Bronchiectatic air bronchograms in pulmonary tuberculosis: a case report and literature review.

We report a case of a 61-year-old Filipino-American male who developed pulmonary tuberculosis after travel to the Philippines. His history, presentation, imaging findings, and clinical course are presented as well as a discussion of the interesting imaging features in his case. Our case highlights the importance of having a high index of suspicion for tuberculosis in the setting of "bronchiectatic air bronchograms" as well as the value of computed tomography (CT) imaging in pulmonary tuberculosis.

The antibiotic support team--a successful educational approach to antibiotic stewardship.

The efficacy of an antibiotic support team (AST) has been demonstrated in both large teaching hospitals and smaller community hospitals. The usefulness of an AST in a medium-sized military hospital was investigated in the present study. Patients at least 18 years old hospitalized at the David Grant USAF Medical Center (DGMC) and receiving > or =1 of 17 specified antibiotics for > or =3 consecutive days were randomized to an educational intervention group or control group. Primary endpoints included antibiotic defined daily dose (DDD) per patient treatment course and days of antibiotic therapy (DOT) per patient. Fifty-two patients were analyzed from March to August 2006. DDD per patient treatment course was significantly lower in the intervention group, (6.7 +/- 7.6 vs. 12.9 +/- 16.3, p = 0.05). A trend toward fewer DOT per patient was seen in the intervention vs. control group. Implementation of an AST decreased the intensity of exposure to antibiotics.

Pseudohyperphosphatemia associated with high-dose liposomal amphotericin B therapy.

BACKGROUND: Acute increases in serum inorganic phosphorus (Pi) up to 4.75 mmol/l in the absence of hypocalcemia and tissue deposition of calcium phosphate were noted in 3 patients receiving liposomal amphotericin B (L-AMB). We investigated L-AMB as a possible cause of pseudohyperphosphatemia. METHODS: Serum samples from the index patient were analyzed for Pi content by our laboratory's primary analyzer (Synchron LX20) and by an alternate analyzer (Vitros). Clear and lipemic serum pools, and normal saline, were spiked with L-AMB and analyzed by the LX20 Pi method. Ultrafiltration studies were performed on patient and spiked sera. RESULTS: Increased Pi values were obtained only from the LX20 analyzer. There was a direct linear relationship between the concentration of L-AMB in the spiked samples and the LX20 Pi results, indicating a 0.9 mmol/l Pi increase for every 100 mg/l increase in L-AMB. Ultrafiltration normalized the Pi results. CONCLUSION: Serum Pi results may be falsely increased in patients receiving L-AMB when measured by the LX20 analyzer. This novel cause of pseudohyperphosphatemia is due to interference of L-AMB with the method and is corrected by ultrafiltration of the specimen. Since the LX20 analyzer is widely used by the clinical laboratories clinicians and laboratory personnel should recognize this interference in order to avoid unnecessary diagnostic procedures and interventions.