[Show abstract][Hide abstract] ABSTRACT: Background The Streptococcus anginosus group (SAG) play important roles in respiratory infections. It is ordinarily difficult to distinguish them from contaminations as the causative pathogens of respiratory infections because they are often cultured in respiratory specimens. Therefore, it is important to understand the clinical characteristics and laboratory findings of respiratory infections caused by the SAG members. The aim of this study is to clarify the role of the SAG bacteria in respiratory infections. Methods A total of 30 patients who were diagnosed with respiratory infections which were caused by the SAG bacteria between January 2005 and February 2015 were retrospectively evaluated. Results Respiratory infections caused by the SAG were mostly seen in male patients with comorbid diseases and were typically complicated with pleural effusion. Pleural effusion was observed in 22 (73.3%) patients. Empyema was observed in half of the 22 patients with pleural effusion. S. intermedius, S. constellatus and S. anginosus were detected in 16 (53.3 %), 11 (36.7 %) and 3 (10.0 %) patients, respectively. Six patients had mixed-infections. The duration from the onset of symptoms to the hospital visit was significantly longer in “lung abscess” patients than in “pneumonia” patients among the 24 patients with single infections, but not among the six patients with mixed-infection. The peripheral white blood cell counts of the “pneumonia” patients were higher than those of the “lung abscess” patients and S. intermedius was identified significantly more frequently in patients with pulmonary and pleural infections (pneumonia and lung abscess) than in patients with bacterial pleurisy only. In addition, the patients in whom S. intermedius was cultured were significantly older than those in whom S. constellatus was cultured. Conclusions Respiratory infections caused by the SAG bacteria tended to be observed more frequently in male patients with comorbid diseases and to more frequently involve purulent formation. In addition, S. intermedius was mainly identified in elderly patients with having pulmonary infection complicated with pleural effusion, and the aspiration of oral secretions may be a risk factor in the formation of empyema thoracis associated with pneumonia due to S. intermedius.
BMC Pulmonary Medicine 12/2015; 15(1). DOI:10.1186/s12890-015-0128-6 · 2.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Angiosarcoma originates from the vascular endothelium and accounts for only 1-2% of all sarcomatous malignancies. The skin is one of the most common primary sites. However, primary pulmonary angiosarcoma is rare, and only 31 cases of primary pulmonary angiosarcoma have been reported. A 79-year-old Japanese female developed bloody sputum, and chest X-ray and chest computed tomography (CT) showed consolidation with ground-glass opacity (GGO) on the right middle and lower lung fields. The bronchoscopic findings demonstrated bleeding from the right B(4) and B(5), and bronchial arterial embolization was subsequently performed. However, the CT findings demonstrated new pulmonary nodules with GGO in the left lung, and she presented with hemosputum and a progression of anemia. Right hemothorax also occurred, and surgical lung resection was performed to control the bleeding. The pathological analysis of the resected lung revealed the focal growth of atypical alveolar epithelioid-like cells that were positive for CD31 and negative for epithelial membrane antigen, and these atypical cells were replacing the endothelium of the pulmonary artery. Based on these findings, the patient was diagnosed with pulmonary angiosarcoma, which might originate from the endothelium of the pulmonary artery. No abnormal findings were observed except for the pulmonary involvement on systemic CT scanning. However, the patient passed away due to respiratory failure with compression of the brainstem caused by brain metastasis three months after the first visit. Early surgical resection is the important treatment for patients with angiosarcoma. In addition, we review the literature reporting the patients with primary pulmonary angiosarcoma.
The Tohoku Journal of Experimental Medicine 11/2015; 237(4):273-278. DOI:10.1620/tjem.237.273 · 1.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 75-year-old Japanese man underwent thoracic surgery to treat a large lung cancer lesion in the left upper lobe with calcified pleural thickening. Postoperatively, viable Mycobacterium tuberculosis was detected in the margin of the resected thickened calcified pleural lesion. Therefore, an infection control investigation of medical staff who had come in contact with the patient was conducted. Consequently, two of the 14 healthcare professionals who had been in the operating room were diagnosed with latent tuberculous infections. Therefore, strict precautions against airborne infections are required to prevent the in-hospital transmission of M. tuberculosis in such cases.
Internal Medicine 10/2015; 54(20):2699-2703. DOI:10.2169/internalmedicine.54.4317 · 0.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 75-year-old man with interstitial pneumonia and enlarged mediastinal lymph nodes underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). He developed a high-grade fever seven days after EBUS-TBNA was performed; laboratory and radiologic findings showed intense inflammatory reactions, with swelling of the mediastinal lymph nodes on chest computed tomography. Mediastinal lymph node abscess was diagnosed, and it worsened in spite of systemic antibacterial treatment. Surgical treatment using a median sternotomy was performed, and the cultivation of surgically obtained mediastinal lymph node abscess fluid revealed Streptococcus intermedius. Combined treatment with antibiotics and surgical treatment was effective, leading to remission.
Internal Medicine 10/2015; 54(20):2647-2650. DOI:10.2169/internalmedicine.54.4465 · 0.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We herein report a case of pulmonary Mycobacterium avium complex (MAC) infection with pulmonary multiple nodules and the "halo sign" on chest computed tomography (CT) in which the patient showed rapid exacerbation seven years after undergoing bone marrow transplantation (BMT). A 68-year-old Japanese female visited our hospital due to a productive cough and dyspnea. She had undergone allogeneic BMT for acute myelocytic leukemia and received both prednisolone (2 mg/day) and cyclosporine (30 mg/day). Chest CT demonstrated no abnormal findings on admission; however, multiple pulmonary nodules and the "halo sign" were detected three weeks later. Although a fungal infection was initially suspected, a bronchoscopic examination revealed pulmonary MAC infection. In the present case, pulmonary MAC infection exhibited rapid progression with unique CT findings. Physicians should consider MAC infection in the differential diagnosis in patients who receive BMT and/or immunosuppressive agents, even if the clinical and radiological findings are atypical of the disease.
Journal of UOEH 09/2015; 37(3):177-83. DOI:10.7888/juoeh.37.177
[Show abstract][Hide abstract] ABSTRACT: Background:
The causative pathogens of healthcare-associated pneumonia (HCAP) remain controversial, and the use of conventional cultivation of sputum samples is occasionally inappropriate due to the potential for oral bacterial contamination. It is also sometimes difficult to determine whether methicillin-resistant Staphylococcus aureus (MRSA) is a true causative pathogen of HCAP.
We evaluated the bacterial diversity in bronchoalveolar lavage fluid (BALF) using molecular and cultivation methods in 82 HCAP patients. BALF specimens were obtained from the lesions of pneumonia using bronchoscopy. The bacterial flora was analyzed according to the clone library method using amplified fragments of the 16S ribosomal RNA gene with universal primers. In addition, sputum cultures and the above specimens were assessed.
Eighty (97.6%) of the 82 BALF samples obtained from the patients with HCAP showed positive polymerase chain reaction results. The predominant phylotypes detected in the BALF in this study included bacteria common in cases of community- and hospital-acquired pneumonia. In addition, the phylotypes of streptococci and anaerobes were detected in 19 (23.2%) and 8 (9.8%) cases, respectively. In particular, phylotypes of streptococci were highly detected among the patients 75 of age or older. Staphylococcus aureus was cultured in 23 (28.0%) cases using conventional cultivation methods and detected in only 6 (7.3%) cases as predominant phylotypes according to the clone library method.
The clone library analysis of BALF in the HCAP patients detected heterogeneous bacteria and a high incidence of streptococci compared with that observed using cultivation methods. In addition, the results of our study may indicate a lower incidence of MRSA than previously expected in HCAP patients.
PLoS ONE 04/2015; 10(4):e0124697. DOI:10.1371/journal.pone.0124697 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 62-year-old Japanese man was admitted to our hospital for evaluation of bilateral chest abnormal shadow.His lacrimal, submandibular and parotid glands had been swollen for several years. His serum immunoglobulin G4 (IgG4) level was >1,500 mg/dl, and chest computed tomography showed bilateral reticular opacities with enlarged mediastinal lymph nodes. Transbronchial lung biopsy and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) results suggested IgG4-related disease. This is the first report, to our knowledge, in the English literature showing EBUS-TBNA to be useful for diagnosing IgG4-related disease.
[Show abstract][Hide abstract] ABSTRACT: Introduction
Pneumonia is the third leading cause of mortality in Japan. In 2011, the use of meropenem (MEPM) at 3 g daily was approved to treat refractory infections in Japan. However, little has been reported on the clinical efficacy and safety of this regimen in Japanese patients with refractory infections.
This study prospectively assessed the clinical efficacy and safety of MEPM (3 g daily) in Japanese patients with refractory pneumonia and/or intrapleural infections.
This study was performed at our university hospital and affiliated hospitals. The plasma concentrations of MEPM before and one and four hours after MEPM administration were also evaluated.
A total of 48 patients were enrolled for the efficacy and safety evaluations. The response rate to MEPM (3 g daily) treatment was 90.9% (40/44). Adverse drug reactions were observed in 17 of the 48 patients (20.8%), and all improved after the cessation of MEPM. The plasma MEPM concentration one hour after administering 1 g of MEPM was 44.9 ± 12.0 μg/ml. A pharmacokinetic analysis revealed that the percentage of time above the MIC/24 h for an MIC of 4 μg/ml or 8 μg/ml was more than 50% in 12 of 13 (92%) and in nine of the 13 patients (69%), respectively, indicating sufficient efficacy of 3 g daily of MEPM.
Treatment with MEPM (3 g daily) in Japanese patients with refractory pneumonia and/or intrapleural infections is effective, with sufficient plasma concentrations of MEPM, and the treatment has a relatively good safety profile.
Journal of Infection and Chemotherapy 12/2014; 20(12). DOI:10.1016/j.jiac.2014.08.011 · 1.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A novel, rapid and noninvasive test (ODK0501, RAPIRUN®S. pneumoniae) uses polyclonal antibodies to detect C polysaccharide of Streptococcus pneumoniae derived from sputum samples using an immunochromatographic assay. We evaluated its usefulness in Japanese patients with pneumonia who exhibited positive urinary antigen tests for S. pneumoniae (BinaxNOW®Streptococcus pneumoniae).Patients and Methods
Forty adult patients with pneumonia treated between May 2011 and August 2013 were enrolled. Bacterial cultures, Gram staining and ODK0501 assays of sputum as well as urinary antigen tests for S. pneumoniae using urine samples obtained from the same patients were performed upon admission, the fourth day after starting antimicrobial treatment and at the end of the antimicrobial treatment.ResultsTwenty-seven of the 40 patients were positive for ODK0501, while a negative result for ODK0501 was associated with low-quality sputum samples according to the Geckler classification of sputum. The sensitivity and specificity of the ODK0501 assay in the 40 patients were 90.9% and 61.1%, respectively, based on the culture results. The results obtained with this kit were more favorable than those observed on Gram staining. The ODK0501 assay also showed a rapid reaction to the disappearance of S. pneumoniae in the sputum samples, while approximately 80% of the patients exhibited persistent positive results on the urinary antigen detection tests at the end of treatment.Conclusions
The ODK0501 test is a noninvasive, rapid and accurate tool for diagnosing respiratory infections caused by S. pneumoniae, although good quality sputum must be obtained prior to adequate treatment with antibiotics. (235 words)
Journal of Infection and Chemotherapy 11/2014; 21(3). DOI:10.1016/j.jiac.2014.11.003 · 1.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Increased expression of several types of nitric oxide synthases (NOS) and increased levels of plasma nitrite and nitrate (NOx) have been reported in patients with pulmonary fibrosis, suggesting that nitric oxide (NO) has important roles in the development of pulmonary fibrosis. However, the roles of the entire system including NO and NOS in the pathogenesis of pulmonary fibrosis has not still being fully elucidated. The aim of the present study was to clarify the roles of NO and NOS in pulmonary fibrosis using the mice lacking all of three NOS isoforms.
Methods: Wild-type, single and triply NOS knockout (n/i/eNOS-/-) mice were treated with intraperitoneal administration of bleomycin (BLM, 8.0 mg/kg/day for 10 consecutive days). Two weeks after the last administration of BLM, fibrotic and inflammatory changes of the lung were pathologically evaluated. In addition, the effects of long-term treatment with isosorbide dinitrate, a NO donor, on the BLM-induced pulmonary fibrosis in n/i/eNOS-/- mice were studied.
Results: The histopathological findings, collagen content and total cell numbers in bronchoalveolar lavage fluid were the highest in the n/i/eNOS-/- mice after BLM treatment. Long-term treatment with supplemental NO donor significantly prevented the progression of these histopathological findings and an increase of collagen contents in the lungs induced by BLM treatment in n/i/eNOS-/- mice.
Conclusions: These results provide the first direct evidence that a lack of all three NOS isoforms led to a deterioration of pulmonary fibrosis in a BLM-treated murine model using n/i/eNOS-/- mice. We speculate that the entire system of endogenous NO and NOS plays an important protective role in the pathogenesis of pulmonary fibrosis.
[Show abstract][Hide abstract] ABSTRACT: Background: Current development of treatment modalities in treating bronchial asthma reduces mortality of asthma and improves quality of life of asthmatic patients. There are several inhaled corticosteroid/long-acting beta-agonist (ICS/LABA) combinations currently used to treat asthmatic patients, however, the clinical differences between these two ICS/LABA combinations have not been fully investigated. Therefore, we evaluated the switching effects of two ICS/LABA combinations (fluticasone propionate/salmeterol combined Discus inhaler; FP/SM, budesonide/formoterol Turbuhaler inhaler; BUD/FM) in a real-world setting.
Patients and Methods: Asthmatic patients over 20 year-old treated with FP/SM or BUD/FM for more than two months with persisting asthmatic symptoms (scores of Asthma Control Test; ACT less than 25 or scores of Asthma Control Questionnaire 5; ACQ5 more than 0) were enrolled. FP/SM (250/50 μg bid) was switched to BUD/FM (160/4.5 μg two inhalations bid) and FP/SM (500/50 μg bid) was also switched to BUD/FM (160/4.5 μg four inhalations bid). Conversely, BUD/FM (160/4.5 μg two inhalations bid) was switched to FP/SM (250/50 μg bid) and BUD/FM (160/4.5 μg four inhalations bid) was switched to FP/SM (500/50 μg bid). The spirometric analysis including the values of the peak expiratory flow (PEF) and forced expiratory volume in one second (FEV1) at the time of 0, 4, 12 and 24 weeks after switching from FP/SM to BUD/FM or from BUD/FM to FP/SM, and the scores of the asthma control test (ACT) and asthma control questionnaire-5 item version (ACQ5) were also evaluated.
Results: Sixty patients (35 and 25 patients had received medium- and high-dose ICS/LABA, respectively) were switched from FP/SM to BUD/FM, and 20 patients (10 and 10 patients had received medium- and high-dose ICS/LABA, respectively) were eligible for an evaluation after switching from BUD/FM to FP/SM. In patients switched from FP/SM to BUD, ACT and ACQ5 were significantly improved four and eight weeks after the switch to ICS/LABA treatments, and the spirometric analysis also revealed significant improvements of the values of the PEF and FEV1 after switching from FP/SM to BUD/FM. In patients switched from BUD/FM to FP/SM, asthmatic symptoms (ACT and ACQ) and the values of spirometric analysis were not significantly changed, except for FEV1 that showed significant improvement after switching ICS/LABA, but one patient dropped out because of an exacerbation of asthmatic symptom.
Discussion: Switching of ICS/LABA combined inhalers can be an alternative treatment for asthma in symptomatic asthmatic patients.
[Show abstract][Hide abstract] ABSTRACT: A 73-year-old Japanese man visited a local hospital due to palpitations and dyspnea. He was diagnosed as having lung cancer (adenocarcinoma, cT1aN2M1b (BRA), stage Ⅳ), but he did not want to receive any anticancer medications, and was simply being observed. Several months later, he was referred to our hospital due to exacerbation of the dyspnea. His chest computed tomography revealed massive pericardial effusion, therefore he was diagnosed as having cardiac tamponade due to carcinomatous pericarditis and was immediately hospitalized. Upon admission, pericardial fenestration was firstly applied in order to drain pericardial effusion, and intraoperative cardiac findings showed suspicion of myocardial and pericardial metastasis. Immediately after the pericardiotomy, he suffered from cardiac arrest caused by shock. In lung cancer patients with pericardial effusion, even though it is rare, myocardial metastasis in addition to carcinomatous pericarditis and pericardial metastasis should be kept in mind.
Journal of UOEH 09/2014; 36(3):199-203. DOI:10.7888/juoeh.36.199
[Show abstract][Hide abstract] ABSTRACT: Background
Increased expression of nitric oxide synthase (NOS) and an increase in plasma nitrite plus nitrate (NOx) have been reported in patients with pulmonary fibrosis, suggesting that nitric oxide (NO) plays an important role in its development. However, the roles of the entire NO and NOS system in the pathogenesis of pulmonary fibrosis still remain to be fully elucidated.¿The aim of the present study is to clarify the roles of NO and the NOS system in pulmonary fibrosis by using the mice lacking all three NOS isoforms.Methods
Wild-type, single NOS knockout and triple NOS knockout (n/i/eNOS¿/¿) mice were administered bleomycin (BLM) intraperitoneally at a dose of 8.0 mg/kg/day for 10 consecutive days. Two weeks after the end of the procedure, the fibrotic and inflammatory changes of the lung were evaluated. In addition, we evaluated the effects of long-term treatment with isosorbide dinitrate, a NO donor, on the n/i/eNOS¿/¿ mice with BLM-induced pulmonary fibrosis.ResultsThe histopathological findings, collagen content and the total cell number in bronchoalveolar lavage fluid were the most severe/highest in the n/i/eNOS¿/¿ mice. Long-term treatment with the supplemental NO donor in n/i/eNOS¿/¿ mice significantly prevented the progression of the histopathological findings and the increase of the collagen content in the lungs.Conclusions
These results provide the first direct evidence that a lack of all three NOS isoforms led to a deterioration of pulmonary fibrosis in a BLM-treated murine model. We speculate that the entire endogenous NO and NOS system plays an important protective role in the pathogenesis of pulmonary fibrosis.
Respiratory Research 08/2014; 15(1):92. DOI:10.1186/s12931-014-0092-3 · 3.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: During the assessments of the correlation of the diseases and the microbiota of various clinical specimens, unique 16S ribosomal RNA (rRNA) gene sequences (less than 80% similarity to known bacterial type strains) were predominantly detected in a bronchoalveolar lavage fluid (BALF) specimen from a patient with chronic lower respiratory tract infection. The origin of this unique sequence is suspected to be the causative agent of the infection. We temporarily named the owner organism of this sequence "IOLA" (Infectious Organism Lurking in Airways). In order to evaluate the significance of IOLA in human lung disorders, we performed several experiments. IOLA-16S rRNA genes were detected in 6 of 386 clone libraries constructed from clinical specimens of patients with respiratory diseases (in our study series). The gene sequences (1,427 bp) are identical, and no significantly similar sequence was found in public databases (using NCBI blastn) except for the 8 shorter sequences detected from patients with respiratory diseases in other studies from 2 other countries. Phylogenetic analyses revealed that the 16S rRNA gene of IOLA is more closely related to eukaryotic mitochondria than bacteria. However, the size and shape of IOLA seen by fluorescent in-situ hybridization are similar to small bacteria (approximately 1 µm with a spherical shape). Furthermore, features of both bacteria and mitochondria were observed in the genomic fragment (about 19 kb) of IOLA, and the GC ratio of the sequence was extremely low (20.5%). Two main conclusions were reached: (1) IOLA is a novel bacteria-like microorganism that, interestingly, possesses features of eukaryotic mitochondria. (2) IOLA is a novel pathogen candidate, and it may be the causative agent of human lung or airway disease. IOLA exists in BALF specimens from patients with remarkable symptoms; this information is an important piece for helping solve the elusive etiology of chronic respiratory disorders.
PLoS ONE 07/2014; 9(7):e103646. DOI:10.1371/journal.pone.0103646 · 3.23 Impact Factor