Kidney Disease: Improving Global Outcomes.

Key Points Question What are the 10-year trends in the delivery of cigarette smoking cessation services for adult smokers in the United States? Findings In this cross-sectional study of 29 106 US adult smokers from 2006 to 2015, the proportion who reported receiving physician advice to quit smoking increased and the use of prescription cessation medication decreased with a corresponding reduction in expenditures. Lower rates of cessation services were observed in certain populations, including men, younger adults, uninsured individuals, racial/ethnic minority groups, and those without smoking-related comorbidities. Meaning The disparities in the delivery of known smoking cessation services among certain subgroups may be associated with higher smoking rates despite an all-time low prevalence of smoking, suggesting the call for a more targeted implementation of smoking cessation guidelines.

Changes in innate and adaptive immune responses caused by viral imprinting can have a significant direct or indirect influence on secondary infections and vaccine responses. The purpose of our current study was to investigate the role of immune imprinting by influenza on pneumococcal vaccine effectiveness during Streptococcus pneumoniae infection in the aged murine lung. Aged adult (18 months) mice were vaccinated with the pneumococcal polyvalent vaccine Pneumovax (5 mg/mouse). Fourteen days post vaccination, mice were instilled with PBS or influenza A/PR8/34 virus (3.5 × 102 PFU). Control and influenza-infected mice were instilled with PBS or S. pneumoniae (1 × 103 CFU, ATCC 6303) on day 7 of infection and antibacterial immune responses were assessed in the lung. Our results illustrate that, in response to a primary influenza infection, there was diminished bacterial clearance and heightened production of pro-inflammatory cytokines, such as IL6 and IL1β. Vaccination with Pneumovax decreased pro-inflammatory cytokine production by modulating NFҡB expression; however, these responses were significantly diminished after influenza infection. Taken together, the data in our current study illustrate that immune imprinting by influenza diminishes pneumococcal vaccine efficacy and, thereby, may contribute to increased susceptibility of older persons to a secondary infection with S. pneumoniae.

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Lung nodules and cavitary lesions are common in granulomatosis with polyangiitis (GPA). While GPA is an uncommon cause of all cavitary lung lesions, it should be considered in patients with upper respiratory tract symptoms. Description: A 31 year-old female presents to the hospital with chronic sinus congestion and new onset of fevers and productive cough. One year prior, she underwent a transphenoidal resection of a Rathke's cleft cyst. Following surgery, she experienced nasal congestion, ear fullness, and intermittent headaches. As a child, she suffered a traumatic retinal detachment requiring scleral buckle prosthesis, and was later diagnosed with phthisis bulbi. She underwent a right eye enucleation five months prior with resolution of headaches. Biopsy from the site showed granulomas and culture of her prosthesis returned with Mycobacterium fortuitum, which was not treated. Her sinus congestion persisted and she later developed polyuria and polydipsia. On presentation, she was febrile and tachycardic. Physical exam was notable for bilateral maxillary sinus tenderness. Her white blood cell (WBC) count was 15.2. She had normal chemistries and negative blood and urine cultures. CT chest revealed a cavitating lesion in the right upper lobe. She underwent a bronchoscopy and transbronchial biopsy. Infectious work-up was unrevealing. Pathology revealed acute granulomatous inflammation. Her proteinase 3 antibody returned with high titers, 835 units/mL and she was started on high dose steroids and rituximab with significant improvement in her symptoms. She was also diagnosed with central diabetes insipidus and treated with desmopressin. Discussion: GPA is an anti-neutrophil cytoplasmic antibody (ANCA)-associated small-to-medium vessel vasculitis that commonly involves the upper respiratory tract, lung, and kidneys, and can present with systemic symptoms such as fever. Common pulmonary manifestations of GPA on chest CT include pulmonary nodules, masses, cavitary lesions, ground-glass opacifications or consolidations. There are case reports where GPA involves the pituitary gland and disrupts the hypothalamic-pituitary axis, in rare cases causing diabetes insipidis. Mycobacterium fortuitum is an opportunistic, environmental, rapidly growing nontuberculous mycobacteria (NTM) and is associated with nosocomial infection, most commonly skin and soft tissue or post-surgical infection. Respiratory infections associated with NTM are commonly related to Mycobacterium avium complex or Mycobacterium abscessus rather than M. fortuitum, and respiratory isolates of M. fortuitum usually reflect colonization. In case reports of M. fortuitum respiratory infection, patients often have underlying structural lung disease and an indolent course of infection. In our patient, M. fortuitum was likely a colonizer of her ocular prosthesis.