Clinicoradiologic features of pleuropulmonary Paragonimus westermani on Kyusyu Island, Japan.

STUDY OBJECTIVE: Recently, the number of new cases of Paragonimus westermani in humans has gradually increased, and paragonimiasis is a re-emerging public health issue in Kyusyu, Japan. We review our recent experience with pleuropulmonary Paragonimus westermani. PATIENTS: Pulmonary paragonimiasis was diagnosed in 13 patients at the Third Department of Internal Medicine, Miyazaki Medical College between 1993 and 1999. RESULTS: Both sputum and bronchoscopic examinations revealed ova in four of nine patients; bronchoscopy yielded ova in two additional patients. Twelve patients (92%) had respiratory symptoms, including cough (92%), sputum and/or hemoptysis (92%), and chest pain (46%). Chest radiography and CT showed pleural lesions (62%) and parenchymal lesions (92%). Of note was the high frequency of solitary nodular lesions (62%), mimicking lung cancer, tuberculosis, or fungal diseases. Immunodiagnosis and bronchoscopic examination were also useful for diagnosis. Praziquantel treatment was very effective and had minimal side effects. One patient required surgical decortication for empyema in spite of treatment with praziquantel. Eosinophilia was noted in peripheral blood and body fluids, which was probably due to increased levels of interleukin-5. CONCLUSIONS: Our findings indicate that our patients with Paragonimus westermani presented with a wide variety of radiographic findings, which were different from the classic presentations reported earlier. Bronchoscopic examination and serologic tests are very useful for accurate diagnosis. As dietary habits change and international transportation increases, it appears likely that paragonimiasis will also increase in frequency in various parts of the world.

Plasma and BAL fluid concentrations of antimicrobial peptides in patients with Mycobacterium avium-intracellulare infection.

STUDY OBJECTIVES: To investigate the roles of human alpha-defensin (HAD), human beta-defensin (HBD)-1, and HBD-2, novel antimicrobial peptides, in patients with Mycobacterium avium-intracellulare infection (MAI). PATIENTS: The study included 25 patients (10 men) with MAI who visited our hospital between June 1998 and August 1999. MEASUREMENTS AND RESULTS: In patients with pulmonary MAI, we measured HAD and HBD-1, and HBD-2 levels in plasma and in BAL fluid (BALF) by radioimmunoassay. Plasma concentrations of HAD and HBD-2 in those patients were higher than those in control subjects, whereas HBD-1 levels were similar to those in the control subjects. High levels of HAD and HBD-2, but not HBD-1, also were observed in the BALF of MAI patients. There was a positive correlation between HAD and interleukin (IL)-8 concentrations in the BALF of patients with MAI. BALF HBD-2 concentrations also correlated positively with those of plasma HBD-2 and BALF IL-1 beta in MAI patients. Patients with cavity formation on the chest roentgenogram had higher HAD and HBD-2 levels in their BALF than those of patients without cavity formation. Treatment with clarithromycin combined with two or three other antibiotics, including ethambutol, rifampicin, ofloxacin, or ciprofloxacin, for at least 6 months resulted in a significant fall in plasma HBD-2 concentrations in responders, but not in nonresponders. CONCLUSION: Our findings suggest that HAD and HBD-2 may participate in host defense and local remodeling of the respiratory tract in patients with MAI and that plasma HBD-2 levels may be a useful marker of disease activity in patients with pulmonary MAI.