ABSTRACT
OBJECTIVE: To evaluate the incidence, clinical characteristics and predicting factors for the development of paradoxical response in human immunodeficiency virus negative patients with isolated pleural tuberculosis (TB). DESIGN: A multicentre, retrospective cohort study including 458 patients who were diagnosed and treated with isolated pleural TB between March 2005 and February 2010. RESULTS: Paradoxical response developed in 72 patients (16%) with isolated pleural TB. The mean time to development of paradoxical response was 8.8 ± 6.4 weeks after initiation of anti-tuberculosis treatment. The main presentation of paradoxical response was aggravation of pre-existing pleural effusion in 58 patients (81%). However, the majority of the patients who developed paradoxical response had no associated symptoms (n = 49, 68%). In multiple logistic regression analysis, development of paradoxical response was independently associated with the proportion of eosinophils (adjusted OR 1.293, 95%CI 1.077-1.553) and protein concentrations (adjusted OR 0.590, 95%CI 0.397-0.878) in the pleural fluid at the time of diagnosis. CONCLUSION: Paradoxical response developed in 16% of the patients approximately 2 months after initiation of anti-tuberculosis treatment, presenting with aggravation of pre-existing pleural effusion. Development of paradoxical response was associated with the proportion of eosinophils and protein concentrations in the pleural fluid at the time of diagnosis.
Subject(s)
Antitubercular Agents/therapeutic use , Tuberculosis, Pleural/drug therapy , Adult , Aged , Antitubercular Agents/adverse effects , Chi-Square Distribution , Eosinophils , Female , Humans , Incidence , Logistic Models , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Pleural Effusion/diagnosis , Pleural Effusion/microbiology , Republic of Korea/epidemiology , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , Tuberculosis, Pleural/diagnosis , Tuberculosis, Pleural/epidemiology , Tuberculosis, Pleural/microbiologyABSTRACT
BACKGROUND: Pneumonia has been reported to be the most life-threatening complication of influenza virus infection. OBJECTIVE: to describe clinical characteristics and determine risk factors for death among patients with H1N1-associated pneumonia. DESIGN: A retrospective cohort study included all adult patients diagnosed and treated with H1N1-associated pneumonia in 14 participating institutions between 1 May 2009 and 28 February 2010 in South Korea. Clinical outcomes were summarised and predictors for death evaluated through univariate and multivariate analysis. RESULTS: A total of 269 adult patients with H1N1-associated pneumonia were diagnosed and treated. Hospital visits or admissions peaked in November 2009, coinciding with the peak in the 2009 H1N1 epidemic in South Korea. The patients' median age was 48 years; 143 were male. Most (n = 266, 98.9%) were admitted for treatment: 97 (36.1%) required intensive care and 28 (10.4%) needed mechanical ventilation. Despite the use of antiviral and antibacterial agents, 19 patients (7.1%) died. Risk factors predictive of death included presence of malignancy (aOR 12.0, 95%CI 2.8-51.5), and pneumonia severity index (PSI) score (aOR 1.03, 95%CI 1.01-1.04). CONCLUSION: Deaths among adult patients with H1N1-associated pneumonia were not rare. Clinicians should be aware of the possibility of a poor prognosis among H1N1-associated pneumonia patients with underlying malignancy or high PSI score.
Subject(s)
Influenza A Virus, H1N1 Subtype/pathogenicity , Influenza, Human/mortality , Pneumonia, Viral/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Antiviral Agents/therapeutic use , Chi-Square Distribution , Critical Care , Female , Hospitalization , Humans , Influenza, Human/diagnosis , Influenza, Human/therapy , Influenza, Human/virology , Logistic Models , Male , Middle Aged , Odds Ratio , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , Republic of Korea/epidemiology , Respiration, Artificial , Retrospective Studies , Risk Assessment , Risk Factors , Severity of Illness Index , Survival Analysis , Survival Rate , Time Factors , Treatment Outcome , Young AdultABSTRACT
Interleukin-18 (IL-18) has multiple important pro-inflammatory effects, including the induction of interferon-gamma (IFN-gamma) in various diseases. In this study, we investigated the IL-18-producing activities in human pulmonary and pleural tuberculosis (TB) in response to purified protein derivative (PPD) antigen (Ag) from Mycobacterium tuberculosis. The most significant IL-18 production was found in chronic refractory TB (CRTB) patients. However, IFN-gamma production in CRTB patients was significantly less than that in healthy tuberculin reactors or in patients with tuberculous pleurisy (TBP). Elevated levels of both IL-18 and IFN-gamma were found in pleural fluids from TBP patients. In vitro production of IL-18 was dramatically decreased following an 18 h stimulation with PPD. However, IFN-gamma was markedly increased in pleural mononuclear cells from TBP patients after in vitro stimulation with PPD. The mesothelial cell type was the main source of pro-IL-18 in pleural cells from TBP patients, suggesting an important role for these cells in TBP. Taken together, these data indicate that IL-18 is elevated in peripheral blood mononuclear cells from CRTB patients, as well as at the site of TBP, indicating a possible role for IL-18 in both protective immunity and pathologic responses in human TB.
Subject(s)
Interleukin-18/biosynthesis , Tuberculosis, Pleural/immunology , Tuberculosis, Pulmonary/immunology , Cells, Cultured , Epithelium/immunology , Humans , Interferon-gamma/biosynthesis , Interleukin-18/genetics , Leukocytes, Mononuclear/immunology , Pleural Effusion/immunology , Pleurisy/immunology , Protein Precursors/biosynthesis , Protein Precursors/genetics , RNA, Messenger/biosynthesis , Tuberculin/immunology , Tuberculosis, Pleural/pathology , Up-RegulationABSTRACT
Parasites of the genus Mammomonogamus affect the respiratory tract of domestic mammals but have only rarely been reported in humans. In this case report the diagnosis of human syngamosis is described following bronchoscopic examination of a patient whose initial symptoms were simply of community acquired pneumonia. The patient had a persistent and productive cough with intermittent fever during 10 days of observation. After bronchoscopic extraction of the parasites and treatment with albendazole he recovered fully. This is one of the first recognised cases of human syngamosis in Korea.
