Urinary tract infections (UTIs) are common and traditionally linked to bacteria; however, yeasts- particularly Trichosporon asahii - have emerged as opportunistic pathogens in immunocompromised and hospitalized patients. The presence of fungi may represent either colonization or infection, and the understanding of immune bases can help in this differentiation. 19 T. asahii isolates from urine cultures of hospitalized patients were analyzed and subjected to antifungal susceptibility testing. Urine samples underwent routine analysis (appearance, protein, specific gravity, pH) and flow cytometry. Clinical and sociodemographic data were obtained from electronic medical records. Results: Of the 19 patients, 11 were catheterized and 8 non-catheterized, with a predominance of males aged ≥60 years. Most were admitted to the ICU (n=13), especially in the catheterized group. A high mortality rate was observed, particularly among catheterized patients (81.1%). Urinalysis demonstrated frequent abnormalities, such as proteinuria, hematuria, and leukocyturia, suggesting an active local immune response. In association with positive cultures for T. asahii, these findings reinforce the hypothesis of active urinary tract infection. The results highlight the relevance of accurate laboratory diagnosis of this pathogen and the implementation of appropriate therapeutic strategies based on antifungal susceptibility testing, clinical expertise, and pharmacokinetic and pharmacodynamic principles. These measures are essential to optimize clinical management, improve therapeutic outcomes, and reduce mortality associated with urinary tract infections caused by multidrug-resistant T. asahii.

Consumer smartwatches can provide longitudinal peripheral oxygen saturation (SpO2) estimates for wellness purposes, but there is limited evidence that they can be used to monitor respiratory disease. In this study, we described a 52-year-old man with fibrotic hypersensitivity pneumonitis who developed exertional hypoxemia, which progressed radiologically and led to functional decline. Systemic corticosteroids improved his symptoms, imaging, and lung function. The monthly mean Apple Watch SpO2 dropped from 95.7% to 94.4% within 3 months of the worsening and recovered to 96.5% 4 weeks after corticosteroid initiation. Daily-life SpO2 trends from smartwatches may be useful for monitoring respiratory diseases.

This case report presents a young female patient whose chief complaint was exertional dyspnea. Right heart catheterization confirmed severe pulmonary hypertension. Concurrently, chest CT showed atypical pulmonary parenchymal and interstitial lesions, and pulmonary function tests indicated severe impairment of diffusion capacity. To clarify whether an association existed between the lung disease and pulmonary hypertension, transbronchial lung cryobiopsy was performed, which revealed multinucleated giant cell aggregates within the alveolar spaces, with cholesterol clefts in the cytoplasm of some of them. Together with a 1-year history of pigeon exposure, the final pulmonary diagnosis was extrinsic allergic alveolitis (hypersensitivity pneumonitis).With respect to the pulmonary hypertension, genetic testing showed no significant abnormalities, thereby ruling out heritable pulmonary hypertension. After oral imatinib combined with macitentan was administered, the patient's pulmonary artery pressure gradually decreased and her symptoms recovered well; however, follow-up chest CT and pulmonary function tests showed no apparent improvement. Because the elevated pulmonary artery pressure was inconsistent with the pulmonary disease, the patient was ultimately diagnosed with idiopathic pulmonary hypertension complicated by allergic alveolitis.

Background: The clinical burden of pulmonary diseases associated with the genus Aspergillus is increasing, although diagnostic focus remains largely on A. fumigatus. This study evaluated the diagnostic value of testing for A. flavus and A. niger-specific IgG in patients with chronic respiratory conditions. Methods: A retrospective study was conducted on 274 subjects (156 with chronic respiratory diseases, Bronchiectasis, Hypersensitivity Pneumonitis [HP], and Interstitial Lung Disease [ILD] non-HP, and 67 healthy controls). Cut-off values were established at the 97.5th percentile of the control group: 30 mg/L for A. fumigatus, 13 mg/L for A. flavus, and 8 mg/L for A. niger. Results: Among 109 patients who tested negative for A. fumigatus, 49.5% showed positivity to at least one other species, preventing a significant diagnostic gap in exposure detection. Notably, 40.4% of these patients exhibited simultaneous positivity for both A. flavus and A. niger. In the HP subgroup, 100% of patients who were A. fumigatus-positive also showed concurrent positivity to the two other species. Furthermore, the Bronchiectasis group showed the highest rate of isolated A. flavus at 11.8%. Conclusions: Testing solely for A. fumigatus IgG leads to substantial underestimation of Aspergillus exposure. Integrating A. flavus and A. niger into diagnostic panels is essential for a comprehensive immunological assessment of fungal interaction, particularly in HP and ILD, where identifying specific antigenic exposure is crucial for managing chronic inflammation and preventing disease progression.

Hypersensitivity pneumonitis (HP) is an immune-mediated lung disease caused by repeated exposure to organic and inorganic antigens. Epidemiological studies suggest particulate matter (PM) exposure as a risk factor; however, the specific mechanisms underlying PM-induced injury remain uncharacterized. Here, we investigated whether repeated exposure to diesel exhaust particles (DEPs), a major component of PM2.5, could induce HP-like immune responses in mice. Mice received repeated intratracheal instillations of DEPs, and histopathological, immunological, and transcriptomic changes were evaluated across multiple points. Repeated DEP exposure showed features commonly used for the diagnosis of HP, including poorly formed non-caseating granulomatous inflammation and infiltration of mononuclear cells and lymphocytes. Transcriptomic and protein analyses demonstrated enhanced FcγR-associated immune complex-related phagocytic processes as well as antigen processing and presentation processes, consistent with immunological features bridging type Ⅲ and Ⅳ hypersensitivity responses. After 14 repeated DEP exposures, mouse lungs shared transcriptomic signatures with human HP lungs, including antigen presentation, humoral immune response, chemokine, and extracellular matrix-related pathways. Based on these findings, we constructed a putative adverse outcome pathway describing DEP-induced HP-like immunopathology. Collectively, these findings indicate that repeated DEP exposure results in key immunopathological features resembling HP and provide mechanistic insight into PM-associated immune-mediated lung disease.