Background. Asymptomatic foreign bodies in the airway can go unnoticed for long periods of time. Case. A 70-year-old man underwent annual postoperative examinations following thymectomy at the ...Department of Thoracic Surgery of this hospital. He developed wet cough and fever in December 2018 and underwent an examination at this department in January 2019. Chest X-ray and computed tomography (CT) showed an infiltrative shadow in the right S3b, and he was diagnosed with bacterial pneumonia. He received antibacterial treatment and recuperated. However, the bacterial pneumonia recurred in the same lobe (right S3b) in February 2019, and he was admitted to our department for a further examination and treatment. Considering the recurrence of pneumonia in the same lobe and the detection of obstructive atelectasis, bronchoscopy was performed for a suspected obstruction at the center of the infiltrative shadow. A black foreign body associated with white mucus was identified at the ostium of the right B3b segment and carefully resected using a sharp curette. An examination revealed the foreign body to be the seed of a plant. A review of the chest CT scans performed since 2011 revealed that the foreign body had first appeared in the right B3b segment in 2014 and subsequently been observable on annual CT scans. The seed gradually obstructed the ostium of the right B3b segment over several years. Conclusion. We encountered a case of a bronchial foreign body that went unnoticed for five years, as it was asymptomatic. This is a rare case of delayed observation of a bronchial foreign body on CT.
ABSTRACT Background: Influenza infection is known to be an exacerbating factor in the control of asthma, therfore its prevention is critical in managing asthma. The aim of this study was to ...investigate the influenza A H1N1 2009 pandemic virus (H1N1 pdm09) infection in adult asthmatic patients. Methods: Data were obtained from a questionnaire-based survey of asthmatic patients conducted from September to October 2010 in Niigata Prefecture. Patient background, H1N1 pdm09 infection, vaccination status, and asthma exacerbation due to influenza infection were analyzed. Results: In total, 2,555 cases were analyzed. The incidence of the infection was 6.7% (95% confidence interval CI: 5.7-7.6), and the rate of vaccination was 63.9% (95% CI: 62.1-65.8). The odds ratio (OR) for vaccination against the infection among adult patients and younger patients (<=the median age) were 0.61 (95% CI: 0.45-0.84) and 0.62 (95% CI: 0.42-0.90), respectively. However, OR among the older patient (>median age) were 1.38 (95% CI: 0.66-2.89). The rate of infection-induced asthma exacerbation was 23.2% (95% CI: 18.6-29.6), and the OR for vaccination against the infection-induced asthma exacerbation was 1.42 (95% CI: 0.69-2.92). Conclusions: The effectiveness of the vaccination against the H1N1 pdm09 virus was confirmed during the first pandemic season, but it was limited. Further investigation on H1N1 pdm09 virus infection in asthmatics will be required.
The emergence and transmission of drug-resistant human immunodeficiency virus-1 (HIV-1) compromises antiretroviral treatment for HIV-1. Thus, testing for drug resistance is recommended at diagnosis ...and before initiating highly active antiretroviral treatment. We conducted an epidemiological study enrolling newly diagnosed patients between 2003 and 2008 in our nationwide surveillance network. In the 6-year study period, the prevalence of drug-resistant HIV-1 among 2573 patients, consisting mainly of Japanese men in their late-30s and infected through male-to-male sexual contacts, followed an increasing trend from 5.9% (16/273) in 2003 to 8.3% (50/605) in 2008. Nucleoside reverse transcriptase inhibitor-associated mutations predominated in each year, with T215 revertants being the most abundant. The predictive factor for drug-resistant HIV-1 transmission was subtype B (OR
=
2.36;
p
=
0.004), and those for recent HIV-1 infection were male gender (OR
=
3.79;
p
=
0.009), MSM behavior (OR
=
1.67;
p
=
0.01), Japanese nationality (OR
=
2.31;
p
=
0.008), and subtype B (OR
=
5.64;
p
<
0.05). Continued activities are needed to raise awareness of the risks of HIV-1 infection and complications of drug-resistant strains. Continued surveillance is also needed to understand trends in the HIV-1 epidemic.
Abstract The Mycobacterium avium complex (MAC) invades cultured human bronchial cells, can replicate intracellularly, and facilitates the release of inflammatory cytokines and chemokines from cells. ...The purpose of this study was to examine the effects of clarithromycin (CAM) on MAC invasion, replication, and the release of cytokines and chemokines. A human bronchial epithelial cell line (BEAS-2B) monolayer grown on a tissue culture plate was infected with MAC. After 24 h, the cells were washed with Hanks’ buffered salt solution, and extracellular bacteria were killed. The monolayer was further cultured for 5 days in medium containing CAM and subjected to a replication assay. The supernatants were assessed using a microchemotaxis assay and enzyme-linked immunosorbent assay (ELISA). mRNA expression was evaluated using a DNA array. The amount of intracellular MAC on day 5 of culture was significantly lower in the presence of CAM at the levels of 1× and 4× MIC. CAM inhibited the release of chemotactic activity and the production of interleukin (IL)-8 and macrophage chemotactic protein (MCP)-1. DNA array analysis of mRNA expression in BEAS-2B cells showed that CAM inhibited the expression of inflammatory cytokines and chemokines, involving IL-6, MCP-1, and IL-8 mRNA. MAC invaded and replicated in BEAS-2B cells and induced the production of chemotactic factors. In contrast, CAM may have bactericidal and bacteriostatic effects leading to the inhibition of inflammatory events.
Hypogammaglobulinemia is a reduction or absence of immunoglobulin, which may be congenital or associated with immunosuppressive therapy. In addition to infectious diseases, autoimmune diseases have ...also been reported in patients with hypogammaglobulinemia. A 26-year-old man with hypogammaglobulinemia had multiple joint pain and swelling with erosive changes in the proximal interphalangeal joint of the right middle finger on X-ray film, mimicking rheumatoid arthritis (RA). As polyarthritis remained after immunoglobulin replacement therapy and there was no finding indicating any infection at that time, a diagnosis of RA was made. Prednisolone and etanercept were started. However, his polyarthritis did not improve and he developed meningitis and massive brain ischemia. Finally, a diagnosis of disseminated Mycoplasma hominis infection was made. The differential diagnosis of polyarthritis in patients with hypogammaglobulinemia should strictly exclude Mycoplasma infection by culture with special media or longer anaerobic culture, and molecular methods for mycoplasma.
Background
There are no data concerning the occurrence of community-acquired pneumonia (CAP) in esophageal cancer patients during long-term follow-up after radical esophagectomy. The aims of the ...present study were to determine the incidence of CAP in esophageal cancer patients who underwent radical esophagectomy and to identify the risk factors.
Methods
A total of 186 consecutive patients who underwent radical esophagectomy for thoracic esophageal carcinoma in our hospital between 1991 and 2000 were enrolled in this study. Data on the occurrence of CAP were retrospectively collected from medical records, follow-up files, and telephone interviews with patients. The cumulative incidence of CAP was calculated by the Kaplan–Meier method, and the risk factors for CAP were determined by univariate and multivariate analyses. The median follow-up time was 77 months (range 12–216 months).
Results
Sixty patients suffered from CAP during the follow-up period. The cumulative incidence was 25.8% at 5 years and 38.4% at 10 years. Multivariate analysis revealed the following as the significant risk factors for CAP: presence of lymph node metastasis (Hazard ratio HR, 2.64; 95% confidence interval CI, 1.55–4.50;
P
< 0.001), colonic interposition (HR, 2.87; 95% CI, 1.41–5.82;
P
= 0.004), obstructive lung disease (HR, 1.95; 95% CI, 1.11–3.42;
P
= 0.021), and preoperative hypoalbuminemia (HR, 2.08; 95% CI, 1.20–3.60;
P
= 0.009).
Conclusions
There is a high incidence of CAP in esophageal cancer patients after esophagectomy. Positive nodal metastasis, colonic interposition, obstructive lung disease, and preoperative hypoalbuminemia are risk factors for this long-term postoperative morbidity.
Objective To compare the efficacy and safety of fixed-dose abacavir/lamivudine (ABC/3TC) and tenofovir/emtricitabine (TDF/FTC) with ritonavir-boosted atazanavir (ATV/r) in treatment-naïve Japanese ...patients with HIV-1 infection. Methods A 96-week multicenter, randomized, open-label, parallel group pilot study was conducted. The endpoints were times to virologic failure, safety event and regimen modification. Results 109 patients were enrolled and randomly allocated (54 patients received ABC/3TC and 55 patients received TDF/FTC). All randomized subjects were analyzed. The time to virologic failure was not significantly different between the two arms by 96 weeks (HR, 2.09; 95% CI, 0.72-6.13; p=0.178). Both regimens showed favorable viral efficacy, as in the intention-to-treat population, 72.2% (ABC/3TC) and 78.2% (TDF/FTC) of the patients had an HIV-1 viral load <50 copies/mL at 96 weeks. The time to the first grade 3 or 4 adverse event and the time to the first regimen modification were not significantly different between the two arms (adverse event: HR 0.66; 95% CI, 0.25-1.75, p=0.407) (regimen modification: HR 1.03; 95% CI, 0.33-3.19, p=0.964). Both regimens were also well-tolerated, as only 11.1% (ABC/3TC) and 10.9% (TDF/FTC) of the patients discontinued the allocated regimen by 96 weeks. Clinically suspected abacavir-associated hypersensitivity reactions occurred in only one (1.9%) patient in the ABC/3TC arm. Conclusion Although insufficiently powered to show non-inferiority of viral efficacy of ABC/3TC relative to TDF/FTC, this pilot trial suggested that ABC/3TC with ATV/r is a safe and efficacious initial regimen for HLA-B*5701-negative patients, such as the Japanese population.
Nephrotoxicity induced by antimicrobial or anticancer drugs is a serious clinical problem. Megalin, an endocytic receptor expressed at the apical membranes of proximal tubules, mediates the ...nephrotoxicity of aminoglycosides and colistin, key antimicrobials for multidrug-resistant organisms. The mechanisms underlying the nephrotoxicity induced by vancomycin, an antimicrobial for methicillin-resistant
, and cisplatin, an important anticancer drug, are unknown, although the nephrotoxicity of these drugs and gentamicin, an aminoglycoside, is suppressed experimentally with cilastatin. In the clinical setting, cilastatin has been used safely to suppress dehydropeptidase-I-mediated renal metabolism of imipenem, a carbapenem antimicrobial, and thereby limit tubular injury. Here, we tested the hypothesis that cilastatin also blocks megalin-mediated uptake of vancomycin, cisplatin, colistin, and aminoglycosides, thereby limiting the nephrotoxicity of these drugs. Quartz crystal microbalance analysis showed that megalin also binds vancomycin and cisplatin and that cilastatin competes with megalin for binding to gentamicin, colistin, vancomycin, and cisplatin. In kidney-specific mosaic megalin knockout mice treated with colistin, vancomycin, or cisplatin, the megalin-replete proximal tubule epithelial cells exhibited signs of injury, whereas the megalin-deficient cells did not. Furthermore, concomitant cilastatin administration suppressed colistin-induced nephrotoxicity in C57BL/6J mice. Notably, cilastatin did not inhibit the antibacterial activity of gentamicin, colistin, or vancomycin
, just as cilastatin did not affect the anticancer activity of cisplatin in previous studies. In conclusion, megalin blockade with cilastatin efficiently suppresses the nephrotoxicity induced by gentamicin, colistin, vancomycin, or cisplatin. Cilastatin may be a promising agent for inhibiting various forms of drug-induced nephrotoxicity mediated
megalin in the clinical setting.
Interferon-γ neutralizing autoantibodies (nIFNγ-autoAb) are reported in patients with disseminated nontuberculous mycobacteria (NTM) infection and may function by increasing the infection risk. ...Notwithstanding, the prevalence of nIFNγ-autoAb as well as the clinical presentation, diagnosis, and natural history, of disseminated NTM infection in these patients is poorly understood.
In this retrospective observational study, data and sera for 331 Japanese subjects with mycobacterial infection were collected and analyzed. IFNγ-autoAb titers in sera were quantified using an enzyme-linked immunosorbent assay; neutralizing capacity was evaluated via flow cytometry.
Disseminated NTM was identified in 50 HIV-negative patients. Of these, 30 of 37 (81%) immunocompetent patients had an increased nIFNγ-autoAb titer while only 1 of 13 (7.7%) immunodeficient patients had an increased nIFNγ-autoAb titer (p<0.0001, chi squared). Presenting symptoms were non-specific and NTM infection was not included in the differential diagnosis in most cases. All patients with disseminated NTM and increased a serum nIFNγ-autoAb level received prolonged antimicrobial therapy. In 6 cases when antibiotic treatment was discontinued, NTM infection recurred and required resumption of antibiotic therapy for infection control. The mortality rate was 3.2% in disseminated NTM patients with nIFNγ-autoAb and 21% in those without.
nIFNγ-autoAb were present in most patients with disseminated NTM infection without a diagnosis of clinical immunodeficiency. Diagnosis of disseminated NTM requires a high degree of suspicion and can be improved by measuring serum nIFNγ-autoAb titer. Long-term antibiotic therapy helps prevent recrudescent NTM infection.
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