[BASELINE SCREENING USING INTERFERON-GAMMA RELEASE ASSAY SUGGESTS AN INCREASED RISK OF MYCOBACTERIUM TUBERCULOSIS INFECTION AMONG EMPLOYEES IN A JAPANESE GENERAL HOSPITAL].

OBJECTIVES: This retrospective study aimed to assess the risk of tuberculosis infection for the employees of a Japanese hospital using baseline interferon-gamma release assay (IGRA). The risk was defined as exposure to the hospital environment. METHODS: In total, 870 hospital employees including 161 new employees, 582 for baseline assay, and 127 for contact examination (709 subjects in the post-employment group) were examined from December 2010 to April 2012. The new employees were considered as the "non-exposure" group, whereas the post-employment group was considered as the "exposure" group. Multiple logistic regression analyses were used to calculate the odds ratio (OR) for IGRA positivity, adjusted for gender, smoking history, and alcohol intake (model 1), and for years of employment (model 2). RESULTS: The exposure group was significantly associated with an increased risk of positive IGRA results, even when adjusted for years of employment (OR: 4.1; 95% confidence interval: 1.4-17.6; P = 0.007). Subgroup analyses stratified by profession indicated a significantly increased OR for laboratory technicians, doctors, and nurses in both models. No correlation was observed between the length of employment and IGRA positivity. CONCLUSION: Exposure to the hospital environment increased the risk of tuberculosis infection for employees irrespective of the length of employment. Laboratory technicians, doctors, and nurses were at the highest risk of infection.

Case reports of primary pulmonary adenocarcinoma with pleural spread: so-called pseudomesotheliomatous adenocarcinoma.

We report two autopsy cases of primary pulmonary adenocarcinoma associated with unusual pleural spread. Both patients had confirmed history of asbestos exposure. In the first patient the tumor was localized in one pulmonary lobe with marked infiltration into pleura, chest wall and diaphragm. In the second patient the entire right lung was covered by irregularly thickened tumor. Both tumors were mainly located in the extrapulmonary area and the intrapulmonary portions represented only minor components. Histologically, tumor cells demonstrated glandular and papillary growth patterns associated with focal hobnail-like features. Immunohistochemical evaluation revealed diffuse and marked immunoreactivity of TTF-1, CEA, CD15 and MOC31 in both cases, while calretinin, CK5/6, vimentin, thrombomodulin and HBME-1 were broadly positive in one case. D2-40 was not detected in either case. Examination using electron microscopy revealed the presence of sparse and short microvilli in tumor cells. All of the above findings are consistent with adenocarcinoma of the lung. Primary adenocarcinoma with a characteristic pleural extention grossly resembling malignant mesothelioma has been previously reported in the literature as pseudomesotheliomatous adenocarcinoma. This is the first report of pseudomesotheliomatous adenocarcinoma displaying variable immunoprofile with a diagnosis using electron microscopical examination. Additionally, we performed quantitative analysis of asbestos bodies in pseudomesotheliomatous adenocarcinoma.

A case of cutaneous protothecosis in a polyarteritis nodosa patient and review of cases reported in Japan.

A 76-year-old woman farmer with a 20-year history of oral steroid treatment for polyarteritis nodosa, noted a rash consisting of numerous small papules on the dorsum of her right hand in February 2007. The rash worsened over time, and in April 2008 red papules and pustules as big as grains of rice fused to form plaques extending up her arm from the dorsum of the right hand to the extensor surface of the forearm. The plaques were accompanied by erosions, ulcers, and crusts. Skin biopsy specimens from the dorsum of the right hand showed a dense cell infiltration in the upper to middle layer of the dermis, with numerous morula-like microorganisms within the cells. Cultures of the specimens on Sabouraud dextrose agar produced creamy, yeast-like colonies. The colonies produced sporangia, with cells of varying sizes arranged in the pattern of a spoked-wheel. The microorganisms were identified as Prototheca wickerhamii on the basis of their morphological characteristics, sugar assimilation patterns, and molecular biological techniques. Treatment with amphotericin B was planned, but the patient died from respiratory failure before initiating treatment. We review the characteristics of the cutaneous protothecosis cases reported to date in Japan.