Chronic Pulmonary Aspergillosis Caused by Aspergillus tubingensis Diagnosed by a Bronchoscopic Biopsy.

We herein report a case of chronic pulmonary aspergillosis (CPA) caused by Aspergillus tubingensis diagnosed by a bronchoscopic biopsy with negative serological and sputum culture findings. A 66-year-old man was referred for the assessment of a pulmonary cavity. Computed tomography showed a thick-walled cavity in the upper right pulmonary lobe. Serum ß-D glucan, Aspergillus galactomannan, and Aspergillus antibody tests were negative. Aspergillus species were not detected in the sputum. Culture and pathological specimens were obtained from the mass by bronchoscopy. Microscopic examination findings were consistent with Aspergillus niger complex morphologically and identified as Aspergillus tubingensis through DNA sequencing. The patient was diagnosed with chronic pulmonary aspergillosis.

Evaluation of tuberculosis diagnostic biomarkers in immunocompromised hosts based on cytokine levels in QuantiFERON-TB Gold Plus.

Tuberculosis (TB) remains a serious health concern globally. QuantiFERON-TB (QFT) is a diagnostic tool for TB detection, and its sensitivity is reduced in immunocompromised hosts with low T lymphocyte counts or abnormal T cell function. This study aimed to evaluate the correlation between T cell and cytokine levels in patients with active TB using QFT-Plus. Forty-five patients with active TB were enrolled, and the cytokines in QFT-Plus tube supernatants were quantified using the MAGPIX System. CD4+ T cell count negatively correlated with patient age (p < 0.001, r = -0.51). The levels of TB1-responsive interleukin-1 receptor antagonist (IL-1Ra) and IL-2 correlated with CD4+ T cell count, whereas the levels of TB2-responsive IL-1Ra and IFN-γ-induced protein 10 correlated with both CD4+ and CD8+ T cell counts. Cytokines that correlated with CD4+ and CD8+ T cell counts might not be suitable TB diagnostic biomarkers in immunocompromised hosts. Notably, cytokines that did not correlate with the T cell counts, such as monocyte chemoattractant protein-1, might be candidate biomarkers for TB in immunocompromised hosts. Our findings might help improve TB diagnosis, which could enable prompt treatment and minimize poor disease outcomes.

Long-Term Outcomes of Bronchial Artery Embolization for Patients with Non-Mycobacterial Non-Fungal Infection Bronchiectasis.

BACKGROUND: There is no study on the predictive factors of recurrent haemoptysis after bronchial artery embolization (BAE) with the long-term outcomes in patients with bronchiectasis (BE). OBJECTIVES: To evaluate the long-term outcomes of BAE in BE patients without accompanying refractory active infection of mycobacteriosis and aspergillosis with analysis for the predictive factors of recurrent haemoptysis. METHODS: Data of 106 patients with BE who underwent BAE using coils between January 2011 and December 2018 were retrospectively reviewed. The cumulative haemoptysis control rate was estimated using Kaplan-Meier methods with log-rank tests to analyze differences in recurrence-free rate between groups based on technical success and failure, bacterial colonization status, number of BE lesions, and vessels embolized to bronchial arteries (BAs) or BAs + non-bronchial systemic arteries (NBSAs). RESULTS: Bacterial colonization was detected in approximately 60% of patients. Computed tomography showed bronchiectatic lesions with 2.9 ± 1.4 lobes. In the first series of BAE, embolization was performed in the BAs alone and BAs + NBSAs in 65.1 and 34.9% of patients, respectively, with 2.4 ± 1.4 embolized vessels in total. The median follow-up period was 1,000 (7-2,790) days. The cumulative haemoptysis control rates were 91.3, 84.2, 81.5, and 78.9% at 1, 2, 3, and 5 years, respectively. The haemoptysis control rates were higher in the technical success group than in the technical failure group (p = 0.029). CONCLUSIONS: High haemoptysis control rates for long-term periods were obtained by embolization for all visualized abnormal arteries, regardless of the colonization status, number of bronchiectatic lobes, and target vessels, irrespective of NBSAs.

[Assessing the usefulness of erlotinib in patients with unknown or negative epidermal growth factor receptor mutation status].

The patient involved in case 1 was an approximately 50-year-old woman with left lung adenocarcinoma (cT4N0M1), pleural dissemination, and carcinomatous pleural effusion. Chemotherapy with cisplatin and S-1 was administered as first-line therapy, and after the second course of chemotherapy, the thoracic drainage tube could be removed. Thereafter, the patient's performance status (PS) improved to 0. However, brain metastasis was detected, with symptoms of dizziness and headache, and activities of daily living (ADL) decreased, resulting in deterioration of the PS to 4. Although epidermal growth factor receptor (EGFR) mutation status was unknown, erlotinib (150 mg/day) was administered, which was evidently effective in reducing brain metastasis and resulted in recovery of the PS to 0. The patient involved in case 2 was an approximately 50- year-old man with a complaint of coughing. Chemotherapy with 4 courses of cisplatin and pemetrexed was administered as first-line therapy, and local radiation therapy (66 Gy) followed by 4 courses of docetaxel was administered as second-line therapy. However, the patient showed progressive disease (PD) and emergence of brain metastasis. Although the patient was negative for EGFR mutation, erlotinib (150 mg/day) was initiated as third-line therapy. Chemotherapy was successful and the local lesions were under control. We performed left pneumonectomy to improve quality of life (QOL), which had decreased because of repeated obstructive pneumonia caused by the tumor. Owing to the surgery, the patient was able to maintain a PS of 0 and a favorable QOL, while the administration of erlotinib was continued. In conclusion, erlotinib functions effectively in 3 ways. First, it can be used for emergency administration in cases of unknown EGFR mutation status. Second, its use facilitates the performance of salvage surgery in patients who are EGFR mutation negative. Finally, erlotinib is expected to be effective in the treatment of brain metastasis.