Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 369
Filtrar
Mais filtros

País/Região como assunto
Tipo de documento
Intervalo de ano de publicação
1.
J Infect Chemother ; 30(2): 129-133, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37769992

RESUMO

INTRODUCTION: It has not been fully elucidated that nutritional parameters affect the change of activities of daily living (ADL) during pneumonia treatment. This study assessed the impact of nutritional status, including erector spinae muscle (ESM) size on ADL changes from admission to discharge among older patients with community-acquired pneumonia (CAP). METHODS: We retrospectively included patients (age: ≥65 years) who were admitted to the hospital for CAP and underwent chest computed tomography (CT) on admission. ADL was evaluated using the Barthel index, and patients were divided into the maintained or improved ADL group and the declined ADL group from admission through discharge. The ESM cross-sectional area was measured on a single-slice CT image. Logistic regression models were applied for assessing factors associated with changes in ADL. RESULTS: A total of 523 patients hospitalized for CAP (median age 86 years) were evaluated. The declined group had significantly higher ADL levels on admission, a greater frequency of smoking history and malignancy, and a lower frequency of cerebrovascular disease and dementia. No significant difference in ESM size was observed between the groups. Multivariate analysis revealed that higher ADL levels on admission (odds ratio 1.034, interquartile range 1.026-1.043) and malignancy (3.002, 1.150-7.836) were associated with a decline in ADL, whereas cerebrovascular disease (0.579, 0.373-0.900) was related to improvement or maintenance of ADL. CONCLUSIONS: Although nutritional status might not affect the change of ADL among older patients hospitalized with pneumonia, a cerebrovascular disease history may be a good predictor for ADL improvement.


Assuntos
Transtornos Cerebrovasculares , Neoplasias , Pneumonia , Humanos , Idoso de 80 Anos ou mais , Idoso , Atividades Cotidianas , Alta do Paciente , Estudos Retrospectivos
2.
J Infect Chemother ; 29(7): 688-692, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37011836

RESUMO

INTRODUCTION: Acid-fast bacillus (AFB) is a major pathogen that causes noncystic fibrosis bronchiectasis requiring multidrug chemotherapy. Bronchoscopic bronchial wash is performed to determine the causative pathogens of bronchiectasis; but, predictive factors for AFB isolation have not been fully elucidated. This study aimed to determine the factors associated with AFB isolation from bronchial wash samples. METHODS: This was a single-center, cross-sectional study. Patients undergoing bronchoscopic bronchial wash for bronchiectasis were included, whereas those who did not undergo high-resolution computed tomography (HRCT); had acute pneumonia, interstitial lung disease, and a positive polymerase chain reaction result but a negative culture result for AFB; or in whom a guide sheath was used for suspected lung cancer were excluded. Binomial logistic regression was used to analyze the factors associated with a positive culture for AFB. RESULTS: Of the 96 included cases, AFB isolation was observed in the bronchial wash fluid of 26 patients (27%). No smoking history, a positive result for antiglycopeptidolipid (GPL)-core IgA antibody, and the presence of tree-in-bud appearance, multiple granular and nodular images on HRCT were more commonly observed in patients with AFB isolation than in those without. In the multivariate analysis, the tree-in-bud appearance (odds ratio, 4.223; 95% CI, 1.046-17.052) and anti-GPL core IgA antibody (odds ratio, 9.443; 95% CI, 2.206-40.421) were significantly associated with AFB isolation. CONCLUSIONS: The tree-in-bud appearance on HRCT is likely to predict AFB isolation independent of anti-GPL core IgA antibody results. Bronchoscopic bronchial wash should be recommended for bronchiectasis with multiple granulomas on HRCT.


Assuntos
Bacillus , Bronquiectasia , Doenças Pulmonares Intersticiais , Humanos , Estudos Transversais , Fibrose
3.
J Infect Chemother ; 29(1): 55-60, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36162646

RESUMO

BACKGROUND: Although the 2019 American Thoracic Society and Infectious Diseases Society of America guidelines for community-acquired pneumonia (CAP) recommend the use of antibiotics with Pseudomonas aeruginosa coverage for patients with prior sputum isolation of P. aeruginosa, further research is needed to confirm its clinical outcomes. This study aimed to assess the impact of the use of antibiotics with P. aeruginosa coverage on mortality in elderly CAP patients with sputum isolation of P. aeruginosa. METHODS: We retrospectively included consecutive elderly patients who were hospitalized for CAP and P. aeruginosa-positive sputum culture. The association between the use of antibiotics with P. aeruginosa coverage and 28-day mortality was assessed based on propensity score to reduce selection bias. RESULTS: A total of 216 patients were included, and 68 (31%) of them were treated with antibiotics with P. aeruginosa coverage. The number of patients treated with antibiotics with P. aeruginosa coverage was significantly higher among nonsurvivors than among survivors. After adjustment using propensity score, the association between the use of antibiotics with P. aeruginosa coverage and the 28-day mortality was found to be statistically nonsignificant (odds ratio 2.182, 95% confidence interval 0.732-6.508, p = 0.162). CONCLUSIONS: The use of antibiotics with P. aeruginosa coverage in elderly CAP patients with sputum isolation of P. aeruginosa did not improve their prognosis. A randomized control study is required to identify cases that should be treated with antibiotics covering P. aeruginosa.


Assuntos
Infecções Comunitárias Adquiridas , Pneumonia , Humanos , Estados Unidos , Idoso , Pseudomonas aeruginosa , Estudos Retrospectivos , Infecções Comunitárias Adquiridas/tratamento farmacológico , Pneumonia/tratamento farmacológico , Antibacterianos/uso terapêutico , Prognóstico
4.
BMC Med ; 20(1): 342, 2022 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-36163020

RESUMO

BACKGROUND: In vitro drug screening studies have indicated that camostat mesilate (FOY-305) may prevent SARS-CoV-2 infection into human airway epithelial cells. This study was conducted to investigate whether camostat mesilate is an effective treatment for SARS-CoV-2 infection (COVID-19). METHODS: This was a multicenter, double-blind, randomized, parallel-group, placebo-controlled study. Patients were enrolled if they were admitted to a hospital within 5 days of onset of COVID-19 symptoms or within 5 days of a positive test for asymptomatic patients. Severe cases (e.g., those requiring oxygenation/ventilation) were excluded. Patients were enrolled, randomized, and allocated to each group using an interactive web response system. Randomization was performed using a minimization method with the factors medical institution, age, and underlying diseases (chronic respiratory disease, chronic kidney disease, diabetes mellitus, hypertension, cardiovascular diseases, and obesity). The patients, investigators/subinvestigators, study coordinators, and other study personnel were blinded throughout the study. Patients were administered camostat mesilate (600 mg qid; four to eight times higher than the clinical doses in Japan) or placebo for up to 14 days. The primary efficacy endpoint was the time to the first two consecutive negative tests for SARS-CoV-2. RESULTS: One-hundred fifty-five patients were randomized to receive camostat mesilate (n = 78) or placebo (n = 77). The median time to the first test was 11.0 days (95% confidence interval [CI]: 9.0-12.0) in the camostat mesilate group and 11.0 days (95% CI: 10.0-13.0) in the placebo group. Conversion to negative viral status by day 14 was observed in 45 of 74 patients (60.8%) in the camostat mesilate group and 47 of 74 patients (63.5%) in the placebo group. The primary (Bayesian) and secondary (frequentist) analyses found no significant differences in the primary endpoint between the two groups. No additional safety concerns beyond those already known for camostat mesilate were identified. CONCLUSIONS: Camostat mesilate did not substantially reduce the time to viral clearance, based on upper airway viral loads, compared with placebo for treating patients with mild to moderate SARS-CoV-2 infection with or without symptoms. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04657497. Japan Registry for Clinical Trials, jRCT2031200198.


Assuntos
Tratamento Farmacológico da COVID-19 , Teorema de Bayes , Método Duplo-Cego , Ésteres/efeitos adversos , Ésteres/uso terapêutico , Guanidinas/efeitos adversos , Guanidinas/uso terapêutico , Humanos , SARS-CoV-2 , Resultado do Tratamento
5.
BMC Infect Dis ; 22(1): 339, 2022 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-35382762

RESUMO

BACKGROUND: Non-conversion of sputum culture or smear within 2 months after the start of treatment is a known poor prognostic factor of pulmonary tuberculosis. In elderly patients, sputum conversion may be delayed because of the age-related decline in immune competence. This study aimed to assess how a long interval to sputum conversion predicts in-hospital mortality in elderly patients with pulmonary tuberculosis. METHODS: Consecutive elderly patients (age > 65 years) who were admitted to our institution for bacteriologically confirmed pulmonary tuberculosis were included. The association between sputum conversion within 30, 60, 90, or 120 days from the start of treatment and in-hospital mortality were analyzed by Cox proportional-hazards regression after adjustment for other potential variables. RESULTS: This study included 262 patients, and 74 patients (28%) died during hospitalization. Multivariate analyses showed that sputum non-conversion within 90 days (adjusted hazard ratio 0.424, 95% CI 0.252-0.712, p = 0.001) or 120 days (0.333, 0.195-0.570, p < 0.001) was independently associated with in-hospital mortality, whereas that within 60 days was not (p = 0.890). CONCLUSIONS: In elderly patients with tuberculosis, 2 months may be insufficient when evaluating sputum conversion as a prognostic factor. Sputum non-conversion within 90 days or longer may predict in-hospital mortality more accurately.


Assuntos
Mycobacterium tuberculosis , Tuberculose Pulmonar , Idoso , Antituberculosos/uso terapêutico , Mortalidade Hospitalar , Humanos , Estudos Retrospectivos , Escarro , Tuberculose Pulmonar/tratamento farmacológico
6.
J Infect Chemother ; 28(8): 1138-1142, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35437226

RESUMO

INTRODUCTION: The 2019 American Thoracic Society/Infectious Diseases Society of America guidelines for community-acquired pneumonia (CAP) recommend methicillin-resistant Staphylococcus aureus (MRSA) coverage for patients with prior sputum isolation of MRSA. This study aimed to determine the impact of MRSA coverage on in-hospital mortality in elderly patients with CAP among whom MRSA was isolated. METHODS: Consecutive elderly patients who were admitted for CAP and had positive sputum culture for MRSA were retrospectively included, and the association between MRSA coverage and in-hospital mortality was analyzed. RESULTS: Twenty (18%) of 111 patients received MRSA coverage. Although patients who received MRSA coverage tended to have more frequent prior isolation of MRSA compared to those who did not, no significant difference in in-hospital mortality was observed between both groups (2/20, 10% vs. 8/91, 9%). MRSA coverage was not associated with in-hospital mortality (odds ratio: 1.15; 95% CI: 0.23-5.89, p = 0.864); however, advanced age, hemoglobin level, a high A-DROP score, and C-reactive protein levels were associated with in-hospital mortality. MRSA coverage may not improve the prognosis of elderly patients with CAP who had positive sputum culture for MRSA. CONCLUSIONS: A randomized control study is required to determine the efficacy of MRSA coverage on the management of CAP in elderly patients.


Assuntos
Infecções Comunitárias Adquiridas , Staphylococcus aureus Resistente à Meticilina , Pneumonia , Infecções Estafilocócicas , Idoso , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Mortalidade Hospitalar , Humanos , Pneumonia/tratamento farmacológico , Estudos Retrospectivos , Infecções Estafilocócicas/tratamento farmacológico , Estados Unidos
7.
J Infect Chemother ; 28(8): 1125-1130, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35414437

RESUMO

INTRODUCTION: Nursing and healthcare-associated pneumonia (NHCAP) was proposed by the Japanese Respiratory Society in 2011. However, the clinical characteristics of NHCAP are still unclear. Thus, this study aimed to clarify its clinical characteristics. METHODS: This multicenter prospective observational study included 596 patients with NHCAP from 73 centers in Japan between May 2014 and February 2016. RESULTS: Patient background was characterized by an older age (81.5 ± 10.1 years), most patients had complications (94.1%), and many patients had a high probability of aspiration pneumonia (68.6%). Among the isolates, Streptococcus pneumoniae was the most common (12.7%), while Pseudomonas aeruginosa was also isolated at 10.8%. The overall 30-day mortality rate for patients was 11.9%, and the factors affecting mortality were non-ambulatory status, high blood urea nitrogen level, impaired consciousness, and low albumin level. Sulbactam/ampicillin was the most commonly administered antibiotic, including in groups with high severity of illness and high risk of multidrug-resistant (MDR) pathogens. Both the A-DROP and I-ROAD scores were useful in predicting the prognosis of NHCAP. Confirmation of intention to provide do not attempt resuscitation (DNAR) instructions was given to 333 patients (55.9%), and 313 patients agreed to DNAR instructions. CONCLUSIONS: NHCAP tends to occur in elderly patients with underlying diseases. The risk of MDR pathogens and the mortality rate are intermediate for community-acquired pneumonia and hospital-acquired pneumonia. As NHCAP is considered an important concept in an aging society, such as in Japan, establishing a treatment strategy that considers not only prognosis but also quality of life would be beneficial.


Assuntos
Infecções Comunitárias Adquiridas , Infecção Hospitalar , Pneumonia Associada a Assistência à Saúde , Pneumonia , Idoso , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Pneumonia Associada a Assistência à Saúde/tratamento farmacológico , Pneumonia Associada a Assistência à Saúde/epidemiologia , Humanos , Japão/epidemiologia , Pneumonia/tratamento farmacológico , Estudos Prospectivos , Qualidade de Vida
8.
J Infect Chemother ; 28(7): 853-858, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35461771

RESUMO

INTRODUCTION: Influenza remains a clinically heavy burden worldwide. It is well known that some populations are at high risk of complications from influenza, whereas, even previously healthy people might suffer from severe influenza. The objective of this study was to clarify clinical manifestations of hospitalized patients without risk factors infected with influenza. METHODS: The clinical data for patients who were severely ill with influenza, and required hospitalization were gathered and analyzed between November 2014 and August 2020 (6 influenza seasons) using an internet-surveillance system. Among them, the patients who had no risk factors of complications from influenza were extracted. RESULTS: Finally, a total of 91 patients (9.0% of all influenza-related hospitalizations) without risk factors were analyzed. The no risk group was younger than the risk group, though other significant differences of clinical characteristics were not recognized between the groups. Pneumonia was the most common cause of hospitalization in the no risk group, and primary influenza viral pneumonia was the most common pneumonia. Antiviral drugs were administered in 96.7% of the no-risk group, and artificial ventilation was performed in 18.7%. In-hospital death was recorded for 3 patients without risk factors. CONCLUSIONS: Severe complications of influenza which required hospitalization may occur in a certain degree of patients with no risk factors. Efforts are needed to diagnose and treat influenza appropriately even in previously healthy younger patients. Continuous nationwide surveillance will be required to clarify risk factors for severe influenza even in previously healthy younger patients. (UMIN000015989).


Assuntos
Influenza Humana , Pneumonia Viral , Mortalidade Hospitalar , Hospitalização , Humanos , Influenza Humana/complicações , Influenza Humana/tratamento farmacológico , Influenza Humana/epidemiologia , Internet , Japão/epidemiologia , Pneumonia Viral/complicações , Estudos Prospectivos , Fatores de Risco
9.
Respir Res ; 22(1): 211, 2021 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-34303372

RESUMO

BACKGROUND: Whether acute respiratory failure in patients with interstitial lung disease is reversible remains uncertain. Consequently, indications for extracorporeal membrane oxygenation in these patients are still controversial, except as a bridge to lung transplantation. The objective of this study was to clarify in-hospital mortality and prognostic factors in interstitial lung disease patients undergoing extracorporeal membrane oxygenation. METHODS: In this case-control study using the Japanese Diagnosis Procedure Combination database, hospitalized interstitial lung disease patients receiving invasive mechanical ventilation and extracorporeal membrane oxygenation from 2010 to 2017 were reviewed. Patients' characteristics and treatment regimens were compared between survivors and non-survivors to identify prognostic factors. To avoid selection biases, patients treated with extracorporeal membrane oxygenation as a bridge to lung transplantation were excluded. RESULTS: A total of 164 interstitial lung disease patients receiving extracorporeal membrane oxygenation were included. Their in-hospital mortality was 74.4% (122/164). Compared with survivors, non-survivors were older and received high-dose cyclophosphamide, protease inhibitors, and antifungal drugs more frequently, but macrolides and anti-influenza drugs less frequently. On multivariate analysis, the following factors were associated with in-hospital mortality: advanced age (odds ratio [OR] 1.043; 95% confidence interval [CI] 1.009-1.078), non-use of macrolides (OR 0.305; 95% CI 0.134-0.698), and use of antifungal drugs (OR 2.416; 95% CI 1.025-5.696). CONCLUSIONS: Approximately three-quarters of interstitial lung disease patients undergoing extracorporeal membrane oxygenation died in hospital. Moreover, advanced age, non-use of macrolides, and use of antifungal drugs were found to correlate with a poor prognosis.


Assuntos
Bases de Dados Factuais/tendências , Oxigenação por Membrana Extracorpórea/métodos , Doenças Pulmonares Intersticiais/mortalidade , Doenças Pulmonares Intersticiais/terapia , Síndrome do Desconforto Respiratório/mortalidade , Síndrome do Desconforto Respiratório/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Mortalidade Hospitalar/tendências , Hospitalização/tendências , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Respiração Artificial/mortalidade , Respiração Artificial/tendências , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
10.
J Infect Chemother ; 27(3): 480-485, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33189538

RESUMO

INTRODUCTION: Influenza remains a clinically heavy burden worldwide. The objective of this study was to clarify clinical manifestations of severely ill patients infected with influenza. METHODS: The clinical data for patients who were severely ill with influenza, and required hospitalization were gathered and analyzed between November 2014 and August 2019 (5 influenza seasons) using an internet-surveillance system. RESULTS: A total of 924 patients were enrolled and analyzed. The median age was 78 years (IQR, 67-84), and the patients in the 2015-2016 season were significantly younger than those in other seasons. Pneumonia was the most common disease indicated as a cause for hospitalization, followed by a poor general condition and exacerbation of underlying respiratory diseases. Antiviral drugs were administered in 97.0% of the patients with peramivir being the most-frequently use antiviral. In-hospital death was recorded for 44 patients (4.8%). Multivariate analysis indicated that nursing home resident (OR: 6.554) and obesity (OR: 24.343) were independent predictors of in-hospital mortality. CONCLUSIONS: Complications of influenza infection remain a heavy burden especially among the elderly. Continuous nationwide surveillance will be required to grasp the actual situation of influenza epidemics. (UMIN000015989).


Assuntos
Influenza Humana , Adulto , Idoso , Mortalidade Hospitalar , Hospitalização , Humanos , Influenza Humana/tratamento farmacológico , Influenza Humana/epidemiologia , Internet , Japão/epidemiologia , Estudos Prospectivos , Estações do Ano
11.
BMC Pulm Med ; 21(1): 293, 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34530790

RESUMO

BACKGROUND: Re-expansion pulmonary edema is an uncommon complication following drainage of a pneumothorax or pleural effusion. While pneumothorax is noted to complicate COVID-19 patients, no case of COVID-19 developing re-expansion pulmonary edema has been reported. CASE REPRESENTATION: A man in his early 40 s without a smoking history and underlying pulmonary diseases suddenly complained of left chest pain with dyspnea 1 day after being diagnosed with COVID-19. Chest X-ray revealed pneumothorax in the left lung field, and a chest tube was inserted into the intrathoracic space without negative pressure 9 h after the onset of chest pain, resulting in the disappearance of respiratory symptoms; however, 2 h thereafter, dyspnea recurred with lower oxygenation status. Chest X-ray revealed improvement of collapse but extensive infiltration in the expanded lung. Therefore, the patient was diagnosed with re-expansion pulmonary edema, and his dyspnea and oxygenation status gradually improved without any intervention, such as steroid administration. Abnormal lung images also gradually improved within several days. CONCLUSIONS: This case highlights the rare presentation of re-expansion pulmonary edema following pneumothorax drainage in a patient with COVID-19, which recovered without requiring treatment for viral pneumonia. Differentiating re-expansion pulmonary edema from viral pneumonia is crucial to prevent unnecessary medication for COVID-19 pneumonia and pneumothorax.


Assuntos
COVID-19/complicações , Tubos Torácicos , Pneumotórax/terapia , Edema Pulmonar/etiologia , Adulto , COVID-19/diagnóstico , Humanos , Masculino , Radiografia Torácica , SARS-CoV-2/isolamento & purificação , Tomografia Computadorizada por Raios X
12.
BMC Pulm Med ; 21(1): 115, 2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827514

RESUMO

BACKGROUND: Intravesical instillation of bacillus Calmette-Guérin (BCG) as a treatment for superficial bladder cancer rarely causes pulmonary complications. While published cases have been pathologically characterized by multiple granulomatous lesions due to disseminated infection, no case presenting as a solitary pulmonary nodule has been reported. CASE PRESENTATION: A man in his 70 s was treated with intravesical BCG for early-stage bladder cancer. After 1 year, he complained of productive cough with a solitary pulmonary nodule at the left lower lobe of his lung being detected upon chest radiography. His sputum culture result came back positive, with conventional polymerase chain reaction (PCR) identifying Mycobacterium tuberculosis complex. However, tuberculosis antigen-specific interferon-gamma release assay came back negative. Considering a history of intravesical BCG treatment, multiplex PCR was conducted, revealing the strain to be Mycobacterium tuberculosis var. BCG. The patient was then treated with isoniazid, ethambutol, levofloxacin, and para-aminosalicylic acid following an antibiotic susceptibility test showing pyrazinamide resistance, after which the size of nodule gradually decreased. CONCLUSION: This case highlights the rare albeit potential radiographic presentation of Mycobacterium tuberculosis var. BCG, showing a solitary pulmonary nodule but not multiple granulomatous lesions, after intravesical BCG treatment. Differentiating Mycobacterium tuberculosis var. BCG from Mycobacterium tuberculosis var. tuberculosis is crucial to determine whether intravesical BCG treatment could be continued for patients with bladder cancer.


Assuntos
Vacina BCG/efeitos adversos , Mycobacterium tuberculosis/isolamento & purificação , Nódulo Pulmonar Solitário/etiologia , Tuberculose/etiologia , Neoplasias da Bexiga Urinária/terapia , Administração Intravesical , Idoso , Vacina BCG/administração & dosagem , Humanos , Masculino , Radiografia Torácica , Nódulo Pulmonar Solitário/microbiologia , Tomografia Computadorizada por Raios X
13.
J Clin Pharm Ther ; 46(2): 343-351, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33016566

RESUMO

WHAT IS KNOWN AND OBJECTIVE: Thrombocytopenia is one of the typical adverse events caused by linezolid (LZD). Recently, some cases of severe hyponatraemia occurring while receiving LZD have been reported. This study investigated a possible relationship between LZD-induced hyponatraemia and thrombocytopenia and identified the risk factors for hyponatraemia and/or thrombocytopenia. METHODS: In this retrospective, single-centre, observational cohort study, 63 hospitalized patients aged over 18 years who received intravenous injection of LZD for more than seven consecutive days in Oita University Hospital between April 2015 and March 2018 were analysed. RESULTS: Thrombocytopenia occurred in 25 (39.7%) patients and hyponatraemia in 11 (17.5%) patients. Seven of 11 patients with hyponatraemia had concurrent thrombocytopenia. Although both serum sodium level and platelet count declined in most patients who developed hyponatraemia, no significant association between thrombocytopenia and hyponatraemia was found. Creatinine clearance level (Ccr) was significantly lower not only in the thrombocytopenia (vs no-thrombocytopenia) but also in the hyponatraemia group (vs no-hyponatraemia group). Univariate and multivariate logistic regression analyses identified different risk factors for thrombocytopenia and/or hyponatraemia (thrombocytopenia: Ccr and administration period; hyponatraemia: serum albumin; thrombocytopenia and hyponatraemia: administration period and serum albumin). WHAT IS NEW AND CONCLUSION: In conclusion, this study found no significant relationship between LZD-induced thrombocytopenia and hyponatraemia and identified some possible risk factors associated with onset of the two adverse events. These require further validation.


Assuntos
Antibacterianos/efeitos adversos , Hiponatremia/induzido quimicamente , Linezolida/efeitos adversos , Trombocitopenia/induzido quimicamente , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Creatinina/sangue , Feminino , Humanos , Linezolida/farmacologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Fatores de Risco , Sódio/sangue
14.
J Infect Chemother ; 26(2): 300-304, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31859040

RESUMO

There have been no case reports of thoracic subcutaneous abscess after surgery for Mycobacterium abscessus complex associated empyema. We herein report a case of Mycobacterium abscessus subsp. abscessus (M. abscessus subsp. abscessus) induced subcutaneous abscesses following surgical treatment for concurrent M. abscessus subsp. abscessus -associated empyema and pneumothorax. A 75-year-old woman had M. abscessus subsp. abscessus -associated empyema and pneumothorax. She underwent surgical treatment of decortication and fistulectomy and suffered from M. abscessus subsp. abscessus -associated subcutaneous abscesses after thoracentesis/drainage. A multidisciplinary approach combined with surgical care, thermal therapy, and multidrug chemotherapy contributed to a successful result. An early multidisciplinary approach is believed to be important in cases of M. abscessus subsp. abscessus -associated empyema and subcutaneous abscess.


Assuntos
Abscesso/microbiologia , Empiema Pleural/microbiologia , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Mycobacterium abscessus/isolamento & purificação , Tela Subcutânea/patologia , Abscesso/diagnóstico , Abscesso/terapia , Idoso , Antibacterianos/uso terapêutico , Empiema Pleural/complicações , Empiema Pleural/diagnóstico , Empiema Pleural/tratamento farmacológico , Feminino , Humanos , Hipertermia Induzida/métodos , Infecções por Mycobacterium não Tuberculosas/complicações , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Pneumotórax/complicações , Pneumotórax/diagnóstico , Pneumotórax/microbiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/microbiologia , Tela Subcutânea/microbiologia , Tórax/diagnóstico por imagem , Tórax/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
J Infect Chemother ; 26(1): 69-75, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31375456

RESUMO

While advanced age is a main prognostic factor in patients with tuberculosis, the factors that specifically affect tuberculosis-related death are unclear because elderly people are at a risk for other age-related lethal diseases. We aimed to assess the impact of performance status on tuberculosis-related death among elderly patients with lung tuberculosis. Elderly patients (≥65 years of age) admitted to our hospital for bacteriologically-diagnosed lung tuberculosis were included, and analyzed the influence of performance status on tuberculosis-related in-hospital death, with non-tuberculosis-related death as a competing risk. Forty and 19 of the 275 patients died from tuberculosis-related causes and non-tuberculosis-related causes, respectively. The tuberculosis-related death group had a greater number of patients with a poor performance status (defined as category 3 and 4 [HR 21.022; 95%CI 2.881-153.414; p = 0.003]), a lower serum albumin level (HR 0.179; 95%CI 0.090-0.359; p < 0.001) and a higher C-reactive protein level (HR1.076; 95%CI 1.026-1.127; p = 0.002). A multivariate competing risk regression analysis showed that a poor performance status (HR 7.311; 95%CI 1.005-53.181; p = 0.049) and low albumin level (HR 0.228; 95%CI 0.099-0.524); p = 0.001) significantly predicted tuberculosis-related death. Performance status can be a useful scale for predicting tuberculosis-related death among elderly patients with pulmonary tuberculosis.


Assuntos
Índice de Gravidade de Doença , Tuberculose Pulmonar , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Prognóstico , Análise de Regressão , Estudos Retrospectivos , Medição de Risco , Albumina Sérica/análise , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/mortalidade
16.
Tohoku J Exp Med ; 250(4): 215-221, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32249237

RESUMO

Pneumocystis jirovecii pneumonia (PJP) occurs in immunocompromised hosts and is classified as PJP with human immunodeficiency virus (HIV) infection (HIV-PJP) and PJP without HIV infection (non-HIV PJP). Non-HIV PJP rapidly progresses to respiratory failure compared with HIV-PJP possibly due to the difference in immune conditions; namely, the prognosis of non-HIV PJP is worse than that of HIV PJP. However, the diagnosis of non-HIV PJP at the early stage is difficult. Herein, we report a case of severe non-HIV PJP successfully managed with veno-venous extracorporeal membrane oxygenation (V-V ECMO). A 54-year-old woman with neuromyelitis optica was treated with oral corticosteroid, azathioprine, and methotrexate. She admitted to our hospital for fever, dry cough, and dyspnea which developed a week ago. On admission, she required endotracheal intubation and invasive ventilation for hypoxia. A chest computed tomography (CT) scan revealed ground-glass opacity and consolidation in the both lungs. Grocott staining and PCR analysis of bronchoalveolar lavage fluid indicated the presence of fungi and Pneumocystis jirovecii, respectively, whereas serum HIV-antibody was negative. The patient was thus diagnosed with non-HIV PJP and was treated with intravenous pentamidine and corticosteroid pulse therapy for PJP. However, hypoxia was worsened; consequently, V-V ECMO assistance was initiated on day 7. The abnormal chest CT findings and hypoxia were gradually improved. The V-V ECMO support was successfully discontinued on day 14 and mechanical ventilation was discontinued on day 15. V-V ECMO could be a useful choice for respiratory assistance in severe cases of PJP among patients without HIV infection.


Assuntos
Oxigenação por Membrana Extracorpórea , Infecções por HIV/complicações , Hospedeiro Imunocomprometido , Pneumocystis carinii/fisiologia , Pneumonia por Pneumocystis/microbiologia , Pneumonia por Pneumocystis/terapia , Veias/patologia , Líquido da Lavagem Broncoalveolar , Feminino , Humanos , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/diagnóstico por imagem , Coloração e Rotulagem , Tomografia Computadorizada por Raios X
17.
Tohoku J Exp Med ; 250(2): 129-135, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32115495

RESUMO

Pulmonary lymphoma is rare, accounting for < 1% of primary lung cancers. Most primary pulmonary lymphomas (PPL) are low-grade mucosa-associated lymphoid tissue (MALT)-type, and among PPL, diffuse large B-cell lymphoma (DLBCL) is extremely rare. In contrast, there has been an increase in the incidence of DLBCL among patients with autoimmune disorders and recurrent or chronic bacterial infection. A subset of DLBCL has been reported to develop through transformation of preexisting or concurrent MALT. The respiratory symptoms are non-specific, and the chest X-ray findings demonstrate the presence of interstitial and mixed alveolar infiltrates, nodular lesions, and localized homogeneous consolidations; the diagnosis of pulmonary DLBCL is thus challenging and often leads to a misdiagnosis or delayed diagnosis. We herein report a case of DLBCL which was assumed to have arisen from the lesion of chronic atelectasis that was successfully diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). A 74-year-old woman with diffuse bronchiectasis and chronic atelectasis of the left lower lobe suffered from productive cough and high fever. Increased airway filling with mucoid secretion was repeatedly observed within the area of atelectasis with bronchiectasis, and left lower lobe atelectasis developed. Subsequently, the hilar and mediastinal lymph nodes gradually became enlarged, and DLBCL was pathologically confirmed. In the present case, DLBCL was considered to have arisen in the lesion of chronic atelectasis. Physicians should recognize that DLBCL may develop at the site of chronic atelectasis during disease course of diffuse bronchiectasis, and thus DLBCL may be misdiagnosed as superimposed infection of chronic atelectasis.


Assuntos
Neoplasias Pulmonares/patologia , Linfoma de Células B/patologia , Atelectasia Pulmonar/patologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ciclofosfamida/uso terapêutico , Doxorrubicina/análogos & derivados , Doxorrubicina/uso terapêutico , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/tratamento farmacológico , Linfoma de Células B/diagnóstico por imagem , Linfoma de Células B/tratamento farmacológico , Tomografia por Emissão de Pósitrons , Prednisolona/uso terapêutico , Atelectasia Pulmonar/diagnóstico por imagem , Atelectasia Pulmonar/tratamento farmacológico , Tomografia Computadorizada por Raios X , Vincristina/uso terapêutico
18.
J Infect Chemother ; 25(2): 147-150, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30097373

RESUMO

Diffuse panbronchiolitis (DPB) is a progressive inflammatory airway disease characterized by a chronic cough, copious sputum expectation, dyspnea, and chronic sinusitis. Owing to the long-term treatment of low-dose macrolides, the prognosis has been remarkably improved. However, in some cases, patients are refractory to macrolides, and the subsequent treatment strategies are controversial. We herein present a patient with the onset of DPB during treatment with long-term, low-dose clarithromycin (CAM) for chronic sinusitis who was successfully treated by switching to long-term treatment with normal-dose CAM. We should recognize that DPB may develop in patients with chronic sinusitis despite treatment with a long-term, low-dose macrolide. We also propose that increasing the dose of macrolide may be a useful strategy for treating refractory patients.


Assuntos
Antibacterianos/uso terapêutico , Bronquiolite , Claritromicina/uso terapêutico , Infecções por Haemophilus , Sinusite/tratamento farmacológico , Adulto , Antibacterianos/efeitos adversos , Doença Crônica , Claritromicina/efeitos adversos , Humanos , Masculino
19.
J Infect Chemother ; 25(9): 714-719, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30982726

RESUMO

Whether or not additional antibiotics with anti-tuberculosis agents are required to treat bacterial co-infection with pulmonary tuberculosis is unclear. We aimed to assess the impact of additional antibiotics on mortality in pulmonary tuberculosis patients whose sputum cultures were positive for general bacteria as a surrogate definition of bacterial pneumonia. This study was a single-center retrospective cohort using a propensity score analysis. We included patients who were admitted for pulmonary tuberculosis and whose sputum cultures were positive for general bacteria. The mortality of patients who received additional antibiotics was analyzed after adjusting for other variables, including the propensity score predicting treatment with additional antibiotics. We assessed 68 and 55 tuberculosis patients treated with and without general antibiotics, respectively. Additional antibiotics tended to be administered to patients with a high level of C-reactive protein and neutrophil count, poor performance status, hypoxemia and hypoalbuminemia (C-statistics of area under receiver operating characteristic curve to the propensity score; 0.884, p < 0.001). In the multivariate analysis, advanced age and not the use of additional antibiotics was associated with in-hospital mortality. Additional antibiotics with anti-tuberculosis agents may not improve the prognosis of pulmonary tuberculosis patients whose sputum cultures were positive for general bacteria. Isolation of general bacteria does not equate to complication with bacterial pneumonia, so physicians should not administer general antibiotics to TB patients based solely on the results of sputum culture for general bacteria. A prospective study is needed to verify these results using a more accurate definition of pulmonary tuberculosis complicated with bacterial pneumonia.


Assuntos
Antibacterianos/uso terapêutico , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/tratamento farmacológico , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Gestão de Antimicrobianos , Estudos de Coortes , Coinfecção , Feminino , Mortalidade Hospitalar , Hospitais de Doenças Crônicas , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/mortalidade , Pontuação de Propensão , Estudos Retrospectivos , Escarro/microbiologia , Tuberculose Pulmonar/mortalidade
20.
Tohoku J Exp Med ; 248(2): 137-141, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31243182

RESUMO

Saddle pulmonary embolism (PE) and paradoxical embolism (PDE) are life-threatening disorders carrying a risk of sudden death, and their prompt diagnosis is extremely important. Saddle PE is a radiologic definition and refers to a thrombus that straddles the bifurcation of the pulmonary artery trunk, carrying a risk of sudden hemodynamic collapse. PDE is defined as a systemic arterial embolus due to the passage of a venous thrombus though a right-to-left shunt, such as patent foramen ovale (PFO). We herein present the rare case of asthma exacerbation coincident with saddle PE and PDE. A 69-year-old woman with asthma was suffering from dyspnea, pulse attenuation of the left radial artery and left upper limb pain. An arterial blood gas analysis revealed hypoxemia, and a pulmonary function test demonstrated an obstructive pattern. Enhanced computed tomography (CT) revealed saddle PE, right popliteal venous thrombosis, and left brachial artery occlusion. After the treatment with edoxaban, an anticoagulant, and aspirin, the PE was significantly alleviated, and the brachial artery occlusion was recanalized. Subsequently, the right-to-left shunt through PFO was confirmed, and PDE was suspected of inducting her brachial artery embolism. In the present case, the pulse attenuation of the radial artery and upper limb pain prompted us to consider peripheral vascular disease or coagulation disorders. Physicians should keep in mind that patients with asthma are at considerable risk of PE, and it is important to be aware of possible PFO in patients presenting with the coexistence of PE and systemic arterial embolism.


Assuntos
Asma/complicações , Asma/patologia , Progressão da Doença , Embolia Paradoxal/complicações , Embolia Pulmonar/complicações , Idoso , Asma/diagnóstico por imagem , Embolia Paradoxal/diagnóstico por imagem , Feminino , Humanos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/patologia , Tomografia Computadorizada por Raios X
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA