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1.
J Infect Chemother ; 27(1): 40-44, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32847717

RESUMEN

INTRODUCTION: Diagnosing tuberculous pleurisy is important in Japan because it currently has a moderate tuberculosis prevalence. However, physicians often have difficulty making a diagnosis. It was reported that thoracoscopy under local anesthesia is useful for the diagnosis of tuberculous pleurisy, but there are no reports focusing on elderly patients. METHODS: In this study, the usefulness of thoracoscopy under local anesthesia was evaluated in elderly patients. Among 170 patients who underwent thoracoscopy under local anesthesia at our hospital during 11 years from January 2008 to December 2018, those aged 75 years or older (n = 75) were investigated retrospectively. RESULTS: A total of 55 patients underwent thoracoscopy under local anesthesia for detailed examination of pleural effusion of unknown cause. Of these, 18 were diagnosed as tuberculous pleurisy. The median age was 82 years (range: 75-92 years). The diagnosis of tuberculous pleurisy was made in 11 patients in whom Mycobacterium tuberculosis was detected and in four patients whose pathological findings indicated epithelioid granuloma accompanied by caseous necrosis. Clinical diagnosis was made in the remaining three patients based on thoracoscopic findings of the pleural cavity and a high level of adenosine deaminase in pleural fluid. No serious complications attributable to the examination were observed in any patient. CONCLUSIONS: Thoracoscopy under local anesthesia was useful for the diagnosis of tuberculous pleurisy in elderly patients, with useful information being also obtained for the treatment of tuberculosis.


Asunto(s)
Derrame Pleural , Tuberculosis Pleural , Anciano , Anciano de 80 o más Años , Anestesia Local , Humanos , Japón , Pleura , Estudios Retrospectivos , Toracoscopía , Tuberculosis Pleural/diagnóstico
2.
BMC Pulm Med ; 20(1): 287, 2020 Nov 07.
Artículo en Inglés | MEDLINE | ID: mdl-33160360

RESUMEN

BACKGROUND: Although cigarette smoking may have a negative impact on the clinical outcome of pulmonary tuberculosis (PTB), few studies have investigated the impact of smoking-associated lung diseases. Emphysema is a major pathological finding of smoking-related lung damage. We aimed to clarify the effect of emphysema on sputum culture conversion rate for Mycobacterium tuberculosis (MTB). METHODS: We retrospectively studied 79 male patients with PTB confirmed by acid-fast bacillus smear and culture at Jikei University Daisan Hospital between January 2015 and December 2018. We investigated the sputum culture conversion rates for MTB after starting standard anti-TB treatment in patients with or without emphysema. Emphysema was defined as Goddard score ≥ 1 based on low attenuation area < - 950 Hounsfield Unit (HU) using computed tomography (CT). We also evaluated the effect on PTB-related CT findings prior to anti-TB treatment. RESULTS: Mycobacterial median time to culture conversion (TCC) in 38 PTB patients with emphysema was 52.0 days [interquartile range (IQR) 29.0-66.0 days], which was significantly delayed compared with that in 41 patients without emphysema (28.0 days, IQR 14.0-42.0 days) (p < 0.001, log-rank test). Multivariate Cox proportional hazards analysis showed that the following were associated with delayed TCC: emphysema [hazard ratio (HR): 2.43; 95% confidence interval (CI): 1.18-4.97; p = 0.015), cavities (HR: 2.15; 95% CI: 1.83-3.89; p = 0.012) and baseline time to TB detection within 2 weeks (HR: 2.95; 95% CI: 1.64-5.31; p < 0.0001). Cavities and consolidation were more often identified by CT in PTB patients with than without emphysema (71.05% vs 43.90%; p = 0.015, and 84.21% vs 60.98%; p = 0.021, respectively). CONCLUSIONS: This study suggests that emphysema poses an increased risk of delayed TCC in PTB. Emphysema detection by CT might be a useful method for prediction of the duration of PTB treatment required for sputum negative conversion.


Asunto(s)
Fumar Cigarrillos/efectos adversos , Mycobacterium tuberculosis/efectos de los fármacos , Enfisema Pulmonar/complicaciones , Esputo/microbiología , Tuberculosis Pulmonar/microbiología , Anciano , Anciano de 80 o más Años , Antituberculosos/farmacología , Humanos , Japón , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Tuberculosis Pulmonar/tratamiento farmacológico
3.
BMC Pulm Med ; 19(1): 10, 2019 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-30626371

RESUMEN

BACKGROUND: Relapse of cryptogenic organizing pneumonia (COP) may lead to poor long-term prognosis and necessitates multiple rounds of steroid treatment with potential adverse effects. The objective of this study is to identify predictive factors of COP relapse by comparing demographic and clinical variables between relapse and non-relapse groups. METHODS: During 2008-2013, 33 COP patients were treated, of which 23 (69.7%) and 10 patients (30.3%) were assigned to the non-relapse and relapse group, respectively. From medical records, we compared the following variables at initial episode: clinical characteristics, serum parameters, chest CT scan findings, and steroid treatment. RESULTS: Clinical characteristics, cumulative prednisone dose, and steroid treatment duration were similar between groups. In univariate analysis, alternatively, the proportion of patients with bilateral shadow pattern, traction bronchiectasis, and partial remission after steroid treatment was significantly higher in the relapse group. These differences were not significant by multivariate Cox regression analysis. CONCLUSIONS: We identified radiographic findings, such as bilateral shadow pattern, traction bronchiectasis, and partial remission, may have possibility of predictive factors for COP relapse. Larger-scale studies are required to confirm if any are independent predictors of COP relapse.


Asunto(s)
Neumonía en Organización Criptogénica/diagnóstico , Pulmón/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano , Anciano de 80 o más Años , Neumonía en Organización Criptogénica/tratamiento farmacológico , Neumonía en Organización Criptogénica/fisiopatología , Femenino , Humanos , Japón , Pulmón/fisiopatología , Masculino , Análisis Multivariante , Evaluación de Resultado en la Atención de Salud , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Esteroides/uso terapéutico
4.
Yale J Biol Med ; 90(2): 165-181, 2017 06.
Artículo en Inglés | MEDLINE | ID: mdl-28656006

RESUMEN

Background: Pneumonia is a major complication of influenza that contributes to mortality. Clinical characteristics and factors of influenza virus contributing to the severity and mortality of pneumonia have not been fully elucidated. Objective: The objective was to clarify clinical characteristics and factors contributing to the severity and mortality of influenza-associated pneumonia (flu-p). Methods: We retrospectively analyzed patients with flu-p. Results: From December 1999 to March 2016, 210 patients with a median age of 69 (range, 17 to 92) years with flu-p based on positive rapid antigen tests, increased antibody titers of paired sera, or positive results of reverse transcription polymerase chain reaction were admitted to our institution. A multivariate analysis found that advanced age (≥ 65 years), pneumonia subtypes (unclassified), diabetes mellitus, and acute kidney injury complicated with flu-p were independent factors associated with disease severity, whereas pneumonia subtypes (mixed viral and bacterial pneumonia and unclassified), healthcare-associated pneumonia, acute kidney injury complicated with flu-p, and severity on admission (severe) were independent factors associated with non-survival. Conclusion: The clinical characteristics of flu-p are varied, and the contribution of several factors to the severity and mortality of flu-p suggest their importance in either preventing flu-p or managing flu-p after it develops.


Asunto(s)
Gripe Humana/complicaciones , Neumonía Bacteriana/etiología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Gripe Humana/mortalidad , Gripe Humana/patología , Gripe Humana/virología , Masculino , Persona de Mediana Edad , Neumonía Bacteriana/microbiología , Neumonía Bacteriana/patología , Neumonía Bacteriana/virología , Neumonía Viral/etiología , Neumonía Viral/mortalidad , Neumonía Viral/patología , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
5.
BMC Infect Dis ; 16(1): 668, 2016 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-27835982

RESUMEN

BACKGROUND: The effectiveness of hepatoprotective drugs for DIH (drug induced hepatotoxicity) during tuberculosis treatment is not clear. We evaluated the effectiveness of hepatoprotective drugs by comparing the period until the normalization of hepatic enzymes between patients who were prescribed with the hepatoprotective drugs after DIH was occurred and patients who were not prescribed with the hepatoprotective drugs. METHODS: During 2006-2010, 389 patients with active tuberculosis were included in this study. DIH was defined as elevation of peak serum aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) of more than twice the upper limit of normal (ULN). We divided the patients into the severe (peak serum AST and/or ALT elevation of >5 times the ULN), moderate (peak serum AST and/or ALT elevation of >3 to ≤5 times the ULN), and mild DIH groups (peak serum AST and/or ALT elevation of >2 to ≤3 times the ULN). We compared the average period until the normalization of hepatic enzymes between patient subgroups with and without hepatoprotective drugs (ursodeoxycholic acid: UDCA, stronger neo-minophagen C: SNMC, and glycyrrhizin). RESULTS: In the severe group, there was no significant difference in the average period until the normalization between subgroups with and without hepatoprotective drugs (21.4 ± 10.8 vs 21.5 ± 11.1 days, P = 0.97). In the mild group, the period was longer in the subgroup with hepatoprotective drugs than that without hepatoprotective drugs (15.7 ± 6.2 vs 12.4 ± 7.9 days, P = 0.046). CONCLUSION: Regardless of the severity, hepatoprotective drugs did not shorten the period until the normalization of hepatic enzymes.


Asunto(s)
Antituberculosos/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/prevención & control , Cisteína/farmacología , Glicina/farmacología , Ácido Glicirretínico/análogos & derivados , Ácido Glicirrínico/farmacología , Ácido Ursodesoxicólico/farmacología , Adulto , Anciano , Alanina Transaminasa/sangre , Antituberculosos/uso terapéutico , Aspartato Aminotransferasas/sangre , Combinación de Medicamentos , Femenino , Ácido Glicirretínico/farmacología , Humanos , Hígado/efectos de los fármacos , Hígado/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Tuberculosis/tratamiento farmacológico , Adulto Joven
6.
J Infect Chemother ; 22(10): 685-91, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27593263

RESUMEN

Comorbidity is known to be associated with the severity and mortality of pneumonia. The severity of each underlying disease varies, and performance status, which is known to be a prognostic factor of malignant diseases, reflects the overall patient condition as affected by his/her comorbidity and underlying diseases of various severity. We investigated whether premorbid patients' performance status is associated with the severity and mortality of pneumococcal pneumonia. This retrospective study assessed these factors in hospitalized patients suffering from pneumococcal pneumonia from 2002 to 2015. We included 424 patients aged 68.9 ± 14.1 years in the study, of which 68.9% were men. A multivariate analysis found that advanced age (≥65 years), diabetes mellitus, and poor performance status were independent factors associated with severity, whereas old pulmonary tuberculosis, poor performance status, pneumococcal bacteremia, and severe pneumonia were independent factors that were associated with non-survival. Poor performance status was associated with the severity and mortality of pneumococcal pneumonia.


Asunto(s)
Actividades Cotidianas , Neumonía Neumocócica/mortalidad , Factores de Edad , Anciano , Anciano de 80 o más Años , Bacteriemia/epidemiología , Comorbilidad , Diabetes Mellitus/epidemiología , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Neumonía Neumocócica/microbiología , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Streptococcus pneumoniae/aislamiento & purificación , Tuberculosis Pulmonar/epidemiología
8.
PLoS One ; 15(4): e0230746, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32243456

RESUMEN

BACKGROUND: The incidence and etiologies of chronic pulmonary infection (CPI) in patients with idiopathic pulmonary fibrosis (IPF) have been poorly investigated. METHODS: We conducted a retrospective study of 659 patients with IPF to assess the incidence, etiologies, and risk factors of CPI development. CPI was defined if the etiology of infection was diagnosed one or more months after the onset of symptoms or upon the appearance of new shadows on pulmonary radiological images. RESULTS: At IPF diagnosis, 36 (5.5%) patients had CPI, and 46 (7.0%) patients without CPI at IPF diagnosis developed CPI over a median follow-up period of 6.1 years. The incidence density of CPI development was 18.90 cases per 1000 person-years. Detected organisms from these 46 patients were Mycobacterium avium complex in 20 patients, other nontuberculous mycobacteria in 4, M. tuberculosis in 7, Aspergillus spp. in 22, and Nocardia sp. in one. In a multivariate Cox regression hazard model, PaO2 <70 Torr and KL-6 ≥2000 U/mL were associated with CPI development. CONCLUSIONS: Nontuberculous mycobacteria, M. tuberculosis, and Aspergillus and Nocardia spp. were the four most frequent etiologies of CPI in patients with IPF. During follow-up of IPF, clinicians should pay attention to the development of CPI, especially in patients with PaO2 <70 Torr or KL-6 ≥2000 U/mL.


Asunto(s)
Fibrosis Pulmonar Idiopática/complicaciones , Infecciones/epidemiología , Infecciones/etiología , Anciano , Enfermedad Crónica/epidemiología , Femenino , Humanos , Infecciones/diagnóstico , Infecciones/mortalidad , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo
9.
Clin Case Rep ; 5(1): 61-65, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-28096992

RESUMEN

Patients with antisynthetase-positive interstitial lung disease (ILD) alone sometimes develop myositis during follow-up, but myasthenia gravis (MG) overlapping on antisynthetase syndrome is unusual. A 56-year-old woman with ILD and anti-EJ antibody treated for 8 years developed MG. Physicians should consider myositis and MG when patients develop muscle symptoms during follow-up.

10.
Intern Med ; 53(23): 2731-5, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25447659

RESUMEN

A 58-year-old man presented with right chest pain, anorexia, general malaise, and fever. Chest computed tomography showed a mass lesion with right middle lobe atelectasis. The bronchoscopy showed polypoid lesions with a smooth surface in each right middle lobe bronchial lumen. The histopathology revealed the dense accumulation of histiocyte-like cells with foamy cytoplasm under the bronchial epithelium along with yeast-like fungi stained positively with both Alcian blue and Grocott's stains. Cryptococcus neoformans was cultured from the bronchial washings. We diagnosed the patient with pulmonary cryptococcosis with endobronchial lesions. The fluconazole treatment was changed to liposomal amphotericin-B and flucytosine after the diagnosis of cryptococcal meningitis. The minimum inhibitory concentration of the fungi suggested resistance to fluconazole and flucytosine. The lesion regressed after these treatments.


Asunto(s)
Bronquios/patología , Criptococosis/diagnóstico , Cryptococcus neoformans/aislamiento & purificación , Pulmón/patología , Meningitis Criptocócica/diagnóstico , Anfotericina B/administración & dosificación , Animales , Broncoscopía/métodos , Columbidae , Criptococosis/tratamiento farmacológico , Criptococosis/patología , Quimioterapia Combinada , Fluconazol/administración & dosificación , Flucitosina/administración & dosificación , Humanos , Masculino , Meningitis Criptocócica/tratamiento farmacológico , Meningitis Criptocócica/patología , Persona de Mediana Edad , Resultado del Tratamiento
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