Hideo Ogata

Fukujuji Hospital, Edo, Tokyo, Japan

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Publications (81)133.1 Total impact

  • European Respiratory Journal 09/2015; 46(suppl 59):PA2737. DOI:10.1183/13993003.congress-2015.PA2737 · 7.64 Impact Factor
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    ABSTRACT: Drugs for tuberculosis and non-tuberculosis mycobacterial diseases are limited. In particular, no new drugs for non-tuberculosis mycobacterial disease have been developed in recent years. Antimycobacterial drugs have many adverse reactions, for which drug desensitization therapy has been used. Rapid drug desensitization (RDD) therapy, including antituberculosis drugs and clarithromycin, has been implemented in many regions in Europe and the United States. We investigated the validity of RDD therapy in Japan. We report our experience with RDD therapy in 13 patients who developed severe drug allergy to antimycobacterial treatment. The desensitization protocol reported by Holland and Cernandas was adapted. The underlying diseases were 7 cases of pulmonary Mycobacterium avium complex disease and 6 cases of pulmonary tuberculosis. Isoniazid was readministered in 2 (100%) of 2 patients; rifampicin, in 8 (67.7%) of 12 patients; ethambutol, in 4 (67.7%) of 6 patients; and clarithromycin, in 2 (100%) of 2 patients. In Japan, the desensitization therapy recommended by the Treatment Committee of the Japanese Society for Tuberculosis have been implemented generally. We think RDD therapy is effective and safe as the other desensitization therapy. We will continue to investigate the efficiency of RDD therapy in patients who had discontinued antimycobacterial treatment because of the drug allergic reaction.
    Kekkaku: [Tuberculosis] 11/2014; 89(11):797-802.
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    ABSTRACT: Objective: To present the long-term outcome of multidrug-resistant tuberculosis (MDR TB) patients. Methods: An observational study of 291 MDR TB cases that were diagnosed from 1990 to 2011 at the Fukujuji Hospital in Japan. Results: The frequency of relapse after cure was 3/168 (1.8%) during a mean follow-up of 4.4 years. Among 16 failure cases, eight patients were negative in later years. One case among the nine lost-to-follow-up patients with culture conversion returned 1.5 years later with positive culture. Conclusions: Chronic-positive patients remain positive for years and require observation. Lost to follow-up cases may relapse.
    Transactions of the Royal Society of Tropical Medicine and Hygiene 06/2014; 108(9). DOI:10.1093/trstmh/tru080 · 1.84 Impact Factor
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    ABSTRACT: [RATIONALE] Since pulmonary disease caused by nontuberculous mycobacteria is already thought to be a big health problem, it is important to clarify the environmental factors including route of infection for prevention. There are some researches reported that both traditional Japanese bath system (Nishiuchi: Jpn J Infect Dis. 2009) and frequent exposure to soil (Maekawa: Chest. 2011) might be the infection source. This study aims to clarify the frequency of bathing and soil exposure of the patients with MAC (MAC-PD) and M. abscessus (MAB-PD) pulmonary disease. [METHODS] We performed the questionnaire survey with patients who were diagnosed with MAC-PD and MAB-PD focusing on the frequency of bathing and soil exposure. Fisher's exact test for categorical variables and t test for continuous variables were used to compare frequency and means between two groups. [RESULTS] Patients background was very similar between 90 cases of MACPD (69 years, female: 84%, BH: 158.2cm, BW: 47.1kg) and 21 cases of MABPD (68 years, female: 86%, BH: 156.9cm, BW: 46.1kg). Although no significant difference was identified, the proportion of patients with repeated exposure to soil was a little higher in MABPD than MACPD (MACPD: 26.3%, MABPD: 44.4, P=0.167). The usage of boiler that attaches to traditional Japanese bathtub (this is for reheating the lukewarm water) was seen in high frequency in both groups (MACPD: 74.3%, MABPD: 78.6%, P=1.000). The water preservation in the bathtub for washing clothes (this is based on ecological lifestyle) were also seen in both groups at the same frequency (P=0.537) [CONCLUSION] We found high frequent usage of boiler and also recurrent exposure to soil in around 30 to 40 percent. Although we failed to find significant difference between MAC-PD and MAB-PD groups by the questionnaire survey, this method gives us fundamental information of patient’s lifestyle. We will also present the age-sex matched control study to compare with the results to the patients.
    American Journal of Respiratory and Critical Care Medicine 05/2014; 186:A6535. · 13.00 Impact Factor
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    ABSTRACT: Objective: Body weight loss in patients with Mycobacterium avium complex (MAC) pulmonary disease can be fatal. The administration of nutritional supplements should be an important component in the treatment of this disease. Objective data regarding the association between the nutritional status and disease severity have not been reported. This cross-sectional study aimed to compare the nutritional status and radiological severity scores in MAC pulmonary disease patients. Methods: We retrospectively reviewed the records of 40 patients who were admitted to our institution for the treatment of MAC pulmonary disease between July 2008 and July 2010. Nutritional indices, including the ideal body weight ratio, triceps skinfold, mid-upper arm muscle circumference, and percentage of predicted resting energy expenditure, were compared with the radiological severity scores. Quantitative values of the extent of nodules, infiltration shadows, cavities, and bronchiectasis on the computed tomography scans were used to evaluate the radiological severity scores. Results: The patients suffered from a significantly decreased percentage of ideal body weight, body fat and muscle mass. The average radiological score was 17.6±8.4 points. The percentage of ideal body weight (p<0.001), percentage of triceps skinfold (p<0.001) and percentage of mid-upper arm muscle circumference (p<0.002) were negatively correlated with the radiological scores, while the percentage of the predicted resting energy expenditure (p<0.001) was positively correlated with the scores. Conclusion: A poor nutritional status is common in patients with progressive MAC pulmonary disease, which supports the hypothesis that aggressive nutritional interventions are indicated in the treatment of this disease.
    Internal Medicine 03/2014; 53(5):397-401. DOI:10.2169/internalmedicine.53.1277 · 0.90 Impact Factor
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    ABSTRACT: PURPOSE To evaluate the bull’s eye imaging of pulmonary regional blood flow using non enhancement dynamic chest X-ray in comparison with 99mTc-MAA scintigraphy. METHOD AND MATERIALS Dynamic chest pulsed X-ray at 15 frames per second in total 10 second of tidal breathing was performed in 69 patients (mail:38, female:31 65.3years± 12.1years) with pulmonary disease. The institutional review board approval and written informed consent was obtained in all patients. Image data-sets were extracted by signal intensity pixels of blood flows by using a band-pass filter optimized for heart beats. Two trained radiologists were diagnosed and determined main vessel phase, capillary phase, and Maximum intensity projection (MIP) of each flames in one heart beat was adjustment to the bull’s eye fields and divided into 6 fields (upper, middle, lower, in right and left in every 2 hours). The signal value rate of the dynamic chest x-ray was compared with the 99mTc-MAA scintigraphy. RESULTS All the patients were performed technically with the total exposed dose of 0.25mGy. The signal rate of the blood flows of main vessels in each upper, middle, lower fields was 11.9%±2.3, 23.1%±4.2, 20.7%±5.3, and 12.1%±2.8, 23.0%±5.5 and 9.2%±3.6 in the left. The signal rate of capillary blood flow was 13.6%±2.4, 16.5%±2.8 and 23.6%±5.1 in the right, and 13.5%±3.1, 16.2%±3.4, and 16.5%±5.0 in each upper, middle, lower fields. The rate of the MIP was 13.0%±1.4, 20.4%±2.2 and 22.4%±3.1 in the right, and 12.9%±1.9, 19.0%±2.6 and 12.4%±3.4 in the left. In those cases, The 99mTc-MAA uptake was 7.3%±2.8, 21.3%±5.6 and 27.6%±8.2 in the right and 7.3%±3.0, 18.4%±5.7 and 18.0%±7.9 in the left, respectively. Comparison of the examinations had good correlations with R=0.59 in main vessel phase, R=0.43 in capillary phase, and R=0.67 in MIP in this study. CONCLUSION Bull’s eye imaging of dynamic chest X-ray blood flows had some collation with 99mTc-MAA scintigraphy. This method has potential to allow measurement and quantification of pulmonary blood flows. CLINICAL RELEVANCE/APPLICATION Bull’s eye imaging for the evaluation of pulmonary blood flow using non enhancement dynamic chest X-ray was shown some colleration with 99mTc-MAA scintigraphy.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: Mycobacterium tuberculosis is the major causative agent of tuberculosis in humans. It is well known that Mycobacterium bovis and other species in the M. tuberculosis complex (MTC) can cause respiratory diseases as zoonosis. We analyzed the MTC isolates collected from tuberculosis patients from Japan in 2002 using a multiplex PCR system that detected cfp32, RD9 and RD12. A total of 970 MTC isolates that were representative of the tuberculosis cases throughout Japan, were examined using this method. As a result, 966 (99.6%) M. tuberculosis, two Mycobacterium africanum and two Mycobacterium canettii were identified using a multiplex PCR system, while no M. bovis was detected. Two isolates that lacked RD9 were initially considered to be M. canettii, but further analysis of the hsp65 sequence revealed them to be M. tuberculosis. Also two M. africanum were identified as M. tuberculosis using the -215 narG nucleotide polymorphism. Though PCR-linked methods have been used for a rapid differentiation of MTC and NTM, from our cases we suggest careful interpretation of RD based identification.
    Tuberculosis (Edinburgh, Scotland) 10/2013; 94(1). DOI:10.1016/j.tube.2013.09.006 · 2.71 Impact Factor
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    ABSTRACT: Rationale: Pulmonary disease caused by nontuberculous mycobacteria is generally reported to have a good prognosis. However, the actual mortality rate over time has not been reported in a large-scale survey. Objectives: To determine the annual trend in mortality from nontuberculous mycobacteriosis based on nearly four decades of patient data and to estimate the prevalence of these cases in 2005. Methods: The annual mortality rate and regional distribution of nontuberculous mycobacteriosis-related deaths in Japan were obtained from Vital Statistics of Japan, which is published annually. The crude and age-adjusted mortality rates and associated regional differences were calculated from the Japanese census data. A 5-year follow-up study including 309 patients with pulmonary nontuberculous mycobacteriosis who visited and registered at our institute from 2004 to 2006 was conducted to determine the 5-year prognosis and the annual mortality rate. Measurements and Main Results: The crude mortality rates for both genders have increased since 1970, and the mortality rate from pulmonary disease was greater in women after 2005. The age-adjusted rates of disease also showed a gradual increase until 2010 in women. Geographically, higher standardized mortality ratios were observed in middle and western Japan, particularly in the southern coastal regions along the Pacific Ocean. In a clinical follow-up study, mortality rate was approximately 1-2% annually. The prevalence of pulmonary nontuberculous mycobacteriosis was estimated to be 6-10-fold higher than the annual incidence. Conclusions: There was a constant and steady increase of nontuberculous mycobacteriosis-related mortality in Japan, and this mortality rate showed significant geographical variation. The prevalence of environmental mycobacterial disease in Japan is higher than reported in most other countries.
    Annals of the American Thoracic Society 10/2013; 11(1). DOI:10.1513/AnnalsATS.201303-067OC
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    ABSTRACT: To clarify whether rifabutin (RBT) can be used for treating tuberculosis in elderly Japanese patients in the clinical setting. We performed a clinical chart review from Oct 2008 to Dec 2011, for patients who were diagnosed with tuberculosis and were prescribed rifabutin, at the Fukujuji Hospital (180 beds for respiratory medicine, including 60 for TB). Primarily, we focused on characteristics of patients, the cause for RBT indication, and success rate of treatment. During the study period, 1129 patients were diagnosed with tuberculosis, and among these, 42 (3.7%) patients were prescribed RBT. Of these, 39 patients were included in this study (3 were excluded because their prescription was terminated within 2 weeks because of reasons other than adverse effects). In all, 69% patients were male. Mean age was 69 years, and mean body mass index was 19.1 +/- 3.4 kg/m2. RFP-related adverse effects were observed in 28 patients (72%; age, 73 years); these included gastrointestinal complications in 16, liver dysfunction in 7, skin rashes in 6, and renal dysfunction and thrombocytopenia in 1 each). Additional medication was required in 6 patients, and RBT-resistant TB was noted in 5 patients (28%; age, 60 years). A success rate of 71.4% was observed in cases of RFP-related adverse effects, and that of 81.8% was observed in cases of other reasons. Except for the patient who experienced renal dysfunction, RBT could be used in all patients who experienced RFP-related adverse effects. RBT showed a relatively good success rate, even in patients who experienced RFP-related adverse effects. Thus, RBT could be an alternative in cases of RFP-related adverse effects, even in elderly patients.
    Kekkaku: [Tuberculosis] 08/2013; 88(8):625-8.
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    ABSTRACT: In our hospital, we analyzed the clinical factors of pulmonary tuberculosis (TB) diagnosed in non-TB wards and the incidence of TB infection among contact patients and healthcare workers (HCWs) using QuantiFERON-TB GOLD (QFT) testing. This study included 16 patients who were diagnosed with pulmonary TB in non-TB wards in our hospital from January 2008 to May 2011. Eight contact patients and 120 HCWs were also enrolled. The 16 TB patients comprised 11 men (77.7 years) and 5 women (74.4 years). Among them, only 9 patients exhibited positive results for Mycobacterium tuberculosis after the first acid-fast bacterial examination; the other 7 patients presented positive results only after the second or third examinations. Moreover, there were 3 cases of positive Mycobacterium avium samples in the first acid-fast bacterial examination. Among 16 pulmonary Mycobacterium tuberculosis cases, 8 were sputum smear and culture positive, 7 were sputum smear negative and culture positive, and 1 was sputum smear and culture negative. Moreover, 17 days had elapsed from the time of admission to the non-TB ward to diagnosis. TB contact examination revealed that QFT results for 2 HCWs changed from negative to positive. We suspected pulmonary aspergillosis or old TB when presented with cases with a history of TB. Moreover, we believe that the periods from admission to diagnosis were delayed when the first acid-fast bacterial sputum examination was negative or showed non-tuberculous mycobacteria.
    Kekkaku: [Tuberculosis] 07/2013; 88(7):605-9.
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    ABSTRACT: RATIONALE: While clinical importance of MAC pulmonary disease (MAC-PD) has been increasing in recent years, biomakers that can be usefull in clinical setting have not been clarified enough so far. We planned to evaluate some biomakers reported recently, focusing on relation to the radiological score. Kitada et al. reported that the usefulness of serum glycopeptidolipid (GPL) core IgA antibody levels in the diagnosis of MAC-PD. Significant elevation of Neutrophil CD64 in tuberculosis comparison to other infectious diseases is shown in some reports. Finally vitamin D and cathelicidin are getting more attention in many diseases referring to innate immunity. METHODS: We enrolled 80 patients with MAC-PD. The data of patient demographics and each biomarkers were collected and analyzed the correlation with the radiologic score (NICE score). To evaluate radiological findings, #1, divide the lung into 6 zones, upper zones-- above the level of the carina, middle zones--between the level of the carina and the level of the inferior pulmonary veins, lower zones--below the level of the inferior pulmonary veins. #2, Evaluate each four findings; Nodule, Infiltration, Cavity and Ectasis (NICE) in 6 zones (1-25%:1 point, 25-50%:2 points, 50-75%:3 points, 75%-:4 points). #3. Sum up all the scores. RESULTS: Average age was 65.6±13.3 years, female ratio was 84%. Body mass index was 19.1±2.1. Sensitivity of GPL core IgA antibody was 65.8% (cutoff value=0.7) and it had correlation between NICE score (R=0.41, P=0.012). The antibody level tended to be influenced by nodular shadow. CD64 expression on neutrophils also showed significant correlation to radiologic score (R=0.39, P=0.006). Vitamin D and cathelicidin showed no correlation to the score. CONCLUSIONS: GPL core IgA antibody and CD64 expression on neutrophil might have correlation to the activity to MAC-PD. We conclude that long term evaluation of these biomarkers should be elucidated in the future.
    American Journal of Respiratory and Critical Care Medicine 05/2013; 157:A5111. · 13.00 Impact Factor
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    ABSTRACT: The QuantiFERON-TB (QFT) blood test is the major tool for the diagnosis of Mycobacterium tuberculosis (TB) infection among healthcare workers (HCWs). We used QFT tests to estimate the prevalence of TB infection among HCWs in our hospital. Between 2003 and 2010, a total of 733 HCWs were enrolled in this study, and the prevalence of TB infection was analyzed according to the HCWs' jobs and work place. Among the 152 men and 581 women who were evaluated, 3 female HCWs had a history of TB. Fifty-eight HCWs (8 men and 50 women with a mean age of 56.3 years and 48.4 years, respectively) demonstrated positive QFT tests. The positive rate was 7.9% for all staff members throughout the study period. The QFT test was positive for 1 HCW who was treated for TB in 1998, and negative and inconclusive for 2 other HCWs treated for TB in 2002. The positive rate for QFT was 16.0% in the TB ward (12/75, 95% confidence interval [CI]: 7.7-24.3%), 9.9% in the other wards (22/222, 95% CI: 7.9-11.9), and 1.1% in the outpatient department (1/91, 95% CI: 0-2.2). According to the job category, the QFT positive rates were as follows: doctors, 4.3% (3/70, 95% CI: 1.9-6.7); nurses, 10.3 (4/35, 95% CI: 6.0-16.8). The positive rate among doctors working in the TB ward was 10.0%, and that for nurses was 24.3%. This indicates that the prevalence of infection among HCWs in the TB ward was significantly higher than that in other work places. A comparison of the results from 2003 through 2007 revealed that for a total of 307 workers, 90.6% and 5.2% remained negative and positive, respectively, while 1.6% converted from negative to positive, and 2.6% from positive to negative. The positive rate among HCWs in the TB ward was higher than that in other wards. This is especially remarkable for doctors and nurses working in the TB ward.
    Kekkaku: [Tuberculosis] 04/2013; 88(4):405-9.
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    Kekkaku: [Tuberculosis] 03/2013; 88(3):291-296.
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    ABSTRACT: Multidrug resistance (MDR) involves resistance to both isoniazid and rifampicin, which makes the treatment of tuberculosis very difficult. Extensive drug resistance (XDR) occurs when, in addition to isoniazid and rifampicin resistance, the microorganisms are resistant to a fluoroquinolone and an injectable agent (e.g., kanamycin, amikacin, or capreomycin). Generally, drug susceptibility testing takes more than 3-4 weeks after the initial cultivation. There is an urgent need to identify methods that can rapidly detect both the presence of Mycobacterium tuberculosis and the status of drug resistance. This study was aimed at evaluating the line probe assay (LiPA; Nipro Co.), for the identification of Mycobacterium species and detection of mutations associated with antituberculous drugs. We found that LiPA enabled the rapid identification of M. tuberculosis, M. avium, M. intracellulare, and M. kansasii. When the results of the LiPA and conventional drug susceptibility tests were compared, there was no difference in the susceptibility to rifampicin, pyrazinamide, and levofloxacin; however, there was a difference in the susceptibility to isoniazid. Thus, LiPA can be used for the rapid identification of Mycobacterium species and the determination of susceptibility to drugs, which can help in the early initiation of appropriate treatment, leading to a reduction in infectiousness.
    Kekkaku: [Tuberculosis] 03/2013; 88(3):291-6.
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    ABSTRACT: We herein report two cases of multidrug-resistant tuberculosis (MDR-TB) in patients with a history of pulmonary nontuberculous mycobacteriosis (PNTM). A 50-year-old man was diagnosed with MDR-TB five years after receiving treatment for pulmonary Mycobacterium kansasii infection. In the second patient, a 72-year-old woman, the diagnosis of PNTM was confirmed twice with two bronchial washings; she was diagnosed with MDR-TB 29 months after presenting with PNTM. It is highly possible that these two patients were already infected with tuberculosis (TB) at the time of PNTM diagnosis and acquired resistance to anti-TB drugs as a result of undergoing treatment for PNTM.
    Internal Medicine 12/2012; 51(24):3435-7. DOI:10.2169/internalmedicine.51.8076 · 0.90 Impact Factor
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    ABSTRACT: PURPOSE To evaluate the severity in COPD using dynamic chest X-ray examination without effort breathing METHOD AND MATERIALS Dynamic chest X-ray from 29 normal volunteers, 30 mild COPD patients (GOLD Stage I or II) and 31 severe COPD patients (GOLD Stage III or IV) were obtained in the upright position in about 10 seconds of tidal breathing at rest. The dynamic image data captured at 7.5 frames per second was synchronized with the pulsed X-ray. The institutional review board approval and written informed consent were obtained in all persons. The maximal differential values in each ventilation phase at the corresponding small local area of lung in the series of dynamic chest X-ray were calculated. The regional relative flow rate ratio was obtained from the peak values of inspiratory phase divided by the peak values of expiratory phase. All groups were compared about the average of flow rate ratio. RESULTS The average of the ratio in normal volunteers, in mild COPD patients and in severe COPD patients were 0.21±0.03, 0.22±0.04 and 0.26±0.04 (mean±SD),respectively. Significant difference was confirmed between the normal volunteers and the severe COPD patients (p=0.00047), and between the the mild COPD patients and the severe COPD patients (p=0.0092),respectively. CONCLUSION The inspiratory / expiratory flow rate ratios in COPD patients were larger than those of healthy volunteers. The new method for ventilation function has possibility to evaluate severity of COPD. CLINICAL RELEVANCE/APPLICATION New method of dinamic chest x-ray evaluate the sevirarity of Chronic Obstructive Pulmonary Disease.The inspiratory / expiratory flow rate ratios in COPD patients were larger than healthy volunteers.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
  • Lina Yi · Takashi Yoshiyama · Masao Okumura · Hideo Ogata · Shoji Kudoh ·
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    ABSTRACT: QuantiFERON-TB Gold (QFT-G) test has been recommended as a new tool for the diagnosis of latent tuberculosis (TB) infection. However, the risk of development of active TB in the future depends on the period after the infection. The aim of this study was to evaluate the risk of development of active TB in individuals who have been infected. Clinical development of TB in subjects with positive baseline QFT test results was retrospectively analyzed. The subjects included healthcare workers, since 2003, at the Fukujuji Hospital who were examined at employment. In total, 667 subjects were examined using the QFT-2G test, and 62 subjects were QFT positive at the first examination. One was treated using isoniazid, and 61 subjects were followed up for an average of 4.7 years (286 person-years). None of the subjects developed active TB during the observation period, and the probability of clinical breakdown (95% confidence interval) was 0-0.0104/person-year. The risk of development of active TB among subjects with positive QFT-G test results at baseline was low. Treatment of latent TB infection is not recommended, unless an individual has been recently infected.
    Kekkaku: [Tuberculosis] 11/2012; 87(11):697-9.
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    ABSTRACT: Delamanid (OPC-67683), a nitro-dihydro-imidazooxazole derivative, is a new antituberculosis medication that inhibits mycolic acid synthesis and has shown potent in vitro and in vivo activity against drug-resistant strains of Mycobacterium tuberculosis. In this randomized, placebo-controlled, multinational clinical trial, we assigned 481 patients (nearly all of whom were negative for the human immunodeficiency virus) with pulmonary multidrug-resistant tuberculosis to receive delamanid, at a dose of 100 mg twice daily (161 patients) or 200 mg twice daily (160 patients), or placebo (160 patients) for 2 months in combination with a background drug regimen developed according to World Health Organization guidelines. Sputum cultures were assessed weekly with the use of both liquid broth and solid medium; sputum-culture conversion was defined as a series of five or more consecutive cultures that were negative for growth of M. tuberculosis. The primary efficacy end point was the proportion of patients with sputum-culture conversion in liquid broth medium at 2 months. Among patients who received a background drug regimen plus 100 mg of delamanid twice daily, 45.4% had sputum-culture conversion in liquid broth at 2 months, as compared with 29.6% of patients who received a background drug regimen plus placebo (P=0.008). Likewise, as compared with the placebo group, the group that received the background drug regimen plus 200 mg of delamanid twice daily had a higher proportion of patients with sputum-culture conversion (41.9%, P=0.04). The findings were similar with assessment of sputum-culture conversion in solid medium. Most adverse events were mild to moderate in severity and were evenly distributed across groups. Although no clinical events due to QT prolongation on electrocardiography were observed, QT prolongation was reported significantly more frequently in the groups that received delamanid. Delamanid was associated with an increase in sputum-culture conversion at 2 months among patients with multidrug-resistant tuberculosis. This finding suggests that delamanid could enhance treatment options for multidrug-resistant tuberculosis. (Funded by Otsuka Pharmaceutical Development and Commercialization; ClinicalTrials.gov number, NCT00685360.).
    New England Journal of Medicine 06/2012; 366(23):2151-60. DOI:10.1056/NEJMoa1112433 · 55.87 Impact Factor

  • American Thoracic Society 2012 International Conference, May 18-23, 2012 • San Francisco, California; 05/2012
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    ABSTRACT: RATIONALE: It has been about 20 years since the macrolide-containing regimens were introduced in the treatment of NTM lung disease, especially MAC. However, the limitations of those regimens are clear because these treatments hardly lead cure in case with advanced cases or cavitary disease. We have to treat MAC patients most effectively with the limited current drugs until the new key drugs are developed. Studies that are elucidated the optimal treatment periods are lacking until now. METHODS: We planned to elucidate the best treatment periods based on one year after culture negative defined as standard period. We retrospectively studied 100 patients evaluable for 2 years after cessation of macrolide containing standard treatment. The primary endpoint was 2 consecutive positive cultures. Logistics and Cox analysis was performed following factors: evaluate age, sex, smoking history, BMI, lung disease, treatment history, dosage of CAM, CRP, Neu/Lym ratio, radiological score. Radiological evaluation was performed by accumulation of score of 6 zone of the lung. Nodule, infiltration (consolidation), cavity and ectasis were scored in each zone :(1-25%:1 point, 25-50%:2 points, 50-75%:3 points, 75%-:4 points). Treatment period was defined standard period, prolonged period, and others (short term, relapse, treatment failure). RESULTS: Average age was 65.9±10.3 years old, male female ratio was 24 and 76% each. Body mass index was 19.1±2.6, 40% patients had lung underling disease. Radiological sore before and after treatment were 11.2±5.2 and 8.3± 4.4. Statistical analysis showed that 12 months of culture-negative (standard period) were not significantly different from > 12 months of culture-negative in non-cavitary lesions (p=0.974). However, in patients with cavitary lesions, > 12 months treatment showed significantly better prognosis than treatment for standard periods (p=0.0353). Average prolongation duration after 12 months culture negative was +9 months (283 days) with cavitary lesion. CONCLUSIONS: In patients with cavitary lesion, longer duration than standard period would be better. Standard period was ideal in patients with non-cavitary lesion. Judging from the initiation of therapy, it could state that the outcome is better in long-term treatment than in standard treatment.
    American Journal of Respiratory and Critical Care Medicine 05/2012; 185:A4025. DOI:10.1164/ajrccm-conference.2012.185.1_MeetingAbstracts.A4025 · 13.00 Impact Factor

Publication Stats

437 Citations
133.10 Total Impact Points


  • 1991-2014
    • Fukujuji Hospital
      Edo, Tokyo, Japan
  • 2013
    • Osaka Prefectural Medical Center for Respiratory and Allergic Diseases
      Ōsaka, Ōsaka, Japan
  • 1993-2007
    • Research Institute of Tuberculosis
      Edo, Tokyo, Japan