Development of Acute Respiratory Failure on Initiation of Anti-Tuberculosis Medication in Patients with Pulmonary Tuberculosis: Clinical and Radiologic Features of 8 Patients and Literature Review / 대한구급학회지

BACKGROUND: Acute respiratory failure can occur paradoxically on initiation of anti-tuberculosis (TB) treatment in patients with pulmonary TB. This study is aimed to analyze the clinical features of anti-TB treatment induced acute respiratory failure. METHODS: We reviewed the clinical and radiological characteristics of 8 patients with pulmonary tuberculosis (5 men and 3 women; mean age, 55 +/- 15.5 years) who developed acute respiratory failure following initiation of anti-TB medication and thus required mechanical ventilation (MV) in the intensive care unit (ICU). RESULTS: The interval between initiation of anti-TB medication and development of MV-requiring acute respiratory failure was 2-14 days (mean, 4.4 +/- 4.39 days), and the duration of MV was 1-18 days (mean, 7.1 +/- 7.03 days). At admission, body temperature and serum levels of lactate dehydrogenase and C-reactive protein were increased. Serum levels of protein, albumin and creatinine were 5.8 +/- 0.98, 2.3 +/- 0.5 and 1.8 +/- 2.58 mg/ml, respectively. Radiographs characterized both lung involvements in all patients. Consolidation with the associated nodule was noted in 7 patients, ground glass opacity in 2, and cavitary lesion in 4. Micronodular lesion in the lungs, suggesting miliary tuberculosis lesion, was noted in 1 patient. At ICU admissions, the ranges of the APACHE II and SOFA scores were 17-38 (mean, 28.2 +/- 7.26) and 6-14 (mean, 10.1 +/- 2.74). The mean lung injury score was 2.8 +/- 0.5. Overall, 6 patients died owing to septic shock and multiorgan failure. CONCLUSIONS: On initiation of treatment for pulmonary TB, acute respiratory failure can paradoxically occur in patients with extensive lung parenchymal involvement and high mortality.

Systemic Corticosteroid Treatment in Severe Community-Acquired Pneumonia Requiring Mechanical Ventilation: Impact on Outcomes and Complications / 결핵및호흡기질환

BACKGROUND: This study is to evaluate the effect of systemic corticosteroid on the clinical outcomes and the occurrence of complications in mechanical ventilated patients with severe community-acquired pneumonia (CAP). METHODS: We retrospectively assessed the clinical outcomes and complications in patients with severe CAP admitted to ICU between March 1, 2003 and July 28, 2009. Outcomes were measured by hospital mortality after ICU admission, duration of mechanical ventilation (MV), ICU, and hospital stay. Complications such as ventilator associated pneumonia (VAP), catheter related-blood stream infection (CR-BSI), and upper gastrointestinal (UGI) bleeding during ICU stay were assessed. RESULTS: Of the 93 patients, 36 patients received corticosteroids over 7 days while 57 patients did not receive corticosteroids. Age, underlying disease, APACHE II, PSI score, and use of vasopressor were not different between two groups. In-hospital mortality was 30.5% in the steroid group and 36.8% in the non-steroid group (p>0.05). The major complications such as VAP, CR-BSI and UGI bleeding was significantly higher in the steroid group than in the non-steroid group (19.4% vs. 7%, p<0.05). The use of steroids and the duration of ICU stay were significantly associated with the development of major complications during ones ICU stay (p<0.05). CONCLUSION: Systemic corticosteroid in patients with severe CAP requiring mechanical ventilation may have no beneficial effect on clinical outcomes like duration of ICU stay and in-hospital mortality but may contribute to the development of ICU acquired complications.

Usefulness of the BACTEC MGIT 960 System for Mycobacterial Culture and TB Ag MPT64 Immunochromatographic Assay to Identify Mycobacterium tuberculosis / 영남의대학술지

BACKGROUND: This study was conducted to evaluate the usefulness of the BACTEC MGIT (Mycobacterium Growth Indicator Tube) 960 system for mycobacteria culture and immunochromatographic assay to identify Mycobacterium tuberculosis (MTB) in positive MGIT culture. METHODS: Mycobacteria-culture-positive cases were retrospectively analyzed from December 2010 to July 2011. The detection rates and the recovery times of the mycobacteria between the Ogawa media and the MGIT were compared. An immunochromatographic assay (ICA) (SD BIO-LINE) was also performed in the positive MGIT culture for identification, and the results were compared with those of the Ogawa media in the Korea National Tuberculosis Association. RESULTS: Among the 261 patients (M:F, 168:93; mean age, 61.6+/-17.16 yrs), 450 specimens (sputa, 365; bronchial washing, 61; and pleural effusion, 24) were found positive with mycobacteria. Mycobacteria were grown both on the MGIT and Ogawa media in 310 cases (68.9%); only on the MGIT in 115 cases (22.6%); and only on the Ogawa media in 25 cases (5.5%) (p<0.05).The recovery time was 28.2+/-8.9 days in the Ogawa media and 11.1+/-5.8 days in the MGIT (p<0.05). Among the 127 cases from the positive MGIT culture, all 92 cases that were confirmed as MTB cases bythe Korea National Tuberculosis Association were identified as MTB by ICA, with 100% sensitivity. CONCLUSION: MGIT increases the detection rate and shortens the recovery time of mycobacteria in clinical respiratory specimens, and the TB Ag MPT64 kit using ICA is useful in identifying MTB in a positive MGIT culture.

The Clinical Significance of Weight Change in Mechanical Ventilated, Critically Ill Patients of ICU / 대한구급학회지

BACKGROUND: Critically ill patients may show significant weight change in their course of disease during ICU stay. However, what weight changes occur and their effects on patient outcome have not yet been reported to our knowledge. Therefore, we evaluated weight change in critically ill patients in the medical ICU and the effect this may have on clinical outcome. METHODS: We measured body weight in patients admitted to the medical ICU daily and evaluated their clinical characteristics and outcome. RESULTS: Thirty-eight patients (M:F = 30:8, mean age = 65.7 +/- 12.5) were enrolled. Thirteen patients (34.2%) showed weight gain and the mean change was 12.8 +/- 4.2%. In contrast, 25 patients (65.8%) showed weight loss and the mean change was 6.3 +/- 6.9%. Patients who showed weight change over 5% or 10% were 26 (68.4%), and 12 (31.6%), respectively, and their mortality rates were 61.5% and 75%, respectively, showing no statistical significance (p > 0.05). However, when the degree of weight change was stratified with 10%, it was associated with death (p = 0.002). Factors like ICU stay, day of mechanical ventilation, initial APACHE II and SOFA score, body mass index (BMI) and serum albumin were not associated with more than 5% change of weight. BMI at admission was only associated with > 10% change of weight (p < 0.05). CONCLUSIONS: The majority of critically ill patients showed a significant weight change during their ICU stay and these patients may have a tendency to have worse clinical outcome.

Endobronchial Aspergilloma: Report of 10 Cases and Literature Review

PURPOSE: A retrospective investigation of the clinical and radiologic features as well as the bronchoscopic appearance was carried out in patients with endobronchial aspergilloma. MATERIALS AND METHODS: Ten patients with endobronchial aspergilloma diagnosed by bronchoscopy and histological examination were identified at the Gyeongsang University Hospital of Korea, from May 2003 to May 2009. RESULTS: The patients included 9 men and 1 woman, and the age of the patients ranged from 36 to 76 (median, 58 years). The associated diseases or conditions were: previous pulmonary tuberculosis in 7 patients, lung cancer in 2 patients, pulmonary resection in 1 patient, and foreign body of the bronchus in 1 patient. The chest radiologic finding showed fibrotic changes as a consequence of previous tuberculosis infection in 6 patients and a mass-like lesion in 2 patients. Two patients had a co-existing fungus ball, and an endobronchial lesion was suspected in only 2 patients on the CT scan. The bronchoscopic appearance was a whitish to yellow necrotic mass causing bronchial obstruction in 7 patients, foreign body with adjacent granulation tissue and whitish necrotic tissue in 1 patient, whitish necrotic tissue at an anastomosis site in 1 patient, and a protruding mass with whitish necrotic tissue in 1 patient. CONCLUSION: An endobronchial aspergilloma is a rare presentation of pulmonary aspergilosis and is usually incidentally found in immunocompetent patients with underlying lung disease. It usually appears as a necrotic mass causing bronchial obstruction on bronchoscopy and can be confirmed by biopsy.

A Case of Anaphylaxis After the Ingestion of Yacon

Anaphylaxis is a potentially life-threatening systemic allergic reaction, often with an explosive onset; the symptoms range from mild flushing to upper respiratory obstruction, with or without vascular collapse. Foods are common offending allergens and remain the leading cause of outpatient anaphylaxis in most surveys. Yacon (Smallanthus sonchifolius) is a plant native to the Andes region, where its root is cultivated and consumed mainly as food. Unlike most edible roots, yacon contains large amounts of ructooligosaccharides. Traditionally, yacon tubers have been used as a source of natural sweetener and syrup for people suffering from various disorders. We report the case of a 55-year-old woman who developed syncope and generalized urticaria after ingesting yacon roots. The patient had positive skin prick and intradermal tests to yacon extract. An open food challenge test was performed to confirm food anaphylaxis and was positive 10 minutes after the consumption of yacon roots. To our knowledge, this is the first reported case of anaphylaxis after the ingestion of yacon roots.

A Case of Anaphylaxis After the Ingestion of Yacon

Anaphylaxis is a potentially life-threatening systemic allergic reaction, often with an explosive onset; the symptoms range from mild flushing to upper respiratory obstruction, with or without vascular collapse. Foods are common offending allergens and remain the leading cause of outpatient anaphylaxis in most surveys. Yacon (Smallanthus sonchifolius) is a plant native to the Andes region, where its root is cultivated and consumed mainly as food. Unlike most edible roots, yacon contains large amounts of ructooligosaccharides. Traditionally, yacon tubers have been used as a source of natural sweetener and syrup for people suffering from various disorders. We report the case of a 55-year-old woman who developed syncope and generalized urticaria after ingesting yacon roots. The patient had positive skin prick and intradermal tests to yacon extract. An open food challenge test was performed to confirm food anaphylaxis and was positive 10 minutes after the consumption of yacon roots. To our knowledge, this is the first reported case of anaphylaxis after the ingestion of yacon roots.

Usefulness of Real-time PCR to Detect Mycobacterium tuberculosis and Nontuberculous Mycobacteria / 결핵및호흡기질환

BACKGROUND: The purpose of this study was to evaluate recently developed real-time polymerase chain reaction (PCR) assay kit to detect Mycobacterium tuberculosis (MTB) and nontuberculous mycobacteria (NTM) in respiratory specimens. METHODS: We assessed the positive rate of the real-time PCR assay to detect MTB and NTM in 87 culture-positive specimens (37 sputum, 50 bronchial washing), which were performed real-time PCR by using Real-Q(TM) MTB&NTM Kit from January 2009 to June 2009, at Gyeongsang University Hospital. To compare the efficacy with the TB-PCR assay, we evaluated 63 culture-positive specimens (19 sputum, 44 bronchial washing) for MTB or NTM, which were performed TB-PCR by using ABSOLUTE(TM) MTB II PCR Kit from March 2008 to August 2008. RESULTS: Among 87 specimens tested using real-time PCR, MTB and NTM were cultured in 58 and 29, respectively. The positive rate of real-time PCR assay to detect MTB was 71% (22/31) and 92.6% (25/27) in AFB stain-negative and stain-positive specimens. For NTM, the positive rate of real-time PCR was 11.1% (2/18) and 72.7% (8/11) in AFB stain-negative and stain-positive specimens. Among 63 specimens performed using TB-PCR, MTB and NTM were cultured in 46 and 17, respectively. The positive rate of TB-PCR was 61.7% (21/34) and 100% (12/12) in AFB stain-negative and stain-positive specimens. TB-PCR was negative in all NTM-cultured 17 specimens. CONCLUSION: TB/NTM real-time PCR assay is useful to differentiate MTB and NTM in AFB stain-positive respiratory specimens and it is as effective in detecting MTB with TB-PCR.