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ABSTRACT: Objective The aim of this study was to describe the epidemiology, clinical features, antimicrobial treatment, and outcomes of patients with nursing and healthcare-associated pneumonia (NHCAP); a new category of pneumonia proposed by the Japanese Respiratory Society. Methods We conducted a retrospective analysis of a prospectively collected database of patients with NHCAP and community-acquired pneumonia (CAP) hospitalized at a single center between January 2008 and December 2010, and compared their clinical characteristics. The criteria for NHCAP were as follows: (1) residence in a nursing home or an extended-care ward, (2) a discharge from a hospital in the preceding 90 days, (3) an elderly or handicapped patient who needs long-term care, (4) a patient who regularly requires vascular access in an outpatient setting. Results A total of 442 NHCAP patients and 451 CAP patients were evaluated. The NHCAP patients were older and had a higher frequency of underlying diseases. Aspiration was thought to be associated with the NHCAP in 63% of patients. Streptococcus pneumoniae was the leading pathogen in both groups, whereas the frequency of multidrug-resistant pathogens was higher in the NHCAP patients. The most frequently used antimicrobials in NHCAP patients were penicillins with beta-lactamase inhibitors. The in-hospital mortality and recurrence rates were significantly higher in NHCAP patients than in CAP patients (13.1% vs. 5.1%, p<0.001 and 18.8% vs. 5.5%, p<0.001). Conclusion The clinical picture of NHCAP is consistent with that of HCAP described in the past. It is thought to be of benefit to modify the healthcare-associated pneumonia (HCAP) criteria considering the healthcare and social health insurance system in Japan.
Internal Medicine 01/2012; 51(18):2537-44. · 0.94 Impact Factor
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ABSTRACT: Lenalidomide is a second-generation immunomodulatory drug that has been approved to treat relapsed or refractory multiple myeloma. Here, we describe a patient who was treated with a low dose of lenalidomide (5 mg/day on days 1-21 of a 28-day cycle) because the standard dose of bortezomib was too toxic and adverse events persisted. However, he developed fever, dyspnea, hypoxia and pulmonary infiltrates. The results of an extensive workup for other causes including infections were negative and the final diagnosis was lenalidomide-induced interstitial pneumonitis. This is the first case report of lenalidomide-induced pneumonitis in a Japanese patient.
Internal Medicine 01/2012; 51(9):1081-5. · 0.94 Impact Factor
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Internal Medicine 01/2012; 51(24):3445-6. · 0.94 Impact Factor
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Kei Kunimasa, Machiko Arita,
Takashi Nakazawa,
Maki Tanaka,
Kazuya Tsubouchi,
Satoshi Konishi,
Yasushi Fukuda,
Mika Saigusa,
Hiroaki Nakagawa,
Satoshi Ubukata,
Yohei Korogi,
Takao Fujii,
Tsuneyo Mimori,
Tadashi Ishida
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ABSTRACT: We herein report the clinical and laboratory characteristics of two anti-OJ (anti-isoleucyl-tRNA synthetase) autoantibody-positive interstitial lung disease patients with polymyositis/dermatomyositis (PM/DM). We compared these characteristics with previously published findings. Previous reports and our present cases show that anti-OJ autoantibody-positive interstitial lung disease (ILD) patients with PM/DM lack the manifestations of Raynaud's phenomenon and sclerodactyly and show good prognoses and responses to glucocorticoid therapy. These results indicate that the presence of anti-OJ autoantibodies may be useful for predicting the prognosis of ILD and its clinical course in PM/DM patients.
Internal Medicine 01/2012; 51(24):3405-10. · 0.94 Impact Factor
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Akihiro Nishiyama,
Tadashi Ishida,
Youhei Kourogi,
Satoshi Konishi,
Kazuya Thubouchi,
Chiya Iga,
Kei Kunimasa,
Masahiro Iwasaku,
Hajime Hukuyama,
Hiroaki Nakagawa,
Akihiro Itou,
Satoshi Ubukata,
Hiroshige Yoshioka,
Hiromasa Tachibana, Machiko Arita,
Toru Hashimoto,
Junko Amemura-Maekawa
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ABSTRACT: Legionella pneumonia tends to be severe and is known to be fatal. Introduction of the urinary Legionella antigen test and changes in the Infectious Disease Law have led to increased numbers of reports, and milder cases are now occasionally seen. We experienced three cases demonstrating mild respiratory infections and one case demonstrating nosocomial pneumonia associated by Legionella pneumophila serogroup 3. Case 1 showed multiple ground-glass opacities on HRCT and productive cough. Cases 2 and 3 showed abnormal findings on chest X-ray, and chest CT findings in both cases suggested chronic respiratory infection. Case 4 experienced fever and hypoxia, and pulmonary edema was noted on X-ray. All of them four cases were diagnosed with respiratory infections isolated L. pneumophila serogroup 3 by culture results, and three of them cases were treated in the outpatient clinic. Thus, milder cases of Legionella pneumonia may be encountered during routine care, and tests for Legionella should be performed in such cases.
Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 07/2011; 85(4):373-9.
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ABSTRACT: Hypereosinophilic syndrome (HES) encompasses both myeloproliferative and lymphoproliferative diseases. We encountered a rare case of lymphocytic HES followed by malignant T cell lymphoma, who was diagnosed as eosinophilic pneumonia upon the first visit. During the clinical course, the transition of the chest CT findings from bilateral multifocal ground-glass opacities and consolidations to bilateral scattered multiple small nodules was impressive and suggestive. Given the increased risk of developing T-cell lymphoma, patients with HES (especially lymphocytic-HES) should be monitored on a regular basis to detect this complication as early as possible.
Internal Medicine 01/2011; 50(20):2417-21. · 0.94 Impact Factor
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ABSTRACT: Several scoring systems have been derived to identify patients with severe community-acquired pneumonia (CAP). Recently, España et al (Am J Respir Crit Care Med 174:1249-1256, 2006) developed a clinical prediction rule that predicts hospital mortality, the need for mechanical ventilation, and risk for septic shock. We assessed the performance of this rule and compared it with other published scoring systems.
A prospective study was conducted of patients with CAP who were hospitalized at our hospital from April 2007 till May 2009. Clinical and laboratory features at presentation were recorded and used in order to calculate España rule, the pneumonia severity index (PSI), CURB-65, A-DROP, the 2007 Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) prediction rule and SMART-COP. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were compared for adverse outcomes. We also assessed the association of the España rule criteria and adverse outcomes.
A total of 505 patients were enrolled in the study. The overall in-hospital mortality rate was 6.5%, and 6.3% of patients were admitted to the intensive care unit (ICU). Sixty-two (12.3%) patients were defined as having severe CAP (in-hospital death or need for mechanical ventilation or septic shock). España rule achieved highest sensitivity and NPV in predicting severe CAP. When ICU admission was the outcome measure, the IDSA/ATS rule and SMART-COP were regarded to be good predictors.
España rule performed well in identifying patients with severe CAP. As a result, each of the severity scores has advantages and limitations for predicting adverse outcomes.
Internal Medicine 01/2011; 50(18):1917-22. · 0.94 Impact Factor
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ABSTRACT: A 50-year-old man with a 30-year occupational history of welding presented with low-grade fever, fatigue and persistent dry cough. Computed tomography (CT) of the chest revealed interlobular septal thickening and bilateral non-segmental patchy ground-glass opacities except in the sub-pleural zone. He revealed that he had inhaled nickel fumes 3 days previously at work. These findings suggested a diagnosis of pneumonitis induced by inhalation of nickel fumes. Fewer reports describe pneumonitis associated with the inhalation of nickel compared with zinc fumes. Although nickel compounds are particularly pernicious among the transition metals and more toxic than zinc compounds, nickel fume inhalation rarely induces lethal acute respiratory distress syndrome. Our patient was successfully treated with corticosteroid.
Internal Medicine 01/2011; 50(18):2035-8. · 0.94 Impact Factor
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ABSTRACT: Pneumonia which develops in patients while living in their own home is categorized as community-acquired pneumonia (CAP), even if these patients are bedridden and receiving home health care. However, because of the differences in patient backgrounds, we speculated that the clinical outcomes and pathogens of bedridden patients with pneumonia who are receiving home health care would be different from those of CAP. We conducted a prospective study of patients with CAP who were hospitalized at our hospital from April 2007 through September 2009. We compared home health care bedridden pneumonia (performance status 4, PS4-CAP) with non-PS4-CAP in a total of 505 enrolled patients in this study. Among these, 66 had PS4-CAP, mostly associated with aspiration. Severity scores, mortality rate, recurrence rate and length of hospital stay of those with PS4-CAP were significantly higher than those with non-PS4-CAP. Drug resistant pathogens were more frequently isolated from patients with PS4-CAP than from those of non-PS4-CAP. The results of patients with PS4-CAP were in agreement with those of previous health care-associated pneumonia (HCAP) reports. The present study suggested home health care bedridden pneumonia should be categorized as HCAP, not CAP.
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society. 12/2010; 48(12):906-11.
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ABSTRACT: To prospectively investigate the incidence and clinical findings of "postinfectious cough" among adult patients with prolonged cough, enrolled from July 2006 to June 2008, we studied the serum antibodies of Mycoplasma pneumoniae, Chlamydophila pneumoniae and Bordetella pertussis in those who complained of cough lasting 3-8 weeks but with no abnormalities on their chest X-ray films. Mycoplasma pneumoniae bronchitis, Chlamydophila pneumoniae bronchitis, and pertussis were diagnosed based on serological criteria in 5.5%, 4.1%, 9.2% of the cases, respectively. Postinfectious cough including "post-common cold cough" comprised 39.4% of all prolonged cough cases. The above diseases lacked specific clinical findings, making it difficult to differentiate between diseases causing postinfectious cough. Postinfectious cough is thought to be a common clinical entity, however further definitions of the diagnostic criteria and rapid diagnostic procedures are desirable, first to prevent familial transmission, and secondly to differentiate from allergic diseases that cause chronic cough.
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society. 03/2010; 48(3):179-85.
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Hidetoshi Hayashi,
Tomoya Ishii,
Tadashi Ishida,
Mika Saigusa,
Hazime Fukuyama,
Masaki Yamamoto,
Toshihide Yokoyama,
Humiaki Tokioka,
Hiroki Nagai,
Maki Noyama,
Hiroshige Yoshioka,
Hiromasa Tachibana, Machiko Arita,
Toru Hashimoto
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ABSTRACT: A 24-year-old woman smoked after using a waterproof spray in a poorly ventilated room. Two days later, she experienced a dry cough and dyspnea and was admitted to our hospital. A chest radiograph and CT showed ground-glass opacity. Bronchoalveolar lavage fluid yielded no specific findings but a transbronchial lung biopsy specimen revealed eosinophilic alveolitis characterized by edema in the alveolar septa. The patient recovered without any treatment subsequent to hospitalization and she remained symptom-free after discharge. It was believed that she had suffered direct pulmonary damage from inhaling waterproof spray. Among the spray components, fluorocarbon resin was the most likely causative agent.
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society. 02/2008; 46(1):35-8.
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ABSTRACT: To evaluate the efficacy of a rapid immunochromatographic membrane test (ICT) for the detection of Streptococcus pneumoniae urinary antigen for diagnosing S. pneumoniae pneumonia, ICT was performed with urine samples using the Binax NOW Streptococcus pneumoniae kit at the time of admission. The results were compared with those from conventional microbiological studies. Three hundred and forty-nine adult patients with CAP who were admitted to the hospital were studied prospectively between February 2001 and January 2004. The ICT test was positive in 115 (33.0%) of 349 patients enrolled into the study and in 63 (75.9%) of 83 patients with pneumococcal pneumonia confirmed by conventional methods. The test revealed a sensitivity of 75.9% and a specificity of 94.0% with conventional microbiological criteria used as the reference standard. The positive predictive value was 91.3%, and the negative predictive value was 82.6%. The clinical features of 53 patients in whom ICT was positive and no pathogen was identified showed no significant difference from those of 83 patients who had pneumococcal pneumonia identified by conventional methods. The diagnostic yield of pneumococcal pneumonia was increased up to 38.9% using ICT combined with conventional methods. The Binax NOW ICT to detect S. pneumoniae urinary antigen is therefore a rapid and useful method for diagnosing pneumococcal pneumonia. Induction of ICT will prove the predominance of S. pneumoniae in the etiology of CAP.
Journal of Infection and Chemotherapy 01/2005; 10(6):359-63. · 1.80 Impact Factor
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ABSTRACT: To evaluate the usefulness of differentiation of atypical pneumonia and bacterial pneumonia in the community-acquired pneumonia guidelines of the Japanese Respiratory Society, we investigated 124 cases of three atypical pneumonias (Mycoplasma pneumonia, 62 cases; Chlamydia pneumoniae pneumonia, 46 cases; Chlamydia psittaci pneumonia, 13 cases) and 403 cases of bacterial pneumonia at our hospital over seven years. Overall, the sensitivity and specificity of the criteria in the guideline were 70.4% and 91.8%, respectively. High accordance was recognized in patients under 60 years old with atypical pneumonia. Items in the criteria that included subjective factors were considered inassessable. We found that the differentiation of pneumonias in the guideline is useful for the diagnosis of atypical pneumonia among younger patients, but it should be concise and objective. We therefore propose that the criteria would be more effective if they consisted of only 4 items: age under 60 years, no underlying disorders, presence of stubborn dry cough, and normal peripheral white blood cell count.
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society. 01/2003; 40(12):929-35.
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ABSTRACT: A 29-year-old woman with primary myelofibrosis developed severe pneumonia, and 20 days later her 31-year-old sister also contracted pneumonia. The first patient had been in contact with parakeets but the second patient had not been in contact with any birds. Psittacosis was diagnosed in both cases by microplate immunofluorescence antibody technique. Person-to-person transmission between the sisters was suspected to have taken place.
Internal Medicine 08/2002; 41(7):580-3. · 0.94 Impact Factor
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ABSTRACT: A 33-y-old man with Hyper-IgM syndrome developed a severe tuberculous disease complicated by pleuritis and spondylitis. An abnormally decreased CD4/CD8 ratio, decreased CD4 + T-cell count and depressed natural killer cell activity implicated a coexistent cell-mediated immunodeficiency. To our knowledge, this is the first detailed report of tuberculosis associated with Hyper-IgM syndrome.
Scandinavian Journal of Infectious Diseases 02/2002; 34(4):305-7. · 1.72 Impact Factor
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ABSTRACT: A 63-year-old male with liver cirrhosis due to type-C hepatitis virus was admitted on June 14, 1999 to our hospital with complaints of dyspnea, and blisters, swelling and purpuras on his legs. He had consumed raw fish one or two days before. He was already in a state of shock with sepsis and disseminated intravascular coagulation shortly after the admission. Although treatment with MEPM and MINO for sepsis, and daltepalin sodium, antithrombin III and gabexate mesilate for disseminated intravascular coagulation was begun within 12 hours, he died only 30 hours after admission. The causative organism was detected from the blood and the contents of blisters, and was determined as Vibrio vulnificus. On autopsy, Vibrio vulnificus was also detected from skin and muscular tissue of his legs, but necrotizing fasciitis were not apparently revealed. Coagulating necrosis and acute tubular necrosis were verified in intestine and kidneys respectively probably due to ischemic changes. Pseudolobuli were formed and a small hepatocellular carcinoma was detected in the liver. Vibrio vulnificus has two infection channels; one is oral intake and the other is an external wound. The former is said to become serious. It has a rather short period from the starting of the symptom to death, and is highly fatal. If this bacteria is suspected by the clinical coarse of the patients or the laboratory examinations, it is necessary to dose effective antibiotics in its early stage. And for prevention, susceptible patients must be informed of the existence of this disease and the necessity of adequately heating raw seafood.
Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 02/2002; 76(1):63-6.
