[Show abstract][Hide abstract] ABSTRACT: To evaluate clinical manifestations of patients with uveitis and scleritis of unknown origin and positive QuantiFERON-TB test Gold In-Tube (quantiferon) in a country not endemic for tuberculosis.
Multicentre retrospective cohort study.
Retrospective review of the clinical, laboratory and imaging data of 77 patients. Main outcome measures consisted of ocular and systemic features as well as results of laboratory examinations.
Out of all, 60/71 (85%) were living for at least 6 months in tuberculosis-endemic regions. Location of uveitis was variable; posterior uveitis 29/77 (38%) was the most frequent. Two clinical entities were commonly noted, retinal occlusive vasculitis (21/77; 27%) and serpiginoid choroiditis (n=11/77, 14%). Anti-tuberculosis treatment was completed in 32 patients, 29 (91%) of them achieved complete remission. Mean quantiferon level was 7.5 U/ml; 71% had values above 2 U/ml and 41% above 10 U/ml. We observed no associations between Quantiferon levels and clinical and/or imaging features. Previous tuberculosis infection was diagnosed in 5/77 (6.5%) patients, while hilar/mediastinal lymphadenopathy was found in 25/76 (33%) patients. Of these, 12 were consistent with the diagnosis of sarcoidosis, 9 were typical for (prior) tuberculosis and 4 were compatible with both diagnoses.
Ocular features of patients with idiopathic uveitis and positive quantiferon were diverse, but retinal occlusive vasculitis and serpiginoid choroiditis were common. The quantiferon levels were usually highly elevated and 33% of patients exhibited lymphadenopathy, suggesting frequently the diagnosis of sarcoidosis. Ocular inflammation reacted favorably to anti-tuberculosis treatment, although only a small minority had documented (prior) tuberculosis.
American Journal of Ophthalmology 11/2013; 157(4). DOI:10.1016/j.ajo.2013.11.013 · 3.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Thirty-year-old observations report frequent asymptomatic Clostridium difficile carriage among cystic fibrosis (CF) patients. In this case-control study, we found more carriers among CF patients than controls (47% versus 11%), but most strains carried by CF patients were non-toxigenic (77% versus 17%). Among CF patients, carriers were younger, with more severe pulmonary disease than non-carriers. Strains belonged to multiple PCR-ribotypes, suggesting that these CF patients did not acquire strains from each other.
[Show abstract][Hide abstract] ABSTRACT: Background:
Because persistent inflammation plays a dominant role in cystic fibrosis (CF), we assessed systemic and local upper airway responses during and after pulmonary exacerbation.
We followed a cohort of Pseudomonas aeruginosa-infected adult CF patients (n=16) over time in pulmonary exacerbation and in stable disease. Interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-17A, IL-22, interferon-γ and TNFα levels were measured in sputum, nasal lavages and plasma.
In CF patients IL-6 and IL-10 levels in nasal lavages were significantly increased in exacerbation compared with stable disease. Systemic IL-6 significantly correlated with CRP levels and FEV1 (%predicted), independently of disease status. Systemic IL-10 also correlated significantly with CRP and FEV1 (%predicted), but only in exacerbation. Other cytokines tested did not discriminate between exacerbation and stable disease.
Determination of IL-6 and IL-10 in nasal lavages may provide a minimally invasive tool in the assessment of an exacerbation in CF.
Journal of cystic fibrosis: official journal of the European Cystic Fibrosis Society 06/2013; 12(6). DOI:10.1016/j.jcf.2013.05.002 · 3.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Respiratory infections caused by respiratory viruses are common in paediatric cystic fibrosis (CF) patients and are associated with increased morbidity. There is only little data on the incidence of viral respiratory pathogens causing exacerbations in the adult CF patient population. In this observational pilot study we show, by using molecular as well as conventional techniques for viral isolation, that during 1 y a viral pathogen could be isolated in 8/24 (33%) adult CF patients who presented with a pulmonary exacerbation. This result shows that there is a considerable incidence of viral pathogens in pulmonary exacerbations in adult CF patients. Newly identified viruses such as pandemic influenza A/H1N1, human metapneumovirus, human bocavirus, and human coronavirus NL63 were not detected in our population, except for 1 human coronavirus NL63.
[Show abstract][Hide abstract] ABSTRACT: It is well known that pulmonary tuberculosis is associated with an increased risk of lung cancer. We investigated whether a history of pulmonary tuberculosis is an independent risk factor for lung cancer survival in Caucasian patients.
The data of the prospective population-based cohort of The Rotterdam Study were used. During a mean follow-up time of 18 years, there were 214 incident cases of pathology-proven lung cancer in a source population of 7983 study participants. History of tuberculosis was assessed at baseline by interviewers using standardized questionnaires. Associations of lung cancer survival with the occurrence of pulmonary tuberculosis were assessed using Cox's proportional hazard regression analysis adjusted for age, gender, pack-years, educational level and tumor stage.
A history of tuberculosis was reported in 13 of the 214 subjects with lung cancer. The survival of patients with lung cancer was significantly shorter in subjects with a history of pulmonary tuberculosis (HR=2.36, CI95%: 1.1-4.9), than in subjects without a history of pulmonary tuberculosis with a mean difference of 311 days.
The presence of a history of pulmonary tuberculosis may be an important prognostic factor in the survival of lung cancer.