PMC9178473_01
Radiographic and bronchoscopic findings.. A: Chest Xray at the admission.. B: Chest Xray at 2 h later after admission.. C: Bronchoscopic finding at ICU.. D: Chest CT scan at the admission.. E: Chest CT scan at 2 h later after admission.. F: Chest CT scan at day 14 after admission.. (A)(. D) Chest Xray and CT scan at admission depicted the infiltration of right upper lobe. (B)(E) At Two hours after admission, radiological findings dramatically changed; Chest Xray and CT scan showed complete opacification of the right hemithorax. (C) Bronchoscopy demonstrated the fresh bleeding from right upper bronchus. (F) Chest CT scan at day14 after admission depicted an abscess formation in the right lung and increase of right pleural effusion. Ground glass opacities and partial consolidation were appeared in the left lung.
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C-reactive protein, 2.59 mg/dl. Chest radiograph and chest computed tomography (CT) scan revealed right S2-inflitration (Fig. 1A, D). Bronchoscopy demonstrated a large amount of bleeding (>1000 ml) from the right upper bronchus (Fig. 1C) and B6 segments resulted in obstructing the right main bronchus. Repetitive chest radiograph and CT scan showed complete opacification of the right hemithorax (Fig. 1B, E). However, the abscess formation was progressed in the right lung, accompanying with P. aeruginosa empyema (Fig. 1F). Because P. aeruginosa thrives in moist environments, cultures of seven swab samples and four liquid samples were obtained from several spots of the bathroom and yard of the patient's residence (Fig. 2A and B, Table 1).
Home whirlpool bathtub in patient's residence.. A: Whole image of the bathroom. It depicted (1) shower head, (2) faucet of bathtub, (3) drain of the bathroom, from top to bottom.. B: Inside the bathtub. It depicted (4) spout of jet and (5) suction port of jet system.. C: Jet stream of whirlpool bathtub. Two streams were vigorously emitted from the spout of jet.. D: Tiny fragments of black mud were intermittently emitted from the spout of jet with water.
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Because P. aeruginosa thrives in moist environments, cultures of seven swab samples and four liquid samples were obtained from several spots of the bathroom and yard of the patient's residence (Fig. 2A and B, Table 1). According to our survey, the bathroom was relatively kept dry and clean, however, a small amount of black mud was intermittently emitted with water, once the jet system was turned on (Fig. 2C and D).
Phylogenetic analysis of Pseudomonas aeruginosa (P. aeruginosa) Phylogenetic analysis was obtained by kSNP3.0 program, based on the genome sequences of 19 strains, including 15 strains of P. aeruginosa whose genome sequences were publicly available. Phylogenetic analysis revealed that the 4 strains (blood, bronchial secretion, and two environmental samples) analyzed in this study were very closely related. JMU is an acronym for Jichi Medical University, indicating the present samples.
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MiSeq platform with the Nextera XT DNA Library Prep Kit (Illumina) and the MiSeq reagent kit version 3 (Illumina), and a phylogenetic analysis based on the whole genome of environmental samples and clinical samples demonstrated high similarity (Table 2, Fig. 3). Multi-locus sequence typing (MLST) analysis identified that these isolates were classified into sequence type (ST)-900 based on PubMLST (https://pubmlst.org/), indicating that they carried the same genomic background (Table 2).