RESUMO
A 71-year-old woman with a high serum α-fetoprotein (AFP) level was closely examined systemically, and a solid nodule was identified in the right middle lobe of her lung by chest computed tomography. As this lesion was highly suspected to be primary lung cancer, right middle lobectomy was performed via hybrid video-assisted thoracic surgery. According to histopathological examination, this lesion consisted of papillary adenocarcinoma and well-differentiated fetal adenocarcinoma (WDFA). In addition, the component of WDFA was positive for AFP, according to immunohistochemical staining. The lesion was eventually diagnosed as AFP-producing primary lung adenocarcinoma, pT2aN2M0, pStage IIIA. The serum AFP level was promptly normalized after surgery. Three courses of adjuvant chemotherapy were administered, but her serum AFP level gradually increased. Thereafter, local recurrence was recognized at the mediastinum 5 months after surgery. Conventional irradiation was delivered to the ipsilateral hilum and mediastinum. Consequently, the metastatic lesion in the mediastinal lymph node was completely eradicated, and her serum AFP level decreased to normal limits. Currently, the patient is alive without local relapse for 23 months after surgery. It is believed that radiation therapy might be an effective treatment option for AFP-producing primary lung adenocarcinoma.
Assuntos
Adenocarcinoma/radioterapia , Neoplasias Pulmonares/radioterapia , Adenocarcinoma/metabolismo , Adenocarcinoma/patologia , Adenocarcinoma de Pulmão , Idoso , Feminino , Humanos , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/patologia , Gradação de Tumores , Estadiamento de Neoplasias , Recidiva , alfa-Fetoproteínas/biossínteseRESUMO
In order to understand the spread of the erythromycin-resistant serotype 3 Streptococcus pneumoniae clone in Japan, we have assessed the molecular characteristics of this clone. Among 156 S. pneumoniae isolates recovered from adults with community-acquired pneumonia between 2003 and 2005, 42 were serotype 3 and 40 were sequence type (ST) 180/Netherlands(3)-31 by multilocus sequence typing. Thirty-eight of the 40 ST 180 isolates had acquired resistance to erythromycin via the ermB gene. Although the ermB-positive ST180 clone isolates were more susceptible to penicillin and trimethoprim-sulfamethoxazole than ermB-positive non-ST180 isolates and contained a less mutated pbp1a or pbp2b gene, without a mefA gene, the ST180 clone was highly prevalent among ermB-positive isolates. Routine surveillance for the ST180 S. pneumoniae clone may soon become necessary.
Assuntos
Pneumonia Pneumocócica/microbiologia , Streptococcus pneumoniae/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteínas de Bactérias/classificação , Proteínas de Bactérias/genética , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Farmacorresistência Bacteriana/genética , Feminino , Genótipo , Humanos , Japão/epidemiologia , Masculino , Metiltransferases/classificação , Metiltransferases/genética , Pessoa de Meia-Idade , Fenótipo , Pneumonia Pneumocócica/epidemiologia , Sorotipagem/métodos , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/efeitos dos fármacosRESUMO
BACKGROUND AND OBJECTIVE: Streptococcus pneumoniae (S. pneumoniae) is the most common pathogen associated with community-acquired pneumonia and its resistance to antimicrobials is a worldwide problem. The aim of this study was to investigate the current drug susceptibilities of S. pneumoniae isolated from adult patients with community-acquired pneumonia in Japan. METHODS: S. pneumoniae strains isolated from adult patients with pneumococcal pneumonia from 10 institutions were collected prospectively between May 2003 and October 2004 and tested for drug susceptibilities. Clinical data were analysed and the risk factors for drug resistance investigated. RESULTS: A total of 141 isolates of S. pneumoniae were analysed. Of these S. pneumoniae isolates, 46.1% had intermediate penicillin resistance and the minimum inhibitory concentration (MIC) occurring in the greatest number of isolates and MIC90 value was 2 microg/mL. The prevalence of resistance to macrolides was 80%, with the MIC90 values being greater than or equal to 16 microg/mL. Approximately 40% of the strains were resistant to oral third-generation cephems. Penicillin and erythromycin resistance were both associated with the pre-existing chronic disease states. CONCLUSIONS: The cephem and macrolide resistance of S. pneumoniae was higher than penicillin resistance in adult patients with community-acquired pneumococcal pneumonia in Japan. We recommend that bacterial identification and sensitivities are determined in areas where the macrolide resistance to S. pneumoniae is high.