[Nontuberculous mycobacterial infections involving solitary pulmonary nodules].

Over the course of 11 years (1993-2003) we encountered 5 cases of pulmonary nontuberculous mycobacterium (NTM) involving a solitary pulmonary nodule. In this report we analyze the chest computed tomography (CT) of these patients, the utility of bronchoscope and transthoracic fine-needle aspiration techniques, the mycobacterium species involved, and treatment results. Four of the 5 NTM cases were due to infection with M. avium and one was due to infection with M. intracellulare. The characteristic findings of the chest CTs were as follows: A solitary nodule was present just under the pleura. No definite distribution pattern was evident. Some cases had agglutinated nodules or fine calcifications. Although fiberoptic bronchoscopy was not used as a diagnostic tool in all 5 NTM cases and histological samples did not contain granulomas, we determined the presence of NTM and we also verified that no cancer cells were present in any of the 5 NTM patients, using transthoracic fine-needle aspiration. Four out of the 5 NTM patients were treated only with drug therapy and they displayed clinical improvement. We resected a solitary nodule in one of the 5 NTM patients because of slow response to drug therapy. We conclude that the solitary pulmonary nodule of NTM is often due to M. avium and that transthoracic fine-needle aspiration is an easy and effective method of detecting NTM.

[A case of multiple nodular pulmonary amyloidosis complicated with primary Sjogren syndrome].

A 79-year-old woman was admitted to the Department of Orthopedics Surgery for treatment of osteoarthritis in her knee. Multiple pulmonary nodular lesions were found on preoperative chest x-ray film screening. Metastatic lung tumor was suspected, but no tumorous lesions were detected in other organs. CT guided lung biopsy was performed. Histopathological examination revealed amyloid consisting of homogenous eosinophilic materials. No amyloid deposits were detected in other organs, so we diagnosed localized nodular pulmonary amyloidosis. She was subsequently given a diagnosis of primary Sjögren syndrome. We believe that such a case of multiple nodular pulmonary amyloidosis with Sjögren syndrome is rare, and the case showed interesting radiological findings, such as mimicking metastatic lung tumor.

[Case reports of the treatment with tobramycin solution for inhalation in severe bronchiectasis patients continuous infection of Pseudomonas aeruginosa].

Aerosolized tobramycin has been frequently used in cystic fibrosis patients in order to directly deliver the antibiotic to the endobronchial site of infection. Recently, we experienced three cases of severe chronic bronchial infection of Pseudomonas aeruginosa treated by aerosolized tobramycin inhalation (TOBI). For two cases, we succeeded in improving the patient's medical condition, quality of life, and reduced the amount of sputum. We consider that TOBI should be useful for chronic bronchial infection by Pseudomonas aeruginosa in the case of a patient who does not respond to usual antibiotics via other routes. But further investigation is necessary to reveal clinical efficacy and safety in non-CF patients with bronchiectasis.

[A case of invasive group A Streptococcus infection which was successfully treated with linezolid].

A 53-year-old male was admitted to our hospital with a high fever and pain in the right arm. He was diagnosed as toxic shock-like syndrome by Streptococcus pyogenes. His arm was amputated because of necrotizing myositis and his renal damage was severe, he was treated in the intensive care unit with continuous hemodiafiltration. Bacteria were isolated from blood, ascites, pleural effusion, skin, and muscle. He was treated with a large amount of ampicillin, clindamycin, and gammaglobulin. However, his general status became worse. His illness improved after linezolid was administered. The reason for the success in treatment with linezolid, which was the inhibitory effect on bacterial toxin and its excellent penetration into the tissue.

[Analysis of tuberculin skin test in employees of Nagasaki University Hospital].

The tuberculin skin test (TST) was conducted in 1,087 employees of Nagasaki University Hospital. The size of erythema (T1) was 27.3 +/- 17.0 mm, and 8.6% of all participants showed < = 9 mm, 49.9% showed 10-29 mm, 41.5% showed > = 30 mm. Laboratory technologists showed significantly larger reactions than other groups. Doctors and nurses working on the tuberculosis ward showed larger reactions than those working on the non-tuberculosis wards. Reactions tended to be larger with aging, and the younger employees in their 20s showed significantly smaller reactions than those in their 40s. The second TST was carried out in 253 employees whose T1 was below 30 mm. The size of erythema enlarged from 16.1 +/- 6.6 mm (T1) to 26.4 +/- 15.4 mm (T2), with the difference (booster phenomenon) of 10.2 +/- 14.4 mm. T2 and T2-T1 were larger in nurses working on the tuberculosis ward than those on the non-tuberculosis wards. It was suggested that laboratory technologists, nurses and doctors especially working on the tuberculosis ward are at risk of tuberculosis infection, and the two-step TST was an essential means to know the baseline reactivity, and to determine recent tuberculosis infection.