[Hospitalized nursing home-acquired pneumonia--comparison with community-acquired pneumonia in older adults].

Nursing home-acquired pneumonia (NHAP) is a frequent cause of hospital admission and death among residents of long-term care facilities. We studied consecutive patients with NHAP who were admitted to our 358-bed acute care hospital from 2004 to 2007. Patients with NHAP (n = 147) were significantly older (85.8 +/- 8.0 years vs. 80.2 +/- 8.2 years); predominantly female (57.1% vs. 41.5%); had higher severity (the 2005 Japanese Respiratory Society guidelines A-DROP score: 2.5 +/- 1.1 vs. 2.1 +/- 1.2) and a higher mortality (10.4% vs. 5.8%); had a longer median length of hospital stay (17 days vs. 15 days) than elderly patients with community-acquired pneumonia (n = 545). Cerebrovascular disorders (31.3% vs. 14.1%), dementia (59.2% vs. 22.9%) and feeding tube placement (19.0% vs. 6.4%), which were associated with aspiration, were more common and bronchial asthma (0.7% vs. 8.8%) and COPD (4.1% vs. 19.8%) less common among those with NHAP. Although Methicillin-resistant Staphylococcus aureus (MRSA) was more frequently isolated from the sputa of the NHAP group (23.1% vs. 9.4%), Streptococcus pneumoniae was the most important causative agent by microbial investigations, including blood culture and urinary antigen testing in addition to sputum examination.

[Value of 18F-fluorodeoxyglucose-PET in the diagonosis and monitoring of pulmonary sarcoidosis: a case report].

A 46-year-old woman was referred to our hospital because of abnormal findings of 18F-fluorodeoxyglucose-PET (FDG-PET) scan at a medical check-up. Her chest radiography and CT showed nodular shadows distributed along the broncho-vascular bundle. The 1st FDG-PET showed a high FDG uptake in the pulmonary nodules, and the hilar, mediastinal and supraclavicular lymph nodes. Although sarcoidosis was suspected, diagnosis was not obtained by bronchoscopy. Thoracoscopic lung biopsy was performed in order to exclude malignancy, resulting in a definite diagnosis of sarcoidosis. No treatment was given and subsequently spontaneous regression was obtained. The follow-up FDG-PET showed no abnormal uptake at all. FDG-PET has been widely used in the assessment of malignancy, however recent reports have indicated that sarcoid lesions could have increased FDG activity. FDG-PET may be useful for diagnosis and monitoring in sarcoidosis.

[A case of pulmonary aspergilloma successfully treated with transbronchial intracavitary itraconazole].

A 74-year-old woman given a diagnosis of chronic necrotizing pulmonary aspergillosis in February, 2007 was treated by intravenous voriconazole (VRCZ) and her conditions improved. Then it was switched to oral VRCZ and continued treatment. However, a fungus ball remained, and (1-3)-beta-D-glucan values increased, which had previously been within normal limit. Therefore transbronchial intracavitary itraconazole therapy was performed twice a week, for a total of 9 times (715 mg) from June, 2007. The fungus ball disappeared at the time of the fourth injection, and (1-3)-beta-D-glucan values decreased gradually. Intravenous ITCZ was administered for two weeks from July, 2007, after which it was switched to oral ITCZ 400 mg/day and treatment was continued without recurrence. Though intracavitary ITCZ therapy caused temporary fever and elevation of CRP, we were able to perform the treatment safely and confirm the elevation of enough serum ITCZ concentrations. This is the first case of pulmonary aspergilloma successfully and safely treated with transbronchial intracavitary itraconazole.