Biomedical subjects

Akira Kajiki

Publications and source records attributed to Akira Kajiki.

6 recordsLinked to original sources

PubMed2005

[Two cases of Mycobacterium szulgai pulmonary disease in the elderly].

The rate of pulmonary nontuberculous mycobacteriosis (NTM) in the total pulmonary mycobacteriosis has been continuously increasing. While M. avium complex is the most common cause of NTM, there are a few case reports of pulmonary infection due to M. szulgai. We described two cases of pulmonary NTM caused by M. szulgai. A 75-year-old male was admitted to our hospital because of dyspnea on effort, and productive cough. A chest X-ray showed an infiltrative shadow with cavity in the right upper lobe. A sputum smear for mycobacteria was positive, and a culture grew M. szulgai which was identified by DNA-DNA hybridization. He was treated with isoniazid, rifampicin, and ethambutol. His symptoms and CT and X-ray findings improved, and his sputum smear and culture converted to negative for mycobacteria. Second case was a 73-year-old male who had previously been diagnosed as MAC and pulmonary aspergillosis, and had been treated with antituberculous and antifungal drugs. He was readmitted to our hospital, because of general fatigue and hemoptysis. A chest X-ray revealed a consolidation with bronchiectasis and cavity in the both upper lung fields. A sptum smear for mycobacteria was positive, and a grown culture was identified as M. szulgai. He was treated with rifampicin, ethambutol and kanamycin based on the results of susceptibility testing. After 3 months of this treatment his sputum smear and culture converted to negative for mycobacteria, and his symptoms, and CT and X-ray findings improved.

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PubMed2004

[Tuberculosis control programme for the elderly with special focus on early detection].

1. Epidemiological trend of TB and its diagnosis among the elderly: Masako OHMORI (Research Institute of Tuberculosis, JATA). It is estimated that over 10,000 TB patients will occur among the elderly aged over 75 years of age during 2010 and 2020. Though the new TB patients among the elderly over 65 years of age decreased in number from 1987 to 2001, sputum smear positive patients, which are highly infectious increased by 1.3 times for the same age group, and 2.3 times for that of over 80 years of age. 17.6% of those elderly patients were detected in institutions, either hospitals or nursing homes. These indicate that the elderly will become higher risk of TB for causing early death and infection to others during their admission in the hospitals or nursing homes. 2. Clinical characteristics of TB among the elderly: Nobuhiko NAGATA (Department of Internal Medicine, National Ohmuta Hospital). Analysis of the 93 elderly TB patients shows that TB diagnosis was delayed among the elderly. For TB diagnosis, 43.2% took over 1 month, and 27.3% over 2 months among the patients over 75 years of age, compared to 22.9% and 9.7% respectively for the patients under 65 years. The prognosis was also poor. Of all who died in the hospital during TB treatment, 40.9% (mostly complicated with other diseases) was among the elderly over 75 years, while it was 6.5% among those under 65 years. Complication of dementia delayed the diagnosis. 79.4% of the smear positive patients over 75 years were diagnosed while admitted in a general ward, and 40% had been admitted 2 weeks or more before diagnosis. 3. Use of serological tests for the diagnosis of TB among the elderly: Atsuyuki KURASHIMA (Department of Clinical Research, National Tokyo Hospital). As TB diagnosis is difficult for the elderly due to non-specific appearances of signs/symptoms, X-ray shadows or negative tuberculin reaction, some serological tests, which have been recently developed, can be useful as a supplementary diagnostic tool. One of them is anti-lipoarabinomannan antibody. 74.3% was positive to this among 148 bacteriologically confirmed TB cases; 77.8% for those aged 65 years and above, and 71.1% for those under 65 years. To anti TBGL antibody, 78% of 170 confirmed TB cases were positive; 75% for those aged 65 years and above, 79.8% for those less than 65 years. Multi-lipo antibody developed by Japan BCG Laboratory showed higher sensitivity of 91.5%. GPL-core antibody may increase the sensitivity. 4. Mode of TB detection in nursing homes: Shinji SHISHIDO (Research Institute of Tuberculosis, JATA). 15 elderly TB patients who had been diagnosed in 23 nursing homes in the last 5 years were analyzed. The average age was 80.7 years. 10 were male and 5 were female. 11 were sputum smear positive. The symptoms were fever (8), cough (7), wheezing (2), hemoptysis (1), chest pain (1), body weight loss (1), appetite loss (1). Number of patients by time durations before consulting a doctor of within 2 weeks, 2 weeks to 1 month, 1 to 2 months, 2 to 3 months, 3 to 6 months, and more than 6 months were 6, 1, 1, 3, 2, 2 respectively. The prognosis: 4 died within 10 days after diagnosis, 4 needed examinations for the symptoms but were delayed in diagnosis as they were not admitted due to dementia or disability. The orientation and training to the staff of the nursing homes are needed for early TB diagnosis. 5. Programme for the early detection of TB among the elderly: Tadayuki AHIKO (Murayama Public Health Center, Yamagata Prefecture). Based on the analysis of 138 confirmed TB cases registered in Yamagata Prefecture in 1998, services for early TB detection among the elderly should be 1) periodical chest X-ray examinations by the patients home doctors when underlying high risk diseases such as diabetes or cancer exist, and 2) -sputum examination for the symptomatic patients. A survey to 31 local governments conducting special TB services showed the special screening programme for the bedridden elderly in nursing homes was not so efficient due to low quality of the available X-ray facilities and low case detection rate. But these X-ray films can be utilized for comparison with those when any symptom arises.

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PubMed2004

[A case of cervical and mediastinal lymph nodes tuberculosis, tuberculous pleurisy, spinal caries and cold abscess in the anterior chest wall].

A 61-year-old woman with schizophrenia that had been treated in a psychiatric hospital was admitted to our hospital because of subileus and back pain. Though subileus was improved, she had a sudden attack of fever 7 days later and developed right pleural effusion, a cold abscess in the anterior chest wall and swelling of a thumb-sized right cervical lymph node which broke through the skin. We made a diagnosis of cervical and mediastinal lymph nodes tuberculosis, tuberculous pleurisy, spinal caries and cold abscess in the anterior chest wall due to the biopsy findings of the specimen taken from the cervical lymph node, examination of pleural effusion, chest CT, bacteriological examination of the cold abscess and spinal MRI. We started chemotherapy with the antituberculous drugs (HRSZ) and symptoms except back pain improved. She complained of paresis of the both lower extremities, which completely paralyzed 8 months later in spite of continued chemotherapy. Thereafter her paralysis was gradually improved and she was able to walk by herself after 12 months chemotherapy.

Abscess↗

PubMed2004

[Case of chronic eosinophilic bronchiolitis associated with bronchial asthma].

A 62 year-old woman presented with diffuse, centriacinar nodular densities on chest radiography and CT, and an increase of peripheral blood eosinophils, four years after diagnosis of bronchial asthma. Diffuse panbronchiolitis was diagnosed, and was treated with erythromycin for a long period. One year later, she noticed exertional dyspnea, and her chest radiograph showed increased nodular densities. Lung biopsy under video-assisted thoracoscopy was performed, and revealed chronic bronchiolitis with eosinophilic infiltration, and focal, peribronchiolar eosinophilic infiltration in the alveolar septa and alveoli. She was treated with prednisolone, and her symptoms and nodular densities on chest radiography and CT were improved. We consider that the clinico-pathological findings of this case are consistent with those of chronic eosinophilic bronchiolitis, which has recently been reported in Japan. This case is different from previously reported ones in that eosinophilic bronchiolitis appeared in the course of bronchial asthma, suggesting the possibility that eosinophilic bronchiolitis may be accompanied with bronchial asthma or eosinophilic pneumonia.

Asthma↗

PubMed2003

[A clinical study on cases with pulmonary M. avium complex (MAC) disease followed up for more than 10 years].

We performed a clinical study on 22 cases with pulmonary M. avium complex disease followed up for more than 10 years. The mean age of these patients at the first visit was 60.1 years old and the extent of the disease among them was minimum or moderate. The progression of the disease was relatively slow. There were 5 cases of tuberculosis-like type and 11 cases of nodular-bronchiectasis type among the primary infection type and 6 cases of the secondary infection type. Classifying these cases by the grade of progression on chest X-ray findings, 2 cases improved, 11 cases slightly progressed, 4 cases moderately progressed and 5 cases severely progressed. Seven cases of the nodular-bronchiectasis type of the primary infection type were observed among 11 slightly progressed cases. This suggested that the prognosis of cases with nodular-bronchiectasis type was relatively good. The frequency of a reaggravation of chest X-ray findings was significantly higher in the severely progressed cases than in the slightly and moderately progressed cases. Generally, the number of used drugs was more and the duration of treatment was longer in the severely progressed cases. This suggested that these cases were intractable. The results of sputum culture for M. avium complex were consistent with the progression of the disease shown on chest X-ray findings among many cases. However, sputum culture negative was observed in some cases with the nodular-bronchiectasis type in spite of the reaggravation on chest X-ray findings. On the other hand, there were some cases in which few reaggravation was observed in spite of continued sputum culture positive. Based on these results, we made some remarks on the treatment and management of pulmonary M. avium complex disease.

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PubMed2002

[A clinical study of deceased cases of pulmonary M. Avium complex (MAC) disease--: in contrast with survived cases followed-up for 5 years or longer].

We performed a clinical study of pulmonary M. avium complex (MAC) disease comparing decreased cases and survived cases followed-up for 5 years or longer. The results were as follows: 1. At the time of starting the initial medical treatment for pulmonary MAC disease, the deceased cases were older than the survived cases, and the deceased cases were severe than the survived cases in clinical conditions. The spread of the lesions was more extensive and cavities were more frequently observed in the deceased cases than in the survived cases. 2. We classified the clinical pattern of pulmonary MAC disease into a primary infection type and a secondary infection type. Then, we subclassified the primary infection type into a localized type, which contained a tuberculosis-like type and middle, lingular or other lobar pneumonia type, and a diffuse type. The secondary infection type was more frequent in the deceased cases than in the survived cases, and any middle, lingular or other lobar pneumonia type was not observed in the deceased cases. 3. We classified the mode of progression of pulmonary MAC disease in the deceased cases into a tuberculosis-like progression and a diffuse progression. The tuberculosis-like type and the secondary infection type frequently showed the tuberculosis-like progression and the diffuse type frequently showed the diffuse progression. The patients who showed the tuberculosis-like progression were frequently sputum culture positive for MAC, while all patients showing the diffuse progression were culture negative at the time of death. An interval from the estimated onset of the disease to death was shorter in the tuberculosis-like progression type than in the diffuse progression type.

Age Factors↗