Risk factors for latent tuberculosis infection in close contacts of active tuberculosis patients in South Korea: a prospective cohort study.

BACKGROUND: The diagnosis and treatment of latent tuberculosis infection (LTBI) have become mandatory to reduce the burden of tuberculosis worldwide. Close contacts of active TB patients are at high risk of both active and LTBI. The aim of this study is to identify the predominant risk factors of contracting LTBI, persons in close contact with TB patients were recruited. This study also aimed to compare the efficacy of the tuberculin skin test (TST) and QuantiFERON(®)-TB GOLD (QFT-G) to diagnose LTBI. METHODS: Close contacts of active pulmonary TB patients visiting a hospital in South Korea were diagnosed for LTBI using TST and/or QFT-G. The association of positive TST and/or QFT-G with the following factors was estimated: age, gender, history of Bacillius Calmette-Guerin (BCG) vaccination, history of pulmonary TB, cohabitation status, the acid-fast bacilli smear status, and presence of cough in source cases. RESULTS: Of 308 subjects, 38.0% (116/305) were TST positive and 28.6% (59/206) were QFT-G positive. TST positivity was significantly associated with male gender (OR: 1.734; 95% CI: 1.001-3.003, p =0.049), history of pulmonary TB (OR: 4.130; 95% CI: 1.441-11.835, p =0.008) and household contact (OR: 2.130; 95% CI: 1.198-3.786, p =0.01) after adjustment for confounding variables. The degree of concordance between TST and QFT-G was fair (70.4%, κ =0.392). CONCLUSIONS: A prevalence of LTBI among close contacts of active pulmonary TB patients was high, and prior TB history and being a household contact were risk factors of LTBI in the study population.

Association between weight change and clinical outcomes in critically ill patients.

PURPOSE: Body weight fluctuates daily throughout a patient's stay in the intensive care unit (ICU) due to a variety of factors, including fluid balance, nutritional status, type of acute illness, and presence of comorbidities. This study investigated the association between change in body weight and clinical outcomes in critically ill patients during short-term hospitalization in the ICU. METHODS: All patients admitted to the Gyeongsang National University hospital between January 2010 and December 2011 who met the inclusion criteria of age 18 or above and ICU hospitalization for at least 2 days were prospectively enrolled in this study. Body weight was measured at admission and daily thereafter using a bed scale. Univariate and multivariate linear and logistic regression analyses were performed to evaluate factors associated with mortality and the association between changes in body weight and clinical outcomes, including duration of mechanical ventilation (MV) use, length of ICU stay, and ICU mortality. RESULTS: Of the 140 patients examined, 33 died during ICU hospitalization, yielding an ICU mortality rate of 23.6%. Non-survivors experienced higher rates of severe sepsis and septic shock and greater weight gain than survivors on days 2, 3, 4, 5, and 6 of ICU hospitalization (P < .05). Increase of body weight on days 2 through 7 on ICU admission was correlated with the longer stay of ICU, and increase on days 3 through 7 on ICU admission was correlated with the prolonged use of mechanical ventilation. Increase of body weight on days 3 through 5 on ICU admission was associated with ICU mortality. CONCLUSIONS: Increase in body weight of critically ill patients may be correlated with duration of mechanical ventilation use and longer stay of ICU hospitalization and be associated with ICU mortality.

Value of cytologic analysis of bronchial washings in lung cancer on the basis of bronchoscopic appearance.

INTRODUCTION: We evaluated the diagnostic yield of cytologic analysis of bronchial washing in addition to forceps biopsy on the basis of bronchoscopic appearance and histologic type in lung cancer. METHODS: This retrospective study included 611 patients who had lung cancer and underwent bronchoscopic procedures between April 2003 and December 2008. Bronchoscopic appearance was classified into six types (tumor, infiltrative, necrotic, normal, compressive and aspecific) on the basis of endoscopic morphology. RESULTS: The forceps biopsy were positive in 492 cases (80.5%), and the diagnostic yield of the combination of forceps biopsy with cytologic analysis of bronchial washing was 84.1% (514/611 cases), that is, a statistically significant increase of 3.6% (P < 0.001). Washing cytologic analysis in the case of tumor, infiltrative and necrotic lesions had higher diagnostic yields than that in the case of normal, compressive and aspecific lesions (41.7% vs 29.3%), but its diagnostic yield did not increase on combination with forceps biopsy (P > 0.05). However, in the case of normal and compressive lesions, the addition of forceps biopsy to washing cytologic analysis significantly increased the diagnostic yield (P < 0.05). The histologic type of lung cancer did not significantly affect the difference in diagnostic yield between forceps biopsy alone and the combination of forceps biopsy and washing cytologic analysis (P > 0.05). CONCLUSIONS: The combination of forceps biopsy and washing cytologic analysis offers a better diagnostic yield than biopsy alone in diagnosing lung cancer. Both procedures should be performed during bronchoscopy even if no endobronchial lesion is present.

A case of isoniazid-induced thrombocytopenia: recovery with immunoglobulin therapy.

Treatment for a 51-year-old man with pulmonary tuberculosis was initiated with isoniazid, rifampicin, ethambutol, and pyrazinamide, and discontinued after 3 weeks because of skin rash and itchiness. Isoniazid monotherapy was restarted after 2 weeks. Two days later, the platelet count decreased from 150 to 4×10(3)/mm(3). Despite platelet transfusion and oral corticosteroid treatment, the platelet count did not recover. However, after a 2-day administration of intravenous immunoglobulin, the platelet count recovered to 209×10(3)/mm(3). This report describes a case of isoniazid-induced thrombocytopenia that was reversed with intravenous immunoglobulin, thus highlighting the efficacy of this treatment for this rare condition.

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.