Gopagoni, Ragini

Ehrlichiosis is a rare tick-borne zoonosis caused by Ehrlichia chaffeensis , E. ewingii and related species. In solid organ transplant recipients, immunosuppression can result in atypical presentations, delayed diagnosis and poor outcomes. The disease remains under-recognised among lung transplant recipients despite its potentially fatal course. A man in his early 70s with a history of bilateral lung transplantation for chronic obstructive pulmonary disease presented with a high-grade fever and shortness of breath. Bronchoalveolar lavage (BAL) culture grew Pseudomonas aeruginosa and meropenem was initiated. He subsequently developed severe thrombocytopenia, acute kidney injury and elevated liver transaminases. Disseminated intravascular coagulation (DIC) and thrombotic thrombocytopenic purpura (TTP) were excluded, while haemophagocytic lymphohistiocytosis (HLH) was considered but not confirmed. His condition rapidly progressed to multiorgan failure requiring mechanical ventilation and haemodialysis. E. chaffeensis was identified postmortem by next-generation sequencing. This case highlights diagnostic challenges and the importance of early empiric doxycycline therapy in endemic areas.

ABSTRACT Celiac disease (CD) is an autoimmune enteropathy with recognized extraintestinal manifestations. We describe a 55‐year‐old man with long‐standing, well‐controlled CD who developed progressive shortness of breath and cough. Imaging was indeterminate for usual interstitial pneumonia (UIP), and a surgical lung biopsy demonstrated a UIP pattern. Autoimmune serologies were negative, and no alternate etiologies for UIP were identified. With intermittent adherence to a gluten‐free diet and medical management including nintedanib, his disease progressed, ultimately leading to lung transplantation. This case raises the possibility of an association between CD and UIP of uncertain aetiology and should prompt further discussion as the relationship remains unclear. To contextualize this observation, we conducted a systematic review of published case reports evaluating pulmonary manifestations of celiac disease.

Background: Hypertension is a major contributor to global cardiovascular morbidity and mortality. Despite a wide range of pharmacologic treatments, many patients continue to have uncontrolled blood pressure. Recent research highlights the gut microbiota as a modifiable factor in blood pressure regulation through mechanisms involving systemic inflammation, microbial metabolites such as short-chain fatty acids, and angiotensin-converting enzyme modulation. Probiotic and prebiotic supplementation has gained interest as an adjunct strategy, yet existing reviews are limited in scope and often lack robust subgroup analysis. Objective: To systematically evaluate the effect of probiotic and prebiotic supplementation on blood pressure in adults with hypertension or elevated blood pressure, with an emphasis on gut microbiota modulation. Methods: We conducted a systematic search of PubMed, Scopus, Cochrane CENTRAL, and ScienceDirect for articles published from May 1, 2015, to April 30, 2025. ClinicalTrials.gov and PROSPERO were also searched. Eligible studies were randomized controlled trials in English involving adults 19-44 years with hypertension or pre-hypertension, comparing probiotic or prebiotic interventions with placebo, no treatment, or standard care. The primary outcome were changes in systolic and diastolic blood pressure; secondary outcomes included gut microbiota composition, inflammatory markers, endothelial function, and adverse effects. Two independent reviewers screened studies and assessed quality using the Cochrane Risk of Bias Tool 2.0. Results: Of 601 records screened, 23 trials met inclusion criteria. Most studies showed modest reductions in systolic and diastolic blood pressure with probiotic or prebiotic use. Mechanistic insights included improved gut barrier integrity, reduced inflammation, and increased beneficial metabolites. Subgroup analyses suggested efficacy varied by strain type, dosage, duration, and delivery method. Secondary outcomes showed improvements in lipid profiles, insulin resistance, and abundance of Bifidobacterium. Conclusion: Modulation of gut microbiota shows potential as an adjunct approach in managing hypertension.. While short-term benefits are observed, variability across studies limits generalizability. Larger trials with standardized methods are needed to confirm long-term clinical relevance. Keywords: Hypertension, Blood Pressure, Gut Microbiota, Probiotics, Prebiotics, Randomized Controlled Trials, Systematic Review