[Show abstract][Hide abstract] ABSTRACT: Pulmonary nocardiosis is a rare respiratory infection which commonly affects immunocompromised patients but also in immunocompetent hosts. The clinical manifestation is variable and endobronchial nocardiosis is a very rare condition. We report a case of endobronchial nocardiosis associated with the presence of a broncholith. The pathogenesis and the treatment of this condition are discussed below.
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 01/2009; 69(4):183-5.
[Show abstract][Hide abstract] ABSTRACT: A 79 year-old patient with lung cancer underwent a standard thoracotomy and lobectomy. Postoperatively, he developed low-grade fever and dyspnoea. Chest X-rays showed progressive lung infiltrates, which was subsequently diagnosed to be Bronchiolitis Obliterans Organizing Pneumonia (BOOP) by transbronchial lung biopsy. He responded well to corticosteroid therapy. The case report is followed by a brief discussion on BOOP in association with lung cancer and thoracotomy.
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 04/2005; 63(1):55-8.
[Show abstract][Hide abstract] ABSTRACT: Nine patients with chronic necrotizing pulmonary aspergillosis (CNPA) were analyzed retrospectively. Eight cases had been treated with itraconazole. Four patients had received intravenous amphotericin B (AMB), three sequentially with itraconazole and one as monotherapy. Three patients died after 1, 2 and 24 weeks of therapy. Six responded to therapy and survived 3 to 58 months after treatment. Only the total number of risk factors was found to be statistically significant in relation to a fatal outcome. The mean number of risk factors was 5.33 for fatal cases compared to 2.83 for treatment responders. The presence of five or more risk factors and two individual risk factors, hypoalbuminemia less than 27 g/L and history of dual pulmonary mycobacterioses, were 100% predictive of mortality in our patients. The overall clinical picture of fatal CNPA cases resembles closely that of acute invasive pulmonary aspergillosis in severely immunocompromised subjects.
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 07/2001; 56(3):202-7.
[Show abstract][Hide abstract] ABSTRACT: To analyze outcomes of patients with multidrug-resistant tuberculosis (MDR-TB) treated with ofloxacin/levofloxacin-containing regimens.
From February 1990 through June 1997, 63 MDR-TB patients (with bacillary resistance to at least isoniazid and rifampin in vitro) were analyzed retrospectively. Twenty-two patients (34.9%) had had no previous antituberculosis chemotherapy. Each patient received either ofloxacin (53) or levofloxacin (10) even though 13 patients had bacilli resistant to ofloxacin in vitro. The other accompanying drugs mainly included aminoglycosides, cycloserine, ethionamide/prothionamide, and pyrazinamide. Sputum smear and culture examinations for acid-fast bacilli (AFB) were performed monthly for the initial 6 months and then at 2- to 3-month intervals until the end of treatment. Comparison was made between clinical successes and failures using univariate and multiple logistic regression analyses for the following variables: age, sex, presence of cavitation, extent of disease, sputum smear positivity, in vitro resistance to ofloxacin, in vitro resistance to streptomycin and/or ethambutol, treatment adherence, and the number of drugs per regimen.
Fifty-one patients (81.0%) were cured, nine patients (14.3%) failed, and three patients (4.7%) died. For the entire group, the mean duration of treatment was 14.0 months, and the mean number of drugs was 4.7. Mean durations of chemotherapy in successful and failed patients were 14.5 and 14.2 months, respectively. Mean time for sputum smear and culture conversions were 1.7 and 2.1 months, respectively. Only cavitation, resistance to ofloxacin, and poor adherence were found to be variables independently associated with adverse outcomes (p < 0.05; odds ratios = 15.9, 13.5, 12.8, respectively). Negative sputum cultures after 2 and 3 months of therapy were 100% predictive of cure. Positive sputum cultures after 2 and 3 months were 52.3% and 84.6% predictive of failure, respectively. One patient (2.1%) relapsed after apparent cure. Twenty-five patients experienced adverse drug reactions, but only 12 of them needed drug modifications.
Most MDR-TB patients can be treated effectively with ofloxacin/levofloxacin-containing regimens. Presence of cavitation, resistance to ofloxacin in vitro, and poor adherence to therapy portend treatment failure. Monitoring monthly sputum culture for AFB in the initial months of chemotherapy helps predict clinical outcomes.
[Show abstract][Hide abstract] ABSTRACT: Liver toxicity is a common side effect of antituberculosis (anti-TB) drugs. We studied the differences in liver dysfunction observed during anti-TB treatment between hepatitis B virus carriers (HBV) and noncarriers. Three hundred twenty-four patients on anti-TB drugs were recruited and followed up for 1 year. Forty-three patients with HBV and 276 non-HBV patients were included for analysis. Liver function tests and viral markers were monitored monthly. Liver biopsy was requested whenever the alanine transaminase (ALT) was persistently abnormal. Eighty-six HBV carriers who were not given anti-TB drugs were chosen as a second control and evaluated prospectively. The incidence of liver dysfunction was significantly higher in HBV carriers given anti-TB drugs (34.9%) when compared to noncarriers (9.4%, P <.001) and with HBV carriers not given anti-TB drugs (8.1%, P <.001). For patients given anti-TB drugs, HBV carriers who developed liver dysfunction were younger (P =.011) and had more severe liver injury compared with noncarriers (P =.008). By multiple logistic regression analysis, age (P =.002) and hepatitis B infection (P <.001) were the only 2 significant risk factors for hepatotoxicity related to anti-TB therapy.
[Show abstract][Hide abstract] ABSTRACT: A total of 562 patients with lung cancer was evaluated by fibreoptic bronchoscopy (FOB) by three bronchoscopic diagnostic procedures: biopsy, bronchial brushing and bronchial washing. Endoscopically visible tumours (EV) were detected in 264, while 257 had endoscopically nonvisible tumours > or = 2 cm in diameter and FOB was done without fluoroscopy because of limited availability (ENV). Forty-one had small (< 2 cm), endoscopically nonvisible tumours with FOB performed under uniplanar fluoroscopy (ENV + F). The overall diagnostic yield rates of FOB were 98.1%, 61.5% and 58.5% for the EV, ENV and ENV + F cases, respectively. Reviewing the differential yield rates of the three diagnostic techniques and comparing them with the results of previous studies led to the following conclusions. (1) Combinations of biopsy with brushing and biopsy with washing can diagnose more than 95% of all fibreoptic bronchoscopy positive cases with endoscopically visible tumours. Performing either of these combinations may be more cost-effective than doing all three techniques routinely. (2) For cases with endoscopically nonvisible tumours, performance of all three diagnostic techniques is recommended, especially when fibreoptic bronchoscopy is performed without fluoroscopic guidance, as washing and brushing seem to compensate for a lower yield of the biopsy. (3) For tumours < 2 cm in diameter, knowledge on the diagnostic efficacy of fibreoptic bronchoscopy was limited owing to the small size of previous studies. The yield of 58.5% for fibreoptic bronchoscopy in these patients with performance of all three diagnostic procedures was comparatively high. It could be further increased to 75.6% if supplemented by percutaneous needle biopsy when fibreoptic bronchoscopy turned out to be nondiagnostic. If available, the use of transbronchial needle aspiration may also increase the overall diagnostic yield of fibreoptic bronchoscopy in these cases.
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 10/1999; 54(5):394-8.
[Show abstract][Hide abstract] ABSTRACT: Studies on the efficacy of antimicrobial agents against actinomycosis in vivo have been limited apart from those involving penicillin. A prospective ministudy on the efficacy of imipenem-cilastatin in the treatment of pulmonary actinomycosis was performed based on preliminary encouraging in vitro and in vivo data. Eight patients were diagnosed as having pulmonary actinomycosis using fibreoptic bronchoscopy (7) and percutaneous transthoracic needle biopsy (1) in the authors' unit between 1994 and 1996. Each patient received a 4-week course of imipenem-cilastatin that comprised 2 weeks of intravenously administered drug (500 mg at 8-hourly intervals) and 2 weeks of intramuscularly administered drug (500 mg at 12-hourly intervals). Seven patients showed a very good clinical and radiographic response as well as bronchoscopically-documented treatment success. Treatment failed in one patient. Amongst the former group, one patient was lost to follow-up, another relapsed 3 months after treatment cessation and the rest remained relapse-free when followed-up for 18-44 months (mean 30.2 months). Furthermore, all patients showed good clinical tolerance and no abnormal treatment-related laboratory findings. The favourable outcome for most patients in this mini-study suggest that a 4-week parenteral course of imipenem-cilastatin is an efficacious treatment for pulmonary actinomycosis. This antimicrobial regimen might be a promising alternative to the time-honoured long-course treatment with intravenous and oral penicillin.
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 05/1999; 54(2):126-9.
[Show abstract][Hide abstract] ABSTRACT: A 35-year-old Chinese woman initially presented with histologically and bacteriologically confirmed tuberculous lymphadenitis. She was also found to have thrombocytopenia, elevated serum alkaline phosphatase, and bilateral lung infiltrates. After 15 months of antituberculosis treatment, despite resolution of the cervical lymphadenopathy, she started to experience dyspnea. Chest radiograph appearance, thrombocyte count, and liver biochemistry had all deteriorated as well. Histologic findings from tissues obtained via transbronchial biopsy and open lung biopsy were consistent with sarcoidosis but also showed the presence of mycobacterial DNA by the polymerase chain reaction. She subsequently achieved a very good response clinically, radiographically, hematologically, and biochemically with 1-year of corticosteroid treatment for her sarcoidosis, and she remained relapse-free afterwards. The concomitant presence of tuberculosis and sarcoidosis in this patient together with the presence of mycobacterial DNA in the sarcoid lesion reiterate the possibility that mycobacteria or some of its components may be capable of inducing the immune response and the pathologic changes of sarcoidosis.
[Show abstract][Hide abstract] ABSTRACT: Four non-AIDS patients with pulmonary cryptococcus infection who could not tolerate amphotericin B treatment were given oral fluconazole at a dose of 600 mg once daily for 4-5 weeks followed by 400 mg once daily for 10-12 weeks resulting in cure. All patients did not have relapse of disease when followed-up for 8-24 months after cessation of treatment. The very good tolerance of oral fluconazole by these patients suggests that such effective monotherapy should be evaluated further in non-AIDS patients with pulmonary cryptococcosis.
Drugs under experimental and clinical research 02/1996; 22(1):25-8.
[Show abstract][Hide abstract] ABSTRACT: Nine Chinese patients with severe asthma who were dependent on a systemic oral steroid for control were given oral methotrexate at a dose of 7.5 mg on alternate days for two weeks, followed by 15 mg once weekly. Only six patients were evaluable; they had received methotrexate for 6 to 24 months. All six patients could have reduction of daily oral prednisolone dosage by 5-15 mg (mean: 10.4 mg). Only four patients, however, had > or = 15% improvement of their best peak expiratory flow rates compared with baseline levels, though all six patients had symptomatic improvement. These beneficial effects were, however, transient and persisted only during methotrexate therapy. Four patients had liver enzyme changes and discontinuation of therapy was required in one patient. One patient also had infective spondylitis secondary to Salmonella bacteremia. Thus low-dose oral methotrexate may be useful in selected patients with severe steroid-dependent asthma with careful monitoring for response and drug toxicity.
Drugs under experimental and clinical research 01/1996; 22(6):317-21.
[Show abstract][Hide abstract] ABSTRACT: A 67 year old woman presented with miliary tuberculosis. She was treated with streptomycin, isoniazid, rifampicin, ethambutol and pyrazinamide. However, she developed rifampicin-induced thrombocytopenia after 6 weeks of treatment, and skin rash, blood eosinophilia and pulmonary infiltrates after 8 weeks of therapy. The latter was found to be ethambutol related. Additional evidence, including blood and sputum eosinophilia and the rapidity of its response to corticosteroid, suggested that the pulmonary infiltrates might also be eosinophilic in nature. To the best of our knowledge, this constitutes the first report of such adverse drug reaction, induced by ethambutol.
European Respiratory Journal 06/1995; 8(5):866-8. · 6.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 3 patients with mycobacterial lung infections, one due to Mycobacterium avium-intracellulare and 2 due to M. tuberculosis, developed ciprofloxacin-induced acute renal dysfunction while receiving the drug together with other antimycobacterial agents. These episodes took place 8-10 days after commencement of therapy and recovered spontaneously after cessation of all antimycobacterial drugs for 2-8 weeks. No recurrence was noted when patients were restarted on regimens that did not contain ciprofloxacin.
[Show abstract][Hide abstract] ABSTRACT: 3 patients with mycobacterial lung infections, one due to Mycobacterium avium-intracellulare and 2 due to M. tuberculosis, developed ciprofloxacin-induced acute renal dysfunction while receiving the drug together with other antimycobacterial agents. These episodes took place 8–10 days after commencement of therapy and recovered spontaneously after cessation of all antimycobacterial drugs for 2–8 weeks. No recurrence was noted when patients were restarted on regimens that did not contain ciprofloxacin.RésuméTrois malades atteints d'infections pulmonaires mycobactériennes, dont l'une due à Mycobacterium avium intracellulare et deux àM. tuberculosis, ont développé une dysfonction rénale aigüe induite par la ciprofloxacine au cours de leur traitement par cette drogue associée à deux autres agents antimycobactériens. Ces épisodes ont eu lieu 8 à 10 jours après le commencement du traitement et ont cessé dès l'interruption de toutes les drogues antimycobactériennes pendant une période de 2 à 8 semaines. Aucune récurrence n'a été notée lorsque les patients ont repris un régime qui ne contenait pas de ciprofloxacine.ResumenTres pacientes con infecciones pulmonares micobacterianas, de las cuales una debida a Mycobacterium avium-intracellulare y dos debidas a M. tuberculosis, presentaron una disfunción renal aguda inducida por la ciprofloxacina durante un tratamiento con este medicamento asociado con otros agentes antimicobacterianos. Estos episodios tuvieron lugar 8 a 10 días después del comienzo de la terapia y cesaron espontáneamente después de la suspensión de todos los medicamentos antimicobacterianos por un período de 2 a 8 semanas. No se constató ninguna recurrencia cuando se volvió a comenzar el tratamiento con esquemas que no contenían ciprofloxacina.
[Show abstract][Hide abstract] ABSTRACT: Twenty-five patients who had extensive pulmonary tuberculosis and hepatitis induced by antituberculosis drugs were treated with ciprofloxacin together with other relatively non-hepatotoxic drugs, either during the interim phase awaiting recovery of liver function in some, or as definitive therapy as required by the compromised hepatic status of others. Only 22 patients were assessable. All tolerated ciprofloxacin well during the phase of hepatic dysfunction. All patients improved with these ciprofloxacin-containing regimens, but the optimal dosage, specific efficacy and long-term safety of the drug in such cases require further evaluation.
Drugs under experimental and clinical research 02/1995; 21(2):79-83.