The prevalence of airway obstruction among Japanese HIV-positive male patients compared with general population; a case-control study of single center analysis.

BACKGROUND AND OBJECTIVE: Previous studies have suggested that human immunodeficiency virus (HIV) infection and/or the airway colonization of Pneumocystis jirovecii (Pcj) impact on the progression of airway obstruction, such as chronic obstructive pulmonary disease (COPD). This study was aimed to evaluate the relationship between HIV infection, airway colonization of Pcj and airway obstruction in Japanese male patients. METHODS: Case-control study of 49 HIV-positive and 257 HIV-negative men were enrolled in this study. Airway obstruction was determined by spirometry. Cigarette smoking was determined by a self report. Laboratory data were obtained from medical records. Among HIV positive patients, the airway colonization of Pcj was evaluated by induced sputum using the real time polymerase chain reaction method. RESULTS: Forty-eight out of 49 (97.9%) HIV-positive patients received antiretroviral therapy, and their median CD4 cell counts were 491/µL (79-935). The prevalence of airway obstruction as determined by spirometry was 10.2% (5/49) in HIV-positive subjects and 2.4% (5/208) in HIV-negative subjects (p = 0.024). Compared with the control group, HIV-positive patients were significantly younger (median age 44 vs 40, p = 0.019). After adjusting for age, pack-years of smoking, HIV infection was an independent risk factor for airway obstruction (OR; 10.93, 95%CI 1.99-60.1, p = 0.006). None of patient was detected the airway colonization of Pcj. CONCLUSIONS: HIV infection was an independent risk factor for airway obstruction regardless of airway colonization of Pcj. Health-care providers should be aware of the increased likelihood of airway obstruction among HIV-positive patients.

[Clinical study on 45 cases of adult and adolescent pertussis].

We studied 45 cases of adult and adolescent pertussis. The diagnosis of pertussis was made by two criteria. 1) 4-fold increase in antibody against B. pertussis with paired sera (A group: 15 cases). 2) Titer of anti PT antibody above 100 EU/ml (B group: 30 cases). Paroxysmal cough was 100% in A and B group, whooping cough was present 93% in A group, 92% in B group, posttussive vomiting was 78% in A group, 67% in B group. Familial infection was 18 cases of 15 families (33%). Marked lymphocytosis was not detected in any stage of pertussis. When initial examination was made 3-4 weeks after cough onset, the proof of 4-fold increase in antibody against B. pertussis with paired sera was low. Nine cases (20%) of 45 adult and adolescent pertussis cases had bronchial asthma, but bronchial asthma did not prolong the duration of cough. As proof of 4-fold increase in antibody against B. pertussis with paired sera in adult and adolescent pertussis is difficult, it is expected that the cut-off point of antibody titer against B. pertussis in single sera is determinated rapidly.

Overwhelming pneumococcal bacteremia revealed by a peripheral blood smear in a 74-year-old healthy woman.

A 76-year-old woman, who had never been seriously ill, was admitted to our hospital with fever and shaking chills. She progressively developed septic shock. We detected Streptococcus pneumoniae in a routine examination of a Giemsa-stained peripheral blood smear. Despite intensive care with antibiotic therapy, she died within several hours after admission. A peripheral blood smear occasionally shows bacteria in cases of overwhelming septicemia, thus indicating a severe impairment of splenic function. We suggest that, in cases of severe septicemia, an examination of a peripheral blood smear is therefore useful for the rapid detection of organisms in comparison to a traditional blood culture.

High expression of p40(tax) and pro-inflammatory cytokines and chemokines in the lungs of human T-lymphotropic virus type 1-related bronchopulmonary disorders.

STUDY OBJECTIVE: Human T-lymphotropic virus type 1 (HTLV-1) is closely associated with the development of certain pulmonary diseases, such as bronchiolitis, although the pathologic mechanism remains unclear. To elucidate the pathogenesis of HTLV-1-associated bronchopulmonary disorders, we analyzed the relationship between expression of p40(tax), a regulatory component of HTLV-1 that stimulates various host genes, and synthesis of pro-inflammatory cytokines and chemokines by cells in BAL fluid (BALF) obtained from HTLV-1-infected patients. DESIGN: Reverse transcription-polymerase chain reaction was used to compare the expression of p40(tax) and pro-inflammatory cytokines and chemokines messenger RNA (mRNA) in BALF of 10 HTLV-1 carriers and 7 healthy subjects. We also studied the correlation between these parameters and the proportion of lymphocytes in BALF. RESULTS: The expression levels of pro-inflammatory cytokines (interferon [IFN]-gamma, interleukin-2) and chemokines (monocyte chemotactic protein-1, macrophage inflammatory protein [MIP]-1alpha, IFN-gamma-inducible protein-10 [IP-10]) were significantly higher in BALF of patients than of healthy subjects. The expression of IFN-gamma and MIP-1alpha mRNA correlated with that of p40(tax). IFN-gamma and IP-10 mRNA expression correlated with the proportion of lymphocytes in BALF. The percentage of lymphocytes in BALF increased with higher expression levels of p40(tax) mRNA, although the correlation was not significant. CONCLUSION: Our results suggested that p40(tax) seems be involved in the development of HTLV-1-associated bronchopulmonary disorders at least in part through the local production of pro-inflammatory cytokines and chemokines.

[A case of disseminated aspergillosis with smoldering adult T-cell leukemia].

The patient was 39-year-old male who had been administrated 20 mg of prednisolone for control of chronic eosinophilic pneumonia. He consulted the hospital with fever, headache and gait disturbance. The laboratory data of peripheral blood revealed a smoldering adult T cell leukemia. Computed tomogram of the chest and MRI of the brain revealed a mass in the right middle lobe of the lung and a brain abscess in the left hemisphere respectively. Biopsied specimens from the lung and brain abscess showed an Aspergillus like fungus. In spite of placement of an Ommaya reservoir for administration of AMPH-B and control of intracranial pressure, he died. During the course, specific antigen and specific gene were not detected in the peripheral blood, and no viable organism was isolated from the specimens. Post mortem examination revealed multiple nodular lesions in the lung, parietal pleura, liver, heart and kidney. After autopsy, disseminated aspergillosis was confirmed through a tissue examination using nested PCR for Aspergillus DNA. In this case, we think that viable fungi could endure in the tissue while circulating Aspergillus markers remained undetectable.