazole and nebulized amphotericin B can be employed as a novel regimen for treating Blastoschizomyces capitatus infection. For pulmonary infection with a history of environmental exposure, early pathogen identification and culture, and appropriate antibiotic treatment are key to optimizing outcome.

Mucormycosis is a group of life-threatening diseases caused by a fungus of the Mucoraceae family and has a higher mortality rate compared with other known fungal infections. Hydatid cyst, caused by Echinococcus, is a crucial health concern in endemic areas and the disease is characterized by slow-growing cysts in the liver, lungs, or other organs. In this report, a woman with coexistence of hydatid cyst and Mucormycosis is introduced. The patient was a 52-year-old woman with approximately 6 years\' history of uncontrolled diabetes mellitus and hypothyroidism, who presented with cough, sputum, and dyspnea 2 months ago. On the initial auscultation of the lungs, there was a decreased sound at the base of the left lung, and she had a fever. In blood tests, she had a high titer of erythrocyte sedimentation rate and 3+ C-Reactive Protein. The symptoms in favor of hydatid cyst were observed in lung computed tomography and in pleural needle biopsy, hydatid cyst was confirmed. With this indication, she underwent wedge resection, and resection of the left lower lung cyst. Two samples are taken from the cyst side and the pathology report was consistent with Mucormycosis (wide filaments with a 90-degree angle). The patient was immediately treated with liposomal amphotericin for 4 weeks. The Lung CT scan was performed before and after treatment. Albendazole was treated to treat hydatid cyst. After discharge, the treatment of the patient continued with oral Posaconazole, and after the treatment finalization, the general condition of the patient was good, and she did not have any complaints. In pulmonary diseases that do not respond significantly to surgical treatment (such as hydatid cyst), fungal disease (mucor) must be considered simultaneously. Mucormycosis is more prevalent in patients with uncontrolled diabetes, and it is necessary to be considered if these patients were infected with pneumonia and their symptoms did not improve with usual treatments.

BACKGROUND: Listeria is a food-borne disease, which is rarely prevalent in the normal population; it mostly occurs in pregnant women, newborns, immunodeficiency patients, and the elderly. The main manifestations of this disease in patients include sepsis, meningitis, etc, and the mortality rate remains high, although the onset of meningitis is relatively insidious.
METHODS: A 75-year-old man presented with a fever for 1 wk and was admitted to the hospital for diagnosis and management of a lung infection. His condition improved after receiving anti-infective treatment for 2 wk. However, soon after he was discharged from the hospital, he developed fever again, and gradually developed various neurological symptoms, impaired consciousness, and stiff neck. Thereafter, through the cerebrospinal fluid metagenomic testing and blood culture, the patient was diagnosed with Listeria monocytogenes meningitis and sepsis. The patient died after being given active treatment, which included penicillin application and invasive respiratory support.
CONCLUSIONS: This case highlights the ultimate importance of early identification and timely application of the various sensitive antibiotics, such as penicillin, vancomycin, meropenem, etc. Therefore, for high-risk populations with unknown causes of fever, multiple blood cultures, timely cerebrospinal fluid examination, and metagenomic detection technology can assist in confirming the diagnosis quickly, thereby guiding the proper application of antibiotics and improving the prognosis.

China is gradually becoming an aging society with the change in the demographics of its population. This is a concern because older adult patients tend to have weaker immune systems. In particular, in patients with malignancies, both the malignant tumor itself and the surgical treatment can contribute to further impairments in immune function. The weakened immune system in older adult patients increases their susceptibility to postoperative complications as compared to in younger patients. However, treatments for inpatients often ignore the compromised immune status of older adult patients during the perioperative period which could lead poor prognosis through various complications. In the case presented here, the patient was already immunocompromised before surgery; she developed fever and cough after a surgery for lung cancer and was later diagnosed with a pulmonary infection, which led to respiratory failure. The outcome of the patient was fair after aggressive treatment. This case was an epitome of therapy with the increase of lung cancer surgery. Infection may not be universal, but the factors always existed. We aimed to find out the reasons cause immunosuppression which leads to infection during perioperative period through the case. Meanwhile, we offered possible treatment to improve immune function state by targeting these causes.

BACKGROUND: In patients receiving single lung transplantation for idiopathic pulmonary fibrosis, worsening of fibrosis of the native lung is usually progressive over time, with no significant effects on gas exchange.
METHODS: Here, we describe the cases of two Caucasian male recipients of single lung transplants for idiopathic pulmonary fibrosis, 65 and 62 years of age, who exhibited acute worsening of lung fibrosis after an episode of serious viral infection (cytomegalovirus primo-infection in one case and COVID-19 in the other). In both cases, along with opacification of the native lung over several days, the patients presented acute respiratory failure that required the use of high-flow nasal oxygen therapy. Eventually, hypoxemic respiratory failure resolved, but with rapid progression of fibrosis of the native lung.
CONCLUSIONS: We conclude that acute worsening of fibrosis on the native lung secondary to a severe viral infection should be added to the list of potential complications developing on the native lung after single lung transplantation for idiopathic pulmonary fibrosis.

Gardnerella vaginalis is a pathogen responsible for bacterial vaginosis, which is commonly found in female vaginas and rarely causes infections outside the female genitalia. Here, we report the use of metagenomic next-generation sequencing (mNGS) to detect and confirm pulmonary infection and pleural effusion caused by G. vaginalis in a 47-year-old man. The patient\'s symptoms and imaging improved after 2 weeks of oral ornidazole, and he was cured after 3 months. Overall, the findings of this case demonstrate that mNGS is a useful tool for diagnosis of unexplained lung infections and pleural effusions. Its effectiveness in rapid and accurate etiological diagnosis and monitoring of diseases can allow detection of the etiology of difficult cases that return negative results after traditional cultures.