[A case of paragonimiasis westermani with a worm migration track on chest CT].

A 59-year-old man with rusty-colored sputum was admitted for evaluation of a nodular shadow on his chest radiograph. Chest computed tomography (CT) revealed nodules and nodular opacities with a cavity in the right S3. Chest CT also showed clearly a double linear shadow other than the bronchovascular bundle, with a different course from that of the bronchovascular bundle, suggesting a worm migration track. The diagnosis of paragonimiasis westermani was confirmed by detection of Paragonimus eggs in a bronchoscopic aspirate smear and by immunoserological examination. The linear lesion on the chest CT is uncommon in paragonimiasis, but the finding is thought to be useful for the diagnosis of this disease.

[Clinical characteristics of elderly patients with tuberculosis].

The purpose of this report is to elucidate the characteristics of elderly patients with tuberculosis (TB), based on 235 patients hospitalized in our institution from January 1999 to October 2001. The mean age of all patients was 60.8 years old and the male-to-female ratio was 2.1:1. The clinical features were compared between 121 patients aged 65 years old or more (elderly group) and 114 patients younger than 65 years old (non-elderly group). The time lag between onset of the symptoms and the first visit to a doctor was 19 days in the elderly and 49 days in the non-elderly (P < 0.01). Previous therapy, extrapulmonary TB, and underlying diseases were significantly frequent in the elderly (P < 0.05). Cavitation on chest X-ray film was found in 23% of the elderly and in 40% of the non-elderly (P < 0.01). The frequency of positive smear was similar in the two groups. Peripheral blood lymphocyte count, serum total protein, albumin and total cholesterol were lower in the elderly who died during admission than in the living elderly (P < 0.01). There was no significant difference in mortality due to TB between the two groups, although deaths due to non-tuberculous diseases were more frequent in the elderly. Pneumonia and other infectious diseases accounted for 50% of deaths in the elderly. Nutrition and infection other than TB should be taken into consideration in treating elderly patients with TB.

[A case of mixed infection by Nocardia asteroides and Mycobacterium tuberculosis].

A 55-year-old man with diabetes mellitus was admitted to our hospital because of abnormal shadows in his chest radiographs. Both chest radiography and CT revealed infiltrative shadows in the right upper lung field. Repeated sputum smears showed no mycobacterium, so bronchoalveolar lavage (BAL) was performed bronchoscopically at the right B3b. The BAL fluid and the sputum obtained on the day after BAL contained acid-fast, branching filamentous structures. The microorganism was identified as Nocardia asteroides. Trimethoprim-sulfamethoxazole (ST) and SPFX were therefore administered. Later, Mycobacterium tuberculosis was detected in a 6-week culture of the sputum and BAL fluid. This case was diagnosed as a mixed infection by Nocardia asteroides and Mycobacterium tuberculosis, so the three anti-tuberculosis agents INH, RFP and EB were added. After 6 months of the combined therapy, neither microorganism could be detected in the sputum, and the lesion in the CT scan had decreased markedly in size. Since such a mixed infection is very rare, no treatment strategy has yet been established. The combined therapy was judged to have been effective in this case.

Elevated levels of alpha-defensins in plasma and BAL fluid of patients with active pulmonary tuberculosis.

STUDY OBJECTIVES: To investigate the role of neutrophil peptides named alpha-defensins in patients with pulmonary tuberculosis (TB). PATIENTS: Thirty-seven patients with TB and 25 healthy subjects. MEASUREMENTS AND RESULTS: Concentrations of alpha-defensins (human neutrophil peptide [HNP]-1, HNP-2, and HNP-3) were measured by radioimmunoassay in plasma and BAL fluid (BALF). Concentrations of alpha-defensins were significantly higher in plasma and BALF of patients with TB than in healthy subjects. In BALF of patients with TB, the concentration of alpha-defensins correlated positively with the levels of interleukin 8, and higher concentrations of alpha-defensins in BALF were also detected in patients with cavitary lesions. There was an inverse relationship between plasma alpha-defensins and FEV(1)/FVC ratio before treatment, and between plasma concentrations of alpha-defensins before treatment and the improvement in percentage of vital capacity after treatment. Plasma alpha-defensin concentrations returned to the normal range after treatment. CONCLUSION: Our data suggest that alpha-defensins released from neutrophils may play an important role in the pathogenesis of TB, and that plasma alpha-defensin concentration may be a useful marker of disease severity and deterioration of pulmonary function.