Unusual microbes in asthma exacerbation:Alcaligenes xylosoxidansand Leishmania

Abstract

Asthma is a chronic inflammatory condition characterised by a variable degree of airflow limitation. Exacerbations during the course of asthma often occur due to environmental factors or infectious, mostly viral, aetiology.The present study reports the case of a 61-yr-old male with severe asthma hospitalised due to increasing respiratory distress. Since recovery was delayed despite anti-obstructive/antiinflammatory and antibiotic therapy, further diagnostic procedures, including bronchoscopy, were performed in order to attempt to identify the cause of the worsening respiratory condition.The surprising finding consisted of a rare coincidence of concomitant infection with the bacterial pathogen Alcaligenes xylosoxidans, grown from bronchoalveolar lavage fluid, and the protozoan parasite Leishmania spp., revealed by histopathological examination of bronchial mucosal biopsy specimens. This is the first report of an isolated bronchial mucosal involvement of Leishmania in an HIV-negative asthma patient following brief exposure in Leishmania-endemic regions. Further, to the best of the present authors' knowledge, this represents the first description of A. xylosoxidans in asthma, although it is questionable whether it was an infection or colonisation.The present observation identifies previously unreported microbial pathogens associated with asthma exacerbation. Further, the report highlights the importance of obtaining a thorough travel history and applying invasive diagnostic procedures in circumstances of treatment failure, even under unfavourable conditions.

Bronchoscopy and Lung Fine-Needle Aspiration for Antemortem Evaluation of Pulmonary Involvement in Dogs with Naturally Occurring Canine Leishmaniosis

“…Nevertheless, dry cough was noted in 16% and 25.9% of the cases in two retrospective studies [ 24 , 25 ], and in separate case reports [ 26 , 27 , 28 , 29 ]. Bronchial mucosa involvement has been described in immunocompetent [ 26 , 30 ], immunocompromised [ 28 , 29 , 31 ], and bronchial asthma patients [ 32 ]. In all cases, bronchoalveolar lavage fluid (BALF) and bronchial mucosal biopsies were obtained via bronchoscopy and led to the diagnosis of VL.…”

Non-Endemic Leishmaniases Reported Globally in Humans between 2000 and 2021—A Comprehensive Review

“…Dermatologic manifestations were reported in nine cases, of which three were described as CL (with typical ulcerated lesions) [40,66,257], while six presented other symptoms such as hyperpigmentation, rash, erythroderma [19,31,35,55,204,252]. Rare and atypical manifestations, with the exception of two patients with isolated lymphadenopathy [37,198] and one with kidney involvement [29], were reported in immunocompromised patients, namely involvement of the eye (n = 1, [35]), lung (n = 2, [32,34]) gastrointestinal tract (n = 6 gastroduodenal, [28,197,261]; n = 4 colorectal, [48,204,252,261]; n = 1 with both, [35]). Similarly, laboratory findings of 125 patients translated the natural history of the disease well known in endemic countries [286]: most patients had single or multiple lineage cytopenias, while elevation of liver enzymes and renal failure were less commonly described (Table 2).…”