RESUMEN
Allergic bronchopulmonary aspergillosis (ABPA) is an inflammatory disease induced by exaggerated immune responses to Aspergillus species. Although ABPA has a high recurrence (48%), its instances with sequential isolation of distinct Aspergillus species are sporadic. Only one case report has documented the metachronous isolation of Aspergillus fumigatus and Aspergillus flavus. However, no reported cases of metachronous isolation involving three distinct Aspergillus species exist. Herein, we report a novel case of a 47-year-old Japanese man with sequential metachronous isolation of A. flavus, A. terreus, and A. fumigatus. Initially presenting with symptoms of productive cough and pulmonary infiltration, the patient experienced two relapses following treatment with oral prednisolone. Adjustments in therapy, including voriconazole and a tailored corticosteroid regimen, resulted in significant improvement without relapse for over 6 months. This case report highlights the challenges and successful management of ABPA involving multiple Aspergillus species.
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A 69-year-old Japanese male with advanced lung adenocarcinoma developed neurological symptoms after chemoradiotherapy and durvalumab maintenance therapy. He was positive for serum antiamphiphysin antibody, which is rarely seen in patients with lung adenocarcinoma. Additionally, his brain magnetic resonance images showed limbic encephalitis which led to the diagnosis of classic paraneoplastic neurological syndrome (PNS). Immune checkpoint inhibitors (ICIs) activate T cells and may also activate antineuronal antibodies that cause PNS. Durvalumab, which is an ICI, may have led to antiamphiphysin antibody-positive PNS in our patient. Treatment with systemic high-dose methylprednisolone was unsuccessful and he died 2 months later. PNS should be considered as one of the differential diagnoses in patients with lung cancer and neurological symptoms during, or after, ICI treatment.
Asunto(s)
Adenocarcinoma del Pulmón , Encefalitis Límbica , Neoplasias Pulmonares , Síndromes Paraneoplásicos , Humanos , Masculino , Anciano , Encefalitis Límbica/diagnóstico , Encefalitis Límbica/tratamiento farmacológico , Encefalitis Límbica/etiología , Síndromes Paraneoplásicos/complicaciones , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/tratamiento farmacológico , Adenocarcinoma del Pulmón/complicaciones , Adenocarcinoma del Pulmón/tratamiento farmacológicoRESUMEN
Fluororesin in waterproof spray becomes a pyrolysis product due to the heat of tobacco as well as a heater and can cause lung injury. People should be aware that waterproof spray must not be used under these circumstances.
RESUMEN
Paraneoplastic neurological syndromes (PNS), such as sensory polyneuropathy, are rare, and serum neuronal antibodies that are used for diagnosing this syndrome are occasionally positive. Similarly, neurological immune-related adverse events due to immune checkpoint inhibitors (ICIs) are also rare. However, their etiologies and the relationship between them remain unclear. We herein report a patient with suspected small cell lung cancer who showed sensory polyneuropathy after treatment with atezolizumab in combination with cytotoxic agents (carboplatin and etoposide) and was doubly positive for serum anti-Hu and anti-SOX-1 antibodies. Treatment with ICI and cytotoxic agents may sometimes lead to the development of PNS.
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Neoplasias Pulmonares , Polineuropatía Paraneoplásica , Carcinoma Pulmonar de Células Pequeñas , Autoanticuerpos , Carboplatino/efectos adversos , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Polineuropatía Paraneoplásica/inducido químicamente , Polineuropatía Paraneoplásica/diagnóstico , Carcinoma Pulmonar de Células Pequeñas/complicaciones , Carcinoma Pulmonar de Células Pequeñas/tratamiento farmacológicoRESUMEN
AIM: To clarify the utility of sepsis evaluation using the Quick Sequential Organ Failure Assessment (qSOFA) tool in addition to the Pneumonia Severity Index (PSI); age, dehydration, respiration, orientation and blood pressure (A-DROP) index; and immunodeficiency, respiration, orientation, age and dehydration (I-ROAD) scoring systems, and risk factor evaluation of potentially drug-resistant (PDR) pathogens are suggested in the 2017 guidelines for pneumonia of the Japanese Respiratory Society in nursing- and healthcare-associated pneumonia patients. METHODS: We included 289 hospitalized nursing- and healthcare-associated pneumonia patients between April 2016 and March 2017, and investigated the ability of PSI, A-DROP, I-ROAD and qSOFA to predict pneumonia-related mortality. We also evaluated the associations among the risk factors for PDR pathogens, the detection ratio of PDR pathogens and pneumonia-related mortality. RESULTS: The mortality rate of pneumonia during hospitalization was 6.9% (20/289). The area under the curve for pneumonia-related mortality predicted using PSI, A-DROP, I-ROAD and qSOFA was 0.697 (95% confidence interval [CI] 0.59-0.80), 0.63 (95% CI 0.51-0.76), 0.61 (95% CI 0.52-0.70) and 0.701 (95% CI 0.59-0.81), respectively. In addition, higher areas under the curve were observed for pneumonia-related mortality predicted according to a combination of PSI and hypoalbuminemia (<2.5 g/dL) (0.75, 95% CI 0.64-0.86), and qSOFA and hypoalbuminemia (0.74, 95% CI 0.62-0.86) than for PSI and qSOFA alone. No significant associations were observed among the risk factors for PDR pathogens, the detection ratios of PDR pathogens and pneumonia-related mortality. CONCLUSIONS: qSOFA and the combination of qSOFA and hypoalbuminemia might be simple and useful evaluation tools for predicting pneumonia-related mortality in nursing- and healthcare-associated pneumonia patients. Geriatr Gerontol Int 2019; 19: 177-183.
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Indicadores de Salud , Neumonía Asociada a la Atención Médica/diagnóstico , Neumonía Asociada a la Atención Médica/mortalidad , Sepsis/diagnóstico , Sepsis/mortalidad , Anciano , Anciano de 80 o más Años , Femenino , Evaluación Geriátrica , Neumonía Asociada a la Atención Médica/complicaciones , Mortalidad Hospitalaria , Humanos , Japón , Masculino , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Sepsis/complicacionesRESUMEN
Chest computed tomography image of a 23-year-old man. Image shows right-sided middle and lower lobe consolidation and multiple cystic bronchiectasis.
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A 37-year-old woman was admitted to a hospital due to a prolonged fever and a rash on her legs. She had systemic lymphadenitis and a skin abscess on her left leg. Pathological findings of a left leg skin biopsy revealed abscess formation with granulomatous dermatitis, Mycobacterium abscessus complex was cultured from the resected left supraclavicular lymph node, and disseminated M. abscessus complex infection was diagnosed. She was treated with combination treatment with antimicrobials and percutaneous drainage, and her clinical findings improved. Four months later, she developed acute lymphocytic leukemia. Leukemia is a risk factor for disseminated M. abscessus complex infection, even before developing leukemia.
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Absceso/complicaciones , Linfadenitis/complicaciones , Infecciones por Mycobacterium no Tuberculosas/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/etiología , Enfermedades de la Piel/complicaciones , Absceso/tratamiento farmacológico , Absceso/microbiología , Adulto , Antibacterianos/uso terapéutico , Femenino , Humanos , Linfadenitis/diagnóstico , Linfadenitis/tratamiento farmacológico , Linfadenitis/microbiología , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Infecciones por Mycobacterium no Tuberculosas/microbiología , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/tratamiento farmacológico , Enfermedades de la Piel/microbiologíaRESUMEN
Helicobacter cinaedi is typically isolated from immunocompromised patients. Some reports of infection caused by H.cinaedi have been found in recent years. We experienced three cases of H.cinaedi bacteremia in one year and ten months in our hospital, although the detection of H.cinaedi in blood cultures is extremely rare. In case 1, a 77-year-old female had been treated with a steroid and immunosuppressive agent for interstitial pneumonia. In cases 2 and 3, two 71-year-old men had been treated with chemotherapy for lung cancer. Although the identification of the bacteria could not be performed by the culture method in the three cases, H.cinaedi bacteremia was diagnosed by a 16S rRNA gene sequencing analysis in case 1, and by nested PCR in cases 2 and 3. H.cinaedi bacteremia often tends to recur and also requires prolonged antimicrobial therapy. We believe that gene analysis is useful in the identification of H.cinaedi.
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Bacteriemia/diagnóstico , Bacteriemia/microbiología , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/microbiología , Helicobacter/genética , Helicobacter/aislamiento & purificación , Anciano , Femenino , Humanos , Huésped Inmunocomprometido , Masculino , Reacción en Cadena de la Polimerasa/métodos , ARN Ribosómico 16S/genética , Análisis de Secuencia de ADN/métodosRESUMEN
A 75-year-old Japanese man underwent thoracic surgery to treat a large lung cancer lesion in the left upper lobe with calcified pleural thickening. Postoperatively, viable Mycobacterium tuberculosis was detected in the margin of the resected thickened calcified pleural lesion. Therefore, an infection control investigation of medical staff who had come in contact with the patient was conducted. Consequently, two of the 14 healthcare professionals who had been in the operating room were diagnosed with latent tuberculous infections. Therefore, strict precautions against airborne infections are required to prevent the in-hospital transmission of M. tuberculosis in such cases.
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Calcinosis/complicaciones , Enfermedades Pleurales/complicaciones , Tuberculosis/diagnóstico , Anciano , Infección Hospitalaria/transmisión , Humanos , Tuberculosis Latente/diagnóstico , Neoplasias Pulmonares/cirugía , Masculino , Mycobacterium tuberculosis , Tuberculosis/transmisiónRESUMEN
We evaluated the incidence and outcome of lung involvement in 35 patients with autoimmune pancreatitis (AIP). Our results indicate that lung involvement is commonly observed in AIP (40%). In addition, corticosteroid treatment improved the lung lesions and appeared to reduce the probability of relapse compared with pancreatic lesions (0% vs 36%). This is the first report to assess the long-term outcome of lung involvement in AIP (52 ± 33 months).
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Enfermedades Autoinmunes , Glucocorticoides/uso terapéutico , Inmunoglobulina G/inmunología , Enfermedades Pulmonares , Pancreatitis , Anciano , Enfermedades Autoinmunes/complicaciones , Enfermedades Autoinmunes/tratamiento farmacológico , Intervención Médica Temprana , Femenino , Humanos , Incidencia , Enfermedades Pulmonares/complicaciones , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/tratamiento farmacológico , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/inmunología , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Pancreatitis/complicaciones , Pancreatitis/tratamiento farmacológico , Pancreatitis/inmunología , PronósticoRESUMEN
BACKGROUND AND OBJECTIVE: Recent advances in cultivation-independent molecular biological modalities for detecting bacterial species have indicated that several bacterial species may play a role in the pathogenesis of certain infectious diseases. The aim of this study was to evaluate the role of bacterial flora in the pathogenesis of nontuberculous mycobacteriosis (NTM) using a bacterial floral analysis of bronchoalveolar lavage fluid (BALF) with 16S rRNA gene sequencing in patients with bronchiectasis. METHODS: Fifty-eight patients with bronchiectasis evaluated using chest computed tomography were enrolled. BALF obtained from the most affected lung lesions was evaluated using culture and culture-independent methodologies. Approximately 600 bp of the bacterial 16S rRNA gene (E341F-E907R) was amplified via polymerase chain reaction using universal primers, and clone libraries were constructed. Nucleotide sequences of 96 randomly chosen clones for each specimen were determined, and the homology was searched using a basic local alignment search tool to determine the bacterial phylotypes and their proportions (bacterial floral analysis) in each specimen. RESULTS: Twenty-nine patients with bronchiectasis were diagnosed with NTM based on culture-based methods using Ogawa medium. The molecular method showed a significantly high rate of anaerobes among the patients with NTM compared with that observed in the bronchiectasis patients without NTM. In addition, findings of collapse/consolidation were significantly related to the proportion of Prevotella species in the BALF samples determined using the molecular method (P < 0.001). CONCLUSION: Given the results of the present study, anaerobes may play an important role in the pathogenesis of bronchiectasis in patients with NTM.
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Bacterias Anaerobias , Bronquiectasia , Infecciones por Mycobacterium no Tuberculosas , Anciano , Bacterias Anaerobias/genética , Bacterias Anaerobias/aislamiento & purificación , Bronquiectasia/diagnóstico , Bronquiectasia/etiología , Bronquiectasia/microbiología , Líquido del Lavado Bronquioalveolar/microbiología , Femenino , Genes Bacterianos/fisiología , Humanos , Japón , Masculino , Persona de Mediana Edad , Infecciones por Mycobacterium no Tuberculosas/complicaciones , Infecciones por Mycobacterium no Tuberculosas/diagnóstico por imagen , Infecciones por Mycobacterium no Tuberculosas/microbiología , Prevotella/aislamiento & purificación , Prevotella/patogenicidad , Estudios Prospectivos , ARN Ribosómico 16S/fisiología , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: A novel, rapid and noninvasive test (ODK0501, RAPIRUN(®)Streptococcus pneumoniae) uses polyclonal antibodies to detect C polysaccharide of S. pneumoniae derived from sputum samples using an immunochromatographic assay. We evaluated its usefulness in Japanese patients with pneumonia who exhibited positive urinary antigen tests for S. pneumoniae (BinaxNOW(®)S. pneumoniae). PATIENTS AND METHODS: Forty adult patients with pneumonia treated between May 2011 and August 2013 were enrolled. Bacterial cultures, Gram staining and ODK0501 assays of sputum as well as urinary antigen tests for S. pneumoniae using urine samples obtained from the same patients were performed upon admission, the fourth day after starting antimicrobial treatment and at the end of the antimicrobial treatment. RESULTS: Twenty-seven of the 40 patients were positive for ODK0501, while a negative result for ODK0501 was associated with low-quality sputum samples according to the Geckler classification of sputum. The sensitivity and specificity of the ODK0501 assay in the 40 patients were 90.9% and 61.1%, respectively, based on the culture results. The results obtained with this kit were more favorable than those observed on Gram staining. The ODK0501 assay also showed a rapid reaction to the disappearance of S. pneumoniae in the sputum samples, while approximately 80% of the patients exhibited persistent positive results on the urinary antigen detection tests at the end of treatment. CONCLUSIONS: The ODK0501 test is a noninvasive, rapid and accurate tool for diagnosing respiratory infections caused by S. pneumoniae, although good quality sputum must be obtained prior to adequate treatment with antibiotics.
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Antígenos Bacterianos/análisis , Cromatografía de Afinidad/métodos , Neumonía Bacteriana/diagnóstico , Infecciones del Sistema Respiratorio/diagnóstico , Esputo/microbiología , Streptococcus pneumoniae/inmunología , Anciano , Anciano de 80 o más Años , Líquido del Lavado Bronquioalveolar/microbiología , Femenino , Violeta de Genciana , Humanos , Masculino , Persona de Mediana Edad , Fenazinas , Neumonía Bacteriana/microbiología , Neumonía Bacteriana/orina , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/orina , Orina/microbiologíaRESUMEN
Azithromycin (AZM) is one of 15-membered rings macrolide antibiotics with wide spectrum of antimicrobial efficacy for Gram-positive and -negative bacteria and also atypical bacteria. So far, there had been no reports of the prospective studies evaluating efficacy and safety of AZM infusion in patients with mild or moderate community-acquired pneumonia (CAP). This study was conducted to evaluate prospectively the efficacy and safety of AZM in patients with mild or moderate CAP. AZM 500 mg was intravenously administered once daily, and the clinical efficacy were evaluated by clinical symptoms, peripheral blood laboratory findings and chest X-rays. Sixty-four patients were firstly registered, and eventually 61 and 62 patients were enrolled for the evaluation of clinical efficacy and safety of AZM, respectively. The efficacy of AZM in 61 patients evaluated was 88.5%. In addition, the efficacies of AZM in each pneumonia severity index by A-DROP system by the Japanese Respiratory Society (JRS) guideline in CAP were 85.2% in mild and 91.2% in moderate. Furthermore, the efficacy of AZM in each differentiation between suspicion of bacterial pneumonia and that of atypical pneumonia by JRS guideline in CAP were 91.7% in suspicion of atypical pneumonia, and its efficacy was high than that of bacterial pneumonia. Nineteen patients (20 cases; 15 with liver dysfunction, 4 with diarrhea, 1 with vascular pain) out of 62 patients were reported to have possible adverse effects of AZM. All of the patients with these adverse effects demonstrated mild dysfunction and continued AZM treatment, and these dysfunctions normalized soon after cessation of AZM. In conclusion, AZM is effective drug for patients with mild or moderate CAP, and we believe that it may be one of effective choice in the treatment of CAP patients who need hospitalization.
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Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Neumonía Bacteriana/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/efectos adversos , Azitromicina/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Levofloxacin (LVFX) is one of respiratory quinolones with wide spectrum of antimicrobial efficacy for Gram-positive and -negative bacteria and also atypical bacteria, and 500 mg of intravenous LVFX infusion has recently been able to use once daily based on pharmacokinetics-pharmacodynamics in Japan. So far, there had been no reports of the prospective studies evaluating efficacy and safety of LVFX in patients with nursing and healthcare-associated pneumonia (NHCAP). This study was conducted to evaluate prospectively the efficacy and safety of LVFX in patients with NHCAP categories B and C (other antibacterial agents were allowed to use with LVFX) according to Japanese guideline for NHCAP by the Japanese Respiratory Society (JRS). LVFX 500 mg was intravenously administered once daily, and the clinical efficacy and safety were evaluated by clinical symptoms, peripheral blood laboratory findings and chest X-rays. Sixty-two patients (average age was 81.2 years old, female/male was 22/40) were firstly registered and evaluated for the safety of LVFX, and eventually 54 patients were enrolled for the evaluation of clinical efficacy of LVFX. The percentage of these 54 patients aged over 65 years old was 96.3%, NHCAP category B/C was 33/21. The efficacy of LVFX in all 54 patients evaluated was 85.2% (categories B/C of NHCAP was 81.8/90.5%). In addition, the efficacies of LVFX in each pneumonia severity category by A-DROP system by JRS in NHCAP patients were 100% in mild, 86.7% in moderate, 77.8% in severe/very severe. Nine patients (2 with liver dysfunction, 6 with renal dysfunction and 1 with thrombocytopenia) out of 62 patients were reported to have possible adverse effects of LVFX. All of the patients with liver and renal dysfunctions after starting LVFX administration demonstrated mild dysfunctions and continued LVFX treatment, and these dysfunctions normalized soon after cessation of LVFX. LVFX was changed to other antibacterial agent in one patient with thrombocytopenia, and also thrombocytopenia was normalized thereafter. In conclusion, LVFX is effective and relatively safe for categories B and C in patients with NHCAP.
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Antibacterianos/uso terapéutico , Levofloxacino/uso terapéutico , Neumonía/tratamiento farmacológico , Antibacterianos/efectos adversos , Infección Hospitalaria , Femenino , Humanos , Japón , Levofloxacino/efectos adversos , Masculino , Ofloxacino , Estudios ProspectivosRESUMEN
Moxifloxacin (MFLX) is a respiratory quinolone, and is effective against not only Gram-positive and negative bacteria but also anaerobes. There has been no prospective studies evaluating the efficacy and safety of MFLX in patients with nursing and healthcare-associated pneumonia (NHCAP). Therefore, we assessed the efficacy and safety of MFLX in patients with NHCAP. NHCAP patients with mild and moderate severity assessed by the A-DROP system in community-acquired pneumonia guideline proposed by Japan Respiratory Society visited our hospitals from April 2011 to March 2012. Clinical symptoms, chest X-ray films and/or computed tomography, peripheral white and red blood cell and platelet counts, serum CRP, AST, ALT, BUN, creatinine were evaluated. Forty patients were eventually evaluated, and average age was 74.1 years old, male/female were 21/19, 92.5% (37/40) of them had one or more comorbidities. Median duration of MFLX administration was 7.1 days (4-15 days). The efficacy of MFLX in all patients was 87.5% (35/40). The efficacies in each age group were 87.9% (aged over 65 years old), 85.7% (aged under 64 years old), and in each pneumonia severity group by the A-DROP system were 91.7% (mild), 85.7% (moderate). Diarrhea and swelling of the breast were observed in one patient (2.5%) after starting MFLX administration. Mild elevated transaminases were observed in three patients (7.5%), and mild renal dysfunction was observed in two patients (5.0%). All abnormally increased levels of transaminases and serum creatinine were recovered after a cessation of MFLX. MFLX is effective and safe in patients with NHCAP.