[Invasive pulmonary aspergillosis].
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Amphotericin B↗
Biomedical subjects
Y Niki
Publications and source records attributed to Y Niki.
[Non-invasive pulmonary aspergillosis].
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Amphotericin B↗
[Eosinophilia and cough induced by resumption of cigarette smoking in a beginning smoker recovering from acute respiratory failure].
A 23-year-old man was admitted to the hospital because of acute respiratory failure accompanied by high fever and severe cough. He had started smoking about 3 weeks earlier and had gradually increased the number of cigarettes he smoked each day. After the number of cigarettes reached 10 per day, the patient experienced cough with serous sputum, high fever (38 degrees C) and dyspnea. Chest X-ray films revealed diffuse, peripheral shadows predominantly in the right lung. The patient was treated with an intravenous drip infusion of antibiotics (FMOX). On the second day of hospitalization, the dyspnea and chest X-ray shadows rapidly resolved. Although the cause of respiratory failure and diffuse shadows on chest X-ray films remained unclear, the patient was discharged. However, on the day of discharge, he smoked cigarettes and experienced cough with serous sputum for a few hours the following morning. He was readmitted for evaluation. We previously reported a case of smoking-induced acute eosinophilic pneumonia (AEP). We suspected that the present case was AEP induced by cigarette smoking but did not perform bronchoalveolar lavage or transbronchial lung biopsy for a definitive diagnosis. Although we did perform a provocation test, the patient demonstrated no respiratory symptoms without cough and respiratory failure. Blood gas analysis and pulmonary function tests also revealed no abnormalities. However, the eosinophil count (3066/mu/l) and percentage (42%) in peripheral blood increased after the patient resumed cigarette smoking, and returned to normal ranges after smoking cessation. These results pointed to a correlation between cigarette smoking and eosinophilia. This case suggested that in some patients, AEP may be induced by cigarette smoking, but does not recur after the resumption of smoking.
Acute Disease↗
Chlamydia pneumoniae and exacerbations of asthma in adults.
BACKGROUND: Chlamydia pneumoniae is a frequent causative agent of acute respiratory disease and has been recently reported as a possible cause of asthma. OBJECTIVE: We assessed the prevalence of C. pneumoniae infections in adult patients with acute exacerbations of asthma. METHODS: One hundred sixty-eight adult patients with acute exacerbations of asthma and 108 control subjects matched for age, sex, and smoking status were studied. Nasopharyngeal swab specimens were obtained from all subjects and analyzed by isolation in cell culture and polymerase chain reaction (PCR) test for C. pneumoniae. Serum samples were also obtained and tested for C. pneumoniae-specific antibodies by the microimmunofluorescence test. RESULTS: C. pneumoniae was isolated from two (1.2%) asthma patients and none from controls and detected by PCR from nine (5.4%) cases and one (0.9%) control. Both culture positive specimens were also positive in PCR. Further, serologic evidence of acute C. pneumoniae infection was present in 15 (8.9%) of asthma patients and in three (2.8%) of controls (P = .048). The prevalence of C. pneumoniae-specific IgG and IgA was significantly higher in asthma cases than in controls (IgG > or = 1:16: 85.1% versus 67.6%, P = .001; IgA > or = 1:16: 47.6% versus 16.7%, P < .001). Mean titer of IgG and IgA was also significantly greater in asthma cases than in controls (IgG: 38.8 versus 18.1, P = .0001; IgA: 17.2 versus 6.1, P = .0001). CONCLUSIONS: Our data suggest that C. pneumoniae infection may trigger acute exacerbations of adult asthma.
Acute Disease↗
[Investigation of the influence of hemodialysis membranes and factors associated with hemodialysis on serum (1-->3)-beta-D-glucan].
The measurement of serum (1-->3)-beta-D-glucan (beta-glucan) is commonly used in the clinical stage. Although it has been considered very useful in the early diagnosis of deep mycosis, it is influenced by several factors, one of which is hemodialysis. Therefore, we decided to investigate clinically the influence of hemodialysis membranes on serum beta-glucan. Plasma samples were collected from 26 patients receiving hemodialysis in Kawasaki Medical School Hospital. The kinds of hemodialysis membranes examined were four synthetic polymers and three natural polymers. We also measured beta-glucan in five washing liquids used in the hemodialysis circuit, five dialyzates, two sodium heparin and two filling liquids for wet type dialyzers to investigate the influence of other factors associated with hemodialysis on serum beta-glucan. Elevations of beta-glucan were observed in some cases treated by hemodialysis apparatus using a saponified cellulose acetate membrane. But, in all cases treated by hemodialysis using a cellulose triacetate membrane, slight elevations of beta-glucan were observed. No significant increases in beta-glucan after hemodialysis were observed in the cases treated by hemodialysis using a synthetic polymer membrane. Elevations of beta-glucan is sodium heparin and in one of the filling liquids for the wet type dialyzer were observed. We, therefore, concluded that there are some other factors having an effect on serum beta-glucan besides the hemodialysis membrane in the patients treated by hemodialysis.
Adolescent↗
Effects of DU-6859a, a new quinolone antimicrobial, on theophylline metabolism in in vitro and in vivo studies.
In vitro and in vivo studies were conducted to investigate the drug interaction between a new quinolone antimicrobial, DU-6859a, and theophylline (TP). The effect of DU-6859a on TP metabolism was evaluated in vitro by measuring the rate of TP metabolite formation by using human liver microsomes. DU-6859a inhibited the metabolism of TP, especially the formation of 1-methylxanthine, in vitro, but to a lesser extent than other drugs that are known to interact with TP. TP was administered alone (200 mg twice a day [b.i.d.] for 9 days) or in combination with DU-6859a (50 or 100 mg b.i.d. for 5 days) to six healthy subjects. DU-6859a administered at a dose of 50 mg resulted in no changes in serum TP concentrations, and slight increases in serum TP concentrations were observed at a dose of 100 mg. Moreover, the administration of 100 mg of DU-6859a resulted in decreases in all urinary TP metabolites, with significant differences. It appears that although DU-6859a has a weak inhibitory effect on TP metabolism in vitro, its concomitant use with TP at clinical dosage levels does not cause any adverse effects, showing only a slight increase in blood TP concentrations and a decrease in urinary metabolites.
Adult↗
Serum KL-6 level as a monitoring marker in a patient with pulmonary alveolar proteinosis.
A raised serum level of KL-6 is known to exist in active pulmonary fibrosis and KL-6 may be produced and secreted by type II pneumocytes. A case is described of pulmonary alveolar proteinosis with high serum KL-6 levels. The serum KL-6 level decreased after whole lung washing and correlated with symptoms, opacities on the chest radiograph, and arterial blood gas measurements. The serum KL-6 level may represent a useful marker for pulmonary alveolar proteinosis.
Adult↗
Cigarette smoke-induced acute eosinophilic pneumonia.
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Acute Disease↗
Chlamydia pneumoniae infection in patients with diffuse panbronchiolitis and COPD.
STUDY OBJECTIVES: To determine the possible association of Chlamydia pneumoniae infection with diffuse panbronchiolitis (DPB) and with COPD. DESIGN: Prospective case-control study. SETTING: Division of Respiratory Diseases, Kawasaki Medical School Hospital. PARTICIPANTS: Fifteen DPB and 77 COPD patients who had acute exacerbations of respiratory conditions and 35 and 120 control subjects, respectively, matched for age, sex, and smoking status. MEASUREMENTS AND RESULTS: Nasopharyngeal swabs and paired serum samples were obtained from all patients and control subjects for isolation and antibody testing of C pneumoniae. C pneumoniae was isolated from one DPB patient and from no COPD patients or control subjects. Serologic evidence of acute C pneumoniae infection was observed in one DPB patient (6.7%) and six COPD patients (7.8%). The prevalence and mean titer of C pneumoniae IgG and IgA antibodies were significantly higher in COPD patients than in control subjects (p<0.001). However, no such differences were observed between DPB patients and control subjects. CONCLUSIONS: This study showed that C pneumoniae infection may be associated with acute exacerbations of COPD and that chronic C pneumoniae infection is common in COPD but not in DPB.
Adult↗
Association of chronic infection of Chlamydia pneumoniae and coronary heart disease in the Japanese.
The association of Chlamydia pneumoniae with atherosclerosis of coronary and carotid arteries and the aorta has been demonstrated by seroepidemiology and by detection of the organism in atheromata. We investigated the frequency of C. pneumoniae seropositivity in patients with acute myocardial infarction (AMI). C. pneumoniae-specific antibodies were measured by the microimmunofluorescence test in 160 AMI patients and 160 control subjects matched for age and gender. The odds ratios (ORs) were 2.2 (95% confidence interval (CI), 1.2 to 3.9) for immunoglobulin (Ig)G and 2.7 (95% CI, 1.7 to 4.3) for IgA. After adjustment for other cardiovascular risk factors of age, gender, hypertension, diabetes, cigarette smoking and serum cholesterol, the ORs were essentially unchanged. This study confirmed that the observations of an association between antibody against C. pneumoniae and coronary heart disease in Western nations is also present in Japan. Our results are comparable to the previous seroepidemiological studies reporting ORs of 2.0 or greater.
Antibodies, Bacterial↗
[Management of intractable deep seated fungal infection].
Recently, deep seated fungal infection is one of important and common complication of immunocompromised patients and is often intractable. The key of the management of patients with high risks of these infection is understanding the patients' condition and make effort to prevent propression of the disease by the prediction of the break out. Active and logical treatments are also needed to control the infection.
Aged↗
The principle of diagnostic method and diagnostic imaging for infectious diseases.
Rapid progress of diagnostic examination or technique for infectious diseases has been observed in recent several years. Diagnostic imaging also developed remarkably through introductions of new technology, and made the diagnosis of infectious diseases much more easier than before. However, the most important point is the perfect collection of patients' or disease information and their appropriate evaluation by medical doctors to make full use of the latest technology. This fundamental ability of medical doctors is indispensable for rapid and certain diagnosis of infectious diseases.
Adult↗
[Adverse reactions of antituberculous agents].
We experienced adverse reactions to antituberculous agents in 17 patients (53%) out of 32 patients treated for tuberculosis and nontuberculous pulmonary mycobacteriosis. Side effects were seen in 15 patients (47%), and abnormal laboratory findings were observed in 9 patients (28%). Most side effects mostly appeared within two weeks after the administration, and were of short duration. However, there were also side effects such as neurological symptoms, arthralgia, and general fatigue which appeared after one month and lasted for a long duration. These results suggest that careful observation for adverse reactions in antituberculous treatment is required. Finally, 11 patients with adverse reactions were successfully treated by changing antituberculous agents or readministration after temporary stop of the administration. Four patients improved even with continued use of agents causing side-effects. However, in the case of two patients who had to change antituberculous agents, adverse reactions to all antituberculous agents appeared and the treatment for tuberculosis and nontuberculous pulmonary mycobacteriosis had to be stopped.
Adolescent↗
[Sulbactam/ampicillin-induced pneumonitis].
We report on two patients with sulbactam/ampicillin (SBT/ABPC)-induced pneumonitis. Both patients were being treated with SBT/ABPC for respiratory-tract infections. Following the initiation of SBT/ABPC chemotherapy, however, chest X-ray films showed a shift of shadow in patient 1 and new pulmonary infiltration shadows in patient 2. Bronchoalveolar lavage fluid (BALF) findings showed a marked increase in the total cell count and percentage of eosinophils in patient 1 and of lymphocytes in patient 2. The results of lymphocyte stimulation tests were SBT/ABPC positive for both patients. SBT/ABPC therapy was therefore discontinued and corticosteroid therapy started. Both patients were subsequently relieved of their symptoms demonstrated significantly lower and pulmonary infiltrate levels. Based on these findings, both patients were given a diagnosis of SBT/ABPC-induced pneumonitis. It has been widely reported that CD 4/CD 8 ratio in BALF decreases in cases of drug-induced pneumonitis. However, some reports have cited increase in the CD 4/CD 8 ratio. In our two patients as well, the CD 4/CD 8 ratio increased. These results, together with the findings from several other case reports, indicate that the CD 4/CD 8 ratio may not be good basis for diagnosing drug-induced pneumonitis. Recently, the incidence of drug-induced pneumonitis has been rising. To our knowledge this is the first report documenting cases of SBT/ABPC-induced pneumonitis.
Aged↗
[Evaluation of serum KL-6 levels in summer-type hypersensitivity pneumonitis].
A high level of serum KL-6 is a known feature of active pulmonary fibrosis. Some researchers have suggested that KL-6 is produced and secreted by type II pneumocytes. The present study evaluated serum KL-6 levels in patients with summer-type hypersensitivity pneumonitis (summer-type HP) (n = 6, 7 episodes), Mycoplasma pneumoniae pneumonia (n = 16), Chlamydia psittaci pneumonia (n = 3), Chlamydia pneumoniae pneumonia (n = 9), and bacterial pneumonia (n = 12). In addition, transbronchial lung biopsy (TBLB) specimens were examined pathologically in order to identify the site of production and secretion of KL-6. In patients with summer-type HP, the serum KL-6 levels exceeded 500 U/ml (2.996 +/- 2.016 U/ml), but was below 500 U/ml (302 +/- 126 U/ml, p < 0.001) in the patients with other infectious pneumonias, with the exception of two. One of these two patients with a high serum KL-6 level had adult respiratory distress syndrome due to Mycoplasma pneumoniae. The other had organizing pneumonia due to Chlamydia pneumoniae. TBLB specimens showed proliferative type II pneumocytes in all summer-type HP cases. We believe that the high serum KL-6 levels were produced by type II pneumocytes, and may provide a useful indicating serum marker for HP. Although serum LDH, serum CRP and PaO2 are known as monitoring markers in summer-type HP, our findings demonstrated no manifest correlations among these markers. However, serum KL-6 levels showed a strong positive correlation with serum LDH levels and an inverse correlation with serum CRP levels. These results suggest that serum KL-6 may be a better marker of the degree of disease activity than serum LDH, CRP, or PaO2 in summer-type HP.
Adolescent↗
[Acetaminophen-induced pneumonitis].
We report a case of drug-induced pneumonitis caused by acetaminophen taken for headache. The patient was a 49-year-old woman who had been taking a common cold drug (Benza BlockSP) containing acetaminophen and an anti-gastritis drug for headache. Seven days after she began taking acetaminophen, fever, dry cough, and dyspnea developed. The patient was admitted to our hospital on December 6,1996. Chest X-ray films and computed tomography scans revealed ground-glass and reticulonodular opacities. All chemotherapy was discontinued under a presumptive diagnosis of drug-induced pneumonitis. Transbronchial lung biopsy specimens revealed infiltration of lymphocytes and eosinophils into the alveolar walls and interstitum, with granulomotous lesions and macrophages in the alveolar spaces. The patient's chest X-ray findings improved and her symptoms subsided after the medications were stopped. However, she was given oral prednisolone (30 mg/day) because shadows were still evident on chest X-ray films. Prednisolone was effective in removing those shadows. A lymphocyte stimulation test was positive for acetaminophen. Based on the above findings, acetaminophen-induced pneumonitis was diagnosed. To our knowledge, acetaminophen-induced pneumonitis is rare. However, when drug-induced pneumonitis is suspended, common cold drugs containing acetaminophen should be kept in mind.
Acetaminophen↗
[Determination of cutoff value of serum anti-Legionella antibody titer--microplate agglutination test (MPAT)].
In order to promote the serological diagnosis of legionellosis in the clinical laboratory, the cutoff values of serum anti-Legionella antibody titers for microplate agglutination (MPAT) test were determined. Antibody levels were tested for 178 serum specimens including 98 healthy persons, 22 ordinally workers having either metabolic or renal failure, definitely diagnosed patients of 17 mycoplasmal and 9 chlamydial pneumonia, 32 patients of other bacterial pneumonia. Heat killed unstained cell suspension of each strain of Legionella pneumophila serogroup (SG) 1a, 1b, SGs 2 to 6, L. bozemanii, L. dumoffii, L. gormanii, and L. micdadei were used as antigens. Strains of L. pneumophila SG 1b were mainly isolated from environmental specimens. However, in some Legionella pneumonia cases, etiologic agents were determined as L. pneumophila SG 1 b. Thus the representative strain of SG 1b was used as an antigen for the determination of the patient's antibody titer. Quantitative agglutination was performed by using a 96-well U-bottom microplate for each antigen. Test sera were diluted from 1:16 to 1:256. Results were read after 20 h at 25 degrees C. Cutoff values for 11 antigens were determined, at this moment, as 4-fold or greater increase in level to > or = 1:128 in paired sera, and > or = 1:256 in single serum. However, final diagnosis should be given by over-all coordination of serological results and clinical symptoms together with other laboratory findings. Two culture-positive Legionella pneumonia cases due to either SG3 or 6 in which significant rise of serum antibody titers against organisms of corresponding SG estimated by MPAT method were discussed.
Agglutination Tests↗
[Clinical significance of (1-->3)-beta-D-glucan in pleural effusion and liquor].
The Measurement of serum (1-->3)-beta-D-glucan (beta-glucan) has been considered to be useful in the early diagnosis of deep mycosis. In this study, we investigated the clinical significance of beta-glucan in pleural effusion or liquor from patients with various conditions. beta-glucan was measured in 29 samples of pleural effusion from 27 patients (male: 17, female: 10 median age: 62.1). Two patients undergoing hemodialysis treatment were excluded from the study of normal range of beta-glucan in these samples. beta-glucan was also measured in 39 samples of liquor from 23 inpatients (male: 15, female: 8 median age: 48.4) with certain neurological disorders. In these cases, only two patients had deep mycosis. beta-glucan in the pleural effusion from a patient with Aspergillus pyothorax showed an extremely high value of more than 1100 pg/ml. Slight elevation of beta-glucan was observed in the spinal fluid from a patient with cryptococal, meningitis. In the other cases with no mycotic infection or any factor influencing the value of beta-glucan, beta-glucan in pleural effusion and spinal fluid were generally lower than the normal range of serum samples. However, there is false positive elevation of beta-glucan in pleural effusion. The above results indicated that measurement of beta-glucan in pleural effusion or spinal fluid may be useful for the diagnosis of mycotic infection as the cause of pleuritis or meningitis.
Adult↗